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Sample records for long-term hospitalization experience

  1. In-hospital and long-term mortality in Takotsubo cardiomyopathy: a community hospital experience

    PubMed Central

    Vriz, Olga; Brosolo, Gabriele; Martina, Stefano; Pertoldi, Franco; Citro, Rodolfo; Mos, Lucio; Ferrara, Francesco; Bossone, Eduardo

    2016-01-01

    Background Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular dysfunction, frequently precipitated by a stressful event. Despite the favorable course and good long-term prognosis, a variety of complications may occur in the acute phase of the disease. The aim of this study was to evaluate the in-hospital and long-term outcomes of a cohort of TTC patients. Methods Fifty-five patients (mean age 68.1±12 years) were prospectively followed for a mean of 69.6±32.2 months (64,635 days). In-hospital (death, heart failure, arrhythmias) and long-term events (death and recurrences) were recorded. Results Patients were predominantly women (87.3%) who experienced a recent stressful event (emotional or physical) and were admitted to hospital for chest pain. Eleven patients (20%) had a diagnosis of depressive disorder, and arterial hypertension was the most frequent cardiovascular risk factor. The ECG revealed ST-segment elevation in 43.6% of patients. At angiography, seven cases (12.7%) had at least one significant (≥50%) coronary artery stenosis and four patients (7.3%) had myocardial bridging of the left anterior descending artery. During hospitalization, three patients died (one from cardiac causes) and cardiovascular complications occurred in 12 patients. During follow-up, five patients died (none from cardiac causes), six patients had recurrences within the first year. Two patients had two recurrences: one after 114 days, triggered by an asthma attack as the first event, and the other after 1,850 days. Conclusions In TTC patients, in-hospital and long-term mortality is primarily due to non-cardiovascular causes. Recurrences are not infrequent and coronary artery disease is not an uncommon finding. PMID:27406446

  2. Kidney autotransplantation: long-term outcomes and complications. Experience in a tertiary hospital and literature review.

    PubMed

    Ruiz, Mercedes; Hevia, Vital; Fabuel, Jose-Javier; Fernández, Alvaro-Amancio; Gómez, Victoria; Burgos, Francisco-Javier

    2017-08-21

    To analyze indications, surgical technique, complications and long-term outcomes of kidney autotransplantation (KAT) after 26-year experience at a single institution. A retrospective observational study of patients who underwent KAT at our institution (January 1990-December 2016) was carried out. Data collected included indications, surgical technique, complications (Clavien-Dindo), hospital stay and long-term outcomes. Literature review was performed through MEDLINE and ClinicalKey databases including "kidney," "renal," "autotransplantation" and "autograft." Fifteen patients underwent a KAT, with a mean age of 41 years (range 34-59). Indications were vascular abnormalities in 8 cases and ureteral injury in 7. Nephrectomy was performed through laparoscopy in 2 cases (13.3%) and open in 13 (86.7%). Vascular grafts to reperfuse the kidney were used in 8 patients, and ureteral reimplantation was performed in 11 cases. Mean hospital stay was 9.1 days (range 3-20). Seven patients (46.7%) developed postoperative complications: 6 minor (Clavien I-II) and 1 major (Clavien III). After a mean follow-up of 73.1 months (range 7-312), 80% of the patients have a functioning graft. Most common indication reported in the literature is ureteral stricture, especially in the most recent years. Graft survival is variable, and complications are frequent, but usually minor. KAT is an effective treatment for complex ureteral lesions and kidney vascular abnormalities, with good results in the long term. Surgical complications are frequent, but usually minor. As a challenging surgery, it should be performed by experienced kidney transplant surgeons. Complex and proximal ureteral injuries are nowadays the main indication of this procedure.

  3. Filarial chyluria: long-term experience of a university hospital in India.

    PubMed

    Tandon, Vipul; Singh, Harbans; Dwivedi, U S; Mahmood, Mufti; Singh, P B

    2004-04-01

    Filariasis is an endemic problem in various Indian states. We evaluated the results of long-term follow up (10-20 years) of patients with filarial chyluria. We conducted a retrospective analysis of 160 patients treated for filarial chyluria who presented to the Banaras Hindu University Hospital from 1982 to 1992. Eighty-four patients (52.5%) were treated using diethylcarbamazine (DEC) and a fat restricted diet and 76 patients (47.5%) underwent surgery. To examine the long-term effects of filarial chyluria we analysed data on post-treatment recurrence, weight gain, dietary freedom, chyluria free period and a number of other associated factors. Previous history of filariasis or its complication was documented in 19% of patients. In 71% of cases, cystoscopy showed that chylous efflux was predominant in the left ureteric orifice. The long-term remission rate was 62% in the conservatively managed group (DEC + fat restricted diet), whereas 90% of patients in the operated group were cured. Postoperative recurrence rate was 10%. There was more weight gain and dietary freedom along with a longer chyluria free period in the operated group relative to the conservatively managed group. Definitive surgical ablation of lymphatic urinary fistula is better than conservative medical management because it has a higher success rate, more dietary freedom and, therefore, better patient acceptability.

  4. Life experiences of elderly people with suicide ideation at the long-term care hospitals in South Korea.

    PubMed

    Kim, Ok Sun; Sok, Sohyune R

    2017-10-05

    To understand the life experiences of elderly people who are living in long-term care hospitals and are afflicted with suicide ideation. A phenomenological qualitative methodology based on Colaizzi's method was used for the study. Participants included 9 elderly people who are 65 years old or older with suicidal ideas and were admitted in any of the 3 long-term care hospitals in D City, Gyeonggi-do, South Korea. Data were collected from July to December 2014. Seven categories, 15 theme categories, 30 themes, and 88 significant items were identified as parts of their life experiences. The 7 categories were identified as "being a slave to one's disease", "sadness as a result of being far away from one's family", "vain care and consolation for me", "continued life in a hospital, which feels like living abroad", "plunging life", "moving toward the end of life", and "sad relief from death". The findings from this study provide a deep understanding of the lives of elderly people who were staying in long-term care hospitals, and these will help improve their quality of life. Additionally, they can be used as references in implementing high-quality nursing practices for such elderly people. © 2017 John Wiley & Sons Australia, Ltd.

  5. Hospital diversification into long-term care.

    PubMed

    Shah, A; Fennell, M; Mor, V

    2001-01-01

    In the 1990s, acute care hospitals in the United States encountered an unstable operating environment created by a series of transformations in the health care delivery system and long-term-care market. Confronted with an array of economic pressures and demographic changes, hospitals were motivated to engage in long-term-care diversification, such as establishing a long-term-care unit or providing home health services, as a means of entering new markets and ensuring financial stability. This article examines the organizational, market, and community factors associated with this strategic activity among a national sample of urban and rural hospitals.

  6. Short- and long-term overall results of liver retransplantation: "Doce de Octubre" hospital experience.

    PubMed

    Pérez-Saborido, B; Menéu-Díaz, J C; de los Galanes, S Jiménez; Barra, V; Fundora, Y; Abradelo, M; Gimeno, A; Molinero, V; Sanz, M; Fernández, M C; Jiménez, C; Moreno González, E

    2009-01-01

    The liver retransplantation rate in Spain is about 6%. The main causes are primary nonfunction, vascular complications, chronic rejection, and recurrent liver disease. The results of this procedure are worse than those of first transplantations. This retrospective study evaluated our experience with 54 retransplantations performed between January 1992 and December 2006, which were 5.6% of the 960 orthotopic liver transplantations (OLT) during this period. In this study, 34.7% of the retransplantations were performed between 4 and 30 days after the first transplantation; another 34.7% were within 1 year. Also, 48.9% of the retransplantations were performed in urgent situations. The main causes for retransplantation during the first month were primary hepatic failure (n = 14) and vascular complications (n = 4). After the first month the main causes were chronic rejection (n = 9), recurrence of hepatic disease (n = 3), and biliary complications (n = 4). Postoperative mortality was 23.9% and morbidity was 76.3%. However, 21.2% of the patients needed a third transplant. The overall rate of patient survival was 60.4% (n = 32) and of graft survival was 56.6% (n = 30). The 5-year actuarial graft survival rate was 65.4% with a mean survival time of 89.84 +/- 8.72 months; the 5-year patient survival rate was 64% with a mean survival time of 114.7 +/- 12.53 months. Worse survival was observed in chronic rejection and in retransplantations performed between 31 and 360 days. Liver retransplantation presents greater surgical complexity than the first transplantation, but is a good option for patients with failure of the first graft with a 5-year patient and graft survival rate greater than 65%.

  7. The long-term hospitalization experience following military service in the 1991 Gulf War among veterans remaining on active duty, 1994–2004

    PubMed Central

    Hooper, Tomoko I; DeBakey, Samar F; Nagaraj, Barbara E; Bellis, Kimberly S; Smith, Besa; Smith, Tyler C; Gackstetter, Gary D

    2008-01-01

    Background Despite more than a decade of extensive, international efforts to characterize and understand the increased symptom and illness-reporting among veterans of the 1991 Gulf War, concern over possible long-term health effects related to this deployment continue. The purpose of this study was to describe the long-term hospitalization experience of the subset of U.S. Gulf War veterans still on active duty between 1994 and 2004. Methods Gulf War veterans on active duty rosters as of October 1, 1994, were identified (n = 211 642) and compared with veterans who had separated from military service and then assessed for attrition at three-year intervals during a 10-year follow-up period, examining demographic and military service characteristics, Gulf War exposure variables, and hospitalization data. Cox proportional hazard modeling was used to evaluate independent predictors of all-cause hospitalization among those still on active duty and to estimate cumulative probability of hospitalization, 1994–2004, by service branch. Results Members of our 1994 active duty cohort were more likely to be officers, somewhat older, and married compared with those who had separated from the military after serving in the 1991 Gulf War. Selected war-related exposures or experiences did not appear to influence separation with the exception of in-theater presence during the brief ground combat phase. Overall the top three diagnostic categories for hospitalizations were musculo-skeletal, injury and poisoning, and digestive disorders. Diseases of the circulatory system and symptoms, signs, and ill-defined conditions increased proportionately over time. In-theater hospitalization was the only significant independent predictor of long-term hospitalization risk among selected war-related exposures or experiences examined. The cumulative probability of hospitalization was highest for Army and lowest for Marines. Conclusion Our results were generally consistent with a previous

  8. Long Term Outcome in Patients with Esophageal Stenting for Cancer Esophagus - Our Experience at a Rural Hospital of Punjab, India

    PubMed Central

    Singh, Abhitesh; Singh, Anantbir; Sharma, Ghansham; Bhatia, Parmod Kumar; Grover, Amarjeet Singh

    2016-01-01

    Introduction Cancer of the esophagus is among the leading cause of cancer deaths in Punjab, India. Patients generally present with dysphagia as their first symptom and more often they have advanced disease at the time of presentation to a tertiary care centre. Palliative procedures have important roles in this setting. Stenting is the best option to palliate the symptoms of dysphagia, from which patient is suffering the most. Aim To know the success rate, early and long term complications and mortality in esophageal stenting, when it was done in malignant esophageal stricture patients. Materials and Methods One hundred patients, who had undergone esophageal stenting from January 2012 to January 2015, were included in the study. We retrospectively analysed the data for patient characteristics, causes of non-operability, early and long term complications, re-interventions, efficacy and mortality. Results Out of 100 patients, indications for stenting were locally advanced disease not amenable to surgery (52%), metastatic disease (35%), CVA (1%), cardiac and respiratory problem (8%), un-willing for surgery in 5% of patients. Majority of patients (94%) had squamous cell carcinoma, while only 6% had adenocarcinoma. 84% of patients presented with dysphagia with or without chest pain and recurrent cough while 16% had recurrent vomiting. 58% had dysphagia to liquids and solids and 17% had complete dysphagia. After stenting 93% had significant improvement in dysphagia score from median of 3 to 1. Post procedure stay was 3.61±1.0 days. One patient had procedure related major complication in the form of post procedural bleed (after 16 days of stenting) leading to death of that patient. Minor complications were present in 52 patients treated conservatively not affecting the efficacy of procedure. These include pain after stenting (38%), stent obstruction (23%) and stent migration (6%). All the minor complications were treated conservatively except in six patients in whom re

  9. Long-Term Care Policy: Singapore's Experience.

    PubMed

    Chin, Chee Wei Winston; Phua, Kai-Hong

    2016-01-01

    Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government's philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers.

  10. Long-term experience with indapamide.

    PubMed

    Beling, S; Vukovich, R A; Neiss, E S; Zisblatt, M; Webb, E; Losi, M

    1983-07-01

    Indapamide, 2.5 mg administered once daily for periods up to 36 months, was found to be safe and effective for the long-term control of mild to moderate hypertension. The effects of hydrochlorothiazide, 50 mg, and indapamide, 2.5 mg, were studied in two randomized, double-blind, multicenter trials. Data from the two multicenter trials (20 study sites) were pooled for purposes of comparison. Significant reductions in systolic and diastolic blood pressure, with patients in both supine and standing positions, occurred in both groups within the first 8 weeks of treatment. This effect was maintained throughout the active treatment period. Success, as determined by the therapeutic success rate (percentage of patients with decreases of standing phase V diastolic blood pressure of at least 10 mm Hg or to below 90 mm Hg), occurred in 53% of the patients given hydrochlorothiazide and in 56% of the indapamide-treated patients. During the study period, the nature, frequency, and severity of adverse reactions were similar for both groups. There was no clinically significant difference between the treatment groups for the laboratory assessments. Patients who completed the multicenter trials were eligible for participation in an ongoing long-term extension study of the safety of indapamide. Data are available for periods up to 36 months and demonstrate neither augmentation of clinical or laboratory adverse effects nor any potentially harmful indicators that could be attributed to prolonged treatment.

  11. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite... payment provisions for long-term care hospitals and satellites of long-term care hospitals that...

  12. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite... payment provisions for long-term care hospitals and satellites of long-term care hospitals that...

  13. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite... payment provisions for long-term care hospitals and satellites of long-term care hospitals that...

  14. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite... payment provisions for long-term care hospitals and satellites of long-term care hospitals that...

  15. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a hospital not located in the same building or on the same campus as the long-term care hospital or satellite... payment provisions for long-term care hospitals and satellites of long-term care hospitals that...

  16. Catheter-related Blood Stream Infection in Patients Receiving Long-term Home Parenteral Nutrition: Tertiary Care Hospital Experience in Saudi Arabia

    PubMed Central

    Al-Tawil, Esraa S.; Almuhareb, Alanoud M.; Amin, Hamdy M.

    2016-01-01

    Background/Aim: Parenteral nutrition (PN) is a lifesaving therapy for patients with many severe conditions, including intestinal failure. Some patients require long-term PN therapy, which makes home parenteral nutrition (HPN) an attractive option to improve the quality of life. Among the most common and serious complications observed in these patients are catheter-related blood stream infections (CRBSIs). The aim of our study is to determine the frequency of CRBSI among patients receiving long-term HPN. Patients and Methods: A retrospective chart review was conducted for patients enrolled in the HPN program between 2006 and 2012. Data on the demographic characteristics, indications and duration of PN therapy, catheter type, number of admissions because of CRBSI, and blood culture results were recorded. Results: Eight pediatric patients were included (mean age of 3.5 years at the start of HPN). Microvillus inclusive disease was noted in 50% of these patients, and 75% of them received HPN under parents' care. CRBSI resulted in 60 admissions with a median of 182 days of hospital stay and 74 changes of central venous catheters. The rate of CRBSI was 2.9 per 1000 catheter days. Staphylococcus species were the most prevalent pathogens (32%), followed by Klebsiella pneumoniae (5%). Conclusion: In this small group of HPN patients, the BSI rate was 2.9 infections per 1000 catheter days, and most common causative organisms were Staphylococcus species. We believe that a well-established training program for caregivers can reduce the rate of infectious complications associated with long-term PN support. PMID:27488325

  17. Confidence in delegation and leadership of registered nurses in long-term-care hospitals.

    PubMed

    Yoon, Jungmin; Kim, Miyoung; Shin, Juhhyun

    2016-07-01

    Effective delegation improves job satisfaction, responsibility, productivity and development. The ageing population demands more nurses in long-term-care hospitals. Delegation and leadership promote cooperation among nursing staff. However, little research describes nursing delegation and leadership style. We investigated the relationship between registered nurses' delegation confidence and leadership in Korean long-term-care hospitals. Our descriptive correlational design sampled 199 registered nurses from 13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent to Delegate Scale and Multifactor Leadership Questionnaire. Confidence in delegation significantly aligned with current-unit clinical experience, length of total clinical-nursing experience, delegation-training experience and leadership. Transformational leadership was the most statistically significant factor influencing delegation confidence. When effective delegation integrates with efficient leadership, staff can deliver optimal care to long-term-care patients. © 2016 John Wiley & Sons Ltd.

  18. Improved long-term survival and renal recovery after acute kidney injury in hospitalized patients: A 20 year experience.

    PubMed

    Long, Thorir E; Sigurdsson, Martin I; Sigurdsson, Gisli H; Indridason, Olafur S

    2016-12-01

    Acute kidney injury (AKI) is a common complication of medical and surgical interventions in hospitalized patients and associates with high mortality. Our aim was to examine renal recovery and long-term survival and time trends in AKI survival. Changes in serum creatinine (SCr) were used to define AKI in patients at Landspitali University Hospital in Iceland from 1993 to 2013. Renal recovery was defined as SCr < 1.5× baseline. Out of 25 274 individuals who had their highest measured SCr during hospitalization and an available baseline SCr, 10,419 (41%) had AKI during hospitalization (H-AKI), 19%, 11% and 12% with Stage 1, 2 and 3, respectively. The incidence of H-AKI increased from 18.6 (95% CI, 14.7-22.5) to 29.9 (95% CI, 26.7-33.1) per 1000 admissions/year over the study period. Survival after H-AKI was 61% at 90-days and 51% at one year. Comparing H-AKI patients to propensity score matched individuals the hazard ratio for death was 1.49 (1.36-1.62), 2.17 (1.95-2.41) and 2.95 (2.65-3.29) for Stage 1, 2 and 3, respectively. One-year survival of H-AKI patients improved from 47% in 1993-1997 to 57% in 2008-2013 and the adjusted hazard ratio for mortality improved, compared to the first 5-year period, 0.85 (0.81-0.89), 0.67 (0.64-0.71), and 0.57 (0.53-0.60) for each subsequent 5-year interval. Recovery of renal function was achieved in 88%, 58% and 44% of patients in Stages 1, 2 and 3, respectively, improving with time. Acute kidney injury is an independent predictor of long-term mortality in hospitalized patients but there has been a marked improvement in survival and renal recovery over the past two decades. © 2015 Asian Pacific Society of Nephrology.

  19. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health... Hospitals § 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites... § 412.22(e)(2), or satellite facilities of long-term care hospitals that meet the criteria in §...

  20. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health... Hospitals § 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites... § 412.22(e)(2), or satellite facilities of long-term care hospitals that meet the criteria in §...

  1. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health... Hospitals § 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites... § 412.22(e)(2), or satellite facilities of long-term care hospitals that meet the criteria in §...

  2. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health... Hospitals § 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites... § 412.22(e)(2), or satellite facilities of long-term care hospitals that meet the criteria in §...

  3. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.534 Special payment provisions for long-term care hospitals within hospitals and satellites...

  4. The Long-Term Hospitalization Experience Following Military Service in the 1991 Gulf War Among Veterans Remaining on Active Duty, 1994-2004

    DTIC Science & Technology

    2008-02-13

    Suadicani P, Guldager B, Appleyard M, Gyntelberg F: Risk factors for gastrointestinal symptoms. The Danish Gulf War Study. Dan Med Bul 1999, 46:420-423. 52...Ishoy T, Guldager B, Appleyard M, Gyntelberg F: Deter- minants of long-term neuropsychological symptoms. The Danish Gulf War Study. Dan Med Bull...Appleyard M, Gyntelberg F: Increased psychological distress among Danish gulf war vet- erans – without evidence for a neurotoxic background. The Danish

  5. Space station experiment definition: Long term cryogenic fluid storage

    NASA Technical Reports Server (NTRS)

    Riemer, David H.

    1987-01-01

    A preliminary design of an experiment to demonstrate and evaluate long-term cryogenic fluid storage and transfer technologies has been performed. This Long-Term Cryogenic Fluid Storage (LTCFS) experiment is a Technology Development Mission (TDM) experiment proposed by the NASA Lewis Research Center to be deployed on the Initial Operational Capability (IOC) space station. Technologies required by future orbital cryogenic systems such as Orbital Transfer Vehicles (OTV's) were defined, and critical technologies requiring demonstration were chosen to be included in the experiment. A three-phase test program was defined to test the following types of technologies: (1) Passive Thermal Technologies; (2) Fluid Transfer Technologies; and (3) Active Refrigeration Technologies. The development status of advanced technologies required for the LTCFS experiment is summarized, including current, past and future programs.

  6. Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs.

    PubMed

    Hume, S K

    1993-06-01

    Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.

  7. Experiences of the Long Term Stability at SLS

    NASA Astrophysics Data System (ADS)

    Wei, F. Q.

    2007-01-01

    The long term stability on the scale from days to a year, besides the short term stability, is one of key performance indicators of a light source. The Swiss Light Source (SLS) was installed and commissioned in 2000. It has successfully worked for more than 5 years without re-alignment of the machine. Hydrostatic Leveling System (HLS) and Horizontal Position System (HPS) have been added at supports of the storage ring (48 girders). They made evidence that the position of SLS Storage Ring (SR) is very stable on the time scale of a day, a week, a month and a year. The evidence for the long term stability is also provided by frequency of the RF cavity. The HLS is a powerful tool. The analysis of the HLS data shows that the vertical displacements, which are adjusted to correct average orbit deviations, of the SLS storage ring foundation and of the girder supports were in the range of 0.15 mm in 2003. The site, the building foundation, the mechanical supports and the temperature control are important pre-conditions to get the good long term stability. The experience gained with the long term stability at SLS is presented.

  8. Experiences of the Long Term Stability at SLS

    SciTech Connect

    Wei, F. Q.

    2007-01-19

    The long term stability on the scale from days to a year, besides the short term stability, is one of key performance indicators of a light source. The Swiss Light Source (SLS) was installed and commissioned in 2000. It has successfully worked for more than 5 years without re-alignment of the machine. Hydrostatic Leveling System (HLS) and Horizontal Position System (HPS) have been added at supports of the storage ring (48 girders). They made evidence that the position of SLS Storage Ring (SR) is very stable on the time scale of a day, a week, a month and a year. The evidence for the long term stability is also provided by frequency of the RF cavity. The HLS is a powerful tool. The analysis of the HLS data shows that the vertical displacements, which are adjusted to correct average orbit deviations, of the SLS storage ring foundation and of the girder supports were in the range of 0.15 mm in 2003. The site, the building foundation, the mechanical supports and the temperature control are important pre-conditions to get the good long term stability. The experience gained with the long term stability at SLS is presented.

  9. [Long-term results of mitral percutaneous valvuloplasty with Inoue technique. Seven-years experience at the Cardiology Hospital of the National Medical Center "Siglo XXI", IMSS].

    PubMed

    Flores Flores, Jesús; Ledesma Velasco, Mariano; Palomo Villada, José Antonio; Montoya Guerrero, Silvestre; Estrada Gallegos, Joel; Astudillo Sandoval, Raúl; Abundes Velasco, Arturo; González Díaz, Belinda; Argüero Sánchez, Rubén; Farell Campa, Javier

    2006-01-01

    Since the last decade, percutaneous balloon mitral valvuloplasty with Inoue catheter is considered the treatment of choice for selected patients (mobile valve, no calcification and minimal subvalvular disease) with rheumatic mitral stenosis. We present the seven-year follow-up experience of 456 patients treated with this technique in the catheter laboratory of the Cardiology Hospital in National Medical Center SXXI. It is a retrospective, transversal and observational study performed with data obtained from January 1994 and December 2000, with a follow-up of 58.5 +/- 26.6 months (range 12-96 mean 22). We achieve an initial success of 82.8%, improvement of initial mitral valve area from 0.9 +/- 0.1 to 1.8 +/- 0.3 cm2, with a gain area from 88 to 106% (p < or = 0.001). At the end of the follow-up, the mean valvular area was maintained in 1.7 +/- 0.3 cm2 in 69.8% of the cases. We found a significant reduction of transmitral gradient and of the pulmonary artery systolic pressure immediately after the procedure; 93.1% of patients were in NYHA functional class II at the end of the follow-up, 11.6% presented complications (mitral regurgitation as the most important), in 15.9% of them, due to leaflet rupture, but only 9.1% corresponded to severe grade Ill-IV. Only one patient died due to septal perforation; 93.8% of the patients remained free of major cardiac events at the end of the study. Only 6.1% of the patients required surgery at the end of the follow-up; 5.5% were in functional class NYHA Ill-IV and restenosis occurred in 14.6%. Percutaneous balloon mitral valvuloplasty with Inoue balloon catheter is a safe and effective technique for treating rheumatic mitral stenosis with Wilkins score < 10, with minimal risk and complications and offers good life expectancy with absence of major cardiac events in > 90%. From these patients, 93.1% remained in NYHA-II or -I functional class and the incidence of restenosis decreased.

  10. Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care.

    PubMed

    Watanabe, Reina; Shimoda, Tomoko; Yano, Rika; Hayashi, Yasuhiro; Nakamura, Shinji; Matsuo, Junji; Yamaguchi, Hiroyuki

    2014-03-04

    Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Ongoing daily hospital cleanliness is not

  11. Visualization of hospital cleanliness in three Japanese hospitals with a tendency toward long-term care

    PubMed Central

    2014-01-01

    Background Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). Methods The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. Results The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Conclusions

  12. Long term effects of smoking cessation in hospitalized schizophrenia patients.

    PubMed

    Miyauchi, Masatoshi; Kishida, Ikuko; Suda, Akira; Shiraishi, Yohko; Fujibayashi, Mami; Taguri, Masataka; Ishii, Chie; Ishii, Norio; Moritani, Toshio; Hirayasu, Yoshio

    2017-03-07

    The prevalence of smoking in patients with schizophrenia is higher than that in the general population and is an important medical issue. Short-term smoking cessation tends to worsen psychiatric symptoms in patients with schizophrenia but decreases sympathetic nervous system activity and improves plasma cholesterol levels in healthy people. Few studies have assessed the long-term effects of smoking cessation in patients with schizophrenia. Subjects were 70 Japanese patients with schizophrenia (38 smokers, 32 non-smokers). We compared the following clinical parameters between the two groups at baseline (before smoking cessation) and in each group separately between baseline and at three years after smoking cessation: autonomic nervous system activity, plasma cholesterol levels, body weight, drug therapy, and Global Assessment of Functioning scores. We also compared the mean changes in clinical parameters throughout this study between the groups at both time points. Autonomic nervous system activity was assessed by power spectral analysis of heart rate variability. Parasympathetic nervous system activity and the doses of antiparkinsonian drugs in smokers were significantly higher than those in non-smokers at baseline. Smoking cessation was associated with significantly decreased sympathetic nervous system activity and decreased doses of antipsychotics and antiparkinsonian drugs at three years after smoking cessation. However, there was no significant difference in the mean change in clinical factors scores, except for Global Assessment of Functioning scores, between smokers and non-smokers at three years after smoking cessation. Our results suggest that smoking reduces both autonomic nervous system activity and the effectiveness of drug therapy with antipsychotics and antiparkinsonian drugs in patients with schizophrenia, but that both factors could be ameliorated over the long term by smoking cessation. Taken together with the findings of previous studies, smoking

  13. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions.

    PubMed

    Kim, Jinkyung; Han, Woosok

    2012-06-01

    To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents' and organizational characteristics. The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria.

  14. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions

    PubMed Central

    Kim, Jinkyung; Han, Woosok

    2012-01-01

    Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria. PMID:24159497

  15. Music and Well-Being in Long-Term Hospitalized Children

    ERIC Educational Resources Information Center

    Longhi, Elena; Pickett, Nick

    2008-01-01

    The aim of this study was to investigate the physiological responses of long-term hospitalized children when exposed to live music. Twenty-one paediatric patients at Great Ormond Street Children's Hospital, London, between 3 months and 14 years of age, took part in the study. They were all long-term patients with cardiac and/or respiratory…

  16. Music and Well-Being in Long-Term Hospitalized Children

    ERIC Educational Resources Information Center

    Longhi, Elena; Pickett, Nick

    2008-01-01

    The aim of this study was to investigate the physiological responses of long-term hospitalized children when exposed to live music. Twenty-one paediatric patients at Great Ormond Street Children's Hospital, London, between 3 months and 14 years of age, took part in the study. They were all long-term patients with cardiac and/or respiratory…

  17. Long-Term Care Insurance: Does Experience Matter?*

    PubMed Central

    Coe, Norma B.; Skira, Meghan M.; Van Houtven, Courtney Harold

    2015-01-01

    We examine whether long-term care (LTC) experience helps explain the low demand for long-term care insurance (LTCI). We test if expectations about future informal care receipt, expectations about inheritance receipt, and LTCI purchase decisions vary between individuals whose parents or in-laws have used LTC versus those who have not. We find parental use of a nursing home decreases expectations that one’s children will provide informal care, consistent with the demonstration effect. Nursing home use by in-laws does not have the same impact, suggesting that individuals are responding to information gained about their own aging trajectory. Nursing home use by either a parent or in-law increases LTCI purchase probability by 0.8 percentage points, with no significant difference in response between parents’ and in-laws’ use. The estimated increase in purchase probability from experience with LTC is about half the previously estimated increase from tax policy-induced price decreases. PMID:25647006

  18. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    PubMed

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  19. Effect of aromatherapy massage on elderly patients under long-term hospitalization in Japan.

    PubMed

    Satou, Tadaaki; Chikama, Mizuki; Chikama, Yoshiko; Hachigo, Masato; Urayama, Haruna; Murakami, Shio; Hayashi, Shinichiro; Koikem, Kazuo

    2013-03-01

    To verify the effectiveness of aromatherapy massage on elderly patients under long-term hospitalization. Aromatherapy massage was performed twice a week for a total of eight times. Nursing home. Elderly women under long-term hospitalization. Questionnaire and measurement of stress marker levels (salivary amylase activity) before and after the first, fifth, and eighth aromatherapy massages. Questionnaire (Face scale, General Health Questionnaire-12 [GHQ-12]), measurement of salivary amylase activity. A decrease in stress after aromatherapy massage compared to before each massage was confirmed at all measurement times and with the stress marker. No marked reduction was observed in Face scale or saliva amylase activity as a whole over the long term, although decreasing tendencies were seen. Marked reductions in GHQ-12 were observed over the long term. Aroma massage appears likely to prove effective in reducing psychological stress among elderly patients under long-term hospitalization.

  20. Fall-Related Hospitalization and Facility Costs among Residents of Institutions Providing Long-Term Care

    ERIC Educational Resources Information Center

    Carroll, Norman V.; Delafuente, Jeffrey C.; Cox, Fred M.; Narayanan, Siva

    2008-01-01

    Purpose: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers.…

  1. Fall-Related Hospitalization and Facility Costs among Residents of Institutions Providing Long-Term Care

    ERIC Educational Resources Information Center

    Carroll, Norman V.; Delafuente, Jeffrey C.; Cox, Fred M.; Narayanan, Siva

    2008-01-01

    Purpose: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers.…

  2. The long-term experience of family life after stroke.

    PubMed

    Kitzmüller, Gabriele; Asplund, Kenneth; Häggström, Terttu

    2012-02-01

    Stroke is a life-threatening and disabling illness known to have a significant impact on families. The purpose of this study was to illuminate the long-term experience of family life after stroke of stroke survivors and their spouses and children, particularly regarding marital and parent-child relationships. Thirty-seven narrative interviews were conducted with stroke survivors and their spouses and adult children who were minors at onset of the illness. A qualitative approach inspired by Gadamer's hermeneutic and van Manen's phenomenological understanding of lived experience was used. The analysis revealed four themes: the family as a lifebuoy, absent presence, broken foundations, and finding a new marital path. Lack of communication and altered roles and relationships endangered marital equilibrium and parent-child relationships after stroke. This study highlighted the need for professional family support as families were unprepared for the life changes that occurred. Nurses and other healthcare workers should examine family relationships and communication patterns and view the family as a unit composed of unique persons with different needs. Further research on the experiences of stroke survivors' children seems urgent.

  3. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews

    PubMed Central

    Bjørk, Ida Torunn; Wahl, Astrid Klopstad; Lennerling, Annette; Andersen, Marit Helen

    2017-01-01

    Objective Live kidney donation is generally viewed as a welcome treatment option for severe kidney disease. However, there is a disparity in the body of research on donor experiences and postdonation outcome, and lack of knowledge on long-term consequences described by the donors. This study was conducted to provide insight into donors' subjective meanings and interpretation of their experiences ∼10 years after donation. Design Qualitative explorative in-depth interviews. The sampling strategy employed maximum variation. Setting Oslo University Hospital is the national centre for organ transplantation and donation in Norway, and there are 26 local nephrology centres. Participants 16 donors representing all parts of Norway who donated a kidney in 2001–2004 participated in the study. The interviews were analysed using an interpretative approach. Results The analysis resulted in 4 main themes; the recipient outcome justified long-term experiences, family dynamics—tension still under the surface, ambivalence—healthy versus the need for regular follow-up, and life must go on. These themes reflect the complexity of live kidney donation, which fluctuated from positive experiences such as pride and feeling privileged to adverse experiences such as altered family relationships or reduced health. Conclusions Live kidney donors seemed to possess resilient qualities that enabled them to address the long-term consequences of donation. The challenge is to provide more uniform information about long-term consequences. In future research, resilient qualities could be a topic to explore in live donation. PMID:28209606

  4. Contemporary In-Hospital and Long-Term Outcomes of Surgical Management for Fungal Endocarditis.

    PubMed

    Chen, Jinmiao; Li, Jun; Zhou, Tianyu; Hu, Kui; Yang, Zhaohua; Wang, Yao; Zhu, Kai; Hong, Tao; Lai, Hao; Wang, Chunsheng

    2017-08-03

    Fungal endocarditis (FE) is a rare and fatal disease. The contemporary in-hospital and long-term surgical outcomes of FE have not been adequately evaluated. This study describes our experience with the surgical management of FE.Eight FE patients who underwent surgery in our center from January 2004 to November 2016 were included in this study. Seven had fungal prosthetic valve endocarditis (PVE) and one fungal native valve endocarditis (NVE). The Bentall operation, Cabrol operation, and mitral valve replacement were performed in 4, 3, and 1 patient, respectively. The overall in-hospital mortality rate was 25% (2/8). The follow-up was completed in all surviving patients and the mean follow-up time was 55.5 ± 63.3 (range, 1-154) months. Two late deaths occurred at 2 months and 4 months after discharge. The other patients recovered well during the follow-up.FE is a devastating disease and surgical treatment has acceptable in-hospital and long-term mortality rates.

  5. 42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... after October 1, 2002, a long-term care hospital must meet the conditions for payment of this section... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE... INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

  6. Innovative use of tele-ICU in long-term acute care hospitals.

    PubMed

    Mullen-Fortino, Margaret; Sites, Frank D; Soisson, Michael; Galen, Julie

    2012-01-01

    Tele-intensive care units (ICUs) typically provide remote monitoring for ICUs of acute care, short-stay hospitals. As part of a joint venture project to establish a long-term acute level of care, Good Shepherd Penn Partners became the first facility to use tele-ICU technology in a nontraditional setting. Long-term acute care hospitals care for patients with complex medical problems. We describe describes the benefits and challenges of integrating a tele-ICU program into a long-term acute care setting and the impact this model of care has on patient care outcomes.

  7. [Long term (10 years) experience of immediate implant placement].

    PubMed

    István, Vajdovich; Katalin, Nagy

    2009-12-01

    Immediate placement of dental implants have been widely used to retain and support cross-arch partial dentures. 3-6 months after implantation the osseointegration is established. This period may be shortened with immediate implant placement technique. The purpose of this study was to evaluate the factors that may influence the long term success of immediate implantation. Clinical results of 10 yrs period of immediate implant placement were investigated in case of 184 patients and 258 Denti implants. The control was carried out with 121 patients and with 192 implants placed with submerged technique. The retrospective long term follow-up examination has revailed that the success rate of Denti implants with traditional two stage surgery was 97,4%. The success rate of Denti implants with immediate placement was 95.75%. According to the data, the prognosis of immediate implantations-method are compatible (comparable) to the traditional inserted implants.

  8. Long Term Stability of Coriolis Flow Meters: DESY experience

    NASA Astrophysics Data System (ADS)

    Boeckmann, T.; Bozhko, Y.; Escherich, K.; Petersen, B.; Putselyk, S.; Schnautz, T.; Sellmann, D.; Zhirnov, A.

    2017-02-01

    The measurement of coolant flow is important operational parameter for reliable operation of cryogenic system with superconducting magnets or cavities as well as for the system diagnostics in case of non-steady-state operation, e.g. during cool-down/warm-up or other transients. Proper flowmeter is chosen according to the different parameters, e.g. turn-down, operating temperature range, leak-tightness, pressure losses, long-term stability, etc. For helium cryogenics, the Venturi tube or Orifice, as well as Coriolis flow meters are often applied. For the present time, the orifices are usually used due to their simplicity and low costs, however, low turn-down range, large pressure drop, restriction of flow area, susceptibility to thermoacoustic oscillations limit their useful operation range. Operational characteristics of Venturi tubes is substantially improved in comparison to orifices, however, relative high costs and susceptibility to thermoacoustic oscillations still limit their application to special cases. The Coriolis flow meters do not have typical drawbacks of Venturi tube and orifices, however long-term stability over many years was not demonstrated yet. This paper describes the long-term behaviour of Coriolis flow meters after many years of operation at AMTF and XMTS facilities.

  9. Post-Intensive Care Syndrome in Family Decision Makers of Long-term Acute Care Hospital Patients.

    PubMed

    Petrinec, Amy

    2017-09-01

    Family members of critically ill patients experience indications of post-intensive care syndrome, including anxiety, depression, and posttraumatic stress disorder. Despite increased use of long-term acute care hospitals for critically ill patients, little is known about the impact of long-term hospitalization on patients' family members. To examine indications of post-intensive care syndrome, coping strategies, and health-related quality of life among family decision makers during and after patients' long-term hospitalization. A single-center, prospective, longitudinal descriptive study was undertaken of family decision makers of adult patients admitted to long-term acute care hospitals. Indications of post-intensive care syndrome and coping strategies were measured on the day of hospital admission and 30 and 60 days later. Health-related quality of life was measured by using the Short Form-36, version 2, at admission and 60 days later. The sample consisted of 30 family decision makers. On admission, 27% reported moderate to severe anxiety, and 20% reported moderate to severe depression. Among the decision makers, 10% met criteria for a provisional diagnosis of posttraumatic stress disorder. At admission, the mean physical summary score for quality of life was 47.8 (SD, 9.91) and the mean mental summary score was 48.00 (SD, 10.28). No significant changes occurred during the study period. Problem-focused coping was the most frequently used coping strategy at all time points. Family decision makers of patients in long-term acute care hospitals have a significant prevalence of indications of post-intensive care syndrome. ©2017 American Association of Critical-Care Nurses.

  10. A case of paracoccidioidomycosis: experience with long-term therapy.

    PubMed

    Borgia, G; Reynaud, L; Cerini, R; Ciampi, R; Schioppa, O; Dello Russo, M; Gentile, I; Piazza, M

    2000-01-01

    We describe long-term therapy for paracoccidioidomycosis occurring in a 61-year-old house-painter from Venezuela. The diagnostic examinations made in South America had shown pulmonary granulomatous lesions and an osteolytic pattern of the left knee that had been considered suspect of malignant disease with an indication for limb amputation. With the aid of fine needle aspiration biopsy (FNAB) and culture examination we diagnosed an osteomyelitis by Paracoccidioides brasiliensis and initiated therapy with itraconazole, 400 mg per day, reduced to 200 mg per day after 2 months. At the end of 2 years of drug therapy, we observed complete regression of the pulmonary lesions and of the osteolytic area of the left knee. Moreover, we have periodically observed our patient to verify his clinical development and he is still in good health. We suggest that this pathology be considered in differential diagnosis of leprosy, tuberculosis, leishmaniasis, and systemic mycoses, even in non-endemic areas.

  11. Reduced Right Ventricular Function Predicts Long-Term Cardiac Re-Hospitalization after Cardiac Surgery

    PubMed Central

    Goldsmith, Yulia; Chan, Jacqueline; Iskandir, Marina; Gulkarov, Iosif; Tortolani, Anthony; Brener, Sorin J.; Sacchi, Terrence J.; Heitner, John F.

    2015-01-01

    Background The significance of right ventricular ejection fraction (RVEF), independent of left ventricular ejection fraction (LVEF), following isolated coronary artery bypass grafting (CABG) and valve procedures remains unknown. The aim of this study is to examine the significance of abnormal RVEF by cardiac magnetic resonance (CMR), independent of LVEF in predicting outcomes of patients undergoing isolated CABG and valve surgery. Methods From 2007 to 2009, 109 consecutive patients (mean age, 66 years; 38% female) were referred for pre-operative CMR. Abnormal RVEF and LVEF were considered <35% and <45%, respectively. Elective primary procedures include CABG (56%) and valve (44%). Thirty-day outcomes were perioperative complications, length of stay, cardiac re-hospitalizations and early mortaility; long-term (> 30 days) outcomes included, cardiac re-hospitalization, worsening congestive heart failure and mortality. Mean clinical follow up was 14 months. Findings Forty-eight patients had reduced RVEF (mean 25%) and 61 patients had normal RVEF (mean 50%) (p<0.001). Fifty-four patients had reduced LVEF (mean 30%) and 55 patients had normal LVEF (mean 59%) (p<0.001). Patients with reduced RVEF had a higher incidence of long-term cardiac re-hospitalization vs. patients with normal RVEF (31% vs.13%, p<0.05). Abnormal RVEF was a predictor for long-term cardiac re-hospitalization (HR 3.01 [CI 1.5-7.9], p<0.03). Reduced LVEF did not influence long-term cardiac re-hospitalization. Conclusion Abnormal RVEF is a stronger predictor for long-term cardiac re-hospitalization than abnormal LVEF in patients undergoing isolated CABG and valve procedures. PMID:26197273

  12. The Regulatory Environment and Rural Hospital Long-Term Care Strategies from 1997 to 2003

    ERIC Educational Resources Information Center

    Fennell, Mary L.; Campbell, Susan E.

    2007-01-01

    Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2…

  13. The Regulatory Environment and Rural Hospital Long-Term Care Strategies from 1997 to 2003

    ERIC Educational Resources Information Center

    Fennell, Mary L.; Campbell, Susan E.

    2007-01-01

    Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2…

  14. CHILDHOOD RESPIRATORY SYMPTOMS, HOSPITAL ADMISSIONS, AND LONG-TERM EXPOSURE TO AIRBORNE PARTICULATE MATTER

    EPA Science Inventory

    The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7--11 years, N=667) living in a moderately industrialized city in Central Sl...

  15. CHILDHOOD RESPIRATORY SYMPTOMS, HOSPITAL ADMISSIONS, AND LONG-TERM EXPOSURE TO AIRBORNE PARTICULATE MATTER

    EPA Science Inventory

    The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7--11 years, N=667) living in a moderately industrialized city in Central Sl...

  16. Risk factors of scabies in psychiatric and long-term care hospitals: a nationwide mail-in survey in Japan.

    PubMed

    Makigami, Kuniko; Ohtaki, Noriko; Ishii, Norihisa; Yasumura, Seiji

    2009-09-01

    Despite the commonness of scabies in Japanese institutional settings, the nationwide prevalence of scabies has not been elucidated. This study was conducted to assess the prevalence of scabies and control measures in Japanese hospitals. A questionnaire on scabies epidemiology (e.g. number of patients and onsets of outbreak) and preventive measures were sent to psychiatric hospitals and long-term care hospitals nationwide (n = 1795) in January 2005. Seven hundred and forty-one hospitals responded (41.3%). Three hundred and thirty-three (44.9%) respondent hospitals had one or more scabies cases in 2004. Among 159 hospitals that had experienced scabies outbreak, only 32 of them reported cases of crusted scabies. Multivariate regression analysis showed that hospitals had a greater number of beds, and that acute- and long-term care wards were more likely to experience scabies onsets. Hospitals that compiled their infection control manuals on scabies, treated suspicious patients with scabicides without confirmed diagnosis, and performed skin checkup of inpatients were more likely to experience scabies cases. Infection control personnel should be aware that unrecognized crusted scabies can cause outbreaks. Higher patient turnover is a risk factor for scabies introduction into a hospital. Preventive measures against scabies, such as patient screening at admission and treating all suspicious patients without confirmed diagnosis, were not effective to avoid scabies introduction.

  17. Soil water repellency in long term drought and warming experiments

    NASA Astrophysics Data System (ADS)

    Urbanek, Emilia; Emmett, Bridget; Tietema, Albert; Robinson, David

    2017-04-01

    Increased global temperatures, altered rainfall patterns and frequently occurring extreme climatic events are already observed globally as a result of the climatic changes and further increases are predicted by the climatic models. Extreme weather events such as prolonged dry spells and heat waves can significantly affect soil ecosystem functions mainly due to decrease in soil moisture. Several studies suggested an increase in soil water repellency severity and spread as a consequence of the warming and drought, however, such understanding is based on the laboratory experimentations with soil treated as a 'black box'. In this study we tested the hypothesis of increased severity of soil water repellency subjected to drought and warming under field conditions. Occurrence and severity of soil water repellency was tested in soils subjected to a long-term (10 years) climatic simulation at two upland heathland sites in Oldebroek (Netherlands) and in Clocaenog (UK)[1]. Soil plots with similar vegetation were subjected to repeated drought and warming, compared with the control plots. Drought effect was created by a rainfall exclusion using an automatic self-retracting waterproof curtains while the warming effect was made by using a self-retracting curtains reflecting infrared radiation overnight. The results available to date provide a strong indication that climatic conditions do affect the development of SWR.

  18. Improving patient safety in a UK dental hospital: long-term use of clinical audit.

    PubMed

    Ashley, M P; Pemberton, M N; Saksena, A; Shaw, A; Dickson, S

    2014-10-01

    The improvement of patient safety has been a long-term aim of healthcare organisations and following recent negative events within the UK, the focus on safety has rightly increased. For over twenty years, clinical audit has been the tool most frequently used to measure safety-related aspects of healthcare and when done so correctly, can lead to sustained improvements. This paper explains how clinical audit is used as a safety improvement tool in an English dental hospital and gives several examples of projects that have resulted in long-term improvements in secondary dental care.

  19. Role of long-term acute care in reducing hospital readmission.

    PubMed

    Velazco, Jorge F; Ghamande, Shekhar; Surani, Salim

    2017-10-01

    Long-term acute care hospitals (LTACs) are health care facilities capable of admitting complex patients with high acuity that are unable to return home after hospitalization in acute care. Its defining characteristic is to accommodate patients for a length of stay greater than 25 days, however, little is known about its role of preventing hospital readmissions. Created in the 1980s, these facilities were designed to help acute care facilities improve their resource management, expenditures, and quality of care. Although these units were initially created for chronic ventilator weaning, their scope of practice has broadened. This article analyzes studies and suggests role of LTACs in reducing hospital readmissions.

  20. Long-Term English Language Learners' Perceptions of Their Language and Academic Learning Experiences

    ERIC Educational Resources Information Center

    Kim, Won Gyoung; García, Shernaz B.

    2014-01-01

    Long-term, adolescent English language learners (ELLs) experience persistent academic underachievement in spite of several years of schooling; yet, the research on this topic is scant. To increase our understanding of these students' educational experiences, we explored perceptions of 13 long-term ELLs about their schooling in the context of their…

  1. Video testimony of long-term hospitalized psychiatrically ill Holocaust survivors.

    PubMed

    Strous, Rael D; Weiss, Mordechai; Felsen, Irit; Finkel, Boris; Melamed, Yuval; Bleich, Avraham; Kotler, Moshe; Laub, Dori

    2005-12-01

    Many Holocaust survivors who have both psychotic disorders and residual symptoms of posttraumatic stress disorder (PTSD) remain chronically hospitalized in psychiatric institutions. This study investigated the clinical benefits of a therapeutic process facilitating a detailed videotaped account of traumatic experience (testimony method) in elderly long-term hospitalized Holocaust survivors. Twenty-four schizophrenia patients (mean age=72.2 years) who were chronically hospitalized in Israeli state psychiatric hospitals underwent assessment by blind rating with a battery of psychiatric rating scales before and 4 months after extensive videotaped interview. The rating scales included the Positive and Negative Syndrome Scale; Clinical Global Impression (CGI); Mini-Mental State Examination (MMSE); Clinician-Administered PTSD Scale, Form 2; and Structured Interview for Disorders of Extreme Stress. Full pre- and postinterview data were available for 21 patients. Thirty-eight percent of the patients met the criteria for PTSD at the first interview, compared with only 19% at the second interview. The patients had significant reductions in functional impairment and in the severity and intensity of all posttraumatic symptom clusters (intrusion, avoidance, hyperarousal); the avoidance cluster showed the most reduction. Eleven subjects had an improvement of 30% or more in total posttraumatic severity score. No differences in Positive and Negative Syndrome Scale, MMSE, Structured Interview for Disorders of Extreme Stress, and CGI total scores were noted postinterview or between the two preinterview evaluation batteries in the comparison group. Female patients had a higher prevalence of PTSD symptoms. Total Clinician-Administered PTSD Scale, Form 2, scores and total Positive and Negative Syndrome Scale scores were inversely correlated both at baseline and at follow-up. Study observations suggest clinical benefits of the testimony method in the alleviation of many posttraumatic

  2. Effectiveness of long-term acute care hospitalization in elderly patients with chronic critical illness

    PubMed Central

    Kahn, Jeremy M.; Werner, Rachel M.; David, Guy; Have, Thomas R. Ten; Benson, Nicole M.; Asch, David A.

    2012-01-01

    Background For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit. Objective To examine the effectiveness of LTAC transfer in patients with chronic critical illness. Research Design Retrospective cohort study in United States hospitals from 2002 to 2006. Subjects Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care. Measures Survival, costs and hospital readmissions. We used multivariate analyses and instrumental variables to account for differences in patient characteristics, the timing of LTAC transfer and selection bias. Results A total of 234,799 patients met our definition of chronic critical illness. Of these, 48,416 (20.6%) were transferred to an LTAC. In the instrumental variable analysis, patients transferred to an LTAC experienced similar survival compared to patients who remained in an intensive care unit (adjusted hazard ratio = 0.99, 95% CI: 0.96 to 1.01, p=0.27). Total hospital-related costs in the 180 days following admission were lower among patients transferred to LTACs (adjusted cost difference = -$13,422, 95% CI: -26,662 to -223, p=0.046). This difference was attributable to a reduction in skilled nursing facility admissions (adjusted admission rate difference = -0.591 (95% CI: -0.728 to -0.454, p <0.001). Total Medicare payments were higher (adjusted cost difference = $15,592, 95% CI: 6,343 to 24,842, p=0.001). Conclusions Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in intensive care units, incur fewer health care costs driven by a reduction in post-acute care utilization, but invoke higher overall Medicare payments. PMID:22874500

  3. 42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

  4. Long-Term Effects of Labeling a Rape Experience

    ERIC Educational Resources Information Center

    McMullin, Darcy; White, Jacquelyn W.

    2006-01-01

    Research has found that approximately half of women who report an experience that meets the legal definition of rape do not label it rape. It has been assumed that labeling the experience as rape is necessary and beneficial for recovery; however, conflicting findings have been reported. In the present study, a longitudinal design was utilized to…

  5. Long-Term Effects of Labeling a Rape Experience

    ERIC Educational Resources Information Center

    McMullin, Darcy; White, Jacquelyn W.

    2006-01-01

    Research has found that approximately half of women who report an experience that meets the legal definition of rape do not label it rape. It has been assumed that labeling the experience as rape is necessary and beneficial for recovery; however, conflicting findings have been reported. In the present study, a longitudinal design was utilized to…

  6. Long term alternative crop rotation experiment: USDA-ARS Akron, Colorado

    USDA-ARS?s Scientific Manuscript database

    In 1990 a long term alternative crop rotation experiment was established at the USDA-ARS Central Great Plains Research Station at Akron Colorado. The goal of this long term effort was to ultimately identify crop rotations other than winter wheat (Triticum aestivum L.) -fallow (WF) that are viable ro...

  7. Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience.

    PubMed

    Giacalone, Nicholas J; Shipley, William U; Clayman, Rebecca H; Niemierko, Andrzej; Drumm, Michael; Heney, Niall M; Michaelson, Marc D; Lee, Richard J; Saylor, Philip J; Wszolek, Matthew F; Feldman, Adam S; Dahl, Douglas M; Zietman, Anthony L; Efstathiou, Jason A

    2017-06-01

    Tri-modality therapy (TMT) is a recognized treatment strategy for selected patients with muscle-invasive bladder cancer (MIBC). Report long-term outcomes of patients with MIBC treated by TMT. Four hundred and seventy-five patients with cT2-T4a MIBC were enrolled on protocols or treated as per protocol at the Massachusetts General Hospital between 1986 and 2013. Patients underwent transurethral resection of bladder tumor followed by concurrent radiation and chemotherapy. Patients with less than a complete response (CR) to chemoradiation or with an invasive recurrence were recommended to undergo salvage radical cystectomy. Disease-specific survival (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method. Median follow-up for surviving patients was 7.21 yr. Five- and 10-yr DSS rates were 66% and 59%, respectively. Five- and 10-yr OS rates were 57% and 39%, respectively. The risk of salvage cystectomy at 5 yr was 29%. In multivariate analyses, T2 disease (OS hazard ratio [HR]: 0.57, 95% confidence interval [CI]: 0.44-0.75, DSS HR: 0.51, 95% CI: 0.36-0.73), CR to chemoradiation (OS HR: 0.61, 95% CI: 0.46-0.81, DSS HR: 0.49, 95% CI: 0.34-0.71), and presence of tumor-associated carcinoma in situ (OS HR: 1.56, 95% CI: 1.17-2.08, DSS HR: 1.50, 95% CI: 1.03-2.17) were significant predictors for OS and DSS. When evaluating our cohort over treatment eras, rates of CR improved from 66% to 88% and 5-yr DSS improved from 60% to 84% during the eras of 1986-1995 to 2005-2013, while the 5-yr risk of salvage radical cystectomy rate decreased from 42% to 16%. These data demonstrate high rates of CR and bladder preservation in patients receiving TMT, and confirm DSS rates similar to modern cystectomy series. Contemporary results are particularly encouraging, and therefore TMT should be discussed and offered as a treatment option for selected patients. Tri-modality therapy is an alternative to radical cystectomy for patients with muscle-invasive bladder cancer, and

  8. Space station experiment definition: Long-term cryogenic fluid storage

    NASA Technical Reports Server (NTRS)

    Jetley, R. L.; Scarlotti, R. D.

    1987-01-01

    The conceptual design of a space station Technology Development Mission (TDM) experiment to demonstrate and evaluate cryogenic fluid storage and transfer technologies is presented. The experiment will be deployed on the initial operational capability (IOC) space station for a four-year duration. It is modular in design, consisting of three phases to test the following technologies: passive thermal technologies (phase 1), fluid transfer (phase 2), and active refrigeration (phase 3). Use of existing hardware was a primary consideration throughout the design effort. A conceptual design of the experiment was completed, including configuration sketches, system schematics, equipment specifications, and space station resources and interface requirements. These requirements were entered into the NASA Space Station Mission Data Base. A program plan was developed defining a twelve-year development and flight plan. Program cost estimates are given.

  9. Long Term Physical Health Consequences of Adverse Childhood Experiences

    PubMed Central

    Monnat, Shannon M.; Chandler, Raeven Faye

    2015-01-01

    This study examined associations between adverse childhood family experiences and adult physical health using data from 52,250 US adults aged 18–64 from the 2009–2012 Behavioral Risk Factor Surveillance System (BRFSS). We found that experiencing childhood physical, verbal, or sexual abuse, witnessing parental domestic violence, experiencing parental divorce, and living with someone who was depressed, abused drugs or alcohol, or who had been incarcerated were associated with one or more of the following health outcomes: self-rated health, functional limitations, diabetes, and heart attack. Adult socioeconomic status and poor mental health and health behaviors significantly mediated several of these associations. The results of this study highlight the importance of family-based adverse childhood experiences on adult health outcomes and suggest that adult SES and stress-related coping behaviors may be crucial links between trauma in the childhood home and adult health. PMID:26500379

  10. Infantile digital fibromatosis: our experience and long-term results.

    PubMed

    Spingardi, O; Zoccolan, A; Venturino, E

    2011-02-01

    Infantile fibromatosis is an uncommon benign proliferation of myofibroblasts in the dermal tissue on the digits and toes with a marked tendency for recurrence. Inclusion bodies in the cytoplasm of neoplastic fibroblasts are a characteristic histologic feature of this condition. The tumor may often resolve spontaneously. There is very little written in the literature on this subject, with only a few or isolated cases having been described. We report our experience of seven cases of recurrent infantile fibromatosis that underwent surgical treatment. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  11. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Method of payment under the long-term care hospital prospective payment system. 412.541 Section 412.541 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... bills are processed or by direct payment by the long-term care hospital. ...

  12. Long-term oxytocin administration enhances the experience of attachment.

    PubMed

    Bernaerts, Sylvie; Prinsen, Jellina; Berra, Emmely; Bosmans, Guy; Steyaert, Jean; Alaerts, Kaat

    2017-04-01

    The neuropeptide 'oxytocin' (OT) is known to play a pivotal role in a variety of complex social behaviors by promoting a prosocial attitude and interpersonal bonding. Previous studies showed that a single-dose of exogenously administered OT can affect trust and feelings of attachment insecurity. With the present study, we explored the effects of two weeks of daily OT administration on measures of state and trait attachment using a double-blind between-subjects randomized placebo-controlled design. In 40 healthy young adult men state and trait attachment were assessed before and after two weeks of daily intranasal OT (24 IU) or placebo using the State Adult Attachment Scale and the Inventory of Parent and Peer Attachment. Mood, social responsiveness and quality of life were additionally assessed as secondary outcome measures. Reductions in attachment avoidance and increases in reports of attachment toward peers were reported after two weeks of OT treatment. Further, treatment-induced changes were most pronounced for participants with less secure attachment towards their peers. indicating that normal variance at baseline modulated treatment response. OT treatment was additionally associated with changes in mood, indicating decreases in feelings of tension and (tentatively) anger in the OT group, not in the placebo group. Further, at the end of the two-week trial, both treatment groups (OT, placebo) reported to experience an increase in social responsiveness and quality of life, but the effects were only specific to the OT-treatment in terms of reports on 'social motivation'. In summary, the observed improvements on state and trait dimensions of attachment after a multiple-dose treatment with OT provide further evidence in support of a pivotal role of OT in promoting the experience of attachment.

  13. Long-term survival following in-hospital cardiac arrest: A matched cohort study☆

    PubMed Central

    Feingold, Paul; Mina, Michael J.; Burke, Rachel M.; Hashimoto, Barry; Gregg, Sara; Martin, Greg S.; Leeper, Kenneth; Buchman, Timothy

    2016-01-01

    Background Each year, 200,000 patients undergo an in-hospital cardiac arrest (IHCA), with approximately 15–20% surviving to discharge. Little is known, however, about the long-term prognosis of these patients after discharge. Previous efforts to describe out-of-hospital survival of IHCA patients have been limited by small sample sizes and narrow patient populations Methods A single institution matched cohort study was undertaken to describe mortality following IHCA. Patients surviving to discharge following an IHCA between 2008 and 2010 were matched on age, sex, race and hospital admission criteria with non-IHCA hospital controls and follow-up between 9 and 45 months. Kaplan–Meier curves and Cox PH models assessed differences in survival. Results Of the 1262 IHCAs, 20% survived to hospital discharge. Of those discharged, survival at 1 year post-discharge was 59% for IHCA patients and 82% for controls (p < 0.0001). Hazard ratios (IHCA vs. controls) for mortality were greatest within the 90 days following discharge (HR = 2.90, p < 0.0001) and decreased linearly thereafter, with those surviving to one year post-discharge having an HR for mortality below 1.0. Survival after discharge varied amongst IHCA survivors. When grouped by discharge destination, out of hospital survival varied; in fact, IHCA patients discharged home without services demonstrated no survival difference compared to their non-IHCA controls (HR 1.10, p = 0.72). IHCA patients discharged to long-term hospital care or hospice, however, had a significantly higher mortality compared to matched controls (HR 3.91 and 20.3, respectively; p < 0.0001). Conclusion Among IHCA patients who survive to hospital discharge, the highest risk of death is within the first 90 days after discharge. Additionally, IHCA survivors overall have increased long-term mortality vs. controls. Survival rates were varied widely with different discharge destinations, and those discharged to home, skilled nursing facilities or to

  14. Long term experience and performance of COMPASS RICH-1

    NASA Astrophysics Data System (ADS)

    Tessarotto, F.; Abbon, P.; Alexeev, M.; Birsa, R.; Bordalo, P.; Bradamante, F.; Bressan, A.; Büchele, M.; Chiosso, M.; Ciliberti, P.; Dafni, T.; Dalla Torre, S.; Dasgupta, S.; Delagnes, E.; Denisov, O.; Duic, V.; Ferrero, A.; Finger, M.; Finger, M., Jr.; Fischer, H.; Franco, C.; Gerassimov, S.; Gobbo, B.; Gregori, M.; Herrmann, F.; Ketzer, B.; Königsmann, K.; Konorov, I.; Kunne, F.; Levorato, S.; Maggiora, A.; Makke, N.; Martin, A.; Menon, G.; Neyret, D.; Novakova, K.; Panzieri, D.; Paul, S.; Pereira, F. A.; Polak, J.; Rocco, E.; Santos, C. A.; Sbrizzai, G.; Schiavon, P.; Schopferer, S.; Slunecka, M.; Sozzi, F.; Steiger, L.; Sulc, M.; Takekawa, S.

    2014-09-01

    COMPASS RICH-1 is a large size gaseous Imaging Cherenkov Detector providing hadron identification in the range from 3 to 55 GeV/c, in the wide acceptance spectrometer of the COMPASS Experiment at CERN SPS. It uses a 3 m long C4F10 radiator, a 21 m2 large VUV mirror surface and two kinds of photon detectors: MAPMTs and MWPCs with CsI photocathodes, covering a total of 5.5 m2. It is in operation since 2002 and its performance increased thanks to progressive optimization and to a major upgrade of its photon detection system, implemented in 2006; a new upgrade is foreseen for 2016, with the use of MPGD-based photon detectors. The main characteristics of COMPASS RICH-1 components are described and the most critical aspects related to the C4F10 radiator gas system, to the mirrors and their alignment, as well as the performance of the photon detectors are presented and discussed. The response of the MWPCs and the observed evolution of the effective quantum efficiency of the CsI photocathodes is analyzed. The properties and performance of the MAPMTs with individual fused lens telescopes are presented together with the readout characteristics. The PID performance of COMPASS RICH-1 is discussed and the future upgrade program is mentioned.

  15. Developing pharmacy applications using a microcomputer relational database in a long-term care psychiatric hospital.

    PubMed

    Salek, W

    1989-03-01

    The database applications developed with a microcomputer for a 1000 bed long-term care forensic psychiatric care hospital are described. The implementation of a microcomputer system was instituted as an interim measure prior to the development of a hospital wide minicomputer system. Primary emphasis was placed on increasing the efficiency of professional staff while enhancing clinical therapeutic monitoring. The system operates on an IBM-AT with 30 megabyte hard disk drive and an Epson FX-100 dot matrix printer. A relational database manager, Team-Up, was utilized in the development of applications that included census maintenance, scheduled drug inventory, drug regimen review, drug utilization protocols and a skilled nursing unit dose patient profile. Other ancillary functions included generation of stock labels, a literature abstract database and an on-line policy and procedure manual. Advantages of the system include an increase in staff productivity through the use of information that is readily attainable from the patient database. Possible disadvantages are the programming and hardware limitations imposed by a microcomputer system. Long term care psychiatric facilities may be able to enhance staff efficiency by computerizing existing manual systems. Because of the diverse and specialized requirements of long term care facilities, a microcomputer used in conjunction with a programmable relational database can be easily customized to fulfill this need.

  16. Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study.

    PubMed

    Del Castillo, Jimena; López-Herce, Jesús; Matamoros, Martha; Cañadas, Sonia; Rodríguez-Calvo, Ana; Cecchetti, Corrado; Rodriguez-Núñez, Antonio; Álvarez, Angel Carrillo

    2015-11-01

    The main objective was to study survival and neurologic evolution of children who suffered in-hospital pediatric cardiac arrest (CA). The secondary objective was to analyze the influence of risk factors on the long term outcome after CA. prospective, international, observational, multicentric study in 48 hospitals of 12 countries. CA in children between 1 month and 18 years were analyzed using the Utstein template. Survival and neurological state measured by Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge was evaluated. 502 patients with in-hospital CA were evaluated. 197 of them (39.2%) survived to hospital discharge. PCPC at hospital discharge was available in 156 of survivors (79.2%). 76.9% had good neurologic state (PCPC 1-2) and 23.1% poor PCPC values (3-6). One year after cardiac arrest we could obtain data from 144 patients (28.6%). PCPC was available in 116 patients. 88 (75.9%) had a good neurologic evaluation and 28 (24.1%) a poor one. A neurological deterioration evaluated by PCPC scale was observed in 40 patients (7.9%). One year after cardiac arrest PCPC scores compared to hospital discharge had worsen in 7 patients (6%), remained constant in 103 patients (88.8%) and had improved in 6 patients (5.2%). Survival one year after cardiac arrest in children after in-hospital cardiac arrest is high. Neurologic outcome of these children a year after cardiac arrest is mostly the same as after hospital discharge. The factors associated with a worst long-term neurological outcome are the etiology of arrest being a traumatic or neurologic illness, and the persistency of higher lactic acid values 24h after ROSC. A standardised basic protocol even practicable for lower developed countries would be a first step for the new multicenter studies. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Long-term Operational Experience with the Barrel CRID at SLD

    SciTech Connect

    Va'Vra, Jaroslav

    1999-05-20

    The Barrel CRID detector has been operating successfully at SLD for the past seven years. It is an important tool for SLD physics analyses. The long-term operational experience with this device is described.

  18. Valve surgery in octogenarians: In-hospital and long-term outcomes

    PubMed Central

    Bossone, Eduardo; Di Benedetto, Giuseppe; Frigiola, Alessandro; Carbone, Giannignazio Luigi; Panza, Antonello; Cirri, Silvia; Ballotta, Andrea; Messina, Stefano; Rega, Saverio; Citro, Rodolfo; Trimarchi, Santi; Fang, Jianming; Righini, Paolo; Distante, Alessandro; Eagle, Kim A; Mehta, Rajendra H

    2007-01-01

    BACKGROUND: Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. METHODS: Three hundred seven consecutive patients 80 years and older (60% female; mean age 83±2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). RESULTS: The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0±0.7 to 1.7±0.6; P<0.0001). CONCLUSIONS: Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients’ preoperative clinical status and increased comorbidity than the type of surgery per se. PMID:17347695

  19. The influence of hospital volume on long-term oncological outcome after rectal cancer surgery.

    PubMed

    Jonker, Frederik H W; Hagemans, Jan A W; Burger, Jacobus W A; Verhoef, Cornelis; Borstlap, Wernard A A; Tanis, Pieter J

    2017-09-07

    The association between hospital volume and outcome in rectal cancer surgery is still subject of debate. The purpose of this study was to assess the impact of hospital volume on outcomes of rectal cancer surgery in the Netherlands in 2011. In this collaborative research with a cross-sectional study design, patients who underwent rectal cancer resection in 71 Dutch hospitals in 2011 were included. Annual hospital volume was stratified as low (< 20), medium (20-50), and high (≥ 50). Of 2095 patients, 258 patients (12.3%) were treated in 23 low-volume hospitals, 1329 (63.4%) in 40 medium-volume hospitals, and 508 (24.2%) in 8 high-volume hospitals. Median length of follow-up was 41 months. Clinical tumor stage, neoadjuvant therapy, extended resections, circumferential resection margin (CRM) positivity, and 30-day or in-hospital mortality did not differ significantly between volume groups. Significantly, more laparoscopic procedures were performed in low-volume hospitals, and more diverting stomas in high-volume hospitals. Three-year disease-free survival for low-, medium-, and high-volume hospitals was 75.0, 74.8, and 76.8% (p = 0.682). Corresponding 3-year overall survival rates were 75.9, 79.1, and 80.3% (p = 0.344). In multivariate analysis, hospital volume was not associated with long-term risk of mortality. No significant impact of hospital volume on rectal cancer surgery outcome could be observed among 71 Dutch hospitals after implementation of a national audit, with the majority of patients being treated at medium-volume hospitals.

  20. A long-term frequency stabilized deep ultraviolet laser for Mg+ ions trapping experiments

    NASA Astrophysics Data System (ADS)

    Zhang, J.; Yuan, W. H.; Deng, K.; Deng, A.; Xu, Z. T.; Qin, C. B.; Lu, Z. H.; Luo, J.

    2013-12-01

    As many precision laser spectroscopy experiments require frequency stabilized lasers, development of long-term stabilized lasers is of great interest. In this work, we report long-term frequency stabilization of a 280 nm deep ultraviolet laser to a high precision wavemeter with digital servo control such that the long-term drift of the laser frequency was greatly reduced. Long-term laser frequency drift was measured with a fiber frequency comb system over 8 h. After locking, the maximum drift rate of the 280 nm laser was lowered from 576 MHz/h to 6.4 MHz/h. With proper environment control of the wavemeter, the maximum drift rate of the 280 nm laser was further lowered to less than 480 kHz/h. The locked laser system was successfully used in a Mg+ ions trapping experiment, which was also discussed in this work.

  1. Initial and Long-Term Costs of Patients Hospitalized with West Nile Virus Disease

    PubMed Central

    Staples, J. Erin; Shankar, Manjunath B.; Sejvar, James J.; Meltzer, Martin I.; Fischer, Marc

    2014-01-01

    There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385–$283,381) and encephalitis (median $20,105; range $3,965–$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624–$439,945) and meningitis (median $10,556; range $0–$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million–$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease. PMID:24515937

  2. Initial and long-term costs of patients hospitalized with West Nile virus disease.

    PubMed

    Staples, J Erin; Shankar, Manjunath B; Sejvar, James J; Meltzer, Martin I; Fischer, Marc

    2014-03-01

    There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385-$283,381) and encephalitis (median $20,105; range $3,965-$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624-$439,945) and meningitis (median $10,556; range $0-$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million-$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease.

  3. Variation in long-term antipsychotic polypharmacy and high-dose prescribing across physicians and hospitals.

    PubMed

    Latimer, Eric A; Naidu, Adonia; Moodie, Erica E M; Clark, Robin E; Malla, Ashok K; Tamblyn, Robyn; Wynant, Willy

    2014-10-01

    This study had two aims: to measure the prevalence of long-term prescribing of high doses of antipsychotics and antipsychotic polypharmacy in a large Canadian province and to estimate the relative contributions of patient-, physician-, and hospital-level factors. Government hospital discharge, physician, and pharmaceutical claims data were linked to identify individuals with schizophrenia who in 2004 had antipsychotics available to them for at least 11 months. Individuals on a high dose throughout that period, as well as individuals on multiple concurrent antipsychotics (polypharmacy), were identified. Logistic and generalized linear mixed models using patient-, physician-, and hospital-level predictors were estimated. Among the 12,150 individuals identified, 11.9% were on a high dose and 10.4% on antipsychotic polypharmacy continually, with 3.7% in both groups. After adjustment for potential confounders, analyses showed that systematic propensity for physicians to prescribe high doses accounted for 10.9% of the remaining unexplained variance, and physicians as a group who prescribed high doses across a hospital or psychiatry department accounted for 3.0%. For antipsychotic polypharmacy the corresponding percentages were 9.7% and 6.2%. Even after adjustment, the variation in high-dose prescribing and antipsychotic polypharmacy remained substantial. Long-term high-dose and antipsychotic polypharmacy prescribing appeared partly driven by some physicians' and some hospitals' propensities to prescribe in this way independently of patient characteristics. Given the weight of the evidence against high-dose prescribing and antipsychotic polypharmacy, measures addressed to physicians and hospitals most likely to prescribe high doses, antipsychotic polypharmacy, or both should be considered.

  4. Long-term effects of earthquake experience of young persons on cardiovascular disease risk factors

    PubMed Central

    Li, Na; Wang, Yumei; Yu, Lulu; Song, Mei; Wang, Lan; Ji, Chunpeng

    2016-01-01

    Introduction The aim of the study was to study the long-term effect on cardiovascular disease risk factors of stress from direct experience of an earthquake as a young person. Material and methods We selected workers born between July 1, 1958 and July 1, 1976 who were examined at Kailuan General Hospital between May and October of 2013. Data on cardiovascular events were taken during the workers’ annual health examination conducted between 2006 and 2007. All subjects were divided into three groups according to their experience of the Tangshan earthquake of July 28, 1976, as follows: control group; exposed group 1 and exposed group 2. We compared cardiovascular disease risk factors between the three groups as well as by gender and age. Results One thousand one hundred and ninety-six workers were included in the final statistical analysis. Among all subjects, resting heart rate (p = 0.003), total cholesterol (p < 0.001), and fasting blood glucose (p < 0.001) were significantly higher among those who experienced the earthquake compared with unexposed controls, but were unrelated to loss of relatives. No significant difference in triglyceride levels was observed between the three groups (p = 0.900). Further refinement showed that the effects were restricted to males 40 years of age or older at the time of analysis, but were due primarily to age at the time of earthquake exposure (p = 0.002, p < 0.001 and p = 0.002). Conclusions Earthquake experience in the early years of life has long-term effects on adult resting heart rate, total cholesterol, and fasting plasma glucose, especially among men. PMID:28144258

  5. Is Long-Term Structural Priming Affected by Patterns of Experience with Individual Verbs?

    ERIC Educational Resources Information Center

    Kaschak, Michael P.; Borreggine, Kristin L.

    2008-01-01

    Several recent papers have reported long-term structural priming effects in experiments where previous patterns of experience with the double object and prepositional object constructions are shown to affect later patterns of language production for those constructions. The experiments reported in this paper address the extent to which these…

  6. Is Long-Term Structural Priming Affected by Patterns of Experience with Individual Verbs?

    ERIC Educational Resources Information Center

    Kaschak, Michael P.; Borreggine, Kristin L.

    2008-01-01

    Several recent papers have reported long-term structural priming effects in experiments where previous patterns of experience with the double object and prepositional object constructions are shown to affect later patterns of language production for those constructions. The experiments reported in this paper address the extent to which these…

  7. Long-term effect of home telehealth services on preventable hospitalization use.

    PubMed

    Jia, Huanguang; Chuang, Ho-Chih; Wu, Samuel S; Wang, Xinping; Chumbler, Neale R

    2009-01-01

    In this study, we assessed the longitudinal effect of a Department of Veterans Affairs (VA) patient-centered Care Coordination Home Telehealth (CCHT) program on preventable hospitalization use by veterans with diabetes mellitus (DM) at four VA medical centers. We used a matched treatment-control design (n = 387 for both groups). All patients were followed for 4 years. We operationalized ambulatory care-sensitive conditions (ACSCs) by applying Agency for Healthcare Research and Quality criteria to VA inpatient databases to determine preventable hospitalization use. We used a generalized linear mixed model to estimate the adjusted effect of the CCHT program on preventable hospitalization use over time. During the initial 18 months of follow-up, CCHT enrollees were less likely to be admitted for a preventable hospitalization than their nonenrollee counterparts, and this difference diminished during the rest of the 4-year follow-up period. The VA CCHT program for DM patients reduced preventable hospitalizations. These findings are some of the first that have systematically examined the extent to which home telehealth programs have a long-term effect on preventable hospitalization use.

  8. Long-term exposure to traffic pollution and hospital admissions in London.

    PubMed

    Halonen, Jaana I; Blangiardo, Marta; Toledano, Mireille B; Fecht, Daniela; Gulliver, John; Anderson, H Ross; Beevers, Sean D; Dajnak, David; Kelly, Frank J; Tonne, Cathryn

    2016-01-01

    Evidence on the effects of long-term exposure to traffic pollution on health is inconsistent. In Greater London we examined associations between traffic pollution and emergency hospital admissions for cardio-respiratory diseases by applying linear and piecewise linear Poisson regression models in a small-area analysis. For both models the results for children and adults were close to unity. In the elderly, linear models found negative associations whereas piecewise models found non-linear associations characterized by positive risks in the lowest and negative risks in the highest exposure category. An increased risk was observed among those living in areas with the highest socioeconomic deprivation. Estimates were not affected by adjustment for traffic noise. The lack of convincing positive linear associations between primary traffic pollution and hospital admissions agrees with a number of other reports, but may reflect residual confounding. The relatively greater vulnerability of the most deprived populations has important implications for public health.

  9. Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.

    PubMed

    Geri, Guillaume; Fahrenbruch, Carol; Meischke, Hendrika; Painter, Ian; White, Lindsay; Rea, Thomas D; Weaver, Marcia R

    2017-06-01

    Bystander cardiopulmonary resuscitation (CPR) is associated with a greater likelihood of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA). However the long-term survival benefits in relationship to cost have not been well-studied. We evaluated bystander CPR, hospital-based costs, and long-term survival following OHCA in order to assess the potential cost-effectiveness of bystander CPR. We conducted a retrospective cohort study of consecutive EMS-treated OHCA patients >=12years who arrested prior to EMS arrival and outside a nursing facility between 2001 and 2010 in greater King County, WA. Utstein-style information was obtained from the EMS registry, including 5-year survival. Costs from the OHCA hospitalization were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Cost effectiveness was based on hospital costs divided by quality-adjusted life years (QALYs) for a 5-year follow-up window. Of the 4448 eligible patients, 18.5% (n=824) were discharged alive from hospital and 12.1% (n=539) were alive at 5 years. Five-year survival was higher in patients who received bystander CPR (14.3% vs. 8.7%, p<0.001) translating to an average 0.09 QALYs associated with bystander CPR. The average (SD) total cost of the initial acute care hospitalization was USD 19,961 (40,498) for all admitted patients and USD 75,175 (52,276) for patients alive at year 5. The incremental cost-effectiveness ratio associated with bystander CPR was USD 48,044 per QALY. Based on this population-based investigation, bystander CPR was positively associated with long-term survival and appears cost-effective. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Dental students' reflections about long-term care experiences through an existing model of oral health.

    PubMed

    Brondani, Mario; Pattanaporn, Komkham

    2017-09-01

    The aim of this study was to explore students' reflective thinking about long-term care experiences from the perspective of a model of oral health. A total of 186 reflections from 193 second-year undergraduate dental students enrolled between 2011/12 and 2014/15 at the University of British Columbia were explored qualitatively. Reflections had a word limit of 300, and students were asked to relate an existing model of oral health to their long-term care experiences. We have identified the main ideas via a thematic analysis related to the geriatric dentistry experience in long-term care. The thematic analysis revealed that students attempted to demystify their pre-conceived ideas about older people and long-term care facilities, to think outside the box, for example away from a typical dental office, and to consider caring for elderly people from an interprofessional lens. According to some students, not all domains from the existing model of oral health were directly relevant to their geriatric experience while other domains, including interprofessionalism and cognition, were missing. While some participants had a positive attitude towards caring for this cohort of the population, others did not take this educational activity as a constructive experience. The nature of most students' reflective thinking within a long-term care experience showed to be related to an existing model of oral health. This model can help to give meaning to the dental geriatric experience of an undergraduate curriculum. Such experience has been instrumental in overcoming potential misconceptions about long-term care and geriatric dentistry. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  11. Long-Term Care Nurse Residency Program: Evaluation of New Nurse Experiences and Lessons Learned.

    PubMed

    Salmond, Susan W; Cadmus, Edna; Black, Katherine Kuren; Bohnarczyk, Nancy; Hassler, Linda

    2017-10-01

    Transitioning to long-term care environments presents a significant challenge for new nurses and their directors of nursing. The complexity of this environment, instability of the workforce, and the lack of support structures frequently affect a new nurse's decision not to apply to long-term care, but to look for positions in acute care hospitals. To address these issues, a long-term care new nurse residency program was developed, implemented, and evaluated in New Jersey through the work of the New Jersey Action Coalition. The purpose of this study was to determine the effects of the residency program on new nurses' confidence, competence, retention, job satisfaction, and perceptions of organizational safety. J Contin Educ Nurs. 2017;48(10):474-484. Copyright 2017, SLACK Incorporated.

  12. Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy.

    PubMed

    Olsen, Morten; Thygesen, Sandra K; Østergaard, John R; Nielsen, Henrik; Henderson, Victor W; Ehrenstein, Vera; Nørgaard, Mette; Sørensen, Henrik Toft

    2015-11-03

    Pertussis is associated with encephalopathy and seizures in infants. However, the risk of childhood epilepsy following pertussis is unknown. To examine whether pertussis is associated with the long-term risk of epilepsy. We used individually linked data from population-based medical registries covering all Danish hospitals to identify a cohort of all patients with pertussis born between 1978 and 2011, followed up through 2011. We used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth. Inpatient or hospital-based outpatient diagnosis of pertussis. Cumulative incidence and hazard ratio of time to hospital-based epilepsy diagnosis (pertussis cohort vs general population cohort), adjusted for birth year, sex, maternal history of epilepsy, presence of congenital malformations, and gestational age. Unique personal identifiers permitted unambiguous data linkage and complete follow-up for death, emigration, and hospital contacts. We identified 4700 patients with pertussis (48% male), of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 years was 1.7% (95% CI, 1.4%-2.1%) for patients with pertussis and 0.9% (95% CI, 0.8%-1.0%) for the matched comparison cohort. The corresponding adjusted overall hazard ratio was 1.7 (95% CI, 1.3-2.1). In Denmark, risk of epilepsy was increased in children with hospital-diagnosed pertussis infections compared with the general population; however, the absolute risk was low.

  13. Does Access Equal Retention? The Experiences of Long-Term English Learners in Higher Education

    ERIC Educational Resources Information Center

    Wonder, Kelly

    2011-01-01

    Through this longitudinal, phenomenological study, I examined the experiences of (H)Mong Long Term English Learners (LTEL) conditionally admitted to Midwest State University through the English for Academic Success Program (EAP). Over the course of six years, I interviewed participants regarding their academic and social experiences during…

  14. Effect of organisational change type and frequency on long-term sickness absence in hospitals.

    PubMed

    Bernstrøm, Vilde H; Kjekshus, Lars Erik

    2015-09-01

    The present study was conducted to investigate how the frequency of structural change and patient care-related change is related to employees' long-term sickness absence. Although a growing body of research is investigating the potentially harmful effects of organisational change on employee health, most studies have focused on single episodes of organisational change and do not differentiate among the types and frequencies of change. National registry data were collected from 2005 and 2007. A total of 34 712 health professionals from 56 hospitals were included (76% nurses, 18% physicians and 6% other health professionals) and the data were analysed using multilevel logistic regression. The research findings reveal a significantly higher probability of long-term sickness absence among employees who experienced more frequent structural changes (OR = 1.03; CI: 1.00-1.06; P < 0.05), but not among employees who experienced more frequent patient care-related changes. A higher frequency of organisational change may lead to more sickness-related absence among employees, with the effect depending on the type of change. These findings highlight the need for managers who are contemplating or are in the process of implementing organisational change to become more aware of the potentially harmful effects of frequent organisational change on employee health. © 2014 John Wiley & Sons Ltd.

  15. Seeking connection: family care experiences following long-term dementia care placement.

    PubMed

    Bramble, Marguerite; Moyle, Wendy; McAllister, Margaret

    2009-11-01

    To outline the experiences of family caregivers in Brisbane, Australia who have placed a relative with dementia into long-term care. Whilst the aged care literature in Australia highlights the rising numbers of people with dementia admitted to long-term care, empirical research exploring family and staff relationships and their influence on quality of care remains limited. International research demonstrates that the transition to long-term care is stressful for families and the person with dementia, often resulting in ongoing family and staff conflict. The study utilised a descriptive qualitative design. A purposive sample of 10 participants from a large study that tested an education intervention took part in the qualitative phase of this mixed method, sequential design study. Semi-structured interviews and confirmatory thematic analysis were used to identify family caregiver experiences following placement of their relative in long-term care. The findings emphasise the increasing isolation and burden of care felt by families prior to admission, which often is perpetuated during long-term care placement and may present as dissatisfaction with care. Improving staff-family relationships has the potential to reduce conflict and to improve the long-term care environment, relieve the pressure of work overload, decrease staff frustration and reduce negative reactions to family caregivers. The findings highlight the crucial need for long-term care facilities to support families, as well as the person with dementia, through the transition to the care environment. The resulting improved family relationships with staff, based on negotiation and increasing knowledge of dementia care, can then provide potential to develop more specialised evidence-based dementia care and service delivery.

  16. Long term experience with the “industrial” 3He vapour-pressure thermometer

    NASA Astrophysics Data System (ADS)

    Benda, V.; Vafeiadis, T.

    2017-02-01

    On the basis of very good experience with a prototype of a 3He vapour-pressure thermometer installed in the magnet feed box (MFB – prototype of LHC magnet test bench), an upgraded version of this thermometer was developed with emphasis on the improvement of its long term stability, reliability and “series” production. The thermometer is working typically around 1.9 K. This article summarises the key points of the prototype design, its upgrade leading to the “industrial/series” realization, the long term experience and the calibration crosscheck of these thermometers after 15 years of operation.

  17. Long-term obesity and avoidable hospitalization among younger, middle-aged, and older adults.

    PubMed

    Schafer, Markus H; Ferraro, Kenneth F

    2007-11-12

    Avoidable hospitalizations are considered to result from conditions that are preventable with timely and effective ambulatory care. We examined whether obesity, particularly long-term obesity, is associated with risk for and frequency of avoidable hospital stays. Data were drawn from the First National Health and Nutrition Examination Survey Epidemiological Follow-up Survey, a 20-year study of adults aged 25 to 74 years (N = 6833). Using measures of body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) at baseline and at 25 years of age, we estimated the effect of obesity (BMI > or =30.0) on avoidable hospitalization risk using Cox proportional hazards models, and we estimated its influence on the rate of avoidable stays per year using interval regression models. All multivariate analyses were adjusted for morbidity and other covariates. One thousand twenty-three subjects experienced a hospitalization considered avoidable. Compared with normal-weight subjects, the adjusted hazard ratio of an avoidable stay among obese subjects was 1.82 (95% confidence interval [CI], 1.31-2.51) for those aged 25 to 44 years, 1.29 (95% CI, 1.05-1.59) for those aged 45 to 64 years, and 1.46 (95% CI, 1.23-1.74) for those 65 years and older. Among participants aged 45 to 64 years at baseline, obesity at 25 years of age was strongly associated with both the risk (hazard ratio, 1.91; 95% CI, 1.59-2.29) and frequency (beta coefficient, 0.057; SE, 0.018) of avoidable stays when accounting for baseline BMI category and additional covariates. For subjects 65 years and older, obesity at 25 years of age was associated with increased risk of avoidable hospitalization (hazard ratio, 1.87; 95% CI, 1.14-3.08) and with increased frequency of such admissions (beta coefficient, 0.138; SE, 0.038). As indicated by its association with avoidable hospitalizations, long-term obesity is a substantial risk for complications in medical care. Interventions should target

  18. 42 CFR 412.526 - Payment provisions for a “subclause (II)” long-term care hospital.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... care hospital. 412.526 Section 412.526 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.526 Payment provisions for a...

  19. Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

    PubMed Central

    Abe, Keiichi; Yamashita, Ryuko; Kondo, Keiko; Takayama, Keiko; Yokota, Osamu; Sato, Yoshiki; Kawai, Mitsumasa; Ishizu, Hideki; Nakashima, Tadao; Hayashi, Hideki; Nakata, Kenji; Asaba, Hiroyuki; Kadota, Koichi; Tanaka, Kazuyoshi; Morisada, Yumi; Oshima, Etsuko; Terada, Seishi

    2016-01-01

    Background/Aims Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival. PMID:27843445

  20. Effect of Long-Term Proton Pump Inhibitor Therapy on Nutritional Status in Elderly Hospitalized Patients.

    PubMed

    Nakamichi, Mariko; Wakabayashi, Hidetaka

    2016-01-01

    The purpose was to investigate the association between proton pump inhibitor (PPI) therapy and nutritional status in elderly hospitalized patients. Participants were 190 elderly patients admitted to the long-term care wards, convalescence rehabilitation wards, and community integrated care wards in January 2015. Nutritional status was assessed using the mini nutritional assessment short-form (MNA-SF). The PPI use group was compared with the PPI non-use group regarding nutrition status. Logistic regression analysis was used to examine whether the period of PPI therapy was associated independently with malnutrition following adjustment for covariates including gender, age, and serum albumin level. Forty-one patients were male (22%) and 149 patients were female (78%), with a mean age of 85.4±8.4. Fifty-three patients (28%) took PPIs (with a median prescription period of 91 d, ranging from 51 to 227). With a MNA-SF score of 7 points or lower designated as malnutrition, there was no significant difference in nutritional status between the PPI and non-PPI groups (p=0.172). The median MNA-SF scores in the PPI and non-PPI groups were 9 vs 7 points, respectively. Logistic regression analysis showed that long-term PPI therapy (odds ratio, 0.994; 95% confidence interval 0.990-0.999) was significantly associated with improved nutritional status. The presence or absence of PPI therapy is not associated with malnutrition in elderly hospitalized patients. Longer-term PPI therapy may improve nutritional status.

  1. Long-term Ecosystem Experiments, Data Assimilation, and Meta-Analysis

    NASA Astrophysics Data System (ADS)

    Hungate, B. A.; Van Groenigen, K. J.; Osenberg, C. W.; van Gestel, N.

    2015-12-01

    Land ecosystems affect climate and the atmosphere, and climate and atmospheric change affects ecosystems. Syntheses of ecosystem experiments investigating their responses to environmental change holds promise for understanding how to model these interactions, and thereby gain insight into Earth's future biosphere, atmosphere, and climate. Long-term experiments examining ecosystem responses are thought to be especially important in this effort, for their potential to reveal cumulative and progressive effects, subtle effects initially undetectable experimentally, but manifest more clearly over time, often with stronger implications for modeled responses than the more dramatic, short-term experimental responses. Here, we present new analyses of long-term experiments manipulating temperature, CO2 concentration, and precipitation, testing the general hypothesis that there are common temporal patterns of responses that reveal general biogeochemical characterizing ecosystem responses to these environmental changes. For example, we show that increased carbon input with elevated CO2 stimulates emissions of nitrous oxide and methane, important greenhouse gases, and that effects show no signs of diminishing over the duration of experiments that have documented responses. At the same time, we show that the temporal resolution for this response is limited, pointing to a potential limitation in the ability of experiments to address clearly long-term hypotheses. We also show that warming tends to have limited cumulative effects on total soil carbon stocks in long-term experiments, and explore the mechanisms underlying this response. Finally, we discuss the implications of these findings for models used to simulate long-term ecosystem responses to these environmental forcings, as well as the implications of these findings for the next generation of terrestrial ecosystem experiments.

  2. Space Life Sciences Research: The Importance of Long-Term Space Experiments

    NASA Technical Reports Server (NTRS)

    1993-01-01

    This report focuses on the scientific importance of long-term space experiments for the advancement of biological science and the benefit of humankind. It includes a collection of papers that explore the scientific potential provided by the capability to manipulate organisms by removing a force that has been instrumental in the evolution and development of all organisms. Further, it provides the scientific justification for why the long-term space exposure that can be provided by a space station is essential to conduct significant research.

  3. The performance of the Barrel CRID at the SLD: Long-term operational experience

    SciTech Connect

    Abe, K.; Ashford, V.; Aston, D.

    1997-11-01

    The Barrel CRID detector has been operating successfully at SLD for the past 7 years. It is an important tool for SLD physics analyses. The authors report results based on long term operational experience of a number of important quantities such as the Cherenkov quality factor, N{sub o}, of the device, fluid transparency, electron lifetime, single electron detection efficiency, anode wire aging, TMAE purity, long term stability of the gas refraction index, liquid radiator transparency, Cherenkov angle resolution and the number of photoelectrons observed per ring.

  4. Long-term experiments on log decomposition at the H.J. Andrews Experimental Forest.

    Treesearch

    M.E. Harmon

    1992-01-01

    A long-term decomposition experiment was established at the H.J. Andrews Experimental Forest, Oregon, during 1985to test the importance of substrate heterogeneity, colonization patterns, and invertebrates on the decomposition of logs. The duration of the study is anticipated to be 200 years. A total of 530 logs (50 centimeters in diameter and 5.5 meters long) were...

  5. PERFORMANCE OF ORGANIC GRAIN CROPPING SYSTEMS IN LONG-TERM EXPERIMENTS

    USDA-ARS?s Scientific Manuscript database

    Organic farming and conventional no-tillage farming systems share many of the same benefits from protecting and improving soils. A review of recent results from long-term systems experiments in the mid-Atlantic region of the U.S.A. demonstrates that organic cropping systems with organic amendments ...

  6. Trajectories, Long-Term Outcomes and Family Experiences of 76 Adults with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Chamak, Brigitte; Bonniau, Béatrice

    2016-01-01

    The aim of this retrospective study was to retrace the trajectories and long-term outcomes of individuals with autism in France, and to explore the family experiences. Data obtained from parents enables us to follow the trajectories of 76 adults. Two-thirds of adults with severe autism had a very poor outcome. Those with moderate autism had a…

  7. Engineering and agronomy aspects of a long-term precision agriculture field experiment

    USDA-ARS?s Scientific Manuscript database

    Much research has been conducted on specific precision agriculture tools and implementation strategies, but little has been reported on long-term evaluation of integrated precision agriculture field experiments. In 2004 our research team developed and initiated a multi-faceted “precision agriculture...

  8. Sustaining School Colleagues' Commitment to a Long-Term Professional Experience Partnership

    ERIC Educational Resources Information Center

    Peters, Judith

    2011-01-01

    This paper presents findings from a qualitative study that investigated school participants' perceptions of the benefits, challenges and supportive factors related to their involvement in a long-term school/university professional experience partnership. Data were collected through interviews with coordinators and a written survey completed by…

  9. A Mathematician Learns the Basics of Writing Instruction: An Immersion Experience with Long-Term Benefits

    ERIC Educational Resources Information Center

    Doty, Lynne L.

    2012-01-01

    Initially designed to be an interdisciplinary experiment that would change attitudes about mathematics, the semester-long collaboration between a writing instructor and a mathematics instructor yielded unexpected long-term results. The collaboration served as an immersion in methods and techniques used by writing instructors. Description of…

  10. Long-Term Research Does Pay Off - A Summary of the Southern Station Experience

    Treesearch

    Margaret S. Devall; Virgil C. Baldwin; [Compilers

    1998-01-01

    Descriptions and summaries of completed and ongoing long-term research studies (those in existence for 5 or more years) conducted by scientists of the USDA Forest Service's former Southern Forest Experiment Station (now part of the Southern Research Station) are presented in this report. The array of data bases at the Southern Station includes forest surveys,...

  11. Trajectories, Long-Term Outcomes and Family Experiences of 76 Adults with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Chamak, Brigitte; Bonniau, Béatrice

    2016-01-01

    The aim of this retrospective study was to retrace the trajectories and long-term outcomes of individuals with autism in France, and to explore the family experiences. Data obtained from parents enables us to follow the trajectories of 76 adults. Two-thirds of adults with severe autism had a very poor outcome. Those with moderate autism had a…

  12. Nitrogen fertilization decreases forest soil fungal and bacterial biomass in three long-term experiments

    Treesearch

    Matthew D. Wallenstein; Steven McNulty; Ivan J. Fernandez; Johnny Boggs; William H. Schlesinger

    2006-01-01

    We examined the effects of N fertilization on forest soil fungal and bacterial biomass at three long-term experiments in New England (Harvard Forest, MA; Mt. Ascutney, VT; Bear Brook, ME). At Harvard Forest, chronic N fertilization has decreased organic soil microbial biomass C (MBC) by an average of 54% and substrate induced respiration (SIR) was decreased by an...

  13. Long-Term Career Impact and Professional Applicability of the Study Abroad Experience

    ERIC Educational Resources Information Center

    Franklin, Kimberly

    2010-01-01

    Research shows that study abroad experience affects professional qualifications. It is evident that employers value the skills and knowledge potentially gained from study abroad and that these competencies are transferable on the job. Nearly all known research lacks a longitudinal component. Of the few studies that focus on long-term outcomes,…

  14. Experiences of participation in occupations of women on long-term sick leave.

    PubMed

    Johansson, Christina; Isaksson, Gunilla

    2011-12-01

    The majority of individuals on long-term sick leave experience negative effects in their lives associated with limitations on their participation, decreased income, and feelings of guilt. The aim was to describe the experiences that women on long-term sick leave have of participation in occupation. Unstructured interviews were used for the data collection, which involved eight women; a grounded theory approach was used. The results showed that the women's long-term sick leave changed their roles, daily habits, and routines, and their participation in occupations was negatively influenced. Their occupational performance also diminished, thereby having a negative influence on their social relationships. However, over time they came to find different strategies that contributed to a feeling of occupational competence and thence they started to rebuild their occupational identity. Through this began the process of occupational adaptation, which resulted in an increased experience of participating in occupation. As a conclusion, it should be noted that occupational therapy interventions should be directed at women on long-term sick leave at an early stage in the rehabilitation process to address the adaptation of their roles, habits, routines, and social environment.

  15. Optimizing laboratory test utilization in long-term acute care hospitals

    PubMed Central

    Krug, Brian S.; Grigonis, Antony M.; Dawson, Amanda; Jing, Yuqing; Hammerman, Samuel I.

    2017-01-01

    Laboratory tests can be considered inappropriate if overused or when repeated, unnecessary “routine” testing occurs. For chronically critically ill patients treated in long-term acute care hospitals (LTACHs), inappropriate testing may result in unnecessary blood draws that could potentially harm patients or increase infections. A quality improvement initiative was designed to increase physician awareness of their patterns of lab utilization in the LTACH environment. Within a large network of LTACHs, 9 hospitals were identified as having higher patterns of lab utilization than other LTACHs. Meetings were held with administrative staff and physicians, who designed and implemented hospital-specific strategies to address lab utilization. Lab utilization was measured in units of lab tests ordered per inpatient day (lab UPPD) for 8 months prior to the initial meeting and 7 months after the meeting. A repeated measures mixed model determined that postintervention lab utilization improved, on average and adjusted by case mix index, by 0.37 lab UPPD (t = −3.61, 95% CI 0.17 to 0.58) compared to the preintervention period. Overall, the case mix index 8 months prior to the intervention was no different than it was 7 months after the initial meeting (t[8] = −0.96, P = 0.37). Patient safety and outcome measures, including percentage of patients weaned from a ventilator, readmission rates, central catheter utilization rates, and the incidence of methicillin-resistant Staphylococcus aureus and other multidrug resistant organisms, showed no significant change. Hospital staff meetings focused on lab utilization and the development and deployment of tailored lab utilization strategies were associated with LTACHs achieving significantly lower lab utilization without negatively impacting quality outcomes. PMID:28127124

  16. Long-term mortality of hospitalized pneumonia in the EPIC-Norfolk cohort.

    PubMed

    Myint, P K; Hawkins, K R; Clark, A B; Luben, R N; Wareham, N J; Khaw, K-T; Wilson, A M

    2016-03-01

    Little is known about cause-specific long-term mortality beyond 30 days in pneumonia. We aimed to compare the mortality of patients with hospitalized pneumonia compared to age- and sex-matched controls beyond 30 days. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study. Hospitalized pneumonia cases were identified from record linkage (ICD-10: J12-J18). For this study we excluded people with hospitalized pneumonia who died within 30 days. Each case identified was matched to four controls and followed up until the end June 2012 (total 15 074 person-years, mean 6·1 years, range 0·08-15·2 years). Cox regression models were constructed to examine the all-cause, respiratory and cardiovascular mortality using date of pneumonia onset as baseline with binary pneumonia status as exposure. A total of 2465 men and women (503 cases, 1962 controls) [mean age (s.d.) 64·5 (8·3) years] were included in the study. Between a 30-day to 1-year period, hazard ratios (HRs) of all-cause and cardiovascular mortality were 7·3 [95% confidence interval (CI) 5·4-9·9] and 5·9 (95% CI 3·5-9·7), respectively (with very few respiratory deaths within the same period) in cases compared to controls after adjusting for age, sex, asthma, smoking status, pack years, systolic and diastolic blood pressure, diabetes, physical activity, waist-to-hip ratio, prevalent cardiovascular and respiratory diseases. All outcomes assessed also showed increased risk of death in cases compared to controls after 1 year; respiratory cause of death being the most significant during that period (HR 16·4, 95% CI 8·9-30·1). Hospitalized pneumonia was associated with increased all-cause and specific-cause mortality beyond 30 days.

  17. Long-term care provision, hospital bed blocking, and discharge destination for hip fracture and stroke patients.

    PubMed

    Gaughan, James; Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

    2017-02-28

    We examine the relationship between long-term care supply (care home beds and prices) and (i) the probability of being discharged to a care home and (ii) length of stay in hospital for patients admitted to hospital for hip fracture or stroke. Using patient level data from all English hospitals and allowing for a rich set of demographic and clinical factors, we find no association between discharge destination and long-term care beds supply or prices. We do, however, find evidence of bed blocking: hospital length of stay for hip fracture patients discharged to a care home is shorter in areas with more long-term care beds and lower prices. Length of stay is over 30% shorter in areas in the highest quintile of care home beds supply compared to those in the lowest quintile.

  18. INTERCAL: long-term inter-comparison experiment for dose rate and spectrometric probes.

    PubMed

    Bleher, M; Doll, H; Harms, W; Stöhlker, U

    2014-08-01

    The Schauinsland inter-calibration facility (INTERCAL) has been designed to enable long-term comparison experiments for 20 different dose rate probes from different networks. Two reference probes characterised by the European Radiation Dosimetry WG3 inter-calibration experiments in 2008 and 2009 have been installed at the INTERCAL facility. Additional instrumentation provides measured data of activity in air and nuclide-specific dose rate as well as environmental parameters such as air pressure, temperature, precipitation and soil moisture. Complementary to WG3 experiments, the INTERCAL platform is an ideal framework to investigate the long-term behaviour of dose rate probes and different spectrometry systems under environmental conditions. Two additional exposure experiments were performed in April 2009 and in May 2012.

  19. The Canadian experience with long-term deflazacort treatment in Duchenne muscular dystrophy.

    PubMed

    McAdam, Laura C; Mayo, Amanda L; Alman, Benjamin A; Biggar, W Douglas

    2012-05-01

    Deflazacort is the most commonly prescribed corticosteroid for the treatment of Duchenne muscular dystrophy in Canada. We review the long-term experience with deflazacort treatment at two centers in Canada; Montreal and Toronto. Deflazacort has benefitted both cohorts by prolonged ambulation, preserved cardiac and respiratory function, less scoliosis and improved survival. Common side effects in both cohorts include weight gain, decreased height and cataract formation. The Canadian experience supports the use of deflazacort in treating boys with Duchenne muscular dystrophy.

  20. Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit.

    PubMed

    Beaulac, Kirthana; Corcione, Silvia; Epstein, Lauren; Davidson, Lisa E; Doron, Shira

    2016-04-01

    OBJECTIVE To offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. METHODS We conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010-March 31, 2011; the postimplementation period was April 1, 2011-March 31, 2014. RESULTS During the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, -0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (-6.58 DDD/1,000 PD [95% CI, -11.48 to -1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (-2.97 DDD/1,000 PD per month [95% CI, -5.65 to -0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, -71.4 to -29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9-56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35-0.92]; P=.02). CONCLUSION Antimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.

  1. Nutritional risk is associated with long term mortality in hospitalized patients with chronic heart failure.

    PubMed

    Tevik, Kjerstin; Thürmer, Hanne; Husby, Marit Inderhaug; de Soysa, Ann Kristin; Helvik, Anne-Sofie

    2016-04-01

    Mortality among patients with chronic heart failure (CHF) is still high despite progress in medical and surgical treatment. The patients' nutritional condition may play an important role, and needs further investigation. The aim of this study was to evaluate whether nutritional risk in hospitalized patients with CHF was associated with three-year mortality. A prospective study was conducted in 131 hospitalized Norwegian patients with CHF. Nutritional screening was performed using Nutritional Risk Screening (NRS-2002). The primary clinical outcome was death from any cause. The prevalence of nutritional risk was 57% (NRS-2002 score ≥ 3). The overall mortality rate was 52.6% within three-year follow up. More patients at nutritional risk (N = 51) died compared to patients not at nutritional risk (N = 18) (P < 0.001). In adjusted analyses patients at nutritional risk had more than five-time higher odds (OR 5.85; 95% CI 2.10-16.24) to die before three-year follow-up than those not at nutritional risk. In adjusted Cox multivariate analysis, the nutritional risk was associated with increased mortality (HR 2.78; 95% CI 1.53-5.03). Furthermore, in adjusted analysis components in NRS-2002 were associated with mortality, i.e. nutritional status (HR 1.82; 95% CI 1.03-3.22), severity of disease (NYHA-class IV) (HR 1.78; 95% CI 1.00-3.16) and age (≥ 70 year) (HR 3.24; 95% CI 1.48-7.10). Nutritional risk as defined by NRS-2002 in hospitalized patients with CHF was significantly associated with long term mortality. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Australian men's long term experiences following prostatectomy: a qualitative descriptive study.

    PubMed

    O'Shaughnessy, Peter 'kevin'; Laws, Tom A

    The experiences of men in the immediate postoperative period following surgery for primary prostate cancer are well reported in the literature. Recognition of the unresolved morbidity encountered by men in the medium term suggests that a more complete understanding of how men cope in the long term is needed. Health professionals are deserving of a more complete literature for the purpose of providing holistic care for this group of men, providing informed advocacy and better support for men living with the diagnosis of prostate cancer. Emerging literature reveals that men's knowledge of the long term problems associated with prostatectomy was inadequate at the time they consented to treatment; the likely outcomes at all phases of recovery should be taken into account when deciding on choice of treatment or no treatment. This qualitative study aims to describe men's long term recovery following prostatectomy for the purpose identifying the effects of unresolved post surgical morbidity. The content analysis of focus group interviews revealed that incontinence and impotence were a major source of emotional tension affecting the men's social interactions and sense of self-worth. The men expressed great regret over the lack of information accessible to them for evaluating the risk and nature of long term problems. The thick description provided in this study identifies the need for empathetic assessment of men with ongoing post surgical issues and alerts the reader to the inadequacies of information provided prior to consent to prostatectomy.

  3. Estimating hydroxyl radical photochemical formation rates in natural waters during long-term laboratory irradiation experiments.

    PubMed

    Sun, Luni; Chen, Hongmei; Abdulla, Hussain A; Mopper, Kenneth

    2014-04-01

    In this study it was observed that, during long-term irradiations (>1 day) of natural waters, the methods for measuring hydroxyl radical (˙OH) formation rates based upon sequentially determined cumulative concentrations of photoproducts from probes significantly underestimate actual ˙OH formation rates. Performing a correction using the photodegradation rates of the probe products improves the ˙OH estimation for short term irradiations (<1 day), but not long term irradiations. Only the 'instantaneous' formation rates, which were obtained by adding probes to aliquots at each time point and irradiating these sub-samples for a short time (≤2 h), were found appropriate for accurately estimating ˙OH photochemical formation rates during long-term laboratory irradiation experiments. Our results also showed that in iron- and dissolved organic matter (DOM)-rich water samples, ˙OH appears to be mainly produced from the Fenton reaction initially, but subsequently from other sources possibly from DOM photoreactions. Pathways of ˙OH formation in long-term irradiations in relation to H2O2 and iron concentrations are discussed.

  4. Soil Organic Matter Dynamics in the Rothamsted Long-term Experiments

    NASA Astrophysics Data System (ADS)

    MacDonald, A.; Poulton, P.

    2009-04-01

    Soil science research at Rothamsted dates from 1843 when John Bennet Lawes and Joseph Henry Gilbert started the first of a series of what became long-term field experiments. The main object of these experiments was to examine the effect of inorganic and organic fertilisers and manures on crop yield and soil fertility. These "Classical Field Experiments" included studies on winter wheat (Broadbalk 1843), spring barley (Hoos Barley 1852) and permanent grassland (Park Grass 1856). Additional experiments were established in the 20th century to examine the value of ley-arable cropping, including the Highfield and Fosters Ley-arable experiments (1948) and the Woburn Ley-arable experiment (1938). More recently, the effects of incorporating organic manures and cereal straw have been examined. Early results quickly showed the benefits of inorganic N and P fertilisers on crop production, but the effects of contrasting land uses and management practices on soil properties emerged more slowly. Measurements of soil organic carbon (C) and nitrogen (N) in soils taken at intervals from the long-term experiments indicate that the rate of soil organic matter (SOM) accumulation is controlled largely by the balance between the rate of organic matter inputs and its oxidation rate, and that these are strongly influenced by land use and management, soil texture (especially clay content) and climate. A recent examination of soil organic C data from two long-term grassland experiments in the UK (including Park Grass) indicates that any changes observed in soil organic C under long-term grasslands over the past 40 years are more likely to be due to changes in land use and management rather than climate change. Data from the Rothamsted Long-term experiments have been used to develop and test biogeochemical models of C and N dynamics. In particular, the Roth-C model has successfully simulated soil C dynamics in the long-term experiments at Rothamsted and elsewhere. This model uses several

  5. Geological Disposal of Radioactive Waste: A Long-Term Socio-Technical Experiment.

    PubMed

    Schröder, Jantine

    2016-06-01

    In this article we investigate whether long-term radioactive waste management by means of geological disposal can be understood as a social experiment. Geological disposal is a rather particular technology in the way it deals with the analytical and ethical complexities implied by the idea of technological innovation as social experimentation, because it is presented as a technology that ultimately functions without human involvement. We argue that, even when the long term function of the 'social' is foreseen to be restricted to safeguarding the functioning of the 'technical', geological disposal is still a social experiment. In order to better understand this argument and explore how it could be addressed, we elaborate the idea of social experimentation with the notion of co-production and the analytical tools of delegation, prescription and network as developed by actor-network theory. In doing so we emphasize that geological disposal inherently involves relations between surface and subsurface, between humans and nonhumans, between the social, material and natural realm, and that these relations require recognition and further elaboration. In other words, we argue that geological disposal concurrently is a social and a technical experiment, or better, a long-term socio-technical experiment. We end with proposing the idea of 'actor-networking' as a sensitizing concept for future research into what geological disposal as a socio-technical experiment could look like.

  6. Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care

    PubMed Central

    2010-01-01

    Background This study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index®) Long-term Care, for measuring client experiences with long-term care in the Netherlands. Methods Three versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study. Results The pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation. Conclusions The CQ-index® Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance. PMID:20384989

  7. A national survey of the use of physical restraint in long-term care hospitals in Japan.

    PubMed

    Chiba, Yumi; Yamamoto-Mitani, Noriko; Kawasaki, Maki

    2012-05-01

    To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background.  Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. Cross-sectional mail survey. A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan. © 2012 Blackwell Publishing Ltd.

  8. Long-Term Outcomes of Group B Eyes in Patients with Retinoblastoma Treated with Short-Course Chemoreduction: Experience from Children's Hospital Los Angeles/University of Southern California

    PubMed Central

    Zhu, Dagny; Berry, Jesse L.; Ediriwickrema, Lilangi; Wong, Kenneth; Lee, Thomas C.; Murphree, A. Linn; Kim, Jonathan W.; Jubran, Rima

    2015-01-01

    Background/Aims Chemoreduction protocols for retinoblastoma vary widely across institutions. Herein, we compare a 3- versus 6-cycle chemotherapy approach for group B retinoblastoma. Methods A nonrandomized, retrospective review of patients diagnosed with group B retinoblastoma from 1991-2011 at Children's Hospital Los Angeles was performed. A total of 72 eyes of 63 patients were analyzed. Mean follow-up time was 82 months (range 6-272 months). Main outcome measures were globe salvage and need for external beam radiation. Results Forty-six patients (55 eyes) were treated upfront with 3 cycles of carboplatin, etoposide, and vincristine; 17 patients (17 eyes) received 6 cycles. Thirty-seven eyes (67%) in the 3-cycle group were cured with initial chemoreduction alone. An additional 10 eyes with persistent or recurrent tumors were rescued with 3 more cycles for a total salvage rate of 85% (47/55 eyes). In the 6-cycle group, 16 of 17 eyes (94%) avoided radiation and enucleation. Conclusion The initial recurrence rate was higher for the 3-cycle group (p = 0.03). However, eyes failing short-course chemoreduction were rescued with 3 additional cycles and achieved a similar overall event-free survival rate (p = 0.16). In our cohort, this short-course approach spared 63% (29/46) of patients with group B retinoblastoma the extra 3 cycles of systemic chemotherapy. PMID:27172535

  9. Long-Term Network Experiments and Interdisciplinary Campaigns Conducted by the USDA-Agricultural Research Service

    NASA Astrophysics Data System (ADS)

    Goodrich, D. C.; Kustas, W. P.; Cosh, M. H.; Moran, S. M.; Marks, D. G.; Jackson, T. J.; Bosch, D. D.; Rango, A.; Seyfried, M. S.; Scott, R. L.; Prueger, J. H.; Starks, P. J.; Walbridge, M. R.

    2014-12-01

    The USDA-Agricultural Research Service has led, or been integrally involved in, a myriad of interdisciplinary field campaigns in a wide range of locations both nationally and internationally. Many of the shorter campaigns were anchored over the existing national network of ARS Experimental Watersheds and Rangelands. These long-term outdoor laboratories provided a critical knowledge base for designing the campaigns as well as historical data, hydrologic and meteorological infrastructure coupled with shop, laboratory, and visiting scientist facilities. This strong outdoor laboratory base enabled cost-efficient campaigns informed by historical context, local knowledge, and detailed existing watershed characterization. These long-term experimental facilities have also enabled much longer term lower intensity experiments, observing and building an understanding of both seasonal and inter-annual biosphere-hydrosphere-atmosphere interactions across a wide range of conditions. A sampling of these experiments include MONSOON'90, SGP97, SGP99, Washita'92, Washita'94, SMEX02-05 and JORNEX series of experiments, SALSA, CLASIC and longer-term efforts over the ARS Little Washita, Walnut Gulch, Little River, Reynolds Creek, and OPE3 Experimental Watersheds. This presentation will review some of the highlights and key findings of these campaigns and long-term efforts including the inclusion of many of the experimental watersheds and ranges in the Long-Term Agro-ecosystems Research (LTAR) network. The LTAR network also contains several locations that are also part of other observational networks including the CZO, LTER, and NEON networks. Lessons learned will also be provided for scientists initiating their participation in large-scale, multi-site interdisciplinary science.

  10. Global change and soil functions - long-term experiments and alternative approaches

    NASA Astrophysics Data System (ADS)

    Gerzabek, M. H.

    2009-04-01

    Soils are practically a non-renewable resource and provide numerous functions for humans and the environment. Both managed and natural soils are under constant development. Soil use changes, however, have the most considerable impact on soil properties. Changes of the nutrient status and productivity were already in the focus of long-term experiments since the middle of the 19th century. From them we learned that equilibrium conditions after management changes in many cases need more than 150 years to be reached. Today, humus dynamics and the impact of soil management on greenhouse gas emission and trapping have gained considerable importance. Investigations in Austria have shown that carbon stocks on average differ by a factor of two between arable land and extensive pasture. Soil tillage regimes and mineral and organic fertilization have additional impacts on humus stocks and dynamics. The long-term changes in humus contents influence different soil functions. Enzyme activities e.g. increase with increasing soil organic matter contents, as does the aggregate stability, just as an example for several physical soil functions. The retention of heavy metals and organic pollutants is heavily influenced by long-term changes of soil organic matter. A variability of a factor of 3 to 5 was observed in long-term experiments in Sweden and Austria. Another aspect is the long-term development of soils and their properties and especially their impact on ecological soil functions. Soil development leads to significant alterations of soil properties, especially accumulation of soil organic matter (SOM), weathering and secondary soil minerals and influence nutrient dynamics and contaminant retention. Soil development itself is distinctly altered by soil use and management resulting e.g. in different SOM accumulation patterns. Such investigations call for additional methodological approaches as e.g. chronosequence and climosequence approaches, which will be exemplified by studies

  11. Long-term effects of traumatic experience: Comparison study in the adolescent IDPs in Serbia.

    PubMed

    Matsunaga, Chieko; Ristic, Dragana; Niregi, Mitsuki

    2006-12-01

    The purpose of this study is to examine the long term psychological effects of war stress regarded as traumatic experience. The subjects are Serbian internally displaced people (IDP) of adolescent population from Kosovo. It is a very big concern whether the adolescents would overcome the social and psychological difficulties caused by the war stress in order to reconstruct the better society. The result came out that the long-term effects still exist in PTSD, depression and hopelessness, which affects self-esteem and the attitude in purpose in life that are important factors for personality development. This paper also examines the difference between IDPs with war stress and the adolescent sufferers of the big earthquake in Japan.

  12. Experiences of care planning in England: interviews with patients with long term conditions

    PubMed Central

    2012-01-01

    Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups. PMID:22831570

  13. Unplanned transfers following admission to a long-term acute care hospital: a quality issue.

    PubMed

    White, Alexander C; Joseph, Bernard; Perrotta, Barbara A; Grandfield, Joanne; Muraldihar, Nina; O'Connor, Heidi H; Hendra, Katherine

    2011-01-01

    The unplanned transfer of patients from long-term acute care hospitals (LTACHs) back to acute facilities disrupts the continuity of care, delays recovery and increases the cost of care. This study was performed to better understand the unplanned transfer of patients with pulmonary disease. A retrospective analysis of data obtained for quality management in a cohort of patients admitted to an LTACH system over a 3-year period. Of the 3506 patients admitted with a pulmonary diagnosis studied, 414 (12%) underwent 526 unplanned transfers back to an acute facility after a median LTACH length of stay (LOS) of 45 days. Mechanical ventilation via tracheostomy was used in 259 (63%) patients admitted to the LTACH with a pulmonary diagnosis. The commonest reasons for unplanned transfers included acute respiratory failure, cardiac decompensation, gastrointestinal bleed and possible sepsis. Over 50% of patients had LOS at the LTACH between 4 and 30 days prior to the unplanned transfer. Patients with an LOS <3 days prior to transfer were more likely to be transferred around the weekend. In all, 32% of patients died within a median of 7 days of transfer back to the acute facility. Thirty-day mortality following unplanned transfer appeared independent of organ system involved, attending physician specialty/coverage status, nursing shift or transferring LTACH unit. Unplanned transfers disrupting continuity of care remain a significant problem in patients admitted to an LTACH with a pulmonary diagnosis and are associated with significant mortality. Strategies designed to reduce cardiopulmonary decompensation, gastrointestinal bleeding and possible sepsis in the LTACH along with additional strategies implemented throughout the health care continuum will be needed to reduce this problem.

  14. Incidence and long-term outcomes of toxic anterior segment syndrome at Aravind Eye Hospital.

    PubMed

    Sengupta, Sabyasachi; Chang, David F; Gandhi, Rajiv; Kenia, Hemal; Venkatesh, Rengaraj

    2011-09-01

    To determine the incidence and long-term outcomes of toxic anterior segment syndrome (TASS) at a single institution. Aravind Eye Hospital, Pondicherry, India. Case series. The records of all eyes developing TASS during a 1-year period after cataract surgery were retrospectively reviewed. Clinical outcomes, including corrected distance visual acuity (CDVA), intraocular pressure, and complications, were recorded at the 1-month and 6-month follow-up visits. Toxic anterior segment syndrome occurred in 60 eyes (0.22%) in 26 408 consecutive cataract surgeries. Although there were 2 identifiable clusters of TASS, 52% of cases were sporadic. The mean duration until resolution of severe iridocyclitis was 6.11 days ± 2.19 (SD). Of the 24 eyes (40%) with a follow-up of at least 6 months (mean 11.24 ± 2.3 months), 6 (24%) had atrophic iris changes, 1 (4%) had cystoid macular edema, 3 (12.5%) developed anterior capsule phimosis, and 4 (16%) had posterior capsule opacification (PCO). There was no statistically significant difference between the mean CDVA at 1 month (0.08 ± 0.06 logMAR) (n = 60) and the mean final CDVA (0.11 ± 0.1 logMAR, minimum 6 months; n = 24) (P=.42). Although it is impossible to generalize for all etiologies, this study found that TASS is uncommon but not rare, responded to intensive topical antiinflammatory medication, and was usually associated with a good visual outcome. Anterior capsule contraction and PCO were the principal delayed-onset complications beyond those present 1 month postoperatively. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  15. Do managerial efficiency and social responsibility drive long-term financial performance of not-for-profit hospitals before acquisition?

    PubMed

    Phillips, J F

    1999-01-01

    Due to steep declines in charitable support and reduced demand for traditional hospital services, economic goals are increasingly important to not-for-profit hospitals. Effects of efficient management and effective pursuit of not-for-profit status (for example, levels of Medicare, indigent patients, and unprofitable services) on financial viability are explored. While previous research compared hospitals of different ownership status, not-for-profit hospital operations before acquisition by for-profit hospital chains are investigated--"neutral ground" relative to ownership. Results suggest minor links between efficiency and long-term profitability despite effectiveness in pursuit of non taxable status.

  16. Long-term experience with Chinese language shapes the fusiform asymmetry of English reading.

    PubMed

    Mei, Leilei; Xue, Gui; Lu, Zhong-Lin; Chen, Chuansheng; Wei, Miao; He, Qinghua; Dong, Qi

    2015-04-15

    Previous studies have suggested differential engagement of the bilateral fusiform gyrus in the processing of Chinese and English. The present study tested the possibility that long-term experience with Chinese language affects the fusiform laterality of English reading by comparing three samples: Chinese speakers, English speakers with Chinese experience, and English speakers without Chinese experience. We found that, when reading words in their respective native language, Chinese and English speakers without Chinese experience differed in functional laterality of the posterior fusiform region (right laterality for Chinese speakers, but left laterality for English speakers). More importantly, compared with English speakers without Chinese experience, English speakers with Chinese experience showed more recruitment of the right posterior fusiform cortex for English words and pseudowords, which is similar to how Chinese speakers processed Chinese. These results suggest that long-term experience with Chinese shapes the fusiform laterality of English reading and have important implications for our understanding of the cross-language influences in terms of neural organization and of the functions of different fusiform subregions in reading.

  17. Long-Term Experience with Chinese Language Shapes the Fusiform Asymmetry of English Reading

    PubMed Central

    Mei, Leilei; Xue, Gui; Lu, Zhong-Lin; Chen, Chuansheng; Wei, Miao; He, Qinghua; Dong, Qi

    2015-01-01

    Previous studies have suggested differential engagement of the bilateral fusiform gyrus in the processing of Chinese and English. The present study tested the possibility that long-term experience with Chinese language affects the fusiform laterality of English reading by comparing three samples: Chinese speakers, English speakers with Chinese experience, and English speakers without Chinese experience. We found that, when reading words in their respective native language, Chinese and English speakers without Chinese experience differed in functional laterality of the posterior fusiform region (right laterality for Chinese speakers, but left laterality for English speakers). More importantly, compared with English speakers without Chinese experience, English speakers with Chinese experience showed more recruitment of the right posterior fusiform cortex for English words and pseudowords, which is similar to how Chinese speakers processed Chinese. These results suggest that long-term experience with Chinese shapes the fusiform laterality of English reading and have important implications for our understanding of the cross-language influences in terms of neural organization and of the functions of different fusiform subregions in reading. PMID:25598049

  18. Effectiveness of a Psychosocial Intervention Model for Persons with Chronic Psychiatric Disorders in Long-Term Hospitalization

    ERIC Educational Resources Information Center

    Elbaz-Haddad, Merav; Savaya, Riki

    2011-01-01

    The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental…

  19. 42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Method of payment for preadmission services under the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT...

  20. Using client experiences for quality improvement in long-term care organizations.

    PubMed

    Zuidgeest, Marloes; Strating, Mathilde; Luijkx, Katrien; Westert, Gert; Delnoij, Diana; Delnoij, En Diana

    2012-06-01

    To examine whether client experiences measured with the Consumer Quality Index (CQ-index or CQI) questionnaires are used in Dutch nursing homes and homes for the elderly for quality improvement. Information was gathered through face-to-face interviews with day-to-day workers, quality managers and middle and senior management representatives on the subjects of quality policy and CQI. Twelve long-term care organizations in the Netherlands. A total of 47 employees were interviewed. Long-term care organizations that systematically incorporate client experiences into their quality system are more active in using the CQI for quality improvement: information was disseminated throughout the organization, project groups pointed out quality improvement initiatives and every worker was involved in this process. These organizations had often held a certificate for their quality policy for some length of time. In other organizations, CQI information was used less systematically. For instance, only the quality manager was involved, or improvement initiatives were left to employees working in the primary process. The actual improvement initiatives varied. For example, employees created more individual time for clients to avoid the feeling of being rushed; other organizations changed the food delivery to enhance food enjoyment. Although measuring client experiences obligatory, it is not sufficient guarantee that client feedback is used for quality improvement. Although measuring client experiences has led to various improvement initiatives, their effectiveness remains unclear. There is need for guidance on effective improvement of client experiences.

  1. Antifouling properties of tough gels against barnacles in a long-term marine environment experiment.

    PubMed

    Murosaki, T; Noguchi, T; Hashimoto, K; Kakugo, A; Kurokawa, T; Saito, J; Chen, Y M; Furukawa, H; Gong, J P

    2009-10-01

    In the marine environment, the antifouling (AF) properties of various kinds of hydrogels against sessile marine organisms (algae, sea squirts, barnacles) were tested in a long-term experiment. The results demonstrate that most hydrogels can endure at least 2 months in the marine environment. In particular, mechanically tough PAMPS/PAAm DN and PVA gels exhibited AF activity against marine sessile organisms, especially barnacles, for as long as 330 days. The AF ability of hydrogels toward barnacles is explained in terms of an 'easy-release' mechanism in which the high water content and the elastic modulus of the gel are two important parameters.

  2. Latest development and status of long term experience in CFB-technology

    SciTech Connect

    Cleve, K.

    1999-07-01

    CFB-fired steam generators have successfully been in operation for over 15 years. After this period of time enough practical knowledge is available to report on the Long Term Experience of selected plants. The success of CFB-fired steam generators--because of their outstanding environmental performance as well as their fuel flexibility--has led world-wide to more and larger units. In addition to well-proven components, the CFB-process is continuously being improved and New Developments are incorporated.

  3. Evaluation of long-term practical training of graduate students at an off-campus hospital-questionnaire survey of graduate students and pharmacists-.

    PubMed

    Fukumoto, Kyoko; Fujimura, Yasuo; Kusumoto, Masaaki; Tatami, Ryozo; Ueno, Kazuyuki

    2010-03-01

    The graduate students in our laboratory underwent 4-5 months of training at Maizuru Kyosai Hospital. To evaluate the effectiveness of this long-term practical training course of the off-campus hospital, we conducted a questionnaire survey before and after the course among the students and the pharmacists. The results of the survey suggest that the students gained experience regarding pharmaceutical management and came to understand the importance of pharmaceutical care during the course. They had an opportunity to connect clinical practice with the research activities conducted at the university. With regard to the pharmacists, this course has motivated them to act as mentors during the practical training, and therefore was also of significance to them. However, this long-term practical training at the off-campus hospital necessitated a change in lifestyle and living arrangements for the students, which placed stress on them. They required emotional support from university staff before and during the placement. These results show that in order to maintain close collaboration with the hospital and to ensure the success of long-term practical training at an off-campus hospital, academic and emotional support for the students is necessary.

  4. Negative information-seeking experiences of long-term prostate cancer survivors.

    PubMed

    Bernat, Jennifer K; Skolarus, Ted A; Hawley, Sarah T; Haggstrom, David A; Darwish-Yassine, May; Wittmann, Daniela A

    2016-12-01

    Many prostate cancer survivors have lasting symptoms and disease-related concerns for which they seek information. To understand survivors' information-seeking experiences, we examined the topics of their information searches, their overall perceptions of the search, and perceptions of their health information seeking self-efficacy (i.e., confidence in their ability to obtain information). We hypothesized that negative search experiences and lower health information seeking self-efficacy would be associated with certain survivor characteristics such as non-white race, low income, and less education. This was a retrospective study using data from the Michigan Prostate Cancer Survivor Study (state-based survey of long-term prostate cancer survivor outcomes, N = 2499, response rate = 38 %). Participants recalled their last search for information and reported the topics and overall experience. We conducted multivariable regression to examine the association between survivor characteristics and the information-seeking experience. Nearly a third (31.7 %) of prostate cancer survivors (median age of 76 years and 9 years since diagnosis) reported having negative information-seeking experiences when looking for information. However, only 13.4 % reported having low health information-seeking self-efficacy. Lower income and less education were both significantly associated with negative information-seeking experiences. Our findings suggest that many long-term prostate cancer survivors have negative experiences when searching for information, and lower income and less education were survivor factors related to negative information-seeking experiences. We advocate for ongoing, information needs assessment at the point-of-care as the survivorship experience progresses to assess and potentially improve survivors' quality of life.

  5. Long-term patterns of dental attendance and caries experience among British adults: a retrospective analysis.

    PubMed

    Aldossary, Arwa; Harrison, Victoria E; Bernabé, Eduardo

    2015-02-01

    There is inconclusive evidence on the value of regular dental attendance. This study explored the relationship between long-term patterns of dental attendance and caries experience. We used retrospective data from 3,235 adults, ≥ 16 yrs of age, who participated in the Adult Dental Health Survey in the UK. Participants were classified into four groups (always, current, former, and never regular-attenders) based on their responses to three questions on lifetime dental-attendance patterns. The association between dental-attendance patterns and caries experience, as measured using the decayed, missing, or filled teeth (DMFT) index, was tested in negative binomial regression models, adjusting for demographic (sex, age, and country of residence) and socio-economic (educational attainment, household income, and social class) factors. A consistent pattern of association between long-term dental attendance and caries experience was found in adjusted models. Former and never regular-attenders had a significantly higher DMFT score and numbers of decayed and missing teeth, but fewer filled teeth, than always regular-attenders. No differences in DMFT or its components were found between current and always regular-attenders. The findings of this study show that adults with different lifetime trajectories of dental attendance had different dental statuses.

  6. Living with a long-term, indwelling urinary catheter: catheter users' experience.

    PubMed

    Fowler, Sarah; Godfrey, Helen; Fader, Mandy; Timoney, Anthony Gerard; Long, Adele

    2014-01-01

    The purpose of this study was to explore the experiences of long-term catheter users within a heterogeneous population. The sample comprised 27 community-dwelling long-term catheter users. Participants included 14 female users (4 urethral, 10 suprapubic catheter) and 13 male users (6 urethral, 7 suprapubic) between 22 and 96 years of age. Interviews were conducted in participants' homes except 1, which took place in a urology outpatient department based on the participant's preference. A qualitative research design using an interpretive description approach was used for data collection and analysis. All interviews were electronically recorded and transcribed verbatim. Interpretive description involved familiarization with the data, thematic analysis, and the development of an interpretive account. The impact of the catheter and daily living adjustments that catheter users made are captured within 8 themes: (1) making adjustments; (2) managing away from home; (3) nighttime adjustment; (4) catheter problems; (5) social interaction; (6) support from others; (7) unpredictability; and (8) intimacy and body image. Catheter users' experiences of living with a catheter are shaped by a variety of interrelated factors. Some participants were determined to overcome catheter-related problems and develop self-reliance while others adopted a more resigned approach to living with a catheter. Having a catheter enabled some participants to experience greater freedom while others led more restricted lives as a consequence of catheterization.

  7. The Impact of a Death Education Program for Nurses in a Long-Term Care Hospital.

    ERIC Educational Resources Information Center

    Fleming, Stephen; Brown, Isabel

    1983-01-01

    Assessed the impact of a death education program for nursing staff (N=130) of a long-term care institution. Analysis of nurses' chart entries (problem-oriented record format-POR) revealed a statistically significant increase from pre- to post-course in charting of patients' subjective state. (Author/JAC)

  8. Molecular Correlates of Cortical Network Modulation by Long-Term Sensory Experience in the Adult Rat Barrel Cortex

    ERIC Educational Resources Information Center

    Vallès, Astrid; Granic, Ivica; De Weerd, Peter; Martens, Gerard J. M.

    2014-01-01

    Modulation of cortical network connectivity is crucial for an adaptive response to experience. In the rat barrel cortex, long-term sensory stimulation induces cortical network modifications and neuronal response changes of which the molecular basis is unknown. Here, we show that long-term somatosensory stimulation by enriched environment…

  9. Large-scale, long-term silvicultural experiments in the United States: historical overview and contemporary examples.

    Treesearch

    R. S. Seymour; J. Guldin; D. Marshall; B. Palik

    2006-01-01

    This paper provides a synopsis of large-scale, long-term silviculture experiments in the United States. Large-scale in a silvicultural context means that experimental treatment units encompass entire stands (5 to 30 ha); long-term means that results are intended to be monitored over many cutting cycles or an entire rotation, typically for many decades. Such studies...

  10. Molecular Correlates of Cortical Network Modulation by Long-Term Sensory Experience in the Adult Rat Barrel Cortex

    ERIC Educational Resources Information Center

    Vallès, Astrid; Granic, Ivica; De Weerd, Peter; Martens, Gerard J. M.

    2014-01-01

    Modulation of cortical network connectivity is crucial for an adaptive response to experience. In the rat barrel cortex, long-term sensory stimulation induces cortical network modifications and neuronal response changes of which the molecular basis is unknown. Here, we show that long-term somatosensory stimulation by enriched environment…

  11. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    PubMed

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry.

  12. Long-term sick workers experience of professional support for re-integration back to work.

    PubMed

    Landstad, Bodil; Hedlund, Marianne; Wendelborg, Christian; Brataas, Hildfrid

    2009-01-01

    In recent years researchers have tried to identify important factors that can explain re-integration to work for workers on long-term sick leave. The results indicate that multiple factors can explain whether or not people return to work. The aim of the study was to investigate long-term sick workers' experience of professional support for re-integration to work. Participants were drawn from the database of The National Social Insurance Board in Norway. A random sample was selected of persons with mental illness or musculoskeletal disorders (either p- or l-diagnosis/symptoms related to International Classification in Primary Care), who were in receipt of Rehabilitation allowance. The questionnaire was sent to 1 493 persons of whom 740 responded. The most significant finding is that work training/mastering actions were identified by the majority of the rehabilitation benefit recipients as being of slight or moderate use. This highlights the importance of work training/mastering actions being relevant in proportion to the specific situation the individual is presently within. Delays in waiting for treatment attributed to approximately half of the rehabilitation benefit recipient's problems returning to work. This study also highlights that rehabilitation benefit recipients experience loss of co-ordinated measures from those who are supposed to contribute to simplifying their return to work.

  13. Long-term and trans-generational effects of neonatal experience on sheep behaviour.

    PubMed

    Clark, Corinna; Murrell, Joanna; Fernyhough, Mia; O'Rourke, Treasa; Mendl, Michael

    2014-07-01

    Early life experiences can have profound long-term, and sometimes transgenerational, effects on individual phenotypes. However, there is a relative paucity of knowledge about effects on pain sensitivity, even though these may impact on an individual's health and welfare, particularly in farm animals exposed to painful husbandry procedures. Here, we tested in sheep whether neonatal painful and non-painful challenges can alter pain sensitivity in adult life, and also in the next generation. Ewes exposed to tail-docking or a simulated mild infection (lipopolysaccharide (LPS)) on days 3–4 of life showed higher levels of pain-related behaviour when giving birth as adults compared with control animals. LPS-treated ewes also gave birth to lambs who showed decreased pain sensitivity in standardized tests during days 2–3 of life. Our results demonstrate long-term and trans-generational effects of neonatal experience on pain responses in a commercially important species and suggest that variations in early life management can have important implications for animal health and welfare.

  14. Appraisal of the cancer experience by family members and survivors in long-term survivorship.

    PubMed

    Bowman, Karen F; Rose, Julia H; Deimling, Gary T

    2006-09-01

    This study assessed the appraisal of the stressfulness of the cancer experience and its correlates for family members and older survivors living in the long-term survivorship phase of the disease. On average, family members appraised the cancer experience as more stressful than their surviving relatives. Beliefs about the effect of the diagnosis and treatment on family members were important correlates for both family members and survivors in the appraisal process. Cancer characteristics were not related to appraisal for survivors, but stage at diagnosis was associated with a more stressful appraisal for family members. Demographic characteristics were unrelated to appraisal for family members, but being African-American was linked to a less stressful appraisal for survivors. These findings highlight the stressful impact of the cancer experience on family members and can help guide health care interventions which include family members from African-American and White ethnicities.

  15. Supporting a relative's move into long-term care: starting point shapes family members' experiences.

    PubMed

    Sussman, Tamara; Dupuis, Sherry

    2012-12-01

    This grounded-theory study explored family members' experiences supporting a relative's move into a long-term care (LTC) home. Each stage in the transition process, and the role of starting point in shaping the experience, were examined. Twenty family members who moved a relative into an LTC home were interviewed within six weeks of the move. The findings revealed that the starting point had a profound effect on family members' experiences accepting the need for, and timing of, their relative's move into LTC (pre-move), and on believing that the selected LTC home was a positive environment for their relative (post-move). LTC home policies and processes were also important. However, when pre-move acceptance was compromised by circumstances attributed to the starting point, these policies and processes were not as effective in fostering post-move acceptance. Conditions that support positive transitions before, during, and after the move from each starting point are discussed.

  16. Serotonin deficiency alters susceptibility to the long-term consequences of adverse early life experience.

    PubMed

    Sachs, Benjamin D; Rodriguiz, Ramona M; Tran, Ha L; Iyer, Akshita; Wetsel, William C; Caron, Marc G

    2015-03-01

    Brain 5-HT deficiency has long been implicated in psychiatric disease, but the effects of 5-HT deficiency on stress susceptibility remain largely unknown. Early life stress (ELS) has been suggested to contribute to adult psychopathology, but efforts to study the long-term consequences of ELS have been limited by a lack of appropriate preclinical models. Here, we evaluated the effects of 5-HT deficiency on several long-term cellular, molecular, and behavioral responses of mice to a new model of ELS that combines early-life maternal separation (MS) of pups and postpartum learned helplessness (LH) training in dams. Our data demonstrate that this paradigm (LH/MS) induces depressive-like behavior and impairs pup retrieval in dams. In addition, we show that brain 5-HT deficiency exacerbates anxiety-like behavior induced by LH/MS and blunts the effects of LH/MS on acoustic startle responses in adult offspring. Although the mechanisms underlying these effects remain unclear, following LH/MS, 5-HT-deficient animals had significantly less mRNA expression of the mineralocorticoid receptor in the amygdala than wild-type animals. In addition, 5-HT-deficient mice exhibited reduced mRNA levels of the 5-HT2a receptor and p11 in the hippocampus regardless of stress. LH/MS decreased the number of doublecortin+ immature neurons in the hippocampus in both wild-type (WT) and 5-HT-deficient animals. Our data emphasize the importance of complex interactions between genetic factors and early life experience in mediating long-term changes in emotional behavior. These findings may have important implications for our understanding of the combinatorial roles of 5-HT deficiency, ELS, and postpartum depression in the development of neuropsychiatric disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Long-Term Soil Experiments: A Key to Managing Earth's Rapidly Changing Critical Zones

    NASA Astrophysics Data System (ADS)

    Richter, D., Jr.

    2014-12-01

    In a few decades, managers of Earth's Critical Zones (biota, humans, land, and water) will be challenged to double food and fiber production and diminish adverse effects of management on the wider environment. To meet these challenges, an array of scientific approaches is being used to increase understanding of Critical Zone functioning and evolution, and one amongst these approaches needs to be long-term soil field studies to move us beyond black boxing the belowground Critical Zone, i.e., to further understanding of processes driving changes in the soil environment. Long-term soil experiments (LTSEs) provide direct observations of soil change and functioning across time scales of decades, data critical for biological, biogeochemical, and environmental assessments of sustainability; for predictions of soil fertility, productivity, and soil-environment interactions; and for developing models at a wide range of temporal and spatial scales. Unfortunately, LTSEs globally are not in a good state, and they take years to mature, are vulnerable to loss, and even today remain to be fully inventoried. Of the 250 LTSEs in a web-based network, results demonstrate that soils and belowground Critical Zones are highly dynamic and responsive to human management. The objective of this study is to review the contemporary state of LTSEs and consider how they contribute to three open questions: (1) can soils sustain a doubling of food production in the coming decades without further impinging on the wider environment, (2) how do soils interact with the global C cycle, and (3) how can soil management establish greater control over nutrient cycling. While LTSEs produce significant data and perspectives for all three questions, there is on-going need and opportunity for reviews of the long-term soil-research base, for establishment of an efficiently run network of LTSEs aimed at sustainability and improving management control over C and nutrient cycling, and for research teams that

  18. Medicare Payment Policy Creates Incentives For Long-Term Care Hospitals To Time Discharges For Maximum Reimbursement.

    PubMed

    Kim, Yan S; Kleerup, Eric C; Ganz, Patricia A; Ponce, Ninez A; Lorenz, Karl A; Needleman, Jack

    2015-06-01

    Long-term care hospitals are postacute care facilities for patients requiring extended hospital-level care. These facilities are reimbursed by Medicare under a prospective payment system with a short-stay outlier policy, which results in substantially lower payments for patients discharged before a diagnosis-related group-specific short-stay threshold. Using Medicare data, we examined the impact of the short-stay policy on lengths-of-stay and Medicare reimbursement among patients in long-term care hospitals who require prolonged mechanical ventilation. After accounting for case-mix and facility-level differences, we found that discharges for reasons other than death in the period 2005-10 were most likely to occur on the day of or immediately after the short-stay threshold; this held true regardless of facility ownership. In contrast, live discharges in 2002—the year before the prospective payment system started phasing out cost-based payment—were evenly distributed around the day that later became the short-stay threshold. Our findings confirm that the short-stay outlier payment policy created a strong financial incentive for long-term care hospitals to time patient discharges to maximize Medicare reimbursement. The results suggest that the new very-short-stay policy implemented in December 2012 could have a similar effect.

  19. Long-term Disability Associated With War-related Experience Among Vietnam Veterans

    PubMed Central

    Gregory, Robert; Salomon, Joshua A.

    2015-01-01

    Background: Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown. Objectives: To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience. Participants: A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas. Outcome Measures: Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration. Results: The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20–30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32–1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%–70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9–24.0) and lowest for injuries, at 1.5 (1.4–1.6) with a relative risk for any disability of 3.7 (3.7–3.8). Veterans with service of >1 year were 2.5 (2.2–2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1–2.5) times more likely to have other disabilities. Conclusions: Long-term effects of

  20. Long-term disability associated with war-related experience among Vietnam veterans: retrospective cohort study.

    PubMed

    Clarke, Philip M; Gregory, Robert; Salomon, Joshua A

    2015-05-01

    Recent combat operations have involved large numbers of personnel. Long-term health effects of military deployment remain largely unknown. To examine patterns and trends in long-term disability among combat veterans and to relate disability to aspects of wartime experience. A total of 60,228 Australian military personnel deployed between 1962 and 1975 during the Vietnam War, and 82,877 military personnel who were not deployed overseas. Accepted physician-assessed disability claims were evaluated over follow-up periods up to 50 years after deployment, and compared with age-matched controls. Multivariable analysis was used to examine differences by service branch, rank, age, and deployment duration. The steepest rise in disability incidence was observed among Vietnam veterans starting in the 1990s, around 20-30 years after deployment for most veterans. After 1994, when Statements of Principles were introduced to guide evaluation of disability claims, the hazard ratio for disability incidence was 1.53 (95% confidence interval, 1.32-1.77) compared with the prior period. By January 2011, after an average follow-up of 42.5 years, 69.7% (95% confidence interval, 69.4%-70.1%) of veterans had at least 1 war-related disability. Many veterans had multiple disabilities, with leading causes being eye and ear disorders (48.0%), mental health conditions (47.9%), and musculoskeletal disorders (18.4%). For specific categories of disability, relative risks for accepted claims among veterans compared with controls were highest for mental health disorders, at 22.9 (21.9-24.0) and lowest for injuries, at 1.5 (1.4-1.6) with a relative risk for any disability of 3.7 (3.7-3.8). Veterans with service of >1 year were 2.5 (2.2-2.7) times more likely to have a mental health disability than those who served <100 days, and 2.3 (2.1-2.5) times more likely to have other disabilities. Long-term effects of deployment into military conflicts are substantial, and likelihood of war-related disability

  1. A Long-term Forest Fertilization Experiment to Understand Ecosystem Responses to Atmospheric Nitrogen Deposition

    NASA Astrophysics Data System (ADS)

    Baron, J.; Advani, S. M.; Allen, J.; Boot, C.; Denef, K.; Denning, S.; Hall, E.; Moore, J. C.; Reuth, H.; Ryan, M. G.; Shaw, E.

    2016-12-01

    Long-term field experiments can reveal changes in ecosystem processes that may not be evident in short-term studies. Short-term measurements or experiments may have narrower objectives or unrealistic treatments in order to see a change, whereas long-term studies can reveal complex interactions that take longer to manifest. We report results from a long-term experiment (1996 to present) in subalpine forests to simulate the consequences of sustained atmospheric nitrogen (N) deposition. Loch Vale watershed in Rocky Mountain National Park, the location of the experiment, has received an order of magnitude greater atmospheric N deposition than estimated background since mid-20th Century. Augmenting that, in 1996 we began adding 25 kg NH4NO3 ha-1 yr-1 to three 30m x 30m old-growth Engelmann spruce and subalpine fir plots. Treated stands were matched by nearby controls. N addition caused rapid leaching of nitrate and cations from soils, and increased N mineralization and nitrification rates. These observations in the fertilized plots have been sustained over time. Soluble aluminum concentrations do not differ significantly between fertilized and control plots, but treated soils are now markedly more acidic (pH of 4.7) than original soil and controls (pH of 5.1); further acidification might increase aluminum leaching. Effects on soil carbon were complex, mediated by reductions in total microbial biomass, decreases in arbuscular mychorrizal and saprotropic fungi, and increased potential rates of N enzyme degrading activities. Initial soil C:N of 24 was lower than similar soils in low N deposition stands (C:N of 36). The C:N declined to 22 with treatment. Fertilized plots lost 11% soil C, but the mechanism is unclear. We did not measure changes in C inputs from litter, microbial biomass, or plant uptake, but there was no change in summer CO2 flux, measured in 2003, 2004, and 2014. Leaching of DOC from fertilized plots was elevated throughout the experiment, providing one

  2. Overview of long-term field experiments in Germany - metadata visualization

    NASA Astrophysics Data System (ADS)

    Muqit Zoarder, Md Abdul; Heinrich, Uwe; Svoboda, Nikolai; Grosse, Meike; Hierold, Wilfried

    2017-04-01

    BonaRes ("soil as a sustainable resource for the bioeconomy") is conducting to collect data and metadata of agricultural long-term field experiments (LTFE) of Germany. It is funded by the German Federal Ministry of Education and Research (BMBF) under the umbrella of the National Research Strategy BioEconomy 2030. BonaRes consists of ten interdisciplinary research project consortia and the 'BonaRes - Centre for Soil Research'. BonaRes Data Centre is responsible for collecting all LTFE data and regarding metadata into an enterprise database upon higher level of security and visualization of the data and metadata through data portal. In the frame of the BonaRes project, we are compiling an overview of long-term field experiments in Germany that is based on a literature review, the results of the online survey and direct contacts with LTFE operators. Information about research topic, contact person, website, experiment setup and analyzed parameters are collected. Based on the collected LTFE data, an enterprise geodatabase is developed and a GIS-based web-information system about LTFE in Germany is also settled. Various aspects of the LTFE, like experiment type, land-use type, agricultural category and duration of experiment, are presented in thematic maps. This information system is dynamically linked to the database, which means changes in the data directly affect the presentation. An easy data searching option using LTFE name, -location or -operators and the dynamic layer selection ensure a user-friendly web application. Dispersion and visualization of the overlapping LTFE points on the overview map are also challenging and we make it automatized at very zoom level which is also a consistent part of this application. The application provides both, spatial location and meta-information of LTFEs, which is backed-up by an enterprise geodatabase, GIS server for hosting map services and Java script API for web application development.

  3. Long-term reactive transport modelling of Berea and chalk core flood experiment

    NASA Astrophysics Data System (ADS)

    Souza, A. V.; Godoy, J.; Tonietto, G.

    2013-12-01

    Carbon sequestration in geological structures establishes a long-term chemical system between the dissolved gas, fluids and rocks from the injection site. Thus, the time scale used to assess the progress of chemical reactions is normally between tens and hundreds of years. Geochemical modeling is used in a variety of fields, including environmental protection and remediation, the petroleum industry, and economic geology and it is one of the best alternatives to evaluate the reactions with geochemical data possible injection sites. In this work we used data presented in a recent article (SPE165500) in different scenarios injection with three scales 50, 100, 250 and 1000 years. The experimental data used were from core flood experiment Berea and chalk in a condition similar to those found in the reservoirs of the North Sea. (340 bar and 130 C). The approach used to the lack of appropriate kinetic parameter in reservoir conditions, was the use of experimental data collected in two different conditions (340 bar and 130 C) and (2 Bar at room temperature) after the rocky core. The numerical simulations carried out using the same conditions with two different geochemical softwares PHREEQC and TOUGHREACTS. The results provide a detailed understanding of the system resulting rock-fluid-CO2 in the medium and long term. However, the accuracy of the models is strongly dependent on the mineral primary and secondary cores found in rocks.

  4. Intelligent power wheelchair use in long-term care: potential users' experiences and perceptions.

    PubMed

    Rushton, Paula W; Mortenson, Ben W; Viswanathan, Pooja; Wang, Rosalie H; Miller, William C; Hurd Clarke, Laura

    2017-10-01

    Long-term care (LTC) residents with cognitive impairments frequently experience limited mobility and participation in preferred activities. Although a power wheelchair could mitigate some of these mobility and participation challenges, this technology is often not prescribed for this population due to safety concerns. An intelligent power wheelchair (IPW) system represents a potential intervention that could help to overcome these concerns. The purpose of this study was to explore a) how residents experienced an IPW that used three different modes of control and b) what perceived effect the IPW would have on their daily lives. We interviewed 10 LTC residents with mild or moderate cognitive impairment twice, once before and once after testing the IPW. Interviews were conducted using a semi-structured interview guide, audio recorded and transcribed verbatim for thematic analyses. Our analyses identified three overarching themes: (1) the difference an IPW would make, (2) the potential impact of the IPW on others and (3) IPW-related concerns. Findings from this study confirm the need for and potential benefits of IPW use in LTC. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitation Intelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments. Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety.

  5. Long-term outcome of nephropathic cystinosis: a 20-year single-center experience.

    PubMed

    Greco, Marcella; Brugnara, Milena; Zaffanello, Marco; Taranta, Anna; Pastore, Anna; Emma, Francesco

    2010-12-01

    Nephropathic cystinosis (NC) is a severe disease that is complicated by early-onset chronic renal failure (CRF) and other complications related to cystine deposition in tissue. Since the 1980s, the prognosis of NC has dramatically improved after the introduction of cysteamine treatment. Limited data are available documenting improvement in prognosis. We reviewed our long-term data (follow-up 6.3-27.8 years) on 23 patients followed in the past 26 years. Overall, stage III CRF was reached at 10 years of age in >90% of patients, whereas >80% reached end-stage renal disease before the age of 14 years. Three patients died during the follow-up. Our analysis shows a clear improvement in renal outcome (p = 0.001) and linear growth (p = 0.04) in patients treated more recently. Improvement in the evolution of renal function was significantly associated with early initiation of cysteamine (p = 0.006), with the dose of cysteamine (p = 0.04), and with the use of angiotensin-converting enzyme inhibitors (p = 0.01). Nonrenal long-term complications are similar to previously reported data. Of note, 3/23 patients developed rare forms of primary tumors that were successfully treated. In conclusion, our experience shows a significant improvement in the renal and nonrenal complications of cystinosis over the past decades and highlights the importance of early diagnosis in order to initiate cysteamine as soon as possible.

  6. Domino heart transplantation: long-term outcome of recipients and their living donors: single center experience.

    PubMed

    Raffa, G M; Pellegrini, C; Viganò, M

    2010-11-01

    "Domino" cardiac procedure is an effective option to increase the donor pool when heart-lung transplantation (HLT) is the only treatment for patients with terminal cardiopneumopathy. We reviewed the long-term outcomes of domino cardiac donors and recipients at our institution. Ten of 35 patients who underwent HLT from 1991 onward served as domino cardiac donors. They included eight female and two male subjects of overall mean age of 33 years and mean weight of 55 kg. Their diagnoses were primary pulmonary hypertension (n = 6) as well as cystic fibrosis, bronchiectasis, Eisenmenger's syndrome, and bronchiolitis obliterans (n = 1 each). The domino cardiac recipients included six males and four females of overall mean age of 47 years and mean weight of 61 kg. They were affected by ischemic heart disease (n = 5), cardiomyopathy (n = 4), and valvular heart disease (n = 1). Mean pulmonary vascular resistance was 3 Wood units. The heart was used either in the orthotopic (n = 8) or in the heterotopic position (n = 2). The 1-, 5-, and 10-year survivals for the domino cardiac donors versus their recipients were 60%, 40%, 30% versus 90%, 70%, 60%, respectively. Five domino donors developed bronchiolitis obliterans syndrome. Among the domino recipients group, cardiac allograft vasculopathy was rare (n = 1). Common causes of late death were in the domino recipients infections in the domino donors (n = 2) and malignancies. Our experience suggested good long-term results of the domino procedure. Copyright © 2010 Elsevier Inc. All rights reserved.

  7. Long-Term Running Experience with the Silicon Micro-Strip

    SciTech Connect

    Jung, Andreas W.; Cherry, M.; Edmunds, D.; Johnson, M.; Matulik, M.; Utes, M.; Zmuda, T.; /Fermilab

    2011-09-13

    The Silicon Microstrip Tracker (SMT) at the D0 experiment in the Fermilab Tevatron collider has been operating since 2001. In 2006, an additional layer, referred to as Layer 0, was installed to improve impact parameter resolution and compensate for detector degradation due to radiation damage to the original innermost SMT layer. The SMT detector provides valuable tracking and vertexing information for the experiment. This talk will highlight aspects of the long term operation of the SMT, including the impact of the silicon readout test stand. Due to the full integration of the test stand into the D0 trigger framework, this test stand provides a valuable tool for training new experts and studying subtle effects in the SMT while minimizing impact on the global data acquisition.

  8. Dietetic students' experiences providing meal assistance in long-term care facilities.

    PubMed

    Osinga, Nicole; Keller, Heather

    2013-01-01

    This qualitative study involved describing the experiences of dietetic students who provided meal help to older adults. Of interest were benefits and challenges, and how training could be enhanced. Individual, face-to-face, semi-structured interviews were conducted with nine undergraduate dietetic students. In the preceding year, these students had volunteered as meal helpers in a long-term care home. Interviews were digitally recorded and transcribed verbatim. Qualitative thematic analysis was used to analyze the transcripts. All participating students were female and from one undergraduate program. Three main themes emerged: growing into the role, learning outside the classroom, and providing quality assistance. This study provides an understanding of how meal helping can be a valuable experience for emerging dietitians. It also gives insights into training and the development of the meal helper role.

  9. Long-term experiments on man's stay in biological life-support system

    NASA Astrophysics Data System (ADS)

    Gitelson, I. I.; Terskov, I. A.; Kovrov, B. G.; Lisovskii, G. M.; Okladnikov, Yu. N.; Sid'Ko, F. Ya.; Trubachev, I. N.; Shilenko, M. P.; Alekseev, S. S.; Pan'kova, I. M.; Tirranen, L. S.

    We describe the experimental system having maximal possible closure of material recycling in an ecosystem, including people and plants, which was carried out in a hermetically sealed experimental complex ``BIOS-3'', 315 m2 in volume. The system included 2 experimentators and 3 phytotrons with plants (total sowing area of 63 m2). Plants were grown with round-the-clock lamp irradiation with 130 Wm-2 PAR intensity. The plants production was food for people. Water exchange of ecosystem, as well as gas exchange, was fully closed excluding liquids and gas samples taken for chemical analysis outside the system. The total closure of material turnover constituted 91%. Health state of the crew was estimated before, during and after the experiment. A 5-months period did not affect their health. The experiments carried out prove that the closed ecosystem of ``man-plants'' is a prototype of a life-support system for long-term space expeditions.

  10. Cerebral performance category at hospital discharge predicts long-term survival of cardiac arrest survivors receiving targeted temperature management*.

    PubMed

    Hsu, Cindy H; Li, Jiaqi; Cinousis, Marisa J; Sheak, Kelsey R; Gaieski, David F; Abella, Benjamin S; Leary, Marion

    2014-12-01

    Despite recent advancements in post-cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. Retrospective chart review. Two academic medical centers from May 2005 to December 2012. The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. None. The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management

  11. Survey of weed composition befor maize sowing in long-term fertilization experiment.

    PubMed

    Kismányoky, A; Lehoczky, E

    2007-01-01

    The study was carried out in a long-term fertilization field experiment of the Experimental Station of University of Pannonia, Department of Crop Science and Soil Science in 2006. The Long-term fertilization experiment was set up in 1983. In the experiment, the success of the weeds ability to grow under the influence of NPK, NPK + FYM* and NPK + straw treatments was compared, and the effect of increasing Nitrogen dosing on weediness was studied. The bifactorial test was arranged in split plot design with three replications. Treatment A: nutrient: NPK, NPK + 35 t/ha FYM* and NPK + straw manure. Treatment B: N kg/ha(-1) N0-N4 (0, 70, 140, 210, 280), and 100 kg P2O5 ha(-1) & 100 kg K20. The weed survey was made on 2nd of May 2006. There were spraying no herbicide until the survey. For the weed survey the Balázs-Ujvárosi coenological method was applied. Altogether, we have found 23 weed species in the trial. In the NPK treatment there were 20 species, in the treatment NPK+organic manure there were 17 species and in the NPK+ stalk rest treatment there were 16 weed species. The most dominant of the weeds on the NPK and NPK+straw manure treatments was Veronica hederifolia while on the fertilizer + FYM, the A. theophrasti was most dominant. The average weed covering value of the treatment NPK + FYM was 1.36 times higher (10.87%) than that of treatment NPK only (7.97%) and 3.65 times higher than on the NPK + straw manure treatment.

  12. Molecular correlates of cortical network modulation by long-term sensory experience in the adult rat barrel cortex

    PubMed Central

    Vallès, Astrid; Granic, Ivica; De Weerd, Peter; Martens, Gerard J.M.

    2014-01-01

    Modulation of cortical network connectivity is crucial for an adaptive response to experience. In the rat barrel cortex, long-term sensory stimulation induces cortical network modifications and neuronal response changes of which the molecular basis is unknown. Here, we show that long-term somatosensory stimulation by enriched environment up-regulates cortical expression of neuropeptide mRNAs and down-regulates immediate-early gene (IEG) mRNAs specifically in the barrel cortex, and not in other brain regions. The present data suggest a central role of neuropeptides in the fine-tuning of sensory cortical circuits by long-term experience. PMID:25171421

  13. Tuberculosis among long term hospital residents: report of a recent outbreak.

    PubMed

    Taylor, D R; Allison, G; Phillips, D E

    1991-10-09

    Following the diagnosis of a case of miliary tuberculosis in a ward of 30 psychogeriatric patients, a further seven patients required treatment for active tuberculosis, and an additional four received prophylactic therapy. Tuberculosis contributed significantly to the deaths of three patients during the outbreak. This report highlights the particular risks of both reactivation and primary tuberculosis among geriatric patients receiving long term residential care. Late diagnosis contributed to the extent of the outbreak. Previous studies indicate that occult transmission of tuberculosis is relatively common in this group. An active policy of screening and prophylactic treatment is advised.

  14. Long- term effects of previous experience determine nutrient discrimination abilities in birds

    PubMed Central

    Schaefer, H Martin; Spitzer, Kathrin; Bairlein, Franz

    2008-01-01

    Background Foraging behaviour is an essential ecological process linking different trophic levels. A central assumption of foraging theory is that food selection maximises the fitness of the consumer. It remains unknown, however, whether animals use innate or learned behaviour to discriminate food rewards. While many studies demonstrated that previous experience is a strong determinant of complex food choices such as diet mixing, the response to simple nutritional stimuli, such as sugar concentrations, is often believed to be innate. Results Here we show that previous experience determines the ability to track changes in sugar composition in same-aged individuals of a short-lived migratory songbird, the garden warbler (Sylvia borin). Although birds received identical foods for seven months prior to the experiment, wild-caught birds achieved higher sugar intake rates than hand-raised birds when confronted with alternative, differently coloured, novel food types. Hand-raised and wild birds did not differ in their initial colour selection or overall food intake, but wild birds were quicker to adjust food choice to varying sugar intake. Conclusion Over a period of at least seven months, broader previous experience translates into a higher plasticity of food choice leading to higher nutrient intake. Our results thus highlight the need to address previous long-term experience in foraging experiments. Furthermore, they show that hand-raised animals are often poor surrogates for testing the foraging behaviour of wild animals. PMID:18291043

  15. Long-term experiment with orchard floor management systems: influence on apple yield and chemical composition.

    PubMed

    Slatnar, Ana; Licznar-Malanczuk, Maria; Mikulic-Petkovsek, Maja; Stampar, Franci; Veberic, Robert

    2014-05-07

    The study focuses on the response of apple primary and secondary metabolism and some important quality parameters to three living mulch treatments, classical herbicide fallow, and black polypropylene strip application in two apple cultivars. Primary and secondary metabolites were analyzed after 10 years of ground cover experiments. Soluble solids, firmness, and color measurements indicate differences among orchard floor management treatments. Significantly, lower levels of individual sugars have been measured in fruit of different living mulch treatments compared with fruit harvested from trees subjected to the herbicide strip treatment. Total sugar content was higher in fruit of the herbicide strip treatment in both cultivars analyzed. Significantly higher levels of total organic acids were only detected in 'Pinova' fruit of the Festuca ovina L. treatment. Long-term response of both cultivars to living mulch treatments indicated that apples increase the accumulation of almost all analyzed individual phenolic compounds.

  16. Beyond resettlement: long-term care for people who have had refugee-like experiences.

    PubMed

    Phillips, Christine

    2014-11-01

    Since 1945, more than 700 000 refugees and displaced persons, survivors of conflicts in over 60 countries, have resettled in Australia. Every general practitioner (GP) will have patients who have had refugee-like experiences. To describe the health needs of survivors of war and conflict in the immediate and long-term resettlement periods. In the immediate post-settlement period, refugees and asylum seekers will need assessment, catch-up primary healthcare and, in some cases, psychological support. Although refugees are generally a resilient group, enhanced support may be needed over key life periods: childbirth, rearing of young children and entering frail age. Asylum seekers (who do not have permanent visas) often face structural impediments to healthcare access and may be unable to meet basic health needs; GPs need to be aware of the enhanced need for psychological safety in addition to catch-up healthcare in this population.

  17. Numerical experiments on the long-term morphodynamics of the Colorado River Delta

    NASA Astrophysics Data System (ADS)

    Montaño, Yovani; Carbajal, Noel

    2008-03-01

    The interaction among tidal currents, sediment transport, and long-term changes of the sea bottom in the Colorado River Delta have been investigated applying a two dimensional nonlinear hydrodynamic-numerical finite differences model. The system was forced by the dominant M 2 tidal component at the open boundary. We carried out calculations to study the morphodynamics of the actual bathymetry caused by the bedload sediment transport. To investigate the origin of actual morphological features, we performed experiments using a smoothed bathymetry, in which the islands Montague, Gore, and Pelícano were eliminated. Under the imposed tidal hydrodynamics, the results indicate that the bedload transport contributes significantly in the genesis of sandbanks and in the formation and maintaining of the Montague and Gore Islands.

  18. Care assistant experiences of dementia care in long-term nursing and residential care environments.

    PubMed

    Talbot, Rebecca; Brewer, Gayle

    2016-11-01

    Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.

  19. Prior contest experience exerts a long-term influence on subsequent winner and loser effects

    PubMed Central

    2011-01-01

    Introduction Animals are capable of using information from recent experiences to modify subsequent behavioral responses. Animals' ability or propensity to modify their behavior in the light of new information has repeatedly been shown to correlate with, or be influenced by, either their intrinsic competitive ability or their dominance experience - an influence which can be long-lasting. Using a mangrove killifish, Kryptolebias marmoratus, as the study organism, we investigated whether and if so how the effect of a winning or a losing experience one day prior to a dyadic contest was modulated by both competitive ability measured two months previously and a winning or losing experience forced on the contestants one month previously. Results Winning/losing experience forced on the fish one month previously affected how they utilized information from their winning/losing experience one day before Test Day: Individuals that were randomly assigned a losing experience one month previously were more susceptible to the influence of their 1-day winning/losing experience than those assigned a winning experience. Competitive ability measured two months previously, winning/losing experience from one month previously and the winning/losing experience received one day previously all significantly influenced the fish's contest behaviors on Test Day, although only 2-month competitive ability significantly influenced escalation duration, indicating that it was still a good index for the fish's competitive ability two months later. Conclusions These results suggest that the value to the fish of information from a recent win or loss depends on the outcome of their past contests and show that contest experience has a long-term effect on contest behavior. PMID:22051441

  20. Does long-term experience of nonstandard employment increase the incidence of depression in the elderly?

    PubMed Central

    Kang, Mo-Yeol; Kang, Young-Joong; Lee, Woncheol; Yoon, Jin-Ha

    2016-01-01

    Objectives: Our prospective study aimed to elucidate the effect of long-term experience of nonstandard employment status on the incidence of depression in elderly population using the Korean Longitudinal Study of Ageing (KLoSA) study. Methods: This study used the first- to fourth-wave cohorts of KLoSA. After the exclusion of the unemployed and participants who experienced a change in employment status during the follow-up periods, we analyzed a total of 1,817 participants. Employment contracts were assessed by self-reported questions:standard or nonstandard employment. The short form of the Center for Epidemiologic Studies Depression Scale (CES-D) served as the outcome measure. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models to evaluate the association between standard/nonstandard employees and development of depression. Results: The mean age of the participants was 53.90 (±7.21) years. We observed that nonstandard employment significantly increased the risk of depression. Compared with standard employees, nonstandard employees had a 1.5-fold elevated risk for depression after adjusting for age, gender, CES-D score at baseline, household income, occupation category, current marital status, number of living siblings, perceived health status, and chronic diseases [HR=1.461, 95% CI= (1.184, 1.805) ]. Moreover, regardless of other individual characteristics, the elevated risk of depression was observed among all kinds of nonstandard workers, such as temporary and day workers, full-time and part-time workers, and directly employed and dispatched labor. Conclusions: The 6-year follow-up study revealed that long-term experience of nonstandard employment status increased the risk of depression in elderly population in Korea. PMID:27108642

  1. Diversity-function relationships changed in a long-term restoration experiment.

    PubMed

    Doherty, James M; Callaway, John C; Zedler, Joy B

    2011-09-01

    The central tenet of biodiversity-ecosystem function (BEF) theory, that species richness increases function, could motivate restoration practitioners to incorporate a greater number of species into their projects. But it is not yet clear how well BEF theory predicts outcomes of restoration, because it has been developed through tests involving short-run and tightly controlled (e.g., weeded) experiments. Thus, we resampled our 1997 BEF experiment in a restored salt marsh to test for long-term effects of species richness (plantings with 1, 3, and 6 species per 2 x 2 m plot), with multiple ecosystem functions as response variables. Over 11 years, 1- and 6-species assemblages converged on intermediate richness (mean = 3.9 species/ 0.25-m2 plot), and composition changed nonrandomly throughout the site. While three species became rare, the two most productive species became co-dominant. The two dominants controlled and increased shoot biomass, which appeared to decrease species richness. Diversity-function relationships became less positive over 11 years and differed significantly with (a) the species-richness metric (planted vs. measured), and (b) the indicator of function (shoot biomass, height, and canopy layering). The loss of positive relationships between species richness and function in our restored site began soon after we stopped weeding and continued with increasing dominance by productive species. Where species-rich plantings are unlikely to ensure long-term restoration of functions, as in our salt marsh, we recommend dual efforts to establish (1) dominant species that provide high levels of target functions, and (2) subordinate species, which might provide additional functions under current or future conditions.

  2. Long-term experiments to better understand soil-human interactions

    NASA Astrophysics Data System (ADS)

    Bormann, B. T.; Homann, P. S.

    2011-12-01

    Interactions between soils and people may be transforming global conditions, but the interactions are poorly understood. Changes in soils have proven difficult to quantify, especially in complex ecosystems manifesting large spatiotemporal variability. Long-term ecosystem experiments that evaluate soil change and demonstrate alternative choices are important to understanding changes, discovering new controls and drivers, and influencing decisions. Inspired by agriculture studies, like Rothamsted, the US Forest Service established in 1990 a network of operational-scale experiments across the Pacific Northwest to evaluate long-term effects of different forest management and disturbance regimes. With a strong experimental design, these experiments are now helping to better understand the long-term effects of managing tree harvesting (clearcutting and thinning), woody debris, and tree and understory species composition, and-serendipitously-the effects of fire. Initial results from the Southern Oregon experimental site indicate surprisingly rapid soil changes in some regimes but not others. We've also learned that rapid change presents challenges to repeat sampling. We present our sample-archive and comparable-layer approaches that seek to accommodate changes in surface elevation, aggregation and disaggregation, and mineral-soil exports. Thinning mature forest stands (80-100 yrs old) did not significantly change soil C in 11-yrs. A small upper-layer C increase was observed after thinning, but it was similar to the control. Significant increases in upper-layer soil N were observed with most treatments, but all increases were similar to the control. Leaving woody debris had little effect. The most remarkable change occurred when mature stands were clearcut and Douglas-firs were planted and tended. Associated with rapid growth of Douglas-fir, an average of 8 Mg C ha-1 was lost from weathered soil 4-18 cm deep. This contrasts with clearcuts where early-seral hardwoods and

  3. 241Am migration in a sandy aquifer studied by long-term column experiments.

    PubMed

    Artinger, Robert; Schuessler, Wolfram; Scherbaum, Franz; Schild, Dieter; Kim, Jae-Il

    2002-11-15

    The migration behavior of 241Am(III) in a sandy aquifer was studied under near-natural conditions by long-term column experiments of more than 1 year duration. Columns with 50 cm length and 5 cm in diameter were packed with aeolian quartz sand and equilibrated with two different groundwaters having an original dissolved organic carbon concentration (DOC) of 1.1 and 7.2 mg x dm(-3), respectively,from the Gorleben site (Lower Saxony, Germany). In each experiment, 1 cm3 of Am-spiked groundwater ([Am] = 0.2 to 2 micromol x dm(-3)) was injected into the column. The flow rate of the groundwater was adjusted to 0.28 m x d(-1). A small colloid-borne Am fraction was found to elute together with tritiated water. After 414 and 559 days, respectively, the experiments were terminated. Whereas the nonsorbing tracer of tritiated water would have covered a distance of about 350 m in that time period, the maximum of the Am activity was detected between 32 and 40 mm column length. Applying selective dissolution analysis to the sand surface, Am was found to be preferentially bound to iron hydroxide/oxide sites. From this Am distribution, a retardation factor R of about 10(4) was determined and compared to static batch experiments. The Am breakthrough was calculated forthe conditions of the column experiment

  4. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States

    PubMed Central

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D.; Weisskopf, Marc G.; Melly, Steven J.; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2015-01-01

    Background Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Objective Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer’s (AD), or Parkinson’s (PD) diseases in an elderly population across the northeastern United States. Methods We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999–2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. Results We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Citation Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological

  5. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States.

    PubMed

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D; Weisskopf, Marc G; Melly, Steven J; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2016-01-01

    Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer's (AD), or Parkinson's (PD) diseases in an elderly population across the northeastern United States. We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999-2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological hospital admissions in the northeastern United States. Environ

  6. Weed Diversity Affects Soybean and Maize Yield in a Long Term Experiment in Michigan, USA.

    PubMed

    Ferrero, Rosana; Lima, Mauricio; Davis, Adam S; Gonzalez-Andujar, Jose L

    2017-01-01

    Managing production environments in ways that promote weed community diversity may enhance both crop production and the development of a more sustainable agriculture. This study analyzed data of productivity of maize (corn) and soybean in plots in the Main Cropping System Experiment (MCSE) at the W. K. Kellogg Biological Station Long-Term Ecological Research (KBS-LTER) in Michigan, USA, from 1996 to 2011. We used models derived from population ecology to explore how weed diversity, temperature, and precipitation interact with crop yields. Using three types of models that considered internal and external (climate and weeds) factors, with additive or non-linear variants, we found that changes in weed diversity were associated with changes in rates of crop yield increase over time for both maize and soybeans. The intrinsic capacity for soybean yield increase in response to the environment was greater under more diverse weed communities. Soybean production risks were greatest in the least weed diverse systems, in which each weed species lost was associated with progressively greater crop yield losses. Managing for weed community diversity, while suppressing dominant, highly competitive weeds, may be a helpful strategy for supporting long term increases in soybean productivity. In maize, there was a negative and non-additive response of yields to the interaction between weed diversity and minimum air temperatures. When cold temperatures constrained potential maize productivity through limited resources, negative interactions with weed diversity became more pronounced. We suggest that: (1) maize was less competitive in cold years allowing higher weed diversity and the dominance of some weed species; or (2) that cold years resulted in increased weed richness and prevalence of competitive weeds, thus reducing crop yields. Therefore, we propose to control dominant weed species especially in the years of low yield and extreme minimum temperatures to improve maize yields

  7. Weed Diversity Affects Soybean and Maize Yield in a Long Term Experiment in Michigan, USA

    PubMed Central

    Ferrero, Rosana; Lima, Mauricio; Davis, Adam S.; Gonzalez-Andujar, Jose L.

    2017-01-01

    Managing production environments in ways that promote weed community diversity may enhance both crop production and the development of a more sustainable agriculture. This study analyzed data of productivity of maize (corn) and soybean in plots in the Main Cropping System Experiment (MCSE) at the W. K. Kellogg Biological Station Long-Term Ecological Research (KBS-LTER) in Michigan, USA, from 1996 to 2011. We used models derived from population ecology to explore how weed diversity, temperature, and precipitation interact with crop yields. Using three types of models that considered internal and external (climate and weeds) factors, with additive or non-linear variants, we found that changes in weed diversity were associated with changes in rates of crop yield increase over time for both maize and soybeans. The intrinsic capacity for soybean yield increase in response to the environment was greater under more diverse weed communities. Soybean production risks were greatest in the least weed diverse systems, in which each weed species lost was associated with progressively greater crop yield losses. Managing for weed community diversity, while suppressing dominant, highly competitive weeds, may be a helpful strategy for supporting long term increases in soybean productivity. In maize, there was a negative and non-additive response of yields to the interaction between weed diversity and minimum air temperatures. When cold temperatures constrained potential maize productivity through limited resources, negative interactions with weed diversity became more pronounced. We suggest that: (1) maize was less competitive in cold years allowing higher weed diversity and the dominance of some weed species; or (2) that cold years resulted in increased weed richness and prevalence of competitive weeds, thus reducing crop yields. Therefore, we propose to control dominant weed species especially in the years of low yield and extreme minimum temperatures to improve maize yields

  8. The effect of hospital mergers on long-term sickness absence among hospital employees: a fixed effects multivariate regression analysis using panel data

    PubMed Central

    2014-01-01

    Background Hospitals are merging to become more cost-effective. Mergers are often complex and difficult processes with variable outcomes. The aim of this study was to analyze the effect of mergers on long-term sickness absence among hospital employees. Methods Long-term sickness absence was analyzed among hospital employees (N = 107 209) in 57 hospitals involved in 23 mergers in Norway between 2000 and 2009. Variation in long-term sickness absence was explained through a fixed effects multivariate regression analysis using panel data with years-since-merger as the independent variable. Results We found a significant but modest effect of mergers on long-term sickness absence in the year of the merger, and in years 2, 3 and 4; analyzed by gender there was a significant effect for women, also for these years, but only in year 4 for men. However, men are less represented among the hospital workforce; this could explain the lack of significance. Conclusions Mergers has a significant effect on employee health that should be taken into consideration when deciding to merge hospitals. This study illustrates the importance of analyzing the effects of mergers over several years and the need for more detailed analyses of merger processes and of the changes that may occur as a result of such mergers. PMID:24490750

  9. The effect of hospital mergers on long-term sickness absence among hospital employees: a fixed effects multivariate regression analysis using panel data.

    PubMed

    Kjekshus, Lars Erik; Bernstrøm, Vilde Hoff; Dahl, Espen; Lorentzen, Thomas

    2014-02-03

    Hospitals are merging to become more cost-effective. Mergers are often complex and difficult processes with variable outcomes. The aim of this study was to analyze the effect of mergers on long-term sickness absence among hospital employees. Long-term sickness absence was analyzed among hospital employees (N = 107 209) in 57 hospitals involved in 23 mergers in Norway between 2000 and 2009. Variation in long-term sickness absence was explained through a fixed effects multivariate regression analysis using panel data with years-since-merger as the independent variable. We found a significant but modest effect of mergers on long-term sickness absence in the year of the merger, and in years 2, 3 and 4; analyzed by gender there was a significant effect for women, also for these years, but only in year 4 for men. However, men are less represented among the hospital workforce; this could explain the lack of significance. Mergers has a significant effect on employee health that should be taken into consideration when deciding to merge hospitals. This study illustrates the importance of analyzing the effects of mergers over several years and the need for more detailed analyses of merger processes and of the changes that may occur as a result of such mergers.

  10. Detailed description of a long-term low-level waste degradation experiment

    SciTech Connect

    Caron, F.; Torok, J.; Haas, M.K.; Manni, G.

    1997-12-31

    This work gives a detailed description of the important aspects of a long-term Low-Level Radioactive Waste (LLRW) degradation experiment, performed at Chalk River Laboratories (CRL). This experiment utilized actual LLRW. The wastes consist of unconditioned compacted refuse (paper, mop heads, paper towels, used clothing, etc.), which represents the bulk of the waste volume intended for near-surface disposal at CRL. Waste material was collected and compacted to make a total of 11 bales for this experiment. Each bale was then placed and sealed in separate steel containers which were connected to sampling lines. After a dry monitoring period, water was added to promote leaching and decomposition of the wastes. The leachate sampled had a composition similar to landfill leachates. Some applications of this experiment, used to support the safety case of near-surface disposal, are briefly discussed in this paper, e.g., the production of colloidal material, the nature and role of dissolved organics of microbial origin, etc.

  11. Surprises and insights from long-term aquatic datasets and experiments

    Treesearch

    Walter K. Dodds; Christopher T. Robinson; Evelyn E. Gaiser; Gretchen J.A. Hansen; Heather Powell; Joseph M. Smith; Nathaniel B. Morse; Sherri L. Johnson; Stanley V. Gregory; Tisza Bell; Timothy K. Kratz; William H. McDowell

    2012-01-01

    Long-term research on freshwater ecosystems provides insights that can be difficult to obtain from other approaches. Widespread monitoring of ecologically relevant water-quality parameters spanning decades can facilitate important tests of ecological principles. Unique long-term data sets and analytical tools are increasingly available, allowing for powerful and...

  12. An African grassland responds similarly to long-term fertilization to the Park Grass experiment.

    PubMed

    Ward, David; Kirkman, Kevin; Tsvuura, Zivanai

    2017-01-01

    We compared the results of a long-term (65 years) experiment in a South African grassland with the world's longest-running ecological experiment, the Park Grass study at Rothamsted, U.K. The climate is warm and humid in South Africa and cool and temperate in England. The African grassland has been fertilized with two forms of nitrogen applied at four levels, phosphorus and lime in a crossed design in 96 plots. In 1951, about 84% of plant cover consisted of Themeda triandra, Tristachya leucothrix and Setaria nigrirostris. Currently, the dominant species are Panicum maximum, Setaria sphacelata and Eragrostis curvula, making up 71% of total biomass. As in the Park Grass experiment, we found a significant (additive) interaction effect on ANPP of nitrogen and phosphorus, and a (marginally significant) negative correlation between ANPP and species richness. Unlike the Park Grass experiment, there was no correlation between ANPP and species richness when pH was included as a covariate. There was also a significant negative effect of nitrogen amount and nitrogen form and a positive effect of lime on species richness and species diversity. Soil pH had an important effect on species richness. Liming was insufficient to balance the negative effects on species richness of nitrogen fertilization. There was a significant effect of pH on biomass of three abundant species. There were also significant effects of light on the biomass of four species, with only Panicum maximum having a negative response to light. In all of the abundant species, adding total species richness and ANPP to the model increased the amount of variance explained. The biomass of Eragrostis curvula and P. maximum were negatively correlated with species richness while three other abundant species increased with species richness, suggesting that competition and facilitation were active. Consistent with the results from the Park Grass and other long-term fertilization experiments of grasslands, we found a

  13. An African grassland responds similarly to long-term fertilization to the Park Grass experiment

    PubMed Central

    Kirkman, Kevin; Tsvuura, Zivanai

    2017-01-01

    We compared the results of a long-term (65 years) experiment in a South African grassland with the world’s longest-running ecological experiment, the Park Grass study at Rothamsted, U.K. The climate is warm and humid in South Africa and cool and temperate in England. The African grassland has been fertilized with two forms of nitrogen applied at four levels, phosphorus and lime in a crossed design in 96 plots. In 1951, about 84% of plant cover consisted of Themeda triandra, Tristachya leucothrix and Setaria nigrirostris. Currently, the dominant species are Panicum maximum, Setaria sphacelata and Eragrostis curvula, making up 71% of total biomass. As in the Park Grass experiment, we found a significant (additive) interaction effect on ANPP of nitrogen and phosphorus, and a (marginally significant) negative correlation between ANPP and species richness. Unlike the Park Grass experiment, there was no correlation between ANPP and species richness when pH was included as a covariate. There was also a significant negative effect of nitrogen amount and nitrogen form and a positive effect of lime on species richness and species diversity. Soil pH had an important effect on species richness. Liming was insufficient to balance the negative effects on species richness of nitrogen fertilization. There was a significant effect of pH on biomass of three abundant species. There were also significant effects of light on the biomass of four species, with only Panicum maximum having a negative response to light. In all of the abundant species, adding total species richness and ANPP to the model increased the amount of variance explained. The biomass of Eragrostis curvula and P. maximum were negatively correlated with species richness while three other abundant species increased with species richness, suggesting that competition and facilitation were active. Consistent with the results from the Park Grass and other long-term fertilization experiments of grasslands, we found a

  14. Association of hospitalization with long-term cognitive and brain MRI changes in the ARIC cohort

    PubMed Central

    Sharrett, A. Richey; Coresh, Josef; Schneider, Andrea L.C.; Alonso, Alvaro; Knopman, David S.; Mosley, Thomas H.; Gottesman, Rebecca F.

    2015-01-01

    Objective: To determine whether hospitalization is associated with subsequent cognitive decline or changes on brain MRI in a community-based cohort. Methods: Baseline and follow-up cognitive testing (n = 2,386) and MRI scans with standardized assessments (n = 885) were available from a subset of white and black participants in the Atherosclerosis Risk in Communities study. Cognitive tests included the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT). Hospitalization characteristics were determined using ICD-9 codes. Regression models adjusted for demographics, education, comorbidities, and APOE ε4 were used to estimate the independent association of hospitalization with changes in cognition or neuroimaging. Results: Over a mean 14.1 years between visits, 1,266 participants (53.1%) were hospitalized. Hospitalization compared with no hospitalization was associated with greater decline in DSST scores (1.25 points greater decline, p < 0.001) but no difference in DWRT or WFT score change. Each additional hospitalization, as well as a critical illness vs noncritical illness hospitalization, was associated with greater decline in DSST scores. A subset of participants (n = 885) underwent MRI scans separated by 10.5 years. Hospitalization (n = 392) compared with no hospitalization was associated with a 57% higher odds of increasing ventricular size at follow-up. Each additional hospitalization, as well as having a critical illness vs noncritical illness hospitalization, and having a hospitalization with major surgery vs no surgery was associated with greater odds of increased ventricular size. Conclusions: Cognitive decline and neuroimaging changes may occur after hospitalization, independent of baseline demographics and comorbidities. PMID:25762715

  15. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

    PubMed

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

    2014-02-01

    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  16. Study on the weediness of winter wheat in a long-term fertilization field experiment.

    PubMed

    Lehoczky, E; Kismányoky, A; Kismányoky, T

    2006-01-01

    The study was carried out in Keszthely, in the long-term fertilization field experiment in April of 2005. In the experiment we had opportunity to compare the weediness in NPK and NPK + FYM* treatments, and we could study the effect of increasing N dosis on the weeds and winter wheat. The weed survey was made on the 20th of April at the end of tillering. For the weed survey used the Balázs-Ujvárosi method. After that we collected all the weeds from the plots per 1 m2. We counted, measured the fresh and dry matter weight of aerial parts. Winter wheat sampels were taken also from all plots (1 running meter per plot). In the experiment 10 weed species were found, 9 annual: Ambrosia artemisiifolia, Consolida regalis, Galium aparine, Lamiunt amplexicaule, Matricaria inodora, Papaver rhoeas, Stellaria media, Veronica hederifolia, Veronica triphyllos, and 1 perennial: Cirsium arvense. Veronica hederifolia was the dominant species in both fertilized plots, Stellaria media has the second highest weed coverage. The manuring treatments, and the N-dosis has important and significantly effect to the weedeness and the biomass production of winter wheat. On the control plots was the relation of biomass weight of weeds the highest. This relation reduced to the effect of N treatments, wich had an favorable effect on the winter wheat.

  17. Neuroplasticity beyond Sounds: Neural Adaptations Following Long-Term Musical Aesthetic Experiences

    PubMed Central

    Reybrouck, Mark; Brattico, Elvira

    2015-01-01

    Capitalizing from neuroscience knowledge on how individuals are affected by the sound environment, we propose to adopt a cybernetic and ecological point of view on the musical aesthetic experience, which includes subprocesses, such as feature extraction and integration, early affective reactions and motor actions, style mastering and conceptualization, emotion and proprioception, evaluation and preference. In this perspective, the role of the listener/composer/performer is seen as that of an active “agent” coping in highly individual ways with the sounds. The findings concerning the neural adaptations in musicians, following long-term exposure to music, are then reviewed by keeping in mind the distinct subprocesses of a musical aesthetic experience. We conclude that these neural adaptations can be conceived of as the immediate and lifelong interactions with multisensorial stimuli (having a predominant auditory component), which result in lasting changes of the internal state of the “agent”. In a continuous loop, these changes affect, in turn, the subprocesses involved in a musical aesthetic experience, towards the final goal of achieving better perceptual, motor and proprioceptive responses to the immediate demands of the sounding environment. The resulting neural adaptations in musicians closely depend on the duration of the interactions, the starting age, the involvement of attention, the amount of motor practice and the musical genre played. PMID:25807006

  18. Evaluating the soil physical quality under long-term field experiments in Southern Italy

    NASA Astrophysics Data System (ADS)

    Castellini, Mirko; Stellacci, Anna Maria; Iovino, Massimo; Rinaldi, Michele; Ventrella, Domenico

    2017-04-01

    Long-term field experiments performed in experimental farms are important research tools to assess the soil physical quality (SPQ) given that relatively stable conditions can be expected in these soils. However, different SPQ indicators may sometimes provide redundant or conflicting results, making difficult an SPQ evaluation (Castellini et al., 2014). As a consequence, it is necessary to apply appropriate statistical procedures to obtain a minimum set of key indicators. The study was carried out at the Experimental Farm of CREA-SCA (Foggia) in two long-term field experiments performed on durum wheat. The first long-term experiment is aiming at evaluating the effects of two residue management systems (burning, B or soil incorporation of crop residues, I) while the second at comparing the effect of tillage (conventional tillage, CT) and sod-seeding (direct drilling, DD). In order to take into account both optimal and non-optimal soil conditions, five SPQ indicators were monitored at 5-6 sampling dates during the crop season (i.e., between November and June): soil bulk density (BD), macroporosity (PMAC), air capacity (AC), plant available water capacity (PAWC) and relative field capacity (RFC). Two additional data sets, collected on DD plot in different cropping seasons and in Sicilian soils differing for texture, depth and land use (N=140), were also used with the aim to check the correlation among indicators. Impact of soil management was assessed by comparing SPQ evaluated under different management systems with optimal reference values reported in literature. Two techniques of multivariate analysis (principal component analysis, PCA and stepwise discriminant analysis, SDA) were applied to select the most suitable indicator to facilitate the judgment on SPQ. Regardless of the considered management system, sampling date or auxiliary data set, correlation matrices always showed significant negative relationships between RFC and AC. Decreasing RFC at increasing AC is

  19. STROBE-Long-Term Exposure to Ambient Fine Particulate Air Pollution and Hospitalization Due to Peptic Ulcers

    PubMed Central

    Wong, Chit-Ming; Tsang, Hilda; Lai, Hak-Kan; Thach, Thuan-Quoc; Thomas, G. Neil; Chan, King-Pan; Lee, Siu-Yin; Ayres, Jon G.; Lam, Tai-Hing; Leung, Wai K.

    2016-01-01

    Abstract Little is known about the effect of air pollution on the gastrointestinal (GI) system. We investigated the association between long-term exposures to outdoor fine particles (PM2.5) and hospitalization for peptic ulcer diseases (PUDs) in a large cohort of Hong Kong Chinese elderly. A total of 66,820 subjects aged ≥65 years who were enrolled in all 18 Government Elderly Health Service centers of Hong Kong participated in the study voluntarily between 1998 and 2001. They were prospectively followed up for more than 10 years. Annual mean exposures to PM2.5 at residence of individuals were estimated by satellite data through linkage with address details including floor level. All hospital admission records of the subjects up to December 31, 2010 were retrieved from the central database of Hospital Authority. We used Cox regression to estimate the hazard ratio (HR) for PUD hospitalization associated with PM2.5 exposure after adjustment for individual and ecological covariates. A total of 60,273 subjects had completed baseline information including medical, socio-demographic, lifestyle, and anthropometric data at recruitment. During the follow-up period, 1991 (3.3%) subjects had been hospitalized for PUD. The adjusted HR for PUD hospitalization per 10 μg/m3 of PM2.5 was 1.18 (95% confidence interval: 1.02–1.36, P = 0.02). Further analysis showed that the associations with PM2.5 were significant for gastric ulcers (HR 1.29; 1.09–1.53, P = 0.003) but not for duodenal ulcers (HR 0.98; 0.78 to 1.22, P = 0.81). Long-term exposures to PM2.5 were associated with PUD hospitalization in elder population. The mechanism underlying the PM2.5 in the development of gastric ulcers warrants further research. PMID:27149464

  20. Long-Term Care and Impending Mortality: Influence Upon Place of Death and Hospital Utilization.

    ERIC Educational Resources Information Center

    Montgomery, Patrick R.; And Others

    1988-01-01

    Analyzed health care use in four years prior to death for 4,256 elderly decedents. Found hospital bed use by nursing home residents declined with age and was much lower than for decedents in community. Institutionalized elders were much less likely to die in hospitals than were community elders, particularly very old and longer-term patients.…

  1. Between unemployment and employment: experience of unemployed long-term pain sufferers.

    PubMed

    Glavare, Maria; Löfgren, Monika; Schult, Marie-Louise

    2012-01-01

    This study explored and analysed how patients experienced possibilities for, and barriers to, work return after participation in a multi-professional pain-rehabilitation program followed by a coached work-training program (CWT). Eleven informants (8 women/3 men) with long-term musculoskeletal pain who had participated in the CWT program for 4-21 months (mean=11) comprised the study. A qualitative emergent design was used. Data collected with interviews were analysed using the constant comparison method of grounded theory. Triangulation in researchers were used. The analyses of the interviews resulted in the development of a three-category theoretical model, which was named "a way back to work". The main category "Experience of a way back to work" consisted of the informants' experience during the process between unemployment and employment. The category "Support" describes the help the informants received from various actors, and the category "Negative response" describes negative responses from the actors involved, which was an important barrier in the process between unemployment and employment. Professional individualised support, participants feeling involved in their rehabilitation process, coaching at real workplaces and multi-professional team including health care personnel, were valuable during the process towards work.

  2. [Using focus groups to explore the group music therapy experience of long term care elderly].

    PubMed

    Lin, Hui-Chuan; Chen, Shu-Ling

    2007-04-01

    The purpose of this study was to explore the elderly's experience and perceptions of group music therapy. The residents of a long term care institution received group music therapy for one year. Afterwards, three interviews were conducted in focus groups of between six and eight of the elderly. Their ages ranged from 64 to 90. Ninety-five percent of these elderly subjects participated in the therapy for over ten months. The tape-recorded interviews were transcribed and analyzed using content analysis. Six themes emerged regarding the elderly subjects' experiences and perceptions of group music therapy, as follows: (1) becoming more willing to participate; (2) feeling pain relief and more controlled moods; (3) getting physically better; (4) being more motivated to live; (5) learning positive personal interaction and obedience to the rules of the group; and (6) learning skills to improve personal health. This information might be used as a helpful and valuable reference in nursing education and by administrative organizations involved in the planning of therapeutic programs for the elderly.

  3. A smart homecage system with 3D tracking for long-term behavioral experiments.

    PubMed

    Byunghun Lee; Kiani, Mehdi; Ghovanloo, Maysam

    2014-01-01

    A wirelessly-powered homecage system, called the EnerCage-HC, that is equipped with multi-coil wireless power transfer, closed-loop power control, optical behavioral tracking, and a graphic user interface (GUI) is presented for long-term electrophysiology experiments. The EnerCage-HC system can wirelessly power a mobile unit attached to a small animal subject and also track its behavior in real-time as it is housed inside a standard homecage. The EnerCage-HC system is equipped with one central and four overlapping slanted wire-wound coils (WWCs) with optimal geometries to form 3-and 4-coil power transmission links while operating at 13.56 MHz. Utilizing multi-coil links increases the power transfer efficiency (PTE) compared to conventional 2-coil links and also reduces the number of power amplifiers (PAs) to only one, which significantly reduces the system complexity, cost, and dissipated heat. A Microsoft Kinect installed 90 cm above the homecage localizes the animal position and orientation with 1.6 cm accuracy. An in vivo experiment was conducted on a freely behaving rat by continuously delivering 24 mW to the mobile unit for > 7 hours inside a standard homecage.

  4. A facility for long-term Mars simulation experiments: the Mars Environmental Simulation Chamber (MESCH).

    PubMed

    Jensen, Lars Liengaard; Merrison, Jonathan; Hansen, Aviaja Anna; Mikkelsen, Karina Aarup; Kristoffersen, Tommy; Nørnberg, Per; Lomstein, Bente Aagaard; Finster, Kai

    2008-06-01

    We describe the design, construction, and pilot operation of a Mars simulation facility comprised of a cryogenic environmental chamber, an atmospheric gas analyzer, and a xenon/mercury discharge source for UV generation. The Mars Environmental Simulation Chamber (MESCH) consists of a double-walled cylindrical chamber. The double wall provides a cooling mantle through which liquid N(2) can be circulated. A load-lock system that consists of a small pressure-exchange chamber, which can be evacuated, allows for the exchange of samples without changing the chamber environment. Fitted within the MESCH is a carousel, which holds up to 10 steel sample tubes. Rotation of the carousel is controlled by an external motor. Each sample in the carousel can be placed at any desired position. Environmental data, such as temperature, pressure, and UV exposure time, are computer logged and used in automated feedback mechanisms, enabling a wide variety of experiments that include time series. Tests of the simulation facility have successfully demonstrated its ability to produce temperature cycles and maintain low temperature (down to -140 degrees C), low atmospheric pressure (5-10 mbar), and a gas composition like that of Mars during long-term experiments.

  5. Histopathology Image Analysis in Two Long-Term Animal Experiments with Helical Flow Total Artificial Heart.

    PubMed

    Wotke, Jiri; Homolka, Pavel; Vasku, Jaromír; Dobsak, Petr; Palanova, Petra; Mrkvicova, Veronika; Konecny, Petr; Soska, Vladimir; Pohanka, Michal; Novakova, Marie; Yurimoto, Terumi; Saito, Itsuro; Inoue, Yusuke; Isoyama, Takashi; Abe, Yusuke

    2016-12-01

    Histopathological analysis can provide important information in long-term experiments with total artificial heart (TAH). Recently, a new type of blood pump, the helical flow total artificial heart (HF-TAH) was developed. This study aimed to investigate the changes in selected vital organs in animal experiments with implanted HF-TAH. Samples from lung, liver, and kidneys from two female goats (No. 1301 and No. 1304) with implanted HF-TAH were analyzed. Tissue samples were fixed in 10% formaldehyde and 4 µm thick transverse sections were stained with hematoxylin-eosin (HE). Additional staining was done for detection of connective tissue (Masson-Goldner stain) and for detection of iron (hemosiderin) deposits (Perls stain). Sections were scanned at 100× and 500× magnification with a light microscope. Experiment no. 1301 survived 100 days (cause of termination was heavy damage of the right pump); experimental goat no.1304 survived 68 days and was sacrificed due to severe right hydrodynamic bearing malfunction. Histopathological analysis of liver samples proved signs of chronic venostasis with limited focal necrotic zones. Dilated tubules, proteinaceous material in tubular lumen, and hemosiderin deposits were detected in kidney samples. Contamination of the organs by embolized micro-particles was suspected at the autopsy after discovery of visible damage (scratches) of the pump impeller surface (made from titanium alloy) in both experiments. Sporadic deposits of foreign micro-particles (presumably titanium) were observed in most of the analyzed parenchymal organs. However, the described deposits were not in direct connection with inflammatory reactions in the analyzed tissues. Histopathological analysis showed the presence of minimal contamination of the lung, kidney, and liver tissue samples by foreign material (titanium very likely). The analysis showed only limited pathological changes, especially in liver and kidneys, which might be attributed to the influence of

  6. Long-term survivors of childhood bone and soft tissue sarcomas are at risk of hospitalization.

    PubMed

    Gonzalez, Cristian D; Randall, R Lor; Wright, Jennifer; Spraker-Perlman, Holly; Ying, Jian; Sweeney, Carol; Smith, Ken R; Kirchhoff, Anne C

    2017-06-01

    Childhood cancer survivors can have a high burden of chronic conditions related to cancer treatment, some of which are debilitating or potentially life-threatening. Much remains to be learned about late effects in bone and soft tissue sarcoma survivors. The Utah Cancer Registry was used to identify survivors of bone (N = 71) and soft tissue sarcomas (N = 98) who were diagnosed at ages 0-20 years between 1973 and 2007 and were alive at least 5 years after diagnosis. We selected an age-sex-matched comparison cohort (N = 934). Hospitalizations from 1996 to 2012 were extracted from the Utah Department of Health statewide inpatient hospitalization discharge records. Cox, Poisson, and Gamma regressions were used to evaluate the risk of hospitalization, rate of admission, and length of stay for survivors versus the comparison cohort. Primary ICD-9 codes defined the most common reasons for hospitalizations. The hazard ratio (HR) of any hospitalization was higher for survivors in reference to the comparison cohort (HR = 2.12, 95% confidence interval [CI] 1.51-2.97). Survivors experienced more hospital admissions (rate ratio [RR] = 4.58, 95% CI 3.92-5.35) and longer length of stay (RR = 1.28, 95% CI 1.12-1.46) compared with the comparison cohort. Survivors treated with any chemotherapy were at three-fold higher risk (HR = 3.37, 95% CI 1.94-5.83) of hospitalization compared with survivors who received surgery and/or radiation alone. Among hospitalized survivors, the most common reason was injury for bone tumor (26.8%) and neoplasm for soft tissue sarcoma (12.2%). Childhood survivors of bone tumor and soft tissue sarcoma face ongoing risk of hospitalization for years after diagnosis. © 2016 Wiley Periodicals, Inc.

  7. An off year for consolidation. 1997 hospital mergers, acquisitions, joint ventures and long-term leases.

    PubMed

    Japsen, B

    1998-01-12

    Because of a significant drop in the number of major corporate mergers and acquisitions, total hospital consolidation in 1997 was well off the record-setting pace of previous years. The number of hospitals involved in dealmaking dropped 18% to 627 compared with the previous year, according to Modern Healthcare's fourth annual roundup of consolidation activity. And there were only four corporate deals, compared with 11 in 1996.

  8. Long-term experience with ZENPEP in infants with exocrine pancreatic insufficiency associated with cystic fibrosis.

    PubMed

    Wooldridge, Jamie L; Schaeffer, David; Jacobs, David; Thieroff-Ekerdt, Ruth

    2014-11-01

    The objective of our study was to determine whether infants with cystic fibrosis who developed exocrine pancreatic insufficiency in early infancy would tolerate long-term treatment with ZENPEP (pancrelipase) delayed-release capsules, containing 3000 US Pharmacopeia units of lipase/capsule, and demonstrate consistent long-term growth. The most common treatment-emergent adverse events were diarrhea, vomiting, and constipation (mild or moderate). At study completion, median weight-for-age percentiles increased from 22nd to 49th, median length-for-age percentiles increased from 36.5th to 42nd, and median weight-for-length percentiles increased from 41.5th to 55.5th. Long-term treatment (up to 12 months) of infants with exocrine pancreatic insufficiency owing to cystic fibrosis with ZENPEP was well tolerated and associated with improved growth parameters. This is the first long-term study of pancreatic enzyme replacement therapy conducted in this patient population.

  9. Decreasing trend of Legionella isolation in a long-term microbial monitoring program in Greek hospitals.

    PubMed

    Velonakis, Emanouil; Karanika, Maria; Mouchtouri, Varavara; Thanasias, Efthimios; Katsiaflaka, Anna; Vatopoulos, Alkis; Hadjichristodoulou, Christos

    2012-01-01

    Legionnaires' disease is a known cause of severe pneumonia in a nosocomial setting. This study examined Legionella isolation in Greek hospitals. Water samples and swabs of showerheads from 41 hospitals were collected over a four-year period (2004-2007) from hot and cold water systems and cooling towers in Greece. In total, 1058 samples were examined for the presence of Legionella. From the hot water samples examined, 166 out of 607 (27.3%) were positive for Legionella, including 111 (18.3%) positive for Legionella pneumophila sg1 samples. The temperature of hot water samples less than 55°C was statistically significant, associated with Legionella spp. isolation (RR 4.01, 95%CI 2.33-6.92). Ten out of 17 (58.8%) hospital cooling towers required remedial actions due to Legionella colonization. Reemergence of Legionella spp. colonization was evident in more than half of the hospitals where frequent monitoring and appropriate risk assessment plans were absent or lacking. Hospitals that were monitored continuously over the study period presented a decreasing trend of Legionella colonization. Environmental risk assessment together with Legionella isolation should be enforced systematically in hospitals.

  10. CQESTR Simulation of Soil Organic Matter Dynamics in Long-term Agricultural Experiments across USA

    NASA Astrophysics Data System (ADS)

    Gollany, H.; Liang, Y.; Albrecht, S.; Rickman, R.; Follett, R.; Wilhelm, W.; Novak, J.

    2009-04-01

    Soil organic matter (SOM) has important chemical (supplies nutrients, buffers and adsorbs harmful chemical compounds), biological (supports the growth of microorganisms and micro fauna), and physical (improves soil structure and soil tilth, stores water, and reduces surface crusting, water runoff) functions. The loss of 20 to 50% of soil organic carbon (SOC) from USA soils after converting native prairie or forest to production agriculture is well documented. Sustainable management practices for SOC is critical for maintaining soil productivity and responsible utilization of crop residues. As crop residues are targeted for additional uses (e.g., cellulosic ethanol feedstock) developing C models that predict change in SOM over time with change in management becomes increasingly important. CQESTR, pronounced "sequester," is a process-based C balance model that relates organic residue additions, crop management and soil tillage to SOM accretion or loss. The model works on daily time-steps and can perform long-term (100-year) simulations. Soil organic matter change is computed by maintaining a soil C budget for additions, such as crop residue or added amendments like manure, and organic C losses through microbial decomposition. Our objective was to simulate SOM changes in agricultural soils under a range of soil parent materials, climate and management systems using the CQESTR model. Long-term experiments (e.g. Champaign, IL, >100 yrs; Columbia, MO, >100 yrs; Lincoln, NE, 20 yrs) under various tillage practices, organic amendments, crop rotations, and crop residue removal treatments were selected for their documented history of the long-term effects of management practice on SOM dynamics. Simulated and observed values from the sites were significantly related (r2 = 94%, P < 0.001) with slope not significantly different from 1. Recent interest in crop residue removal for biofuel feedstock prompted us to address that as a management issue. CQESTR successfully simulated a

  11. Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

    SciTech Connect

    Kapoor, Sumit; Batra, Sachin; Carson, Kathryn; Shuck, John; Kharkar, Siddharth; Gandhi, Rahul; Jackson, Juan; Wemmer, Jan; Terezakis, Stephanie; Shokek, Ori; Kleinberg, Lawrence; Rigamonti, Daniele

    2011-11-01

    Purpose: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm{sup 3} were 18.02 times more likely to progress than those with tumor volumes of 1 cm{sup 3} or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the 'no salvage surgery needed' and 'no additional treatment needed' criteria for treatment success need to be complemented by the radiologic data.

  12. Sarin experiences in Japan: acute toxicity and long-term effects.

    PubMed

    Yanagisawa, N; Morita, H; Nakajima, T

    2006-11-01

    Two terrorist attacks with the nerve agent Sarin affected citizens in Matsumoto and Tokyo, Japan in 1994 and 1995, killing 19 and injuring more the 6000. Sarin, a very potent organophosphate nerve agent, inhibits acetylcholinesterase (AchE) activity within the central, peripheral, and autonomic nervous systems. Acute and long-term Sarin effects upon humans were well documented in these two events. Sarin gas inhalation caused instantaneous death by respiratory arrest in 4 victims in Matsumoto. In Tokyo, two died in station yards and another ten victims died in hospitals within a few hours to 3 months after poisoning. Six victims with serum ChE below 20% of the lowest normal were resuscitated from cardiopulmonary arrest (CPA) or coma with generalized convulsion. Five recovered completely and one remained in vegetative state due to anoxic brain damage. EEG abnormalities persisted for up to 5 years. Miosis and copious secretions from the respiratory and GI tracts (muscarinic effects) were common in severely to slightly affected victims. Weakness and twitches of muscles (nicotinic effects) appeared in severely affected victims. Neuropathy and ataxia were observed in small number (less than 10%) of victims, which findings disappeared between 3 days and 3 months. Leukocytosis and high serum CK levels were common. Hyperglycemia, ketonuria, low serum triglyceride, hypopotassemia were observed in severely affected victims, which abnormalities were attributed to damage of the adrenal medulla. Oximes, atropine sulphate, diazepam and ample intravenous infusion were effective treatments. Pralidoxime iodide IV reversed cholinesterase and symptoms quickly even if administered 6 h after exposure. Post Traumatic Stress Disorder (PTSD) was less than 8% after 5 years. However, psychological symptoms continue in victims of both incidents. In summary, both potent toxicity and quick recovery from critical ill conditions were prominent features. Conventional therapies proved effective in

  13. The TAPS project. 17: Readmission to hospital for long term psychiatric patients after discharge to the community.

    PubMed Central

    Thornicroft, G.; Gooch, C.; Dayson, D.

    1992-01-01

    OBJECTIVE--To identify risk factors which increase the likelihood of readmission for long stay psychiatric patients after discharge from hospital. DESIGN--Follow up for five years of all long stay patients discharged from two large psychiatric hospitals to compare patients readmitted and not readmitted. SETTING--Friern and Claybury Hospitals in north London and their surrounding catchment areas. Most patients were discharged to staffed or unstaffed group homes. SUBJECTS--357 psychiatric patients who had been in hospital for over one year, of whom 118 were "new" long stay and 239 "old" long stay patients. MAIN OUTCOME MEASURES--Readmission to hospital and length of subsequent stay. RESULTS--Of all discharged patients 97 (27%) were readmitted at some time during the follow up period, 57 (16%) in the first year after discharge, and 31 (9%) then remained in hospital for over a year. The best explanatory factors for readmission were: male sex, younger age group, high number of previous admissions, higher levels of symptomatic and social behavioural disturbance, a diagnosis of manic-depressive psychosis, and living in a non-staffed group home. CONCLUSIONS--During the closure of psychiatric hospitals, facilities need to be preserved for acute relapses among long term, and especially younger, discharged patients. Staffed group homes may help prevent relapse and reduce the number of admission beds required. PMID:1458148

  14. Recent results of comparative radiobiological experiments with short and long term expositions of Arabidopsis seed embryos

    NASA Astrophysics Data System (ADS)

    Zimmermann, M. W.; Gartenbach, K. E.; Kranz, A. R.; Baican, B.; Schopper, E.; Heilmann, C.; Reitz, G.

    1996-01-01

    Comparison of experimental data obtained from short (SDEF) and long duration exposure flights (LDEF) recently led to results, which will contribute for the estimation of genetic risk for long and/or repeated stay of man in space. Under orbital conditions biological stress and damage are induced in test subjects by cosmic radiation, especially the high energetic, densely ionizing component of heavy ions. Plant seeds were successful model systems for a biotest in studying the physiological damages and mutagenic effects caused by ionizing radiation in particular stem cells. In this article we present an overview of our space experiments with Arabidopis thaliana seeds. We present first results of investigations on certain damage endpoints (seed germination, plant survival, mutation frequencies), caused by cosmic ionizing radiation in dry dormant plant seeds ofArabidopsis thaliana after different short term (e.g. IML-1 and D-2) and long term (e.g. EURECA and LDEF-1) space exposures. Total dose effects of heavy ions and the other components of the mixed radiation field on damage endpoints and survival after space exposure and gamma-ray pre-irradiation were obtained. A new method of total dose spectrometry by neutron activation has been applied.

  15. Experience using central venous access for long-term hemodialysis. A new concept.

    PubMed

    McGonigle, D J; Schrock, L G; Hickman, R O

    1983-05-01

    Central venous access for acute renal failure has been used for a number of years. The femoral vein and, more recently, the subclavian vein have been the routes of access. This technique has many advantages, however, it also has some significant limitations. We have recently been using a catheter for long- as well as short-term hemodialysis. The catheter is placed by means of a short incision through an opening in the internal jugular vein, and maneuvered so that the tip lies in the superior portion of the right atrium. After dialysis, the catheter is filled with heparin. The catheter then requires no additional care between between hemodialysis sessions. We have reported an experience of 50 patients in whom this catheter has been used. The complications have been remarkably few, and none were serious or fatal. At present, the patient using the catheter for the longest period of time has had it in position for approximately 19 months. We believe this technique provides a significant new choice among the ways in which hemodialysis can be achieved for short- or long-term needs.

  16. Video tracking algorithm of long-term experiment using stand-alone recording system

    NASA Astrophysics Data System (ADS)

    Chen, Yu-Jen; Li, Yan-Chay; Huang, Ke-Nung; Jen, Sun-Lon; Young, Ming-Shing

    2008-08-01

    Many medical and behavioral applications require the ability to monitor and quantify the behavior of small animals. In general these animals are confined in small cages. Often these situations involve very large numbers of cages. Modern research facilities commonly monitor simultaneously thousands of animals over long periods of time. However, conventional systems require one personal computer per monitoring platform, which is too complex, expensive, and increases power consumption for large laboratory applications. This paper presents a simplified video tracking algorithm for long-term recording using a stand-alone system. The feature of the presented tracking algorithm revealed that computation speed is very fast data storage requirements are small, and hardware requirements are minimal. The stand-alone system automatically performs tracking and saving acquired data to a secure digital card. The proposed system is designed for video collected at a 640×480 pixel with 16 bit color resolution. The tracking result is updated every 30 frames/s. Only the locomotive data are stored. Therefore, the data storage requirements could be minimized. In addition, detection via the designed algorithm uses the Cb and Cr values of a colored marker affixed to the target to define the tracked position and allows multiobject tracking against complex backgrounds. Preliminary experiment showed that such tracking information stored by the portable and stand-alone system could provide comprehensive information on the animal's activity.

  17. Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis.

    PubMed

    Conrozier, Thierry; Chevalier, Xavier

    2008-07-01

    Osteoarthritis is the most frequent musculoskeletal disease and a major cause of disability in the elderly. Knee osteoarthritis is the first cause of consultations for osteoarthritis-related symptoms. Its current management requires the combination of pharmaceutical and non-pharmacological strategies, including intra-articular injections of hyaluronic acid that are aimed at decreasing pain and improving joint function by restoring joint homeostasis (viscosupplementation). Hylan GF-20 is a cross-linked hyaluronic acid derivative, FDA approved as a medical device since 1997 for the treatment of patients with symptomatic knee osteoarthritis. This review aims to summarise recently published evidence and offer practical suggestions to clinical colleagues who are considering including viscosupplementation in their practices. The authors reviewed extensively the published papers on the topic, but selected only those that appeared to be the most relevant, on the mechanisms of action, efficacy and safety of the treatment, clinical predictors of response, ideal dosing regimen and differences between commercial preparations. They also give their own clinical experience with hylan GF-20 as a symptomatic treatment of knee osteoarthritis. Data of the literature clearly demonstrate that hylan GF-20 is a safe and effective treatment for decreasing pain and improving function in patients suffering from knee osteoarthritis. Its long-term (10 years) use allows knowing with accuracy the main indications, contraindications, side effects and prognostic factors of response, which are all extensively discussed throughout this review.

  18. Tracer experiment results during the Long-Term Flow Test of the Fenton Hill reservoir

    SciTech Connect

    Rodrigues, N.E.V.; Robinson, B.A.; Counce, D.A.

    1993-02-01

    Three chemical tracer experiments and one extended injection of fluid low in concentration of dissolved species have been carried out during the Long Term Flow Test (LTFT) of the Fenton Hill Hot Dry Rock (HDR) reservoir. The tracer tests,results illustrate the dynamic nature of the flow system, with more fluid traveling through longer residence time paths as heat is extracted. The total fracture volumes calculated from these tests allow us to determine the fate of unrecovered injection fluid, examine the pressure-dependence of fracture volume, and, through a comparison to the hydraulic performance, postulate a model for the nature of the pressure drops through the system. The Fresh Water Flush (FWF) test showed that while no dissolved specie behavior is truly conservative (no sources or sinks), several breakthrough curves are well explained with a pore fluid displacement model. Other dissolved components are clearly influenced by dissolution or precipitation reactions. Finally, the transient response of the chemistry during the FWF to an increase in production well pressure showed that some fractures connected to the production well preferentially open when pressure is raised.

  19. The personal significance of home: habitus and the experience of receiving long-term home care.

    PubMed

    Angus, Jan; Kontos, Pia; Dyck, Isabel; McKeever, Patricia; Poland, Blake

    2005-03-01

    The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.

  20. A Natural Electromagnetic Fields Effect on Healthy Volunteers During Long-Term Experiment with Isolation

    NASA Astrophysics Data System (ADS)

    Gurfinkel, Yury I.; Mikhailov, Valery M.; Ushakov, Boris B.

    2008-06-01

    There were investigated four healthy volunteers at the age of 37, 40, 41 and 48 during the baseline 240-d isolation period starting from July 3, 1999 in the frame of SFINCSS-99 - "SIMULATION OF FLIGHT OF INTERNATIONAL CREW ON SPACE STATION". Before a starting of experiment with long-term isolation were carried out measurements of magnetic properties of module and sleeping places. With the regularity of 3 times a week each subject made records of no less then 3 video episodes with the total length of one minute minimum at the same time between 1 and 2 p.m. Applying vital non-invasive computer capillaroscopy of nailbed has allowed quantitatively estimating a capillary blood velocity (CBV). The microcirculation parameters obtained during experiment were compared to local indexes of geomagnetic activity. About 1500 episodes were recorded on laser disks and analyzed. Parameters of microcirculation were compared with other physiological parameters monitored in the experiment. CBV investigation during the most intensive magnetic storm for the period of isolation (A-index- 44) show, that CBV at all volunteers was considerably slowed down. The greatest delay of blood flow velocity revealed at the subject which the factor of shielding of a constant magnetic field at the level of the sleeping berth has made 2,0. CBV at the subject has made 498 ± 46 μm/s with (- 65,8 % from base line). Least delay of a CBV is revealed at the subject which the factor of shielding of a constant magnetic field at the level of the sleeping berth has made 3, 15 (-12 % from base line).

  1. Mixing induced by a propagating normal mode in long term experiments

    NASA Astrophysics Data System (ADS)

    Dossmann, Yvan; Pollet, Florence; Odier, Philippe; Dauxois, Thierry

    2017-04-01

    The energy pathways from propagating internal waves to the scales of irreversible mixing in the ocean are numerous. The triadic resonant instability (TRI) is an intrinsic destabilization process that can lead to mixing away from topographies. It consists in the destabilization of a primary internal wave generation leading to the radiation of two secondary waves of lower frequencies and different wave vectors. In the process, internal wave energy is carried down to smaller scales. A previous study focused on the assessment of instantaneous turbulent fluxes fields associated with the TRI process in laboratory experiments [1]. The present study investigates the integrated impact of mixing processes induced by a propagative normal mode over long term experiments using a similar setup. Configurations for which the TRI process is either favored or inhibited are tackled. Optical measurements using the light attenuation technique allow to follow the internal waves dynamics and the evolution of the density profile between two runs of one hour typical duration. The horizontally averaged turbulent diffusivity Kt(z) and the mixing efficiency Γ are assessed. One finds values up to Kt = 10-6 m2/s and Γ = 11 %, with slightly larger values in the presence of TRI. The maximum value for Kt is measured at the position(s) of the maximum shear normal mode shear for both normal modes 1 and 2. The development of staircases in the density profile is observed after several hours of forcing. This mechanism can be explained by Phillips' argument by which sharp interfaces can form due to vertical variations of the buoyancy flux. The staircases are responsible for large variations in the vertical distribution of turbulent diffusivity. These results could help to refine parameterizations of the impact of low order normal modes in ocean mixing. Reference : [1] Dossmann et al. 2016, Mixing by internal waves quantified using combined PIV/PLIF technique, Experiments in Fluids, 57, 132.

  2. [Oxidation Stress Markers Dynamics in the Experiment of Long-Term Antiorthostatic Hypokinesia (Retrospective Study)].

    PubMed

    Zhuravlyova, O A; Markin, A A; Kuzichkin, D S; Loginov, V I; Zabolotskaya, I V; Vostrikova, L V

    2016-01-01

    In blood serum of 9 volunteers aged 27 to 42, participated in the experiment with 370-day antiorthostatic hypokinesia (-5 degrees), the lipid peroxidation derivates concentration--diene conjugates (DC), malonic dialdehyde (MDA), Schiff bases (SB) as well as antioxidant defense system indices--tocopherol (TP) concentration and total antioxidative activity level (AOA) were measured. The volunteers were divided into two groups subjected to physical training regimes and used prophylactic measures. In both groups the lipoperoxidation processes initial stages depression (by 54-73%) was observed starting from 50th day, thus the lipid peroxidation final product--SB level was decreased (by 50-61%) only to the 230 day and remains approximately at the same level till the end of the experiment. The restorative period was characterized by decreasing (in 1.6-2.3 times) of MDA and SB concentrations. The decrease in lotal AOA during the aftereffect period was detected in all volunteers, and its level was significantly lower physiological norm range. Probably, long-term adaptation to the simulated weightlessness conditions is accompanied by expressed decrease in biological oxidation processes intensity and significant stress effect, as indicates by essential depression of lipid free radical oxidation in the course of the experiment. At the same time the restorative period after 370-day antiorthostatic hypokinesia was characterized by significantly expressed and prolonged readaptation stress progress. It is evidenced by practically twofold decrease in lipoperoxidation processes intensity against significant increase in TP concentration and water-soluble antioxidants functional reserves exhaustion. Lipid peroxidation activation absence in all terms of examination reflects appropriate compensation of studying impact by volunteers.

  3. Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities.

    PubMed

    Cross, Dori A; Adler-Milstein, Julia

    2017-01-01

    Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P < .01 for stage 2), participate in a regional HIE effort (OR, 1.34; P = .021), and exchange information electronically with other hospitals or ambulatory providers (OR, 4.54; P < .01). Organizational affiliation with a skilled nursing facility (OR, 1.29; P = .041) and higher 30-day readmission rates (OR, 1.19; P = .016) were also associated with LTC HIE, but not accountable care organization nor bundled payment participation. As payment to LTC providers and hospitals increasingly emphasizes total patient care and paying for value, those leading these organizations have new incentives to pursue collaborative relationships. Hospitals appear to be investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would

  4. Factors Differentiating Hospital Transfers from Long-term Care Facilities with High and Low Transfer Rates.

    ERIC Educational Resources Information Center

    Teresi, Jeanne A.; And Others

    1991-01-01

    Examined differences among nursing homes in rates at which they transfer patients to hospitals. Data from nursing staff and charts on 286 most recent transfers from 10 nursing homes revealed that, from relatively equivalent patient populations, high-rate facilities transferred more chronically ill, physically frail patients and patients with…

  5. Neurological Manifestations of Mycoplasma pneumoniae Infection in Hospitalized Children and Their Long-Term Follow-Up.

    PubMed

    Kammer, Jessica; Ziesing, Stefan; Davila, Lukas Aguirre; Bültmann, Eva; Illsinger, Sabine; Das, Anibh M; Haffner, Dieter; Hartmann, Hans

    2016-10-01

    Objective In this retrospective study, we aimed to assess frequency, types, and long-term outcome of neurological disease during acute Mycoplasma pneumoniae (M. pneumoniae) infection in pediatric patients. Materials and Methods Medical records of patients hospitalized with acute M. pneumoniae infection were reviewed. Possible risk factors were analyzed by uni- and multivariate regression. Patients with neurological symptoms were followed up by expanded disability status score (EDSS) and the cognitive problems in children and adolescents (KOPKJ) scale. Results Out of 89 patients, 22 suffered from neurological symptoms and signs. Neurological disorders were diagnosed in 11 patients: (meningo-) encephalitis (n = 6), aseptic meningitis (n = 3), transverse myelitis (n = 1), and vestibular neuritis (n = 1), 11 patients had nonspecific neurological symptoms and signs. Multivariate logistic regression identified lower respiratory tract symptoms as a negative predictor (odds ratio [OR] = 0.1, p < 0.001), a preexisting immune deficit was associated with a trend for a decreased risk (OR = 0.12, p = 0.058). Long-term follow-up after a median of 5.1 years (range, 0.6-13 years) showed ongoing neurological deficits in the EDSS in 8/18, and in the KOPKJ in 7/17. Conclusion Neurological symptoms occurred in 25% of hospitalized pediatric patients with M. pneumoniae infection. Outcome was often favorable, but significant sequels were reported by 45%.

  6. Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

    PubMed Central

    2011-01-01

    Background After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE). Results The median follow-up time was 9.0 (0.3-18.1) years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74), patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52) and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25). Conclusions Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended. PMID:21708039

  7. Preparedness for Resident Death in Long-Term Care: The Experience of Front-Line Staff

    PubMed Central

    van Riesenbeck, Isabelle; Boerner, Kathrin; Barooah, Adrita; Burack, Orah R.

    2015-01-01

    Context Although resident death is a common occurrence in long-term care, little attention has focused on how prepared certified nursing assistants (CNAs), who provide most of residents' daily care, are for this experience. Objectives To identify characteristics of the resident, CNA, and care context associated with CNAs' preparedness for resident death, and to determine differential patterns for emotional versus informational preparedness. Methods One hundred forty CNAs completed semi-structured in-person interviews concerning their experiences around resident death. The associations of CNA characteristics (e.g., personal end-of-life [EOL] care preferences), CNAs' perceptions of resident status (e.g., knowledge of resident's condition), and the caregiving context (e.g., coworker support and hospice involvement) with emotional and informational preparedness were examined using bivariate and multivariate analyses. Results CNAs who reported that their resident was “aware of dying” or “in pain” expressed higher levels of both emotional and informational preparedness. CNAs who endorsed an EOL care preference of wanting all possible treatments regardless of chances for recovery were likely to report lower emotional preparedness. More senior CNAs, both in regard to age and tenure, reported higher preparedness levels. Greater support from coworkers and hospice involvement also were associated with higher levels of both facets of preparedness, the latter in particular when hospice care was viewed positively by the CNA. Conclusion Having more information about resident status and more exchange opportunities within the care team around EOL-related challenges may help CNAs feel more prepared for resident death and strengthen their ability to provide good EOL care. PMID:25701690

  8. Migrant care workers or migrants working in long-term care? A review of Australian experience.

    PubMed

    Howe, Anna L

    2009-01-01

    Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

  9. Long-term lysimeter experiment to analyze the influence of the climate change on matter fluxes

    NASA Astrophysics Data System (ADS)

    Pütz, Thomas; Groh, Jannis; Wollschläger, Ute; Gerke, Horst; Priesack, Eckart; Kiese, Ralf; Borg, Erik; Vereecken, Harry

    2015-04-01

    Based on the TERENO SoilCan infrastructure, a long-term large-scale experiment was designed to study the effects of climate change on terrestrial systems. The water and matter fluxes in soil are the main focuses of SoilCan. In the frame of SoilCan, fully automated lysimeter systems were installed on several highly equipped experimental field sites of the TERENO-observatories and the relevant status variables of each ecosystem were monitored (e.g. climate, hydrology, biosphere-atmosphere exchange, biodiversity, etc.). In total, 90 lysimeters (1.5 m depth, 1m2 surface) were filled with soil monoliths at the four TERENO-observatories and were instrumented with TDRs, tensiometers, temperature sensors, soil heat flux plates, and CO2 sensors. For the controlling of the lower boundary condition, suction candle rakes were installed into the lysimeter bottoms. In combination with bi-directional pumps and tanks, the water content of the lysimeters was adjusted to the surrounded original field sites. To simulate the expected climate change, 48 lysimeters were transferred along temperature and rainfall gradients within the respective observatories and between the observatories, based on the principle 'Space for Time'. In case of the "Rur" observatory, three intensively instrumented field sites ("Wüstebach", "Rollesbroich" und "Selhausen") were equipped with lysimeter stations. These three field sites include different land uses, "Wüstebach" as a forest site, "Rollesbroich" as a grassland and "Selhausen" as an arable site. In order to standardize the agronomic management, the crop rotation at the arable lysimeters comprised winter wheat - winter rye - winter barley - oats. For investigation of the matter flux, soil solutions and leachates were regularly sampled. The water balances and the dynamics of the carbon and nitrogen fluxes in the first two years of the experiment will be presented.

  10. Increased frequency of chromosome translocations in airline pilots with long-term flying experience

    PubMed Central

    Yong, L C; Sigurdson, A J; Ward, E M; Waters, M A; Whelan, E A; Petersen, M R; Bhatti, P; Ramsey, M J; Ron, E; Tucker, J D

    2008-01-01

    Background Chromosome translocations are an established biomarker of cumulative exposure to external ionising radiation. Airline pilots are exposed to cosmic ionising radiation, but few flight crew studies have examined translocations in relation to flight experience. Methods We determined the frequency of translocations in the peripheral blood lymphocytes of 83 airline pilots and 50 comparison subjects (mean age 47 and 46 years, respectively). Translocations were scored in an average of 1039 cell equivalents (CE) per subject using fluorescence in situ hybridisation (FISH) whole chromo-some painting and expressed per 100 CE. Negative binomial regression models were used to assess the relationship between translocation frequency and exposure status and flight years, adjusting for age, diagnostic x ray procedures, and military flying. Results There was no significant difference in the adjusted mean translocation frequency of pilots and comparison subjects (0.37 (SE 0.04) vs 0.38 (SE 0.06) translocations/100 CE, respectively). However, among pilots, the adjusted translocation frequency was significantly associated with flight years (p = 0.01) with rate ratios of 1.06 (95% CI 1.01 to 1.11) and 1.81 (95% CI 1.16 to 2.82) for a 1- and 10-year incremental increase in flight years, respectively. The adjusted rate ratio for pilots in the highest compared to the lowest quartile of flight years was 2.59 (95% CI 1.26 to 5.33). Conclusions This data suggests that pilots with long-term flying experience may be exposed to biologically significant doses of ionising radiation. Epidemiological studies with longer follow-up of larger cohorts of pilots with a wide range of radiation exposure levels are needed to clarify the relationship between cosmic radiation exposure and cancer risk. PMID:19074211

  11. How Schools Can Help Students Recover from Traumatic Experiences: A Tool Kit for Supporting Long-Term Recovery. Technical Report

    ERIC Educational Resources Information Center

    Jaycox, Lisa H.; Morse, Lindsey K.; Tanielian, Terri; Stein, Bradley D.

    2006-01-01

    This tool kit is designed for schools that want to help students recover from traumatic experiences such as natural disasters, exposure to violence, abuse or assault, terrorist incidents, and war and refugee experiences. It focuses on long-term recovery, as opposed to immediate disaster response. To help schools choose an approach that suits their…

  12. How Schools Can Help Students Recover from Traumatic Experiences: A Tool Kit for Supporting Long-Term Recovery. Technical Report

    ERIC Educational Resources Information Center

    Jaycox, Lisa H.; Morse, Lindsey K.; Tanielian, Terri; Stein, Bradley D.

    2006-01-01

    This tool kit is designed for schools that want to help students recover from traumatic experiences such as natural disasters, exposure to violence, abuse or assault, terrorist incidents, and war and refugee experiences. It focuses on long-term recovery, as opposed to immediate disaster response. To help schools choose an approach that suits their…

  13. Long-term care: dignity, autonomy, family integrity, and social sustainability: the Hong Kong experience.

    PubMed

    Chan, Ho Mun; Pang, Sam

    2007-01-01

    This article reveals the outcome of a study on the perceptions of elders, family members, and healthcare professionals and administration providing care in a range of different long-term care facilities in Hong Kong with primary focus on the concepts of autonomy and dignity of elders, quality and location of care, decision making, and financing of long term care. It was found that aging in place and family care were considered the best approaches to long term care insofar as procuring and balancing the values of dignity, autonomy, family integrity and social sustainability were concerned. An elder having the final say was generally accepted. The results also initiated the importance of sharing of financial responsibility among elders, children and government albeit the emphasis was placed on individuals. Furthermore, dignity of elders was not considered purely a synonym of autonomy, but it had also to do with respect, family and social connections.

  14. Long-Term CO2 Exposure Experiments - Geochemical Effects on Brine-Saturated Reservoir Sandstone

    NASA Astrophysics Data System (ADS)

    Fischer, Sebastian; Zemke, Kornelia; Liebscher, Axel; Wandrey, Maren

    2010-05-01

    The injection of CO2 into deep saline aquifers is the most promising strategy for the reduction of CO2 emissions to the atmosphere via long-term geological storage. The study is part of the CO2SINK project conducted at Ketzin, situated 40 km west of Berlin. There, food grade CO2 has been pumped into the Upper Triassic Stuttgart Formation since June 2008. The main objective of the experimental program is to investigate the effects of long-term CO2 exposure on the physico-chemical properties of the reservoir rock. To achieve this goal, core samples from observation well Ktzi 202 have been saturated with synthetic brine and exposed to CO2 in high quality steel autoclaves at simulated reservoir P-T-conditions of 5.5 MPa and 40 ° C. The synthetic brine had a composition representative of the formation fluid (Förster et al., 2006) of 172.8 g/l NaCl, 8.0 g/l MgCl2×2H2O, 4.8 g/l CaCl2×2H2O and 0.6 g/l KCl. After 15 months, the first set of CO2-exposed samples was removed from the pressure vessels. Thin sections, XRD, SEM as well as EMP data were used to determine the mineralogical features of the reservoir rocks before and after the experiments. Additionally, NMR relaxation and MP was performed to measure poroperm and pore size distribution values of the twin samples. The analyzed samples are fine- to medium grained, moderately well- to well sorted and weakly consolidated sandstones. Quartz and plagioclase are the major components, while K-feldspar, hematite, white & dark mica, chlorite and illite are present in minor and varying amounts. Cements are composed of analcime, dolomite and anhydrite. Some samples show mm- to cm-scale cross-beddings. The laminae comprise lighter, quartz- and feldspar-dominated layers and dark-brownish layers with notably less quartz and feldspars. The results are consistent with those of Blaschke et al. (2008). The plagioclase composition indicates preferred dissolution of the Ca-component and a trend toward albite-rich phases or even pure

  15. Fertilization effects on soil organic matter turnover in a long term experiment

    NASA Astrophysics Data System (ADS)

    Gioacchini, Paola; Giordani, Gianni; Montecchio, Daniela; Nastri, Anna; Triberti, Loretta; Baldoni, Guido; Ciavatta, Claudio

    2010-05-01

    Agricultural management practices such as residues application, level and kind of fertilization and amendment, tillage intensity can affect the capacity of soil to sequester and incorporate carbon (C). These practices also influence both above-ground and below-ground plant production and, as a consequence, the amount of C that enters the soil. However, studing the dyamics of C inputs in soils and the effects of the agricultural management practices on C incorporation in soil organic matter (SOM) requires long-term field experiments. The long-term field experiment in Cadriano, at the University of Bologna, Italy, started in 1966 and still in progress, compares two continuous rotations of corn and wheat, interacting with two cattle manure supplies (M0: no manure - M1: 20 t ha-1 year-1 of fresh material) and two mineral NP rates (N0P0: no NP fertilizers - N1P1: 100 kg P2O5 ha-1 plus 200 and 300 kg N ha-1 for wheat and maize, respectively). The experimental design is a split-plot replicated twice, with fertilizer sub-plots of 56 m2 of area each. The field is annually ploughed to 40 cm depth. Crop residues are always removed, with the exception of roots and stubbles. By using the delta 13C technique we measured the amount of corn-derived C retained over a 36-years period in total soil organic C (SOC) and in the humic fraction that is referred as the most stable pool of SOC. These amounts were compared with the total inputs of belowground C (roots and rhizodepositions) in order to highlight if the capacity of soil to stabilize the new C inputs can be affected by the different fertilization practices. The results showed that the amount of corn-derived C in SOC increased in the following order: control (20.5%), Mineral (25%) Manure (29.4%), the same trend was observed for the humic fraction. On the contrary the cumulative C input over the same period followed a different order, the highest was obtained for the mineral treatment, than for the manure and the control

  16. Health care experiences of long-term survivors of adolescent and young adult cancer.

    PubMed

    Kaul, Sapna; Fluchel, Mark; Spraker-Perlman, Holly; Parmeter, Christopher F; Kirchhoff, Anne C

    2016-09-01

    Evaluate health care access and experiences with care among long-term survivors of adolescent and young adult (AYA) cancer relative to a comparison group in the USA. The 2008 to 2012 Medical Expenditure Panel Surveys identified 1163 survivors of cancer, diagnosed ages 15-39, current ages 20-64, who were at least 5 years after diagnosis. A comparison group without cancer was matched using age, sex, and other characteristics. Primary outcomes included having ≥1 visit to doctor's office/clinic in the previous year and perceived health care quality (0 = worst to 10 = best; categorized as low (0-4), intermediate (5-7), and high (8-10)). Other experience-related outcomes (e.g., having adequate time with providers and providers show respect) were also evaluated. Bivariate analyses compared these outcomes between survivors and the comparison group. Multivariable logistic regressions identified survivor-level factors associated with health care visits and quality. Survivors had ≥1 visit more often (82.1 vs. 75.8 %, p = 0.005) yet rated their health care quality lower (low or intermediate 30.7 vs. 23.6 %, p < 0.001) than the comparison group. Fewer survivors reported always having enough time with providers (41.7 vs. 54.6 %, p < 0.001) and that providers always show respect (57.5 vs. 67.7 %, p = 0.002). Uninsured survivors were less likely to have ≥1 visit (odds ratio (OR) = 0.26, 95 % confidence interval (CI) 0.17-0.40, p < 0.001) and rated their health care quality lower (OR = 0.25, 95 % CI 0.13-0.48, p < 0.001) than privately insured. Many other factors were associated with visits and quality. Survivors of AYA cancer reported more health care visits but worse health care experiences than individuals without cancer. Targeted interventions that may improve survivors' experiences with health care should be evaluated.

  17. Microbiological parameters of aggregates in typical chernozems of long-term field experiments

    NASA Astrophysics Data System (ADS)

    Zhelezova, A. D.; Tkhakakhova, A. K.; Yaroslavtseva, N. V.; Garbuz, S. A.; Lazarev, V. I.; Kogut, B. M.; Kutovaya, O. V.; Kholodov, V. A.

    2017-06-01

    The changes in microbiological parameters of aggregates (1-2 mm) in typical chernozems under different land uses as dependent on the intensity and character of anthropogenic loads were studied with the help of the real-time polymerase chain reaction (PCR). The samples from the following long-term field experiments were examined: permanent black fallow, continuous cultivation of potato, 17-year-old unmanaged fallow after permanent black fallow, and annually mown reserved steppe. The soil samples were treated in two ways. In the first case, the samples were air-dried, sieved through the screens to separate aggregate fraction of 1-2 mm, and microbiological parameters were determined in this fraction. In the second case, the samples were frozen immediately after the sampling, and the aggregates of 1-2 mm were manually separated from the samples before the PCR analysis. It was shown that air-dry aggregates of chernozems could be used for the quantitative analysis of DNA of microbial community in comparative studies. According to the quantitative estimate of the content of DNA fragments from different phylogenetic groups, the bacterial community was most sensitive to the type of the soil use, and its restoration after the removal of extreme anthropogenic loads proceeded faster than that of other microorganisms. The content of archaeal DNA in the chernozem under the 17-year-old unmanaged fallow did not differ significantly from its content in the annually plowed chernozems. The changes in the content of micromycetal DNA related to anthropogenic load decrease were intermediate between changes in the contents of archaeal and bacterial DNA.

  18. Towards a smart experimental arena for long-term electrophysiology experiments.

    PubMed

    Jow, Uei-Ming; Kiani, Mehdi; Huo, Xueliang; Ghovanloo, Maysam

    2012-10-01

    Wireless power and data transmission have created promising prospects in biomedical research by enabling perpetual data acquisition and stimulation systems. We present a work in progress towards such a system, called the EnerCage, equipped with scalable arrays of overlapping planar spiral coils (PSC) and 3-axis magnetic sensors for focused wireless power transmission to randomly moving targets, such as small freely behaving animal subjects. The EnerCage system includes a stationary unit for 3D non-line-of-sight localization and inductive power transmission through a geometrically optimized PSC array. The localization algorithm compares the magnetic sensor outputs with a threshold to activate a PSC. All PSCs are optimized based on the worst-case misalignment, considering parasitics from the overlapping and adjacent PSCs. EnerCage also has a mobile unit attached to or implanted in the subject's body, which includes a permanent magnetic tracer for localization and back telemetry circuit for efficient closed-loop inductive power regulation. The EnerCage system is designed to enable long-term electrophysiology experiments on freely behaving small animal subjects in large experimental arenas without requiring them to carry bulky batteries. A prototype of the EnerCage system with five PSCs and five magnetic sensors achieved power transfer efficiency (PTE) of 19.6% at the worst-case horizontal misalignment of 49.1 mm (√1/3 of the PSC radius) and coupling distance of 78 mm with a mobile unit coil, 20 mm in radius. The closed-loop power management mechanism maintains the mobile unit received power at 20 mW despite misalignments, tilting, and distance variations up to a maximum operating height of 120 mm (PTE = 5%).

  19. Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

    PubMed Central

    Engsig, Magaly; Søholm, Helle; Folke, Fredrik; Gadegaard, Peter J; Wiis, Julie Therese; Molin, Rune; Mohr, Thomas; Engsig, Frederik N

    2016-01-01

    Objective The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. Design, setting, and patients Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. Measurements Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological outcome assessed using the Pittsburgh cerebral performance category (CPC). Results A total of 282 patients were included in this study; 233 (83%) OHCA and 49 (17%) IHCA. The IHCA group presented more often with asystole, received bystander cardiopulmonary resuscitation (CPR) in all cases, and had shorter time to return of spontaneous circulation (ROSC). Survival to hospital discharge was 54% for OHCA and 53% for IHCA (adjusted odds ratio 0.98 [95% confidence interval {CI}; 0.43–2.24]). Age ≤60 years, bystander CPR, time to ROSC ≤10 min, and shockable rhythm at presentation were associated with survival to hospital discharge. Good neurologic outcome among survivors was achieved by 86% of OHCA and 92% of IHCA (P=0.83). After a median follow-up time of >5 years, 83% of OHCA and 77% of IHCA were alive (adjusted hazard ratio [HR] 1.51 [95% CI; 0.59–3.91]). Age ≤60 years was the only factor associated with long-term survival (adjusted HR 2.73 [95% CI; 1.36–5.52]). Conclusion There was no difference in short- and long-term survival and no difference in neurologic outcome to hospital discharge between IHCA and OHCA patients treated with TTM despite higher frequency of asystole in IHCA. PMID:27877067

  20. An investigation of ESSA 7 radiation data for use in long-term earth energy experiments, phases 1 and 2

    NASA Technical Reports Server (NTRS)

    House, F. B.

    1974-01-01

    The results are presented of an investigation of ESSA 7 satellite radiation data for use in long-term earth energy experiments. Satellite systems for performing long-term earth radiation balance measurements over geographical areas, hemispheres, and the entire earth for periods of 10 to 30 years are examined. The ESSA 7 satellite employed plate and cone radiometers to measure earth albedo and emitted radiation. Each instrument had a black and white radiometer which discriminated the components of albedo and emitted radiation. Earth measurements were made continuously from ESSA 7 for ten months. The ESSA 7 raw data is processed to a point where it can be further analyzed for: (1) development of long-term earth energy experiments; and (2) document climate trends.

  1. [Long-term survival related to cognitive performance in older adults treated at a tertiary hospital level].

    PubMed

    Gutiérrez-Robledo, Luis Miguel; Villalpando-Berumen, Juan Manuel; García-Cruz, Juan Carlos; Reyes-Guerrero, Jorge Antonio; Villa, Antonio Rafael

    2009-01-01

    To determine the association between cognitive performance and long-term survival in an elderly Mexican population sample. In this retrospective, retrolective and observational study elderly subjects were assessed in the Geriatrics Clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" between January 1994 and August 1999 using a comprehensive geriatric assessment. All 2544 subjects for whom vitality status was known up to September 2002 were included in the analysis. Socio-demographic and health-related information was gathered during the clinical interview, and their emotional and functional status was determined using the Katz, Lawton and GDS scales. Cognition was measured using the Mini-Mental State Examination (MMSE), grouping the subjects according to their performance into four groups: normal-high performance, normal-low performance, mild-to-moderate impairment and moderate-to-severe impairment. Vitality status was determined by searching the hospital's clinical records or by telephonic contact with the patient or primary caregiver when needed. Long-term mortality rates increased in a linear fashion as MMSE scores decreased (p < 0.001), even for MMSE scores over 24. This association persisted even after adjustment for comorbidity, depression, functional status and socio-demographic factors. Patients showed a progressive decline in long-term survival according to their cognitive performances. MMSE scores between 24 and 27 were also associated with an increased mortality and should not be considered as normal, even if they are not sensitive enough to detect impairment.

  2. Long-Term Results after Surgical Treatment of Ebstein's Anomaly: a 30-year Experience

    PubMed Central

    Kim, Min-Seok; Lim, Hong-Gook; Kim, Woong Han; Lee, Jeong Ryul

    2016-01-01

    Background and Objectives The aim of the study is to evaluate the long-term results after a surgical repair of Ebstein's anomaly. Subjects and Methods Forty-eight patients with Ebstein's anomaly who underwent open heart surgery between 1982 and 2013 were included. Median age at operation was 5.6 years (1 day-42.1 years). Forty-five patients (93.7%) demonstrated tricuspid valve (TV) regurgitation of less than moderate degree. When the patients were divided according to Carpentier's classification, types A, B, C, and D were 11, 21, 12, and 4 patients, respectively. Regarding the type of surgical treatment, bi-ventricular repair (n=38), one-and-a half ventricular repair (n=5), and single ventricle palliation (n=5) were performed. Of 38 patients who underwent a bi-ventricular repair, TV repairs were performed by Danielson's technique (n=20), Carpentier's technique (n=11), Cone repair (n=4), and TV annuloplasty (n=1). Two patients underwent TV replacement. Surgical treatment strategies were different according to Carpentier's types (p<0.001) and patient's age (p=0.022). Results There were 2 in-hospital mortalities (4.2%; 1 neonate and 1 infant) and 2 late mortalities during follow-up. Freedom from recurrent TV regurgitation rates at 5, 10, and 15 years were 88.6%, 66.3%, 52.7%, respectively. TV regurgitation recurrence did not differ according to surgical method (p=0.800). Survival rates at 5, 10, and 20 years were 95.8%, 95.8%, and 85.6%, respectively, and freedom from reoperation rates at 5, 10, and 15 years were 85.9%, 68.0%, and 55.8%, respectively. Conclusion Surgical treatment strategies were decided according to Carpentier's type and patient's age. Overall survival and freedom from reoperation rates at 10 years were 95.8% and 68.0%, respectively. Approximately 25% of patients required a second operation for TV during the follow-up. PMID:27721863

  3. Japanese Experience with Long-term Recovery from the 2011 Tohoku Earthquake and Tsunami Disaster

    NASA Astrophysics Data System (ADS)

    Hayashi, H.

    2015-12-01

    On March 11, 2011, a huge tsunami disaster hit Pacific coast of Tohoku region due to a magnitude of 9.0 earthquake, and killed almost 20,000 people. It was also the beginning of long-term recovery to prepare for next tsunami attack in the future. In this presentation, I would like to review the recovery process from the following five elements: quantification of tsunami hazards, public education, evacuation model, land-use planning, and real-time tsunami warning. It should be noted that there are lessons from the 2011 event at two different levels: national level and prefecture levels. In relation to the quantification of tsunami hazard and real-time tsunami warning, it followed a big change in tsunami policy at national level such as setting up two levels of tsunami scenarios for tsunami preparedness and mitigation: Level 1 tsunami (L1) and Level 2 tsunami (L2). L1 is the tsunami risk with 50 year return period, and L2 is the one with 1,000 year return period. As for public education, evacuation model, and land-use planning, There existed a big difference for what happened in the northern half of the coast and the southern half. Northern half of the coast belongs to Iwate Prefecture whose geography is rias coast. People in the Rias coast of Iwate Prefecture has been hit many times by tsunami on the average of about 50 years. With these many experiences, they succeeded in reducing the number of mortality down to 4,000 in comparison with 20,000 at the 1886 tsunami disaster. Most of the Southern half belongs to Miyagi Prefecture whose geography is coastal plain. People in the coastal plain in Miyagi Prefecture has little experience with tsunami disaster and end up with 14,000 deaths due to tsunami attack. The differences in the past tsunami experiences in these two prefectures resulted in big differences in public education, evacuation model, and land-use planning.

  4. Long-term effects of a computer-based nutritional training program for inpatient hospital care.

    PubMed

    Westergren, Albert; Edfors, Ellinor; Norberg, Erika; Stubbendorff, Anna; Hedin, Gita; Wetterstrand, Martin; Hagell, Peter

    2017-08-01

    A previous short-term study showed that a computer-based training in eating and nutrition increased the probability for hospital inpatients at undernutrition (UN) risk to receive nutritional treatment and care without increasing overtreatment (providing nutritional treatment to those not at UN risk). The aim of this study was to investigate if a computer-based training in eating and nutrition influences the precision in nutritional treatment and care in a longer-term perspective. A preintervention and postintervention study was conducted with a cross-sectional design at each time points (baseline and 7 months postintervention). Hospital inpatients >18 years old at baseline (2013; n = 201) and follow-up (2014; n = 209) were included. A computer-based training was implemented during a period of 3 months with 297 (84%) participating registered nurses and nurse assistants. Undernutrition risk was screened for using the minimal eating observation and nutrition form-version II. Nutritional treatment and care was recorded using a standardized protocol. The share of patients at UN risk that received energy-dense food (+25.2%) and dietician consultations (+22.3%) increased between baseline and follow-up, while fewer received oral nutritional supplements (-18.9%). "Overtreatment" (providing nutritional treatment to those not at UN risk) did not change between baseline and follow-up. The computer-based training increased the provision of energy-dense food and dietician consultations to patients at UN risk without increasing overtreatment of patients without UN risk. © 2017 John Wiley & Sons, Ltd.

  5. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure.

    PubMed

    Barsheshet, Alon; Goldenberg, Ilan; Garty, Moshe; Gottlieb, Shmuel; Sandach, Amir; Laish-Farkash, Avishag; Eldar, Michael; Glikson, Michael

    2011-02-15

    There is controversy regarding type of bundle branch block (BBB) that is associated with increased mortality risk in patients with heart failure (HF). The present study was designed to explore the association between BBB pattern and long-term mortality in hospitalized patients with systolic HF. Risk of 4-year all-cause mortality was assessed in 1,888 hospitalized patients with systolic HF (left ventricular ejection function <50%) without a pacemaker in a prospective national survey. Cox proportional hazards regression modeling was used to compare mortality risk in patients with right BBB (RBBB; 10%), left BBB (LBBB; 14%), and no BBB (76%) on admission electrocardiogram. At 4 years of follow up, mortality rates were highest in patients with RBBB (69%), intermediate in those with LBBB (63%), and lowest in those without BBB (50%, p <0.001). Multivariate analysis demonstrated a significant 36% increased mortality risk in patients with RBBB versus no BBB (p = 0.002) but no significant difference in mortality risk for patients with LBBB versus no BBB (hazard ratio 1.04, p = 0.66). RBBB versus LBBB was associated with a 29% (p = 0.035) increased risk for 4-year mortality in the total population and with a 58% (p = 0.015) increased risk in patients with ejection fraction <30%. In conclusion, RBBB but not LBBB on admission electrocardiogram is associated with a significant increased long-term mortality risk in hospitalized patients with systolic HF. Deleterious effects of RBBB compared to LBBB appear to be more pronounced in patients with more advanced left ventricular dysfunction. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. [Description of the clinical complexity of patients admitted to long term care hospitals in Catalonia during 2003-2009].

    PubMed

    Salvà, Antoni; Roqué, Marta; Vallès, Elisabeth; Bustins, Montse; Rodó, Montse; Sanchez, Pau

    2014-01-01

    This work describes the clinical complexity of patients admitted to long term care hospitals between 2003 and 2009. Cross-sectional analysis of Minimum Basic Dataset for Social and Healthcare Units information system data for 47,855 admissions. Outcomes assessed were functional and cognitive status, Resource Utilization Groups III (RUG-III), resource use categories, coverage and intensity of therapies, diagnosis, comorbidities, and medical procedures. Descriptive analyses were performed by year of admission. Dementia and acute cerebrovascular disease were the most frequent primary diagnoses, and showed a steady decline over time (8.8% and 2.3% decline), while family respite admissions and fractures increased (7.7% and 1.9%, respectively). The average functional and cognitive status of the treated population was similar across all years, although individuals with dependence in each Activity of Daily Living increased. The most frequent resource use categories were rehabilitation, reduced physical function, clinically complex care, and special care. A sharp increase in rehabilitation was observed during the study period (20.3%), while the other categories decreased. Increasingly more patients received rehabilitation therapy during their hospital stay (20.8%). Coverage increased particularly for physiotherapy (25.4%) and occupational therapy (17.4%). The clinical complexity faced by long term care hospitals increased during 2003- 2009. The use of resources and provision of therapies show an increasing rehabilitation effort, possibly as a response to changes in the clinical complexity of the treated population, the standards of care, or the established information reporting practices. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

  7. The Long Term Implication of RTLB Support: Listening to the Voices of Student Experiences

    ERIC Educational Resources Information Center

    Pillay, Poobie; Flanagan, Paul

    2011-01-01

    Resource Teachers: Learning and Behaviour (RTLB) have supported more than 15,000 students since RTLB 1999 by assisting teachers to manage and support students with learning or behaviour difficulties within inclusive classroom environments. Research indicates that there are long term positive educational effects for students receiving short-term…

  8. Simulating Soil Organic Carbon Dynamics in Long-term Agricultural Experiments Using CQESTR

    USDA-ARS?s Scientific Manuscript database

    Soil carbon (C) models are useful for examining the complex interactions between climate, crop, and soil management practices and their influences on long-term changes in soil organic carbon (SOC). The CQESTR model was developed to evaluate the effect of agricultural management practices on short- a...

  9. Long-Term Impacts of Faculty Development Programs: The Experience of Teli and Piedmont

    ERIC Educational Resources Information Center

    Barlett, Peggy F.; Rappaport, Ann

    2009-01-01

    A long-term study of two faculty development programs on sustainability and the environment reveals enduring changes in teaching, research, interdisciplinary collaboration, and engaged action. Participants in cohorts of Tufts University's Environmental Literacy Institute (12-16 years ago) and Emory University's Piedmont Project (1-5 years ago)…

  10. Study Abroad for Global Engagement: The Long-Term Impact of Mobility Experiences

    ERIC Educational Resources Information Center

    Paige, R. Michael; Fry, Gerald W.; Stallman, Elizabeth M.; Josic, Jasmina; Jon, Jae-Eun

    2009-01-01

    This paper reports on the preliminary results of a research project "'Beyond immediate impact: Study abroad for global engagement' (SAGE)" which examines the long-term impact of study abroad on various forms of global engagement. The study employs a retrospective tracer study and mixed methods research design. Survey results from 6391 study-abroad…

  11. The North American long-term soil productivity experiment: findings from the first decade of research

    Treesearch

    Robert F. Powers; D. Andrew Scott; Felipe g. Sanchez; Richard A. Voldseth; Deborah Page-Dumroese; John D. Elioff; Douglas M. Stone

    2005-01-01

    First decade findings on the impacts of organic matter removal and soil compaction are reported for the 26 oldest installations in the nation-wide network of long-term soil productivity sites. Complete removal of surface organic matter led to declines in soil C concentration to 20 cm depth and to reduced nutrient availability. The effect is attributed mainly to the...

  12. Study Abroad for Global Engagement: The Long-Term Impact of Mobility Experiences

    ERIC Educational Resources Information Center

    Paige, R. Michael; Fry, Gerald W.; Stallman, Elizabeth M.; Josic, Jasmina; Jon, Jae-Eun

    2009-01-01

    This paper reports on the preliminary results of a research project "'Beyond immediate impact: Study abroad for global engagement' (SAGE)" which examines the long-term impact of study abroad on various forms of global engagement. The study employs a retrospective tracer study and mixed methods research design. Survey results from 6391 study-abroad…

  13. Rett syndrome: long-term clinical follow-up experiences over four decades.

    PubMed

    Hagberg, Bengt

    2005-09-01

    Long-term clinical profiles of female patients with classic Rett syndrome are presented and exemplified by three cases, as experienced over four decades. Emphasized is the frequently surprisingly well-preserved eye contact and primitive memory, in contrast to a premature neuromuscular aging and often advanced peripheral atrophy, usually combined with dystonic-rigid signs that are predominantly right sided.

  14. Long term preservation of electronic health records. Recommendations in a large teaching hospital in Belgium.

    PubMed

    France, F H; Beguin, C; van Breugel, R; Piret, C

    2000-01-01

    Health records should be readily accessed by authorised persons for diagnosis, treatment and legal security purposes during patient's lifetime and thereafter for research and training purposes. Technology makes difficult the preservation of digital material, because of rapid changes in information media, hardware and software evolution, and because of the multiplicity of its location as well as the complexity of its environment. A committee in a large teaching hospital in Belgium, recommends two complementary approaches: (1) After a patient departure, all his health information should be managed by a unique organisation that would update regularly accesses to all data bases concerned by this patient. Health archives should be formatted using XML (Extensible Mark up Language) software family, and set on supports such as DVD-ROM, to be upgraded or updated when needed. This archive media is fast but not safe. (2) Computer output microfilm (COM) and scanners for non electronic data to be preserved appears to be also needed, as it is storage safe for at least 250 years and readable directly by eye. This archive media is safe but not fast.

  15. Long-term health effects of Vietnam-era military service: A quasi-experiment using Australian conscription lotteries.

    PubMed

    Johnston, David W; Shields, Michael A; Siminski, Peter

    2016-01-01

    This paper estimates the long-term health effects of Vietnam-era military service using Australia's National conscription lotteries for identification. Our primary contribution is the quality and breadth of our health outcomes. We use several administrative sources, containing a near-universe of records on mortality (1994-2011), cancer diagnoses (1982-2008), and emergency hospital presentations (2005-2010). We also analyse a range of self-reported morbidity indicators (2006-2009). We find no significant long-term effects on mortality, cancer or emergency hospital visits. In contrast, we find significant detrimental effects on a number of morbidity measures. Hearing and mental health appear to be particularly affected.

  16. Long-term clinical and biochemical follow-up in medullary thyroid carcinoma: a single institution's experience over 20 years.

    PubMed

    Cupisti, Kenko; Wolf, Achim; Raffel, Andreas; Schott, Matthias; Miersch, Daniel; Yang, Qin; Eisenberger, Claus F; Röher, Hans D; Knoefel, Wolfram T

    2007-11-01

    Many patients with medullary thyroid carcinomas (MTC) have reoperative surgery in different hospitals, which makes their follow-up difficult. To comprehend these complex courses and to find relevant prognostic factors we report a 20-year single center experience of 289 patients with MTC or precursor C-cell-hyperplasias. Between April 1986 and May 2006, 289 consecutive patients with MTC or MEN2 gene carriers were treated at the Department of Surgery at the University Hospital Düsseldorf. Tumor stages were documented according to the classification of the International Union against Cancer 5th edition, 1997 (Schott. Endocr Relat Cancer. 2006;13:779-795). A system to easily comprehend operative procedures is suggested. There were 159 female and 130 male patients (f/m ratio 1.22). Mean age at time of diagnosis was 32 years (4-77) in the familial cases and 53 years (23-84) years in the sporadic cases. Sixty-six patients (23%) had multifocal disease. Twelve MEN2-patients had only C-cell-hyperplasia (pT0). Tumor stage was pT1 in 86 patients, pT2 in 106 patients, pT3 in 25 patients, pT4 in 52 patients and unclear in 8 patients. In the 289 patients 648 operations were performed. One hundred seventy patients had more than 1 operation (59%). Ninety-nine patients (34%) are calcitonin-negative and 91 patients (31%) live with elevated calcitonin. Median follow-up time of the surviving 211 patients was 8.9 years (range, 0.3-30.7 years). The 5- and 10-year survival of all tumor patients was 86% and 68%, respectively. The chance to achieve biochemical cure in MTC is clearly dependent on the primary tumor size. The chance for long-term biochemical cure in a pT4-tumor is almost nil even after multiple and extended reoperations, whereas a pT1 tumor can be cured in up to 67% of the patients. Long-term survival, however, can be achieved even in pT4 tumor patients in almost 50%.

  17. Long-term geoelectrical monitoring of laboratory freeze-thaw experiments on bedrock samples

    NASA Astrophysics Data System (ADS)

    Kuras, Oliver; Uhlemann, Sebastian; Murton, Julian; Krautblatter, Michael

    2014-05-01

    Much attention has recently focussed on the continuous and near-real-time geophysical monitoring of permafrost-affected bedrock with permanently installed sensor arrays. It is hoped that such efforts will enhance process understanding in such environments (permafrost degradation, weathering mechanisms) and augment our capability to predict future instabilities of rock walls and slopes. With regard to electrical methods for example, recent work has demonstrated that temperature-calibrated electrical resistivity tomography (ERT) is capable of imaging recession and re-advance of rock permafrost in response to the ambient temperature regime. However, field experience also shows that several fundamental improvements to ERT methodology are still required to achieve the desired sensitivity, spatial-temporal resolution and long-term robustness that must underpin continuous geophysical measurements. We have applied 4D geoelectrical tomography to monitoring laboratory experiments simulating permafrost growth, persistence and thaw in bedrock over a period of 26 months. Six water-saturated samples of limestone and chalk of varying porosity represented lithologies commonly affected by permafrost-related instability. Time-lapse imaging of the samples was undertaken during multiple successive freeze-thaw cycles, emulating annual seasonal change over several decades. Further experimental control was provided by simultaneous measurements of vertical profiles of temperature and moisture content within the bedrock samples. These experiments have helped develop an alternative methodology for the volumetric imaging of permafrost bedrock and tracking active layer dynamics. Capacitive resistivity imaging (CRI), a technique based upon low-frequency, capacitively-coupled measurements emulates ERT methodology, but without the need for galvanic contact on frozen rock. The latter is perceived as a key potential weakness, which could lead to significant limitations as a result of the variable

  18. The long-term agroecological research (LTAR) experiment in Iowa: Organic resilience in soil quality and profitability

    USDA-ARS?s Scientific Manuscript database

    The Long-Term Agroecological Research (LTAR) experiment, at the Iowa State University Neely-Kinyon Farm in Greenfield, Iowa, was established in 1998 to compare the agronomic, ecological, and economic performance of conventional and organic cropping systems. The certified organic systems are designed...

  19. Subplots facilitate assessment of corn yield losses from weed competition in a long-term systems experiment

    USDA-ARS?s Scientific Manuscript database

    Weeds can potentially limit crop yield, particularly in organic systems where herbicide technologies are unavailable. Weedy and weed-free subplots were established within full plots of a long-term cropping systems experiment, the Farming Systems Project, at Beltsville, Maryland, USA, to determine t...

  20. The Long-Term Effects of College Diversity Experiences: Well-Being and Social Concerns 13 Years after Graduation

    ERIC Educational Resources Information Center

    Bowman, Nicholas A.; Brandenberger, Jay W.; Hill, Patrick L.; Lapsley, Daniel K.

    2011-01-01

    Many college administrators and researchers assert that diversity interactions are critical for preparing young adults for a diverse society, but very little research has examined the long-term impact of these experiences. This study examines a longitudinal sample of college students (n = 416) who were followed into their mid-30s. Structural…

  1. Spotlight on "Long-Term English Language Learners": Characteristics and Prior Schooling Experiences of an Invisible Population

    ERIC Educational Resources Information Center

    Menken, Kate; Kleyn, Tatyana; Chae, Nabin

    2012-01-01

    This article presents qualitative research findings about the characteristics and prior schooling experiences of "long-term English language learners" (LTELLs), who have attended U.S. schools for 7 years or more, and about whom there is little empirical research, despite their significant numbers. Findings indicate that these students are orally…

  2. "It Is Just Habitual": An Interpretative Phenomenological Analysis of the Experience of Long-Term Recovery from Addiction

    ERIC Educational Resources Information Center

    Shinebourne, Pnina; Smith, Jonathan A.

    2011-01-01

    This study explores experiences and understandings of people who have engaged with the process of recovery from alcohol or drug problems over a long period of time. Although there is a large body of research studies on recovery, few have examined long-term recovery from a qualitative perspective. The participants in this study were women who have…

  3. "It Is Just Habitual": An Interpretative Phenomenological Analysis of the Experience of Long-Term Recovery from Addiction

    ERIC Educational Resources Information Center

    Shinebourne, Pnina; Smith, Jonathan A.

    2011-01-01

    This study explores experiences and understandings of people who have engaged with the process of recovery from alcohol or drug problems over a long period of time. Although there is a large body of research studies on recovery, few have examined long-term recovery from a qualitative perspective. The participants in this study were women who have…

  4. Spotlight on "Long-Term English Language Learners": Characteristics and Prior Schooling Experiences of an Invisible Population

    ERIC Educational Resources Information Center

    Menken, Kate; Kleyn, Tatyana; Chae, Nabin

    2012-01-01

    This article presents qualitative research findings about the characteristics and prior schooling experiences of "long-term English language learners" (LTELLs), who have attended U.S. schools for 7 years or more, and about whom there is little empirical research, despite their significant numbers. Findings indicate that these students are orally…

  5. The Experiences of Long-Term Unemployed Young Adults in the South West of England: Some New Insights

    ERIC Educational Resources Information Center

    Lawy, Robert; Wheeler, Rachel

    2013-01-01

    In this paper we explore the experiences of three long-term unemployed young adults from different backgrounds in the 18-24 age range. The data comprise three interviews conducted over an 18-month period with seven of the original 19 participants in the research. At the time of first interview none of the young adults had been in education,…

  6. A Performance Analysis of Long-term Acute-Care Hospitals Owned by Large, Multistate Investor-Owned Companies.

    PubMed

    Nayar, Preethy; Liu, Xinliang; McCue, Michael J

    2016-01-01

    This study provides a descriptive assessment of the operating performance of for-profit long-term acute-care hospitals owned by multistate, investor-owned companies (large FP LTCHs) compared with FP LTCHs owned by smaller FP companies (small FP LTCHs) and nonprofit LTCHs (NP LTCHs). The study used the Centers for Medicare & Medicaid Services cost report data for 290 LTCHs from 2010 through 2012 to compare the financial performance of large and small FP LTCHs and NP LTCHs. The study found that the median operating profit margin for large FP LTCHs was 8.06%, which was twice as high as that of the small FP LTCHs and NP LTCHs (4.78% and 2.80%, respectively). Larger size, serving a greater proportion of private pay and more complex patients and incurring lower operating expenses, including salary expenses, may account for the higher operating margin of the large FP LTCHs.

  7. The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability.

    PubMed

    Stanger, Olaf; Bleuel, Irina; Gisler, Fabian; Göber, Volkhard; Reineke, Sylvia; Gahl, Brigitta; Aymard, Thierry; Englberger, Lars; Carrel, Thierry; Tevaearai, Hendrik

    2015-07-01

    To report our institutional experience and long-term results with the Freedom Solo bovine pericardial stentless bioprosthesis (Sorin Group, Saluggia, Italy). Between January 2005 and November 2009, 149 patients (mean age, 73.6 ± 8.7 years; 68 [45.6%] female) underwent isolated (n = 75) or combined (n = 74) aortic valve replacement (AVR) using the Solo in our institution. Follow-up was 100% complete with an average follow-up time of 5.9 ± 2.6 years (maximum, 9.6 years) and a total of 885.3 patient years. Operative (30-day) mortality was 2.7% (1.3% for isolated AVR [n = 1] and 4.0% for combined procedures [n = 3]). All causes of death were not valve-related. Preoperative peak (mean) gradients of 74.2 ± 23.0 mm Hg (48.6 ± 16.3 mm Hg) decreased to 15.6 ± 5.4 mm Hg (8.8 ± 3.0 mm Hg) after AVR, and remained low for up to 9 years. The postoperative effective orifice area was 1.6 ± 0.57 cm(2), 1.90 ± 0.45 cm(2), 2.12 ± 0.48 cm(2), and 2.20 ± 0.66 cm(2) for the valve sizes 21, 23, 25, and 27, respectively, with absence of severe prosthesis-patient mismatch and 0.7% (n = 1) experienced moderate prosthesis-patient mismatch. During follow-up, 26 patients experienced structural valve deterioration (SVD) and 14 patients underwent explantation. Kaplan-Meier estimates for freedom from death, explantation, and SVD at 9 years averaged 0.57 (range, 0.47-0.66), 0.82 (range, 0.69-0.90), and 0.70 (range, 0.57-0.79), respectively. The Freedom Solo stentless aortic valve is safe to implant and shows excellent early and midterm hemodynamic performance. However, SVD was observed in a substantial number of patients after only 5-6 years and the need for explantation increased markedly, suggesting low durability. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  8. Long-term flow-through column experiments and their relevance to natural granitoid weathering rates

    USGS Publications Warehouse

    White, Arthur F.; Schulz, Marjorie S.; Lawrence, Corey R.; Vivit, Davison V.; Stonestrom, David A.

    2017-01-01

    reaction (fresh granitoids) or increased slowly with time (weathered granitoids). Analysis of cumulative Na release indicated that plagioclase dissolution achieved steady state in 3 of the 4 fresh granitoids during the last decade of reaction. Surface-area normalized plagioclase dissolution rates exhibited a narrow range (0.95 to 1.26 10-13 moles m-2 s-1), in spite of significant stoichiometric differences (An0.21 to An0.50). Rates were an order of magnitude slower than previously reported in shorter duration experiments but generally 2 to 3 orders of magnitude faster than corresponding natural analogs. CrunchFlow simulations indicated that more than a hundredfold decrease in column flow rates would be required to produce near-saturation reaction affinities that would start to slow plagioclase weathering to real-world levels. Extending simulations to approximate long term weathering in naturally weathered profiles required additional decreases in the intrinsic plagioclase dissolution and kaolinite precipitation rates and relatively large decreases in the fluid flow rate, implying that exposure to reactive mineral surfaces is significantly limited in the natural environment compared to column experiments.

  9. Long-term flow-through column experiments and their relevance to natural granitoid weathering rates

    NASA Astrophysics Data System (ADS)

    White, Art F.; Schulz, Marjorie S.; Lawrence, Corey R.; Vivit, Davison V.; Stonestrom, David A.

    2017-04-01

    (fresh granitoids) or increased slowly with time (weathered granitoids). Analysis of cumulative Na release indicated that plagioclase dissolution achieved steady state in 3 of the 4 fresh granitoids during the last decade of reaction. Surface-area normalized plagioclase dissolution rates exhibited a narrow range (0.95-1.26 10-13 moles m-2 s-1), in spite of significant stoichiometric differences (An0.21 to An0.50). Rates were an order of magnitude slower than previously reported in shorter duration experiments but generally 2-3 orders of magnitude faster than corresponding natural analogs. CrunchFlow simulations indicated that more than a hundredfold decrease in column flow rates would be required to produce near-saturation reaction affinities that would start to slow plagioclase weathering to real-world levels. Extending simulations to approximate long term weathering in naturally weathered profiles required additional decreases in the intrinsic plagioclase dissolution and kaolinite precipitation rates and relatively large decreases in the fluid flow rate, implying that exposure to reactive mineral surfaces is significantly limited in the natural environment compared to column experiments.

  10. Long Term Psychological and Physical Effects of the POW Experience: A Review of the Literature

    DTIC Science & Technology

    1974-01-01

    psychological problems over time. The need for more comprehensive and de- finitive long-term follow-up studies of former United States ...human terms, is as important as any that now surrounds the POWs returned from cap- tivity in Southeast Asia. The problem may be simply stated : What...the United States . About 15 years later, articles began to appear In the literature, reporting the extent of psychiatric problems among these

  11. Long-term consequences of traumatic experiences: an assessment of former political detainees in romania

    PubMed Central

    2005-01-01

    Background Research has suggested that organized violence and torture have long-term psychological effects that persist throughout the lifespan. The present survey aimed at examining the prevalence of posttraumatic stress disorder (PTSD), and other disorders and symptoms, all present in old age, as long-term consequences of politically motivated violence in a comparison design. Methods A group of former political detainees (N = 59, mean age 73.5 years) who had been arrested by the Romanian communist regime were compared to an age- and gender-matched control group (N = 39). PTSD was assessed using a structured clinical interview (CIDI). The investigation of the clinical profile was further accomplished by self-rating measures for anxiety, depression, and health-related functioning, as well as by clinician-administrated interviews for substance abuse, dissociation, and somatization symptoms. Results Lifetime prevalence of PTSD was 54%. In the case of participants left untreated, PTSD persisted, often over four decades, such that current PTSD was diagnosed still in a third of the survivors. Other clinical conditions such as somatization, substance abuse, dissociative disorders, and major depression were also common among the former political detainees and often associated with current PTSD. Conclusion Our findings suggest that political detention may have long-term psychological consequences that outlast the changes in the political system. PMID:16185364

  12. Progress in the treatment of chronic hepatitis B: long-term experience with adefovir dipivoxil.

    PubMed

    Delaney, William E

    2007-05-01

    Most chronic hepatitis B patients do not undergo a curative response to interferon-alpha or nucleoside/nucleotide-based regimens and require long-term therapy. Long-term safety, efficacy and resistance profiles of hepatitis B virus (HBV) drugs are therefore crucial issues for patient management. Adefovir dipivoxil is a nucleotide prodrug indicated for the treatment of patients with hepatitis B e antigen positive or hepatitis B e antigen negative chronic hepatitis B, lamivudine-resistant HBV infection, HBV infection pre- or post-liver transplantation, or HlV co-infection. Long-term data from clinical trials of up to 5 years duration of adefovir dipivoxil have recently become available and are reviewed here. These data demonstrate that adefovir dipivoxil therapy results in sustained efficacy and safety in the majority of patients after multiple years of treatment. The efficacy of adefovir dipivoxil in treating lamivudine-resistant HBV and the delayed emergence of adefovir resistance are key factors contributing to the durable response achieved in broad groups of chronic hepatitis B patients.

  13. Adult Supratentorial Low-Grade Glioma: Long-Term Experience at a Single Institution

    SciTech Connect

    Bauman, Glenn; Fisher, Barbara; Watling, Christopher; Cairncross, J. Gregory; Macdonald, David

    2009-12-01

    Purpose: To report the long-term follow-up of a cohort of adult patients with supratentorial low-grade glioma treated at a single institution. Methods and Materials: A cohort of 145 adult patients treated at the London Regional Cancer Program between 1979 and 1995 was reviewed. Results: With a median follow-up of 105 months, the median progression-free survival was 61 months (95% confidence interval, 53-77), and the median overall survival was 118 months (95% confidence interval, 93-129). The 10- and 20-year progression-free and overall survival rate was 18% and 0% and 48% and 22%, respectively. Cox regression analysis confirmed the importance of age, histologic type, presence of seizures, Karnofsky performance status, and initial extent of surgery as prognostic variables for overall and cause-specific survival. Function among long-term survivors without tumor progression was good to excellent for most patients. Conclusion: Low-grade glioma is a chronic disease, with most patients dying of their disease. However, long-term survival with good function is possible. Survival is determined primarily by the disease factors with selection and timing of adjuvant treatments having less influence on outcome.

  14. Long-term outcomes of children treated for Cushing's disease: a single center experience.

    PubMed

    Yordanova, Galina; Martin, Lee; Afshar, Farhad; Sabin, Ian; Alusi, Ghassan; Plowman, Nicholas P; Riddoch, Fiona; Evanson, Jane; Matson, Matthew; Grossman, Ashley B; Akker, Scott A; Monson, John P; Drake, William M; Savage, Martin O; Storr, Helen L

    2016-12-01

    Pediatric Cushing's disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients. Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7-17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9-27.2). Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT). One patient underwent bilateral adrenalectomy (BA). CD recurrence occurred in 3 (14.3 %) patients: 2 at 2 and 6 years after TSS and 1 7.6 years post-RT. The BA patient developed Nelson's syndrome requiring pituitary RT 0.6 years post-surgery. Short-term growth hormone deficiency (GHD) was present in 14 patients (81 % patients tested) (11 following TSS and 3 after RT) and 4 (44 % of tested) had long-term GHD. Gonadotropin deficiency caused impaired pubertal development in 9 patients (43 %), 4 requiring sex steroid replacement post-puberty. Four patients (19 %) had more than one pituitary hormone deficiency, 3 after TSS and 1 post-RT. Five patients (24 %) had long-term psychiatric co-morbidities (cognitive dysfunction or mood disturbance). There were significant long-term improvements in growth, weight and bone density but not complete reversal to normal in all patients. The long-term consequences of the diagnosis and treatment of CD in children is broadly similar to that seen in adults, with recurrence of CD after successful treatment uncommon but still seen. Pituitary hormone deficiencies occurred in the majority of patients after remission, and assessment and appropriate treatment of GHD is essential. However, while many parameters improve, some children may still have mild but persistent defects.

  15. Parents' experiences of pediatric palliative care and the impact on long-term parental grief.

    PubMed

    van der Geest, Ivana M M; Darlington, Anne-Sophie E; Streng, Isabelle C; Michiels, Erna M C; Pieters, Rob; van den Heuvel-Eibrink, Marry M

    2014-06-01

    Approximately 25% of children diagnosed with cancer eventually die. Losing a child puts parents at increased risk for developing psychological problems. To explore parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement) and symptom management during the pediatric palliative phase, and to investigate the influence on long-term grief in parents who lost a child to cancer. A total of 89 parents of 57 children who died of cancer between 2000 and 2004 participated in this retrospective cross-sectional study by completing a set of questionnaires measuring grief (Inventory of Traumatic Grief), parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement), and symptom management during the palliative phase. Care was assessed on a five point Likert scale (1=disagree and 5=agree). Parents highly rated communication (4.6±0.6), continuity of care (4.3±0.6), and parental involvement (4.6±0.7) during the palliative phase. Parents' most often reported physical and psychological symptoms of their child during the palliative phase were fatigue (75%), pain (74%), anxiety to be alone (52%), and anger (48%). Higher ratings of parents on communication (β=-9.08, P=0.03) and continuity of care (β=-11.74, P=0.01) were associated with lower levels of long-term parental grief. The severity of the child's dyspnea (β=2.96, P=0.05), anxiety to be alone (β=4.52, P<0.01), anxiety about the future (β=5.02, P<0.01), anger (β=4.90, P<0.01), and uncontrolled pain (β=6.60, P<0.01) were associated with higher levels of long-term parental grief. Multivariate models combining the interaction with health care professionals and symptom management showed a significant influence of both aspects on long-term parental grief. Both interaction with health care professionals, especially communication and continuity of care, and symptom management in

  16. Preferences for long-term care services: willingness to pay estimates derived from a discrete choice experiment.

    PubMed

    Nieboer, Anna P; Koolman, Xander; Stolk, Elly A

    2010-05-01

    Ageing populations increase pressure on long-term care. Optimal resource allocation requires an optimal mix of care services based on costs and benefits. Contrary to costs, benefits remain largely unknown. This study elicits preferences in the general elderly population for long-term care services for varying types of patients. A discrete choice experiment was conducted in a general population subsample aged 50-65 years (N = 1082) drawn from the Dutch Survey Sampling International panel. To ascertain relative preferences for long-term care and willingness to pay for these, participants were asked to choose the best of two care scenarios for four groups of hypothetical patients: frail and demented elderly, with and without partner. The scenarios described long-term care using ten attributes based on Social Production Function theory: hours of care, organized social activities, transportation, living situation, same person delivering care, room for individual preferences, coordination of services, punctuality, time on waiting list, and co-payments. We found the greatest value was attached to same person delivering care and transportation services. Low value was attached to punctuality and room for individual preferences. Nursing homes were generally considered to be detrimental for well-being except for dementia patients without a partner. Overall, long-term care services were thought to produce greatest well-being for the patients 'without a partner' and those 'with dementia'. Individuals combining these two risk factors would benefit the most from all services except transportation which was considered more important for the frail elderly. The results support the notion that long-term care services represent different value for different types of patients and that the value of a service depends upon the social context. Examination of patient profiles confirmed the notion that physical, mental and social vulnerability affect valuation of the services. Policy

  17. Digoxin and 30-Day All-Cause Readmission in Long-Term Care Residents Hospitalized for Heart Failure.

    PubMed

    Sheriff, Helen M; Thogaripally, Manik R; Panjrath, Gurusher; Arundel, Cherinne; Zeng, Qing; Fonarow, Gregg C; Butler, Javed; Fletcher, Ross D; Morgan, Charity; Blackman, Marc R; Deedwania, Prakash; Love, Thomas E; Aronow, Wilbert S; Anker, Stefan D; Allman, Richard M; Ahmed, Ali

    2017-09-01

    Digoxin use has been shown to be associated with a lower risk of 30-day all-cause hospital readmissions in older patients with heart failure (HF). In the current study, we examined this association among long-term care (LTC) residents hospitalized for HF. Of the 8049 Medicare beneficiaries discharged alive after hospitalization for HF from 106 Alabama hospitals, 545 (7%) were LTC residents, of which 227 (42%) received discharge prescriptions for digoxin. Propensity scores for digoxin use, estimated for each of the 545 patients, were used to assemble a matched cohort of 158 pairs of patients receiving and not receiving digoxin who were balanced on 29 baseline characteristics. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with digoxin among matched patients were estimated using Cox regression models. Matched patients (n = 316) had a mean age of 83 years, 74% were women, and 18% African American. Thirty-day all-cause readmission occurred in 21% and 20% of patients receiving and not receiving digoxin, respectively (HR, 1.02; 95% CI, 0.63-1.66). Digoxin had no association with all-cause mortality (HR, 0.90; 95% CI, 0.48-1.70), HF readmission (HR, 0.90; 95% CI, 0.38-2.12), or a combined endpoint of all-cause readmission or all-cause mortality (HR, 0.97; 95% CI, 0.65-1.45) at 30 days. These associations remained unchanged at 1 year postdischarge. The lack of an association between digoxin and 30-day all-cause readmission in older nursing home residents hospitalized for HF is intriguing and needs to be interpreted with caution given the small sample size. Published by Elsevier Inc.

  18. Short and long-term readmission rates after infrainguinal bypass in a safety net hospital are higher than expected.

    PubMed

    Krafcik, Brianna M; Komshian, Sevan; Lu, Kimberly; Roberts, Lauren; Farber, Alik; Kalish, Jeffrey A; Rybin, Denis; Siracuse, Jeffrey J

    2017-09-28

    Readmission rates are expected to have an increasing effect on both the hospital bottom line and physician reimbursements. Safety net hospitals may be most vulnerable. We examined readmissions at 30 days, 90 days, and 1 year in a large safety net hospital to determine the magnitude and effect of short and long-term readmission rates after lower extremity infrainguinal bypass in this setting. All nonemergent extremity infrainguinal bypass performed at a large safety net hospital between 2008 and 2016 were identified. Patient demographic, social, clinical, and procedural details were extracted from the electronic medical record. An analysis of patients readmitted at 30 days, 90 days, and 1 year was completed to determine the details of the readmission. A total of 350 patients undergoing extremity infrainguinal bypass were identified. The most frequent indication was tissue loss (57%), followed by claudication (25.6%), and rest pain (17.4%). Patient insurance carriers included Medicare (61.7%), Medicaid (25.4%), and private (13%). The distal target was the popliteal and tibial artery in 52.6% and 47.4% cases, respectively. The majority of bypasses used autologous vein (73.1%). In-hospital complications included pulmonary complications (4.3%), urinary tract infection (3.1%), acute renal failure (2%), graft occlusion (2%), myocardial infarction (1.7%), bleeding (1.4%), surgical wound complications (1.1%), and stroke (0.9%). The 30-day readmission rate was 30% with the most common reasons for readmission being surgical wound complications, nonsurgical foot/leg wounds, nonextremity infectious causes, cardiac ischemia, and congestive heart failure. The 90-day readmission rate was 49.4% and the most common reasons for readmission from 31 to 90 days were nonsurgical foot/leg wounds, graft complications, surgical wound complications, cardiac ischemia, and contralateral leg morbidity. The readmission rate within 1 year was 72.2%. Readmission causes from 91 days to 1

  19. [Geriatric multimorbidity in claims data - part 1. Analysis of hospital data and long-term care insurance data].

    PubMed

    Lübke, N; Meinck, M

    2012-08-01

    In Germany, typical geriatric multimorbidity is--next to age itself--of special significance for the identification of target groups for specific geriatric care offers. The present article primarily focuses on typical geriatric multimorbidity in the claims data of statutory health insurance and long-term care insurance in Germany. Using the definition of "the geriatric patient" that is agreed on by providers of services as well as by cost bearers, geriatric multimorbidity is defined as the coexistence of at least 2 of 15 typical geriatric conditions. A suggestion made by the German Geriatric Association was to assign ICD-10-GM codes to each of these 15 conditions. Thus, it becomes possible to identify the corresponding geriatric conditions in claims data. The article investigates the frequency of geriatric conditions and, thus, of geriatric multimorbidity of patients aged ≥ 60 years admitted to a hospital with a geriatric ward. Patients treated in a geriatric ward were compared with those who did not receive geriatric care. In anticipation of a high correlation between typical geriatric conditions and specific features that are preconditions for receiving long-term care insurance benefits (such as care levels and status of a nursing home resident), claims data of the long-term care insurance were included for external validation. The analyses showed a distinctly higher proportion of insured people with typical geriatric multimorbidity or rather a certain care level among the geriatrically treated cases than among those patients not receiving geriatric treatment (68.5%/67.9% versus 24.2%/33.4%). The different proportions of typical geriatric multimorbidity coded among the patients with features of a certain care level in the two given groups give rise to the suspicion that typical geriatric multimorbidity is not always statistically recorded--especially in cases of treatment without provision of geriatric care. The frequency of cases of typical geriatric

  20. Influence of experience and the surgical learning curve on long-term patient outcomes in cardiac surgery.

    PubMed

    Burt, Bryan M; ElBardissi, Andrew W; Huckman, Robert S; Cohn, Lawrence H; Cevasco, Marisa W; Rawn, James D; Aranki, Sary F; Byrne, John G

    2015-11-01

    We hypothesized that increased postgraduate surgical experience correlates with improved operative efficiency and long-term survival in standard cardiac surgery procedures. Utilizing a prospectively collected retrospective database, we identified patients who underwent isolated coronary artery bypass grafting (CABG) (n = 3726), aortic valve replacement (AVR) (n = 1626), mitral valve repair (n = 731), mitral valve replacement (MVR) (n = 324), and MVR + AVR (n = 184) from January 2002 through June 2012. After adjusting for patient risk and surgeon variability, we evaluated the influence of surgeon experience on cardiopulmonary bypass and crossclamp times, and long-term survival. Mean surgeon experience after fellowship graduation was 16.0 ± 11.7 years (range, 1.0-35.2 years). After adjusting for patient risk and surgeon-level fixed effects, learning curve analyses demonstrated improvements in cardiopulmonary bypass and crossclamp times with increased surgeon experience. There was marginal improvement in the predictability (R(2) value) of cardiopulmonary bypass and crossclamp time for CABG with the addition of surgeon experience; however, all other procedures had marked increases in the R(2) following addition of surgeon experience. Cox proportional hazard models revealed that increased surgeon experience was associated with improved long-term survival in AVR (hazard ratio [HR], 0.85; P < .0001), mitral valve repair (HR, 0.73; P < .0001), and MVR + AVR (HR, 0.95; P = .006) but not in CABG (HR, 0.80; P = .15), and a trend toward significance in MVR (HR, 0.87; P = .09). In cardiac surgery, not including CABG, surgeon experience is an important determinant of operative efficiency and of long-term survival. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  1. Impact of long-term stress in Takotsubo syndrome: Experience of patients

    PubMed Central

    Wallström, Sara; Ulin, Kerstin; Määttä, Sylvia; Omerovic, Elmir; Ekman, Inger

    2015-01-01

    Background: The connection between stress and disease has been part of folk wisdom for a long time and has even made its way into our language with phrases such as ‘scared to death’ and ‘a broken heart’. Takotsubo syndrome is a form of acute, reversible heart failure characterized by ballooning of the left ventricle. Post-menopausal women are primarily affected, but cases have been described in both sexes and at all ages. The complete pathophysiology is unknown, but the disease has been connected to psychological or physical stress and a surge in catecholamines. Despite the strong connection with stress, knowledge about the life of patients before the onset of Takotsubo syndrome is lacking. Aim: The aim of this study was to describe and interpret patients’ narratives about long-term stress experienced before the onset of Takotsubo syndrome. Method: Nineteen people diagnosed with Takotsubo syndrome were interviewed. The narrative interviews were recorded and transcribed verbatim. The resulting texts were analysed using phenomenological hermeneutics. Results: The analysis revealed that the interviewees lived under stressful circumstances, characterized by feeling burdened by responsibilities, injustice and uncertainty, long before the onset of Takotsubo syndrome. This long-term stress wore down the defences of the interviewees to the degree that their capacity was exhausted and the smallest stressor could ‘tip them over the edge’. The findings indicated that the social structure of gender possibly contributed to the interviewees’ condition. Conclusions: These findings indicated that long-term stressful circumstances may cause vulnerability to acute psychological or physical stressors and, subsequently, to the onset of Takotsubo syndrome. PMID:26572162

  2. Impact of long-term stress in Takotsubo syndrome: Experience of patients.

    PubMed

    Wallström, Sara; Ulin, Kerstin; Määttä, Sylvia; Omerovic, Elmir; Ekman, Inger

    2016-12-01

    The connection between stress and disease has been part of folk wisdom for a long time and has even made its way into our language with phrases such as 'scared to death' and 'a broken heart'. Takotsubo syndrome is a form of acute, reversible heart failure characterized by ballooning of the left ventricle. Post-menopausal women are primarily affected, but cases have been described in both sexes and at all ages. The complete pathophysiology is unknown, but the disease has been connected to psychological or physical stress and a surge in catecholamines. Despite the strong connection with stress, knowledge about the life of patients before the onset of Takotsubo syndrome is lacking. The aim of this study was to describe and interpret patients' narratives about long-term stress experienced before the onset of Takotsubo syndrome. Nineteen people diagnosed with Takotsubo syndrome were interviewed. The narrative interviews were recorded and transcribed verbatim. The resulting texts were analysed using phenomenological hermeneutics. The analysis revealed that the interviewees lived under stressful circumstances, characterized by feeling burdened by responsibilities, injustice and uncertainty, long before the onset of Takotsubo syndrome. This long-term stress wore down the defences of the interviewees to the degree that their capacity was exhausted and the smallest stressor could 'tip them over the edge'. The findings indicated that the social structure of gender possibly contributed to the interviewees' condition. These findings indicated that long-term stressful circumstances may cause vulnerability to acute psychological or physical stressors and, subsequently, to the onset of Takotsubo syndrome. © The European Society of Cardiology 2015.

  3. Long-term traffic air and noise pollution in relation to mortality and hospital readmission among myocardial infarction survivors.

    PubMed

    Tonne, Cathryn; Halonen, Jaana I; Beevers, Sean D; Dajnak, David; Gulliver, John; Kelly, Frank J; Wilkinson, Paul; Anderson, H Ross

    2016-01-01

    There is relatively little evidence of health effects of long-term exposure to traffic-related pollution in susceptible populations. We investigated whether long-term exposure to traffic air and noise pollution was associated with all-cause mortality or hospital readmission for myocardial infarction (MI) among survivors of hospital admission for MI. Patients from the Myocardial Ischaemia National Audit Project database resident in Greater London (n = 1 8,138) were followed for death or readmission for MI. High spatially-resolved annual average air pollution (11 metrics of primary traffic, regional or urban background) derived from a dispersion model (resolution 20 m × 20 m) and road traffic noise for the years 2003-2010 were used to assign exposure at residence. Hazard ratios (HR, 95% confidence interval (CI)) were estimated using Cox proportional hazards models. Most air pollutants were positively associated with all-cause mortality alone and in combination with hospital readmission. The largest associations with mortality per interquartile range (IQR) increase of pollutant were observed for non-exhaust particulate matter (PM(10)) (HR = 1.05 (95% CI 1.00, 1.10), IQR = 1.1 μg/m(3)); oxidant gases (HR = 1.05 (95% CI 1.00, 1.09), IQR = 3.2 μg/m(3)); and the coarse fraction of PM (HR = 1.05 (95% CI 1.00, 1.10), IQR = 0.9 μg/m(3)). Adjustment for traffic noise only slightly attenuated these associations. The association for a 5 dB increase in road-traffic noise with mortality was HR = 1.02 (95% CI 0.99, 1.06) independent of air pollution. These data support a relationship of primary traffic and regional/urban background air pollution with poor prognosis among MI survivors. Although imprecise, traffic noise appeared to have a modest association with prognosis independent of air pollution. Copyright © 2015 The Authors. Published by Elsevier GmbH.. All rights reserved.

  4. Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

    PubMed Central

    Jenkins, Timothy C.; Knepper, Bryan C.; Shihadeh, Katherine; Haas, Michelle K.; Sabel, Allison L.; Steele, Andrew W.; Wilson, Michael L.; Price, Connie S.; Burman, William J.; Mehler, Philip S.

    2016-01-01

    Objective To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use Design Quasi-experimental, interrupted-time series study Setting 525-bed public safety-net hospital Intervention Implementation of a formal ASP in July 2008 Methods We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008 – September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005 – June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. difficile infection, and other patient-centered measures. Results During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD per quarter, p=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. Conclusion In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures; however, this study highlights limitations of commonly used stewardship outcome measures. PMID:25740560

  5. An educational intervention to improve antimicrobial use in a hospital-based long-term care facility.

    PubMed

    Schwartz, David N; Abiad, Homer; DeMarais, Patricia L; Armeanu, Emilian; Trick, William E; Wang, Yue; Weinstein, Robert A

    2007-08-01

    To improve antimicrobial use in patients receiving long-term care (LTC). Prospective, quasi-experimental before-after assessment of the effects of physician education and guideline implementation. Public LTC and acute care hospital. Twenty salaried internists who provided most of the medical care to LTC patients. National guidelines, hospital resistance data, and physician feedback were incorporated into a series of four teaching sessions presented over 18 months and into booklets detailing institutional guidelines on the optimal management of common LTC infection syndromes. One hundred randomly selected LTC patients treated with antimicrobials were reviewed before these interventions were implemented and 100 after, and measures of the quality of care were compared. The effect of the interventions on antimicrobial days and starts were also assessed using interrupted time series analysis. Charted clinical abnormalities met guideline diagnostic criteria (62% vs 38%, P=.006), and initial therapy agreed with guideline recommendations (39% vs 11%, P<.001), more often in the post- than in the preintervention cohort. Mean census-adjusted monthly LTC antimicrobial days fell 29.7%, and antimicrobial starts fell 25.9% during the intervention period; both decreases were sustained during the 2-year postintervention period. The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients.

  6. Risk factors for recurrence of scabies: a retrospective study of scabies patients in a long-term care hospital.

    PubMed

    Makigami, Kuniko; Ohtaki, Noriko; Ishii, Norihisa; Tamashiro, Tetsuko; Yoshida, Sadao; Yasumura, Seiji

    2011-09-01

    A considerable number of patients suffer recurrence of scabies. To elucidate risk factors for recurrence of scabies, we compared patients who experienced scabies recurrence and those who suffered scabies only once. We conducted a retrospective review of medical records of all scabies patients in a long-term care hospital for the elderly (300 beds; six wards) for a period of 42 months to determine frequency of scabies onsets, underlying diseases, history of treatment, and demographic data such as age and sex. One hundred and forty-eight patients and five hospital staff members suffered scabies during the 42-month study period. All staff members and 98 patients had no recurrence, while 50 patients experienced at least one recurrence of scabies. The cumulative number of scabies diagnoses was 228. The rates of scabies onset and recurrence were considerably different among wards. The dementia unit showed the highest rate of onset and recurrence. In addition to frequent exposure to infectious sources, problematic behavior, such as lying in other patients beds, might cause the high recurrence rate in dementia units. Higher serum total lymphocyte count and topical use of γ-benzene hexachloride were associated with lower risk of scabies recurrence. Recurrence of scabies is not uncommon among elderly patients in institutional settings. Impaired immunity may be a risk factor for recurrence of scabies. Groups with a high onset rate of scabies pose a high likelihood of recurrence. Problematic behavior of demented patients may increase the risk of recurrence. Use of effective topical treatment may effectively prevent recurrence.

  7. Developing biographies: the experiences of children, young people and their parents of living with a long-term condition.

    PubMed

    Bray, Lucy; Kirk, Sue; Callery, Peter

    2014-07-01

    This article reports on data from a qualitative interview study that sought to understand the experiences, choices and actions of children and young people undergoing surgery for a long-term condition and that of their parents. Using the concept of biography the article examines how the biographies of children, young people and their parents can be influenced by surgery and the ongoing management of a long-term continence condition. This article challenges previous work that characterises the presence of a condition from birth as a continuous and normal part of the illness experiences of these patients. Although this may be the case in some instances, children, young people and their parents can experience diverse and changing experiences associated with ongoing condition management as well as surgery. Biographical continuity, enrichment and disruption are all relevant concepts for such patients living with a long-term continence condition. These can be influenced by their previous experiences of their condition, their expectations, and dynamics with parents, including changes associated with development and the increasing independence of young people.

  8. Long-term effects of prenatal x-ray of human females: reproductive experience

    SciTech Connect

    Meyer, M.B.; Tonascia, J.

    1981-09-01

    A cohort of singleton black human females exposed to diagnostic x-ray in utero and controls matched by parity, hospital of birth and birthdate have been followed to ages 25 to 30 years in Baltimore, Maryland. The search for possible effects of prenatal irradiation has focused on health, growth, development, and reproductive experience of exposed and control women. This paper reports findings related to reproductive experience. From an original data set of 1458 matched exposed-control pairs of women, questionnaire responses were received from 1109 exposed and 1124 control women including 852 each from pairs in which both the exposed and control woman responded. After careful search for alternative explanations of the findings, the authors concluded that females exposed in utero to low doses of x-ray (probably 1 to 5 rads) had significant increases in their rates of early onset of menses, births at age 15 years or less, numbers of living children, stillbirths, and sterilizing operations by their mid-twenties. These findings are compatible with animal studies in which prenatal irradiation kills many oocytes, but accelerates the development of remaining cells to stages more closely correlated with fertility. Although these animals subsequently became sterile, this cannot be tested in the current study because significantly more of the irradiated women have had surgical sterilizations.

  9. Long-term exposure to traffic-related air pollution and the risk of coronary heart disease hospitalization and mortality.

    PubMed

    Gan, Wen Qi; Koehoorn, Mieke; Davies, Hugh W; Demers, Paul A; Tamburic, Lillian; Brauer, Michael

    2011-04-01

    Epidemiologic studies have demonstrated that exposure to road traffic is associated with adverse cardiovascular outcomes. We aimed to identify specific traffic-related air pollutants that are associated with the risk of coronary heart disease (CHD) morbidity and mortality to support evidence-based environmental policy making. This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents 45-85 years of age who resided in Metropolitan Vancouver during the exposure period and without known CHD at baseline were included in this study (n=452,735). Individual exposures to traffic-related air pollutants including black carbon, fine particles [aerodynamic diameter ≤ 2.5 µm (PM(2.5))], nitrogen dioxide (NO(2)), and nitric oxide were estimated at residences of the subjects using land-use regression models and integrating changes in residences during the exposure period. CHD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration records. An interquartile range elevation in the average concentration of black carbon (0.94 × 10(-5)/m filter absorbance, equivalent to approximately 0.8 µg/m(3) elemental carbon) was associated with a 3% increase in CHD hospitalization (95% confidence interval, 1-5%) and a 6% increase in CHD mortality (3-9%) after adjusting for age, sex, preexisting comorbidity, neighborhood socioeconomic status, and copollutants (PM(2.5) and NO(2)). There were clear linear exposure-response relationships between black carbon and coronary events. Long-term exposure to traffic-related fine particulate air pollution, indicated by black carbon, may partly explain the observed associations between exposure to road traffic and adverse cardiovascular outcomes.

  10. Long-Term Exposure to Traffic-Related Air Pollution and the Risk of Coronary Heart Disease Hospitalization and Mortality

    PubMed Central

    Gan, Wen Qi; Koehoorn, Mieke; Davies, Hugh W.; Demers, Paul A.; Tamburic, Lillian; Brauer, Michael

    2011-01-01

    Background Epidemiologic studies have demonstrated that exposure to road traffic is associated with adverse cardiovascular outcomes. Objectives We aimed to identify specific traffic-related air pollutants that are associated with the risk of coronary heart disease (CHD) morbidity and mortality to support evidence-based environmental policy making. Methods This population-based cohort study included a 5-year exposure period and a 4-year follow-up period. All residents 45–85 years of age who resided in Metropolitan Vancouver during the exposure period and without known CHD at baseline were included in this study (n = 452,735). Individual exposures to traffic-related air pollutants including black carbon, fine particles [aerodynamic diameter ≤ 2.5 μm (PM2.5)], nitrogen dioxide (NO2), and nitric oxide were estimated at residences of the subjects using land-use regression models and integrating changes in residences during the exposure period. CHD hospitalizations and deaths during the follow-up period were identified from provincial hospitalization and death registration records. Results An interquartile range elevation in the average concentration of black carbon (0.94 × 10−5/m filter absorbance, equivalent to approximately 0.8 μg/m3 elemental carbon) was associated with a 3% increase in CHD hospitalization (95% confidence interval, 1–5%) and a 6% increase in CHD mortality (3–9%) after adjusting for age, sex, preexisting comorbidity, neighborhood socioeconomic status, and copollutants (PM2.5 and NO2). There were clear linear exposure–response relationships between black carbon and coronary events. Conclusions Long-term exposure to traffic-related fine particulate air pollution, indicated by black carbon, may partly explain the observed associations between exposure to road traffic and adverse cardiovascular outcomes. PMID:21081301

  11. Decontamination Work and the Long-term Increase in Hospital Visits for Hymenoptera Stings Following the Fukushima Nuclear Disaster.

    PubMed

    Ozaki, Akihiko; Yokota, Takeru; Nomura, Shuhei; Tsubokura, Masaharu; Leppold, Claire; Tanimoto, Tetsuya; Miura, Toru; Yamamoto, Kana; Sawano, Toyoaki; Tsukada, Manabu; Kami, Masahiro; Kanazawa, Yukio; Ohira, Hiromichi

    2017-03-08

    Animals, including arthropods, are one health threat that can be affected by disasters. This institution-based study aimed to assess trends in Hymenoptera stings following the 2011 Fukushima nuclear disaster. We reviewed the medical records of patients with hymenopteran stings who visited Minamisoma Municipal General Hospital, located 23 km from Fukushima Daiichi Nuclear Power Plant, from March 2005 to March 2016. Patient and sting characteristics of post-disaster patients were examined, and the annual incidence of hospital visits for hymenopteran stings was compared with the pre-disaster baseline, calculating an incidence rate ratio (IRR) for each year. We identified 152 pre-disaster patients (2005-2011) and 222 post-disaster patients (2011-2016). In the post-disaster period, 160 males (72.1%) were identified, with a median age of 59 years (range: 2-89 years). A total of 45 patients (20.3%) were decontamination workers. Post-disaster increases were found in the IRR for hymenopteran stings, peaking first in 2011 (IRR: 2.8; 95% confidence interval [CI]: 1.9-4.2) and later in 2014 (IRR: 3.2; 95% CI: 2.4-4.3) and 2015 (IRR 3.3; 95% CI: 2.5-4.4). Long-term increases were found in the IRR of hospital visits for hymenopteran stings in an institution affected by the Fukushima nuclear disaster. Decontamination workers appear to have been particularly affected by this phenomenon. Better disaster field worker monitoring and education about potential environmental health hazards may help to identify and prevent worker exposure to insect stings and other vectors in these settings. (Disaster Med Public Health Preparedness. 2017;page 1 of 7).

  12. Long-term results of children diagnosed with idiopathic nephrotic syndrome; single center experience

    PubMed Central

    Hacıhamdioğlu, Duygu Övünç; Kalman, Süleyman; Gök, Faysal

    2015-01-01

    Aim: The aim of this study was to determine the long-term results of children followed up with a diagnosis of nephrotic syndrome in a single center. Materials and Method: The medical data of 33 patients aged between 6 months and 10 years who were diagnosed with idiopathic nephrotic syndrome in our center between January 2000 and December 2012 and followed up for a period of 2–12 years were reviewed (Gulhane Military Medical Academy Ethics committee, 07.11.2012/10). Results: The mean age of disease onset was 3.2±2.04 years (range: 0.5–10 years) and the mean follow-up period was 6±3.4 years (range: 2–12 years). Thirteen (39.4%) of the study group (or the patients) were female and 20 (60.6%) were male. Twenty seven (1.8%) of the patients were sensitive to steroid and 6 (18.1%) were resistant to steroid. Four (12.1%) of the steroid-resistant patients had steroid-dependent nephrotic syndrome, 5 (15.2%) had frequently relapsing nephrotic syndrome and 18 (54.5%) had rarely relapsing nephrotic syndrome. Histopathological diagnoses of six patients who underwent biopsy because of resistance to steroid were as follows: focal segmental glomerulosclerosis (n=3), C1q nephropathy (n=1), diffuse mesangial proliferation (n=1) and membraneous nephropathy (n=1). Fifteen (45.5%) patients entered into full remission and 2 (6%) patients developed chronic renal failure. Treatment complications including decreased bone mineral density in three patients (9%), short stature in 2 patients (6%) and cataract in 2 patients (6%) developed. Conclusions: Children with nephrotic syndrome carry a risk in terms of short stature, osteoporosis, cataract and renal failure in the long-term follow-up. It was observed that our rates of response to steroid were similar to the literature and the most common histopathological diagnosis was focal segmental glomerulosclerosis in our patients who underwent biopsy because of resistance to steroid. It was thought that multi-center studies should be

  13. Long-term experiment to study the development, interaction, and influencing factors of DEXA parameters.

    PubMed

    Fuchs, Helmut; Gau, Christine; Hans, Wolfgang; Gailus-Durner, Valerie; Hrabě de Angelis, Martin

    2013-10-01

    Dual-energy X-ray absorption (DEXA) is commonly used to measure bone mineral density (BMD), bone mineral content (BMC), and body composition data (fat mass and lean mass) for phenotype assessment in mice. We were interested in the long-term development of BMD, BMC, lean mass, and fat mass of mice, also taking into account sex and genetic background. The dataset was used to analyze correlations among the different parameters. We analyzed males and females from inbred strains C3HeB/FeJ and C57BL/6J, starting from 42 until 528 days of age. To evaluate the effect of husbandry systems, we repeated a part of the study in a second facility with a different caging system. We also assessed different DEXA settings and repeatability of the scans. The results of this study were used to draw conclusions for the use of DEXA analysis in mouse phenotyping approaches.

  14. Bariatric surgery in type 1 diabetes mellitus; long-term experience in two cases.

    PubMed

    Fuertes-Zamorano, Nuria; Sánchez-Pernaute, Andrés; Torres García, Antonio J; Rubio Herrera, Miguel A

    2013-01-01

    In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI) within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  15. Effectiveness of enzyme replacement therapy in Fabry disease: Long term experience in Argentina.

    PubMed

    Cabrera, Gustavo; Politei, Juan; Antongiovani, Norberto; Amartino, Hernán

    2017-06-01

    Evidence regarding long term effectiveness of enzyme replacement therapy (ERT) in Fabry disease (FD) is needed. The aim of this study was to analyze in a cohort of FD patients in Argentina, the long term effectiveness of ERT on renal, cardiac and cerebrovascular parameters. Patients with genetically proven FD were included from GADYTEF (Argentinean group for the treatment of FD) between 2001 and 2014. Renal, cardiac, and cerebral outcomes were prospectively studied in patients treated with ERT. Additionally, the occurrence of major cardiac complications, stroke, end-stage renal disease and death was analyzed during follow up. During the follow-up 8 major complications occurred in 5 patients (n = 2 deaths, n = 4 cases of end stage renal disease and n = 1 atrial fibrillation), 4 of them males and only 1 female who suffered an atrial fibrillation. Sudden death or stroke did not occur. Four (40%) of 10 males with baseline left ventricular hypertrophy (LVH) reduced left ventricular mass index (LVMI) from 163.1 ± 64.7 to 123.4 ± 49.8 g/m(2), 2 stabilized LVMI and 4 increased LVMI from157.9 ± 32.3 to 261.6 ± 48.6 g/m(2). Estimated glomerular filtration was stable in 30 patients (17 males and 13 females). We observed a few major complications during the follow up. Future studies are necessary to show the effectiveness of ERT in affected patients.

  16. Monotherapy with lanreotide depot for acromegaly: long-term clinical experience in a pituitary center.

    PubMed

    Sagvand, Babak Torabi; Khairi, Shafaq; Haghshenas, Arezoo; Swearingen, Brooke; Tritos, Nicholas A; Miller, Karen K; Klibanski, Anne; Nachtigall, Lisa B

    2016-08-01

    Long-acting somatostatin analogs are one of the main classes of medical therapy used for acromegaly and most patients require ongoing treatment. Few studies have evaluated the long-term efficacy and safety of lanreotide depot beyond 2 years. The goal of this study was to provide a long-term longitudinal assessment of efficacy and safety of lanreotide depot in lanreotide responders compared to a surgically cured control group. In this retrospective longitudinal case-control study, patients with acromegaly receiving lanreotide depot monotherapy continuously for at least 24 months (N = 24) and surgically cured patients (N = 39) were compared. Serum IGF-1, pituitary MRIs, lanreotide dose, co-morbidities and adverse effects were assessed longitudinally. In the lanreotide group, IGF-1 remained normal and unchanged over 6 years; comparable to the surgery only group. There was no difference in prevalence of normal IGF-1 between the lanreotide and surgery only groups at 6 months (100 vs. 97 %), 6 years (89 vs. 90 %) and at last follow-up (96 vs. 92 %). Tumor size remained stable (79 %) or decreased (21 %) in the lanreotide group. In the surgery only group, tumor size remained unchanged in all patients. Hemoglobin A1C did not differ between lanreotide and surgery only groups (baseline 5.8 vs. 6.1 %; last follow-up 6.0 vs. 5.7 %). Two (8 %) of the lanreotide and none of the surgery only group developed new diabetes mellitus. Lanreotide depot maintains normalization of IGF-1 in 89 % of responders after 6 years, comparable to surgically cured controls, and controlled tumor size in all without significant adverse effects.

  17. Long-term clinical practice experience with cinacalcet for treatment of hypercalcemic hyperparathyroidism after kidney transplantation.

    PubMed

    Thiem, Ursula; Gessl, Alois; Borchhardt, Kyra

    2015-01-01

    Within this prospective, open-label, self-controlled study, we evaluated the long-term effects of the calcimimetic cinacalcet on calcium and phosphate homeostasis in 44 kidney transplant recipients (KTRs) with hypercalcemic hyperparathyroidism by comparing biochemical parameters of mineral metabolism between pre- and posttreatment periods. Results are described as mean differences (95% CIs) between pre- and posttreatment medians that summarize all repeated measurements of a parameter of interest between the date of initial hypercalcemia and cinacalcet initiation (median of 1.6 (IQR: 0.6-3.8) years) and up to four years after treatment start, respectively. Cinacalcet was initiated after 1.8 (0.8-4.7) years posttransplant and maintained for 6.2 (3.9-7.6) years. It significantly decreased total serum calcium (-0.30 (-0.34 to -0.26) mmol/L, P < 0.001) and parathyroid hormone levels (-79 (-103 to -55) pg/mL, P < 0.001). Serum levels of inorganic phosphate (Pi) and renal tubular reabsorption of phosphate to glomerular filtration rate (TmP/GFR) increased simultaneously (Pi: 0.19 (0.15-0.23) mmol/L, P < 0.001, TmP/GFR: 0.20 (0.16-0.23) mmol/L, P < 0.001). In summary, cinacalcet effectively controlled hypercalcemic hyperparathyroidism in KTRs in the long-term and increased low Pi levels without causing hyperphosphatemia, pointing towards a novel indication for the use of cinacalcet in KTRs.

  18. Long-Term Clinical Practice Experience with Cinacalcet for Treatment of Hypercalcemic Hyperparathyroidism after Kidney Transplantation

    PubMed Central

    Gessl, Alois; Borchhardt, Kyra

    2015-01-01

    Within this prospective, open-label, self-controlled study, we evaluated the long-term effects of the calcimimetic cinacalcet on calcium and phosphate homeostasis in 44 kidney transplant recipients (KTRs) with hypercalcemic hyperparathyroidism by comparing biochemical parameters of mineral metabolism between pre- and posttreatment periods. Results are described as mean differences (95% CIs) between pre- and posttreatment medians that summarize all repeated measurements of a parameter of interest between the date of initial hypercalcemia and cinacalcet initiation (median of 1.6 (IQR: 0.6–3.8) years) and up to four years after treatment start, respectively. Cinacalcet was initiated after 1.8 (0.8–4.7) years posttransplant and maintained for 6.2 (3.9–7.6) years. It significantly decreased total serum calcium (−0.30 (−0.34 to −0.26) mmol/L, P < 0.001) and parathyroid hormone levels (−79 (−103 to −55) pg/mL, P < 0.001). Serum levels of inorganic phosphate (Pi) and renal tubular reabsorption of phosphate to glomerular filtration rate (TmP/GFR) increased simultaneously (Pi: 0.19 (0.15–0.23) mmol/L, P < 0.001, TmP/GFR: 0.20 (0.16–0.23) mmol/L, P < 0.001). In summary, cinacalcet effectively controlled hypercalcemic hyperparathyroidism in KTRs in the long-term and increased low Pi levels without causing hyperphosphatemia, pointing towards a novel indication for the use of cinacalcet in KTRs. PMID:25861621

  19. Long term results of liver transplantation for Wilson's disease: experience in France.

    PubMed

    Guillaud, Olivier; Dumortier, Jérôme; Sobesky, Rodolphe; Debray, Dominique; Wolf, Philippe; Vanlemmens, Claire; Durand, François; Calmus, Yvon; Duvoux, Christophe; Dharancy, Sébastien; Kamar, Nassim; Boudjema, Karim; Bernard, Pierre Henri; Pageaux, Georges-Philippe; Salamé, Ephrem; Gugenheim, Jean; Lachaux, Alain; Habes, Dalila; Radenne, Sylvie; Hardwigsen, Jean; Chazouillères, Olivier; Trocello, Jean-Marc; Woimant, France; Ichai, Philippe; Branchereau, Sophie; Soubrane, Olivier; Castaing, Denis; Jacquemin, Emmanuel; Samuel, Didier; Duclos-Vallée, Jean-Charles

    2014-03-01

    Liver transplantation (LT) is the therapeutic option for severe complications of Wilson's disease (WD). We aimed to report on the long-term outcome of WD patients following LT. The medical records of 121 French patients transplanted for WD between 1985 and 2009 were reviewed retrospectively. Seventy-five patients were adults (median age: 29 years, (18-66)) and 46 were children (median age: 14 years, (7-17)). The indication for LT was (1) fulminant/subfulminant hepatitis (n = 64, 53%), median age = 16 years (7-53), (2) decompensated cirrhosis (n = 50, 41%), median age = 31.5 years (12-66) or (3) severe neurological disease (n = 7, 6%), median age = 21.5 years (14.5-42). Median post-transplant follow-up was 72 months (0-23.5). Actuarial patient survival rates were 87% at 5, 10, and 15 years. Male gender, pre-transplant renal insufficiency, non elective procedure, and neurological indication were significantly associated with poorer survival rate. None of these factors remained statistically significant under multivariate analysis. In patients transplanted for hepatic indications, the prognosis was poorer in case of fulminant or subfulminant course, non elective procedure, pretransplant renal insufficiency and in patients transplanted before 2000. Multivariate analysis disclosed that only recent period of LT was associated with better prognosis. At last visit, the median calculated glomerular filtration rate was 93 ml/min (33-180); 11/93 patients (12%) had stage II renal insufficiency and none had stage III. Liver failure associated with WD is a rare indication for LT (<1%), which achieves an excellent long-term outcome, including renal function. Copyright © 2014. Published by Elsevier B.V.

  20. Parental experiences before and long-term after their children's hemispherotomy - A population-based qualitative study.

    PubMed

    Ozanne, Anneli; Verdinelli, Cecilia; Olsson, Ingrid; H Graneheim, Ulla; Malmgren, Kristina

    2016-07-01

    Severe childhood epilepsy has an impact on the whole family. For selected children, hemispherotomy is the treatment of choice. The aim of this study was to explore parents' experiences before and after hemispherotomy as reported at a long-term follow-up and their view on received information and support. This was a population-based qualitative descriptive study, using qualitative content analysis of interviews. Seven to eighteen years after hemispherotomy, parents of twenty-one operated children were interviewed about the family life situation, expectations before surgery, and support and information before and after surgery. Before surgery, the theme 'Living in a chaotic bubble' illuminates how parents felt: the family lived in isolation, they felt both dissatisfaction and satisfaction about support and information, and they experienced that surgery was a question about life or death. After surgery, the theme 'Hovering between success and disaster' illuminates how parents hovered between happiness if the surgery was successful and sadness about e.g., complications and behavior problems. They experienced both excellent and poor support, in hospital and at rehabilitation. Regardless of all concerns, parents were satisfied that the child had received an operation. The hemispherotomies were successful and generated a better life situation. However, in order to cope, families need support and information throughout the whole process, from the onset of epilepsy and for a long time after surgery. If the child has behavior problems, an assessment should be made before surgery in order for the families to get adequate support. The specialist team needs to be involved as early as possible and follow the families for several years after surgery. Focus should be on the whole family, if needed including grandparents; family-centered care might be relevant for this patient group. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Agitation during prolonged mechanical ventilation at a long-term acute care hospital: risk factors, treatments, and outcomes.

    PubMed

    O'Connor, Heidi; Al-Qadheeb, Nada S; White, Alexander C; Thaker, Vishal; Devlin, John W

    2014-01-01

    The prevalence, risk factors, treatment practices, and outcomes of agitation in patients undergoing prolonged mechanical ventilation (PMV) in the long-term acute care hospital (LTACH) setting are not well understood. We compared agitation risk factors, management strategies, and outcomes between patients who developed agitation and those who did not, in LTACH patients undergoing PMV. Patients admitted to an LTACH for PMV over a 1-year period were categorized into agitated and nonagitated groups. The presence of agitation risk factors, management strategies, and relevant outcomes were extracted and compared between the 2 groups. A total of 80 patients were included, 41% (33) with agitation and 59% (47) without. Compared to the nonagitated group, the agitated group had a lower Sequential Organ Failure Assessment score (P < .0006), a greater transfer rate from an academic center (P = .05), a greater delirium frequency at both baseline (P = .04) and during admission (P < .001), and a greater rate of benzodiazepine discontinuation (P = .02). Although the use of scheduled antipsychotic (P = .0005) or restraint (P = .002) therapy was more common in the agitated group, use of benzodiazepines (P = .16), opioids (P = .11), or psychiatric evaluation (P = .90) was not. Weaning success, duration of LTACH stay, and daily costs were similar. Agitation among the LTACH patients undergoing PMV is associated with greater delirium and use of antipsychotics and restraints but does not influence weaning success or LTACH stay. Strategies focused on agitation prevention and treatment in this population need to be developed and formally evaluated. © The Author(s) 2013.

  2. Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois

    PubMed Central

    Haverkate, Manon R.; Weiner, Shayna; Lolans, Karen; Moore, Nicholas M.; Weinstein, Robert A.; Bonten, Marc J. M.; Hayden, Mary K.; Bootsma, Martin C. J.

    2016-01-01

    Background. High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to identify patients at risk of KPC colonization upon readmission and to make predictions on the effects of transmission control measures. Methods. We analyzed data on surveillance isolates that were collected at 4 LTACHs in the Chicago region during a period of bundled interventions, to simultaneously estimate the duration of colonization during an LTACH admission and between LTACH (re)admissions. A maximum-likelihood method was used, taking interval-censoring into account. Results. Eighty-three percent of patients remained colonized for at least 4 weeks, which was the median duration of LTACH stay. Between LTACH admissions, the median duration of colonization was 270 days (95% confidence interval, 91–∞). Conclusions. Only 17% of LTACH patients lost colonization with KPC within 4 weeks. Approximately half of the KPC-positive patients were still carriers when readmitted after 9 months. Infection control practices should take prolonged carriage into account to limit transmission of KPCs in LTACHs. PMID:27747253

  3. Long-Term Ethylene Oxide Exposure Trends in US Hospitals: Relationship With OSHA Regulatory and Enforcement Actions

    PubMed Central

    LaMontagne, Anthony D.; Oakes, J. Michael; Lopez Turley, Ruth N.

    2004-01-01

    Objectives. We assessed long-term trends in ethylene oxide (EtO) worker exposures for the purposes of exposure surveillance and evaluation of the impacts of the Occupational Safety and Health Administration (OSHA) 1984 and 1988 EtO standards. Methods. We obtained exposure data from a large commercial vendor and processor of EtO passive dosimeters. Personal samples (87 582 workshift [8-hr] and 46 097 short-term [15-min] samples) from 2265 US hospitals were analyzed for time trends from 1984 through 2001 and compared with OSHA enforcement data. Results. Exposures declined steadily for the first several years after the OSHA standards were set. Workshift exposures continued to taper off and have remained low and constant through 2001. However, since 1996, the probability of exceeding the short-term excursion limit has increased. This trend coincides with a decline in enforcement of the EtO standard. Conclusions. Results indicate the need for renewed intervention efforts to preserve gains made following the passage and implementation of the 1984 and 1988 EtO standards. PMID:15333324

  4. Long-term ethylene oxide exposure trends in US hospitals: relationship with OSHA regulatory and enforcement actions.

    PubMed

    LaMontagne, Anthony D; Oakes, J Michael; Lopez Turley, Ruth N

    2004-09-01

    We assessed long-term trends in ethylene oxide (EtO) worker exposures for the purposes of exposure surveillance and evaluation of the impacts of the Occupational Safety and Health Administration (OSHA) 1984 and 1988 EtO standards. We obtained exposure data from a large commercial vendor and processor of EtO passive dosimeters. Personal samples (87,582 workshift [8-hr] and 46,097 short-term [15-min] samples) from 2265 US hospitals were analyzed for time trends from 1984 through 2001 and compared with OSHA enforcement data. Exposures declined steadily for the first several years after the OSHA standards were set. Workshift exposures continued to taper off and have remained low and constant through 2001. However, since 1996, the probability of exceeding the short-term excursion limit has increased. This trend coincides with a decline in enforcement of the EtO standard. Results indicate the need for renewed intervention efforts to preserve gains made following the passage and implementation of the 1984 and 1988 EtO standards.

  5. Long-term use of antipsychotics in community-dwelling dementia patients: prevalence and profile accounting for unobservable time bias because of hospitalization.

    PubMed

    Boucherie, Quentin; Gentile, Gaëtan; Chalançon, Coralie; Sciortino, Vincent; Blin, Olivier; Micallef, Joëlle; Bonin-Guillaume, Sylvie

    2017-01-01

    The aim of this study was to assess the prevalence of long-term antipsychotic (AP) use in community-dwelling patients with dementia considering hospitalization periods as AP exposure or not. A retrospective study was carried out from 2009 to 2012 on a PACA-Alzheimer cohort (which included 31 963 patients in 2009 and 36 442 in 2012 from 5 million inhabitants). Three groups of patients were identified according to the longest exposure to APs without interruption: nonusers, short-term users (≤3 successive months without discontinuation), and long-term users. Sensitivity analyses on hospitalization periods were carried out. The percentage of patients with at least one AP dispensing was stable over the study period (25.6% in 2009 vs. 26.5% in 2012). In 2012, 27.6% were AP long-term users. This increased to 46.7% when hospitalization periods were counted as AP exposure. In comparison with nonusers, AP users took more benzodiazepines and antidepressants. Short-term users were men [odds ratio (OR)=1.2, 95% confidence interval (CI) (1.1-1.3)] older than 85 years old [OR=1.2, 95% CI (1.1-1.2)]. Long-term users were more exposed to benzodiazepines [OR=1.2, 95% CI (1.1-1.4)]. This study showed that long-term use of AP remained frequent in community-dwelling patients with dementia. It also showed that the prevalence of long-term users almost doubled when hospitalization periods were counted as AP exposure. This underlines the need to consider hospitalization periods when assessing medication exposure in populations with frequent periods of hospitalization.

  6. Lunar heat-flow experiment: Long term temperature observations on the lunar surface at Apollo sites 15 and 17

    NASA Technical Reports Server (NTRS)

    Peters, K.

    1975-01-01

    Several investigators of the Apollo lunar experiments have observed gradual increases in the mean temperatures recorded by various surface thermometers. Similar effects were noticed in the temperatures of the thermometers of the Apollo 15 and 17 Heat Flow Experiments. An analysis of the long term temperature histories of the heat flow experiment thermometers is presented. These data show that no change in mean surface temperature at the Apollo 15 and 17 sites has occurred, and suggest that the slow increase in mean temperatures of thermometers in the electronics housing are due to changes in radiative properties of the housing's surfaces.

  7. Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study.

    PubMed

    Weiss-Faratci, Netanela; Lurie, Ido; Benyamini, Yael; Cohen, Gali; Goldbourt, Uri; Gerber, Yariv

    2017-01-01

    To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI). A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism. The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47-0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score. Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  8. Exploring the Concepts of Abstinence and Recovery Through the Experiences of Long-Term Opiate Substitution Clients.

    PubMed

    Notley, Caitlin; Blyth, Annie; Maskrey, Vivienne; Pinto, Hayley; Holland, Richard

    2015-01-01

    This study aimed to explore the client experience of long-term opiate substitution treatment (OST). A qualitative grounded theory study set in a U.K. rural community drug treatment service. Continuous OST enabled stability and a sense of "normality." Participants expressed relief at moving away from previous chaotic lifestyles and freedom from the persistent fear of opiate withdrawal. However, for some, being on a script made them feel withdrawn, lethargic, and unable to fully participate in mainstream society. Intrapersonal barriers (motivation and fear) were perceived as key barriers to abstinence. Participants experienced long-term OST as a transition between illicit drug use and recovery. Recovery was seen as a process rather than a fixed goal, confirming that there is a need for services to negotiate individualized recovery goals, spanning harm minimization and abstinence-oriented treatment approaches.

  9. Valacyclovir for herpes simplex virus infection: long-term safety and sustained efficacy after 20 years' experience with acyclovir.

    PubMed

    Tyring, Stephen K; Baker, David; Snowden, Wendy

    2002-10-15

    An extensive clinical trial program combined with 5 years' postmarketing experience with valacyclovir provides evidence of favorable safety and efficacy in herpes simplex virus (HSV) management. Valacyclovir enhances acyclovir bioavailability compared with orally administered acyclovir. Long-term use of acyclovir for up to 10 years for HSV suppression is effective and well tolerated. Acyclovir is also approved for use in children, is available in some countries over the counter in cream formulation for herpes labialis, and has been monitored in over 1000 pregnancies. Safety monitoring data from clinical trials of valacyclovir, involving over 3000 immunocompetent and immunocompromised persons receiving long-term therapy for HSV suppression, were analyzed. Safety profiles of valacyclovir (

  10. Long-term outcomes of radiotherapy for stage II testicular seminoma--the Mayo Clinic experience.

    PubMed

    Hallemeier, Christopher L; Pisansky, Thomas M; Davis, Brian J; Choo, Richard

    2013-11-01

    To report long-term outcomes of patients with stage II testicular seminoma treated with radiotherapy (RT). A retrospective review was performed of 52 patients who received megavoltage RT for stage II testicular seminoma at Mayo Clinic between 1974 and 2007. Forty-eight patients (92%) had computed tomography staging. Overall survival (OS), relapse-free survival (RFS), and cause-specific survival (CSS) were determined using the Kaplan-Meier method. Major cardiac event (MCE) was defined as myocardial infarction, coronary artery bypass grafting or stenting, or valve replacement. Second malignancy (SM) was defined as biopsy-confirmed malignancy occurring in the RT field. The median patient age at diagnosis was 36 years. Stage was IIA (n = 24), IIB (n = 7), IIC (n = 17), and II not otherwise specified (NOS, n = 4). The median infradiaphragmatic RT dose was 30.7 Gy. Twenty-six patients (50%) received prophylactic mediastinal/supraclavicular (MSCV) RT. The median follow-up was 19 years. Estimates of OS, RFS, and CSS were 94%, 80%, and 96% at 10 years, and 83%, 72%, and 96% at 20 years, respectively. RFS at 10 years for stage IIA, IIB, IIC, and II NOS were 83%, 54%, 81%, and 100%, respectively (log-rank P = 0.21). Ten patients (19%) experienced disease relapse in the MSCV region (n = 7), para-aortic lymph nodes (n = 1), lung (n = 1), or peritoneal cavity (n = 1). Eight patients were successfully salvaged with chemotherapy and/or surgery, while 2 died of seminoma. Risk of MSCV relapse was significantly lower in patients who received MSCV RT vs. those who did not (10-year estimates: 4% vs. 21%, respectively, log-rank P = 0.01). MCE occurred in 10 patients (19%) at a median of 18 years (range 7-30) after RT. SM occurred in 5 patients (10%) at a median of 27 years (range 20-34) after RT. In patients with stage II testicular seminoma treated with RT, relapse in the irradiated site was uncommon. Infradiaphragmatic RT alone was associated with a significant risk of MSCV failure

  11. Climate effects and feedback structure determining weed population dynamics in a long-term experiment.

    PubMed

    Lima, Mauricio; Navarrete, Luis; González-Andujar, José Luis

    2012-01-01

    Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years) on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors). Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements.

  12. Climate Effects and Feedback Structure Determining Weed Population Dynamics in a Long-Term Experiment

    PubMed Central

    Lima, Mauricio; Navarrete, Luis; González-Andujar, José Luis

    2012-01-01

    Pest control is one of the areas in which population dynamic theory has been successfully applied to solve practical problems. However, the links between population dynamic theory and model construction have been less emphasized in the management and control of weed populations. Most management models of weed population dynamics have emphasized the role of the endogenous process, but the role of exogenous variables such as climate have been ignored in the study of weed populations and their management. Here, we use long-term data (22 years) on two annual weed species from a locality in Central Spain to determine the importance of endogenous and exogenous processes (local and large-scale climate factors). Our modeling study determined two different feedback structures and climate effects in the two weed species analyzed. While Descurainia sophia exhibited a second-order feedback and low climate influence, Veronica hederifolia was characterized by a first-order feedback structure and important effects from temperature and rainfall. Our results strongly suggest the importance of theoretical population dynamics in understanding plant population systems. Moreover, the use of this approach, discerning between the effect of exogenous and endogenous factors, can be fundamental to applying weed management practices in agricultural systems and to controlling invasive weedy species. This is a radical change from most approaches currently used to guide weed and invasive weedy species managements. PMID:22272362

  13. Construction and performance of a long-term earthen liner experiment

    USGS Publications Warehouse

    Cartwright, Keros; Krapac, Ivan G.; Bonaparte, Rudolph

    1990-01-01

    In land burial schemes, compacted soil barriers with low hydraulic conductivity are commonly used in cover and liner systems to control the movement of liquids and prevent groundwater contamination. An experimental liner measuring 8 x 15 x 0.9 m was constructed with design criteria and equipment to simulate construction of soil liners built at waste disposal facilities. The surface of the liner was flooded with a 29.5 cm deep pond on April 12, 1988. Infiltration of water into the liner has been monitored for two years using 4 large-ring (1.5 m OD) and 32 small-ring (0.28 m OD) infiltrometers, and a water-balance that accounts for total infiltration and evaporation. Average long-term infiltration fluxes based on two years of monitoring are 5.8 x 10-9 cm/s, 6.0 x 10-8 cm/s and 5.6 x 10-8 for the large-ring, small-ring, and water-balance data, respectively. The saturated hydraulic conductivity of the liner based on small-ring data, estimated using Darcy's Law and the Green-Ampt Approximation, is 3 x 10-8 and 4 x 10-8 cm/s, respectively. All sets of data indicate that the liner's performance exceed that which is required by the U.S. EPA.

  14. Dual institution experience of extranodal marginal zone lymphoma reveals excellent long-term outcomes.

    PubMed

    Starr, Adam G; Caimi, Paolo F; Fu, PingFu; Massoud, Mira R; Meyerson, Howard; Hsi, Eric D; Mansur, David B; Cherian, Sheen; Singh, Arun D; Cooper, Brenda W; De Lima, Marcos J G; Lazarus, Hillard M; Gerson, Stanton L; Jagadeesh, Deepa; Smith, Mitchell R; Dean, Robert M; Pohlman, Brad L; Hill, Brian T; William, Basem M

    2016-05-01

    Extranodal marginal zone lymphoma (EMZL) is a B-cell lymphoma arising from mucosa-associated lymphoid tissue (MALT). The disease characteristics, clinical course and treatment vary considerably based on site of involvement. Because long-term outcome data for EMZL are limited, we sought to describe the clinical details of a large number of patients with EMZL evaluated at the Case Comprehensive Cancer Center over a 12-year period to identify prognostic markers including the impact of site of involvement. We identified 211 cases of EMZL involving the stomach (30%), ocular adnexa (19%), lungs (16%) and intestines (9%). Initial treatment included antibiotics (18%), radiation (21%), rituximab (20%), chemotherapy (3%), rituximab + chemotherapy (7%), surgery (17%) or observation (8%). After a median follow-up of 44·3 months (range 2·2-214·9), median progression-free survival (PFS) was 68·2 months (95% confidence interval [CI] 54·5-111·3) and median overall survival (OS) has not been reached. Age >60 years, elevated lactate dehydrogenase level (LDH), ≥4 lymph node groups involvement, and high follicular lymphoma international prognostic index (FLIPI) were associated with inferior PFS/OS. In summary, patients with EMZL have excellent prognosis with median OS in excess of 10 years. Age, elevated LDH, advanced disease, and high FLIPI score are associated with worse outcomes.

  15. Comparison of Dental Caries Experience in Children Suffering From Epilepsy with and without Administration of Long Term Liquid Oral Medication

    PubMed Central

    Bhadravathi, Manjunath Chaluvaiah; Kumar, Adarsh; Narang, Ridhi; Gupta, Ambika; Singh, Harneet

    2016-01-01

    Introduction Sucrose is added as sweetening agent in liquid oral medication (LOM) to mask the acrid taste of medicines which may be potentially cariogenic. Many children under long term LOM therapy for treatment of epilepsy may be susceptible to dental caries. Aim To assess and compare dental caries experience in children under long term liquid oral medication with those not under such medication among 2-12 years old children suffering from epilepsy. Materials and Methods A cross-sectional study was undertaken on a total of 84 children aged 2–12 years, who were suffering from epilepsy receiving liquid oral medication for more than 3 months were selected (study group) and for comparison 106 children of similar age group and disease but on other forms of medication were included as control group. Dental caries was assessed using DMFT/DMFS (Decayed, Missing, Fillled Teeth / Surfaces), dmft/dft and dmfs/dfs indices. One-way ANOVA and t-test were used with p-value fixed at 0.05. Univariate logistic regression was applied. Results Children on LOM were at increased risk of dental caries than those with other forms of medications (OR: 2.55, 95% CI (2.37-4.15) p=0.000, HS). Caries prevalence was high in the study group (76.1%) when compared to control group (55.6%). Conclusion Long term use of liquid medicines containing sucrose is a risk factor for dental caries among children with epilepsy. PMID:27504416

  16. Long-term clinical and real-world experience with pirfenidone in the treatment of idiopathic pulmonary fibrosis.

    PubMed

    Cottin, Vincent; Maher, Toby

    2015-03-01

    Idiopathic pulmonary fibrosis (IPF) is a chronic, irreversible, progressively destructive lung disease that culminates in respiratory failure and death. Randomised controlled trials have demonstrated that treatment of IPF patients with pirfenidone reduces lung function decline, improves progression-free survival and significantly reduces the risk of all-cause mortality at 1 year. Pirfenidone has been shown to have a favourable safety profile and was generally well tolerated over the long term in clinical trials and real-world experience. However, side-effect management is critical to help some patients remain on treatment over the long term. The primary treatment-related adverse events associated with pirfenidone therapy are gastrointestinal upset, rash and photosensitivity. Gastrointestinal events may be mitigated by ensuring that pirfenidone is taken with food, while skin symptoms may be reduced by avoiding sun exposure and frequent use of sunblock. Educating patients about the potential for these adverse events to occur and providing instructions prior to treatment to avoid adverse drug reactions are an important means of ensuring patients may derive the important benefits provided by long-term treatment with pirfenidone.

  17. Comparison of Dental Caries Experience in Children Suffering From Epilepsy with and without Administration of Long Term Liquid Oral Medication.

    PubMed

    Goyal, Ankita; Bhadravathi, Manjunath Chaluvaiah; Kumar, Adarsh; Narang, Ridhi; Gupta, Ambika; Singh, Harneet

    2016-06-01

    Sucrose is added as sweetening agent in liquid oral medication (LOM) to mask the acrid taste of medicines which may be potentially cariogenic. Many children under long term LOM therapy for treatment of epilepsy may be susceptible to dental caries. To assess and compare dental caries experience in children under long term liquid oral medication with those not under such medication among 2-12 years old children suffering from epilepsy. A cross-sectional study was undertaken on a total of 84 children aged 2-12 years, who were suffering from epilepsy receiving liquid oral medication for more than 3 months were selected (study group) and for comparison 106 children of similar age group and disease but on other forms of medication were included as control group. Dental caries was assessed using DMFT/DMFS (Decayed, Missing, Fillled Teeth / Surfaces), dmft/dft and dmfs/dfs indices. One-way ANOVA and t-test were used with p-value fixed at 0.05. Univariate logistic regression was applied. Children on LOM were at increased risk of dental caries than those with other forms of medications (OR: 2.55, 95% CI (2.37-4.15) p=0.000, HS). Caries prevalence was high in the study group (76.1%) when compared to control group (55.6%). Long term use of liquid medicines containing sucrose is a risk factor for dental caries among children with epilepsy.

  18. [An interprofessional or an interdisciplinary problem? Distinctions to develop an analytical scheme of interdisciplinarity based on the case of a long-term care hospital].

    PubMed

    Couturier, Yves

    2009-06-01

    This communication distinguishes interdisciplinary problems from other neighbouring difficulties, such as difficulties related to work organization. The conceptual proximity between discipline and profession can in fact cause difficulties experienced in the interprofessionnal space to mistakenly incriminate interdisciplinarity. For the analyst, this proximity blurs his insight and, in effect, inhibits the development of adequate solutions to the encountered problem. Hence, this article, based on an ethnographic study of interdisciplinary relations in a small long-term care hospital, aims to alleviate the ambiguity surrounding this issue. In order to do so, this article will begin by recalling the parameters of the theoretical field of interdisciplinarity. Subsequently, the difficulties observed in the long-term care hospital's setting, as they were conceived in the light of interdisciplinarity theory, will be exposed. This article will notably highlight how the nursing staffs contribute to the maintenance of a philosophy of care favourable to the long term deployment of interdisciplinarity.

  19. Long-term outcomes of the shaken baby syndrome prevention program: Turkey’s experience

    PubMed Central

    Taşar, Medine Ayşin; Şahin, Figen; Polat, Selda; İlhan, Mustafa; Çamurdan, Aysu; Dallar, Yıldız; Beyazova, Ufuk

    2014-01-01

    Aim: Shaken baby syndrome (SBS) is a condition which may cause to serious health problems in the baby. SBS may be prevented by increasing awareness with giving education to parents especially in the early postnatal period. In shaken baby prevention programs, education is recommended to be given before the 2–4th month during which the frequency of crying is increased. It is important that education given in the early period is permanent until the period during which the frequency of crying is increased. The aim of this study was to evaluate the persistency of the benefit of the SBS prevention program until the 2–4th month during which crying is intensified. Material and Methods: This study is an interventional study. When the babies became 2–4 months old, a questionnaire which questioned the usefulness of education and the experiences with babies was applied to a group selected randomly among the mothers who received SBS prevention education during pregnancy or in the first 7 postnatal days (group A). The same questionnaire was applied to 143 mothers whose babies completed their first 2 months, who presented to the hospital for vaccination and who did not receive education about SBS as the control group (group B). The data were evaluated using the Statistical Program for Social Sciences (SPSS) 15.0 statistical analysis package program. Ethical approval was obtained from the local ethics committee (30.12.2009, 2785). Results: The rate of the mothers who stated “yes” to the sentence “babies occasionally cry” which was one of the main messages of the education was statistically significantly higher in group A compared to group B (p=0.001). The rate of the mothers who stated “I agree” to the sentence “battering is harmful for babies” was statistically significantly higher in group A compared to group B (p=0.001). Conclusions: Conclusively, it was found that SBS prevention program education was permanent until the 2–4th month. PMID:26078664

  20. Long-term prognosis of AL and AA renal amyloidosis: a Japanese single-center experience.

    PubMed

    Ozawa, Masatoyo; Komatsuda, Atsushi; Ohtani, Hiroshi; Nara, Mizuho; Sato, Ryuta; Togashi, Masaru; Takahashi, Naoto; Wakui, Hideki

    2017-04-01

    Few studies have been conducted on the long-term prognosis of patients with amyloid light chain (AL) and amyloid A (AA) renal amyloidosis in the same cohort. We retrospectively examined 68 patients with biopsy-proven renal amyloidosis (38 AL and 30 AA). Clinicopathological findings at the diagnosis and follow-up data were evaluated in each patient. We analyzed the relationship between clinicopathological parameters and survival data. Significant differences were observed in several clinicopathological features, such as proteinuria levels, between the AL and AA groups. Among all patients, 84.2 % of the AL group and 93.3 % of the AA group received treatments for the underlying diseases of amyloidosis. During the follow-up period (median 18 months in AL and 61 months in AA), 36.8 % of the AL group and 36.7 % of the AA group developed end-stage renal failure requiring dialysis, while 71.1 % of the AL group and 56.7 % of the AA group died. Patient and renal survivals were significantly longer in the AA group than in the AL group. eGFR of >60 mL/min/1.73 m(2) at biopsy and an early histological stage of glomerular amyloid deposition were identified as low-risk factors. A multivariate analysis showed that cardiac amyloidosis and steroid therapy significantly influenced patient and renal survivals. Our results showed that heart involvement was the major predictor of poor outcomes in renal amyloidosis, and that the prognosis of AA renal amyloidosis was markedly better than that in previously reported cohorts. Therapeutic advances in inflammatory diseases are expected to improve the prognosis of AA amyloidosis.

  1. Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience.

    PubMed

    Mialou, Valerie; Philip, Thierry; Kalifa, Chantal; Perol, David; Gentet, Jean-Claude; Marec-Berard, Perrine; Pacquement, Helene; Chastagner, Pascal; Defaschelles, Anne-Sophie; Hartmann, Olivier

    2005-09-01

    The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively. The medical records of patients who were treated for metastatic osteosarcoma from 1987 to 2000 were reviewed. Patients were treated with the chemotherapy regimens recommended for nonmetastatic disease in children (the French Society of Pediatric Oncology OS 87 and OS 94 protocols) or, in a few patients, with other chemotherapy regimens. Surgical excision of the primary tumor and, when possible, of all metastatic sites was performed based on a personalized assessment of each patient's situation. Seventy-eight patients age < 20 years were treated. Forty-six patients (59%) had only 1 metastatic site (35 to the lungs and 11 to bone). Twenty-eight patients (36%) achieved a complete remission after combination chemotherapy and surgery. The event-free survival and overall survival rates at 5 years were 14% and 19%, respectively. To date, 14 patients (18%) have remained alive with a median follow-up of 112 months. Pretreatment features associated with a shorter event-free survival in the multivariate analysis were metastasis to at least two organs and high alkaline phosphatase level. Patients with at least 1 of these poor prognostic factors had a 2.6% event-free survival rate at 5 years despite treatment. The survival of patients with metastatic osteosarcoma were treated with conventional chemotherapy and surgery remained very poor. Patients should be classified into different prognostic groups and treated accordingly. New therapeutic approaches are warranted to improve the prognosis for patients with the most severe disease.

  2. National experience with long-term use of the wearable cardioverter defibrillator in patients with cardiomyopathy.

    PubMed

    Lamichhane, Madhab; Gardiner, Joseph C; Bianco, Nicole R; Szymkiewicz, Steven J; Thakur, Ranjan K

    2017-01-01

    The wearable cardioverter defibrillator (WCD) is generally used for short periods of sudden cardiac death (SCD) risk; circumstances may occasionally result in prolonged use (over 1 year). The aim of this study was to determine the benefits and risks of prolonged use in patients with systolic heart failure (HF). ZOLL's post-market US database included adult patients (≥18 years) with ischemic and/or non-ischemic cardiomyopathy (ICM, NICM) and at least 1 year of use. Cox-regression was used to identify factors associated with survival with WCD use, and reasons for stopping use were entered as time-dependent factors. Among 220 patients, age (mean ± SD) 55.4 ± 14.8 years, WCD use 451.4 ± 289.9 days, and 67.3 % were male and their left ventricle ejection fraction (EF) averaged 20.9 ± 7.2 %. Eighty-nine (40.5 %) were continuing WCD use at the last follow-up. Thirty-six (16.4 %) and 56 (25.5 %) patients discontinued WCD use because of EF recovery and implantable cardioverter (ICD) implantation, respectively. Nine patients (4.1 %) received appropriate shock therapy for 13 episodes of sustained ventricular tachyarrhythmia with 12 (92.3 %) successful shocks. One patient died of refractory ventricular fibrillation. One patient died from sinus bradycardia transitioning to asystole. Eight patients (3.6 %) had nine episodes of non-fatal inappropriate shocks. Long-term use of the WCD is safe and effective. Recovery of EF was seen in significant number of patients even after 1 year of WCD use.

  3. Long Term Incidence of Secondary Malignancies Following Allogeneic Hematopoietic Cell Transplantation: a Single Center Experience.

    PubMed

    Michelis, Fotios V; Kotchetkov, Rouslan; Grunwald, Rebecca M; Azeem, Aamir; Atenafu, Eshetu G; Lipton, Jeffrey H; Loach, David; Gupta, Vikas; Kuruvilla, John; Kim, Dennis D; Viswabandya, Auro; Deotare, Uday; Messner, Hans A

    2017-02-27

    To review the emergence of secondary malignancies (SM) in recipients of allogeneic hematopoietic cell transplantation (HCT). We documented the occurrence of SM in 2415 allogeneic HCT recipients, ages 18-71, in a single center over four decades. SM was seen in 209 patients, including 58 with non-metastatic squamous cell (SCC) and basal cell carcinoma (BCC) of the skin. Cumulative incidence of SM was 6.3% at 10 years, 13.5% at 20 years and 17.6% at 30 years post-HCT. Median age at diagnosis of SM was 61 years (range 21-85). By multivariable analysis, older age at HCT was the only independent prognostic factor for SM (HR=1.39 for age 41-55 and HR=1.92 for age >55 compared to age ≤40, p=0.001). The rate of SM (excluding non-metastatic SCC/BCC of skin) after HCT was 2.07 times higher (p=0.01) compared to the general population. Overall survival (OS) following diagnosis of SM (excluding non-metastatic SCC/BCC of skin) was 58% at 5 years and 50% at 10 years post-diagnosis. ECOG score was the only independent predictor of OS on multivariable analysis, with over 2 fold increased risk of death for patients with an ECOG score of 1 and over 6 fold for ECOG 2-4, compared to ECOG score 0 (p<0.0001). Forty (19%) of the 209 patients diagnosed with SM subsequently developed another new malignancy. OS was 68% and 51% at 5 and 10 years, respectively. The survival of SM patients post-HCT is favorable, thus warranting diligent long-term cancer screening and standard of care treatment. ECOG status of these patients is a predominant prognostic factor.

  4. Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

    SciTech Connect

    Lo, Andrea C.; Howard, A. Fuchsia; Nichol, Alan; Sidhu, Keerat; Abdulsatar, Farah; Hasan, Haroon; Goddard, Karen

    2014-04-01

    Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.

  5. Subtarsal Versus Transconjunctival Approach-Esthetic and Functional Long-Term Experience.

    PubMed

    Strobel, Lisa; Hölzle, Frank; Riediger, Dieter; Hilgers, Ralf-Dieter; Modabber, Ali; Gerressen, Marcus

    2016-11-01

    In addition to the transconjunctival approach, the subtarsal incision is one of the most commonly used procedures for surgical exploration of the orbital floor and infraorbital rim. However, available data are limited regarding validity and long-term esthetic and functional outcomes. The aim of this study was to verify the favorable clinical results of the subtarsal approach and compare these results with the transconjunctival procedure. Forty-five patients (subtarsal group, n = 30; transconjunctival group, n = 15) were examined 6 to 30 months after surgical intervention using a standardized follow-up. Clinically noted complications, such as paresthesia, epiphora, or ocular foreign body sensation, were scored. Postoperative scar formation was investigated using the modified Vancouver Scar Scale (mVSS) and recorded according to standardized photographic documentation procedures. Photographic images were evaluated in a blinded manner by experts and nonexperts according to fixed criteria. Concomitant photographic evaluation was performed by age- and gender-matched healthy controls. Recorded data analyzed by χ(2) test and unrelated samples analyzed by the Wilcoxon-Mann-Whitney test were statistically significant (P = .05). Comparable complication rates were found for the 2 approaches without any significant differences (P = .29). Using the subtarsal approach, discrete scar formation was discerned in 7 of 30 cases. Moreover, categorization by the mVSS showed that, in 93.3% of cases, the scar was measured as unremarkable hyper- or hypotrophy (mean, 1.7 of 10 possible points). No statistically significant differences in conspicuous scars and asymmetries were observed between the 2 approaches in the nonexpert and expert groups (P > .05). The results of the present study confirm that the subtarsal approach is a safe and esthetically favorable method. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights

  6. Uptake of ferrocyanide in willow and poplar trees in a long term greenhouse experiment.

    PubMed

    Dimitrova, Tsvetelina; Repmann, Frank; Raab, Thomas; Freese, Dirk

    2015-04-01

    Phytoremediation of sites contaminated with iron cyanides can be performed using poplar and willow trees. Poplar and willow trees were grown in potting substrate spiked with ferrocyanide concentrations of up to 2,000 mg kg(-1) for 4 and 8 weeks respectively. Soil solution and leaf tissue of different age were sampled for total cyanide analysis every week. Chlorophyll content in the leaves was determined to quantify cyanide toxicity. Results showed that cyanide in the soil solution of spiked soils differed between treatments and on weekly basis and ranged from 0.5 to 1,200 mg l(-1). The maximum cyanide content in willow and poplar leaves was 518 mg kg(-1) fresh weight (FW) and 148 mg kg(-1) FW respectively. Cyanide accumulated in the leaves increased linearly with increasing cyanide concentration in the soil solution. On the long term, significantly more cyanide was accumulated in old leaf tissue than in young tissue. Chlorophyll content in poplar decreased linearly with increasing cyanide in the soil solution and in leaf tissue, and over time. The inhibitory concentration (IC50) value for poplars after 4 weeks of exposure was 173 mg l(-1) and for willow after 8 weeks of exposure-768 mg l(-1). Results show that willows tolerate much more cyanide and over a longer period than poplars, making them very appropriate for remediating sites highly contaminated with iron cyanides.

  7. Left-colon antegrade enema (LACE): Long-term experience with the Macedo-Malone approach.

    PubMed

    Anselmo, Christophe B; do Amaral, Rafael D R; Oliveira, Diego E G; da Cruz, Marcela Leal; Liguori, Riberto; Garrone, Gilmar; Leslie, Bruno; Ottoni, Sérgio L; Ortiz, Valdemar; Macedo, Antonio

    2017-01-01

    We evaluated the long-term results with a left antegrade continence enema (LACE) approach: "Macedo-Malone (MM) procedure" to define parameters such as clinical durability of the technique and patients' compliance with the method. We reviewed the medical records of all patients that underwent the MM procedure in our institution since 2001 and conducted a telephonic interview to investigate the use of the enema and satisfaction with the procedure. Thirty-five MM procedures were performed, but eight patients lost to follow-up were excluded. Fifteen patients (55%) were female. Myelomeningocele was the clinical diagnoses in 25 (93%). Mean age at surgery was 9 years (3-27 years) and mean follow-up was 75 months (median: 56 months). The indication for LACE was clinically intractable constipation with fecal leakage. Most patients still used the stoma regularly to do the enema (74%). Mean washout time was 27 min (2-90 min). The revision rate due to stenosis was 22.2% (6/27) and all underwent suprafascial revision. We performed one classical MACE by infrafascial approach as a salvage procedure. Overall reoperation rate was 25.8% and fecal continence was 89%. There were no reports of leakage through the stoma. Among patients who still used the stoma, 74% were satisfied with surgery and would strongly recommend the procedure to another patient. The MM procedure is a straightforward procedure, which can be performed in 15-20 min, avoids additional entero-entero anastomosis, precludes the use of the appendix, and has shown comparable results to either "classical" MACE or other LACE variants. Neurourol. Urodynam. 36:111-115, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  8. The eating experience in long-term survivors of head and neck cancer: a mixed-methods study.

    PubMed

    Ganzer, Heidi; Rothpletz-Puglia, Pamela; Byham-Gray, Laura; Murphy, Barbara A; Touger-Decker, Riva

    2015-11-01

    This study explored the eating experience in long-term survivors of head and neck cancer (HNC) ≥3 years post concurrent chemoradiation. Quality of life (QOL) and the meanings and perceptions survivors had as it related to the eating experience were explored. Purposive sampling was utilized; 10 long-term survivors of HNC participated in the study. A mixed-methods approach was used; exploratory qualitative research using content analysis and summary statistics was used to describe demographic and clinical characteristics and the Vanderbilt Head and Neck Symptom Survey version 2.0 scores (VHNSS 2.0). Four categories (psychological, social impact, functional status, and the current eating experience) containing 15 subthemes and 1 overarching theme (adaptation) emerged. Current health status, QOL, and QOL related to eating were viewed favorably despite the impact of treatment late effects on participants' daily lives. Adaptation and maladaptation in regard to food choice and downplaying of symptoms were recognized. Interviews as well as the VHNSS 2.0 scores indicated that xerostomia, mucosal sensitivity, swallowing difficulty, length of time required to eat, and dysgeusia remained problematic. Psychological, functional, and social losses associated with eating were identified. Participants modify or avoid foods that are challenging yet report enjoyment with eating. Challenges with eating were downplayed. Due to the potential negative nutritional and social implications of avoiding specific food/food groups, standard of care in long-term survivors of HNC should include assessment of the eating experience and functional challenges. Nutrition professional can help patients optimize dietary intake and the eating experience.

  9. Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review.

    PubMed

    Davis, Kermit G; Kotowski, Susan E

    2015-08-01

    The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides. Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry. A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review. Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies). MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities. © 2015, Human Factors and Ergonomics Society.

  10. Understanding staff perceptions about Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae control efforts in Chicago long-term acute care hospitals.

    PubMed

    Lyles, Rosie D; Moore, Nicholas M; Weiner, Shayna B; Sikka, Monica; Lin, Michael Y; Weinstein, Robert A; Hayden, Mary K; Sinkowitz-Cochran, Ronda L

    2014-04-01

    To identify differences in organizational culture and better understand motivators to implementation of a bundle intervention to control Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC). Mixed-methods study. Four long-term acute care hospitals (LTACHs) in Chicago. LTACH staff across 3 strata of employees (administration, midlevel management, and frontline clinical workers). Qualitative interviews or focus groups and completion of a quantitative questionnaire. Eighty employees (frontline, 72.5%; midlevel, 17.5%; administration, 10%) completed surveys and participated in qualitative discussions in August 2012. Although 82.3% of respondents felt that quality improvement was a priority at their LTACH, there were statistically significant differences in organizational culture between staff strata, with administrative-level having higher organizational culture scores (ie, more favorable responses) than midlevel or frontline staff. When asked to rank the success of the KPC control program, mean response was 8.0 (95% confidence interval, 7.6-8.5), indicating a high level of agreement with the perception that the program was a success. Patient safety and personal safety were reported most often as personal motivators for intervention adherence. The most convergent theme related to prevention across groups was that proper hand hygiene is vital to prevention of KPC transmission. Despite differences in organizational culture across 3 strata of LTACH employees, the high degree of convergence in motivation, understanding, and beliefs related to implementation of a KPC control bundle suggests that all levels of staff may be able to align perspectives when faced with a key infection control problem and quality improvement initiative.

  11. Modeling spread of KPC-producing bacteria in long-term acute care hospitals in the Chicago region, USA.

    PubMed

    Haverkate, Manon R; Bootsma, Martin C J; Weiner, Shayna; Blom, Donald; Lin, Michael Y; Lolans, Karen; Moore, Nicholas M; Lyles, Rosie D; Weinstein, Robert A; Bonten, Marc J M; Hayden, Mary K

    2015-10-01

    Prevalence of bla KPC-encoding Enterobacteriaceae (KPC) in Chicago long-term acute care hospitals (LTACHs) rose rapidly after the first recognition in 2007. We studied the epidemiology and transmission capacity of KPC in LTACHs and the effect of patient cohorting. Data were available from 4 Chicago LTACHs from June 2012 to June 2013 during a period of bundled interventions. These consisted of screening for KPC rectal carriage, daily chlorhexidine bathing, medical staff education, and 3 cohort strategies: a pure cohort (all KPC-positive patients on 1 floor), single rooms for KPC-positive patients, and a mixed cohort (all KPC-positive patients on 1 floor, supplemented with KPC-negative patients). A data-augmented Markov chain Monte Carlo (MCMC) method was used to model the transmission process. Average prevalence of KPC colonization was 29.3%. On admission, 18% of patients were colonized; the sensitivity of the screening process was 81%. The per admission reproduction number was 0.40. The number of acquisitions per 1,000 patient days was lowest in LTACHs with a pure cohort ward or single rooms for colonized patients compared with mixed-cohort wards, but 95% credible intervals overlapped. Prevalence of KPC in LTACHs is high, primarily due to high admission prevalence and the resultant impact of high colonization pressure on cross transmission. In this setting, with an intervention in place, patient-to-patient transmission is insufficient to maintain endemicity. Inclusion of a pure cohort or single rooms for KPC-positive patients in an intervention bundle seemed to limit transmission compared to use of a mixed cohort.

  12. Environmental response to sewage treatment strategies: Hong Kong's experience in long term water quality monitoring.

    PubMed

    Xu, Jie; Lee, Joseph H W; Yin, Kedong; Liu, Hongbin; Harrison, Paul J

    2011-11-01

    In many coastal cities around the world, marine outfalls are used for disposal of partially treated wastewater effluent. The combined use of land-based treatment and marine discharge can be a cost-effective and environmentally acceptable sewage strategy. Before 2001, screened sewage was discharged into Victoria Harbour through many small outfalls. After 2001, the Hong Kong Harbour Area Treatment Scheme (HATS) was implemented to improve the water quality in Victoria Harbour and surrounding waters. Stage I of HATS involved the construction of a 24 km long deep tunnel sewerage system to collect sewage from the densely populated urban areas of Hong Kong to a centralized sewage treatment plant at Stonecutters Island. A sewage flow of 1.4 million m3 d(-1) receives Chemically Enhanced Primary Treatment (CEPT) followed by discharge via a 1.2 km long outfall 2 km west of the harbor. The ecosystem recovery in Victoria Harbour and the environmental response to sewage abatement after the implementation of HATS was studied using a 21-year data set from long term monthly water quality monitoring. Overall, the pollution control scheme has achieved the intended objectives. The sewage abatement has resulted in improved water quality in terms of a significant reduction in nutrients and an increase in bottom DO levels. Furthermore, due to the efficient tidal mixing and flushing, the impact of the HATS discharge on water quality in the vicinity of the outfall location is relatively limited. However, Chl a concentrations have not been reduced in Victoria Harbour where algal growth is limited by hydrodynamic mixing and water clarity rather than nutrient concentrations. Phosphorus removal in the summer is suggested to reduce the risk of algal blooms in the more weakly-flushed and stratified southern waters, while nutrient removal is less important in other seasons due to the pronounced role played by hydrodynamic mixing. The need for disinfection of the effluent to reduce bacterial (E

  13. Predicting long-term denitrification capacity of sandy aquifers from incubation experiments and sediment properties

    NASA Astrophysics Data System (ADS)

    Eschenbach, W.; Well, R.

    2012-07-01

    Knowledge about the spatial variability of denitrification rates and the lifetime of denitrification in nitrate-contaminated aquifers is crucial to predict the development of groundwater quality. Therefore, regression models were derived to estimate the measured denitrification capacity of incubated aquifer sediments from initial denitrification rates and several sediment parameters, namely total sulphur, total organic carbon, extractable sulfate, extractable dissolved organic carbon, hot water soluble organic carbon and potassium permanganate labile organic carbon. For this purpose, we incubated aquifer material from two sandy Pleistocene aquifers in Northern Germany under anaerobic conditions in the laboratory using the 15N tracer technique. The measured long-term denitrification capacities ranged from 0.18 to 56.2 mg N kg-1 yr-1. The laboratory incubations exhibited high differences between non-sulphidic and sulphidic aquifer material in both aquifers with respect to all investigated sediment parameters. Denitrification rates and the estimated lifetime of denitrification were higher in the sulphidic samples. Denitrification capacity measured during one year of incubation (Dcap) was predictable from sediment variables within a range of uncertainty of 0.5 to 2 (calculated Dcap/measured Dcap) for aquifer material with a Dcap > 20 mg N kg-1 yr-1. Predictions were poor for samples with lower Dcap like samples from the NO3--bearing groundwater zone, which includes the non-sulphidic samples, from the upper part of both aquifers where Dcap is not sufficient to protect groundwater from anthropogenic NO3- input. Calculation of Dcap from initial denitrification rates was only successful for samples from the NO3--bearing zone, whereas a lag-phase of denitrification in samples from deeper zones of NO3- free groundwater caused imprecise predictions. Our results thus show that Dcap of sandy Pleistocene aquifers can be predicted using a combination of short-term incubation and

  14. The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: a longitudinal correlational study.

    PubMed

    Yoon, Ju Young; Lee, Ji Yun; Bowers, Barbara J; Zimmerman, David R

    2012-12-01

    With the rapid increase in the number of long-term care hospitals in Korea, care quality has become an important issue. Urinary incontinence is an important condition affecting many residents' quality of life. Thus, it is important that urinary incontinence be amenable to improving conditions with appropriate interventions, since a change in urinary incontinence status can reflect care quality in long-term care facilities if patient level factors are adjusted. We aim to examine the impact of organizational factors on urinary incontinence care quality defined as the improvement of urinary incontinence status or maintenance of continent status post-admission to Korean long-term care hospitals. DESIGN AND DATA: This is a longitudinal correlation study. Data came from two sources: monthly patient assessment reports using the Patient Assessment Instrument and the hospital information system from the Health Insurance Review and Assessment Services. The final analysis includes 5271 elderly adults without indwelling urinary catheter or urostomy who were admitted to 534 Korean long-term care hospitals in April 2008. Multi-level logistic analysis was used to explore the organizational factors that influence urinary incontinence care quality controlling for patient level factors. With respect to the organizational factors, the findings showed that location and RN/total nursing staff ratio variables were statistically significant, controlling for risk factors at the patient level. The odds of urinary incontinence improvement from admission in urban long-term care hospitals were 1.28 times higher than rural long-term care hospitals. In addition, when a long-term care hospital increased one standard deviation (0.19) in the RN ratio, the odds of urinary incontinence status improvement or maintenance of continence status from admission increased about 1.8 times. The most significant finding was that a higher RN to patient ratio and urban location were associated with better

  15. Using 31P-NMR to investigate dynamics of soil phosphorus compounds in the Rothamsted Long Term Experiments

    NASA Astrophysics Data System (ADS)

    Blackwell, Martin; Turner, Ben; Granger, Steve; Hooper, Tony; Darch, Tegan; Hawkins, Jane; Yuan, Huimin; McGrath, Steve

    2015-04-01

    The technique of 31P-NMR spectroscopy has done more to advance the knowledge of phosphorus forms (especially organic phosphorus) in environmental samples than any other method. The technique has advanced such that specific compounds can be identified where previously only broad categories such as orthophosphate monoesters and diesters were distinguishable. The Soil Archive and Long Term Experiments at Rothamsted Research, UK, potentially provides an unequalled opportunity to use this technique to observe changes in soil phosphorus compounds with time and under different treatments, thereby enhancing our understanding of phosphorus cycling and use by plants. Some of the earliest work using this technique on soils was carried out by Hawkes et al. in 1984 and this used soils from two of the oldest Rothamsted Long Term Experiments, namely Highfield and Park Grass. Here we revisit the samples studied in this early work and reanalyse them using current methodology to demonstrate how the 31P-NMR technique has advanced. We also present results from a study on the phosphorus chemistry in soils along the Hoosfield acid strip (Rothamsted, UK), where a pH gradient from 3.7 to 7.8 occurs in a single soil with little variation in total phosphorus (mean ± standard deviation 399 ± 27 mg P kg-1). Soil pH was found to be an important factor in determining the proportion of phosphomonoesters and phosphodiesters in the soil organic phosphorus, although total organic phosphorus concentrations were a relatively consistent proportion of the total soil phosphorus (36 ± 2%) irrespective of soil pH. Key words. 31P-NMR, soil organic phosphorus, long term experiments, Hoosfield acid strip

  16. Long-term ex vivo bovine experiments with the Gyro C1E3 centrifugal blood pump.

    PubMed

    Kawahito, Shinji; Maeda, Tomohiro; Motomura, Tadashi; Takano, Tamaki; Nonaka, Kenji; Linneweber, Joerg; Ichikawa, Seiji; Kawamura, Masaki; Glueck, Julie; Fujisawa, Akira; Makinouchi, Kenzo; Nosé, Yukihiko

    2003-01-01

    Centrifugal blood pumps are used widely for cardiopulmonary bypass, as ventricular assist devices, and for extracorporeal membrane oxygenation (ECMO). However, there is no centrifugal blood pump that is suitable for long-term ECMO. The authors developed the Gyro C1E3 centrifugal blood pump (Kyocera Corporation, Kyoto, Japan), which has superior antithrombogenic, antitraumatic, and hydraulic features in comparison with the conventional centrifugal blood pumps. Five ex vivo long-term durability tests of the Gyro C1E3 were performed using healthy miniature calves. The ECMO circuit was composed of a prototype hollow fiber silicone membrane oxygenator and a Gyro C1E3 pump. Venous blood was drained from the left jugular vein of a calf, passed through the oxygenator and infused into the left carotid artery using a Gyro C1E3. Ex vivo studies were performed from 7 to 15 days at a blood flow rate of 1 L/min. During this period, the Gyro C1E3 demonstrated a stable performance without exchanging the pump. Bleeding complications were the major reason for termination of each experiment. Rotational speed was maintained around 2,000 rpm. All five calves demonstrated neither abnormal signs nor abnormal blood examination data throughout the experiment. Neither clot nor thrombus formations were found during the necropsy in the cannula or pump nor were infarctions observed in any of the major organs. In conclusion, the Gyro C1E3 showed a stable and reliable performance during long-term ex vivo bovine experiments under the conditions tested.

  17. Reinterpreting Long-Term Evolution Experiments: Is Delayed Adaptation an Example of Historical Contingency or a Consequence of Intermittent Selection?

    PubMed Central

    Maisnier-Patin, Sophie

    2016-01-01

    Van Hofwegen et al. demonstrated that Escherichia coli rapidly evolves the ability to use citrate when long selective periods are provided (D. J. Van Hofwegen, C. J. Hovde, and S. A. Minnich, J Bacteriol 198:1022–1034, 2016, http://dx.doi.org/10.1128/JB.00831-15). This contrasts with the extreme delay (15 years of daily transfers) seen in the long-term evolution experiments of Lenski and coworkers. Their idea of “historical contingency” may require reinterpretation. Rapid evolution seems to involve selection for duplications of the whole cit locus that are too unstable to contribute when selection is provided in short pulses. PMID:26883821

  18. Clinical experience with guanfacine in long-term treatment of hypertension

    PubMed Central

    Jerie, P.

    1980-01-01

    1 Of 662 hypertensive patients originally selected for long-term treatment, 580 were evaluated after one year and 169 continued for a second year of treatment with guanfacine. 2 There were 257 women (mean age 52.1 yr) and 323 men (mean age 51.7 yr) in the trial: 499 (86%) suffered from essential, 55 (9%) from renal, 22 (4%) from renovascular and 4 (1%) from other forms of hypertension; 200 (34%) were classified as having mild, 275 (47.5%) moderate and 101 (17.5%) severe hypertension. In four patients the degree of severity was not specified. Nearly 40% of all patients had signs of left ventricular hypertrophy, and in 71% a pathological ocular fundus was found; 72% had been pretreated with antihypertensive drugs, 56% suffered from a concomitant disease and 18% had signs of heart failure; 224 patients were classified as having a sedentary mode of life, 316 were moderate and 27 heavy physical workers. In 13 no classification was given. 3 Whenever possible, a wash-out period of 3 weeks with a placebo identical in appearance with the active drug was carried out at the beginning and at the end of the 12-month treatment period to establish the pretreatment blood pressure and the possible withdrawal phenomena after therapy discontinuation. At the beginning, two doses of guanfacine 1 mg were administered daily and the dose was successively increased. A diuretic was added if necessary. To non-responders, a β-adrenoceptor-blocker or a vasodilator was given. 4 In all trial groups a statistically significant decrease in blood pressure was found. The average reduction in mean arterial pressure was 16% at the end of the first year and 17% at the end of the second year. Normalization of blood pressure was achieved in 54% of the patients at the end of the first year and in 66% after the second year of treatment. 5 In patients with hypertension of a higher degree of severity, combined treatment was used more often and higher doses of guanfacine were administered; monotherapy was

  19. [Long-term experience with the combined ARBOND hydroxyapatite coating in implant osteointegration].

    PubMed

    Landor, I; Vavrík, P; Jahoda, D; Pokorný, D; Ballay, R; Sosna, A

    2009-06-01

    The hydroxyapatite coating of an implant surface provides osteoactive conditions that can support osteointegration of cementless joint arthroplasties. However, the possibilities of hydroxyapatite degradation, resorption and delamination that may become responsible for failure of total hip arthroplasty (THA) have been reported. The aim of the study was to assess the properties of Arbond hydroxyapatite coating by comparing the long-term survival of implants identical in construction but different in surface coating. One group (HA) comprised 86 patients (100 THAs) with an average age of 45.14 years (range, 22.3 to 77.4 years) at the time of surgery who received a femoral stem (Walter) with a coating of Arbond sprayed over the proximal half. The other group (control) included 92 patients (100 THAs) with an average age of 49.7 years (range, 33 to 68.7) who had an identical femoral component without coating. In both groups the conical-shaped acetabular cup (Walter) and femoral head made of sintered ceramics were used. The patients in whom one or both components were replaced or extracted were not included in the final clinical evaluation (Harris Hip Score). For the statistical analysis of survival, a stable component still in place at the date of the revision procedure was regarded as surviving; a lose component at the same date was considered a failure. Finally, 71 hips of the HA group followed up for an average of 15.51 (range, 5.6 to 18.56) years and 39 control hips at an average follow-up of 14.19 (range, 6.24 to 18.48) years were clinically evaluated. The data of patients who died in the course of study (HA group, 11; control group, 14) were included in the clinical evaluation with the date of their last follow-up. For both groups, the Kaplan-Meier survival curves were constructed for overall survival and for the survival of acetabular and femoral components separately. Differences in survival curves were evaluated with the use of Gehan's Wilcoxon test. Component

  20. Long-term outcome after bilateral lung transplantation - a retrospective study from a low-volume center experience.

    PubMed

    Yang, Shun-Mao; Huang, Shu-Chien; Kuo, Shuenn-Wen; Huang, Pei-Ming; Pan, Sung-Ching; Lee, Jang-Ming; Lai, Hong-Shiee; Hsu, Hsao-Hsun

    2015-03-18

    The aim of this study is to review the long-term outcomes of bilateral lung transplantation (BLTx) in our institution and examine the potential issues that may influence outcomes in a low-volume center. A retrospective review of BLTx performed in our institution between July 2006 and December 2012 was conducted. Standardized donor selection, procurement, and preservation protocols for brain-dead donors were applied. Measured outcomes were in-hospital mortality and actuarial survival using the Kaplan-Meier method. Twenty-five consecutive patients (13 male, 12 female) underwent BLTx with a mean age of 41.8 ± 13.5 years. Before LTx, the mean body mass index was 18.3 ± 3.1 kg/m2. Seven of these patients (28%) required oxygen supplementation at rest before LTx, while the remaining patients (72%) required noninvasive mechanical ventilation (n = 6, 24%), invasive mechanical ventilation (n = 9, 36%) or extracorporeal membrane oxygenation (ECMO) (n = 3, 12%). The lung grafts were procured from brain-dead donors with the mean age of 26.8 ± 11.4 year and the best PaO2 / FiO2 ratio of 513 ± 77 before procurement. All cross match results between same-race donors and recipients were negative. The percentage of same-sex matching and CMV mismatching were 64% and 4%, respectively. The mean time listed on the transplant list was 308 ± 261 days. The mean ischemic time for the first and second grafts were 222 ± 62 and 361 ± 67 minutes. During transplantation, 22 (88%) patients depended on ECMO and one (4%) on cardiopulmonary bypass support. All but two patients (82%) were discharged home in good condition; two (8%) patients died within 3 months after BLTx. The cumulative survival rates at 1-, 2-, 3-, and 5-years were 88%, 83%, 72%, and 72%, respectively. Although the comparatively few annual LTx performed is consistent with the low donation rate, our single-center growing experience demonstrates that good post-lung transplant outcomes can

  1. Global environmental change and the nature of aboveground net primary productivity responses: insights from long-term experiments.

    PubMed

    Smith, Melinda D; La Pierre, Kimberly J; Collins, Scott L; Knapp, Alan K; Gross, Katherine L; Barrett, John E; Frey, Serita D; Gough, Laura; Miller, Robert J; Morris, James T; Rustad, Lindsey E; Yarie, John

    2015-04-01

    Many global change drivers chronically alter resource availability in terrestrial ecosystems. Such resource alterations are known to affect aboveground net primary production (ANPP) in the short term; however, it is unknown if patterns of response change through time. We examined the magnitude, direction, and pattern of ANPP responses to a wide range of global change drivers by compiling 73 datasets from long-term (>5 years) experiments that varied by ecosystem type, length of manipulation, and the type of manipulation. Chronic resource alterations resulted in a significant change in ANPP irrespective of ecosystem type, the length of the experiment, and the resource manipulated. However, the pattern of ecosystem response over time varied with ecosystem type and manipulation length. Continuous directional responses were the most common pattern observed in herbaceous-dominated ecosystems. Continuous directional responses also were frequently observed in longer-term experiments (>11 years) and were, in some cases, accompanied by large shifts in community composition. In contrast, stepped responses were common in forests and other ecosystems (salt marshes and dry valleys) and with nutrient manipulations. Our results suggest that the response of ANPP to chronic resource manipulations can be quite variable; however, responses persist once they occur, as few transient responses were observed. Shifts in plant community composition over time could be important determinants of patterns of terrestrial ecosystem sensitivity, but comparative, long-term studies are required to understand how and why ecosystems differ in their sensitivity to chronic resource alterations.

  2. Local technicians in long-term research projects: evaluation of 25 years experience in an active tropical research station.

    PubMed

    Hurtado, Johanna; Clark, David B

    2011-12-01

    Most field ecology is conceived and financed by scientists from urban areas but is actually carried out in rural areas. Field staff can either be imported from urban areas or recruited from local residents. We evaluated the advantages and disadvantages of involving rural residents as local technicians over a 25- year period at active field research site in Costa Rica. We defined "local technicians" as local residents with no university education who acquired significant experience in field data collection, data management and/or laboratory work. We analyzed the experiences of incorporating these technicians into field research in developing countries from the points of view of scientist and of the local technicians themselves. Primary data were written responses from to a standardized survey of 19 senior scientists and Ph.D. students,and results from standardized personal interviews with 22 local technicians. Researchers highlighted the advantages of highly-skilled technicians with minimal staff turnover, as well as the technicians' knowledge of local ecological conditions. Local technicians considered the primary advantages of their jobs to be opportunities for continuing education training in science as well as cultural enrichment through interactions with people of different cultures. The main challenges identified by researchers were the lack of long-term funding for projects and extended training required for local technicians. Local technicians can be of great benefit to research projects by providing high-quality data collection at reasonable costs with low staff turnover. Over the last 25 years the research model at the field station we studied has evolved to the point that most long-term projects now depend heavily on local technicians. This model of involving local technicians in long-term research has multiple benefits for the researchers, the technicians and the local community, and could be adapted to a variety of settings in rural areas of developing

  3. Atmospheric Chemistry Experiment (ACE) Measurements of Tropospheric and Stratospheric Chemistry and Long-Term Trends

    NASA Technical Reports Server (NTRS)

    Rinsland, Curtis P.; Bernath, Peter; Boone, Chris; Nassar, Ray

    2007-01-01

    We highlight chemistry and trend measurement results from the Atmospheric Chemistry Experiment (ACE) which is providing precise middle troposphere to the lower thermosphere measurements with a 0.02/cm resolution Fourier transform spectrometer covering 750-4400/cm

  4. Chernozem aggregate waterstability loss investigation in a long-term bare fallow experiment

    NASA Astrophysics Data System (ADS)

    Vasilyeva, N. A.; Milanovskiy, E. Y.

    2009-04-01

    POM (0.5%). In analytical aspect of the research possibility to describe soil components as a whole through parameters of soil particles and SOM characteristics can be realized: a) profile distribution of the average Corg content over soil layer mass is closely fitted by the sum (exp1+exp2+C), indicating particular OM pools; b) Corg content (~2%) of stable to long-term degradation sorbed SOM is set in the power parameter of experimental curve SSA (Corg) for chernozem under grassland. c) fractal dimension discontinuities correspond to classification boundaries of colloidal, clay, silt and sand particles (0.5; 2; 20 mkm); d) qualitative change of hydrophobic properties is described by one parameter presumably related to structure of high molecular HS.

  5. Ethics consultation in pediatrics: long-term experience from a pediatric oncology center.

    PubMed

    Johnson, Liza-Marie; Church, Christopher L; Metzger, Monika; Baker, Justin N

    2015-01-01

    There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000-2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.

  6. Long-term management of ventilated-assisted individuals: the Boston University experience.

    PubMed

    Make, B J

    1986-04-01

    In the 4 1/2 years beginning in January 1981, the University Hospital at the Boston University Medical Center admitted 46 ventilator-assisted individuals to its Respiratory Care Center and discharged 38 of them to their homes with ventilators. Of the 46 admitted, 23 had COPD and 23 had neuromuscular or skeletal disorders. All the latter were successfully sent home, and 15 of the 23 with COPD went home. At follow-up in 1985, of the 38 patients managed at home for periods of 1 to 51 months, 30 were surviving and 4 with COPD and 4 with neuromuscular disorders had died. One died immediately after discharge, one who had amyotrophic lateral sclerosis lived 9 months at home before dying, and the other 6 lived at home a year or more before dying. These results were made possible by an inpatient facility that had the goal of improving the quality of life of ventilator-assisted persons. This was done by the use of portable ventilators on motorized wheelchairs, by the use of traditional rehabilitation techniques, and by encouraging and training patients to become independent and responsible for their own personal and respiratory care. The hospital-based Respiratory Care Center is staffed by a team from physical therapy, occupational therapy, respiratory therapy, rehabilitation nursing, social service, psychiatry, rehabilitation medicine, and otolaryngology. A pulmonary physician directs the program and a respiratory nurse specialist is co-director and oversees its daily operation. The rehabilitation process has six stages: Stage 1 is stabilization, Stage II is evaluation, Stage III is rehabilitation planning, Stage IV is rehabilitation training, Stage V is discharge planning.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Mixtures of Uncaria and Tabebuia extracts are potentially chemopreventive in CBA/Ca mice: a long-term experiment.

    PubMed

    Budán, Ferenc; Szabó, István; Varjas, Tímea; Nowrasteh, Ghodratollah; Dávid, Tamás; Gergely, Péter; Varga, Zsuzsa; Molnár, Kornélia; Kádár, Balázs; Orsós, Zsuzsa; Kiss, István; Ember, István

    2011-04-01

    A long-term experimental animal model was developed by our research group for the evaluation of potential chemopreventive effects. The inhibitory effects of agents on carcinogen (7,12-dimethylbenz[a]anthracene (DMBA) induced molecular epidemiological biomarkers, in this case the expression of key onco/suppressor genes were investigated. The expression pattern of c-myc, Ha-ras, Bcl-2, K-ras protooncogene and p53 tumour suppressor gene were studied to elucidate early carcinogenic and potential chemopreventive effects. The consumption of so-called Claw of Dragon tea (CoD™ tea) containing the bark of Uncaria guianensis, Cat's Claw (Uncaria sp. U. tomentosa) and Palmer trumpet-tree (Tabebuia sp. T. avellanedae) was able to decrease the DMBA-induced onco/suppressor gene overexpression in a short-term animal experiment. In a following study CBA/Ca mice were treated with 20 mg/kg bw DMBA intraperitoneally (i.p.) and the expression patterns of onco/suppressor genes were examined at several time intervals. According to the examined gene expression patterns in this long-term experiment the chemopreventive effect of CoD™ tea consumption could be confirmed. Copyright © 2010 John Wiley & Sons, Ltd.

  8. Experiences of the Swedish healthcare system: an interview study with refugees in need of long-term health care.

    PubMed

    Razavi, Monireh Farsi; Falk, Lars; Björn, Åke; Wilhelmsson, Susan

    2011-05-01

    Refugees needing long-term health care must adapt to new healthcare systems. The aim of this study was to examine the viewpoints of nine refugees in a county in Sweden, with a known chronic disease or functional impairment requiring long-term medical care, on their contacts with care providers regarding treatment and personal needs. Semi-structured interviews with nine individuals and/or their next of kin. Inductive content analysis was used to identify experiences. ''Care organisations/resources'' and ''professional competence'' were the categories extracted. Participants felt cared for due to accessibility to and regular appointments with the same care provider. Visiting different clinics contributed to a negative experience and lack of trust. The staff 's interest in participants' lives and health contributed to a sense of professionalism. Most participants said the problems experienced were not related to their backgrounds as refugees. Many patients did not fully understand which clinic they were attending or the purpose of the care that the specific clinic provided. Some lacked knowledge of their disease. Health care was perceived as equal to other Swedish citizens and problems experienced were not explained by refugee backgrounds. Lack of information from care providers and being sent to various levels of care created feelings of a lack of overall medical responsibility.

  9. Long term experience with semi-conductive glaze high voltage post insulators

    SciTech Connect

    Baker, A.C.; Maney, J.W.; Szilagyi, Z. )

    1990-01-01

    Insulators using semi-conductive glaze have long been known for their superior contamination performance. Early glazes for this type however were not stable and successful use of semi-conductive glazed porcelain insulators was delayed many years until tin-antimony oxide glazes were developed. Service experience of eighteen years is now available for line and station post insulators with this type of glaze. Based on this experience, the aging characteristics of tin-antimony oxide semi-conductive glazes are described and quantified. Several different applications of these insulators are also described.

  10. Analyzing fertilizer-induced dynamics of soluble organic matter composition in soils from long-term field experiments

    NASA Astrophysics Data System (ADS)

    Ellerbrock, Ruth; Gerke, Horst, H.

    2016-04-01

    Fertilization and soil management can affect soil organic matter. However, it is unclear how amount and composition of SOM will be changed by mineral and organic fertilization. The objective of this study was to test the applicability of infrared spectroscopy for analyzing management-induced impacts on OM composition. Ap horizon samples were collected from the long term-field experiments at Bad Lauchstädt (loam), Groß Kreutz and Müncheberg (loamy sand) of plots fertilized with farmyard manure (FYM), farmyard manure plus mineral nitrogen (FYM+N), and mineral nitrogen only (N), and an unfertilized Control plot. Fourier-transform infrared (FTIR) spectroscopy was used to analyze SOM, hot water soluble (OM-HW) and sodium pyrophosphate soluble (OM-PY) organic matter fractions. The OM composition was evaluated in terms of the ratio between absorption band intensities in FTIR. The soluble OM fractions of FYM had larger C=O/C-O-C ratios as compared to N and Control. While the cation exchange capacity (CEC) of OM-PY from FYM plots was larger, it was smaller for the N plots as compared to that of the Control at all sites. The results allowed identifying fertilization-induced long-term dynamics in (i) the OM composition and (ii) the CEC and the potential wettability of SOM and OM fractions. The OM-PY fraction could be used to identify and characterize the long-term changes in organic matter composition. For a more quantitative analysis, however, more replicate samples and a seasonal differentiation would be required to separate between shorter- and longer-term changes.

  11. Continued wilderness participation: Experience and identity as long-term relational phenomena

    Treesearch

    Jeffrey J. Brooks; Daniel R. Williams

    2012-01-01

    Understanding the relationship between wilderness outings and the resulting experience has been a central theme in resource-based, outdoor recreation research for nearly 50 years. The authors provide a review and synthesis of literature that examines how people, over time, build relationships with wilderness places and express their identities as consequences of...

  12. The Black Professor Abroad: Long-Term Teaching Experiences in Foreign Lands

    ERIC Educational Resources Information Center

    Fikes, Robert, Jr.

    2006-01-01

    The experiences of African American professors reach back nearly 150 years beginning with their pioneering efforts to educate Africans in Liberia. With the gradual racial integration of the American professoriate in the post-World War II era and the redoubled effort of the federal government and private agencies, along with the support of colleges…

  13. Early Experiences Can Alter Gene Expression and Affect Long-Term Development. Working Paper #10

    ERIC Educational Resources Information Center

    National Scientific Council on the Developing Child, 2010

    2010-01-01

    New scientific research shows that environmental influences can actually affect whether and how genes are expressed. Thus, the old ideas that genes are "set in stone" or that they alone determine development have been disproven. In fact, scientists have discovered that early experiences can determine how genes are turned on and off and even…

  14. Rapid quantification of soilborne pathogen communities in wheat-based long-term field experiments

    USDA-ARS?s Scientific Manuscript database

    Traditional isolation and quantification of inoculum density is difficult for most soilborne pathogens. Quantitative PCR methods have been developed to rapidly identify and quantify many of these pathogens using a single DNA extract from soil. Rainfed experiments operated continuously for up to 84 y...

  15. Early Experiences Can Alter Gene Expression and Affect Long-Term Development. Working Paper #10

    ERIC Educational Resources Information Center

    National Scientific Council on the Developing Child, 2010

    2010-01-01

    New scientific research shows that environmental influences can actually affect whether and how genes are expressed. Thus, the old ideas that genes are "set in stone" or that they alone determine development have been disproven. In fact, scientists have discovered that early experiences can determine how genes are turned on and off and even…

  16. Interaction between mode of learning and subjective experience: translation effects in long-term memory.

    PubMed

    Rackie, James M; Brandt, Karen R; Eysenck, Michael W

    2015-01-01

    It has been suggested that writing auditorily presented words at encoding involves distinctive translation processes between visual and auditory domains, leading to the formation of distinctive memory traces at retrieval. This translation effect leads to higher levels of recognition than the writing of visually presented words, a non-translation effect. The present research investigated whether writing and the other translation effect of vocalisation (vocalising visually presented words) would be present in tests of recall, recognition memory and whether these effects are based on the subjective experience of remembering or knowing. Experiment 1 found a translation effect in the auditory domain in recall, as the translation effect of writing yielded higher recall than both non-translation effects of vocalisation and silently hearing. Experiment 2 found a translation effect in the visual domain in recognition, as the translation effect of vocalisation yielded higher recognition than both non-translation effects of writing and silently reading. This translation effect was attributable to the subjective experience of remembering rather than knowing. The present research therefore demonstrates the beneficial effect of translation in both recall and recognition, with the effect of vocalisation in recognition being based on rich episodic remembering.

  17. The Long-Term Effects of War Experiences on Children's Depression in the Republic of Croatia

    ERIC Educational Resources Information Center

    Brajsa-Zganec, A.

    2005-01-01

    Objective:: The aim of the study was to investigate whether different levels of depressive symptoms in early adolescent boys and girls could be predicted on the basis of war experiences, perceived available social support (instrumental support, support to self-esteem, belonging and acceptance) and extraversion. Methods:: The sample consisted of…

  18. The Long-Term Effects of War Experiences on Children's Depression in the Republic of Croatia

    ERIC Educational Resources Information Center

    Brajsa-Zganec, A.

    2005-01-01

    Objective:: The aim of the study was to investigate whether different levels of depressive symptoms in early adolescent boys and girls could be predicted on the basis of war experiences, perceived available social support (instrumental support, support to self-esteem, belonging and acceptance) and extraversion. Methods:: The sample consisted of…

  19. Ethics Consultation in Pediatrics: Long-Term Experience from a Pediatric Oncology Center

    PubMed Central

    Johnson, Liza-Marie; Church, Christopher L.; Metzger, Monika; Baker, Justin N.

    2015-01-01

    There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children’s Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician’s fiduciary responsibility to the patient. Non-patient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision-making among multiple stakeholders and further prospective research is needed on the role of ethics consultation in pediatrics. PMID:25970382

  20. Long-Term Operating Experience with High-Power Gyrotron Oscillators

    NASA Astrophysics Data System (ADS)

    Felch, Kevin

    2005-10-01

    High-power, megawatt-class gyrotron oscillators have now been used in electron cyclotron heating (ECH) experiments for several years. The long periods of sustained operation have provided important information about the design limits that had initially been placed on the key elements of the gyrotron. In particular, observations made on recent 110 GHz, 1 MW gyrotrons used in ECH experiments on DIII-D at General Atomics indicate that several of the important components of the device, including the electron guns, interaction cavities and diamond output windows, have performed quite well, while analyses of the electron beam collectors on some of the devices indicate that design limits have often been exceeded. Observations made on these gyrotrons will be summarized and plans to address problem areas will be discussed.

  1. Ocean acidification effects on mesozooplankton community development: Results from a long-term mesocosm experiment

    PubMed Central

    Algueró-Muñiz, María; Alvarez-Fernandez, Santiago; Thor, Peter; Bach, Lennart T.; Esposito, Mario; Horn, Henriette G.; Ecker, Ursula; Langer, Julia A. F.; Taucher, Jan; Malzahn, Arne M.; Riebesell, Ulf; Boersma, Maarten

    2017-01-01

    Ocean acidification may affect zooplankton directly by decreasing in pH, as well as indirectly via trophic pathways, where changes in carbon availability or pH effects on primary producers may cascade up the food web thereby altering ecosystem functioning and community composition. Here, we present results from a mesocosm experiment carried out during 113 days in the Gullmar Fjord, Skagerrak coast of Sweden, studying plankton responses to predicted end-of-century pCO2 levels. We did not observe any pCO2 effect on the diversity of the mesozooplankton community, but a positive pCO2 effect on the total mesozooplankton abundance. Furthermore, we observed species-specific sensitivities to pCO2 in the two major groups in this experiment, copepods and hydromedusae. Also stage-specific pCO2 sensitivities were detected in copepods, with copepodites being the most responsive stage. Focusing on the most abundant species, Pseudocalanus acuspes, we observed that copepodites were significantly more abundant in the high-pCO2 treatment during most of the experiment, probably fuelled by phytoplankton community responses to high-pCO2 conditions. Physiological and reproductive output was analysed on P. acuspes females through two additional laboratory experiments, showing no pCO2 effect on females’ condition nor on egg hatching. Overall, our results suggest that the Gullmar Fjord mesozooplankton community structure is not expected to change much under realistic end-of-century OA scenarios as used here. However, the positive pCO2 effect detected on mesozooplankton abundance could potentially affect biomass transfer to higher trophic levels in the future. PMID:28410436

  2. Saving the soil: lessons from the long-term soil productivity experiment

    Treesearch

    Mark T. Sampson; Robert F. Featured: Powers

    2007-01-01

    Soil nourishes and sustains the forest, yet it’s also one of the least understood ecosystem components. In a landmark experiment involving the Forest Services of both the United States and Canada, scientist Robert F.Powers leads the world’s largest effort at understanding how to best manage this resource to improve the health and productivity of the forest.

  3. Growth properties of protoplanetary dust in a long-term microgravity experiment

    NASA Astrophysics Data System (ADS)

    Brisset, Julie; Kothe, Stefan; Weidling, Rene; Heisselmann, Daniel; Blum, Juergen

    2014-11-01

    In the very first steps of the formation of a new planetary system, dust agglomerates and grows inside the protoplanetary disk that rotates around the newly formed star. In this disk, collisions between the dust particles, induced by interactions with the surrounding gas, lead to sticking. Aggregates start growing until their sizes and relative velocities are high enough for collisions to result in bouncing or fragmentation. As part of a series of microgravity experiments aiming at the investigation of the transitions between sticking, bouncing and fragmentation of colliding dust aggregates, the Suborbital Particle and Aggregation Experiment (SPACE) was designed, built and operated both at the drop tower in Bremen (August 2011) and on the REXUS 12 suborbital rocket (March 2012). The SPACE experiment allowed for the observation of collisions between aggregates of sizes of a few 100 µm that were composed of SiO2, a commonly used protoplanetary dust analog material. At velocities below 10 cm/s, clusters composed of a high number of aggregates (more than 10^4) formed and grew to sizes of up to 5 mm. The analysis of these collisions delivered valuable input to a current dust collision model, which maps the outcome of collisions depending on the aggregate sizes and their relative velocities. The sticking probability of sub-mm-sized dust aggregates could directly be measured during the suborbital rocket flight, over a velocity range covering the transition between the sticking and bouncing regimes. In addition, the evolution of clusters formed from sub-mm-sized aggregates during the different experiments could be observed and some of their intrinsic properties derived. The measured characteristics were the cluster fractal dimensions, the tensile strength of their outer aggregate layer and the effective surface energy of their constituents. Threshold energies for cluster restructuring and fragmentation could also be determined. All these cluster properties are important

  4. Ocean acidification effects on mesozooplankton community development: Results from a long-term mesocosm experiment.

    PubMed

    Algueró-Muñiz, María; Alvarez-Fernandez, Santiago; Thor, Peter; Bach, Lennart T; Esposito, Mario; Horn, Henriette G; Ecker, Ursula; Langer, Julia A F; Taucher, Jan; Malzahn, Arne M; Riebesell, Ulf; Boersma, Maarten

    2017-01-01

    Ocean acidification may affect zooplankton directly by decreasing in pH, as well as indirectly via trophic pathways, where changes in carbon availability or pH effects on primary producers may cascade up the food web thereby altering ecosystem functioning and community composition. Here, we present results from a mesocosm experiment carried out during 113 days in the Gullmar Fjord, Skagerrak coast of Sweden, studying plankton responses to predicted end-of-century pCO2 levels. We did not observe any pCO2 effect on the diversity of the mesozooplankton community, but a positive pCO2 effect on the total mesozooplankton abundance. Furthermore, we observed species-specific sensitivities to pCO2 in the two major groups in this experiment, copepods and hydromedusae. Also stage-specific pCO2 sensitivities were detected in copepods, with copepodites being the most responsive stage. Focusing on the most abundant species, Pseudocalanus acuspes, we observed that copepodites were significantly more abundant in the high-pCO2 treatment during most of the experiment, probably fuelled by phytoplankton community responses to high-pCO2 conditions. Physiological and reproductive output was analysed on P. acuspes females through two additional laboratory experiments, showing no pCO2 effect on females' condition nor on egg hatching. Overall, our results suggest that the Gullmar Fjord mesozooplankton community structure is not expected to change much under realistic end-of-century OA scenarios as used here. However, the positive pCO2 effect detected on mesozooplankton abundance could potentially affect biomass transfer to higher trophic levels in the future.

  5. Long-term effects of the Moving to Opportunity residential mobility experiment on crime and delinquency.

    PubMed

    Sciandra, Matthew; Sanbonmatsu, Lisa; Duncan, Greg J; Gennetian, Lisa A; Katz, Lawrence F; Kessler, Ronald C; Kling, Jeffrey R; Ludwig, Jens

    2013-12-01

    Using data from a randomized experiment, to examine whether moving youth out of areas of concentrated poverty, where a disproportionate amount of crime occurs, prevents involvement in crime. We draw on new administrative data from the U.S. Department of Housing and Urban Development's Moving to Opportunity (MTO) experiment. MTO families were randomized into an experimental group offered a housing voucher that could only be used to move to a low-poverty neighborhood, a Section 8 housing group offered a standard housing voucher, and a control group. This paper focuses on MTO youth ages 15-25 in 2001 (n = 4,643) and analyzes intention to treat effects on neighborhood characteristics and criminal behavior (number of violent- and property-crime arrests) through 10 years after randomization. We find the offer of a housing voucher generates large improvements in neighborhood conditions that attenuate over time and initially generates substantial reductions in violent-crime arrests and sizable increases in property-crime arrests for experimental group males. The crime effects attenuate over time along with differences in neighborhood conditions. Our findings suggest that criminal behavior is more strongly related to current neighborhood conditions (situational neighborhood effects) than to past neighborhood conditions (developmental neighborhood effects). The MTO design makes it difficult to determine which specific neighborhood characteristics are most important for criminal behavior. Our administrative data analyses could be affected by differences across areas in the likelihood that a crime results in an arrest.

  6. Long-term effects of the Moving to Opportunity residential mobility experiment on crime and delinquency

    PubMed Central

    Sciandra, Matthew; Sanbonmatsu, Lisa; Duncan, Greg J.; Gennetian, Lisa A.; Katz, Lawrence F.; Kessler, Ronald C.; Kling, Jeffrey R.; Ludwig, Jens

    2013-01-01

    Objectives Using data from a randomized experiment, to examine whether moving youth out of areas of concentrated poverty, where a disproportionate amount of crime occurs, prevents involvement in crime. Methods We draw on new administrative data from the U.S. Department of Housing and Urban Development’s Moving to Opportunity (MTO) experiment. MTO families were randomized into an experimental group offered a housing voucher that could only be used to move to a low-poverty neighborhood, a Section 8 housing group offered a standard housing voucher, and a control group. This paper focuses on MTO youth ages 15–25 in 2001 (n = 4,643) and analyzes intention to treat effects on neighborhood characteristics and criminal behavior (number of violent- and property-crime arrests) through 10 years after randomization. Results We find the offer of a housing voucher generates large improvements in neighborhood conditions that attenuate over time and initially generates substantial reductions in violent-crime arrests and sizable increases in property-crime arrests for experimental group males. The crime effects attenuate over time along with differences in neighborhood conditions. Conclusions Our findings suggest that criminal behavior is more strongly related to current neighborhood conditions (situational neighborhood effects) than to past neighborhood conditions (developmental neighborhood effects). The MTO design makes it difficult to determine which specific neighborhood characteristics are most important for criminal behavior. Our administrative data analyses could be affected by differences across areas in the likelihood that a crime results in an arrest. PMID:24348277

  7. Different early rearing experiences have long term effects on cortical organization in captive chimpanzees (Pan troglodytes)

    PubMed Central

    Bogart, Stephanie L.; Bennett, Allyson J.; Schapiro, Steven J.; Reamer, Lisa A.; Hopkins, William D.

    2014-01-01

    Consequences of rearing history in chimpanzees (Pan troglodytes) have been explored in relation to behavioral abnormalities and cognition, however, little is known about the effects of rearing conditions on anatomical brain development. Human studies have revealed that experiences of maltreatment and neglect during infancy and childhood can have detrimental effects on brain development and cognition. In this study, we evaluated the effects of early rearing experience on brain morphology in 92 captive chimpanzees (ages 11-43) who were either reared by their mothers (n = 46) or in a nursery (n = 46) with age-group peers. Magnetic resonance brain images were analyzed with a processing program (BrainVISA) that extracts cortical sulci. We obtained various measurements from 11 sulci located throughout the brain, as well as whole brain gyrification and white and grey matter volumes. We found that mother-reared chimpanzees have greater global white-to-grey matter volume, more cortical folding and thinner grey matter within the cortical folds than nursery-reared animals. The findings reported here are the first to demonstrate that differences in early rearing conditions have significant consequences on brain morphology in chimpanzees and suggests potential differences in the development of white matter expansion and myelination. PMID:24206013

  8. The Messenger Matters: Teacher Research Experiences and Effective, Long-term Science Communication

    NASA Astrophysics Data System (ADS)

    Timm, K.; Warburton, J.; Larson, A. M.

    2010-12-01

    PolarTREC - Teachers and Researchers Exploring and Collaborating, an NSF-Funded program of the Arctic Research Consortium of the US, matches K-12 teachers with researchers for 2-6 week hands on research experiences in the polar regions. During their teacher research experience, teachers and researchers in the field communicate widely with students and members of the public online through teacher journals, photo galleries, interactive discussion forums, multimedia resources, and real-time live events that connect the science of the Arctic or Antarctic to students and the public around the world. Due to the exciting nature of field-based polar science and the novelty of teacher participation, PolarTREC creates a natural pathway for information—from scientists to students and the general public. Initial data from the PolarTREC evaluation indicates that researchers viewed the dissemination activities of PolarTREC as an essential outreach activity allowing them to meet broader impact objectives of their project. Many researchers noted that conducting outreach through PolarTREC was “easy,” and that it “really increased our public image and bridged the separation between science and the public at large.” Although the immediate outreach activities related to the field experience are valuable, the lasting impacts of PolarTREC are related to the professional development received by the teachers through their participation. Many K-12 teachers, in both undergraduate and graduate education, have little opportunity to actually conduct inquiry-based science. The curriculum at this level consists of primarily memorizing facts and conducting contrived experiments (Michaels et al, 2008). After being embedded in an actual research project with professional scientists, participating teachers reported significant increases in their knowledge of the polar regions and improvements in their ability to teach pertinent science concepts. In particular, teachers had a better

  9. Long-term experience with rituximab in anti-synthetase syndrome-related interstitial lung disease.

    PubMed

    Andersson, Helena; Sem, Marthe; Lund, May Brit; Aaløkken, Trond Mogens; Günther, Anne; Walle-Hansen, Ragnhild; Garen, Torhild; Molberg, Øyvind

    2015-08-01

    To retrospectively evaluate the efficacy and safety of rituximab (Rtx) treatment in patients with anti-synthetase syndrome (ASS) and severe interstitial lung disease (ILD). Patients with severe ILD and >12 months follow-up post-Rtx were identified from the Oslo University Hospital ASS cohort (n = 112). Clinical data, including pulmonary function tests (PFTs), were retrospectively collected from medical reports. Extent of ILD pre-, and post-Rtx was scored on thin-section high-resolution CT (HRCT) images and expressed as a percentage of total lung volume. Muscle strength was evaluated by manual muscle testing of eight muscle groups (MMT8). Altogether, 34/112 ASS patients had received Rtx; 24/34 had severe ILD and >12 months follow-up post-Rtx (median 52 months). In these 24 patients, the median percentage of predicted forced vital capacity, forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO) increased by 24%, 22% and 17%, respectively, post-Rtx. Seven patients (all with disease duration <12 months and/or acute onset/exacerbation of ILD) had >30% improvement in all three PFTs. HRCT analysis showed a median 34% reduction in ILD extent post-Rtx. MMT8 score increased post-Rtx. During follow-up, 7/34 (21%) Rtx-treated ASS patients died; 6/7 deaths were related to infections. The mortality rate in the Rtx-treated group was comparable to that of the remaining ASS cohort (25/78 deceased; 32%). This study, which included 24 Rtx-treated ASS patients with severe ILD, reports improved PFTs after a median 52 months follow-up post-Rtx. The best outcome was observed in patients with a disease duration <12 months and/or acute onset/exacerbation of ILD. The study indicates that Rtx could be a treatment option for selected ASS patients, but infections should be given attention. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email

  10. Long-term experience in autologous in vitro endothelialization of infrainguinal ePTFE grafts.

    PubMed

    Deutsch, Manfred; Meinhart, Johann; Zilla, Peter; Howanietz, Norbert; Gorlitzer, Michael; Froeschl, Alexander; Stuempflen, Andreas; Bezuidenhout, Deon; Grabenwoeger, Martin

    2009-02-01

    .9 +/- 17.8 months. Autologous in vitro endothelialization was shown to be a feasible routine procedure at a nontertiary hospital. Explants confirmed the presence of an endothelium years after implantation while the primary patency in the particularly challenging subgroup of patients without a suitable saphenous vein resembles that of vein grafts.

  11. Microwave snow emission model using a long-term field experiment

    NASA Astrophysics Data System (ADS)

    Munoz-Barreto, Jonathan

    Microwave remote sensing has shown great potential in estimating snowpack properties such as: snow depth and Snow Water Equivalent (SWE). However, other snow properties like density, wetness and grain size, which are variable in space and time, largely impact the microwave signal scattering, still need to be investigated and understood. With the objective to improve our understanding of the effect of changing snow characteristics (grain size, snow wetness, density, temperature) under various meteorological conditions on the microwave emission of snow, the CREST-Snow Analysis and Field Experiment (CREST-SAFE) was established at the research site of the National Weather Service office, Caribou, ME, USA. In this ground experiment, 37 and 89 GHz dual polarized microwave observations are conducted continuously, along with detailed synchronous observations of snowpack physical properties. The first part of this work provides an overview of the field experiment, the snow pack and other environmental parameters which are routinely measured at the station both automatically and manually. The measurement programme includes microwave observations, meteorological observations (air temperature, snow skin-temperature, humidity, wind speed and direction, precipitation, incoming and outgoing radiations), along with the measurements of the snow pack bulk physical properties (snow depth, grain size, shape, hardness, and density) and vertical temperature profiles. The detailed analysis of microwave observations collected during the last three years along with the observed and simulated snowpack properties are presented. The second component of this work focuses on the development of a new approach to estimate the snow wetness (liquid water content) using information on the snow grain size and temperature. The objective of these efforts is to directly assimilate the predicted snow wetness in the HUT (Helsinki University of Technology) microwave emission model. The modified version of

  12. Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives and nurses in Finland.

    PubMed

    Teeri, Sari; Leino-Kilpi, Helena; Välimäki, Maritta

    2006-03-01

    The aim of this study was to explore ethically problematic situations in the long-term nursing care of elderly people. It was assumed that greater awareness of ethical problems in caring for elderly people helps to ensure ethically high standards of nursing care. To obtain a broad perspective on the current situation, the data for this study were collected among elderly patients, their relatives and nurses in one long-term care institution in Finland. The patients (n = 10) were interviewed, while the relatives, (n = 17) and nurses (n = 9) wrote an essay. Interpretation of the data was based on qualitative content analysis. Problematic experiences were divided into three categories concerning patients' psychological, physical and social integrity. In the case of psychological integrity, the problems were seen as being related to treatment, self-determination and obtaining information; for physical integrity, they were related to physical abuse and lack of individualized care; and for social integrity, to loneliness and social isolation. This study provided no information on the prevalence of ethical problems. However, it is clear from the results that patient integrity warrants more attention in the nursing care of elderly patients.

  13. Long-term opioid contract use for chronic pain management in primary care practice. A five year experience.

    PubMed

    Hariharan, Jaishree; Lamb, Geoffrey C; Neuner, Joan M

    2007-04-01

    The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. Retrospective cohort study. All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients.

  14. The experience of facilitators and participants of long term condition self-management group programmes: A qualitative synthesis.

    PubMed

    Hughes, Stephen; Lewis, Sophie; Willis, Karen; Rogers, Anne; Wyke, Sally; Smith, Lorraine

    2017-07-01

    Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. We searched 7 databases using the terms 'self-management', 'group' and 'qualitative'. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. Group programmes' medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Real-world clinical experience with long-term miglustat maintenance therapy in type 1 Gaucher disease: the ZAGAL project

    PubMed Central

    Giraldo, Pilar; Alfonso, Pilar; Atutxa, Koldo; Fernández-Galán, María A.; Barez, Abelardo; Franco, Rafael; Alonso, Dora; Martin, Alejandro; Latre, Paz; Pocovi, Miguel

    2009-01-01

    There are few published data from real-world clinical experience with miglustat (Zavesca®), an oral inhibitor of glucosylceramide synthase, in type 1 Gaucher disease. We report data from a prospective, open-label investigational study that evaluated substrate reduction therapy with miglustat 100 mg t.i.d. as a maintenance therapy in patients with Type 1 Gaucher disease who had been switched from previous enzyme replacement therapy. Long-term data on changes in organ size, blood counts, disease severity bio-markers, bone marrow infiltration, overall clinical status and safety/tolerability were analyzed from 28 patients with Type 1 Gaucher disease who were attending routine clinic visits. Assessments were performed at six, 12, 24, 36 and 48 months of therapy. Disease severity biomarkers improved up to 48 months after initiation of miglustat, while other disease parameters remained stable. Miglustat showed an acceptable profile of safety and tolerability throughout treatment. In conclusion, miglustat is an effective therapy for the long-term maintenance of patients with Type 1 Gaucher disease previously stabilized with enzyme replacement therapy. PMID:19608672

  16. Young and midlife stroke survivors' experiences with the health services and long-term follow-up needs.

    PubMed

    Martinsen, Randi; Kirkevold, Marit; Sveen, Unni

    2015-02-01

    The aim of this qualitative study was to explore young and midlife stroke survivors' experiences with the health services and to identify long-term follow-up needs. Sixteen participants from two cohorts were interviewed in-depth. The interviews were analyzed applying a hermeneutic-phenomenological analysis. The participants struggled to gain access to follow-up health services. They felt that whether they were systematically followed up was more coincidental than planned. Young and midlife stroke survivors thus appear vulnerable to falling outside the follow-up system. Those participants who received some follow-up care perceived it as untailored to their specific needs. To be considered supportive, the follow-up programs must be in line with their long-term needs, take into account their particular challenges as young and midlife stroke survivors, and be planned in close collaboration with the individual patient. To secure systematic and follow-up health services tailored to the individual, knowledgeable and committed healthcare professionals should play a prominent role within the community health services.

  17. How does adaptation sweep through the genome? Insights from long-term selection experiments.

    PubMed

    Burke, Molly K

    2012-12-22

    A major goal in evolutionary biology is to understand the origins and fates of adaptive mutations. Natural selection may act to increase the frequency of de novo beneficial mutations, or those already present in the population as standing genetic variation. These beneficial mutations may ultimately reach fixation in a population, or they may stop increasing in frequency once a particular phenotypic state has been achieved. It is not yet well understood how different features of population biology, and/or different environmental circumstances affect these adaptive processes. Experimental evolution is a promising technique for studying the dynamics of beneficial alleles, as populations evolving in the laboratory experience natural selection in a replicated, controlled manner. Whole-genome sequencing, regularly obtained over the course of sustained laboratory selection, could potentially reveal insights into the mutational dynamics that most likely occur in natural populations under similar circumstances. To date, only a few evolution experiments for which whole-genome data are available exist. This review describes results from these resequenced laboratory-selected populations, in systems with and without sexual recombination. In asexual systems, adaptation from new mutations can be studied, and results to date suggest that the complete, unimpeded fixation of these mutations is not always observed. In sexual systems, adaptation from standing genetic variation can be studied, and in the admittedly few examples we have, the complete fixation of standing variants is not always observed. To date, the relative frequency of adaptation from new mutations versus standing variation has not been tested using a single experimental system, but recent studies using Caenorhabditis elegans and Saccharomyces cerevisiae suggest that this a realistic future goal.

  18. A Smart Wirelessly Powered Homecage for Long-Term High-Throughput Behavioral Experiments.

    PubMed

    Lee, Byunghun; Kiani, Mehdi; Ghovanloo, Maysam

    2015-09-01

    A wirelessly powered homecage system, called the EnerCage-HC, that is equipped with multicoil wireless power transfer, closed-loop power control, optical behavioral tracking, and a graphic user interface is presented for longitudinal electrophysiology and behavioral neuroscience experiments. The EnerCage-HC system can wirelessly power a mobile unit attached to a small animal subject and also track its behavior in real-time as it is housed inside a standard homecage. The EnerCage-HC system is equipped with one central and four overlapping slanted wire-wound coils with optimal geometries to form three- and four-coil power transmission links while operating at 13.56 MHz. Utilizing multicoil links increases the power transfer efficiency (PTE) compared with conventional two-coil links and also reduces the number of power amplifiers to only one, which significantly reduces the system complexity, cost, and heat dissipation. A Microsoft Kinect installed 90 cm above the homecage localizes the animal position and orientation with 1.6-cm accuracy. Moreover, a power management ASIC, including a high efficiency active rectifier and automatic coil resonance tuning, was fabricated in a 0.35-μm 4M2P standard CMOS process for the mobile unit. The EnerCage-HC achieves a max/min PTE of 36.3%/16.1% at the nominal height of 7 cm. In vivo experiments were conducted on freely behaving rats by continuously delivering 24 mW to the mobile unit for >7 h inside a standard homecage.

  19. A Smart Wirelessly Powered Homecage for Long-Term High-Throughput Behavioral Experiments

    PubMed Central

    Lee, Byunghun; Kiani, Mehdi

    2015-01-01

    A wirelessly powered homecage system, called the EnerCage-HC, that is equipped with multicoil wireless power transfer, closed-loop power control, optical behavioral tracking, and a graphic user interface is presented for longitudinal electrophysiology and behavioral neuroscience experiments. The EnerCage-HC system can wirelessly power a mobile unit attached to a small animal subject and also track its behavior in real-time as it is housed inside a standard homecage. The EnerCage-HC system is equipped with one central and four overlapping slanted wire-wound coils with optimal geometries to form three- and four-coil power transmission links while operating at 13.56 MHz. Utilizing multicoil links increases the power transfer efficiency (PTE) compared with conventional two-coil links and also reduces the number of power amplifiers to only one, which significantly reduces the system complexity, cost, and heat dissipation. A Microsoft Kinect installed 90 cm above the homecage localizes the animal position and orientation with 1.6-cm accuracy. Moreover, a power management ASIC, including a high efficiency active rectifier and automatic coil resonance tuning, was fabricated in a 0.35-μm 4M2P standard CMOS process for the mobile unit. The EnerCage-HC achieves a max/min PTE of 36.3%/16.1% at the nominal height of 7 cm. In vivo experiments were conducted on freely behaving rats by continuously delivering 24 mW to the mobile unit for >7 h inside a standard homecage. PMID:26257586

  20. Short-term versus long-term responses to drought stress: coupling manipulation experiments with gradient studies

    NASA Astrophysics Data System (ADS)

    Martin, Nicolas; Misson, Laurent

    2010-05-01

    Water availability is the main factor shaping plants form and function in Mediterranean ecosystems. Understanding the mechanisms that drive plants productivity in drought conditions is crucial in a climate change context. So far, functional relationships between drought stress and leaf physiology has mostly been studied in short term experiments unable to address the potential acclimation in leaf function and the link between short term responses and long term acclimation. Here we hypothesize that the functional relationships between drought and leaf physiology can change under the temporal scale at witch drought is applied. Hence, we measured leaf physiological parameters (gs, gm, Amax, Vcmax Jmax) implicated in the limitation of carbon assimilation on Holm Oak leaves using a design combining 2 contrasting field experiments: (1) a rainfall exclusion experiment simulating a spring extreme drought in order to study short term processes, (2) a natural rainfall gradient (650 mm to 1150 mm) made of 3 plots in order to study long term acclimation. For each experiment we related leaf physiological parameters and their respective limitation to carbon assimilation with predawn leaf water potential as a surrogate of drought stress. Results showed that functional relationships relating gs, Vcmax and Jmax to leaf water potential changed in the total rainfall exclusion, probably because of a strong effect of spring drought on phenology. In addition, trees in the wet plot of the rainfall gradient showed a stronger stomatal conductance decline relative to leaf water potential than trees in the dry plot. We interpret these changes as a result of structural modification at canopy level in the rainfall gradient related to changes in leaf area index (LAI), hydraulic adjustment or fine root/LAI ratio. As a consequence, stomatal limitation of carbon assimilation was stronger in the wet plot than in the dry plot, while total limitation was lower in the dry plot. Water conservation in

  1. Long-Term (4 mo) Oxygen Isotope Exchange Experiment between Zircon and Hydrothermal Fluid

    NASA Astrophysics Data System (ADS)

    Bindeman, I. N.; Schmitt, A. K.; Lundstrom, C.; Golledge, S.

    2013-12-01

    Knowing oxygen diffusivity in zircon has several critical applications: 1) establishing zircon stability and solubility in hot silica-saturated hydrothermal solutions; 2) deriving metamorphic and magmatic heating timescales from intra-crystal oxygen isotopic gradients; 3) assessing the survivability of oxygen isotopic signatures in Hadean zircons. We report results of a microanalytical investigation of an isotope exchange experiment using a cold-seal pressure apparatus at 850°C and 500 MPa over 4 months duration. Natural zircon, quartz and rutile were sealed with a silica-rich solution doped with 18-O, D, 7-Li and 10-B in a gold capsule. The diffusion length-scales were examined by depth profiling using time-of-flight (TOF) and high-sensitivity dynamic secondary ionization mass spectrometry (SIMS). Starting materials had distinct and homogeneous δ18O: zircon from Mesa Falls tuff of Yellowstone (+3.6‰), rutile from Karelia (-29‰), Bishop Tuff Quartz (+8.4‰), and δ18O doped water (+400‰). Starting material zircon showed invariant 18O/16O during depth profiling. After the 4 month experiment, rutile crystal surfaces displayed etching (100's of nm), while zircon exteriors lacked visible change. Quartz was completely dissolved and reprecipitated in a minor residue. Rutile developed ~2 μm long Fickian diffusion profiles largely consistent with the wet diffusion coefficients for rutile previously reported [1]. Surface U-Pb dating of zircon detected no significant Pb loss from the outermost ~300 nm of the crystal face and returned identical core-face ages. We performed δ18O depth profiling of zircon in two directions. First, forward profiles (crystal rim inwards) by dynamic SIMS (no surface treatment besides Au-coating; Cs+ beam of 20 kV impact energy) showed initially high and decreasing 18O/16O over ~130 nm; TOF-SIMS forward profiles using a 2 kV Cs+ sputter beam and 25 kV Bi3+ primary ions on uncoated zircon surfaces (cleaned for 2 min with HF) yielded

  2. Observations from a Long-Term Self-Noise Experiment at the Conrad Observatory, Austria

    NASA Astrophysics Data System (ADS)

    Gerner, Andreas; Lenhardt, Wolfgang; Grasemann, Bernhard

    2017-04-01

    An analysis of four years of data recorded between 2012 and 2015 by four collocated and co-aligned seismic broadband sensors (STS-2) reveals that the quality of self-noise estimates computed using the three-channel spectral correlation technique shows significant variation, which on first order appears to be related to seasonally changing microseismic activity. We compute self-noise estimates for every day within the time-frame studied, and from these derive probability density representations of self-noise for each of the four sensors and their components. During self-noise computation we apply a recently developed approach to correct sensor misalignment during the experiment by numerical trace rotation, and are thus able to study the efficiency of this correction technique under varying conditions, as well as compare results for non-aligned sensors with those after performing the sensor alignment procedure. Seasonally separating the resulting probability density functions allowed us to study the influence of the general noise conditions on the quality of our self-noise estimates, as well as possible limits of increasing coherence by numerical trace rotation. Results show that for vertical components good-quality self-noise estimates can be, with few exceptions, computed almost all through the year. Numerically rotating traces to improve sensor alignment has a strong and visible effect of improving coherence between recorded traces. However, our results also indicate that no trace rotation is necessary to improve alignment during some of the microseismically quietest days of the year around the month of July. The amount of self-noise disturbance found within the secondary microseisms' frequency band correlates with the angle of misalignment between sensors as well as with signal strength. Previous, rough estimates of around 10 dB/0.1 degree of misalignment could be revised and a rough relationship with signal strength established. Our results indicate that

  3. In-hospital and long-term mortality in infective endocarditis in injecting drug users compared to non-drug users: a retrospective study of 192 episodes.

    PubMed

    Thalme, Anders; Westling, Katarina; Julander, Inger

    2007-01-01

    In a retrospective study, in-hospital and long-term mortality for patients with infective endocarditis (IE) was analysed. The study was conducted at a department of infectious diseases in Stockholm, Sweden. Mortality was compared between injecting drug users (IDUs) and patients without drug abuse (non-IDUs). 192 episodes of IE from 1995 to 2000 were analysed, 60 in IDUs and 135 in non-IDUs, median follow-up 4.4 y. Episodes were classified using the Duke criteria: 145 definite and 47 possible. Of 53 definite episodes in IDUs, 55% were right-sided IE and 43% left-sided IE (including combined left- and right-sided). Surgical treatment was used in 34/145 definite episodes, all being left-sided IE. The in-hospital mortality was 14/145 (9.6%). There was no difference in in-hospital mortality between patient groups with left-sided IE. The IDU patients with left-sided IE had a higher long-term mortality with the increased mortality rate explained by late deaths in the surgically treated IDUs. Treatment results for IDUs with right-sided IE were good with no in-hospital mortality, no relapses and no increase in long-term mortality. This difference in prognosis between left-sided and right-sided IE in IDUs makes high quality echocardiography important to identify patients with left-sided IE and worse prognosis.

  4. Integration of Long term experiments on terrestrial ecosystem in AnaEE-France Research Infrastructure : concept and adding value

    NASA Astrophysics Data System (ADS)

    Chanzy, André; Chabbi, Abad; Houot, Sabine; Lafolie, François; Pichot, Christian; Raynal, Hélène; Saint-André, Laurent; Clobert, Jean; Greiveldinger, Lucile

    2015-04-01

    Continental ecosystems represent a critical zone that provide key ecological services to human populations like biomass production, that participate to the regulation of the global biogeochemical cycles and contribute and contribute to the maintenance of air and water quality. Global changes effects on continental ecosystems are likely to impact the fate of humanity, which is thus facing numerous challenges, such as an increasing demand for food and energy, competition for land and water use, or rapid climate warming. Hence, scientific progress in our understanding of the continental critical zone will come from studies that address how biotic and abiotic processes react to global changes. Long term experiments are required to take into account ecosystem inertia and feedback loops and to characterize trends and threshold in ecosystem dynamics. In France, 20 long-term experiments on terrestrial ecosystems are gathered within a single Research Infrastructure: ANAEE-France (http://www.anaee-s.fr), which is a part of AnaEE-Europe (http://www.anaee.com/). Each experiment consist in applying differentiated pressures on different plot over a long period (>20 years) representative of a range of management options. The originality of such infrastructure is a combination of experimental set up and long-term monitoring of simultaneous measurements of key ecosystem variables and parameters through a multi-disciplinary approach and replications of each treatment that improve the statistical strength of the results. The sites encompass gradients of climate conditions, ecosystem complexity and/or management, and can be used for calibration/validation of ecosystem functioning models as well as for the design of ecosystem management strategies. Gathering those experiments in a single research infrastructure is an important issue to enhance their visibility and increase the number of hosting scientific team by offering a range of services. These are: • Access to the ongoing long

  5. Experiences in long-term evaluation of mercury emission monitoring systems

    SciTech Connect

    Chin-Min Cheng; Hung-Ta Lin; Qiang Wang; Chien-Wei Chen; Chia-Wei Wang; Ming-Chung Liu; Chi-Kuan Chen; Wei-Ping Pan

    2008-09-15

    Six mercury continuous emission monitoring (CEM) systems provided by two leading mercury (Hg) CEM system manufacturers were tested at five coal combustion utilities. The linearity, response time, day-to-day stability, efficiency of the Hg speciation modules, and ease of use were evaluated by following procedures specified in the Code of Federal Regulation Title 40 Part 75 (40 CFR Part 75). Mercury monitoring results from Hg CEM systems were compared to an EPA-recognized reference method. A sorbent trap sampling system was also evaluated in this study to compare the relative accuracy to the reference method as well as to Hg CEM systems. A conceptual protocol proposed by U.S. EPA (Method 30A) for using an Hg CEM system as the reference method for the Hg relative accuracy (RA) test was also followed to evaluate the workability of the protocol. This paper discusses the operational experience obtained from these field studies and the remaining challenges to overcome while using Hg CEM systems and the sorbent trap method for continuous Hg emission monitoring. 3 refs., 5 figs., 11 tabs.

  6. Impact of long term socio-political conflict on health: a traumatic Nepalese experience.

    PubMed

    Nepal, Manoj

    2007-09-01

    Twelve years of traumatic experience of thousands of poor Nepalese is still lingering aftermath of the ceasefire between the government and the Maoist rebels and it has devastated all sectors of health care in the country. Almost twenty thousand peoples have lost their lives during this period as a direct result of or consequence of insurgency. About a quarter million people are internally displaced; many homeless and many more skilled people have fled the country. Nearly half of the people are deprived of basic health necessities and eighty percent of them with basic medical supplies. Repeated strikes and agitation organized by different groups and organizations have left the economy in limbo and has added woes and worries of daily living thus making necessary medical checkups a luxury. It has taken a heavy toll on the health of the nearly 85% of those people living in the countryside and one survey done recently shows more than half of them are suffering from anxiety, depression, posttraumatic stress disorder and major depressive illnesses. To improve the ground situation and provide relief, the government has announced truce with Maoists and called different warring factions and ethnic minorities to the table for dialogue. A hard work needs to be done to raise the standards of living, meet aspirations of people and meet the millennium development goals (MDGs) as outlined by government; it also needs urgent humanitarian assistance from the national and international donor agencies.

  7. Is plant community richness regulated over time? Contrasting results from experiments and long-term observations.

    PubMed

    Elmendorf, Sarah C; Harrison, Susan P

    2011-03-01

    There is considerable debate among ecologists as to whether or not communities are saturated. In saturated communities, species richness should remain relatively constant over time, despite compositional turnover, because richness is negatively correlated with colonization and positively correlated with local extinction. Few studies have tested for saturation using temporal observational data as well as diversity-perturbation experiments. We analyzed 10 years of data for plant species richness at 71 sites on contrasting serpentine and non-serpentine soils within Californian (USA) grasslands. We also manipulated local richness and measured its effects on immigration and extinction. Consistent with saturation, we observed that richness was positively correlated with extinction rates and negatively correlated with colonization rates, and randomization tests confirmed that diversity fluctuated less than expected by chance. However, experimental species additions and removals did not affect extinction or colonization, suggesting that richness is not regulated by local species interactions. Instead, we propose three reasons why richness may fluctuate within narrow limits causing the appearance of saturation in temporal observational data sets: negatively autocorrelated patterns of biotic response to yearly conditions, differential affinities of particular species for local conditions, or stochastic abundance-dependent colonization and extinction rates. We illustrate the latter using a metacommunity model.

  8. Long-term experience with a low-dose oral contraceptive.

    PubMed

    Brill, K; Schnitker, J; Albring, M

    1990-12-01

    Oral contraception has proved to be the most efficient reversible method of fertility control for over 25 years. During this period, various investigations and epidemiological studies have suggested that some risks may be involved, but, on the other hand, a number of non-contraceptive benefits have become obvious. The results of these investigations were taken into account when new formulations had to be developed, with an aim to improving hormonal fertility control with regard to its tolerance, cycle control, and impact on metabolism. Since then, the objective of research has been to contrive new hormonal contraceptives which ensure safety to the largest possible extent, from a medical point of view, for the sake of the patient, without affecting contraceptive effectiveness. The aim to reduce side-effects connected with the use of oral contraception, as well as to lower the risks possibly involved, has obviously been achieved by extensive research. Both by devising a new substance and reducing doses, the criteria of modern low-dose oral contraception have been met, as has become evident in the course of the clinical experience gathered with Femovan.

  9. Long-term mesocosm experiments to investigate microbial degradation of fluorescent tracers

    NASA Astrophysics Data System (ADS)

    Fernández-Pascual, Elena; Zaman, Sameera; Lang, Friederike; Lange, Jens

    2017-04-01

    Uranine (UR) and sulforhodamine B (SRB) are two of the most commonly used fluorescent tracers in hydrology. Their suitability to be used as ideal tracers has been discussed since they might interact with the soil or become degraded. However, these properties have recently served to mimic processes of sorption and degradation of pollutants. The present study attempts to investigate to what extent UR and SRB could be used to imitate such processes in environments where saturation conditions are variable and the presence of plants might play an important role. For this purpose, both tracers were applied to 36 small mesocosms filled with a layer of 10 cm of gravel and 30 cm of sand in which 6 types of treatments, with 3 replicates each, were implemented based on the presence of two species of wetland plants (Typha latifolia and Phalaris arundinacea) and two types of hydrological conditions (saturated and unsaturated). The entire experiment lasted 10 months, during which two injections of equal concentration of tracers were performed. The first months served to ensure the adaptability of the plants and to achieve stationary conditions in the system. Water and sediment samples were collected weekly after the second injection while plants were measured at the end of the experiment distinguishing between roots and aerial parts. Mass balances of the tracers were combined with excitation emission matrix fluorescence spectroscopy (EEMS) to characterize dissolved organic matter in the water and soil. Degradation was quantified by subtracting the non-degraded tracer fraction (sorption and plant uptake) and the remaining non-degraded mass in the water from the tracer mass injected. Results revealed that most of the SRB accumulated in the sand in agreement with its sorption affinity, while UR was mainly found in the pore water. Both tracers showed more degradation in the treatments with plants than the controls. Overall, UR exhibited higher degradation than SRB. Differences

  10. Recycling vs. stabilisation of soil sugars - a long-term laboratory incubation experiment

    NASA Astrophysics Data System (ADS)

    Basler, A.; Dippold, M.; Helfrich, M.; Dyckmans, J.

    2015-06-01

    Independent of its chemical structure carbon (C) persists in soil for several decades, controlled by stabilisation and recycling. To disentangle the importance of the two factors on the turnover dynamics of soil sugars, an important compound of soil organic matter (SOM), a three year incubation experiment was conducted on a silty loam soil under different types of land use (arable land, grassland and forest) by adding 13C-labeled glucose. The compound specific isotope analysis of soil sugars was used to examine the dynamics of different sugars during incubation. Sugar dynamics were dominated by a pool of high mean residence times (MRT) indicating that recycling plays an important role for sugars. However, this was not substantially affected by soil C content. Six months after label addition the contribution of the label was much higher for microbial biomass than for CO2 production for all examined soils, corroborating that substrate recycling was very effective within the microbial biomass. Two different patterns of tracer dynamics could be identified for different sugars: while fucose (fuc) and mannose (man) showed highest label contribution at the beginning of the incubation with a subsequent slow decline, galactose (gal) and rhamnose (rha) were characterised by slow label incorporation with subsequently constant levels, which indicates that recycling is dominating the dynamics of these sugars. This may correspond to (a) different microbial growing strategies (r and K-strategist) or (b) location within or outside the cell membrane (lipopolysaccharides vs. exopolysaccharides) and thus be subject of different re-use within the microbial food web. Our results show how the microbial community recycles substrate very effectively and that high losses of substrate only occur during initial stages after substrate addition.

  11. EARLY-ESLI study: Long-term experience with eslicarbazepine acetate after first monotherapy failure.

    PubMed

    Villanueva, V; Bermejo, P; Montoya, J; Toledo, M; Gómez-Ibáñez, A; Garcés, M; Vilella, L; López-González, F J; Rodriguez-Osorio, X; Campos, D; Martínez, P; Giner, P; Zurita, J; Rodríguez-Uranga, J; Ojeda, J; Mauri, J A; Camacho, J L; Ruiz-Giménez, J; Poza, J J; Massot-Tarrús, A; Galiano, M L; Bonet, M

    2017-09-01

    Evaluate real-life experience with eslicarbazepine acetate (ESL) after first monotherapy failure in a large series of patients with focal epilepsy. Multicentre, retrospective, 1-year, observational study in patients older than 18 years, with focal epilepsy, who had failed first antiepileptic drug monotherapy and who received ESL. Data from clinical records were analysed at baseline, 3, 6 and 12 months to assess effectiveness and tolerability. Eslicarbazepine acetate was initiated in 253 patients. The 1-year retention rate was 92.9%, and the final median dose of ESL was 800 mg. At 12 months, 62.3% of patients had been seizure free for 6 months; 37.3% had been seizure free for 1 year. During follow-up, 31.6% of the patients reported ESL-related adverse events (AEs), most commonly somnolence (8.7%) and dizziness (5.1%), and 3.6% discontinued due to AEs. Hyponatraemia was observed in seven patients (2.8%). After starting ESL, 137 patients (54.2%) withdrew the prior monotherapy and converted to ESL monotherapy; 75.9% were seizure free, 87.6% were responders, 4.4% worsened, and 23.4% reported ESL-related AEs. Use of ESL after first monotherapy failure was associated with an optimal seizure control and tolerability profile. Over half of patients were converted to ESL monotherapy during follow-up. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Long-term results of pneumatic dilation for achalasia: A 15 years’ experience

    PubMed Central

    Katsinelos, Panagiotis; Kountouras, Jannis; Paroutoglou, George; Beltsis, Athanasios; Zavos, Christos; Papaziogas, Basilios; Mimidis, Kostas

    2005-01-01

    AIM: Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years’ experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic dilation. METHODS: Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia (diagnosed by clinical presentation, esophagoscopy, barium esophagogram, and manometry) who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS: Symptoms were dysphagia (n = 39, 100%), regurgitation (n = 23, 58.7%), chest pain (n = 4, 10.2%), and weight loss (n = 26, 66.6%). A total of 74 dilations were performed in 39 patients; 13 patients (28%) underwent a single dilation, 17 patients (48.7%) required a second procedure within a median of 26.7 mo (range 5-97 mo), and 9 patients (23.3%) underwent a third procedure within a median of 47.8 mo (range 37-120 mo). Post-dilation lower esophageal sphincter (LES) pressure, assessed in 35 patients, has decreased from a baseline of 35.8 ± 10.4-10.0 ± 7.1 mmHg after the procedure. The median follow-up period was 9.3 years (range 0.5-15 years). The dysphagia-free duration by Kaplan-Meier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION: Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. PMID:16237769

  13. Long-term experience of mycophenolate mofetil for treatment of diffuse cutaneous systemic sclerosis

    PubMed Central

    Le, Elizabeth N; Wigley, Fredrick M; Shah, Ami A; Boin, Francesco; Hummers, Laura K

    2013-01-01

    Background Immunosuppressive therapy may potentially alter the natural disease course of scleroderma. There have been reports of using mycophenolate mofetil (MMF) for the treatment of scleroderma skin disease. Objective To analyse the experience of using MMF for the treatment of active diffuse cutaneous scleroderma. Methods The authors compared the change in mean modified Rodnan skin scores (mRSS) in an MMF cohort at baseline with scores at 3, 6, 9 and 12 months and with those of historical controls from a pooled analysis of three multicentre randomised clinical trials of recombinant human relaxin, d-penicillamine and oral bovine type I collagen. Results Improvement in mRSS after treatment with MMF compared with baseline was seen as early as 3 months and continued through the 12-month follow-up. The mRSS of the MMF cohort was not different from that of the historical controls at 6 months (MMF −3.05±7.4 vs relaxin −4.83±6.99, p=0.059), but was significantly lower at 12 months (MMF −7.59±10.1 vs d-penicillamine −2.47±8.6, p<0.001; collagen −3.4±7.12, p=0.002). General and muscle severity scores and quality of life measures also improved compared with baseline. Pulmonary function remained stable. Conclusions MMF may benefit skin disease in patients with diffuse scleroderma, but prospective studies are required to determine its role. PMID:21378404

  14. Long-term animal experiments with an intraventricular axial flow blood pump.

    PubMed

    Yamazaki, K; Kormos, R L; Litwak, P; Tagusari, O; Mori, T; Antaki, J F; Kameneva, M; Watach, M; Gordon, L; Mukuo, H; Umezu, M; Tomioka, J; Outa, E; Griffith, B P; Koyanagai, H

    1997-01-01

    A miniature intraventricular axial flow blood pump (IVAP) is undergoing in vivo evaluation in calves. The IVAP system consists of a miniature (phi 13.9 mm) axial flow pump that resides within the left ventricular (LV) chamber and a brushless DC motor. The pump is fabricated from titanium alloy, and the pump weight is 170 g. It produces a flow rate of over 5 L/min against 100 mmHg pressure at 9,000 rpm with an 8 W total power consumption. The maximum total efficiency exceeds 17%. A purged lip seal system is used in prototype no. 8, and a newly developed "Cool-Seal" (a low temperature mechanical seal) is used in prototype no. 9. In the Cool-Seal system, a large amount of purge flow is introduced behind the seal faces to augment convective heat transfer, keeping the seal face temperature at a low level for prevention of heat denaturation of blood proteins. The Cool-Seal system consumes < 10 cc purge fluid per day and has greatly extended seal life. The pumps were implanted in three calves (26, 30, and 168 days of support). The pump was inserted through a left thoracotomy at the fifth intercostal space. Two pursestring sutures were placed on the LV apex, and the apex was cored with a myocardial punch. The pump was inserted into the LV with the outlet cannula smoothly passing through the aortic valve without any difficulty. Only 5 min elapsed between the time of chest opening and initiation of pumping. Pump function remained stable throughout in all experiments. No cardiac arrhythmias were detected, even at treadmill exercise tests. The plasma free hemoglobin level remained in the acceptable range. Post mortem examination did not reveal any interference between the pump and the mitral apparatus. No major thromboembolism was detected in the vital organs in Cases 1 or 2, but a few small renal infarcts were detected in Case 3.

  15. Soil fertility increases with plant species diversity in a long-term biodiversity experiment.

    PubMed

    Dybzinski, Ray; Fargione, Joseph E; Zak, Donald R; Fornara, Dario; Tilman, David

    2008-11-01

    Most explanations for the positive effect of plant species diversity on productivity have focused on the efficiency of resource use, implicitly assuming that resource supply is constant. To test this assumption, we grew seedlings of Echinacea purpurea in soil collected beneath 10-year-old, experimental plant communities containing one, two, four, eight, or 16 native grassland species. The results of this greenhouse bioassay challenge the assumption of constant resource supply; we found that bioassay seedlings grown in soil collected from experimental communities containing 16 plant species produced 70% more biomass than seedlings grown in soil collected beneath monocultures. This increase was likely attributable to greater soil N availability, which had increased in higher diversity communities over the 10-year-duration of the experiment. In a distinction akin to the selection/complementarity partition commonly made in studies of diversity and productivity, we further determined whether the additive effects of functional groups or the interactive effects of functional groups explained the increase in fertility with diversity. The increase in bioassay seedling biomass with diversity was largely explained by a concomitant increase in N-fixer, C4 grass, forb, and C3 grass biomass with diversity, suggesting that the additive effects of these four functional groups at higher diversity contributed to enhance N availability and retention. Nevertheless, diversity still explained a significant amount of the residual variation in bioassay seedling biomass after functional group biomass was included in a multiple regression, suggesting that interactions also increased fertility in diverse communities. Our results suggest a mechanism, the fertility effect, by which increased plant species diversity may increase community productivity over time by increasing the supply of nutrients via both greater inputs and greater retention.

  16. Long-term monitoring experiences at the HADES underground lab and its relevance for radwaste repository monitoring

    SciTech Connect

    Verstricht, Jan

    2013-07-01

    In the frame of its radwaste disposal research programme, SCK-CEN started the construction of the HADES underground research facility in 1980. Including several extensions and a comprehensive experimental programme, it has provided a lot of experience on monitoring. Monitoring is performed for many reasons: construction follow-up, field characterisation, investigation of phenomena, and model validations - in which the underground lab offers the opportunity for up-scaling conventional laboratory set-ups. Construction monitoring has allowed to develop and optimise the underground construction techniques in a previously poorly known environment, resulting in a well-mastered application of mechanised methods for gallery construction with minimal damage to the host formation. Access to this formation also allows its characterisation, both geotechnical, geological and geochemical, and the detailed investigation of phenomena such as fracturing and oxidation. Finally, instrumented set-ups allow to test various numerical models by comparing the observations with the predicted behaviour. The specific conditions of the underground laboratory put particular requirements to the sensors. These conditions include the long-term nature of many set-ups - typically several years to decades, the inaccessibility of many sensors after installation, high mechanical and water pressures, and corrosion. Combined with the fact that many sensors are custom made, obtaining and maintaining a fully functional instrumented set-up can be challenging. A lot of experience has therefore been gained which is very valuable when designing the monitoring of radwaste repositories - and it has allowed us to determine the critical success factors for monitoring. Engineers tend to look at this first from a technical viewpoint - and there are many technical aspects indeed that determine the reliability of monitoring. A first one is the combination of different observations ('redundancy') which can be

  17. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience.

    PubMed

    Nadeau, Stephen E; Dobkin, Bruce; Wu, Samuel S; Pei, Qinglin; Duncan, Pamela W

    2016-08-01

    Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait. © The Author(s) 2015.

  18. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience

    PubMed Central

    Nadeau, Stephen E.; Dobkin, Bruce; Wu, Samuel S.; Pei, Qinglin; Duncan, Pamela W

    2015-01-01

    Background Paresis in stroke is largely due to damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the two neurologists in the LEAPS trial on the basis of clinical CT and MRI scans. A series of regression models was employed to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2–12 month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1-year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect due to prior stroke may impact long-term outcome of rehabilitation of hemiparetic gait. PMID:26498434

  19. Sex differences of in-hospital outcome and long-term mortality in patients with Takotsubo cardiomyopathy

    PubMed Central

    Weidner, KJ; El-Battrawy, I; Behnes, M; Schramm, K; Fastner, C; Kuschyk, J; Hoffmann, U; Ansari, U; Borggrefe, M; Akin, I

    2017-01-01

    Background Previous studies revealed that patients with Takotsubo cardiomyopathy (TTC) have a higher mortality rate than the general population. It is still unclear whether sex differences may influence long-term prognosis of TTC patients. The purpose of this study was to determine whether sex differences do influence the short- and long-term outcomes of TTC. Methods and results A total of 114 patients with TTC were admitted to the University Medical Centre Mannheim from January 2003 to September 2015 and entered into the TTC database of the University Medical Centre Mannheim, and retrospectively analyzed. Patients were diagnosed by the Mayo Clinic criteria. All-cause mortality over mean follow-up of 1,529±1,121 days was revealed. Significantly more male patients died within long-term follow-up compared to female TTC patients (log-rank test; P=0.01). Most males died of noncardiac causes. In multivariate Cox regression analysis, the male sex (P=0.02, hazard ratio [HR] 2.8, 95% CI 1.1–7.2), the ejection fraction ≤35% (P=0.01, HR 3.3, 95% CI 1.2–9.2) and glomerular filtration rate <60 mL/min (P<0.01, HR 3.1, 95% CI 1.4–7.0) figured out as independent predictors of the adverse outcome. Conclusion This study shows that males suffering from TTC reveal a higher long-term all-cause mortality rate than females over a 5 year follow-up period. PMID:28744135

  20. The impact of admission neutrophil-to-platelet ratio on in-hospital and long-term mortality in patients with infective endocarditis.

    PubMed

    Wei, Xue-Biao; Liu, Yuan-Hui; He, Peng-Cheng; Yu, Dan-Qing; Tan, Ning; Zhou, Ying-Ling; Chen, Ji-Yan

    2017-05-01

    Infective endocarditis (IE) is associated with increased neutrophil and reduced platelet counts. We assessed the relationship between the neutrophil-to-platelet ratio (NPR) on admission and adverse outcomes in patients with IE. Patients diagnosed with IE between January 2009 and July 2015 (n=1293) were enrolled, and 1046 were finally entered into the study. Study subjects were categorized into four groups according to NPR quartiles: Q1<18.9 (n=260); Q2: 18.9-27.7 (n=258); Q3: 27.7-43.3 (n=266); and Q4>43.3 (n=262). Cox proportional hazards regression was performed to identify risk factors for long-term mortality; the optimal cut-off was evaluated by receiver operating characteristic curves. Risk of in-hospital death increased progressively with NPR group number (1.9 vs. 5.0 vs. 9.8 vs. 14.1%, p<0.001). The follow-up period was a median of 28.8 months, during which 144 subjects (14.3%) died. Long-term mortality increased from the lowest to the highest NPR quartiles (7.6, 11.8, 17.4, and 26.2%, respectively, p<0.001). Multivariate Cox proportional hazard analysis revealed that lgNPR (HR=2.22) was an independent predictor of long-term mortality. Kaplan-Meier survival curves showed that subjects in Q4 had an increased long-term mortality compared with the other groups. Increased NPR was associated with in-hospital and long-term mortality in patients with IE. As a simple and inexpensive index, NPR may be a useful and rapid screening tool to identify IE patients at high risk of mortality.

  1. Metabolic modelling in a dynamic evolutionary framework predicts adaptive diversification of bacteria in a long-term evolution experiment.

    PubMed

    Großkopf, Tobias; Consuegra, Jessika; Gaffé, Joël; Willison, John C; Lenski, Richard E; Soyer, Orkun S; Schneider, Dominique

    2016-08-20

    Predicting adaptive trajectories is a major goal of evolutionary biology and useful for practical applications. Systems biology has enabled the development of genome-scale metabolic models. However, analysing these models via flux balance analysis (FBA) cannot predict many evolutionary outcomes including adaptive diversification, whereby an ancestral lineage diverges to fill multiple niches. Here we combine in silico evolution with FBA and apply this modelling framework, evoFBA, to a long-term evolution experiment with Escherichia coli. Simulations predicted the adaptive diversification that occurred in one experimental population and generated hypotheses about the mechanisms that promoted coexistence of the diverged lineages. We experimentally tested and, on balance, verified these mechanisms, showing that diversification involved niche construction and character displacement through differential nutrient uptake and altered metabolic regulation. The evoFBA framework represents a promising new way to model biochemical evolution, one that can generate testable predictions about evolutionary and ecosystem-level outcomes.

  2. Effects of crop rotation and reduced nitrogen fertilisation on Apera spica-venti populations in a long-term experiment.

    PubMed

    Schulz, A; Pallurt, B; Gerowitt, B

    2011-01-01

    Apera spica-venti is one of the most serious annual grass weeds in Germany and may cause considerably yield losses in untreated fields. A long-term field experiment was conducted investigating the effects of crop rotation and nitrogen fertiliser use on A. spica-venti populations. A six-field cash-crop rotation with 67% winter cereals and a six-field fodder crop rotation with 50% winter cereals were studied. The rate of tillering was in the fodder crop rotation significantly higher than in the cash crop rotation. The halving of nitrogen fertilizer dose caused a significant increase in the tillering rate. Most plants of A. spica-venti emerged in winter wheat. There was an increase of emerged A. spica-venti in winter wheat from year to year.

  3. Long-term intravenous administration of antibiotics for lumbar spinal surgery prolongs the duration of hospital stay and time to normalize body temperature after surgery.

    PubMed

    Ohtori, Seiji; Inoue, Gen; Koshi, Takana; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Orita, Sumihisa; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Takaso, Masashi; Takahashi, Kazuhisa

    2008-12-15

    Comparative study of differing durations of antibiotics for spinal surgery. To compare rate of infection, duration of hospital stay, days until normal body temperature, and a panel of blood tests after surgery between long-term and short-term administration of antibiotics for spinal surgery using instrumentation. Recent studies have reported that long-term administration of intravenous antibiotics is not necessary to avoid superficial and deep infections. We therefore changed the duration of administration from 9 to 2 days in our lumbar surgery patients. We examined 135 patients (average age, 64.9 years) who underwent lumbar spinal surgery to insert a pedicle screw system to treat spinal canal stenosis. We administered 2 g of cefotiam daily to 60 patients for 9 days after surgery and to 75 patients for 2 days after surgery. Surgical time, loss of blood, rate of infection, duration of hospital stay, days until normal body temperature, and data from blood analysis (white blood cell count, and C-reactive protein [CRP] level) were statistically compared between the 2 groups. No significant differences in intraoperative measures of surgical invasion were observed between the 2 groups (surgical time, 209 vs. 220 minutes; blood loss, 530 vs. 576 mL; blood transfusion, 344 vs. 380 mL for the long-term and short-term groups, respectively). No acute infections occurred in either group. However, the duration of hospital stay (20.7 days), time until normal body temperature (5.1 days), and CRP level (2.23 mg/dL) at day 7 after surgery were significantly less in the short-term group than those in the long-term group (27.9 days, 6.8 days, and 3.13 mg/dL, respectively; P < 0.05). These results indicate that short-term intravenous administration of antibiotics did not elevate the infection rate after spinal surgery using instrumentation. However, long-term administration of antibiotics prolonged the duration of hospital stay, inhibited normalization of body temperature, and

  4. Long-Term Regional Shifts in Plant Community Composition Are Largely Explained by Local Deer Impact Experiments

    PubMed Central

    Frerker, Katie; Sabo, Autumn; Waller, Donald

    2014-01-01

    The fact that herbivores and predators exert top-down effects to alter community composition and dynamics at lower trophic levels is no longer controversial, yet we still lack evidence of the full nature, extent, and longer-term effects of these impacts. Here, we use results from a set of replicated experiments on the local impacts of white-tailed deer to evaluate the extent to which such impacts could account for half-century shifts in forest plant communities across the upper Midwest, USA. We measured species' responses to deer at four sites using 10–20 year-old deer exclosures. Among common species, eight were more abundant outside the exclosures, seven were commoner inside, and 16 had similar abundances in- and outside. Deer herbivory greatly increased the abundance of ferns and graminoids and doubled the abundance of exotic plants. In contrast, deer greatly reduced tree regeneration, shrub cover (100–200 fold in two species), plant height, plant reproduction, and the abundance of forbs. None of 36 focal species increased in reproduction or grew taller in the presence of deer, contrary to expectations. We compared these results to data on 50-year regional shifts in species abundances across 62 sites. The effects of herbivory by white-tailed deer accurately account for many of the long-term regional shifts observed in species' abundances (R2 = 0.41). These results support the conjecture that deer impacts have driven many of the regional shifts in forest understory cover and composition observed in recent decades. Our ability to link results from shorter-term, local experiments to regional long-term studies of ecological change strengthens the inferences we can draw from both approaches. PMID:25551827

  5. Long-term regional shifts in plant community composition are largely explained by local deer impact experiments.

    PubMed

    Frerker, Katie; Sabo, Autumn; Waller, Donald

    2014-01-01

    The fact that herbivores and predators exert top-down effects to alter community composition and dynamics at lower trophic levels is no longer controversial, yet we still lack evidence of the full nature, extent, and longer-term effects of these impacts. Here, we use results from a set of replicated experiments on the local impacts of white-tailed deer to evaluate the extent to which such impacts could account for half-century shifts in forest plant communities across the upper Midwest, USA. We measured species' responses to deer at four sites using 10-20 year-old deer exclosures. Among common species, eight were more abundant outside the exclosures, seven were commoner inside, and 16 had similar abundances in- and outside. Deer herbivory greatly increased the abundance of ferns and graminoids and doubled the abundance of exotic plants. In contrast, deer greatly reduced tree regeneration, shrub cover (100-200 fold in two species), plant height, plant reproduction, and the abundance of forbs. None of 36 focal species increased in reproduction or grew taller in the presence of deer, contrary to expectations. We compared these results to data on 50-year regional shifts in species abundances across 62 sites. The effects of herbivory by white-tailed deer accurately account for many of the long-term regional shifts observed in species' abundances (R2 = 0.41). These results support the conjecture that deer impacts have driven many of the regional shifts in forest understory cover and composition observed in recent decades. Our ability to link results from shorter-term, local experiments to regional long-term studies of ecological change strengthens the inferences we can draw from both approaches.

  6. Long-term operation of ''Orlan'' space suits in the ''Mir'' orbiting station: Experience obtained and its application

    NASA Astrophysics Data System (ADS)

    Abramov, I. P.; Glazov, G. M.; Svertshek, V. I.

    2002-07-01

    The started assembly of the International Space Station (ISS) and its further operation will call for a great number of extravehicular activity sorties (EVA) to be performed by ISS crews. Therefore, of great importance is to make use of the EVA experience gained by cosmonauts in the process of 15-year operation of the Mir orbiting station (OS). Over the 15-year period, Mir crewmembers wearing Orlan type semi-rigid space suits have accumulated 158 man/sorties from the orbiting station. Crewmembers used 15 suits in orbit and some of the suits were in operation for more than 3 years. The paper presents principal design features, which provide effective and safe operation of orbit-based suits, and briefly describes procedures for preparation and maintenance of suit systems, which ensure long-term operation of space suit in orbit. The paper gives results of the space suit modifications, presents suit performance characteristics and lists novel or upgraded components of the space suit and its systems. The paper also summarizes improvements in the Orlan type suits described in some earlier publications. They refer, in the first run, to the improvement of space suit operations characteristics and reliability, and the utilization of the Orlan type space suit in the ISS program. The paper analyses the experience gained and drawbacks detected and observations made, and gives statistical data on long-term space suit operations aboard the Mir station. The paper reviews certain problems in the process of EVAs performed from the station, and describes the ways of their solution as applied to the further utilization of the suit within the ISS program.

  7. Long-Term Care

    MedlinePlus

    ... this page please turn Javascript on. Long-Term Care What Is Long-Term Care? Long-term care involves a variety of services ... the Escape (Esc) button on your keyboard.) Most Care Provided at Home Long-term care is provided ...

  8. Incidence and influence of hospitalization for recurrent syncope and its effect on short- and long-term all-cause and cardiovascular mortality.

    PubMed

    Ruwald, Martin H; Numé, Anna-Karin; Lamberts, Morten; Hansen, Carolina M; Hansen, Morten L; Vinther, Michael; Kober, Lars; Torp-Pedersen, Christian; Hansen, Jim; Gislason, Gunnar H

    2014-05-15

    Recurrence of syncope is a common event, but the influence of recurrent syncope on the risk of death has not previously been investigated on a large scale. We examined the prognostic impact of recurrent syncope in a nationwide cohort of patients with syncope. All patients (n = 70,819) hospitalized from 2001 to 2009 in Denmark with a first-time diagnosis of syncope aged from 15 to 90 years were identified from national registries. Recurrence of syncope was incorporated as a time-dependent variable in multivariable-adjusted Cox models on the outcomes of 30-day, 1-year, and long-term all-cause mortality and cardiovascular death. During a mean follow-up of 3.9 ± 2.6 years, a total of 11,621 patients (16.4%) had at least 1 hospitalization for recurrent syncope, with a median time to recurrence of 251 days (33 to 364). A total of 14,270 patients died, and 3,204 deaths were preceded by a hospitalization for recurrent syncope. The long-term risk of all-cause death was significantly associated with recurrent syncope (hazard ratio 2.64, 95% confidence interval 2.54 to 2.75) compared with those with no recurrence. On 1-year mortality, recurrent syncope was associated with a 3.2-fold increase in risk and on 30-day mortality associated with a threefold increase. The increased mortality risk was consistent over age groups 15 to 39, 40 to 59, and 60 to 89 years, and a similar pattern of increase in both long-term and short-term risk of cardiovascular death was evident. In conclusion, recurrent syncope is independently associated with all-cause and cardiovascular mortality across all age groups exhibiting a high prognostic influence. Increased awareness on high short- and long-term risk of adverse events in subjects with recurrent syncope is warranted for future risk stratification.

  9. Long-Term Opioid Contract Use for Chronic Pain Management in Primary Care Practice. A Five Year Experience

    PubMed Central

    Lamb, Geoffrey C.; Neuner, Joan M.

    2007-01-01

    Background The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. Objective To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. Design Retrospective cohort study. Subjects All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. Measurements Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. Results A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. Conclusions Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients. PMID:17372797

  10. Carbon sequestration strategies for crop- and grasslands evaluated in long-term field experiments in Northern Europe

    NASA Astrophysics Data System (ADS)

    Kätterer, Thomas; Bolinder, Martin; Börjesson, Gunnar; Kirchmann, Holger

    2013-04-01

    Improved management of grass- and croplands is a win-win strategy resulting in both increased soil fertility and carbon sequestration. We quantified the effect of N fertilization, organic amendments and ley-arable rotations versus continuous annual cropping systems on soil carbon stocks by analyzing data from long-term field experiments in Nordic countries. Increasing net primary production was found to be the main driver for higher soil carbon storage. Mineral N fertilization increased soil carbon stocks by about 1-2 kg C ha-1 for each kg of N applied to cropland. Ley-arable rotations, being a combination of annual and perennial crops, are expected to have C stocks intermediate between continuous grass- and croplands. A summary of data from 15 long-term sites showed that on average 0.5 Mg ha-1 yr-1 (range 0.3 to 1.1; median 0.4 Mg ha-1 yr-1) more carbon was retained in soils in ley-arable compared to exclusively annual systems, depending on species composition, management, soil depth and the duration of the studies. We also quantified the effect of organic amendments on soil carbon stocks. Retention factors calculated for straw, manure, sawdust, peat, sewage sludge and composted household waste varied widely from about 15% for above-ground crop residues to about 90% for composted household waste. We also emphasize that increased soil carbon stocks not always lead to carbon sequestration of atmospheric CO2 and discuss misunderstandings related to mitigation options earlier proposed for carbon sequestration such as organic farming, manure application, residue handling or application of biochar. Finally, the consequences of different land use and management are discussed, taking into account two critical boundaries - the limited area of agricultural land on Earth and requirements to produce sufficient food, fibres and energy for a growing population.

  11. First European long-term experience with the orphan drug rufinamide in childhood-onset refractory epilepsy.

    PubMed

    Kluger, Gerhard; Haberlandt, Edda; Kurlemann, Gerhard; Ernst, Jan-Peter; Runge, Uwe; Schneider, Felix; Makowski, Christine; Boor, Rainer; Bast, Thomas

    2010-04-01

    Recently, we published the first postmarketing European experience with rufinamide (RUF) in a retrospective 12-week observational study. This follow-up report summarizes the long-term effectiveness and tolerability of RUF after 18 months for the same patient sample. In total, 52 of 60 initially included patients from eight centers in Germany and Austria (45 children and 15 adults aged 1-50 years) with various severe and inadequately controlled epilepsy syndromes continued treatment with RUF after the initial 3-month observation period (mean final dose: 38.2+/-17.3mg/kg/day). Efficacy was assessed by seizure frequency evaluated by comparison with baseline frequency. Tolerability was evaluated by analysis of parental report of adverse events and laboratory tests. Responders were defined as patients who achieved a 50% or greater decrease in countable seizures within 18 months of initiating RUF therapy. Mean overall duration of RUF treatment was 14.5 months (range: 3-18 months). Retention rate, defined as the percentage of patients still taking RUF after 18 months, was 41.7% (n=25/60). The overall response rate after 18 months was 26.7% (16/60 patients). The highest response rates were found in the subgroup of patients with Lennox-Gastaut syndrome (LGS, 35.5%) and in patients with other generalized epilepsy syndromes. Complete seizure control was maintained in one patient (1.6%). A total of 73 adverse events were reported in 37 of 60 patients. The most frequently occurring adverse events were fatigue (18.3%), vomiting (15.0%), and loss of appetite (10.0%). Only 4 new adverse events were reported after week 12. No serious adverse events were observed. The present data suggest that RUF is efficacious and well tolerated in the long-term treatment of children and adults with various epilepsy syndromes and difficult-to-control seizures. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. Dissociative symptoms as a consequence of traumatic experiences: the long-term effects of childhood sexual abuse.

    PubMed

    Gaon, Ariel; Kaplan, Zeev; Dwolatzky, Tzvi; Perry, Zvi; Witztum, Eliezer

    2013-01-01

    The purpose of this study was to assess the prevalence of dissociative symptoms and post-traumatic experiences in an ambulatory setting. The study was conducted in the ambulatory outpatient clinic of the Beersheva Mental Health Center. Over a period of six months new patients over 18 years of age were asked to participate in this survey. Patients completed questionnaires including the Dissociative experience Scale, trauma History Questionnaire, impact of event Scale, and Post-traumatic Diagnostic Scale. A total of 505 patients were enrolled in the study, and 456 completed questionnaires were analyzed. of these, 442 (97%) participants reported at least one traumatic event during their lifetime. the traumatic events were experienced as meaningful and severe at the time of occurrence. the effects of sexual and childhood emotional abuse remained very intense throughout the victim's life and were viewed as powerful, significant experiences. on the other hand, traumatic experiences such as natural disasters and battle trauma were associated with longterm effects of relatively low intensity. The presence of undiagnosed posttraumatic stress disorder (PtSD) among patients in outpatient mental health clinics suggests that screening and diagnostic procedures for this condition be more carefully defined. our most important finding is the large impact of childhood trauma, especially sexual abuse, on later life. thus the prevention, early detection and treatment of child abuse in preventing long term psychopathology must be emphasized.

  13. Results of the "Komplast" experiment on the long-term exposure of materials specimens on the ISS surface

    NASA Astrophysics Data System (ADS)

    Shumov, Andrey; Novikov, Lev

    The "Komplast" materials experiment was designed by the Khrunichev State Research and Production Space Center together with Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University and other Russian scientific institutes, and has been carried out since 1998. The aim of the experiment is to study the complex effects of space factors on specimens of various materials. Eight “Komplast” panels fitted with material specimens equipped UV-sensors and temperature sensors were located on the International Space Station (ISS) Functional Cargo Block (FGB) module exterior surface. The panels were sent into orbit with the FGB when it launched on November 20, 1998. Two of these panels were subsequently returned to Earth by Space Shuttle Discovery after 12 years of LEO exposure. The uniqueness of the "Komplast" experiment determined by long duration of open space exposure, which is much longer than in other similar experiments. For example LDEF: 1984-1990, МЕЕР (Space Station «Mir»): 1996-1997, MISSE-1, -2 (ISS): 1,5-2 years. In this work reveals laboratory research results of some materials specimens, which had been exposed on “Komplast” panels. A distinctive feature of this research was additional irradiation of specimens by atomic oxygen and electrons with energies of ~ 1-8 MeV in laboratory. In the interpretation of the experiment results was taken into account the specimens exposure temperature conditions on the ISS exterior surface and the conditions of their sunlit, defined by the above-mentioned sensors readings. Lot of attention was paid to the investigation of rubber materials specimens. The deformation, mechanical and relaxation characteristics were defined for the specimens. Also were investigations the seals-ability of model rubber seals after the long-term outer exposure. It was determined conservation volumetric deformation and relaxation characteristics of the exposed specimens and the localization of structural changes in the thin

  14. Personal characteristics and experiences of long-term allied health professionals in rural and northern British Columbia.

    PubMed

    Manahan, Candice M; Hardy, Cindy L; MacLeod, Martha L P

    2009-01-01

    Health sciences programs are being designed to attract students who are likely to stay and practice in rural and northern Canada. Consequently, student recruitment and screening are increasingly including assessment of suitability for rural practice. Although retention factors among rural physicians and nurses have been investigated, little is known about factors that contribute to the retention of other healthcare professionals who work in rural areas. The primary objective of this project was to identify the personal characteristics and experiences of allied health professionals who have worked long term in northern British Columbia (BC), Canada. The study used a qualitative descriptive approach. Six speech language pathologists, four psychologists, four occupational therapists, eight social workers, and four physiotherapists practicing long term in northern BC were recruited, using a convenience sample and the snowball technique, to participate in semi-structured telephone interviews. The interviews were audiotaped and transcribed verbatim. A thematic content analysis identified the motivations for their decision to begin or stay working in northern communities, the reasons for choosing rural or northern education and key themes concerning personal characteristics and experiences. A process of member checking and an external audit validated the analysis and findings. There were two major themes for choosing rural and northern education. For some, selection of rural or northern training was based on accessibility to health education programs; all participants who chose rural and northern education had already decided that they were going to practice rurally. Generally, participants identified past positive experiences and rural background as influencing their practice location decision. Participants named the community's need for healthcare professionals, career advancement opportunities, welcoming employers, peer support, as well as promises of continuing

  15. Long-term sphere culture cannot maintain a high ratio of cancer stem cells: a mathematical model and experiment.

    PubMed

    Peng, Tang; Qinghua, Ma; Zhenning, Tang; Kaifa, Wang; Jun, Jiang

    2011-01-01

    Acquiring abundant and high-purity cancer stem cells (CSCs) is an important prerequisite for CSC research. At present, researchers usually gain high-purity CSCs through flow cytometry sorting and expand them by short-term sphere culture. However, it is still uncertain whether we can amplify high-purity CSCs through long-term sphere culture. We have proposed a mathematical model using ordinary differential equations to derive the continuous variation of the CSC ratio in long-term sphere culture and estimated the model parameters based on a long-term sphere culture of MCF-7 stem cells. We found that the CSC ratio in long-term sphere culture presented as gradually decreased drift and might be stable at a lower level. Furthermore, we found that fitted model parameters could explain the main growth pattern of CSCs and differentiated cancer cells in long-term sphere culture.

  16. Mortality and readmission of outcomes after discharge from the surgical intensive care unit to long-term, acute-care hospitals.

    PubMed

    Nguyen, Michelle C; Strosberg, David S; Jones, Teresa S; Bhakta, Ankur; Jones, Edward L; Lyaker, Michael R; Byrd, Cindy A; Sobol, Carly; Eiferman, Daniel S

    2017-05-01

    Patients with prolonged hospitalizations in the surgical intensive care unit often have ongoing medical needs that require further care at long-term, acute-care hospitals upon discharge. Setting expectations for patients and families after protracted operative intensive care unit hospitalization is challenging, and there are limited data to guide these conversations. The purpose of this study was to determine patient survival and readmission rates after discharge from the surgical intensive care unit directly to a long-term, acute-care hospital. All patients who were admitted to the surgical intensive care unit at an academic, tertiary care medical center from 2009-2014 and discharged directly to long-term, acute-care hospitals were retrospectively reviewed. Patients represented all surgical subspecialties excluding cardiac and vascular surgery patients. Primary outcomes included 30-day readmission, and 1- and 3-year mortality rates following discharge. In total, 296 patients were discharged directly from the surgical intensive care unit to a long-term, acute-care hospital during the study period. There were 190 men (64%) and mean age was 61 ± 16 years. Mean duration of stay in the surgical intensive care unit was 27 ± 17 days. The most frequent complication was prolonged mechanical ventilation (277, 94%) followed by pneumonia (139, 47%), sepsis (78, 26%), and acute renal failure (32, 11%); 93% of patients required tracheostomy and enteral feeding access prior to discharge, and 19 patients (6%) were newly dependent on hemodialysis. The readmission rate was 20%. There were 86 deaths within 1 year from discharge (29%) with an overall 3-year mortality of 32%. In a multiple logistic regression analysis, a history of end-stage renal disease had a greater odds of readmission (odds ratio 6.07, P = .028). Patients with history of cancer had greater odds of 1- and 3-year mortality (odds ratio = 2.99, P = .028 and odds ratio 2.56, P = .053, respectively

  17. Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience.

    PubMed

    Muratorio, Francesco; Tringali, G; Levi, V; Ligarotti, G K I; Nazzi, V; Franzini, A A

    2016-11-01

    Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication. All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus. There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30-87 years; mean follow-up 40.92 months, range 8-48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed. Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

  18. The Impact of Na—H+ Exchange on Long-Term Borosilicate Glass Corrosion: Experiments and Field Observations

    SciTech Connect

    Icenhower, Jonathan P; Pierce, Eric M; McGrail, B Peter

    2009-05-01

    New insights from laboratory experiments coupled with field observations indicate that pore water solutions that eventually breach containment materials in disposal systems will interact with sodium-excess borosilicate waste glass in an unexpected way. Because many glass waste forms are relatively sodium-rich, they are especially vulnerable to Na+—H+ exchange (ion exchange or simply, IEX). Although the kinetics of this process has been previously investigated for early-stage glass reactions, the implications of IEX for long-term dissolution resistance have not yet been realized. Non-radioactive glass with major- and minor-element chemical compositions similar to Hanford high-Na waste glass were subjected to dissolution experiments to quantify the rates of matrix dissolution and IEX rates. Single-Pass Flow-Through (SPFT) tests quantified the IEX rate at 40°C pH = 8 and silica saturation and showed a dependence upon the fraction of excess sodium in the glass. The equation for the rate (in moles of sodium released per meter squared per second) dependence on excess sodium is: log10rate[mol/(m2∙s)] = 0.63R + (-11.0); r2 = 0.86 where R = molar Na+/(M3+). Further, rates of Na release are slower by ≥30% in D2O-based solutions compared to those in H2O. These results are the hallmark of IEX reactions. Our results are compared against those from a lysimeter field experiment consisting of glasses buried in Hanford sand and to dissolution experiments conducted with a Pressurized Unsaturated Flow (PUF) apparatus. These longer-term tests indicate an initial decrease in dissolution rate by a factor of 10×, and then a constant steady-state rate thereafter. Thus, these data show that IEX reactions are important at near-saturation conditions and effectively prevent dissolution rates from falling below a minimum value. In sum, IEX modifies the long-term behavior of glass dissolution and models cannot assume that dissolution of Na-rich borosilicate glass will decrease by a

  19. [Effects of aroma massage on pruritus, skin pH, skin hydration and sleep in elders in long-term care hospitals].

    PubMed

    Roh, So Young; Kim, Kye Ha

    2013-12-01

    The purpose of this study was to examine the effects of aroma massage on pruritus, skin pH, skin hydration and sleep in elders in long-term care hospitals. The participants were elders over 65 years old admitted to long-term care. They were assigned to the experimental group (26) or control group (28). Data were collected from May to August, 2012. Visual Analogue Scale and Verran and Snyder-Halpern Sleep scale were used to identify levels of pruritus and sleep. A skin-pH meter and moisture checker were used to measure skin pH and skin hydration. Aroma massage was performed three times a week for 4 weeks for elders in the experimental group. The data were analyzed using the SPSS Win 17.0 program. There were significant differences in pruritus, skin pH and skin hydration between the two groups. However there was no significant difference in sleep. The results indicate that aroma massage is effective in reducing pruritus, skin pH and increasing skin hydration in elders. Therefore, this intervention can be utilized in clinical practice as an effective nursing intervention to reduce pruritus in elders in long-term care hospitals.

  20. Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest.

    PubMed

    Duchateau, François-Xavier; Hamada, Sophie; Raux, Mathieu; Gay, Matthieu; Mantz, Jean; Paugam Burtz, Catherine; Gauss, Tobias

    2017-01-01

    Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA. This study is a retrospective database review of all patients from a multicentre prospective registry that experienced a TCA and had undergone successful cardiopulmonary resuscitation (CPR) prior their admission at the trauma centre. The primary end point was neurological outcome at 6 months among patients who survived to hospital discharge. 88 victims of TCA underwent successful CPR and were admitted to the hospital, 90% of whom were victims of blunt trauma. Of these 88 patients, 10 patients (11%; CI 95% 6% to 19%) survived to discharge: on discharge, 9 patients displayed a GCS of 15 and Cerebral Performance Categories (CPC) 1-2 and one patient had a GCS 7 and CPC of 3. Hypoxia was the most frequent cause of CA among survivors. 6-month follow-up was achieved for 9 patients of the 10 surviving patients. The 9 patients with a good outcome on hospital discharge had a CPC of 1 or 2 6 months post discharge. All returned to their premorbid family and social settings. Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. A study of pumps for the Hot Dry Rock Geothermal Energy extraction experiment (LTFT (Long Term Flow Test))

    SciTech Connect

    Tatro, C.A.

    1986-10-01

    A set of specifications for the hot dry rock (HDR) Phase II circulation pumping system is developed from a review of basic fluid pumping mechanics, a technical history of the HDR Phase I and Phase II pumping systems, a presentation of the results from experiment 2067 (the Initial Closed-Loop Flow Test or ICFT), and consideration of available on-site electrical power limitations at the experiment site. For the Phase II energy extraction experiment (the Long Term Flow Test or LTFT) it is necessary to provide a continuous, low maintenance, and highly efficient pumping capability for a period of twelve months at variable flowrates up to 420 gpm and at surface injection pressures up to 5000 psi. The pumping system must successfully withstand attacks by corrosive and embrittling gases, erosive chemicals and suspended solids, and fluid pressure and temperature fluctuations. In light of presently available pumping hardware and electric power supply limitations, it is recommended that positive displacement multiplex plunger pumps, driven by variable speed control electric motors, be used to provide the necessary continuous surface injection pressures and flowrates for LTFT. The decision of whether to purchase the required circulation pumping hardware or to obtain contractor provided pumping services has not been made.

  2. Long-term outcomes of complete vascular ring division in children: a 36-year experience from a single institution.

    PubMed

    Naimo, Phillip S; Fricke, Tyson A; Donald, Julia S; Sawan, Elie; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E

    2017-02-01

    Complete vascular rings are rare and cause tracheoesophageal compression. Following surgical division, some patients have persisting tracheomalacia. We aim to assess the long-term outcomes of complete vascular ring division. All patients (n = 132) who underwent surgical division of a complete vascular ring between 1978 and 2014 were identified from the hospital database and retrospectively reviewed. Complete vascular rings consisted of a double aortic arch (n = 80), right aortic arch with an aberrant subclavian artery and left ligamentum arteriosum (n = 50), right aortic arch with mirror image branching and left ligamentum arteriosum (n = 1), and a left aortic arch with right descending aorta and right ligamentum arteriosum (n = 1). Kommerell's diverticulum was identified in 10 patients. Preoperative tracheomalacia was identified via bronchoscopy in 25 patients. Concomitant tracheal reconstruction was not performed in any patient. Kommerell's diverticulum was resected in 1 patient. The hospital mortality rate was 1.5% (2/132). There were no late deaths. The overall survival rate was 98.3 ± 1.2% (95% CI: 93.4, 99.6) at 20 years. Postoperatively, persistent tracheal compression was reported in 3 patients, and tracheomalacia in 16 patients. The rate of freedom from reoperation was 88.6 ± 4.0% (95% CI: 77.9, 94.3) at 20 years. No patient required tracheal surgery during the follow-up period. Follow-up was 92% (121/132) complete, with a median follow-up of 11.4 years (range 44 days to 36 years). At the last follow-up, 7 patients had mild tracheomalacia. Outcomes of division of a complete vascular ring are excellent. Tracheomalacia often improves following division of the vascular ring. Respiratory symptoms following complete vascular ring division are uncommon.

  3. Mineral-microbial interaction in long term experiments with sandstones and reservoir fluids exposed to CO2

    NASA Astrophysics Data System (ADS)

    Kasina, Monika; Morozova, Daria; Pellizzari, Linda; Würdemann, Hilke

    2013-04-01

    Microorganisms represent very effective geochemical catalysts, and may influence the process of the CO2 storage significantly. The goal of this study is to characterize the interactions between minerals and microorganisms during their exposure to the CO2 in a long term experiment in high pressure vessels to better understand the influence of biological processes on the composition of the reservoir sandstones and the long term stability of CO2 storage. The natural gas reservoir, proposed for the CO2 storage is characterized by high salinity (up to 420 g/l) and temperatures around 130°C, at depth of approximately 3.5 km. Microbial community of the reservoir fluid samples was dominated by different H2-oxidising, thiosulfate-oxidising and biocorrosive thermophilic bacteria as well as microorganisms similar to representatives from other deep environments, which have not previously been cultivated. The cells were attached to particles and were difficult to detect because of low cell numbers (Morozova et al., 2011). For the long term experiments, the autoclaved rock core samples from the core deposit were grinded, milled to the size of 0.5 mm and incubated with fresh reservoir fluids as inoculum for indigenous microorganisms in a N2/CH4/H2-atmosphere in high pressure vessels at a temperature of 80°C and pressure of 40 bars. Incubation was performed under lower temperature than in situ in order to favor the growth of the dormant microorganisms. After three months of incubation samples were exposed to high CO2 concentrations by insufflating it into the vessels. The sampling of rock and fluid material was executed 10 and 21 months after start of the experiment. Mineralogical analyses performed using XRD and SEM - EDS showed that main mineral components are quartz, feldspars, dolomite, anhydrite and calcite. Chemical fluid analyses using ICP-MS and ICP-OES showed that after CO2 exposure increasing Si4+ content in the fluid was noted after first sampling (ca. 25 relative

  4. Using historical woodland creation to construct a long-term, large-scale natural experiment: the WrEN project.

    PubMed

    Watts, Kevin; Fuentes-Montemayor, Elisa; Macgregor, Nicholas A; Peredo-Alvarez, Victor; Ferryman, Mark; Bellamy, Chloe; Brown, Nigel; Park, Kirsty J

    2016-05-01

    Natural experiments have been proposed as a way of complementing manipulative experiments to improve ecological understanding and guide management. There is a pressing need for evidence from such studies to inform a shift to landscape-scale conservation, including the design of ecological networks. Although this shift has been widely embraced by conservation communities worldwide, the empirical evidence is limited and equivocal, and may be limiting effective conservation. We present principles for well-designed natural experiments to inform landscape-scale conservation and outline how they are being applied in the WrEN project, which is studying the effects of 160 years of woodland creation on biodiversity in UK landscapes. We describe the study areas and outline the systematic process used to select suitable historical woodland creation sites based on key site- and landscape-scale variables - including size, age, and proximity to other woodland. We present the results of an analysis to explore variation in these variables across sites to test their suitability as a basis for a natural experiment. Our results confirm that this landscape satisfies the principles we have identified and provides an ideal study system for a long-term, large-scale natural experiment to explore how woodland biodiversity is affected by different site and landscape attributes. The WrEN sites are now being surveyed for a wide selection of species that are likely to respond differently to site- and landscape-scale attributes and at different spatial and temporal scales. The results from WrEN will help develop detailed recommendations to guide landscape-scale conservation, including the design of ecological networks. We also believe that the approach presented demonstrates the wider utility of well-designed natural experiments to improve our understanding of ecological systems and inform policy and practice.

  5. Evolving techniques in text-based medical consultation - Physicians' long-term experiences at an Ask the doctor service.

    PubMed

    Björk, Anna Bell; Hillborg, Helene; Augutis, Marika; Umefjord, Göran

    2017-09-01

    Both the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text. To improve text-based medical consultation by learning from long-term experiences. Physicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach. Over time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients. Text-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Short- and long-term prognosis of critically-ill patients referred to the ICU from the Emergency Department of a tertiary hospital.

    PubMed

    García-Gigorro, Renata; Dominguez Aguado, Helena; Barea Mendoza, Jesús Abelardo; Viejo Moreno, Rubén; Sánchez Izquierdo, Jose Angel; Montejo-González, Juan Carlos

    2017-03-03

    A frequent source of critically-ill patients admitted to the ICU is the Emergency Department. It is essential to analyse the short-term prognosis of these patients, but also their evolution after their discharge from the hospital, since this is one of the major concerns of these patients. The aim of this study is to describe the epidemiological characteristics of patients admitted to the ICU from the Emergency Department and to analyse their outcome. This consisted of an observational prospective cohorts study which included 269 Emergency Department patients consecutively admitted to the ICU over an 18-month period. Factors associated with hospital mortality were presented as an odds ratio (OR) and factors associated with long-term mortality were presented as a hazard ratio (HR). A P-value lower than .05 was accepted as significant. The overall survival was analysed on the basis of the Kaplan-Meier curves. Hospital mortality was 15%, ICU complications where the variables with the greatest impact on short-term mortality: acute renal failure (OR 22.7) and respiratory distress syndrome (OR 51.2). After hospital discharge, the cumulative mortality at 12, 24 and 36 months was 6, 11 and 15%, respectively. The degree of functional dependence (HR 3.7), cancer (HR 3.4) and arrhythmias (HR 2.4) were factors related to long-term mortality. The short-term outcome of ICU patients is related to age and comorbidity, but more significantly to the characteristics of the acute illness. However, the long-term outcome is more closely associated with the patients' characteristics. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  7. Reactive Transport Modeling of the Long-term Performance of Column Experiments for the Remediation of Acid Mine Drainage

    NASA Astrophysics Data System (ADS)

    Amos, R. T.; Mayer, K. U.; Blowes, D. W.; Ptacek, C. J.

    2002-12-01

    Reactive transport modeling was used to evaluate the long-term performance of two similar column experiments (Waybrant et al., 2002, ES&T, 36, 1349-1356), which were designed to simulate the treatment of acid mine drainage by an organic carbon permeable reactive barrier through microbially mediated sulfate reduction and subsequent sulfide mineral precipitation. Principal reactions considered in the simulations include reduction of sulfate by organic matter, mineral dissolution/precipitation reactions and aqueous complexation. Simulations of Column 1, containing composted leaf mulch, wood chips, sawdust, and sewage sludge as an organic carbon source, accurately predicted sulfate concentrations in the column effluent throughout the duration of the experiment using a single fixed rate constant for sulfate reduction of 8E-09 mol L-1 s-1. The same reduction rate was used for Column 2 which contained only composted leaf mulch and sawdust as an organic carbon source. In this case, sulfate concentrations at the column outlet were over-predicted at late times suggesting that sulfate reduction rates increased over the duration of the column experiment and that microbial growth kinetics may have played an important role. These modeling results suggest that the reactivity of the organic carbon treatment material with respect to sulfate reduction does not significantly decrease over the duration of the fourteen-month experiments. However, the simulations over-predicted the attenuation of ferrous iron at late time for both experiments, which suggests that the overall rate of sulfide production and/or the overall rate of iron monosulfide formation decrease with time.

  8. Combining long term field experiments and nanoscale analysis to enhance process understanding of root litter stabilization by mineral interactions

    NASA Astrophysics Data System (ADS)

    Chabbi, Abad; Baumann, Karen; Remusat, Laurent; Barre, Pierre; Dignac, Marie-France; Rumpel, Cornelia

    2015-04-01

    Mineral interaction may affect the stabilisation of root litter directly or indirectly after microbial decomposition and transformation. The importance of both processes may vary within the soil profile. In this study we studied C stabilisation of isotopically labelled root litter (13C and 15N), which was incubated during 3 year in the field at different soil depth. Samples from this field experiment were recovered and subjected to nanoscale analyses in order to elucidate mineral interactions occurring in different parts of the soil profile. Our results showed enrichment of mineral associated organic matter in subsoil horizons. However, material derived from new plant litter may be stabilised at similar rates in top- and subsoil horizons. N-containing compounds are enriched in the mineral associated fraction of subsoil horizons, indicating enrichment of microbial derived material with depth. Nano scale analyses showed that indeed plant-derived material may be associated with metal oxides in topsoil horizons, whereas the mineral associated organic matter in subsoil horizons may consist of microbial cells. Interestingly, in contrast to short term laboratory analysis, decoupling of C and N through stabilisation with soil minerals was observed during this long term field experiment. Our results indicate that the nature of OM stabilised by mineral interactions is depth specific. Therefore, we suggest, that plant derived lignocellulosic material may be preserved by mineral interactions in topsoil given its incomplete degradation, thereby leading to the formation of functional groups and favouring adsorption to soil minerals. This is consistent with the higher state of lignin-degradation observed in topsoil horizons as compared to subsoil. At depth, where microorganisms are most likely energy limited, degradation of fresh plant litter may be complete, thereby diminishing the formation of lignocellulosic compounds capable of sorption onto metal oxides. As a result

  9. Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital's local population can be inaccurate.

    PubMed

    Masursky, Danielle; Dexter, Franklin; O'Leary, Colleen E; Applegeet, Carol; Nussmeier, Nancy A

    2008-04-01

    Anesthesia department planning depends on forecasting future demand for perioperative services. Little is known about long-range forecasting of anesthesia workload. We studied operating room (OR) times at Hospital A over 16 yr (1991-2006), anesthesia times at Hospital B over 26 yr (1981-2006), and cases at Hospital C over 13 yr (1994-2006). Each hospital is >100 yr old and is located in a US city with other hospitals that are >50 yr old. Hospitals A and B are the sole University hospitals in their metropolitan statistical areas (and many counties beyond). Hospital C is the sole tertiary hospital for >375 km. Each hospital's choice of a measure of anesthesia work to be analyzed was likely unimportant, as the annual hours of anesthesia correlated highly both with annual numbers of cases (r = 0.98) and with American Society of Anesthesiologist's Relative Value Guide units of work (r = 0.99). Despite a 2% decline in the local population, the hours of OR time at Hospital A increased overall (Pearson r = -0.87, P < 0.001) and for children (r = -0.84). At Hospital B, there was a strong positive correlation between population and hours of anesthesia (r = 0.97, P < 0.001), but not between annual increases in population and workload (r = -0.18). At Hospital C, despite a linear increase in population, the annual numbers of cases increased, declined with opening of two outpatient surgery facilities, and then stabilized. The predictive value of local personal income was low. In contrast, the annual increases in the hours of OR time and anesthesia could be modeled using simple time series methods. Although growth of the elderly population is a simple justification for building more ORs, managers should be cautious in arguing for strategic changes in capacity at individual hospitals based on future changes in the national age-adjusted population. Local population can provide little value in forecasting future anesthesia workloads at individual hospitals. In addition, anesthesia

  10. Frictional healing and sealing in anhydrite-filled faults: from short duration experiments to long-term CO2 storage

    NASA Astrophysics Data System (ADS)

    Pluymakers, Anne; Bakker, Elisenda; Samuelson, Jon; Spiers, Christopher

    2014-05-01

    The efficacy of long-term subsurface CO2 storage requires that the stored gas remains isolated from the atmosphere for thousands of years. Faults crosscutting the reservoir and topseal system of storage sites are considered one of the most likely leakage pathways, especially if reactivation leads to fault dilation. For a proper risk assessment it is important to know if CO2 affects the self-sealing potential of fault gouges, as well as how it affects strength recovery after fault slip ceases (frictional healing). A thorough understanding of the physical processes operating in the fault gouge will help to extrapolate the data from short-term experimental time scales to long-term storage time scales. Anhydrite is a common caprock mineral in many hydrocarbon fields worldwide, and particularly in the Netherlands. In cases where faults crosscut the caprock, it is likely that these contain fine-grained, anhydrite-rich, damage material, or "fault gouge". Therefore, we have performed two sets of experiments: 1) fault shearing experiments on simulated anhydrite fault gouge, to investigate the frictional behavior of anhydrite faults, and 2) compaction creep experiments, to investigate the potential for self-sealing. All experiments were performed under pressure and temperature conditions representative for CO2 storage conditions (set 1: T = 80-150°C; normal stress = 25MPa; Pf = 15MPa; set 2: T = 80°C; stress = 5-12MPa and P¬f = 15MPa). The use of different pore fluid phases (air, vacuum, water, CO2 saturated solution, moist CO¬2 and dry CO2), as well as the range in pressures and temperatures, allows us to study the effect of the in-situ conditions on the frictional behavior, and also to identify the mechanisms responsible for the compaction behavior. Our results indicate that in both types of experiments water plays an essential role, by enhancing both fault-healing (type 1) and fault-sealing potential (type 2). The compaction experiments indicate fault sealing in fine

  11. Effect of coronary artery revascularization on in-hospital outcomes and long-term prognoses in acute myocardial infarction patients with prior ischemic stroke

    PubMed Central

    Li, Bo-Yu; Li, Xiao-Ming; Zhang, Yan; Wei, Zhan-Yun; Li, Jing; Hua, Qi

    2016-01-01

    Objective To investigate whether coronary artery revascularization therapies (CART), including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), can improve the in-hospital and long-term outcomes for acute myocardial infarction (AMI) patients with prior ischemic stroke (IS). Methods A total of 387 AMI patients with prior IS were enrolled consecutively from January 15, 2005 to December 24, 2011 in this cohort study. All patients were categorized into the CART group (n = 204) or the conservative medications (CM) group (n = 183). In-hospital cardiocerebral events and long-term mortality of the two groups after an average follow-up of 36 months were recorded by Kaplan-Meier survival curves and compared by Logistic regression and the Cox regression model. Results The CART patients were younger (66.5 ± 9.7 years vs. 71.7 ± 9.7 years, P < 0.01), had less non-ST segment elevation myocardial infarction (11.8% vs. 20.8%, P = 0.016) and more multiple-vascular coronary lesions (50% vs. 69.4%, P = 0.031). The hospitalization incidence of cardiocerebral events in the CART group was 9.3% while 26.2% in the CM group (P < 0.01). CART significantly reduced the risk of in-hospital cardiocerebral events by 65% [adjusted odds ratio (OR) = 0.35, 95% CI: 0.13–0.92]. By the end of follow-up, 57 cases (41.6%) died in CM group (n = 137) and 24 cases (12.2%) died in CART group (n = 197). Cox regression indicated that CART decreased the long-term mortality by 72% [adjusted hazard ratio (HR) = 0.28, 95% CI: 0.06–0.46], while categorical analysis indicated no significant difference between PCI and CABG. Conclusions CART has a significant effect on improving the in-hospital and long-term prognoses for AMI patients with prior IS. PMID:27168740

  12. Can Robotic Gastrectomy Surpass Laparoscopic Gastrectomy by Acquiring Long-Term Experience? A Propensity Score Analysis of a 7-Year Experience at a Single Institution

    PubMed Central

    Hong, Sung-Soo; Shin, Ho-Jung; Cui, Long-Hai; Hur, Hoon; Han, Sang-Uk

    2016-01-01

    Purpose It is hypothesized that robotic gastrectomy may surpass laparoscopic gastrectomy after the operators acquire long-term experience and skills in the manipulation of robotic arms. This study aimed to evaluate the long-term learning curve of robotic distal gastrectomy (RDG) for gastric cancer compared with laparoscopic distal gastrectomy (LDG). Materials and Methods From October 2008 to December 2015, patients who underwent LDG (n=809) were matched to patients who underwent RDG (n=232) at a 1:1 ratio, by using a propensity score matching method after stratification for the operative year. The surgical outcomes, such as trends of operative time, blood loss, and complication rate, were compared between the two groups. Results The RDG group showed a longer operative time (171.3 minutes vs. 147.6 minutes, P<0.001) but less estimated blood loss (77.6 ml vs. 116.6 ml, P<0.001). The complication rate and postoperative recovery did not differ between the two groups. The RDG group showed a longer operative time and similar estimated blood loss compared with the LDG group after 5 years of experience (operative time: 159.2 minutes vs. 136.0 minutes in 2015, P=0.003; estimated blood loss: 72.9 ml vs. 78.1 ml in 2015, P=0.793). Conclusions In terms of short-term surgical outcomes, RDG may not surpass LDG after a long-term experience with the technique. PMID:28053810

  13. Long-Term Outcomes of Hospitalized Patients with a Non-Acute Coronary Syndrome Diagnosis and an Elevated Cardiac Troponin Level

    PubMed Central

    McFalls, Edward O.; Larsen, Greg; Johnson, Gary; Apple, Fred S.; Goldman, Steven; Arai, Andrew; Nallamathu, Brahmajee; Jesse, Bob; Holmstrom, Scott T.; Sinnott, Patricia L.

    2013-01-01

    Background Cardiac troponin levels help risk-stratify patients presenting with an acute coronary syndrome (ACS). Although they may be elevated in patients presenting with Non-ACS conditions, specific diagnoses and long-term outcomes within that cohort are unclear. Methods and Results Using the Veterans Affairs (VA) centralized databases, we identified all hospitalized patients in 2006 who had a troponin assay obtained during their initial reference hospitalization. Based on ICD-9 diagnostic codes, primary diagnoses were categorized as either ACS or Non-ACS conditions. Of a total of 21,668 patients with an elevated troponin level who were discharged from the hospital, 12,400 (57.2%) had a Non-ACS condition. Among that cohort, the most common diagnostic category involved the cardiovascular system and congestive heart failure (N=1661) and chronic coronary artery disease (N=1648) accounted for the major classifications. At one-year following hospital discharge, mortality in patients with a Non-ACS condition was 22.8% and was higher than the ACS cohort (Odds Ratio=1.39; 95%CI: 1.30–1.49). Despite the high prevalence of cardiovascular diseases in patients with a Non-ACS diagnosis, utilization of cardiac imaging within 90 days of hospitalization was low compared with ACS patients (Odds Ratio=0.25; 95%CI: 0.23–0.27). Conclusions Hospitalized patients with an elevated troponin level most often have a primary diagnosis that is not an acute coronary syndrome. Their long-term survival is poor and justifies novel diagnostic or therapeutic strategy-based studies to target the highest risk subsets prior to hospital discharge. PMID:21601821

  14. 42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... delay in the hospital's preparation and submittal of bills to the intermediary beyond its normal billing... discharge bill. (b) Periodic interim payments—(1) Criteria for receiving periodic interim payments. (i) A... admitted to the hospital. Payment for the interim bill is determined as if the bill were a final...

  15. Long term microparticle impact fluxes on LDEF determined from optical survey of Interplanetary Dust Experiment (IDE) sensors

    NASA Technical Reports Server (NTRS)

    Simon, C. G.; Oliver, J. P.; Cooke, W. J.; Downey, K. I.; Kassel, P. C.

    1995-01-01

    leading side during LDEF's first year in orbit.) The overall east/west ratio was 44, but during LDEF's first year in orbit the ratio was 8.5, and during years 2-6 the ratio was 114. Long term microparticle impact fluxes on the space end decreased from 1.12 to 0.55 x 10(exp -4) m(exp -2)/s from the first year in orbit compared to years 2-6. The earth end showed the opposite trend with an increase from 0.16 to 0.38 x 10(exp -4) m(exp -2)/s. Fluxes on rows 6 and 12 decreased from 6.1 to 3.4 and 6.7 to 3.7 x 10(exp -4) m(exp -2)/s, respectively, over the same time periods. This resulted in space/earth microparticle impact flux ratios of 7.1 during the first year and 1.5 during years 2-6, while the south/north, space/north and space/south ratios remained constant at 1.1, 0.16 and 0.17, respectively, during the entire mission. This information indicates the possible identification of long term changes in discrete microparticle orbital debris component contributions to the total impact flux experienced by LDEF. A dramatic decrease in the debris population capable of striking the trailing side was detected that could possibly be attributed to the hiatus of western launch activity experienced from 1986-1989. A significant increase in the debris population that preferentially struck the leading side was also observed and could possibly be attributed to a single breakup event that occurred in September of 1986. A substantial increase in the microparticle debris population that struck the earth end of LDEF, but not the space end, was also detected and could possibly be the result of a single breakup event at low altitude. These results point to the importance of including discrete orbital debris component contribution changes in flux models in order to achieve accurate predictions of the microparticle environment that a particular spacecraft will experience in earth orbit. The only reliable, verified empirical measurements of these changes are reported in this paper. Further time

  16. Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

    PubMed Central

    Heiro, Maija; Helenius, Hans; Hurme, Saija; Savunen, Timo; Metsärinne, Kaj; Engblom, Erik; Nikoskelainen, Jukka; Kotilainen, Pirkko

    2008-01-01

    Background Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE). Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery. Methods A total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients. Results The mean (SD) follow-up time for the 1-year survivors was 11.5 (7.3) years (range 25 days to 25.5 years). The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003) and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010) or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005) as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p < 0.001). Heart failure was also significantly associated with the long-term cardiac mortality (p = 0.032). Of all 303 patients, 20 had more than 1 disease episode. Chronic dialysis (p = 0.002), intravenous drug use (p = 0.002) and diabetes (p = 0.015) were significant risk factors for recurrent episodes of IE, but when analysed separately for the 1-year survivors, only chronic dialysis remained significant (p = 0.017). Recurrences and late valve surgery did not confer a poor prognosis. Conclusion Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery

  17. Soil wettability, moisture status and CO2 flux in a long term drought and warming simulation experiment

    NASA Astrophysics Data System (ADS)

    Urbanek, Emilia; Bösken, Janina; Titema, Albert; Nunez Pastrana, David; Emmett, Bridget

    2014-05-01

    Current climatic predictions include altered rainfall patterns and increased temperatures which in consequence can enhance the development of soil water repellency (SWR; i.e. hydrophobicity). Soils may become more severely water-repellent or SWR may spread into the environments where it has not been observed before. As the soil moisture dynamics, including restricted infiltration and uneven distribution of water is severely altered in water-repellent soils, so might be the decomposition of organic matter and overall exchange of gases like CO2 between the soil and the atmosphere. Long-term climatic simulation study has been conducted for over a decade at upland heathland sites in Oldebroek (Netherlands) and in Clocaenog (UK) [1]. At each site nine 20 m2-large plots were selected and each three were subjected to: a drought effect created by a rainfall exclusion using an automatic self retracting waterproof curtains; a warming effect using a self retracting curtains reflecting infrared radiation overnight, and control plots. The soil at the sites was a peaty podzol and sandy podzol both highly prone to soil water repellency development. The sites were constantly monitored since the start of the experiment and the range of meteorological and environmental measurements included for example: soil moisture, temperature, vegetation and root zone changes, soil CO2 flux. The observations of soil moisture content have shown that the soil moisture did not recover to the original values in the drought system even after the rainfall exclusion has been stopped for winter time, suggesting the development of soil water repellency [2]. The severe changes in moisture dynamics have also significantly affected the soil CO2 flux. The aim of the study was to investigate whether the long-term drought and warming treatments have any effect on the severity and persistence of SWR and how far the moisture changes and the SWR altered the CO2 flux from these soils. The measurements of the SWR

  18. A 35-year experience with syndromic cleft palate repair: operative outcomes and long-term speech function.

    PubMed

    Basta, Marten N; Silvestre, Jason; Stransky, Carrie; Solot, Cynthia; Cohen, Marilyn; McDonald-McGinn, Donna; Zackai, Elaine; Kirschner, Richard; Low, David W; Randall, Peter; LaRossa, Don; Jackson, Oksana A

    2014-12-01

    Associated comorbidities can put syndromic patients with cleft palate at risk for poor speech outcomes. Reported rates of velopharyngeal insufficiency (VPI) vary from 8% to 64%, and need for secondary VPI surgery from 23% to 64%, with few studies providing long-term follow-up. The purpose of this study was to describe our institutional long-term experience with syndromic patients undergoing cleft palatoplasty. A retrospective review was conducted of all patients with syndromic diagnoses undergoing primary Furlow palatoplasty from 1975 to 2011. Outcomes included postoperative oronasal fistula (ONF) and need for secondary VPI surgery. Speech scores for verbal patients 5 years or older were collected via the Pittsburgh scale for speech assessment. Aggregate scores categorized the velopharyngeal mechanism as competent, borderline, or incompetent. Outcomes were analyzed by patient and operative factors. One hundred thirty-two patients were included with average age at repair of 20.7 months. Cleft type was 9% submucosal, 16% Veau class I, 50% class II, 12% class III, and 13% class IV. Forty-five syndromes were recorded, most commonly Stickler syndrome (n = 32) and 22q11.2 deletion syndrome [22q11.2DS (n = 19)]. Forty-four patients also had associated Pierre Robin sequence (PRS). The overall ONF rate was 4.5% and was highest in Veau class IV clefts (P = 0.048). Seventy-six patients were included in speech analysis, with an average age at last assessment of 10.4 years. Overall, 60.5% of patients had a competent velopharyngeal mechanism, 23.7% borderline, and 15.8% incompetent mechanism. Fifty percent of 22q11.2DS patients had borderline speech and none had competent speech, compared to 73.3% with Stickler syndrome (P = 0.01) and 71.4% of patients with associated PRS (P = 0.02). Secondary VPI surgery was performed in 11.4% of patients overall. Patients with PRS (13.6%) and with Stickler syndrome (15.6%) had secondary VPI surgery, compared to 31.6% of patients with 22q11.2DS

  19. Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up.

    PubMed

    Schiavina, Riccardo; Zaramella, Stefano; Chessa, Francesco; Pultrone, Cristian Vincenzo; Borghesi, Marco; Minervini, Andrea; Cocci, Andrea; Chindemi, Andrea; Antonelli, Alessandro; Simeone, Claudio; Pagliarulo, Vincenzo; Parma, Paolo; Samuelli, Alessanrdo; Celia, Antonio; De Concilio, Bernardino; Rocco, Bernardo; De Lorenzis, Elisa; La Manna, Gaetano; Terrone, Carlo; Falsaperla, Mario; Dente, Donato; Porreca, Angelo

    2016-12-01

    The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.

  20. Bacteria and virus removal effectiveness of ceramic pot filters with different silver applications in a long term experiment.

    PubMed

    van der Laan, H; van Halem, D; Smeets, P W M H; Soppe, A I A; Kroesbergen, J; Wubbels, G; Nederstigt, J; Gensburger, I; Heijman, S G J

    2014-03-15

    In 2012 more than 4 million people used a ceramic pot filter (CPF) as household water treatment system for their daily drinking water needs. In the normal production protocol most low cost filters are impregnated with a silver solution to enhance the microbial removal efficiency. The aim of this study was to determine the role of silver during the filtration and subsequent storage. Twenty-two CPFs with three different silver applications (non, only outside and both sides) were compared in a long-term loading experiment with Escherichia coli (K12 and WR1) and MS2 bacteriophages in natural challenge water under highly controlled laboratory circumstances. No significant difference in Log Removal Values were found between the filters with different silver applications. The results show that the storage time in the receptacle is the dominant parameter to reach E. coli inactivation by silver, and not the contact time during the filtration phase. The hypothesis that the absence of silver would enhance the virus removal, due to biofilm formation on the ceramic filter element, could not be confirmed. The removal effectiveness for viruses is still of major concern for the CPF. This study suggests that the ceramic pot filter characteristics, such as burnt material content, do not determine E. coli removal efficacies, but rather the contact time with silver during storage is the dominant parameter to reach E. coli inactivation.

  1. Soil ionomic and enzymatic responses and correlations to fertilizations amended with and without organic fertilizer in long-term experiments

    PubMed Central

    Feng, Xumeng; Ling, Ning; Chen, Huan; Zhu, Chen; Duan, Yinghua; Peng, Chang; Yu, Guanghui; Ran, Wei; Shen, Qirong; Guo, Shiwei

    2016-01-01

    To investigate potential interactions between the soil ionome and enzyme activities affected by fertilization with or without organic fertilizer, soil samples were collected from four long-term experiments over China. Irrespective of variable interactions, fertilization type was the major factor impacting soil ionomic behavior and accounted for 15.14% of the overall impact. Sampling site was the major factor affecting soil enzymatic profile and accounted for 34.25% of the overall impact. The availabilities of Pb, La, Ni, Co, Fe and Al were significantly higher in soil with only chemical fertilizer than the soil with organic amendment. Most of the soil enzyme activities, including α-glucosidase activity, were significantly activated by organic amendment. Network analysis between the soil ionome and the soil enzyme activities was more complex in the organic-amended soils than in the chemical fertilized soils, whereas the network analysis among the soil ions was less complex with organic amendment. Moreover, α-glucosidase was revealed to generally harbor more corrections with the soil ionic availabilities in network. We concluded that some of the soil enzymes activated by organic input can make the soil more vigorous and stable and that the α-glucosidase revealed by this analysis might help stabilize the soil ion availability. PMID:27079657

  2. Soil ionomic and enzymatic responses and correlations to fertilizations amended with and without organic fertilizer in long-term experiments.

    PubMed

    Feng, Xumeng; Ling, Ning; Chen, Huan; Zhu, Chen; Duan, Yinghua; Peng, Chang; Yu, Guanghui; Ran, Wei; Shen, Qirong; Guo, Shiwei

    2016-04-15

    To investigate potential interactions between the soil ionome and enzyme activities affected by fertilization with or without organic fertilizer, soil samples were collected from four long-term experiments over China. Irrespective of variable interactions, fertilization type was the major factor impacting soil ionomic behavior and accounted for 15.14% of the overall impact. Sampling site was the major factor affecting soil enzymatic profile and accounted for 34.25% of the overall impact. The availabilities of Pb, La, Ni, Co, Fe and Al were significantly higher in soil with only chemical fertilizer than the soil with organic amendment. Most of the soil enzyme activities, including α-glucosidase activity, were significantly activated by organic amendment. Network analysis between the soil ionome and the soil enzyme activities was more complex in the organic-amended soils than in the chemical fertilized soils, whereas the network analysis among the soil ions was less complex with organic amendment. Moreover, α-glucosidase was revealed to generally harbor more corrections with the soil ionic availabilities in network. We concluded that some of the soil enzymes activated by organic input can make the soil more vigorous and stable and that the α-glucosidase revealed by this analysis might help stabilize the soil ion availability.

  3. Evaluating the long-term performance of low-cost adsorbents using small-scale adsorption column experiments.

    PubMed

    Callery, O; Healy, M G; Rognard, F; Barthelemy, L; Brennan, R B

    2016-09-15

    This study investigated a novel method of predicting the long-term phosphorus removal performance of large-scale adsorption filters, using data derived from short-term, small-scale column experiments. The filter media investigated were low-cost adsorbents such as aluminum sulfate drinking water treatment residual, ferric sulfate drinking water treatment residual, and fine and coarse crushed concretes. Small-bore adsorption columns were loaded with synthetic wastewater, and treated column effluent volume was plotted against the mass of phosphorus adsorbed per unit mass of filter media. It was observed that the curve described by the data strongly resembled that of a standard adsorption isotherm created from batch adsorption data. Consequently, it was hypothesized that an equation following the form of the Freundlich isotherm would describe the relationship between filter loading and media saturation. Moreover, the relationship between filter loading and effluent concentration could also be derived from this equation. The proposed model was demonstrated to accurately predict the performance of large-scale adsorption filters over a period of up to three months with a very high degree of accuracy. Furthermore, the coefficients necessary to produce said model could be determined from just 24 h of small-scale experimental data. Copyright © 2016. Published by Elsevier Ltd.

  4. Determination of longevities, chamber building rates and growth functions for Operculina complanata from long term cultivation experiments

    NASA Astrophysics Data System (ADS)

    Woeger, Julia; Kinoshita, Shunichi; Wolfgang, Eder; Briguglio, Antonino; Hohenegger, Johann

    2016-04-01

    Operculina complanata was collected in 20 and 50 m depth around the Island of Sesoko belonging to Japans southernmost prefecture Okinawa in a series of monthly sampling over a period of 16 months (Apr.2014-July2015). A minimum of 8 specimens (4 among the smallest and 4 among the largest) per sampling were cultured in a long term experiment that was set up to approximate conditions in the field as closely as possible. A set up allowing recognition of individual specimens enabled consistent documentation of chamber formation, which in combination with μ-CT-scanning after the investigation period permitted the assignment of growth steps to specific time periods. These data were used to fit various mathematical models to describe growth (exponential-, logistic-, generalized logistic-, Gompertz-function) and chamber building rate (Michaelis-Menten-, Bertalanffy- function) of Operculina complanata. The mathematically retrieved maximum lifespan and mean chamber building rate found in cultured Operculina complanata were further compared to first results obtained by the simultaneously conducted "natural laboratory approach". Even though these comparisons hint at a somewhat stunted growth and truncated life spans of Operculina complanata in culture, they represent a possibility to assess and improve the quality of further cultivation set ups, opening new prospects to a better understanding of the their theoretical niches.

  5. Soil ionomic and enzymatic responses and correlations to fertilizations amended with and without organic fertilizer in long-term experiments

    NASA Astrophysics Data System (ADS)

    Feng, Xumeng; Ling, Ning; Chen, Huan; Zhu, Chen; Duan, Yinghua; Peng, Chang; Yu, Guanghui; Ran, Wei; Shen, Qirong; Guo, Shiwei

    2016-04-01

    To investigate potential interactions between the soil ionome and enzyme activities affected by fertilization with or without organic fertilizer, soil samples were collected from four long-term experiments over China. Irrespective of variable interactions, fertilization type was the major factor impacting soil ionomic behavior and accounted for 15.14% of the overall impact. Sampling site was the major factor affecting soil enzymatic profile and accounted for 34.25% of the overall impact. The availabilities of Pb, La, Ni, Co, Fe and Al were significantly higher in soil with only chemical fertilizer than the soil with organic amendment. Most of the soil enzyme activities, including α-glucosidase activity, were significantly activated by organic amendment. Network analysis between the soil ionome and the soil enzyme activities was more complex in the organic-amended soils than in the chemical fertilized soils, whereas the network analysis among the soil ions was less complex with organic amendment. Moreover, α-glucosidase was revealed to generally harbor more corrections with the soil ionic availabilities in network. We concluded that some of the soil enzymes activated by organic input can make the soil more vigorous and stable and that the α-glucosidase revealed by this analysis might help stabilize the soil ion availability.

  6. Impact of weed control on arbuscular mycorrhizal fungi in a tropical agroecosystem: a long-term experiment.

    PubMed

    Ramos-Zapata, José A; Marrufo-Zapata, Denis; Guadarrama, Patricia; Carrillo-Sánchez, Lilia; Hernández-Cuevas, Laura; Caamal-Maldonado, Arturo

    2012-11-01

    Cover crop species represent an affordable and effective weed control method in agroecosystems; nonetheless, the effect of its use on arbuscular mycorrhizal fungi (AMF) has been scantily studied. The goal of this study was to determine root colonization levels and AMF species richness in the rhizosphere of maize plants and weed species growing under different cover crop and weed control regimes in a long-term experiment. The treatment levels used were (1) cover of Mucuna deeringian (Muc), (2) "mulch" of Leucaena leucocephala (Leu), (3) "mulch" of Lysiloma latisiliquum (Lys), (4) herbicide (Her), (5) manual weeding (CD), (6) no weeding (SD), and (7) no maize and no weeding (B). A total of 18 species of AMF belonging to eight genera (Acaulospora, Ambispora, Claroideoglomus, Funneliformis, Glomus, Rhizophagus, Sclerocystis, and Scutellospora) were identified from trap cultures. Muc and Lys treatments had a positive impact on AMF species richness (11 and seven species, respectively), while Leu and B treatments on the other hand gave the lowest richness values (six species each). AMF colonization levels in roots of maize and weeds differed significantly between treatment levels. Overall, the use of cover crop species had a positive impact on AMF species richness as well as on the percentage of root colonized by AMF. These findings have important implications for the management of traditional agroecosystems and show that the use of cover crop species for weed control can result in a more diverse AMF community which should potentially increase crop production in the long run.

  7. Studies of HT and HTO Behavior in the Vicinity of Long-Term Emission Source: Model - Experiment Intercomparison

    SciTech Connect

    Golubev, A. V.; Aleinikov, A. Y.; Golubeva, V. N.; Khabibulin, M. M.; Glagolev, M. V.; Misatyuk, S. E.; Mavrin, S. V.; Belot, Y. A.; Raskob, W.; Tate, P. J.

    2003-02-24

    There are presented in the research results of HT and HTO deposition and the model of HT (HTO) atmosphere concentration in the vicinity of a long-term HT and HTO emission source. Scavenging of HTO by precipitations was studied in 6 field experiments. The site of the scavenging experiments was around a 30 m emission source. The sampling arcs were chosen at 150-300 m from the base of the source to minimize dry deposition on the precipitation collectors. Data of the scavenging experiments are presented. Kinetics of HT deposition to soil through its oxidation has been studied in laboratory conditions. The activity of HTO converted in the soil sample during a certain period of time was used to determine the oxidation rate. This rate varies, depending on the catalytic and/or biological activity of the soil material. Theoretical considerations have shown that the deposition rate can be expressed by the effective rate of oxidation, which formally corresponds to the first-order HT oxidation. HT deposition rates are reported. The model, used for assessments, takes into account atmospheric dispersion, deposition and reemission. The model of HTO wet deposition is taken into account kinetics of HTO exchange between vapor and liquid phase with parameters such as rain drop spectra, rain intensity, condensation-evaporation on drop's interface. Gauss type formulae for continuous emission source is used to calculate HTO atmospheric concentration. Meteorological data are used as input parameters for modeling. The data presented on HT deposition to soil and HTO washout by precipitation is required for assessment of consequences of HT (HTO) release into the atmosphere.

  8. Transport of Cryptosporidium parvum in porous media: Long-term elution experiments and continuous time random walk filtration modeling

    NASA Astrophysics Data System (ADS)

    Cortis, Andrea; Harter, Thomas; Hou, Lingling; Atwill, E. Robert; Packman, Aaron I.; Green, Peter G.

    2006-12-01

    Complex transport behavior other than advection-dispersion, simple retardation, and first-order removal has been observed in many biocolloid transport experiments in porous media. Such nonideal transport behavior is particularly evident in the late time elution of biocolloids at low concentrations. Here we present a series of saturated column experiments that were designed to measure the breakthrough and long-term elution of Cryptosporidium parvum in medium sand for a few thousand pore volumes after the initial source of oocysts was removed. For a wide range of ionic strengths, I, we consistently observe slower-than-Fickian, power law tailing. The slope of the tail is flatter for higher I. At very high ionic strength the slope decays to a rate slower than t-1. To explain this behavior, we propose a new filtration model based on the continuous time random walk (CTRW) theory. Our theory upscales heterogeneities at both the pore-scale geometry of the flow field and the grain surface physicochemical properties that affect biocolloid attachment and detachment. Pore-scale heterogeneities in fluid flow are shown to control the breakthrough of a conservative tracer but are shown to have negligible effect on oocyst transport. In our experiments, C. parvum transport is dominated by the effects of physicochemical heterogeneities. The CTRW model provides a parsimonious theory of nonreactive and reactive transport. The CTRW filtration process is controlled by three parameters, Λ, β, and c, which are related to the overall breakthrough retardation (R = 1 + Λ), the slope of the power law tail (β), and the transition to a slower than t-1 decay (c).

  9. The Stealthy Superbug: the Role of Asymptomatic Enteric Carriage in Maintaining a Long-Term Hospital Outbreak of ST228 Methicillin-Resistant Staphylococcus aureus

    PubMed Central

    Senn, Laurence; Clerc, Olivier; Zanetti, Giorgio; Basset, Patrick; Prod’hom, Guy; Gordon, Nicola C.; Sheppard, Anna E.; Crook, Derrick W.; James, Richard; Thorpe, Harry A.; Feil, Edward J.

    2016-01-01

    ABSTRACT Whole-genome sequencing (WGS) of 228 isolates was used to elucidate the origin and dynamics of a long-term outbreak of methicillin-resistant Staphylococcus aureus (MRSA) sequence type 228 (ST228) SCCmec I that involved 1,600 patients in a tertiary care hospital between 2008 and 2012. Combining of the sequence data with detailed metadata on patient admission and movement confirmed that the outbreak was due to the transmission of a single clonal variant of ST228, rather than repeated introductions of this clone into the hospital. We note that this clone is significantly more frequently recovered from groin and rectal swabs than other clones (P < 0.0001) and is also significantly more transmissible between roommates (P < 0.01). Unrecognized MRSA carriers, together with movements of patients within the hospital, also seem to have played a major role. These atypical colonization and transmission dynamics can help explain how the outbreak was maintained over the long term. This “stealthy” asymptomatic colonization of the gut, combined with heightened transmissibility (potentially reflecting a role for environmental reservoirs), means the dynamics of this outbreak share some properties with enteric pathogens such as vancomycin-resistant enterococci or Clostridium difficile. PMID:26787833

  10. Long-term Engagement in Authentic Research with NASA (LEARN): Lessons Learned from an Innovative Model for Teacher Research Experiences

    NASA Astrophysics Data System (ADS)

    Pippin, M. R.; Kollmeyer, R.; Joseph, J.; Yang, M. M.; Omar, A. H.; Harte, T.; Taylor, J.; Lewis, P. M.; Weisman, A.; Hyater-Adams, S.

    2013-12-01

    The NASA LEARN Project is an innovative program that provides long-term immersion in the practice of atmospheric science for middle and high school in-service teachers. Working alongside NASA scientists and using authentic NASA Science Mission Directorate (SMD) Research and Analysis (R&A) related and mission-based research data, teachers develop individual research topics of interest during two weeks in the summer while on-site at NASA Langley. With continued, intensive mentoring and guidance of NASA scientists, the teachers further develop their research throughout the academic year through virtual group meetings and data team meetings mirroring scientific collaborations. At the end of the first year, the LEARN teachers present scientific posters. During summer 2013, Cohort 1 (7 teachers) presented posters at an open session and discussed their research topics with Cohort 2 (6 teachers) and science and educator personnel at Langley. The LEARN experience has had such an impact that 6 teachers from Cohort 1 have elected to continue a second year of research working alongside Cohort 2 and LEARN scientists. In addition, Cohort 1 teachers have brought their LEARN experiences back to their classrooms in a variety of ways. The LEARN project evaluation has provided insights into the outcomes of this research experience for teachers and particularly effective program elements. In particular, the LEARN evaluation has focused on how an extended research experience for teachers spanning a full year influences teacher views of science and classroom integration of scientific principles. Early findings indicate that teachers' perceptions of the scientific enterprise have changed, and that LEARN provided substantial resources to help them take real-world research to their students. Teachers also valued the teamwork and cohort approach. In addition, the LEARN evaluation focuses on the experiences of scientists involved in the LEARN program and how their experiences working with

  11. The Stratospheric Aerosol and Gas Experiment III - International Space Station: Extending Long-Term Ozone and Aerosol Observations (Invited)

    NASA Astrophysics Data System (ADS)

    Eckman, R.; Zawodny, J. M.; Cisewski, M.; Gasbarre, J.; Flittner, D. E.; Hill, C.; Roell, M.; Moore, J. R.; Hernandez, G.; McCormick, M. P.

    2013-12-01

    The Stratospheric Aerosol and Gas Experiment III - International Space Station (SAGE III on ISS) will extend the global measurements of vertical profiles of ozone, aerosols, water vapor, nitrogen dioxide, and other trace gases begun with SAGE I in 1979, enabling the detection of long-term trends. SAGE III on ISS is the fourth in a series of instruments developed for monitoring these constituents in the stratosphere and troposphere. The SAGE III instrument is a moderate resolution spectrometer covering wavelengths from 290 nm to 1550 nm, using the heritage occultation technique, utilizing both the sun and the moon. Launch to ISS is planned for early 2015 aboard a Falcon 9 spacecraft. SAGE III will investigate the spatial and temporal variability of the measured species in order to determine their role in climatological processes, biogeochemical cycles, the hydrologic cycle, and atmospheric chemistry. It will characterize tropospheric, as well as stratospheric aerosols and upper tropospheric and stratospheric clouds, and investigate their effects on the Earth's environment including radiative, microphysical, and chemical interactions. The multi-decadal SAGE ozone and aerosol data sets have undergone intense scrutiny and are the international standard for accuracy and stability. SAGE data have been used to monitor the effectiveness of the Montreal Protocol. Amongst its key objectives will be to assess the state of the recovery in the distribution of ozone, to reestablish the aerosol measurements needed by both climate and ozone models, and to gain further insight into key processes contributing to ozone and aerosol variability. The ISS is ideal for Earth observing experiments; its mid-inclination orbit allows for a large range in latitude sampling and nearly continuous communications with payloads. In this presentation, we describe the SAGE III on ISS mission, its implementation, current status, and concentrate on its key science objectives.

  12. Surgical Experience and Long-term Results of Baroreflex Activation Therapy for Heart Failure With Reduced Ejection Fraction.

    PubMed

    Weaver, Fred A; Abraham, William T; Little, William C; Butter, Christian; Ducharme, Anique; Halbach, Marcel; Klug, Didier; Lovett, Eric G; Madershahian, Navid; Müller-Ehmsen, Jochen; Schafer, Jill E; Senni, Michele; Swarup, Vijay; Wachter, Rolf; Zile, Michael R

    2016-01-01

    The purpose of this publication is to describe the intraoperative experience along with long-term safety and efficacy of the second-generation baroreflex activation therapy (BAT) system in patients with heart failure (HF) and reduced ejection fraction HF (HFrEF). In a randomized trial of New York Heart Association Class III HFrEF, 140 patients were assigned 1:1 to receive BAT plus medical therapy or medical therapy alone. Procedural information along with safety and efficacy data were collected and analyzed over 12 months. Within the cohort of 71 patients randomized to BAT, implant procedure time decreased with experience, from 106 ± 37 minutes on the first case to 83 ± 32 minutes on the third case. The rate of freedom from system- and procedure-related complications was 86% through 12 months, with the percentage of days alive without a complication related to system, procedure, or underlying cardiovascular condition identical to the control group. The complications that did occur were generally mild and short-lived. Overall, 12 months therapeutic benefit from BAT was consistent with previously reported efficacy through 6 months: there was a significant and sustained beneficial treatment effect on New York Heart Association functional Class, quality of life, 6-minute hall walk distance, plasma N-terminal pro-brain natriuretic peptide, and systolic blood pressure. This was true for the full trial cohort and a predefined subset not receiving cardiac resynchronization therapy. There is a rapid learning curve for the specialized procedures entailed in a BAT system implant. BAT system implantation is safe with the therapeutic benefits of BAT in patients with HFrEF being substantial and maintained for at least 1 year.

  13. Effects of landscape transformation on bird colonization and extinction patterns in a large-scale, long-term natural experiment.

    PubMed

    Mortelliti, Alessio; Lindenmayer, David B

    2015-10-01

    Conversion of agricultural land to forest plantations is a major driver of global change. Studies on the impact of forest plantations on biodiversity in plantations and in the surrounding native vegetation have been inconclusive. Consequently, it is not known how to best manage the extensive areas of the planet currently covered by plantations. We used a novel, long-term (16 years) and large-scale (30,000 ha) landscape transformation natural experiment (the Nanangroe experiment, Australia) to test the effects of land conversion on population dynamics of 64 bird species associated with woodland and forest. A unique aspect of our study is that we focused on the effects of plantations on birds in habitat patches within plantations. Our study design included 56 treatment sites (Eucalyptus patches where the surrounding matrix was converted from grazed land to pine plantations), 55 control sites (Eucalyptus patches surrounded by grazed land), and 20 matrix sites (sites within the pine plantations and grazed land). Bird populations were studied through point counts, and colonization and extinction patterns were inferred through multiple season occupancy models. Large-scale pine plantation establishment affected the colonization or extinction patterns of 89% of studied species and thus led to a comprehensive turnover in bird communities inhabiting Eucalyptus patches embedded within the maturing plantations. Smaller bodied species appeared to respond positively to plantations (i.e., colonization increased and extirpation of these species decreased in patches surrounded by plantations) because they were able to use the newly created surrounding matrix. We found that the effects of forest plantations affected the majority of the bird community, and we believe these effects could lead to the artificial selection of one group of species at the expense of another. © 2015 Society for Conservation Biology.

  14. Ca. Nitrososphaera and Bradyrhizobium are inversely correlated and related to agricultural practices in long-term field experiments.

    PubMed

    Zhalnina, Kateryna; de Quadros, Patricia D; Gano, Kelsey A; Davis-Richardson, Austin; Fagen, Jennie R; Brown, Christopher T; Giongo, Adriana; Drew, Jennifer C; Sayavedra-Soto, Luis A; Arp, Dan J; Camargo, Flavio A O; Daroub, Samira H; Clark, Ian M; McGrath, Steve P; Hirsch, Penny R; Triplett, Eric W

    2013-01-01

    Agricultural land management, such as fertilization, liming, and tillage affects soil properties, including pH, organic matter content, nitrification rates, and the microbial community. Three different study sites were used to identify microorganisms that correlate with agricultural land use and to determine which factors regulate the relative abundance of the microbial signatures of the agricultural land-use. The three sites included in this study are the Broadbalk Experiment at Rothamsted Research, UK, the Everglades Agricultural Area, Florida, USA, and the Kellogg Biological Station, Michigan, USA. The effects of agricultural management on the abundance and diversity of bacteria and archaea were determined using high throughput, barcoded 16S rRNA sequencing. In addition, the relative abundance of these organisms was correlated with soil features. Two groups of microorganisms involved in nitrogen cycle were highly correlated with land use at all three sites. The ammonia oxidizing-archaea, dominated by Ca. Nitrososphaera, were positively correlated with agriculture while a ubiquitous group of soil bacteria closely related to the diazotrophic symbiont, Bradyrhizobium, was negatively correlated with agricultural management. Analysis of successional plots showed that the abundance of ammonia oxidizing-archaea declined and the abundance of bradyrhizobia increased with time away from agriculture. This observation suggests that the effect of agriculture on the relative abundance of these genera is reversible. Soil pH and NH3 concentrations were positively correlated with archaeal abundance but negatively correlated with the abundance of Bradyrhizobium. The high correlations of Ca. Nitrososphaera and Bradyrhizobium abundances with agricultural management at three long-term experiments with different edaphoclimatic conditions allowed us to suggest these two genera as signature microorganisms for agricultural land use.

  15. Ca. Nitrososphaera and Bradyrhizobium are inversely correlated and related to agricultural practices in long-term field experiments

    PubMed Central

    Zhalnina, Kateryna; de Quadros, Patricia D.; Gano, Kelsey A.; Davis-Richardson, Austin; Fagen, Jennie R.; Brown, Christopher T.; Giongo, Adriana; Drew, Jennifer C.; Sayavedra-Soto, Luis A.; Arp, Dan J.; Camargo, Flavio A. O.; Daroub, Samira H.; Clark, Ian M.; McGrath, Steve P.; Hirsch, Penny R.; Triplett, Eric W.

    2013-01-01

    Agricultural land management, such as fertilization, liming, and tillage affects soil properties, including pH, organic matter content, nitrification rates, and the microbial community. Three different study sites were used to identify microorganisms that correlate with agricultural land use and to determine which factors regulate the relative abundance of the microbial signatures of the agricultural land-use. The three sites included in this study are the Broadbalk Experiment at Rothamsted Research, UK, the Everglades Agricultural Area, Florida, USA, and the Kellogg Biological Station, Michigan, USA. The effects of agricultural management on the abundance and diversity of bacteria and archaea were determined using high throughput, barcoded 16S rRNA sequencing. In addition, the relative abundance of these organisms was correlated with soil features. Two groups of microorganisms involved in nitrogen cycle were highly correlated with land use at all three sites. The ammonia oxidizing-archaea, dominated by Ca. Nitrososphaera, were positively correlated with agriculture while a ubiquitous group of soil bacteria closely related to the diazotrophic symbiont, Bradyrhizobium, was negatively correlated with agricultural management. Analysis of successional plots showed that the abundance of ammonia oxidizing-archaea declined and the abundance of bradyrhizobia increased with time away from agriculture. This observation suggests that the effect of agriculture on the relative abundance of these genera is reversible. Soil pH and NH3 concentrations were positively correlated with archaeal abundance but negatively correlated with the abundance of Bradyrhizobium. The high correlations of Ca. Nitrososphaera and Bradyrhizobium abundances with agricultural management at three long-term experiments with different edaphoclimatic conditions allowed us to suggest these two genera as signature microorganisms for agricultural land use. PMID:23641242

  16. Childhood leukaemia survivors' experiences of long-term follow-ups in an endocrine clinic - A focus-group study.

    PubMed

    Pålsson, Anna; Malmström, Marlene; Follin, Cecilia

    2017-02-01

    The survival rate after childhood cancer has improved markedly and today more than 80% of patients will survive. Many childhood cancer survivors suffer from late complications due to radiotherapy and chemotherapy. Survivors of Acute Lymphoblastic Leukaemia (ALL), treated with cranial radiotherapy, are at a particularly high risk of having endocrine complications. To illuminate childhood ALL survivors' experiences of a long-term follow-up in an endocrine clinic. Data collection carried out using semi-structured focus-group interviews. Fifteen ALL survivors were included in the study, divided into 4 groups. Data was analysed with conventional qualitative content analysis. The survivors' experiences were captured in the theme: "The need for understanding and support in order to manage daily life". An understanding of their situation, as well as support for managing daily life was fundamental. Lack of understanding and support from the community was connected with a fear for the future. The follow-up at the endocrine clinic was shown to be crucial for increasing the survivors' understanding of late complications. The past feeling of being out of control was replaced with an increased self-confidence. Many leukaemia survivors experienced their daily lives as a struggle and as a complicated issue to cope with. The theme "understanding and support to manage daily life" mirrors how the survivors are in need of knowledge and support in order to handle and understand their complex situation after surviving leukaemia. Offering understanding and support with a holistic approach, may be a way in which to strengthen the survivors' health. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. [An Experience of Providing Palliative Care in a Long-Term Care Facility: Let Good Death in Place Become a Feasible Reality].

    PubMed

    Chen, Ming-Mei; Chou, Chun-Chen; Hsu, Kuei-Ying; Yen, Yung-Feng; Yang, Ya-Ting; Huang, Hsiu-Li

    2017-04-01

    As the number of elderly in long-term care facilities (LTCFs) continues to increase, the number of resident deaths in these facilities is expected to increase. Thus, LTCFs may become a main focus for end-of-life (EoL) care in the future. Therefore, promoting quality EoL care in LTCFs should be a priority issue. Currently, the four types of hospice services include hospice wards and hospice-share-services in hospitals and home hospice care and community hospice care in patient homes. However, to date, there has been limited discussion regarding promoting palliative care in LTCFs. The present article describes the LTCF nursing process that was used in caring for an EoL resident. Several interventions were used to assist this EoL resident to experience a dignified and peaceful death. These interventions included promoting the advance directive on hospice palliative care, linking community hospice palliative teams, ceating a warm environment, integrating the multidisciplinary team to alleviate the resident's distress symptoms, supporting the resident's psycho-social-spiritual needs, and accompanying family members through the process of anticipatory grief. This experience illustrates the feasibility of maintaining EoL residents in familiar LTCF environs in order to help them experience a good death in place.

  18. 'It is a completely new world you step into.' How older clients and their representatives experience the operational access to Dutch long-term institutional care.

    PubMed

    Schipper, Lisette; Luijkx, Katrien G; Meijboom, Bert R; Schols, Jos M G A

    2015-12-01

    The access process is an important first step in the long-term institutional care for older people. Access can be seen as a concept consisting of three closely related dimensions: availability, affordability and acceptability (three A's). This study takes a new perspective by investigating how older clients experience the access process. Data were gathered through interviews with representatives of clients that were recently admitted in a long-term care facility, or if possible with clients themselves. A total of 33 respondents from 4 organizations that provide long-term institutional care were interviewed. The first contact with the long-term care provider was made in several different ways. Finding a location nearby family was a common aim, which in urgent situations was not always feasible. Most respondents were satisfied about the process and felt taken care of personally. Yet, many respondents mention the lack of practical information and 'guidance' in the complexity of elder care. For acceptability, having a dedicated liaison in the organization was relevant. The study revealed that the 3A model can be used to understand how older clients or their representatives experience the operational access process to long-term care. Especially the dimensions' availability and acceptability seemed to shape their experience. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Production dynamics of intensively managed loblolly pine stands in the southern United States: a synthesis of seven long-term experiments

    Treesearch

    Eric J. Jokela; Philip M. Dougherty; Timothy A. Martin

    2004-01-01

    Results from seven long-term experiments in the southern US were summarized to understand production dynamics of intensively managed loblolly pine plantations. Replicated studies that spanned a wide range of soil and climatic conditions were established (North Carolina-NC; Georgia-GA (three sites); Florida-F%; Louisiana-LA; Oklahoma--OK). A11 experiments received some...

  20. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study

    PubMed Central

    Holter, Jan C.; Ueland, Thor; Jenum, Pål A.; Müller, Fredrik; Brunborg, Cathrine; Frøland, Stig S.; Aukrust, Pål; Husebye, Einar; Heggelund, Lars

    2016-01-01

    Background Contributors to long-term mortality in patients with community-acquired pneumonia (CAP) remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics. Methods Two hundred and sixty-seven consecutive patients admitted in 2008–2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality. Results Of 259 hospital survivors of CAP (median age 66 years), 79 (30.5%) died over a median of 1,804 days (range 1–2,520 days). Cumulative 5-year survival rate was 72.9% (95% CI 67.4–78.4%). Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD), vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI): age (1.83 per decade, 1.47–2.28), cardiovascular disease (2.63, 1.61–4.32), COPD (2.09, 1.27–3.45), immunocompromization (1.98, 1.17–3.37), and low serum albumin level at admission (0.75 per 5g/L higher, 0.58–0.96), whereas active smoking was protective (0.32, 0.14–0.74); active smokers were younger than non-smokers (P < 0.001). Microbial etiology did not predict mortality. Conclusions Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend

  1. The effectiveness of the JOBS program among the long-term unemployed: a randomized experiment in the Netherlands.

    PubMed

    Brenninkmeijer, Veerle; Blonk, Roland W B

    2012-06-01

    Given the adverse effects of long-term unemployment, it is of major concern that evidence-based interventions are available for the long-term unemployed. Therefore, we examined the effectiveness of the JOBS program, a group training for the unemployed [Caplan, R. D., Vinokur, A. D., Price, R. H. and Van Ryn, M. (1989). Journal of Applied Psychology, 74, 759-769], among long-term unemployed individuals. In a randomly controlled trial, JOBS was compared with a control condition and a voucher intervention, in which individuals were given the opportunity to spend a certain budget on services that could help them reintegrate. After 6 months JOBS participants had more often found a job and were more satisfied with the intervention. After 12 months effects were still visible, but less pronounced.

  2. Long Term Thawing Experiment