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  1. MediMax Elektronik-Marktkette

    NASA Astrophysics Data System (ADS)

    Die Elektronikkette MediMax setzt auf Server Based Computing mit Windows Server 2003® und Thin Clients. Mit über 100 Filialen ist MediMax die erfolgreiche Fachmarktlinie der ElectronicPartner-Verbundgruppe in Deutschland. Die Zugehörigkeit zum Mutterverbund garantiert den Franchisenehmern der Elektronikkette eine schnelle Warenversorgung und günstige Einkaufskonditionen. Über 50.000 Artikel zahlreicher namhafter Markenhersteller und unterschiedlicher Preisklassen sind ständig abrufbar. Darüber hinaus profitieren die Filialen von einer zentralen Organisation und Betreuung ihrer IT. Von Düsseldorf aus administriert ein internes Supportteam die Arbeitsplätze aller Standorte und stellt außerdem die Warenwirtschaftslösung zur Verfügung. Dank der Umstellung auf eine moderne Server Based Computing-Umgebung sind Wartung und Support künftig so effizient wie nie zuvor.

  2. Targeting CD73 in the tumor microenvironment with MEDI9447

    PubMed Central

    Hay, Carl M.; Sult, Erin; Huang, Qihui; Mulgrew, Kathy; Fuhrmann, Stacy R.; McGlinchey, Kelly A.; Hammond, Scott A.; Rothstein, Raymond; Rios-Doria, Jonathan; Poon, Edmund; Holoweckyj, Nick; Durham, Nicholas M.; Leow, Ching Ching; Diedrich, Gundo; Damschroder, Melissa; Herbst, Ronald; Hollingsworth, Robert E.; Sachsenmeier, Kris F.

    2016-01-01

    ABSTRACT MEDI9447 is a human monoclonal antibody that is specific for the ectoenzyme CD73 and currently undergoing Phase I clinical trials. Here we show that MEDI9447 is a potent inhibitor of CD73 ectonucleotidase activity, with wide ranging immune regulatory consequences. MEDI9447 results in relief from adenosine monophosphate (AMP)-mediated lymphocyte suppression in vitro and inhibition of mouse syngeneic tumor growth in vivo. In contrast with other cancer immunotherapy agents such as checkpoint inhibitors or T-cell agonists, MEDI9447 drives changes in both myeloid and lymphoid infiltrating leukocyte populations within the tumor microenvironment of mouse models. Changes include significant alterations in a number of tumor micro-environmental subpopulations including increases in CD8+ effector cells and activated macrophages. Furthermore, these changes correlate directly with responder and non-responder subpopulations within animal studies using syngeneic tumors. Combination data showing additive activity between MEDI9447 and anti-PD-1 antibodies using human cells in vitro and mouse tumor models further demonstrate the potential value of relieving adenosine-mediated immunosuppression. Based on these data, a Phase I study to test the safety, tolerability, and clinical activity of MEDI9447 in cancer patients was initiated (NCT02503774). PMID:27622077

  3. MediDial cards: a quick win for service improvement.

    PubMed

    Davies, Mike; Panchal, Sonia

    2014-01-01

    One of the key roles of a junior doctor is co-ordinating the care of their patients and communicating with different departments or specialties within the hospital. To do this, junior doctors often spend a lot of time on a daily basis contacting the hospital switchboard in order to locate a required bleep/extension/fax number, or trying to navigate an intranet based directory which can be difficult to use. We aimed to improve this task for junior doctors as a pilot project for engaging junior doctors in service improvement. Our multi-disciplinary team, led by junior doctors and with the support of the Trust, produced and implemented lanyard (MediDial) cards containing common and relevant (fax, bleep, and extension) numbers for use by junior doctors. Through the introduction of our MediDial cards we not only reduced the frequency junior doctors needed to contact the switchboard on a daily basis, but also the length of time spent waiting to speak to an operator. The MediDial cards were also found to be time saving and more useful than the previous intranet based database. Since the introduction of the MediDial cards, the project has been rolled out across the Trust and presented at Grand Rounds as an example of junior doctor led service improvement, aiming to encourage trainees to engage with quality improvement projects.

  4. Runaway Costs in Medi-Cal—A Myth

    PubMed Central

    Heckman, John R.; Jones, Michael W.

    1980-01-01

    An analysis of increases in Medi-Cal expenditures to their present level, more than $4 billion a year, shows them to be attributable largely to changes in eligibility and scope of benefits. The actual costs of providing care have risen at a relatively modest rate. If in fact costs are to be lowered from present levels, public policy makers must make important decisions concerning program changes which transcend merely altering payment and delivery methods. PMID:6996335

  5. The Return of Two-Class Medicine—III Effects of Medi-Cal Reform

    PubMed Central

    Waitzkin, Howard

    1985-01-01

    California's drastic Medi-Cal reforms have created great difficulties in health care for the poor. Patients' clinical problems seldom are apparent in descriptions of changes in public insurance programs. Rapidly escalating costs of Medi-Cal led to irresistible pressures for reform, especially from the business community. The new Medi-Cal regulations provide for prospective contracts with hospitals for inpatient services, the transfer of “Medically Indigent Adults” to the responsibility of county governments and various other straightforward funding cutbacks. Confusion, disruption of services and adverse health outcomes have accompanied the Medi-Cal reforms. PMID:3892917

  6. MediGuide-impact on catheter ablation techniques and workflow.

    PubMed

    Pillarisetti, Jayasree; Kanmanthareddy, Arun; Reddy, Yeruva Madhu; Lakkireddy, Dhanunjaya

    2014-09-01

    Since the introduction of percutaneous intervention in modern medical science, specifically cardiovascular medicine fluoroscopy has remained the gold standard for navigation inside the cardiac structures. As the complexity of the procedures continue to increase with advances in interventional electrophysiology, the procedural times and fluoroscopy times have proportionately increased and the risks of radiation exposure both to the patients as well as the operator continue to rise. 3D electroanatomic mapping systems have to some extent complemented fluoroscopic imaging in improving catheter navigation and forming a solid platform for exploring the electroanatomic details of the target substrate. The 3D mapping systems are still limited as they continue to be static representations of a dynamic heart without being completely integrated with fluoroscopy. The field needed a technological solution that could add a dynamic positioning system that can be successfully incorporated into fluoroscopic imaging as well as electroanatomic imaging modalities. MediGuide is one such innovative technology that exploits the geo-positioning system principles. It employs a transmitter mounted on the X-ray panel that emits an electromagnetic field within which sensor-equipped diagnostic and ablation catheters are tracked within prerecorded fluoroscopic images. MediGuide is also integrated with NavX mapping system and helps in developing better 3D images by field scaling-a process that reduces field distortions that occur from impedance mapping alone. In this review, we discuss about the principle of MediGuide technology, the catheter ablation techniques, and the workflow in the EP lab for different procedures.

  7. [Non-fluoroscopic catheter tracking: the MediGuide™ system].

    PubMed

    Sommer, Philipp; Rolf, S; Richter, S; Hindricks, G; Piorkowski, C

    2012-12-01

    Conventional fluoroscopy is the main technology for intracardiac device tracking in interventional cardiovascular procedures. For therapy delivery it carries the advantage of being able to instantaneously localize the device and its spatial relationship with respect to the moving target organ. However, besides the associated X-ray exposure, fluoroscopy only provides 2D orientation. For treatment of complex cardiac anatomies and substrates such as in interventional electrophysiology, 3-D mapping technologies have been introduced to facilitate spatial, anatomic, and electrical orientation. A new technological platform (MediGuide(™)) offers the option to continuously display the catheter tip on a prerecorded cine-loop allowing better anatomic understanding of the underlying substrate. We describe our initial experience using the system with diagnostic catheters only and the first procedures with the MediGuide(™) equipped ablation catheter (available since May 2012). We could show a significant decrease of fluoroscopy time in all types of procedures with comparable procedure times. No increase in complication rates was observed.

  8. Accuracy of the morphology enabled dipole inversion (MEDI) algorithm for quantitative susceptibility mapping in MRI.

    PubMed

    Liu, Tian; Xu, Weiyu; Spincemaille, Pascal; Avestimehr, A Salman; Wang, Yi

    2012-03-01

    Determining the susceptibility distribution from the magnetic field measured in a magnetic resonance (MR) scanner is an ill-posed inverse problem, because of the presence of zeroes in the convolution kernel in the forward problem. An algorithm called morphology enabled dipole inversion (MEDI), which incorporates spatial prior information, has been proposed to generate a quantitative susceptibility map (QSM). The accuracy of QSM can be validated experimentally. However, there is not yet a rigorous mathematical demonstration of accuracy for a general regularized approach or for MEDI specifically. The error in the susceptibility map reconstructed by MEDI is expressed in terms of the acquisition noise and the error in the spatial prior information. A detailed analysis demonstrates that the error in the susceptibility map reconstructed by MEDI is bounded by a linear function of these two error sources. Numerical analysis confirms that the error of the susceptibility map reconstructed by MEDI is on the same order of the noise in the original MRI data, and comprehensive edge detection will lead to reduced model error in MEDI. Additional phantom validation and human brain imaging demonstrated the practicality of the MEDI method.

  9. Accuracy of the Morphology Enabled Dipole Inversion (MEDI) Algorithm for Quantitative Susceptibility Mapping in MRI

    PubMed Central

    Liu, Tian; Xu, Weiyu; Spincemaille, Pascal; Avestimehr, A. Salman

    2013-01-01

    Determining the susceptibility distribution from the magnetic field measured in a magnetic resonance (MR) scanner is an ill-posed inverse problem, because of the presence of zeroes in the convolution kernel in the forward problem. An algorithm called morphology enabled dipole inversion (MEDI), which incorporates spatial prior information, has been proposed to generate a quantitative susceptibility map (QSM). The accuracy of QSM can be validated experimentally. However, there is not yet a rigorous mathematical demonstration of accuracy for a general regularized approach or for MEDI specifically. The error in the susceptibility map reconstructed by MEDI is expressed in terms of the acquisition noise and the error in the spatial prior information. A detailed analysis demonstrates that the error in the susceptibility map reconstructed by MEDI is bounded by a linear function of these two error sources. Numerical analysis confirms that the error of the susceptibility map reconstructed by MEDI is on the same order of the noise in the original MRI data, and comprehensive edge detection will lead to reduced model error in MEDI. Additional phantom validation and human brain imaging demonstrated the practicality of the MEDI method. PMID:22231170

  10. Novel neutralizing hedgehog antibody MEDI-5304 exhibits antitumor activity by inhibiting paracrine hedgehog signaling.

    PubMed

    Michaud, Neil R; Wang, Youzhen; McEachern, Kristen A; Jordan, Jerold J; Mazzola, Anne Marie; Hernandez, Axel; Jalla, Sanjoo; Chesebrough, Jon W; Hynes, Mark J; Belmonte, Matthew A; Wang, Lidong; Kang, Jaspal S; Jovanovic, Jelena; Laing, Naomi; Jenkins, David W; Hurt, Elaine; Liang, Meina; Frantz, Christopher; Hollingsworth, Robert E; Simeone, Diane M; Blakey, David C; Bedian, Vahe

    2014-02-01

    The hedgehog pathway has been implicated in the tumorigenesis, tumor progression, and metastasis of numerous human cancers. We generated the first fully human hedgehog antibody MEDI-5304 and characterized its antitumor activity and preclinical toxicology. MEDI-5304 bound sonic hedgehog (SHH) and Indian hedgehog (IHH) with low picomolar affinity and neutralized SHH and IHH activity in cellular mGLI1 reporter assays. The antibody inhibited transcription of hedgehog target genes and osteoblast differentiation of C3H10T1/2 cells. We evaluated the activity of MEDI-5304 in vivo in model systems that allowed us to evaluate two primary hypotheses of hedgehog function in human cancer, paracrine signaling between tumor and stromal cells and cancer stem cell (CSC) self-renewal. MEDI-5304 displayed robust pharmacodynamic effects in stromal cells that translated to antitumor efficacy as a single agent in an HT-29/MEF coimplantation model of paracrine hedgehog signaling. MEDI-5304 also improved responses to carboplatin in the HT-29/MEF model. The antibody, however, had no effect as a single agent or in combination with gemcitabine on the CSC frequency or growth of several primary pancreatic cancer explant models. These findings support the conclusion that hedgehog contributes to tumor biology via paracrine tumor-stromal signaling but not via CSC maintenance or propagation. Finally, the only safety study finding associated with MEDI-5304 was ondontodysplasia in rats. Thus, MEDI-5304 represents a potent dual hedgehog inhibitor suitable for continued development to evaluate efficacy and safety in human patients with tumors harboring elevated levels of SHH or IHH.

  11. The medi-drama as an instrument to teach doctor-patient relationships.

    PubMed

    Yaffe, M J

    1989-01-01

    This paper reviews an experience of the Curriculum Development Group of the College of Family Physicians of Canada in describing the doctor-patient relationship and its value in the clinical process. It proposes the use of a medi-drama or multi-scene script encompassing a broad range of bio-psycho-social-ethical issues as a practical tool to teach the doctor-patient relationship. Principles for conducting a medi-drama are presented, as are the advantages of this experiential teaching modality. An example of a specific script developed along the theme of Adult Children of Ageing Parents is described, and an evaluation of its usefulness in teaching the doctor-patient relationship is presented from feedback from seven different family medicine residency or faculty development groups. Finally, examples of the breadth of topics that can be generated from a single medi-drama are presented.

  12. MediAgent: a WWW-based scalable and self-learning medical search engine.

    PubMed Central

    Tay, J.; Ke, S.; Lun, K. C.

    1998-01-01

    Searching for medical information on the Internet can be tedious and frustrating due to the number of irrelevant entries returned from generic search engines. We have developed MediAgent, a scalable search engine that aims to deliver a web-based medical search solution which is focused, exhaustive and able to keep improving its databases. The software package can run off a single low-end system and be scaled into a client-server, distributed computing architecture for high-end needs. This scalable architecture boosts MediAgent's handling capacity to tens of millions of web pages. In addition to large volume handling, MediAgent is designed to be manageable. All subsystems are not only highly configurable, but also support remote, interactive management and monitoring by the system administrator. PMID:9929289

  13. MediBook: Combining Semantic Networks with Metadata for Learning Resources To Build a Web Based Learning System.

    ERIC Educational Resources Information Center

    Steinacker, Achim; Faatz, Andreas; Seeberg, Cornelia; Rimac, Ivica; Hormann, Stefan; El Saddik, Abdulmotaleb; Steinmetz, Ralf

    This paper gives an overview of MediBook, a joint project of the Medical Department of the University GieBen (Germany) and the Department of Electrical Engineering and Information Technology at Darmstadt University of Technology (Germany) funded by the Hessian Ministry for Science and Arts (HMWK). The basis of MediBook is a formal representation…

  14. Medi-Cal Hospital Contracting—Did It Achieve Its Legislative Objectives?

    PubMed Central

    Brown, E. Richard; Price, Walter T.; Cousineau, Michael R.

    1985-01-01

    The 1982 Medi-Cal reforms and reductions established selective contracting with hospitals for inpatient care of Medi-Cal beneficiaries. The legislation established a special negotiator and criteria to be used in selecting contract hospitals. We report the findings of a study that analyzed the characteristics of contract and noncontract hospitals in Los Angeles County to assess how well these criteria were reflected in the outcome of the contracting process. We examine issues of beneficiary access to general inpatient care and to specialized services, the efficiency of contract hospitals compared with noncontract ones and quality-related issues. PMID:3898595

  15. MediCaring: development and test marketing of a supportive care benefit for older people.

    PubMed

    Lynn, J; O'Connor, M A; Dulac, J D; Roach, M J; Ross, C S; Wasson, J H

    1999-09-01

    To develop an alternative healthcare benefit (called MediCaring) and to assess the preferences of older Medicare beneficiaries concerning this benefit, which emphasizes more home-based and supportive health care and discourages use of hospitalization and aggressive treatment. To evaluate the beneficiaries' ability to understand and make a choice regarding health insurance benefits; to measure their likelihood to change from traditional Medicare to the new MediCaring benefit; and to determine the short-term stability of that choice. Focus groups of persons aged 65+ and family members shaped the potential MediCaring benefit. A panel of 50 national experts critiqued three iterations of the benefit. The final version was test marketed by discussing it with 382 older people (men > or = 75 years and women > or = 80 years) in their homes. Telephone surveys a few days later, and again 1 month after the home interview, assessed the potential beneficiaries' understanding and preferences concerning MediCaring and the stability of their responses. Focus groups were held in community settings in New Hampshire, Washington, DC, Cleveland, OH, and Columbia, SC. Test marketing occurred in New Hampshire, Cleveland, OH; Columbia, SC, and Los Angeles, CA. Focus group participants were persons more than 65 years old (11 focus groups), healthcare providers (9 focus groups), and family decision-makers (3 focus groups). Participants in the in-home informing (test marketing group) were persons older than 75 years who were identified through contact with a variety of services. Demographics, health characteristics, understanding, and preferences. Focus group beneficiaries between the ages of 65 and 74 generally wanted access to all possible medical treatment and saw MediCaring as a need of persons older than themselves. Those older than age 80 were mostly in favor of it. Test marketing participants understood the key points of the new benefit: 74% generally liked it, and 34% said they would

  16. Hospital Selective Contracting without Consumer Choice: What Can We Learn from Medi-Cal?

    ERIC Educational Resources Information Center

    Bamezai, Anil; Melnick, Glenn A.; Mann, Joyce M.; Zwanziger, Jack

    2003-01-01

    In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population…

  17. Hospital Selective Contracting without Consumer Choice: What Can We Learn from Medi-Cal?

    ERIC Educational Resources Information Center

    Bamezai, Anil; Melnick, Glenn A.; Mann, Joyce M.; Zwanziger, Jack

    2003-01-01

    In the selective contracting era, consumer choice has generally been absent in most state Medicaid programs, including California's (called Medi-Cal). In a setting where beneficiary exit is not a threat, a large payer may have both the incentives and the ability to exercise undue market power, potentially exposing an already vulnerable population…

  18. MediSyn: uncertainty-aware visualization of multiple biomedical datasets to support drug treatment selection.

    PubMed

    He, Chen; Micallef, Luana; Tanoli, Zia-Ur-Rehman; Kaski, Samuel; Aittokallio, Tero; Jacucci, Giulio

    2017-09-13

    Dispersed biomedical databases limit user exploration to generate structured knowledge. Linked Data unifies data structures and makes the dispersed data easy to search across resources, but it lacks supporting human cognition to achieve insights. In addition, potential errors in the data are difficult to detect in their free formats. Devising a visualization that synthesizes multiple sources in such a way that links between data sources are transparent, and uncertainties, such as data conflicts, are salient is challenging. To investigate the requirements and challenges of uncertainty-aware visualizations of linked data, we developed MediSyn, a system that synthesizes medical datasets to support drug treatment selection. It uses a matrix-based layout to visually link drugs, targets (e.g., mutations), and tumor types. Data uncertainties are salient in MediSyn; for example, (i) missing data are exposed in the matrix view of drug-target relations; (ii) inconsistencies between datasets are shown via overlaid layers; and (iii) data credibility is conveyed through links to data provenance. Through the synthesis of two manually curated datasets, cancer treatment biomarkers and drug-target bioactivities, a use case shows how MediSyn effectively supports the discovery of drug-repurposing opportunities. A study with six domain experts indicated that MediSyn benefited the drug selection and data inconsistency discovery. Though linked publication sources supported user exploration for further information, the causes of inconsistencies were not easy to find. Additionally, MediSyn could embrace more patient data to increase its informativeness. We derive design implications from the findings.

  19. MediGuide in supraventricular tachycardia: initial experience from a multicentre registry.

    PubMed

    Sommer, Philipp; Piorkowski, Christopher; Gaspar, Thomas; Eitel, Charlotte; Derndorfer, Michael; Martinek, Martin; Pürerfellner, Helmut; Arya, Arash; Hindricks, Gerhard; Rolf, Sascha

    2013-09-01

    Currently, fluoroscopy-based catheter visualization is the standard modality in invasive electrophysiological procedures. Recently a new technology for non-fluoroscopic visualization of diagnostic (since 2010) and ablation catheters (since May 2012) has been introduced. The MediGuide™-Technology (MediGuide) projects catheter tips on prerecorded cine loops in a high time resolution. We report on MediGuide-based supraventricular tachycardia (SVT) cases [atrioventricular nodal reentry tachycardia (AVNRT), atrioventricular reentry tachycardia (AVRT), Wolff-Parkinson-White syndrome (WPW), ectopic atrial tachycardia (EAT) and typical atrial flutter) from two European centres. In all patients, diagnostic and/or ablation catheters with a special sensor were used to perform the ablation procedures. All procedural data such as acute success, duration of the procedure, fluoroscopy time, and dose and patients' characteristics were analyzed and compared with conventionally ablated patients (n = 1865). Procedure-related complications during the hospital stay were recorded. A total of 24 consecutive patients were analyzed: no significant difference to the control group was seen in the baseline characteristics. The MediGuide patients were predominantly male (66%), aged 58 ± 14 years and were ablated for 6 AVNRT (25%), 4 AVRT/WPW (17%), 1 EAT (4%), and 13 typical atrial flutter (54%). The acute success rate was 100% (98% in the control group, n.s.). The median fluoroscopy time was 0.5 ± 1.4 min (10.2 ± 9.6 in the control group, P < 0.001), the median fluoroscopy dose was 187 ± 554 cGy cm(2) (996 ± 2593 cGy cm(2), P < 0.05). Mean procedure time was 70 ± 25 min (60 ± 36 min, n.s.). No complications during the hospital stay were recorded. In several different forms of supraventricular tachycardias the MediGuide-Technology contributed to a dramatic reduction in irradiation exposure. With a median fluoroscopy time of 30 s all SVT cases were effectively performed with no

  20. Dai Nippon Printing Co., Ltd Medi·Ca CC for Enumeration of Coliform Bacteria.

    PubMed

    Saito, Fumihiko; Shimizu, Mai; Suzuki, Takeo; Hamada, Chie; Iwase, Tatsuhiko; Okochi, Norihiko; Yamazaki, Mamoru; Kyotani, Hitoshi

    2015-01-01

    A ready-made dry medium method for coliform count, the Medi·Ca CC method, was compared to the Violet Red Bile Agar method (Bacteriological Analytical Manual, Chapter 4, Enumeration of Escherichia coli and the Coliform Bacteria, Section G) for nine raw foods from four food categories: raw ground pork, raw lamb, raw ground chicken, raw tuna fillet, raw salmon fillet, raw shrimp, fresh peeled banana, fresh cut pineapple, and fresh cut apple. The 95% confidence interval for the mean difference between the two methods at each contamination level for seven matrixes from all four categories fell within the range of -0.50 to 0.50, and no statistical difference was observed at all three contamination levels for four matrixes from three categories. These results demonstrated that the Medi·Ca CC method is a reasonable alternative to the reference method for raw meat, raw poultry, raw fish, and fresh fruits.

  1. Health Promotion Interventions for Low-Income Californians Through Medi-Cal Managed Care Plans, 2012

    PubMed Central

    Kohatsu, Neal D.; Paciotti, Brian M.; Byrne, Jennifer V.; Kizer, Kenneth W.

    2015-01-01

    Introduction Prevention is the most cost-effective approach to promote population health, yet little is known about the delivery of health promotion interventions in the nation’s largest Medicaid program, Medi-Cal. The purpose of this study was to inventory health promotion interventions delivered through Medi-Cal Managed Care Plans; identify attributes of the interventions that plans judged to have the greatest impact on their members; and determine the extent to which the plans refer members to community assistance programs and sponsor health-promoting community activities. Methods The lead health educator from each managed care plan was asked to complete a 190-item online survey in January 2013; 20 of 21 managed care plans responded. Survey data on the health promotion interventions with the greatest impact were grouped according to intervention attributes and measures of effectiveness; quantitative data were analyzed using descriptive statistics. Results Health promotion interventions judged to have the greatest impact on Medi-Cal members were delivered in various ways; educational materials, one-on-one education, and group classes were delivered most frequently. Behavior change, knowledge gain, and improved disease management were cited most often as measures of effectiveness. Across all interventions, median educational hours were limited (2.4 h), and median Medi-Cal member participation was low (265 members per intervention). Most interventions with greatest impact (120 of 137 [88%]) focused on tertiary prevention. There were mixed results in referring members to community assistance programs and investing in community activities. Conclusion Managed care plans have many opportunities to more effectively deliver health promotion interventions. Establishing measurable, evidence-based, consensus standards for such programs could facilitate improved delivery of these services. PMID:26564012

  2. Morphology enabled dipole inversion (MEDI) from a single-angle acquisition: comparison with COSMOS in human brain imaging.

    PubMed

    Liu, Tian; Liu, Jing; de Rochefort, Ludovic; Spincemaille, Pascal; Khalidov, Ildar; Ledoux, James Robert; Wang, Yi

    2011-09-01

    Magnetic susceptibility varies among brain structures and provides insights into the chemical and molecular composition of brain tissues. However, the determination of an arbitrary susceptibility distribution from the measured MR signal phase is a challenging, ill-conditioned inverse problem. Although a previous method named calculation of susceptibility through multiple orientation sampling (COSMOS) has solved this inverse problem both theoretically and experimentally using multiple angle acquisitions, it is often impractical to carry out on human subjects. Recently, the feasibility of calculating the brain susceptibility distribution from a single-angle acquisition was demonstrated using morphology enabled dipole inversion (MEDI). In this study, we further improved the original MEDI method by sparsifying the edges in the quantitative susceptibility map that do not have a corresponding edge in the magnitude image. Quantitative susceptibility maps generated by the improved MEDI were compared qualitatively and quantitatively with those generated by calculation of susceptibility through multiple orientation sampling. The results show a high degree of agreement between MEDI and calculation of susceptibility through multiple orientation sampling, and the practicality of MEDI allows many potential clinical applications.

  3. European Commission-supported development of targeted nanomedicines: did MediTrans make a difference?

    PubMed

    Storm, G; Aime, S

    2011-07-01

    Nanotechnology-inspired approaches to particle design and formulation, an improved understanding of (patho) physiological processes and biological barriers to drug targeting, as well as the limited input of new chemical entities in the 'pipeline' of pharmaceutical companies, suggest a bright future for targeted nanomedicines as pharmaceuticals. There is an increased consensus to the view that a major limitation hampering the entry of targeted delivery systems into the clinic is that new concepts and innovative research ideas within academia are not being developed and exploited in close collaboration with the pharmaceutical industry. Thus, an integrated 'bench-to-clinic' approach realized within a structural collaboration between industry and academia, will facilitate and promote the progression of targeted nanomedicines towards clinical application. The MediTrans project performed under the EU Framework Program 6, was designed to contribute to this ambition. The objectives of this collaborative initiative were: to apply nanotechnology for development of innovative targeted drug-delivery systems; to optimize targeted nanomedicines by using imaging guidance; to promote structural collaboration between industry and academia; and to forward targeted nanomedicines towards the clinic and the market. In this article, we will briefly address the research content, outcome and impact of the MediTrans project.

  4. Effects of ICOS+ T cell depletion via afucosylated monoclonal antibody MEDI-570 on pregnant cynomolgus monkeys and the developing offspring.

    PubMed

    Nicholson, Simone M; Carlesso, Gianluca; Cheng, Lily I; Cook, Halie; DaCosta, Karma; Leininger, Joel; McKeever, Kathleen; Scott, Stephen Weasel; Taylor, Devon; Streicher, Katie; Eck, Steve; Reed, Molly; Faggioni, Raffaella; Herbst, Ronald; Dixit, Rakesh; Ryan, Patricia C

    2017-09-13

    MEDI-570 is a fully human afucosylated monoclonal antibody (MAb) against Inducible T-cell costimulator (ICOS), highly expressed on CD4+ T follicular helper (TFH) cells. Effects of MEDI-570 were evaluated in an enhanced pre-postnatal development toxicity (ePPND) study in cynomolgus monkeys. Administration to pregnant monkeys did not cause any abortifacient effects. Changes in hematology and peripheral blood T lymphocyte subsets in maternal animals and infants and the attenuated infant IgG immune response to keyhole limpet hemocyanin (KLH) were attributed to MEDI-570 pharmacology. Adverse findings included aggressive fibromatosis in one dam and two infant losses in the high dose group with anatomic pathology findings suggestive of atypical lymphoid hyperplasia. The margin of safety relative to the no observed adverse effect level (NOAEL) for the highest planned clinical dose in the Phase 1a study was 7. This study suggests that women of child bearing potential employ effective methods of contraception while being treated with MEDI-570. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. MEDI1873, a potent, stabilized hexameric agonist of human GITR with regulatory T-cell targeting potential

    PubMed Central

    Tigue, Natalie J.; Bamber, Lisa; Andrews, John; Ireland, Samantha; Hair, James; Carter, Edward; Sridharan, Sudharsan; Jovanović, Jelena; Rees, D. Gareth; Springall, Jeremy S.; Li, Yi-Ming; Chodorge, Matthieu; Perez-Martinez, David; Higazi, Daniel R.; Oberst, Michael; Kennedy, Maureen; Black, Chelsea M.; Yan, Li; Schwickart, Martin; Maguire, Shaun; Young, Lesley L.; Vaughan, Tristan; Wilkinson, Robert W.; Stewart, Ross

    2017-01-01

    ABSTRACT Glucocorticoid-induced tumor necrosis factor receptor-related protein (GITR) is part of a system of signals involved in controlling T-cell activation. Targeting and agonizing GITR in mice promotes antitumor immunity by enhancing the function of effector T cells and inhibiting regulatory T cells. Here, we describe MEDI1873, a novel hexameric human GITR agonist comprising an IgG1 Fc domain, a coronin 1A trimerization domain and the human GITRL extracellular domain (ECD). MEDI1873 was optimized through systematic testing of different trimerization domains, aglycosylation of the GITRL ECD and comparison of different Fc isotypes. MEDI1873 exhibits oligomeric heterogeneity and superiority to an anti-GITR antibody with respect to evoking robust GITR agonism, T-cell activation and clustering of Fc gamma receptors. Further, it recapitulates, in vitro, several aspects of GITR targeting described in mice, including modulation of regulatory T-cell suppression and the ability to increase the CD8+:CD4+ T-cell ratio via antibody-dependent T-cell cytotoxicity. To support translation into a therapeutic setting, we demonstrate that MEDI1873 is a potent T-cell agonist in vivo in non-human primates, inducing marked enhancement of humoral and T-cell proliferative responses against protein antigen, and demonstrate the presence of GITR- and FoxP3-expressing infiltrating lymphocytes in a range of human tumors. Overall our data provide compelling evidence that MEDI1873 is a novel, potent GITR agonist with the ability to modulate T-cell responses, and suggest that previously described GITR biology in mice may translate to the human setting, reinforcing the potential of targeting the GITR pathway as a therapeutic approach to cancer. PMID:28405505

  6. Phase 1, open-label study of MEDI-547 in patients with relapsed or refractory solid tumors.

    PubMed

    Annunziata, Christina M; Kohn, Elise C; LoRusso, Patricia; Houston, Nicole D; Coleman, Robert L; Buzoianu, Manuela; Robbie, Gabriel; Lechleider, Robert

    2013-02-01

    Targeting the cell-surface receptor EphA2, which is highly expressed in some solid tumors, is a novel approach for cancer therapy. We aimed to evaluate the safety profile, maximum tolerated dose (MTD), pharmacokinetics, and antitumor activity of MEDI-547, an antibody drug conjugate composed of the cytotoxic drug auristatin (toxin) linked to a human anti-EphA2 monoclonal antibody (1C1), in patients with solid tumors relapsed/refractory to standard therapy. In this phase 1, open-label study with planned dose-escalation and dose-expansion cohorts, patients received a 1-h intravenous infusion of MEDI-547 (0.08 mg/kg) every 3 weeks. Six patients received 0.08 mg/kg; all discontinued treatment. Dose escalation was not pursued. The study was stopped before cohort 2 enrollment due to treatment-related bleeding and coagulation events (hemorrhage-related, n = 3; epistaxis, n = 2). Therefore, lower doses were not explored and an MTD could not be selected. The most frequently reported treatment-related adverse events (AEs) were increased liver enzymes, decreased hemoglobin, decreased appetite, and epistaxis. Three patients (50%) experienced treatment-related serious AEs, including conjunctival hemorrhage, pain (led to study drug discontinuation), liver disorder, and hemorrhage. Best response included progressive disease (n = 5; 83.3%) and stable disease (n = 1; 16.7%). Minimal or no dissociation of toxin from 1C1 conjugate occurred in the blood. Serum MEDI-547 concentrations decreased rapidly, ~70% by 3 days post-dose. No accumulation of MEDI-547 was observed at 0.08 mg/kg upon administration of a second dose 3 weeks following dose 1. The safety profile of MEDI-547 does not support further clinical investigation in patients with advanced solid tumors.

  7. Análise da medição do raio solar em ultravioleta

    NASA Astrophysics Data System (ADS)

    Saraiva, A. C. V.; Giménez de Castro, C. G.; Costa, J. E. R.; Selhorst, C. L.; Simões, P. J. A.

    2003-08-01

    A medição acurada do raio solar em qualquer banda do espectro eletromagnético é de relevância na formulação e calibração de modelos da estrutura e atmosfera solar. Esses modelos atribuem emissão do contínuo do Sol calmo em microondas à mesma região da linha Ha do Hell. Apresentamos a medição do raio solar em UV com imagens do EIT (Extreme Ultraviolet Image Telescope) entre 1996 e 2002, no comprimento de onda 30,9 nm (Ha do Hell), que se forma na região de transição/cromosfera solar. A técnica utilizada para o cálculo do raio UV foi baseada na transformada Wavelet B3spline. Fizemos um banco de dados com 1 imagem por dia durante o período citado. Obtivemos como resultado o raio médio da ordem de 975.61" e uma diminuição do mesmo para o período citado variando em média -0,45" /ano. Comparamos estes dados com os valores obtidos pelo ROI (Radio Observatório de Itapetinga) em 22/48 GHz e Nobeyama Radio Heliograph em 17 GHz mostrando que os raios médios são muito próximos o que indica que a região de formação nessas freqüências é a mesma conforme os modelos. Comparamos os resultados também com outros índices de atividade solar.

  8. MediBoost: a Patient Stratification Tool for Interpretable Decision Making in the Era of Precision Medicine

    PubMed Central

    Valdes, Gilmer; Luna, José Marcio; Eaton, Eric; Simone, Charles B.; Ungar, Lyle H.; Solberg, Timothy D.

    2016-01-01

    Machine learning algorithms that are both interpretable and accurate are essential in applications such as medicine where errors can have a dire consequence. Unfortunately, there is currently a tradeoff between accuracy and interpretability among state-of-the-art methods. Decision trees are interpretable and are therefore used extensively throughout medicine for stratifying patients. Current decision tree algorithms, however, are consistently outperformed in accuracy by other, less-interpretable machine learning models, such as ensemble methods. We present MediBoost, a novel framework for constructing decision trees that retain interpretability while having accuracy similar to ensemble methods, and compare MediBoost’s performance to that of conventional decision trees and ensemble methods on 13 medical classification problems. MediBoost significantly outperformed current decision tree algorithms in 11 out of 13 problems, giving accuracy comparable to ensemble methods. The resulting trees are of the same type as decision trees used throughout clinical practice but have the advantage of improved accuracy. Our algorithm thus gives the best of both worlds: it grows a single, highly interpretable tree that has the high accuracy of ensemble methods. PMID:27901055

  9. MediBoost: a Patient Stratification Tool for Interpretable Decision Making in the Era of Precision Medicine

    NASA Astrophysics Data System (ADS)

    Valdes, Gilmer; Luna, José Marcio; Eaton, Eric; Simone, Charles B.; Ungar, Lyle H.; Solberg, Timothy D.

    2016-11-01

    Machine learning algorithms that are both interpretable and accurate are essential in applications such as medicine where errors can have a dire consequence. Unfortunately, there is currently a tradeoff between accuracy and interpretability among state-of-the-art methods. Decision trees are interpretable and are therefore used extensively throughout medicine for stratifying patients. Current decision tree algorithms, however, are consistently outperformed in accuracy by other, less-interpretable machine learning models, such as ensemble methods. We present MediBoost, a novel framework for constructing decision trees that retain interpretability while having accuracy similar to ensemble methods, and compare MediBoost’s performance to that of conventional decision trees and ensemble methods on 13 medical classification problems. MediBoost significantly outperformed current decision tree algorithms in 11 out of 13 problems, giving accuracy comparable to ensemble methods. The resulting trees are of the same type as decision trees used throughout clinical practice but have the advantage of improved accuracy. Our algorithm thus gives the best of both worlds: it grows a single, highly interpretable tree that has the high accuracy of ensemble methods.

  10. Validation of Medi·Ca EC Method for AOAC Research Institute Performance Tested Methods(SM) Certification.

    PubMed

    Shimizu, Mai; Saito, Fumihiko; Takenaka, Kentaro; Kimura, Narumi; Suzuki, Takeo; Iwase, Tatsuhiko; Kyotani, Hitoshi

    2017-03-01

    A ready-made dry medium method for Escherichia coli and coliform count, the Medi·Ca EC method, was compared with the most probable number (MPN) method using Brilliant Green Lactose Bile broth and E. coli broth (AOAC INTERNATIONAL Official MethodSM 966.24) for seven food matrixes: raw beef, raw pork, raw frozen pork, raw lamb, raw salmon, frankfurter sausage, and cooked ham. The mean difference between the two methods at each contamination level for each matrix was <0.5 log10, and the 95% confidence intervals for the mean differences fell within the range of -0.5 to 0.5, with the exception of a few cases in the independent laboratory study. sr and RSDr values of the Medi·Ca EC method were generally lower than those of the MPN method, and r2 ranged from 0.91 to 0.99. Product consistency and stability studies showed little variability between production lots and the shelf-life of 20 months. An incubation time within the range of 22-26 h did not adversely affect the results; however, variations in sample volume did affect final counts. These results showed that the Medi·Ca EC method is a reasonable alternative to the reference method for the selected food matrixes and makes it possible to simultaneously detect and enumerate E. coli and coliform in only 24 h.

  11. MediSim: A Prototype VR System for Training Medical First Responders

    SciTech Connect

    Stansfield, S.; Shawver, D.; Sobel, A.

    1997-12-31

    This paper presents a prototype virtual reality (VR) system for training medical first responders. The initial application is to battlefield medicine and focuses on the training of medical corpsmen and other front-line personnel who might be called upon to provide emergency triage on the battlefield. The system is built upon Sandia`s multi-user, distributed VR platform and provides an interactive, immersive simulation capability. The user is represented by an Avatar and is able to manipulate his virtual instruments and carry out medical procedures. A dynamic casualty simulation provides realistic cues to the patient`s condition (e.g. changing blood pressure and pulse) and responds to the actions of the trainee (e.g. a change in the color of a patient`s skin may result from a check of the capillary refill rate). The current casualty simulation is of an injury resulting in a tension pneumothorax. This casualty model was developed by the University of Pennsylvania and integrated into the Sandia MediSim system.

  12. The CEA/CD3-Bispecific Antibody MEDI-565 (MT111) Binds a Nonlinear Epitope in the Full-Length but Not a Short Splice Variant of CEA

    PubMed Central

    Huang, Jiaqi; Brohawn, Philip; Morehouse, Chris; Lekstrom, Kristen; Baeuerle, Patrick A.; Wu, Herren; Yao, Yihong; Coats, Steven R.; Dall’Acqua, William; Damschroder, Melissa; Hammond, Scott A.

    2012-01-01

    MEDI-565 (also known as MT111) is a bispecific T-cell engager (BiTE®) antibody in development for the treatment of patients with cancers expressing carcinoembryonic antigen (CEA). MEDI-565 binds CEA on cancer cells and CD3 on T cells to induce T-cell mediated killing of cancer cells. To understand the molecular basis of human CEA recognition by MEDI-565 and how polymorphisms and spliced forms of CEA may affect MEDI-565 activity, we mapped the epitope of MEDI-565 on CEA using mutagenesis and homology modeling approaches. We found that MEDI-565 recognized a conformational epitope in the A2 domain comprised of amino acids 326–349 and 388–410, with critical residues F326, T328, N333, V388, G389, P390, E392, I408, and N410. Two non-synonymous single-nucleotide polymorphisms (SNPs) (rs10407503, rs7249230) were identified in the epitope region, but they are found at low homozygosity rates. Searching the National Center for Biotechnology Information GenBank® database, we further identified a single, previously uncharacterized mRNA splice variant of CEA that lacks a portion of the N-terminal domain, the A1 and B1 domains, and a large portion of the A2 domain. Real-time quantitative polymerase chain reaction analysis of multiple cancers showed widespread expression of full-length CEA in these tumors, with less frequent but concordant expression of the CEA splice variant. Because the epitope was largely absent from the CEA splice variant, MEDI-565 did not bind or mediate T-cell killing of cells solely expressing this form of CEA. In addition, the splice variant did not interfere with MEDI-565 binding or activity when co-expressed with full-length CEA. Thus MEDI-565 may broadly target CEA-positive tumors without regard for expression of the short splice variant of CEA. Together our data suggest that MEDI-565 activity will neither be impacted by SNPs nor by a splice variant of CEA. PMID:22574157

  13. Safety, Tolerability, and Pharmacokinetics of MEDI4893, an Investigational, Extended-Half-Life, Anti-Staphylococcus aureus Alpha-Toxin Human Monoclonal Antibody, in Healthy Adults

    PubMed Central

    Yu, Xiang-Qing; Robbie, Gabriel J.; Wu, Yuling; Esser, Mark T.; Jensen, Kathryn; Schwartz, Howard I.; Bellamy, Terramika; Hernandez-Illas, Martha

    2016-01-01

    ABSTRACT MEDI4893 is an investigational immunoglobulin G1(κ) monoclonal antibody that specifically binds to and neutralizes alpha-toxin, a key Staphylococcus aureus virulence factor. A triple-amino-acid substitution, M252Y/S254T/T256E, was engineered into the MEDI4893 Fc region to extend its serum half-life. A phase 1, double-blind, dose escalation study was designed to evaluate the safety, tolerability, pharmacokinetics, anti-alpha-toxin-neutralizing activity, and antidrug antibody (ADA) response of MEDI4893 following a single intravenous infusion in healthy adults 18 to 65 years of age. Thirty-three subjects were randomly assigned to receive MEDI4893 at 225 mg (n = 3), 750 mg (n = 3), 2,250 mg (n = 8), or 5,000 mg (n = 12) or placebo (n = 7) and were followed for 360 days. Adverse events were mild or moderate in severity; none were serious. The MEDI4893 peak serum concentration increased dose proportionally from 77.2 μg/ml (225-mg dose) to 1,784 μg/ml (5,000-mg dose). The area under the concentration-time curve from 0 to 360 days also increased dose proportionally, from 4,840 μg · day/ml (225-mg dose) to 91,493 μg · day/ml (5,000-mg dose), indicating linear pharmacokinetics. MEDI4893's terminal half-life was estimated to be 80 to 112 days, which is approximately 4-fold longer than the half-lives of other human immunoglobulin G antibodies. The alpha-toxin-neutralizing activity in serum correlated highly with the MEDI4893 concentrations in serum. Three adults transiently tested positive for ADA on day 151, but this did not have an impact on MEDI4893 serum concentrations or the MEDI4893 safety profile; no subjects exhibited serum ADA at the study end. These data support the continued development of MEDI4893 for the prevention of S. aureus-mediated pneumonia. (This study has been registered at ClinicalTrials.gov under identifier NCT02296320.) PMID:27795368

  14. Prograf five milligrams versus Tacrolimus medis in healthy volunteers: a bioequivalence study.

    PubMed

    Masri, M; Rizk, S; Boujbel, L; Bellahirich, W; Baassoumi, D; Attia, M; Matha, V

    2013-01-01

    For FDA approval, bioequivalence of a generic version of Tacrolimus must be demonstrated in a randomized, two-treatments, two-periods, two-sequences, single-dose crossover study in healthy adult volunteers. Currently there are at least 3 differents generic equivalent for Tacrolimus, that are approved by the EMA and the FDA, with a USA market share of nearly 50%. However, the market share of generic immunosuppressive drugs in the Middle East region is still very low due to the reluctance of the physician to accept Tacrolimus generics, considered to be a narrow therapeutic window drug, that are approved using the standard bioequivalence criteria of 80% to 125%. Herein we present a bioequivalence study of a new Tacrolimus generic, Tacrolimus Medis 5 mg developed by Medis Tunisia batch number 12G3003 compared with Prograf® 5 mg batch number 7202 manufactured by Astellas Toyama Co., Ltd. Japan and HIKMA Pharmaceuticals, Amman-Jordan in healthy adult volunteers using the 90%-111% criteria recommended for drugs with narrow therapeutic window. The study was, balanced, randomized, two-treatments, two-periods, two-sequences, single dose, crossover, comparative oral bioavailability study in healthy adult human volunteers. The study was carried out in accordance with the Basic Principles defined in the U.S. 21 CFR Part 312.20, the principles enunciated in the Declaration of Helsinki (World Medical Association Declaration of Helsinki). Thirty six non-smoking healthy, as determined by medical history, volunteers, 18 years and older, were included. Following randomization using a computer software (pharma solution) the volunteers were given a single oral dose of 5 milligrams following a 12 hour fast with a wash out period of 7 days. Pharmacokinetics profile with blood levels at: 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10, 12, and 24 hours were performed following each dose. Tacrolimus plasma level was determined using an HPLC validated method (Transmedical For Life S.A.R.L. Beirut

  15. Non-fluoroscopic catheter visualization using MediGuide™ technology: experience from the first 600 procedures.

    PubMed

    Sommer, P; Richter, S; Hindricks, G; Rolf, S

    2014-09-01

    A novel cardiovascular navigation system known as MediGuide™ (MG) which allows non-fluoroscopic catheter tracking over a background of pre-recorded cine loops was recently introduced. This system allows significant reduction of fluoroscopy exposure which is one of the potentially harmful aspects of today's electrophysiological procedures such as ablations or device implantations. We provide a summary of recently published studies related to this new technological platform and describe our experience from the first 600 MG procedures at our institution.After reviewing the currently available publications in the field of MG-supported EP procedures, we describe the workflows for (1) ablation of supraventricular tachycardia (SVT), atrial fibrillation (AF), and ventricular tachycardia using MG-enabled diagnostic and ablation catheters, as well as (2) implant of cardiac resynchronization therapy (CRT) devices using sensor-equipped delivery tools including sheaths, sub-selectors, and guidewires.As shown in several studies [5-9], MG procedures resulted in similar efficacy as conventional cases but with a significant reduction in fluoroscopy time and dose. In particular, for SVT ablations, the median fluoroscopy time using the MG technology was 0.5 ± 1.4 min compared to 10.2 ± 9.6 min in conventional fluoroscopic settings. Similar reductions were demonstrated for AF ablation procedures from 25 min in conventional settings with electroanatomical mapping systems and live x-ray to 4.6 min with the addition of the MG technology. Recently, it was demonstrated that the application of MG for CRT device implants could successfully result in a median fluoroscopy time of 2.6 min for LV lead deployment.In summary, the first measurable clinical impact of the MG technology on a daily clinical routine is the reduction of fluoroscopy time and radiation exposure for various EP indications. These beneficial effects were achieved without negative consequences on procedural

  16. Safety, Tolerability, and Pharmacokinetics of MEDI8897, the Respiratory Syncytial Virus Prefusion F-Targeting Monoclonal Antibody with an Extended Half-Life, in Healthy Adults

    PubMed Central

    Khan, Anis A.; Esser, Mark T.; Jensen, Kathryn; Takas, Therese; Kankam, Martin K.; Villafana, Tonya; Dubovsky, Filip

    2016-01-01

    ABSTRACT Prevention of respiratory syncytial virus (RSV) illness in infants is a major public health priority, but there is no approved vaccine. Palivizumab is a monoclonal antibody that provides RSV prophylaxis but requires 5 monthly injections and is approved only for infants who experience the greatest morbidity and mortality from RSV. Thus, there remains a significant unmet medical need for prevention of RSV disease in healthy infants. MEDI8897 is a recombinant human RSV monoclonal antibody with a modified Fc region that extends its half-life and is being developed as RSV prophylaxis for all infants. In this phase 1, first-in-human, placebo-controlled study, 136 healthy adults were randomized to receive a single dose of MEDI8897 (n = 102) or placebo (n = 34) in 1 of 5 cohorts (300, 1,000, or 3,000 mg intravenously or 100 or 300 mg intramuscularly [i.m.]) and were monitored for 360 days. The mean half-life of MEDI8897 was 85 to 117 days across dose groups, and bioavailability after 300-mg i.m. dose administration was 77%. Time to maximum concentration following i.m. dosing was 5 to 9 days. Antidrug antibody (ADA) responses were detected in a similar proportion of placebo (15.2%) and MEDI8897 (13.7%) recipients. The safety profile of MEDI8897 was similar to that of the placebo. These results support clinical studies of the i.m. administration of a single dose of MEDI8897 in the target population of infants to provide protection for the duration of the RSV season. (This study has been registered at ClinicalTrials.gov under identifier NCT02114268.) PMID:27956428

  17. Safety profile and clinical activity of multiple subcutaneous doses of MEDI-528, a humanized anti-interleukin-9 monoclonal antibody, in two randomized phase 2a studies in subjects with asthma

    PubMed Central

    2011-01-01

    Background Interleukin-9 (IL-9)-targeted therapies may offer a novel approach for treating asthmatics. Two randomized placebo-controlled studies were conducted to assess the safety profile and potential efficacy of multiple subcutaneous doses of MEDI-528, a humanized anti-IL-9 monoclonal antibody, in asthmatics. Methods Study 1: adults (18-65 years) with mild asthma received MEDI-528 (0.3, 1, 3 mg/kg) or placebo subcutaneously twice weekly for 4 weeks. Study 2: adults (18-50 years) with stable, mild to moderate asthma and exercise-induced bronchoconstriction received 50 mg MEDI-528 or placebo subcutaneously twice weekly for 4 weeks. Adverse events (AEs), pharmacokinetics (PK), immunogenicity, asthma control (including asthma exacerbations), and exercise challenge test were evaluated in study 1, study 2, or both. Results In study 1 (N = 36), MEDI-528 showed linear serum PK; no anti-MEDI-528 antibodies were detected. Asthma control: 1/27 MEDI-528-treated subjects had 1 asthma exacerbation, and 2/9 placebo-treated subjects had a total of 4 asthma exacerbations (one considered a serious AE). In study 2, MEDI-528 (n = 7) elicited a trend in the reduction in mean maximum decrease in FEV1 post-exercise compared to placebo (n = 2) (-6.49% MEDI-528 vs -12.60% placebo; -1.40% vs -20.10%; -5.04% vs -15.20% at study days 28, 56, and 150, respectively). Study 2 was halted prematurely due to a serious AE in an asymptomatic MEDI-528-treated subject who had an abnormal brain magnetic resonance imaging that was found to be an artifact on further evaluation. Conclusions In these studies, MEDI-528 showed an acceptable safety profile and findings suggestive of clinical activity that support continued study in subjects with mild to moderate asthma. Trial registration ClinicalTrials (NCT): NCT00507130 and ClinicalTrials (NCT): NCT00590720 PMID:21356110

  18. Risk of preterm birth by subtype among Medi-Cal participants with mental illness.

    PubMed

    Baer, Rebecca J; Chambers, Christina D; Bandoli, Gretchen; Jelliffe-Pawlowski, Laura L

    2016-10-01

    Previous studies have demonstrated an association between mental illness and preterm birth (before 37 weeks). However, these investigations have not simultaneously considered gestation of preterm birth, the indication (eg, spontaneous or medically indicated), and specific mental illness classifications. The objective of the study was to examine the likelihood of preterm birth across gestational lengths and indications among Medi-Cal (California's Medicaid program) participants with a diagnostic code for mental illness. Mental illnesses were studied by specific illness classification. The study population was drawn from singleton live births in California from 2007 through 2011 in the birth cohort file maintained by the California Office of Statewide Health Planning and Development, which includes birth certificate and hospital discharge records. The sample was restricted to women with Medi-Cal coverage for prenatal care. Women with mental illness were identified using International Classification of Diseases, ninth revision, codes from their hospital discharge record. Women without a mental illness International Classification of Diseases, ninth revision, code were randomly selected at a 4:1 ratio. Adjusting for maternal characteristics and obstetric complications, relative risks and 95% confidence intervals were calculated for preterm birth comparing women with a mental illness diagnostic code with women without such a code. We identified 6198 women with a mental illness diagnostic code and selected 24,792 women with no such code. The risk of preterm birth in women with a mental illness were 1.2 times higher than women without a mental illness (adjusted relative risk, 1.2, 95% confidence interval, 1.1-1.3). Among the specific mental illnesses, schizophrenia, major depression, and personality disorders had the strongest associations with preterm birth (adjusted relative risks, 2.0, 2.0 and 3.3, respectively). Women receiving prenatal care through California's low

  19. Phase-I study MEDI-534, of a live, attenuated intranasal vaccine against respiratory syncytial virus and parainfluenza-3 virus in seropositive children.

    PubMed

    Gomez, Margarita; Mufson, Maurice A; Dubovsky, Filip; Knightly, Conor; Zeng, Wen; Losonsky, Genevieve

    2009-07-01

    A live, attenuated respiratory syncytial virus and parainfluenza virus type 3 vaccine was evaluated in healthy respiratory syncytial virus/parainfluenza virus type 3 seropositive children aged 1 to 9 years. Three cohorts of 40 children were randomized 1:1 to receive 10, 10, or 10 median tissue culture infectious dose50 MEDI-534 vaccine or placebo. The vaccine's safety profile was similar to placebo, no viral shedding was detected, and the vaccine was minimally immunogenic.

  20. MediSPECT: Single photon emission computed tomography system for small field of view small animal imaging based on a CdTe hybrid pixel detector

    NASA Astrophysics Data System (ADS)

    Accorsi, R.; Autiero, M.; Celentano, L.; Chmeissani, M.; Cozzolino, R.; Curion, A. S.; Frallicciardi, P.; Laccetti, P.; Lanza, R. C.; Lauria, A.; Maiorino, M.; Marotta, M.; Mettivier, G.; Montesi, M. C.; Riccio, P.; Roberti, G.; Russo, P.

    2007-02-01

    We describe MediSPECT, a new scanner developed at University and INFN Napoli, for SPECT studies on small animals with a small field of view (FOV) and high spatial resolution. The CdTe pixel detector (a 256×256 matrix of 55 μm square pixels) operating in single photon counting for detection of gamma-rays with low and medium energy (e.g. 125I, 27-35 keV, 99mTc, 140 keV), is bump bonded to the Medipix2 readout chip. The FOV of the MediSPECT scanner with a coded aperture mask collimator ranges from 6.3 mm (system spatial resolution 110 μm at 27-35 keV) to 24.3 mm. With a 0.30 mm pinhole the FOV ranges from 2.4 to 29 mm (where the system spatial resolution is 1.0 mm at 27-35 keV and 2.0 mm at 140 keV). MediSPECT will be used for in vivo imaging of small organs or tissue structures in mouse, e.g., brain, thyroid, heart or tumor.

  1. Making It Safe to Grow Old: A Financial Simulation Model for Launching MediCaring Communities for Frail Elderly Medicare Beneficiaries.

    PubMed

    Bernhardt, Antonia K; Lynn, Joanne; Berger, Gregory; Lee, James A; Reuter, Kevin; Davanzo, Joan; Montgomery, Anne; Dobson, Allen

    2016-09-01

    At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with "activities of daily living." Available services fail to match frail elders' needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs. The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long-term care costs, and declining family caregiver availability portend gaps in badly needed services. The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. The

  2. Coping with stress in medical students: results of a randomized controlled trial using a mindfulness-based stress prevention training (MediMind) in Germany.

    PubMed

    Kuhlmann, S M; Huss, M; Bürger, A; Hammerle, F

    2016-12-28

    High prevalence rates of psychological distress in medical training and later professional life indicate a need for prevention. Different types of intervention were shown to have good effects, but little is known about the relative efficacy of different types of stress management interventions, and methodological limitations have been reported. In order to overcome some of these limitations, the present study aimed at evaluating the effect of a specifically developed mindfulness-based stress prevention training for medical students (MediMind) on measures of distress, coping and psychological morbidity. We report on a prospective randomized controlled trial with three study conditions: experimental treatment (MediMind), standard treatment (Autogenic Training) and a control group without treatment. The sample consisted of medical or dental students in the second or eighth semester. They completed self-report questionnaires at baseline, after the training and at one year follow-up. Distress (Trier Inventory for the Assessment of Chronic Stress, TICS) was assessed as the primary outcome and coping (Brief COPE) as a co-primary outcome. Effects on the psychological morbidity (Brief Symptom Inventory, BSI) as a secondary outcome were expected one year after the trainings. Initially, N = 183 students were randomly allocated to the study groups. At one year follow-up N = 80 could be included into the per-protocol analysis: MediMind (n =31), Autogenic Training (n = 32) and control group (n = 17). A selective drop-out for students who suffered more often from psychological symptoms was detected (p = .020). MANCOVA's on TICS and Brief COPE revealed no significant interaction effects. On the BSI, a significant overall interaction effect became apparent (p = .002, η2partial = .382), but post hoc analyses were not significant. Means of the Global Severity Index (BSI) indicated that MediMind may contribute to a decrease in psychological morbidity. Due

  3. Nonclinical phenotypic and genotypic analyses of a Phase 1 pediatric respiratory syncytial virus vaccine candidate MEDI-559 (rA2cp248/404/1030ΔSH) at permissive and non-permissive temperatures.

    PubMed

    Schickli, Jeanne H; Kaur, Jasmine; Tang, Roderick S

    2012-10-01

    MEDI-559 is a recombinant live attenuated intranasal RSV vaccine candidate currently being evaluated in 5 to <24 month old RSV seronegative infants for safety and immunogenicity. MEDI-559 and the previously tested rA2cp248/404/1030ΔSH both have 5 cold-passaged mutations, 3 temperature sensitive (ts) markers designated 248, 404, and 1030, and deletion of the SH gene that collectively contribute to their attenuation and temperature sensitive growth phenotypes. However, MEDI-559 differs from rA2cp248/404/1030ΔSH by 39 silent nucleotide substitutions. Nevertheless, these viruses have comparable in vitro and in vivo phenotypes. Temperature sensitivity is monitored by the efficiency of plaque formation at elevated temperatures. The efficiency of plaque formation of MEDI-559 is reduced by ≥ 100-fold at 35 ° C and by ≥ 1000 fold at 37 °C compared to 32 °C. Passaging of MEDI-559 at temperatures up to 37 °C resulted in generation of temperature sensitive intermediate (tsi) viruses. The most frequent change was a reversion to wildtype tyrosine at the 1030 ts site followed by a less frequently observed leucine to non-wildtype serine substitution at the 248 ts site. One tsi virus had changes at both the 248 and 1030 ts sites and another tsi virus that had maintained all of the 248, 404 and 1030 ts sites had two novel changes (Asp158Gly and Ser1313Cys) in the polymerase (L) gene. Asp158Gly and Ser1313Cys singly or in combination in the MEDI-559 genetic background were confirmed to result in a tsi growth phenotype. All the tsi viruses have small plaque phenotypes and are highly attenuated in the lungs of cotton rats. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Staphylococcus aureus Alpha-Toxin Is Conserved among Diverse Hospital Respiratory Isolates Collected from a Global Surveillance Study and Is Neutralized by Monoclonal Antibody MEDI4893

    PubMed Central

    Yu, Li; Mok, Hoyin; Tkaczyk, Christine; Sellman, Bret R.; Wu, Yuling; Oganesyan, Vaheh; Slidel, Tim; Jafri, Hasan; McCarthy, Michael; Bradford, Patricia; Esser, Mark T.

    2016-01-01

    Staphylococcus aureus infections lead to an array of illnesses ranging from mild skin infections to serious diseases, such endocarditis, osteomyelitis, and pneumonia. Alpha-toxin (Hla) is a pore-forming toxin, encoded by the hla gene, that is thought to play a key role in S. aureus pathogenesis. A monoclonal antibody targeting Hla, MEDI4893, is in clinical development for the prevention of S. aureus ventilator-associated pneumonia (VAP). The presence of the hla gene and Hla protein in 994 respiratory isolates collected from patients in 34 countries in Asia, Europe, the United States, Latin America, the Middle East, Africa, and Australia was determined. Hla levels were correlated with the geographic location, age of the subject, and length of stay in the hospital. hla gene sequence analysis was performed, and mutations were mapped to the Hla crystal structure. S. aureus supernatants containing Hla variants were tested for susceptibility or resistance to MEDI4893. The hla gene was present and Hla was expressed in 99.0% and 83.2% of the isolates, respectively, regardless of geographic region, hospital locale, or age of the subject. More methicillin-susceptible than methicillin-resistant isolates expressed Hla (86.9% versus 78.8%; P = 0.0007), and S. aureus isolates from pediatric patients expressed the largest amounts of Hla. Fifty-seven different Hla subtypes were identified, and 91% of the isolates encoded an Hla subtype that was neutralized by MED4893. This study demonstrates that Hla is conserved in diverse S. aureus isolates from around the world and is an attractive target for prophylactic monoclonal antibody (MAb) or vaccine development. PMID:27324766

  5. The impact of threshold language assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting.

    PubMed

    McClellan, Sean R; Wu, Frances M; Snowden, Lonnie R

    2012-06-01

    Title VI of the 1964 Civil Rights Act prohibits federal funds recipients from providing care to limited English proficiency (LEP) persons more limited in scope or lower in quality than care provided to others. In 1999, the California Department of Mental Health implemented a "threshold language access policy" to meet its Title VI obligations. Under this policy, Medi-Cal agencies must provide language assistance programming in a non-English language where a county's Medical population contains either 3000 residents or 5% speakers of that language. We examine the impact of threshold language policy-required language assistance programming on LEP persons' access to mental health services by analyzing the county-level penetration rate of services for Russian, Spanish, and Vietnamese speakers across 34 California counties, over 10 years of quarterly data. Exploiting a time series with nonequivalent control group study design, we studied this phenomena using linear regression with random county effects to account for trends over time. Threshold language policy-required assistance programming led to an immediate and significant increase in the penetration rate of mental health services for Russian (8.2, P < 0.01) and Vietnamese (3.3, P < 0.01) language speaking persons. Threshold language assistance programming was effective in increasing mental health access for Russian and Vietnamese, but not for Spanish-speaking LEP persons.

  6. Reducing Radiation Exposure During CRT Implant Procedures: Single-Center Experience With Low-Dose Fluoroscopy Settings and a Sensor-Based Navigation System (MediGuide).

    PubMed

    Thibault, Bernard; Mondésert, Blandine; Macle, Laurent; Dubuc, Marc; Dyrda, Katia; Talajic, Mario; Roy, Denis; Rivard, Léna; Guerra, Peter G; Andrade, Jason G; Khairy, Paul

    2016-07-26

    Cardiac resynchronization therapy (CRT) implant procedures are often complex and prolonged, resulting in substantial ionizing radiation (IR) exposure to the patient and operator. We assessed the impact of lower-dose fluoroscopy settings and a sensor-based electromagnetic tracking system (MediGuide™, MDG) on reducing IR exposure during CRT implantation. A single-center 2-group cohort study was conducted on 348 consecutive patients, age 66.4 ± 11.0 years, 80.4% male, with CRT implant procedures from 2013 to 2015. Patients were arbitrarily assigned to MDG (N = 239) versus no MDG (N = 109) guidance. Lower-dose fluoroscopy settings were adopted in January 2015 (3 instead of 6 fps; 23 instead of 40 nGy/pulse; N = 101). Overall, MDG was associated with an 82.1% reduction in IR exposure (393 μGray·m(2) vs. 2191 μGray·m(2) , P < 0.001). Lower-dose fluoroscopy resulted in a 59.5% reduction in IR-exposure without MDG (1055 μGray·m(2) vs. 2608 μGray·m(2) , P < 0.001) and 81.8% reduction with MDG (108 μGray·m(2) vs. 595 μGray·m(2) , P < 0.001). Low-dose fluoroscopy combined with MDG was associated with a 95.9% lower exposure to IR when compared to standard fluoroscopy without MDG (108 μGray·m(2) vs. 2608 μGray·m(2) , P < 0.001). Procedures with MDG were shorter (96 minutes vs. 123 minutes, P < 0.001) and associated with a trend towards a higher success rate (94.6% vs. 89.0%, P = 0.062), with fewer coronary sinus cannulation failures (2.1% vs. 6.4%, P = 0.040). Low-dose fluoroscopy settings are highly effective (>50%) in reducing IR exposure during CRT implant procedures. When combined with MDG, >95% reduction in IR exposure is achieved. Moreover, MDG shortens procedural duration and may improve acute procedural outcomes. © 2016 Wiley Periodicals, Inc.

  7. Antiretroviral therapy adherence, medication use, and health care costs during 3 years of a community pharmacy medication therapy management program for Medi-Cal beneficiaries with HIV/AIDS.

    PubMed

    Hirsch, Jan D; Gonzales, Marco; Rosenquist, Ashley; Miller, Teresa Ann; Gilmer, Todd P; Best, Brookie M

    2011-04-01

    The types of pharmacist-provided medication therapy management (MTM) services provided to patients with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and the effects of MTM on medication adherence and patient outcomes have only recently begun to be studied. Although available studies suggest that patients receiving MTM services have better antiretroviral therapy (ART) adherence and outcomes, only 1 study has examined a large group of patients with HIV/AIDS, and none has examined adherence or outcomes for more than 1 year. A pilot program conducted by the California Department of Health Care Services (DHCS) and Medi-Cal (California's Medicaid program) provided an opportunity to examine ART adherence and outcomes in a large patient population receiving MTM services in community pharmacies over 3 years. To examine an HIV/AIDS pharmacy MTM compensation pilot program over a 3-year period (2005- 2007) in a sample of Medi-Cal beneficiaries by describing the associations between use of pilot pharmacies and (a) adherence to ART regimens; (b) medication utilization, including number and type of ART medication regimens and use of contraindicated ART regimens; (c) occurrence of opportunistic infections; and (d) all-cause pharmacy and medical costs. This was a cohort study examining Medi-Cal pharmacy and medical claims data (2005-2007) for patients with HIV/AIDS who were served by pilot pharmacies versus other (nonpilot) pharmacies. The study groups, pilot and nonpilot pharmacy patients with HIV/AIDS, consisted of Medi-Cal beneficiaries aged 18 years or older as of January 1, 2005, who were continuously enrolled from January 1, 2004, through December 31, 2007, and who received both a diagnosis of HIV/AIDS and at least 1 ART pharmacy claim during both the index period (2004) and the study period (January 1, 2005, through December 31, 2007). Pilot pharmacy patients were identified as having filled 50% or more of their ART prescriptions each year at 1

  8. Sex-specific association of fatty acid binding protein 2 and microsomal triacylglycerol transfer protein variants with response to dietary lipid changes in the 3-mo Medi-RIVAGE primary intervention study.

    PubMed

    Gastaldi, Marguerite; Dizière, Sophie; Defoort, Catherine; Portugal, Henri; Lairon, Denis; Darmon, Michel; Planells, Richard

    2007-12-01

    The dietary guidelines targeted at reducing cardiovascular risk lead to largely heterogeneous responses in which genetic determinants are largely involved. We evaluated the effect of fatty acid binding protein 2 (FABP2) Ala54Thr and microsomal triacylglycerol transfer protein (MTTP) -493G/T allelic variations on plasma lipid markers, at baseline and on the response to the 3-mo Medi-RIVAGE primary prevention study. Subjects with moderate cardiovascular disease risk (n = 169) were advised to reduce total and saturated dietary fats and to increase intake of monounsaturated and polyunsaturated fats. They were genotyped for FABP2 Ala54Thr and MTTP -493G/T allelic variations, and plasma was processed for cardiovascular risk marker analyses. At baseline, men and women homozygous for Thr54 presented a significant opposite profile for plasma oleic acid (18:1), triacylglycerol-rich lipoprotein (TRL) cholesterol, and TRL phospholipids. In addition, all Thr/Thr men presented higher 18:1 values than did women. For the MTTP -493G/T polymorphism, although all TT subjects presented high apolipoprotein B-48, a genotype x sex interaction was present for palmitic acid, linolenic acid, eicosatrienoic acid, and insulin. The prudent diet clearly improved plasma lipid markers. FABP2 genotype did not interact much with the amplitude of the response. However, for MTTP polymorphism, men homozygous for the T allele displayed a significantly more pronounced response than did men carrying the G allele, which is particularly evident by their larger decrease in the Framingham score. These 2 polymorphic loci are thus differently associated with the baseline lipid markers as well as with the response to nutritional recommendations, but both presented a marked sex-specific profile, with the response to diet being particularly efficient in men homozygous for the MTTP -493T allele.

  9. CDA Templates - Utilizing the MediCUBE.

    PubMed

    Burwitz, Martin; Benedict, Martin; Schlieter, Hannes

    2016-01-01

    The specification and customization of clinical document types are tasks that need a strong collaboration between domain experts and IT specialists. However, these collaborators are often faced with difficulties due to different interpretation of domain knowledge. Therefore, an adequate method for sharing domain knowledge about documents is necessary. Even though there are some tools that help to define medical document types, there is a lack of approaches that focus on the understandability of the specification for the domain experts. This paper proposes a modeling approach based on the Clinical Document Architecture to address this gap.

  10. Medi-Port Pilot Randomized Controlled Trial

    ClinicalTrials.gov

    2016-10-13

    Actively Undergoing Cancer Treatment; 4-9 Years of Age; At Least 1 Month From Diagnosis; Able to Speak and Understand English; Presenting to Clinic for at Least a 2nd Subcutaneous Port Needle Insertion

  11. California Medi-Corps Evaluation Report Summer 1980.

    ERIC Educational Resources Information Center

    Rice, Joseph P.

    Using data obtained from two external evaluators, health assistants, team leaders/coordinators, and migrant pupil service delivery forms, the evaluation examined the supervision services; preservice workshops; whether health education assistants were directly serving migrant pupils and functioning at levels of competence commensurate with their…

  12. Advanced Networks in Dental Rich Online MEDiA (ANDROMEDA)

    NASA Astrophysics Data System (ADS)

    Elson, Bruce; Reynolds, Patricia; Amini, Ardavan; Burke, Ezra; Chapman, Craig

    There is growing demand for dental education and training not only in terms of knowledge but also skills. This demand is driven by continuing professional development requirements in the more developed economies, personnel shortages and skills differences across the European Union (EU) accession states and more generally in the developing world. There is an excellent opportunity for the EU to meet this demand by developing an innovative online flexible learning platform (FLP). Current clinical online systems are restricted to the delivery of general, knowledge-based training with no easy method of personalization or delivery of skill-based training. The PHANTOM project, headed by Kings College London is developing haptic-based virtual reality training systems for clinical dental training. ANDROMEDA seeks to build on this and establish a Flexible Learning Platform that can integrate the haptic and sensor based training with rich media knowledge transfer, whilst using sophisticated technologies such as including service-orientated architecture (SOA), Semantic Web technologies, knowledge-based engineering, business intelligence (BI) and virtual worlds for personalization.

  13. Improving interMediAte Risk management. MARK study

    PubMed Central

    2011-01-01

    Background Cardiovascular risk functions fail to identify more than 50% of patients who develop cardiovascular disease. This is especially evident in the intermediate-risk patients in which clinical management becomes difficult. Our purpose is to analyze if ankle-brachial index (ABI), measures of arterial stiffness, postprandial glucose, glycosylated hemoglobin, self-measured blood pressure and presence of comorbidity are independently associated to incidence of vascular events and whether they can improve the predictive capacity of current risk equations in the intermediate-risk population. Methods/Design This project involves 3 groups belonging to REDIAPP (RETICS RD06/0018) from 3 Spanish regions. We will recruit a multicenter cohort of 2688 patients at intermediate risk (coronary risk between 5 and 15% or vascular death risk between 3-5% over 10 years) and no history of atherosclerotic disease, selected at random. We will record socio-demographic data, information on diet, physical activity, comorbidity and intermittent claudication. We will measure ABI, pulse wave velocity and cardio ankle vascular index at rest and after a light intensity exercise. Blood pressure and anthropometric data will be also recorded. We will also quantify lipids, glucose and glycosylated hemoglobin in a fasting blood sample and postprandial capillary glucose. Eighteen months after the recruitment, patients will be followed up to determine the incidence of vascular events (later follow-ups are planned at 5 and 10 years). We will analyze whether the new proposed risk factors contribute to improve the risk functions based on classic risk factors. Discussion Primary prevention of cardiovascular diseases is a priority in public health policy of developed and developing countries. The fundamental strategy consists in identifying people in a high risk situation in which preventive measures are effective and efficient. Improvement of these predictions in our country will have an immediate, clinical and welfare impact and a short term public health effect. Trial Registration Clinical Trials.gov Identifier: NCT01428934 PMID:21992621

  14. MediKids Health Insurance Act of 2009

    THOMAS, 111th Congress

    Sen. Rockefeller, John D., IV [D-WV

    2009-05-01

    05/01/2009 Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S5023-5027) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  15. Chocolate in History: Food, Medicine, Medi-Food

    PubMed Central

    Lippi, Donatella

    2013-01-01

    Throughout history, chocolate has been used to treat a wide variety of ailments, and in recent years, multiple studies have found that chocolate can have positive health effects, providing evidence to a centuries-long established use; this acknowledgement, however, did not have a straight course, having been involved in religious, medical and cultural controversies. Christian Europe, in fact, feared the exhilarating effects of new drinks, such as chocolate, coffee and tea. Therefore, these beverages would have been banished, had not doctors and scientists explained that they were good for the body. The scientific debate, which reached its peak in Florence in the 18th century, regarded the therapeutic effectiveness of the various chocolate components: it was necessary to know their properties first, in order to prepare the best cacao concoction for every patient. When Dietetics separated from Medicine, however, chocolate acquired the role of vehicle for easing the administration of bitter medicines, being associated to different health problems. The recent rediscovery of the beneficial use of cacao and chocolate focuses upon its value as supplemental nutrition. Building a bridge to the past may be helpful to detect the areas where the potential health benefits of chocolate are likely to be further explored. PMID:23673608

  16. Chocolate in history: food, medicine, medi-food.

    PubMed

    Lippi, Donatella

    2013-05-14

    Throughout history, chocolate has been used to treat a wide variety of ailments, and in recent years, multiple studies have found that chocolate can have positive health effects, providing evidence to a centuries-long established use; this acknowledgement, however, did not have a straight course, having been involved in religious, medical and cultural controversies. Christian Europe, in fact, feared the exhilarating effects of new drinks, such as chocolate, coffee and tea. Therefore, these beverages would have been banished, had not doctors and scientists explained that they were good for the body. The scientific debate, which reached its peak in Florence in the 18th century, regarded the therapeutic effectiveness of the various chocolate components: it was necessary to know their properties first, in order to prepare the best cacao concoction for every patient. When Dietetics separated from Medicine, however, chocolate acquired the role of vehicle for easing the administration of bitter medicines, being associated to different health problems. The recent rediscovery of the beneficial use of cacao and chocolate focuses upon its value as supplemental nutrition. Building a bridge to the past may be helpful to detect the areas where the potential health benefits of chocolate are likely to be further explored.

  17. Effects of Energy Per-Unit Length on the Structure and Hardness of the Metal in the Weld-Affected Zone in Welding Alpha-Ti Alloy (Vliyaniye Pogonnoy Energii na Strukturu i Tverdost’ Metalla Okoloshovnoy Zony pri Sbarke Alpha-Splava Titana),

    DTIC Science & Technology

    1978-03-10

    we 3 .. 1 230 16 22 800 • 4 ~~Bom~pauoebdt CliCk- 1 230 17 22 850oa, npnca.aka 81-1 5 ~ To we 1 310 18 22 1200 6 BoIb~ pauoe~~ ~~~~~~~~~ 1 450 34 22...Vickers hardness results are given below. MaplcHpoBxa o6pa~~a 1 2 3 4 5 6 - 7 8 10 11 12 • I COOTIeTCTBiui C ,aój, . 1• 0 T.ep~ocm no Buic- 284 286 280 262...SM. Metallurg i cal Problems of Welding Titanium . In Sbornik “Titan I yego splavy” AN SSSR, Moscow, 1960, pp. 124—134. 4 . Shorshorov, K.Kh. and

  18. MediLink: a wearable telemedicine system for emergency and mobile applications.

    PubMed

    Koval, T; Dudziak, M

    1999-01-01

    The practical needs of the medical professional faced with critical care or emergency situations differ from those working in many environments where telemedicine and mobile computing have been introduced and tested. One constructive criticism of the telemedicine initiative has been to question what positive benefits are gained from videoconferencing, paperless transactions, and online access to patient record. With a goal of producing a positive answer to such questions an architecture for multipurpose mobile telemedicine applications has been developed. The core technology is based upon a wearable personal computer with a smart-card interface coupled with speech, pen, video input and wireless intranet connectivity. The TransPAC system with the MedLink software system is designed to provide an integrated solution for a broad range of health care functions where mobile and hands-free or limited-access systems are preferred or necessary and where the capabilities of other mobile devices are insufficient or inappropriate. Structured and noise-resistant speech-to-text interfacing plus the use of a web browser-like display, accessible through either a flatpanel, standard, or headset monitor, gives the beltpack TransPAC computer the functions of a complete desktop including PCMCIA card interfaces for internet connectivity and a secure smartcard with 16-bit microprocessor and upwards of 64K memory. The card acts to provide user access control for security, user custom configuration of applications and display and vocabulary, and memory to diminish the need for PC-server communications while in an active session. TransPAC is being implemented for EMT and ER staff usage.

  19. MEDI4736 (Durvalumab) in Patients With Brain Metastasis From Epithelial-derived Tumors

    ClinicalTrials.gov

    2017-01-23

    Non-Small Cell Lung Cancer; Nonsmall Cell Lung Cancer; Breast Cancer; Cancer of Breast; Cancer of the Breast; Gastroesophageal Cancer; Pancreatic Cancer; Cancer of the Pancreas; Colorectal Cancer; Colorectal Carcinoma; Renal Cancer; Kidney Cancer; Cancer of the Kidney; Cancer of Kidney; Ovarian Cancer; Ovary Cancer; Cancer of the Ovary; Cancer of Ovary

  20. The Role of Energy Balance in Successful Aging Among Elderly Individuals: The Multinational MEDIS Study.

    PubMed

    Tyrovolas, Stefanos; Haro, Josep Maria; Mariolis, Anargiros; Piscopo, Suzanne; Valacchi, Giuseppe; Makri, Kornilia; Zeimbekis, Akis; Tyrovola, Dimitra; Bountziouka, Vassiliki; Gotsis, Efthimios; Metallinos, George; Tur, Josep-Antoni; Matalas, Antonia; Lionis, Christos; Polychronopoulos, Evangelos; Panagiotakos, Demosthenes

    2015-12-01

    The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging. A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measured through successful aging. © The Author(s) 2015.

  1. Successful Aging among Elders Living in the Mani Continental Region vs. Insular Areas of the Mediterranean: the MEDIS Study

    PubMed Central

    Mariolis, Anargiros; Foscolou, Alexandra; Tyrovolas, Stefanos; Piscopo, Suzanne; Valacchi, Giuseppe; Tsakountakis, Nikos; Zeimbekis, Akis; Bountziouka, Vassiliki; Gotsis, Efthimios; Metallinos, George; Tyrovola, Dimitra; Tur, Josep-Antoni; Matalas, Antonia-Leda; Lionis, Christos; Polychronopoulos, Evangelos; Panagiotakos, Demosthenes

    2016-01-01

    To evaluate the role of geography i.e., continental vs. insular Mediterranean, on successful aging among older inhabitants. During 2005-2014, 2693 elderly (aged 65 to 100 years) individuals from 21 Mediterranean islands in Greece, Italy and Spain as well as Cyprus, Malta, and the rural region of Mani (southeast continental region of Greece keeping old-time traditions), were voluntarily recruited. Successful aging was evaluated using a validated index composed of 10 health-related socio-lifestyle and clinical characteristics. After accounting for age, sex, body mass index (BMI), physical activity, smoking habits, MedDietScore and access to health care services, the older inhabitants of islands were found to have a higher level of the successful aging index when compared to their counterparts in Mani (Beta=0.174, p<0.001); moreover, islanders exhibited slightly more years of “good” health (68.7 vs 68.4 years for Mani residents (p=0.99)). However, compared to the residents of Mani, islanders had 1.64 times higher odds (95%CI, 1.08-2.48) for having hypertension, 2.4-times higher odds (95%CI, 1.34-4.21) for having diabetes and 1.52 times higher odds (95%CI, 0.97-2.38) for having hypercholesterolemia. Engaging in physical activities and healthy dietary habits were the major determinants of healthy aging, among islanders as compared to their counterparts of continental Mani region. Elder residents of the continental Mani area enjoyed a better health status, whereas elder islanders had a higher level of successful aging; a finding which could be attributed to differences in lifestyle among elders. PMID:27330843

  2. 78 FR 6167 - Order of Suspension of Trading; In the Matter of Medis Technologies Ltd., Modern Medical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-29

    ...., Tamir Biotechnology, Inc., and Techmedia Advertising, Inc., January 25, 2013. It appears to the... concerning the securities of Tamir Biotechnology, Inc. because it has not filed any periodic reports since...

  3. Current and future directions in Medi-Cal chronic disease care management: a view from the top.

    PubMed

    Goldman, L Elizabeth; Handley, Margaret; Rundall, Thomas G; Schillinger, Dean

    2007-05-01

    To determine the extent to which Medicaid managed care (MMC) organizations are engaged in chronic disease care management (CDCM), tailor CDCM for diverse populations, or plan to expand CDCM. Web-based survey of 23 eligible California MMC health plan executives in fall 2005. Frequency distributions of survey responses. Nineteen (83%) of 23 executives responded, representing 2.5 million beneficiaries. Eighteen (95%) MMC plans reported implementing 1 or more elements of CDCM. Although plans used a wide range of CDCM strategies to reach performance goals, most implemented provider awareness activities such as offering guidelines or disease-specific feedback to physician groups. More than half of the plans reported interest in expanding CDCM to include more active interventions such as disease registries, pay for performance, telephone counseling to patients, and other self-management support programs. Few plans reported tailoring their CDCM to vulnerable member populations such as those with limited literacy or limited English proficiency. Executives reported that insufficient financial resources at the plan level, lack of organizational leadership and commitment in physician organizations, and limited information technology in physician offices were barriers to CDCM expansion. California MMC health plans reported substantial interest in CDCM and a desire to increase CDCM. Representatives reported intentions to expand to strategies that more directly engage providers and patients. To ensure that the growing number of vulnerable enrollees with chronic disease receive high-quality care, policy efforts should focus on enabling MMC health plans to more consistently implement and target population-based strategies such as CDCM.

  4. Glucose meters: evaluation of the new formulation measuring strips from Roche (Accu-Chek) and Abbott (MediSense).

    PubMed

    Dimeski, G; Jones, B W; Tilley, V; Greenslade, M N; Russell, A W

    2010-07-01

    Both Roche and Abbott have released new glucose meter strips. They supply the entire Australian hospital market. The present study compared the performance of the new strips utilizing various specimen types (capillary, venous lithium heparin whole blood, venous lithium heparin plasma and serum) and evaluated how well they comply with the International Standards Organization (ISO) 15197 criteria. The study included imprecision, patient comparison and interference studies. Participants with and without diabetes were recruited to evaluate the performance of various specimen types against the Beckman DxC800 glucose method. The strips were tested for different interferences: galactose, maltose, lactose, Icodextrin, Intragam, paracetamol, sodium, ascorbic acid, variable strip storage temperature, haematocrit, haemolysis and lipaemia. The imprecision of the two strips was approximately 5% or less, except for the Abbott strip at very low values (1.4 mmol/L), approximately 7%. In total, 78% and 84%, respectively, of the results from the finger prick capillary specimens with the Roche (Accu-Chek Performa meter) and Abbott (Optium Xceed meter) strips, not 95% or greater as recommended by the ISO guideline, were within the recommended limits compared with reference plasma estimation on laboratory analysers. Galactose, ascorbic acid, haematocrit and sodium on the Roche and ascorbic acid and haematocrit on the Abbott strip continue to interfere to a variable degree with the glucose measurement. Analytically small differences exist between the glucose meter strips. The most significant analytical difference with the strips was at low glucose levels when compared with laboratory analyses and this may be of clinical importance. The impact of some of the interferences is variable between the two strips. Individuals, health-care professionals and health-care institutions should consider these data when selecting glucose meters for the management of people with diabetes mellitus.

  5. Skeletal muscle mass and body fat in relation to successful ageing of older adults: The multi-national MEDIS study.

    PubMed

    Tyrovolas, Stefanos; Haro, Josep-Maria; Mariolis, Anargiros; Piscopo, Suzanne; Valacchi, Giuseppe; Bountziouka, Vassiliki; Anastasiou, Foteini; Zeimbekis, Akis; Tyrovola, Dimitra; Foscolou, Alexandra; Gotsis, Efthimios; Metallinos, George; Tur, Josep-Antoni; Matalas, Antonia; Lionis, Christos; Polychronopoulos, Evangelos; Panagiotakos, Demosthenes

    2016-01-01

    The determinants that promote successful ageing still remain unknown. The aim of the present work was to evaluate the role of skeletal muscle mass and body fat percentage (BF%), in the level of successful ageing. during 2005-2011, 2663 older (aged 65-100 years) from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Appendicular skeletal muscle mass (ASM), skeletal muscle mass index (SMI) and BF% were calculated using population formulas. Dietary habits, energy intake, expenditure and energy balance were derived throughout standard procedures. A successful ageing index ranging from 0 to 10 was used. The mean ASM mass was 24±6.0kg, the SMI was 0.84±0.21 and the BF% was 44%. Females had lower SMI and higher BF% in comparison with males, respectively [(SMI: 0.66±0.09 vs. 1.03±0.11; BF%: 51% vs. 34%, (p<0.001)]. High successful agers had better rates in ASM (p=0.01), SMI (p<0.001) and BF% (p<0.001), compared with the medium and low successful ones. Changes in SMI [b-coefficient (95% CI):2.14 (1.57 to 2.71)] were positively associated with successful ageing, while changes in BF% [b-coefficient (95% CI): -0.04 (-0.05 to -0.03)] were inversely associated with successful ageing. Results from sensitivity analysis showed that the effects of variations on body composition were consistent, less pronounced in the positive energy balance group and more pronounced among the oldest old. Body composition changes seem to be associated with lower quality of life in the older adults, as measured through successful ageing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Successful aging, dietary habits and health status of elderly individuals: a k-dimensional approach within the multi-national MEDIS study.

    PubMed

    Tyrovolas, Stefanos; Haro, Josep Maria; Mariolis, Anargiros; Piscopo, Suzanne; Valacchi, Giuseppe; Tsakountakis, Nikos; Zeimbekis, Akis; Tyrovola, Dimitra; Bountziouka, Vassiliki; Gotsis, Efthimios; Metallinos, George; Tur, Josep-Antoni; Matalas, Antonia-Leda; Lionis, Christos; Polychronopoulos, Evangelos; Panagiotakos, Demosthenes

    2014-12-01

    The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100 years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. The Impact of the Financial Crisis on Lifestyle Health Determinants Among Older Adults Living in the Mediterranean Region: The Multinational MEDIS Study (2005-2015)

    PubMed Central

    Soulis, George; Mariolis, Anargiros; Piscopo, Suzanne; Anastasiou, Foteini; Zeimbekis, Akis; Tur, Josep-Antoni; Tyrovola, Dimitra; Gotsis, Efthimios; Metallinos, George; Matalas, Antonia-Leda

    2017-01-01

    Objectives By the end of the 2000s, the economic situation in many European countries started to deteriorate, generating financial uncertainty, social insecurity and worse health status. The aim of the present study was to investigate how the recent financial crisis has affected the lifestyle health determinants and behaviours of older adults living in the Mediterranean islands. Methods From 2005 to 2015, a population-based, multi-stage convenience sampling method was used to voluntarily enrol 2749 older adults (50% men) from 20 Mediterranean islands and the rural area of the Mani peninsula. Lifestyle status was evaluated as the cumulative score of four components (range, 0 to 6), that is, smoking habits, diet quality (MedDietScore), depression status (Geriatric Depression Scale) and physical activity. Results Older Mediterranean people enrolled in the study from 2009 onwards showed social isolation and increased smoking, were more prone to depressive symptoms, and adopted less healthy dietary habits, as compared to their counterparts participating earlier in the study (p<0.05), irrespective of age, gender, several clinical characteristics, or socioeconomic status of the participants (an almost 50% adjusted increase in the lifestyle score from before 2009 to after 2009, p<0.001). Conclusions A shift towards less healthy behaviours was noticeable after the economic crisis had commenced. Public health interventions should focus on older adults, particularly of lower socioeconomic levels, in order to effectively reduce the burden of cardiometabolic disease at the population level. PMID:28173690

  8. Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.

    PubMed

    Tuttle, C R; Dewey, K G

    1996-09-01

    To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California. Cost-savings analysis. Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal. Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%. Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from $3,442 to $4,944 (4% discount) to $4,475 to $6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between $459 and $659 (4% discount) and $597 and $808 (0% discount) per family. Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.

  9. A longitudinal evaluation of the effect of Medi-Cal managed care on supplemental security income and aid to families with dependent children enrollees in two California counties.

    PubMed

    Lo Sasso, A T; Freund, D A

    2000-09-01

    We examined the differential effect of Medicaid managed care (MMC) among Aid to Families With Dependent Children (AFDC) and Supplemental Security Income (SSI) enrollees over time by comparing the experiences of adult nonelderly enrollees in the Health Plan of San Mateo in California versus Ventura County's fee-for-service (FFS) enrollees. Four years of administrative claims data were used to construct a longitudinal data set and estimate panel data models to decompose the effect of managed care over time. AFDC MMC enrollees exhibited generally fewer ambulatory visits, lower expenditures, and higher monthly probabilities of a preventable hospitalization relative to comparably enrolled FFS patients. SSI MMC enrollees had more emergency department visits and higher monthly probabilities of hospitalization. However, SSI MMC enrollees had more ambulatory visits and more medications during the first year of enrollment relative to SSI FFS enrollees, although levels were similar in subsequent years. SSI MMC enrollees did not exhibit a significantly higher level of expenditures in the first year of enrollment, although in subsequent years, expenditure levels were significantly lower. The results for emergency department visits and preventable hospitalizations presented a decidedly downbeat picture of access to care for AFDC and SSI enrollees in MMC. However, some aspects of utilization under managed care exhibited results consistent with long-term- oriented treatment for enrollees with a greater likelihood of remaining in the system for a longer period of time (SSI enrollees). By contrast, enrollees more likely to be enrolled for shorter periods (AFDC enrollees) tended to exhibit care patterns under MMC consistent with lower levels of care relative to FFS.

  10. Anti-ICOS Monoclonal Antibody MEDI-570 in Treating Patients With Relapsed or Refractory Peripheral T-cell Lymphoma Follicular Variant or Angioimmunoblastic T-cell Lymphoma

    ClinicalTrials.gov

    2017-09-28

    Follicular Variant Peripheral T-Cell Lymphoma; Grade 1 Follicular Lymphoma; Grade 2 Follicular Lymphoma; Grade 3a Follicular Lymphoma; Recurrent Angioimmunoblastic T-cell Lymphoma; Recurrent Follicular Lymphoma; Recurrent Mature T- and NK-Cell Non-Hodgkin Lymphoma; Recurrent Mycosis Fungoides; Recurrent Primary Cutaneous T-Cell Non-Hodgkin Lymphoma; Refractory Angioimmunoblastic T-cell Lymphoma; Refractory Follicular Lymphoma; Refractory Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma; Stage IB Mycosis Fungoides; Stage II Mycosis Fungoides; Stage III Cutaneous T-Cell Non-Hodgkin Lymphoma; Stage III Mycosis Fungoides; Stage IV Cutaneous T-Cell Non-Hodgkin Lymphoma; Stage IV Mycosis Fungoides

  11. Nutrient intake in relation to central and overall obesity status among elderly people living in the Mediterranean islands: the MEDIS study.

    PubMed

    Tyrovolas, S; Psaltopoulou, T; Pounis, G; Papairakleous, N; Bountziouka, V; Zeimbekis, A; Gotsis, E; Antonopoulou, M; Metallinos, G; Polychronopoulos, E; Lionis, C; Panagiotakos, D B

    2011-06-01

    The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders. During 2005-2007, 553 elderly men and 637 elderly women (mean age 74±7years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern. The prevalence of obesity was 27% in males and 39% in females (p<0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p<0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity. The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight. Copyright © 2009 Elsevier B.V. All rights reserved.

  12. Promethium-147 capacitor.

    PubMed

    Kavetskiy, A; Yakubova, G; Lin, Q; Chan, D; Yousaf, S M; Bower, K; Robertson, J D; Garnov, A; Meier, D

    2009-06-01

    Beta particle surface fluxes for tritium, Ni-63, Pm-147, and Sr-90 sources were calculated in this work. High current density was experimentally achieved from Pm-147 oxide in silica-titana glass. A 96 GBq (2.6 Ci) Pm-147 4pi-source with flux efficiency greater than 50% was used for constructing a direct charge capacitor with a polyimide coated collector and vacuum as electrical insulation. The capacitor connected to high resistance (TOmega) loads produced up to 35 kV. Overall conversion efficiency was over 10% (on optimal load).

  13. Uniformed Services University of the Health Sciences Journal, 2001 Edition

    DTIC Science & Technology

    2002-05-15

    the specific goal of meeting the demands of military medi- cine . – The Honorable F. Whitten Peters, Secretary of the Air Force, Department of Defense...High-Speed Network Link to Internet-2. Through collaboration with the National Library of Medi- cine , an ultra, high-speed network link to Internet-2...Center’s Commission on Accreditation; the 2001 Conference on Military Medi- cine was recognized for 30.7 contact hours by the USU Office of CHE

  14. 75 FR 31797 - Center for Scientific Review; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-04

    ... for Scientific Review Special Emphasis Panel; Special Topics: Social Science and Population Studies... . Name of Committee: Center for Scientific Review Special Emphasis Panel; BMIT/CMIP/MEDI Imaging...

  15. The SAATELLITE and EVADE Clinical Studies Within the COMBACTE Consortium: A Public-Private Collaborative Effort in Designing and Performing Clinical Trials for Novel Antibacterial Drugs to Prevent Nosocomial Pneumonia.

    PubMed

    François, Bruno; Chastre, Jean; Eggiman, Philippe; Laterre, Pierre-François; Torres, Antoni; Sanchez, Miguel; Esser, Mark T; Bishop, Brian; Bonten, Marc; Goosens, Herman; Jafri, Hasan S

    2016-08-15

    The Innovative Medicines Initiative-funded COMBACTE consortium fosters academic-industry partnership in pioneering studies to combat serious bacterial infections. We describe how this partnership is advancing the development of 2 monoclonal antibodies, MEDI4893 and MEDI3902, for the prevention of nosocomial pneumonia.

  16. Development and evaluation of an ensemble resource linking medications to their indications

    PubMed Central

    Wei, Wei-Qi; Cronin, Robert M; Xu, Hua; Lasko, Thomas A; Bastarache, Lisa; Denny, Joshua C

    2013-01-01

    Objective To create a computable MEDication Indication resource (MEDI) to support primary and secondary use of electronic medical records (EMRs). Materials and methods We processed four public medication resources, RxNorm, Side Effect Resource (SIDER) 2, MedlinePlus, and Wikipedia, to create MEDI. We applied natural language processing and ontology relationships to extract indications for prescribable, single-ingredient medication concepts and all ingredient concepts as defined by RxNorm. Indications were coded as Unified Medical Language System (UMLS) concepts and International Classification of Diseases, 9th edition (ICD9) codes. A total of 689 extracted indications were randomly selected for manual review for accuracy using dual-physician review. We identified a subset of medication–indication pairs that optimizes recall while maintaining high precision. Results MEDI contains 3112 medications and 63 343 medication–indication pairs. Wikipedia was the largest resource, with 2608 medications and 34 911 pairs. For each resource, estimated precision and recall, respectively, were 94% and 20% for RxNorm, 75% and 33% for MedlinePlus, 67% and 31% for SIDER 2, and 56% and 51% for Wikipedia. The MEDI high-precision subset (MEDI-HPS) includes indications found within either RxNorm or at least two of the three other resources. MEDI-HPS contains 13 304 unique indication pairs regarding 2136 medications. The mean±SD number of indications for each medication in MEDI-HPS is 6.22±6.09. The estimated precision of MEDI-HPS is 92%. Conclusions MEDI is a publicly available, computable resource that links medications with their indications as represented by concepts and billing codes. MEDI may benefit clinical EMR applications and reuse of EMR data for research. PMID:23576672

  17. In-Situ Missions for the Exploration of Titan's Lakes

    NASA Technical Reports Server (NTRS)

    Elliott, John O.; Waite, J. Hunter

    2011-01-01

    The lakes of Titan represent an increasingly tantalizing target for future exploration. As Cassini continues to reveal more details the lakes appear to offer a particularly rich reservoir of knowledge that could provide insights to Titan's formation and evolution, as well as an ideal location to explore Titan's potential for pre-biotic chemistry. A recent study of Titan Lake Probe missions was undertaken as one of several dozen studies commissioned by the National Research Council (NRC) Planetary Decadal Survey to explore the technical readiness, feasibility and affordability of scientifically promising mission scenarios. This in-depth study focused on an in-situ examination of a hydrocarbon lake on the Saturnian moon Titan--a target that presents unique scientific opportunities as well as several unique engineering challenges (e.g., submersion systems and cryogenic sampling) to enable those measurements. Per direction from the NRC Planetary Decadal Survey Satellites Panel, and after an initial trade-space examination, study architectures focused on three possible New Frontiers-class missions and a more ambitious Flagship-class lander intended as the in-situ portion of a larger collaborative mission. Detailed point designs were developed to explore these four potential mission options, including consideration of flight system and mission designs, as well as operations on and under the lake's surface and scenarios for data return. In this paper we present an overview of the science objectives of the missions, the mission architecture and surface.

  18. In-Situ Missions for the Exploration of Titan's Lakes

    NASA Technical Reports Server (NTRS)

    Elliott, John O.; Waite, J. Hunter

    2011-01-01

    The lakes of Titan represent an increasingly tantalizing target for future exploration. As Cassini continues to reveal more details the lakes appear to offer a particularly rich reservoir of knowledge that could provide insights to Titan's formation and evolution, as well as an ideal location to explore Titan's potential for pre-biotic chemistry. A recent study of Titan Lake Probe missions was undertaken as one of several dozen studies commissioned by the National Research Council (NRC) Planetary Decadal Survey to explore the technical readiness, feasibility and affordability of scientifically promising mission scenarios. This in-depth study focused on an in-situ examination of a hydrocarbon lake on the Saturnian moon Titan--a target that presents unique scientific opportunities as well as several unique engineering challenges (e.g., submersion systems and cryogenic sampling) to enable those measurements. Per direction from the NRC Planetary Decadal Survey Satellites Panel, and after an initial trade-space examination, study architectures focused on three possible New Frontiers-class missions and a more ambitious Flagship-class lander intended as the in-situ portion of a larger collaborative mission. Detailed point designs were developed to explore these four potential mission options, including consideration of flight system and mission designs, as well as operations on and under the lake's surface and scenarios for data return. In this paper we present an overview of the science objectives of the missions, the mission architecture and surface.

  19. Molecular basis for the antagonistic activity of an anti-CXCR4 antibody

    PubMed Central

    Peng, Li; Damschroder, Melissa M.; Cook, Kimberly E.; Wu, Herren; Dall'Acqua, William F.

    2016-01-01

    Antagonistic antibodies targeting the G-protein C-X-C chemokine receptor 4 (CXCR4) hold promising therapeutic potential in various diseases. We report for the first time the detailed mechanism of action at a molecular level of a potent anti-CXCR4 antagonistic antibody (MEDI3185). We characterized the MEDI3185 paratope using alanine scanning on all 6 complementary-determining regions (CDRs). We also mapped its epitope using CXCR4 mutagenesis to assess the relative importance of the CXCR4 N-terminal peptide, extracellular loops (ECL) and ligand-binding pocket. We show that the interaction between MEDI3185 and CXCR4 is mediated mostly by CDR3H in MEDI3185 and ECL2 in CXCR4. The MEDI3185 epitope comprises the entire ECL2 sequence, lacks any so-called ‘hot-spot’ and is remarkably resistant to mutations. The structure of MEDI3185 variable domains was modeled, and suggested a β-strand/β-strand interaction between MEDI3185 CDR3H and CXCR4 ECL2, resulting in direct steric hindrance with CXCR4 ligand SDF-1. These findings may have important implications for designing antibody therapies against CXCR4. PMID:26514996

  20. Relationship Of Mediterranean Diet And Caloric Intake To Phenoconversion In Huntington Disease

    PubMed Central

    Marder, Karen; Gu, Yian; Eberly, Shirley; Tanner, Caroline M.; Scarmeas, Nikolaos; Oakes, David; Shoulson, Ira

    2014-01-01

    Importance Adherence to Mediterranean-type diet (MeDi) may delay onset of Alzheimer's and Parkinson's disease. Whether adherence to MeDi affects time to phenoconversion in Huntington’s Disease (HD), a highly penetrant, single gene disorder, is unknown. Objective To determine if MeDi modifies the time to clinical onset of HD ('phenoconversion') in premanifest carriers participating in Prospective Huntington At Risk Observational Study (PHAROS), and to examine the effects of BMI and caloric intake on time to phenoconversion. Design A prospective cohort study. Setting 41 Huntington Study Group sites in the US and Canada. Participants 1001 participants were enrolled in PHAROS between July 1999 and January 2004, and were followed every 9 months until 2010. A total of 211 participants aged 26–57 with an expanded CAG repeat (≥37) were included in the current study. Exposure A semi-quantitative food frequency questionnaire (FFQ) was administered 33 months after baseline. We calculated daily gram intake for dairy, meat, fruit, vegetables, legumes, cereals, fish, monounsaturated and saturated fatty-acids, and alcohol, and constructed MeDi scores (0–9); higher scores indicate higher adherence. Demographics, medical history, BMI, and Unified Huntington's Disease Rating Scale (UHDRS) were collected. Main Outcome Measure Cox proportional hazards models to determine the association of MeDi and phenoconversion. Results Age, caloric intake, gender, education, and UHDRS motor scores did not differ among MeDi tertiles (0–3, 4–5, 6–9). The highest BMI was associated with lowest adherence to MeDi. 31 participants phenoconverted. In a model adjusted for age, CAG, and caloric intake, MeDi was not associated with phenoconversion (p for trend=0.14 for tertile of MeDi, and p=0.22 for continuous MeDi). When individual diet components of MeDi were analyzed, higher dairy consumption (hazard ratio 2.36; 1.0–5.57; p=0.051) and higher caloric intake (p=0.035) were associated with

  1. Relationship of Mediterranean diet and caloric intake to phenoconversion in Huntington disease.

    PubMed

    Marder, Karen; Gu, Yian; Eberly, Shirley; Tanner, Caroline M; Scarmeas, Nikolaos; Oakes, David; Shoulson, Ira

    2013-11-01

    Adherence to Mediterranean-type diet (MeDi) may delay onset of Alzheimer and Parkinson diseases. Whether adherence to MeDi affects time to phenoconversion in Huntington disease (HD), a highly penetrant, single-gene disorder, is unknown. To determine if MeDi modifies the time to clinical onset of HD (phenoconversion) in premanifest carriers participating in Prospective Huntington at Risk Observational Study (PHAROS), and to examine the effects of body mass index and caloric intake on time to phenoconversion. A prospective cohort study of 41 Huntington study group sites in the United States and Canada involving 1001 participants enrolled in PHAROS between July 1999 and January 2004 who were followed up every 9 months until 2010. A total of 211 participants aged 26 to 57 years had an expanded CAG repeat length (≥ 37). A semiquantitative food frequency questionnaire was administered 33 months after baseline. We calculated daily gram intake for dairy, meat, fruit, vegetables, legumes, cereals, fish, monounsaturated and saturated fatty acids, and alcohol and constructed MeDi scores (0-9); higher scores indicate higher adherence. Demographics, medical history, body mass index, and Unified Huntington's Disease Rating Scale (UHDRS) score were collected. Cox proportional hazards regression models to determine the association of MeDi and phenoconversion. RESULTS Age, sex, caloric intake, education status, and UHDRS motor scores did not differ among MeDi tertiles (0-3, 4-5, and 6-9). The highest body mass index was associated with the lowest adherence to MeDi. Thirty-one participants phenoconverted. In a model adjusted for age, CAG repeat length, and caloric intake, MeDi was not associated with phenoconversion (P for trend = 0.14 for tertile of MeDi, and P = .22 for continuous MeDi). When individual components of MeDi were analyzed, higher dairy consumption (hazard ratio, 2.36; 95% CI, 1.0-5.57; P = .05) and higher caloric intake (P = .04) were associated with risk of

  2. Molecular basis for the mechanism of action of an anti-TACE antibody

    PubMed Central

    Peng, Li; Cook, Kimberly; Xu, Linda; Cheng, Li; Damschroder, Melissa; Gao, Changshou; Wu, Herren; Dall'Acqua, William F.

    2016-01-01

    ABSTRACT Inhibitors of tumor necrosis factor-α converting enzyme (TACE) have potential as therapeutics for various diseases. Many small molecule inhibitors, however, exhibit poor specificity profiles because they target the highly conserved catalytic cleft of TACE. We report for the first time the molecular interaction of a highly specific anti-TACE antagonistic antibody (MEDI3622). We characterized the binding of MEDI3622 using mutagenesis, as well as structural modeling and docking approaches. We show that MEDI3622 recognizes a unique surface loop of sIVa-sIVb β-hairpin on TACE M-domain, but does not interact with the conserved catalytic cleft or its nearby regions. The exquisite specificity of MEDI3622 is mediated by this distinct structural feature on the TACE M-domain. These findings may aid the design of antibody therapies against TACE. PMID:27610476

  3. EXPOSURE ASSESSMENT TOOLS FOR CUMULATIVE RISK ASSESSMENT: MEASUREMENT OF ENDOGENOUS BIOMARKERS

    EPA Science Inventory

    Direct assessment of cumulative risks is a difficult task due to combinations of multiple chemicals, exposure pathways, and concentration profiles using suites of environmental measurements. We are investigating the use of endogenous compounds commonly present in biological medi...

  4. Adherence to a Mediterranean diet in Morocco and its correlates: cross-sectional analysis of a sample of the adult Moroccan population

    PubMed Central

    2012-01-01

    Background Dietary habits in Morocco are changing and the causes are not well understood. This study aimed to analyse socio-demographic factors associated with adherence to the Mediterranean diet (MeDi) in a national random sample of the adult Moroccan population. Methods The data collected in this cross-sectional survey included socio-demographic factors and a food frequency questionnaire. MeDi adherence was assessed in 2214 individuals with complete dietary data. MeDi adherence was measured according to a simplified MeDi score based on the weekly frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and olive oil) with the use of the sex specific medians of the sample as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. Logistic regression was used to estimate the association between MeDi adherence (low score 1-4 vs. high 5-8) and other factors. Results Mean age of the sample was 41.4 (standard deviation 15.3) years, 45.4% were men and 29.9% had a low MeDi adherence. Married subjects (adjusted odds ratio ORa=0.68, 95% CI 0.55-0.84) were less likely to have a low MeDi adherence compared to single, divorced or widowed persons. Persons from rural areas (ORa=1.46, 95% CI: 1.02-2.08), were more often low MeDi adherents compared to those from urban areas. Obese persons (ORa=1.56, 95% CI: 1.16-2.11) were more prone to low MeDi adherence than normal weight individuals. Conclusion MeDi is far from being a universal pattern in the Moroccan population. Intervention strategies should be implemented in target groups to maintain the traditional MeDi pattern considered as the original diet in Morocco. PMID:22578133

  5. The Valium Project: Diagnostic restrictions as a utilization control in a Medicaid drug program

    PubMed Central

    Boisseree, Victor R.; Keith, John C.; Little, Daniel L.

    1984-01-01

    This study examines the effectiveness of diagnosis restrictions as a drug utilization control in California's Medi-Cal (Medicaid) program. The numbers of Valium prescriptions dispensed, the numbers of Medi-Cal beneficiaries using Valium and the expenditures represented by those prescriptions were measured during application of a diagnosis restriction for a 33-month base period, followed by removal of the diagnosis restriction for a 14-month period. PMID:10310598

  6. Mediterranean Diet, Inflammatory and Metabolic Biomarkers, and Risk of Alzheimer’s Disease

    PubMed Central

    Gu, Yian; Luchsinger, Jose A.; Stern, Yaakov; Scarmeas, Nikolaos

    2011-01-01

    We aimed to investigate the association between adherence to the Mediterranean diet (MeDi) and Alzheimer’s disease (AD) risk in a prospective study. Specifically, we analyzed reduced inflammation and improved metabolic profile as a potential medium through which the MeDi reduced the risk of AD. During a 4-year follow-up, 118 incident AD cases were identified among the 1219 non-demented elderly (age ≥ 65) subjects who provided dietary information and blood samples at baseline. We used high-sensitivity C-reactive protein (hsCRP) as an index of systemic inflammation, and fasting insulin and adiponectin as indexes of metabolic profile. We investigated whether there was a change in the association between MeDi and incident AD risk when the biomarkers were introduced into multivariable adjusted COX models. Better adherence to MeDi was associated with lower level of hsCRP (p = 0.003), but not fasting insulin or adiponectin. Better adherence to MeDi was significantly associated with lower risk for AD: compared to those in the lowest tertile of MeDi, subjects in the highest tertile had a 34% less risk of developing AD (p-for-trend = 0.04). Introduction of the hsCRP, fasting insulin, adiponectin, or combinations of them into the COX model did not change the magnitude of the association between MeDi and incident AD. Ultimately, the favorable association between better adherence to MeDi and lower risk of AD did not seem to be mediated by hsCRP, fasting insulin, or adiponectin. Other aspects of inflammatory and metabolic pathways not captured by these biomarkers, or non-inflammatory or non-metabolic pathways, may be relevant to the MeDi-AD association. PMID:20847399

  7. To Determine the Best Means of Providing a Diagnostic Nuclear Medicine Capability at U.S. Darnall Army Hospital, Fort Hood, Texas.

    DTIC Science & Technology

    1979-07-01

    accuracy. 1 The scintillation camera, which detects radioactive tracers, became readily available comercially in 1964, and significantly im- pacted on the...Hospital to accommodate a nuclear medi- cine service. The hospital was about to start an extensive renovation and new construction program and the...September 1, 1970), p. 55. 6N. Jeanne Harris and Leslie R. Bennett, "Planning a Nuclear Medi- cine Service," Hospitals 47 (October 1, 1973), p. 90. 7

  8. Major International R and D Ranges and Test Facilities. Summary of Capabilities

    DTIC Science & Technology

    1990-01-01

    preventive medi- cine including the study of respiratory disease (viral and Developing airborne target systems that can be used for bacterial...support equipment to protect aircrews in normal operations and emergencies. School of Operational and Aerospace Medi- I cine . The School is a source of...closed circuit television (CCTV) for dynamic radiography and fluoroscopy . RARDE Headquarters 104 3 I UK ROYAL ARMAMENT I RESEARCHAND * DEVELOPMENT

  9. The Uniformed Services University of the Health Sciences Journal 2002 Edition Learning to Care for Those in Harm’s Way

    DTIC Science & Technology

    2003-08-25

    hospital GE Advantx X-ray unit equipped with fluoroscopy . This equipment allows advanced diagnostic capabilities for the central animal facility and...Professor, USU SOM Department of Medi- cine , was selected to serve as the Deputy Director of the Food and Drug Administration’s Office of New Drugs during...Emergency and Operational Medi- cine at the Walter Reed Army Medical Center (WRAMC). He was the first emergency physician to arrive on the scene

  10. Department of Clinical Investigation Annual Research Progress Report, Fiscal Year 1987

    DTIC Science & Technology

    1987-10-01

    Locally Advanced Ad- enocarcinoma of the Rectum. Present Concepts in Internal Medi- cine , American College of Physicians Meeting, San Francisco, CA...Oct 86 Colman LK: CT, CT Myelography and MRI in the Diagnosis of Metasta- ses to the Axial Skeleton. Present Concepts in Internal Medi- cine , American...possible by fluoroscopy . A radiopaque catheter will be used to identify the relevant subsegmental bronchus, and the bronchoscope will be wedged into

  11. A newly developed container for safe, easy, and cost-effective overnight transportation of tissues and organs by electrically keeping tissue or organ temperature at 3 to 6°C.

    PubMed

    Ohkawara, H; Kitagawa, T; Fukushima, N; Ito, T; Sawa, Y; Yoshimine, T

    2012-05-01

    As there is only one skin procurement organization in Japan the Japan Skin Bank Network (JSBN), all skin grafts procured in Japan are sent by a commercialized delivery system. Preliminarily, bottles containing saline were transported in a cardboard box using a so-called "cooled home delivery service" using a truck with a refrigerated cargo container. During transportation the temperature in the cardboard box increased to 18°C in summer and decreased to -5°C in winter. For these reasons, we investigated whether a newly developed container "Medi Cube" would be useful to transport skin grafts. Four bottles with a capacity of 300 mL containing 150 mL of saline in a Medi Cube container were transported from Osaka to the JSBN in Tokyo between 4 PM and 10 AM using a commercialized cooled home delivery service. Two bottles were transported in a Medi Cube container without phase change materials (PCM) in winter and summer, respectively. Another two bottles were transported in the Medi Cube with PCMs in winter. The temperatures inside saline, inside a transportation container, and outside the container, and air temperature were monitored continuously with a recordable thermometer. The temperatures inside saline and inside a Medi Cube container were maintained between 3 and 6°C, even when the temperature outside the container increased during parking. The temperature inside a Medi Cube container without PCM decreased to -3°C when the inside of the cargo container was overcooled in winter. However, the temperatures inside saline and inside a Medi Cube container with PCM were between 3 and 6°C, even when the temperature outside the container decreased to below 0°C in winter. A Medi Cube container with PCM provided a safe, easy, and cost-effective method for overnight transportation of skin grafts. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Adherence to a Mediterranean diet and Alzheimer's disease risk in an Australian population

    PubMed Central

    Gardener, S; Gu, Y; Rainey-Smith, S R; Keogh, J B; Clifton, P M; Mathieson, S L; Taddei, K; Mondal, A; Ward, V K; Scarmeas, N; Barnes, M; Ellis, K A; Head, R; Masters, C L; Ames, D; Macaulay, S L; Rowe, C C; Szoeke, C; Martins, R N

    2012-01-01

    The Mediterranean diet (MeDi), due to its correlation with a low morbidity and mortality for many chronic diseases, has been widely recognised as a healthy eating model. We aimed to investigate, in a cross-sectional study, the association between adherence to a MeDi and risk for Alzheimer's disease (AD) and mild cognitive impairment (MCI) in a large, elderly, Australian cohort. Subjects in the Australian Imaging, Biomarkers and Lifestyle Study of Ageing cohort (723 healthy controls (HC), 98 MCI and 149 AD participants) completed the Cancer Council of Victoria Food Frequency Questionnaire. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of AD and MCI status in multinominal logistic regression models that were adjusted for cohort age, sex, country of birth, education, apolipoprotein E genotype, total caloric intake, current smoking status, body mass index, history of diabetes, hypertension, angina, heart attack and stroke. There was a significant difference in adherence to the MeDi between HC and AD subjects (P<0.001), and in adherence between HC and MCI subjects (P<0.05). MeDi is associated with change in Mini-Mental State Examination score over an 18-month time period (P<0.05) in HCs. We conclude that in this Australian cohort, AD and MCI participants had a lower adherence to the MeDi than HC participants. PMID:23032941

  13. Cognitive and literacy screening as predictors of ability to fill a pillbox using two pillbox assessment scoring methods.

    PubMed

    Anderson, Kitty; Willmore, Catherine; Doran, Elizabeth; Oki, Naoto; Vonnahme, Joel; Gates, Brian J

    2014-01-01

    To compare patient cognition measured by Medi-Cog, a tool to assess cognitive literacy and pillbox skills, with pillbox concordance using two scoring methods, Pillbox Fill (PBF) and Prospective Pill Count (PPC). Prospective, descriptive, cross-sectional study. Primary care. Multiethnic participants with type 2 diabetes with sufficient vision and dexterity to load a pillbox. Medi-Cog scores were correlated with ability to fill a pillbox based on both the PPC and the PBF scoring methods. Variables were analyzed by multivariate linear and logistic regression. To determine whether there is a difference between PBF and PPC scoring methods relative to Medi-Cog prediction of pillbox concordance. Sixty-four participants loaded an average of 5.2 medications. Mean Medi-Cog score for five patients who failed PBF but passed PPC were lower than the entire cohort (5.6 compared with 6.2). Correlation between PBF and PPC methods was 0.978; P = 0.01. Regression values for Medi-Cog's ability to predict PBF and PPC scores were r = 0.668 and r2 = 0.446, and r = 0.660 and r2 = 0.436; P < 0.01 for all. Compared with PPC, PBF proved to be a more conservative scoring method and captured an additional five patients who scored less-well on the Medi-Cog. Future studies are needed to explore the value of using pillbox assessments as well as cognitive screening prior to recommending pillbox use.

  14. Mediterranean Diet and Mild Cognitive Impairment

    PubMed Central

    Scarmeas, Nikolaos; Stern, Yaakov; Mayeux, Richard; Manly, Jennifer; Schupf, Nicole; Luchsinger, Jose A.

    2009-01-01

    Background Higher adherence to the Mediterranean diet (MeDi) may protect from Alzheimer’s disease (AD) but its association with Mild Cognitive Impairment (MCI) has not been explored. Objective To investigate the association between MeDi and MCI. Design, Setting, Patients, Outcomes In a multiethnic community study in New York, we used Cox proportional hazards to investigate the association between adherence to the MeDi (0 – 9 scale; higher scores higher adherence) and (1) incidence of MCI and (2) progression from MCI to AD. All models were adjusted for cohort, age, gender, ethnicity, education, APOE genotype, caloric intake, body mass index and time duration between baseline dietary assessment and baseline diagnosis. Results There were 1393 cognitively normal participants, 275 of whom developed MCI during 4.5 (± 2.7, 0.9–16.4) years of follow-up. Compared to subjects in the lowest MeDi adherence tertile, subjects in the middle MeDi tertile had 17 % (HR, 0.83; 95% CI, 0.62 – 1.12; p=0.24) less risk of developing MCI, while those at the highest MeDi adherence tertile had 28 % (HR, 0.72; 95% CI, 0.52 – 1.00; p=0.05) less risk of developing MCI (trend HR, 0.85; 95% CI, 0.72 – 1.00; p for trend= 0.05). There were 482 subjects with MCI, 106 of whom developed AD during 4.3 (± 2.7, 1.0 – 13.8) years of follow-up. Compared to subjects in the lowest MeDi adherence tertile, subjects in the middle MeDi adherence tertile had 45 % (HR, 0.55; 95% CI, 0.34 – 0.90; p=0.01) less risk of developing AD, while those at the highest MeDi adherence tertile had 48 % (HR, 0.52; 95% CI, 0.30 – 0.91; p=0.02) less risk of developing AD (trend HR, 0.71; 95% CI, 0.53 – 0.95; p for trend= 0.02). Conclusions Higher adherence to the MeDi is associated with a trend for reduced risk for developing MCI and with reduced risk for MCI conversion to AD. PMID:19204158

  15. Mediterranean diet and Alzheimer disease mortality

    PubMed Central

    Scarmeas, Nikolaos; Luchsinger, Jose A.; Mayeux, Richard; Stern, Yaakov

    2009-01-01

    Background We previously reported that the Mediterranean diet (MeDi) is related to lower risk for Alzheimer disease (AD). Whether MeDi is associated with subsequent AD course and outcomes has not been investigated. Objectives To examine the association between MeDi and mortality in patients with AD. Methods A total of 192 community-based individuals in New York who were diagnosed with AD were prospectively followed every 1.5 years. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of mortality in Cox models that were adjusted for period of recruitment, age, gender, ethnicity, education, APOE genotype, caloric intake, smoking, and body mass index. Results Eighty-five patients with AD (44%) died during the course of 4.4 (±3.6, 0.2 to 13.6) years of follow-up. In unadjusted models, higher adherence to MeDi was associated with lower mortality risk (for each additional MeDi point hazard ratio 0.79; 95% CI 0.69 to 0.91; p = 0.001). This result remained significant after controlling for all covariates (0.76; 0.65 to 0.89; p = 0.001). In adjusted models, as compared with AD patients at the lowest MeDi adherence fertile, those at the middle fertile had lower mortality risk (0.65; 0.38 to 1.09; 1.33 years’ longer survival), whereas subjects at the highest fertile had an even lower risk (0.27; 0.10 to 0.69; 3.91 years’ longer survival; p for trend = 0.003). Conclusion Adherence to the Mediterranean diet (MeDi) may affect not only risk for Alzheimer disease (AD) but also subsequent disease course: Higher adherence to the MeDi is associated with lower mortality in AD. The gradual reduction in mortality risk for higher MeDi adherence tertiles suggests a possible dose–response effect. PMID:17846408

  16. Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study

    PubMed Central

    Gardener, Hannah; Wright, Clinton B.; Cabral, Digna; Scarmeas, Nikolaos; Gu, Yian; Cheung, Ken; Elkind, Mitchell S.V.; Sacco, Ralph L.; Rundek, Tatjana

    2015-01-01

    Objective Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area. Methods The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0–9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6 –9 vs. 0–2). Results Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm2, 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = −0.049 mm, p = 0.03; median of plaque area = −0.371 mm2, p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0–2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested. Conclusions Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease. PMID:24721190

  17. Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study.

    PubMed

    Gardener, Hannah; Wright, Clinton B; Cabral, Digna; Scarmeas, Nikolaos; Gu, Yian; Cheung, Ken; Elkind, Mitchell S V; Sacco, Ralph L; Rundek, Tatjana

    2014-06-01

    Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area. The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0-9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6-9 vs. 0-2). Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm(2), 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = -0.049 mm, p = 0.03; median of plaque area = -0.371 mm(2), p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0-2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested. Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease. Copyright © 2014. Published by Elsevier Ireland Ltd.

  18. Mediterranean diet and Alzheimer disease mortality.

    PubMed

    Scarmeas, Nikolaos; Luchsinger, Jose A; Mayeux, Richard; Stern, Yaakov

    2007-09-11

    We previously reported that the Mediterranean diet (MeDi) is related to lower risk for Alzheimer disease (AD). Whether MeDi is associated with subsequent AD course and outcomes has not been investigated. To examine the association between MeDi and mortality in patients with AD. A total of 192 community-based individuals in New York who were diagnosed with AD were prospectively followed every 1.5 years. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of mortality in Cox models that were adjusted for period of recruitment, age, gender, ethnicity, education, APOE genotype, caloric intake, smoking, and body mass index. Eighty-five patients with AD (44%) died during the course of 4.4 (+/-3.6, 0.2 to 13.6) years of follow-up. In unadjusted models, higher adherence to MeDi was associated with lower mortality risk (for each additional MeDi point hazard ratio 0.79; 95% CI 0.69 to 0.91; p = 0.001). This result remained significant after controlling for all covariates (0.76; 0.65 to 0.89; p = 0.001). In adjusted models, as compared with AD patients at the lowest MeDi adherence tertile, those at the middle tertile had lower mortality risk (0.65; 0.38 to 1.09; 1.33 years' longer survival), whereas subjects at the highest tertile had an even lower risk (0.27; 0.10 to 0.69; 3.91 years' longer survival; p for trend = 0.003). Adherence to the Mediterranean diet (MeDi) may affect not only risk for Alzheimer disease (AD) but also subsequent disease course: Higher adherence to the MeDi is associated with lower mortality in AD. The gradual reduction in mortality risk for higher MeDi adherence tertiles suggests a possible dose-response effect.

  19. [Comparison between two caller groups of a medical call centre in Switzerland].

    PubMed

    Ackermann Rau, S; Zwahlen, M

    2008-05-01

    The incidence distribution of triage advice in the medical call centre Medi24 and the pattern of service utilisation were analysed with respect to two groups of callers with different insurance schemes. Individuals having contracted insurance of the Medi24 model could use the telephone consultation service of the medical call centre Medi24 (mainly part of the mandatory basic health insurance) voluntarily and free of charge whereas individuals holding an insurance policy of the Telmed model (special contract within the mandatory basic health insurance with a premium discount ranging from 8% to 12%) were obliged to have a telephone consultation before arranging an appointment with a medical doctor. A cross-sectional study was carried out in the medical call centre Medi24 based on all triage datasets of the Medi24 and Telmed groups collected during the one year period from July 1st 2005 to June 30th 2006. The distribution of the six different urgency levels within the two groups and their respective pattern of service utilisation was determined. In a multivariable logistic regression model the Odds Ratio for every enquiry originating from the Telmed group versus those originating from the Medi24 group was calculated. During a one-year period 48 388 triage requests reached the medical call centre Medi24, 56% derived from the Telmed group and 44% from the Medi24 group. Within the Medi24 group more than 25% of the individuals received self-care advice, within the Telmed group, on the other hand, only about 18% received such advice. In contrast, 27% of the Telmed triage requests but only 18% of the Medi24 triage requests resulted in the advice to make a routine appointment with a medical doctor. The probability that an individual of the Telmed group obtained the advice to go to the accident and emergency department was lower than for an individual of the Medi24 group (OR 0.77, 95% CI 0.60-0.99). Likewise, the probability of self-care advice was decreased in regard to the

  20. Mediterranean Diet, Alzheimer Disease, and Vascular Mediation

    PubMed Central

    Scarmeas, Nikolaos; Stern, Yaakov; Mayeux, Richard; Luchsinger, Jose A.

    2011-01-01

    Objectives To examine the association between the Mediterranean diet (MeDi) and Alzheimer disease (AD) in a different AD population and to investigate possible mediation by vascular pathways. Design, Setting, Patients, and Main Outcome Measures A case-control study nested within a community-based cohort in New York, NY. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of AD status (194 patients with AD vs 1790 nondemented subjects) in logistic regression models that were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical comorbidity index, and body mass index (calculated as weight in kilograms divided by height in meters squared). We investigated whether there was attenuation of the association between MeDi and AD when vascular variables (stroke, diabetes mellitus, hypertension, heart disease, lipid levels) were simultaneously introduced in the models (which would constitute evidence of mediation). Results Higher adherence to the MeDi was associated with lower risk for AD (odds ratio, 0.76; 95% confidence interval, 0.67–0.87; P<.001). Compared with subjects in the lowest MeDi tertile, subjects in the middle MeDi tertile had an odds ratio of 0.47 (95% confidence interval, 0.29–0.76) and those at the highest tertile an odds ratio of 0.32 (95% confidence interval, 0.17–0.59) for AD (P for trend <.001). Introduction of the vascular variables in the model did not change the magnitude of the association. Conclusions We note once more that higher adherence to the MeDi is associated with a reduced risk for AD. The association does not seem to be mediated by vascular comorbidity. This could be the result of either other biological mechanisms (oxidative or inflammatory) being implicated or measurement error of the vascular variables. PMID:17030648

  1. Mediterranean-style diet and risk of ischemic stroke, myocardial infarction, and vascular death: the Northern Manhattan Study1234

    PubMed Central

    Gardener, Hannah; Wright, Clinton B; Gu, Yian; Demmer, Ryan T; Boden-Albala, Bernadette; Elkind, Mitchell SV; Sacco, Ralph L; Scarmeas, Nikolaos

    2011-01-01

    Background: A dietary pattern common in regions near the Mediterranean appears to reduce risk of all-cause mortality and ischemic heart disease. Data on blacks and Hispanics in the United States are lacking, and to our knowledge only one study has examined a Mediterranean-style diet (MeDi) in relation to stroke. Objective: In this study, we examined an MeDi in relation to vascular events. Design: The Northern Manhattan Study is a population-based cohort to determine stroke incidence and risk factors (mean ± SD age of participants: 69 ± 10 y; 64% women; 55% Hispanic, 21% white, and 24% black). Diet was assessed at baseline by using a food-frequency questionnaire in 2568 participants. A higher score on a 0–9 scale represented increased adherence to an MeDi. The relation between the MeDi score and risk of ischemic stroke, myocardial infarction (MI), and vascular death was assessed with Cox models, with control for sociodemographic and vascular risk factors. Results: The MeDi-score distribution was as follows: 0–2 (14%), 3 (17%), 4 (22%), 5 (22%), and 6–9 (25%). Over a mean follow-up of 9 y, 518 vascular events accrued (171 ischemic strokes, 133 MIs, and 314 vascular deaths). The MeDi score was inversely associated with risk of the composite outcome of ischemic stroke, MI, or vascular death (P-trend = 0.04) and with vascular death specifically (P-trend = 0.02). Moderate and high MeDi scores were marginally associated with decreased risk of MI. There was no association with ischemic stroke. Conclusions: Higher consumption of an MeDi was associated with decreased risk of vascular events. Results support the role of a diet rich in fruit, vegetables, whole grains, fish, and olive oil in the promotion of ideal cardiovascular health. PMID:22071704

  2. A Mediterranean-Style Diet and White Matter Hyperintensity Volume: the Northern Manhattan Study

    PubMed Central

    Gardener, Hannah; Scarmeas, Nikolaos; Gu, Yian; Boden-Albala, Bernadette; Elkind, Mitchell S.V.; Sacco, Ralph L.; DeCarli, Charles; Wright, Clinton B.

    2011-01-01

    Objective To examine the association between a Mediterranean-style diet (MeDi) and brain MRI white matter hyperintensities (WMH). The MeDi has previously been associated with a reduced risk of cardiovascular morbidity, possibly including stroke. A greater understanding of modifiable risk factors for small vessel damage may facilitate the prevention of stroke and cognitive decline. Design A cross-sectional analysis within a longitudinal population-based cohort study. A semi-quantitative food frequency questionnaire was administered and a score (range 0-9) was calculated to reflect increasing similarity to the MeDi pattern. Setting The Northern Manhattan Study. Participants 1,091 participants, of which 966 had dietary information (mean age 72, 59% women, 65% Hispanic, 16% White, 17% Black). Main outcome measures WMH volume was measured by quantitative brain MRI. Linear regression models were constructed to examine the relation between the MeDi score and the log-transformed WMH volume as a proportion of total cranial volume, controlling for sociodemographic and vascular risk factors. Results On the MeDi scale, 12% scored 0-2, 16 scored 3, 23% scored 4, 23% scored 5, 26% scored 6-9. Each 1-point increase in MeDi score was associated with a lower log WMH volume (β=-0.04, p=0.02). The only MeDi score component that was an independent predictor of WMH volume was the ratio of monounsaturated to saturated fat (β=-0.20, p=0.001). Conclusions A Mediterranean-style diet was associated with a lower WMH burden, a marker of small vessel damage in the brain. However, white matter hyperintensities are etiologically heterogenous and can include neurodegeneration. Replication by other population-based studies is needed. PMID:22332193

  3. Mediterranean diet, Alzheimer disease, and vascular mediation.

    PubMed

    Scarmeas, Nikolaos; Stern, Yaakov; Mayeux, Richard; Luchsinger, Jose A

    2006-12-01

    To examine the association between the Mediterranean diet (MeDi) and Alzheimer disease (AD) in a different AD population and to investigate possible mediation by vascular pathways. Design, Setting, Patients, and A case-control study nested within a community-based cohort in New York, NY. Adherence to the MeDi (0- to 9-point scale with higher scores indicating higher adherence) was the main predictor of AD status (194 patients with AD vs 1790 nondemented subjects) in logistic regression models that were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, smoking, medical comorbidity index, and body mass index (calculated as weight in kilograms divided by height in meters squared). We investigated whether there was attenuation of the association between MeDi and AD when vascular variables (stroke, diabetes mellitus, hypertension, heart disease, lipid levels) were simultaneously introduced in the models (which would constitute evidence of mediation). Higher adherence to the MeDi was associated with lower risk for AD (odds ratio, 0.76; 95% confidence interval, 0.67-0.87; P<.001). Compared with subjects in the lowest MeDi tertile, subjects in the middle MeDi tertile had an odds ratio of 0.47 (95% confidence interval, 0.29-0.76) and those at the highest tertile an odds ratio of 0.32 (95% confidence interval, 0.17-0.59) for AD (P for trend <.001). Introduction of the vascular variables in the model did not change the magnitude of the association. We note once more that higher adherence to the MeDi is associated with a reduced risk for AD. The association does not seem to be mediated by vascular comorbidity. This could be the result of either other biological mechanisms (oxidative or inflammatory) being implicated or measurement error of the vascular variables.

  4. Mediterranean-type diet and brain structural change from 73 to 76 years in a Scottish cohort

    PubMed Central

    Corley, Janie; Cox, Simon R.; Valdés Hernández, Maria C.; Craig, Leone C.A.; Dickie, David Alexander; Karama, Sherif; McNeill, Geraldine M.; Bastin, Mark E.; Wardlaw, Joanna M.; Deary, Ian J.

    2017-01-01

    Objective: To assess the association between Mediterranean-type diet (MeDi) and change in brain MRI volumetric measures and mean cortical thickness across a 3-year period in older age (73–76 years). Methods: We focused on 2 longitudinal brain volumes (total and gray matter; n = 401 and 398, respectively) plus a longitudinal measurement of cortical thickness (n = 323), for which the previous cross-sectional evidence of an association with the MeDi was strongest. Adherence to the MeDi was calculated from data gathered from a food frequency questionnaire at age 70, 3 years prior to the baseline imaging data collection. Results: In regression models adjusting for relevant demographic and physical health indicators, we found that lower adherence to the MeDi was associated with greater 3-year reduction in total brain volume (explaining 0.5% of variance, p < 0.05). This effect was half the size of the largest covariate effect (i.e., age). Cross-sectional associations between MeDi and baseline MRI measures in 562 participants were not significant. Targeted analyses of meat and fish consumption did not replicate previous associations with total brain volume or total gray matter volume. Conclusions: Lower adherence to the MeDi in an older Scottish cohort is predictive of total brain atrophy over a 3-year interval. Fish and meat consumption does not drive this change, suggesting that other components of the MeDi or, possibly, all of its components in combination are responsible for the association. PMID:28053008

  5. Factors associated with Mediterranean diet adherence in Huntington's disease.

    PubMed

    Rivadeneyra, Jéssica; Cubo, Esther; Gil, Cecilia; Calvo, Sara; Mariscal, Natividad; Martínez, Asunción

    2016-04-01

    Little is known about the importance of the Mediterranean Diet (MeDi) and dietary intake as environmental neuroprotective factors in Huntington's disease (HD); so, we evaluated and analyzed the prevalence and factors associated with MeDi adherence, and dietary intake in HD. Spanish participants of the European Huntington Disease Network (EHDN) Registry study diagnosed with HD or premanifest HD gene carriers were included from June 2012 to August 2013. Self-reported dietary intake was collected by 3-day dietary record, MeDi adherence was assessed by 0-9 range (proposed by Trichopoulou et al.) and, other contributing factors related to nutrition were collected by telephone. Demographics and clinical variables were obtained from the EHDN Registry study database. Association of HD with MeDi adherence and nutritional characteristics were performed using logistic regression models. Ninety eight participants were included in the study, median age of 48 years (38-60 range), and median total functional capacity (TFC) 9 (5-13 range). HD severity was similar between participants with low vs moderate/high MeDi; however, quality of life (P = 0.009) was significantly higher among participants with moderate/high MeDi adherence. In terms of nutrients, higher MUFA/SFA intake was moderately correlated with better TFC and Unified HD Rating Scale (UHDRS) cognitive. Better TFC was associated with having a caregiver (OR = 11.86, P < 0.001), and non-smoking (OR = 0.21, P = 0.013). Moderate adherence to MeDi, was associated with older participants (OR = 1.19, P = 0.031), lower comorbidity (OR = 0.18, P = 0.018), lower UHDRS motor (OR = 0.90, P = 0.041), and lower risk for abdominal obesity (OR = 0.02, P = 0.011). In HD the moderate MeDi adherence is associated with better quality of life, lower comorbidity, lower motor impairment and lower risk for abdominal obesity compared to those participants with low MeDi adherence. Copyright © 2016 European Society for

  6. Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools.

    PubMed

    Cousineau, Michael R; Wada, Eriko O; Hogan, Laura

    2007-01-01

    California has several health insurance programs for children. However, the system for enrolling into these programs is complex and difficult to manage for many families. Express Lane Eligibility is designed to streamline the Medicaid (called Medi-Cal in California) enrollment process by linking it to the National School Lunch Program. If a child is eligible for free lunch and the parents consent, the program provides two months of presumptive eligibility for Medi-Cal and a simplified application process for continuation in Medi-Cal. For those who are ineligible, it provides a referral to other programs. An evaluation of Express Lane shows that while many children were presumptively enrolled, nearly half of the applicants were already enrolled in Medi-Cal. Many Express Enrolled children failed to complete the full Medi-Cal enrollment process. Few were referred to the State Children's Health Insurance Program or county programs. Express Lane is less useful as a broad screening strategy, but can be one of many tools that communities use to enroll children in health insurance.

  7. Structure and Function Analysis of an Antibody Recognizing All Influenza A Subtypes.

    PubMed

    Kallewaard, Nicole L; Corti, Davide; Collins, Patrick J; Neu, Ursula; McAuliffe, Josephine M; Benjamin, Ebony; Wachter-Rosati, Leslie; Palmer-Hill, Frances J; Yuan, Andy Q; Walker, Philip A; Vorlaender, Matthias K; Bianchi, Siro; Guarino, Barbara; De Marco, Anna; Vanzetta, Fabrizia; Agatic, Gloria; Foglierini, Mathilde; Pinna, Debora; Fernandez-Rodriguez, Blanca; Fruehwirth, Alexander; Silacci, Chiara; Ogrodowicz, Roksana W; Martin, Stephen R; Sallusto, Federica; Suzich, JoAnn A; Lanzavecchia, Antonio; Zhu, Qing; Gamblin, Steven J; Skehel, John J

    2016-07-28

    Influenza virus remains a threat because of its ability to evade vaccine-induced immune responses due to antigenic drift. Here, we describe the isolation, evolution, and structure of a broad-spectrum human monoclonal antibody (mAb), MEDI8852, effectively reacting with all influenza A hemagglutinin (HA) subtypes. MEDI8852 uses the heavy-chain VH6-1 gene and has higher potency and breadth when compared to other anti-stem antibodies. MEDI8852 is effective in mice and ferrets with a therapeutic window superior to that of oseltamivir. Crystallographic analysis of Fab alone or in complex with H5 or H7 HA proteins reveals that MEDI8852 binds through a coordinated movement of CDRs to a highly conserved epitope encompassing a hydrophobic groove in the fusion domain and a large portion of the fusion peptide, distinguishing it from other structurally characterized cross-reactive antibodies. The unprecedented breadth and potency of neutralization by MEDI8852 support its development as immunotherapy for influenza virus-infected humans.

  8. Incontinence pad absorption and skin barrier creams: a non-patient study.

    PubMed

    Dykes, Peter; Bradbury, Sarah

    2016-12-08

    Exposure of the skin to excessive moisture, such as in cases of incontinence, can damage its natural barrier function and lead to tissue damage and breakdown. Common methods for managing incontinence and preventing related skin damage include the use of incontinence pads and the application of skin barrier creams to reduce exposure to moisture and irritants. Previous reports have indicated that barrier creams can transfer onto incontinence pads from the skin and reduce their absorbency, and thus the efficacy of both products. This study, using non-patient volunteers, investigated the effect on incontinence pad absorbency of Medi Derma-S and Medi Derma-Pro; two products from the Medi Skin Protection range, in comparison with other market-leading products. Results indicated that, while there was a small degree of product transfer onto the incontinence pads, this did not have a major impact on the absorption of synthetic urine. Medi Derma-S and Medi Derma-Pro performed consistently with other similar market-leading products.

  9. Capitation in California—An Analysis of At-Risk Financing of Medicaid Services

    PubMed Central

    Halfon, Neal; Newacheck, Paul W.

    1986-01-01

    Recent legislative changes have fostered the growth of a highly competitive health care market in California. In addition to selective hospital contracting for Medicaid (Medi-Cal) services, the California Medical Assistance Commission is attempting to initiate pilot projects to capitate Medi-Cal beneficiaries in selected geographic areas throughout the state. Selective contracting with county capitated organized health systems is also underway in Santa Barbara County, with plans for other counties on the drawing boards. This paper describes these capitated programs as well as addressing problems that may arise in this transition from a fee-for-service to a capitated Medi-Cal system. Specifically considered are issues related to underutilization, quality of care, implementation, eligibility and effects on existing patterns of care. PMID:3532566

  10. An additive effect of anti-PAI-1 antibody to ACE inhibitor on slowing the progression of diabetic kidney disease.

    PubMed

    Gu, Chunyan; Zhang, Jiandong; Noble, Nancy A; Peng, Xiao-Rong; Huang, Yufeng

    2016-11-01

    While angiotensin II blockade slows the progression of diabetic nephropathy, current data suggest that it alone cannot stop the disease process. New therapies or drug combinations will be required to further slow or halt disease progression. Inhibition of plasminogen activator inhibitor type 1 (PAI-1) aimed at enhancing ECM degradation has shown therapeutic potential in diabetic nephropathy. Here, using a mouse model of type diabetes, the maximally therapeutic dose of the PAI-1-neutralizing mouse monoclonal antibody (MEDI-579) was determined and compared with the maximally effective dose of enalapril. We then examined whether addition of MEDI-579 to enalapril would enhance the efficacy in slowing the progression of diabetic nephropathy. Untreated uninephrectomized diabetic db/db mice developed progressive albuminuria and glomerulosclerosis associated with increased expression of transforming growth factor (TGF)-β1, PAI-1, type IV collagen, and fibronectin from weeks 18 to 22, which were reduced by MEDI-579 at 3 mg/kg body wt, similar to enalapril given alone from weeks 12 to 22 Adding MEDI-579 to enalapril from weeks 18 to 22 resulted in further reduction in albuminuria and markers of renal fibrosis. Renal plasmin generation was dramatically reduced by 57% in diabetic mice, a decrease that was partially reversed by MEDI-579 or enalapril given alone but was further restored by these two treatments given in combination. Our results suggest that MEDI-579 is effective in slowing the progression of diabetic nephropathy in db/db mice and that the effect is additive to ACEI. While enalapril is renal protective, the add-on PAI-1 antibody may offer additional renoprotection in progressive diabetic nephropathy via enhancing ECM turnover.

  11. A Novel IL6 Antibody Sensitizes Multiple Tumor Types to Chemotherapy Including Trastuzumab-Resistant Tumors.

    PubMed

    Zhong, Haihong; Davis, April; Ouzounova, Maria; Carrasco, Rosa A; Chen, Cui; Breen, Shannon; Chang, Yong S; Huang, Jiaqi; Liu, Zheng; Yao, Yihong; Hurt, Elaine; Moisan, Jacques; Fung, Michael; Tice, David A; Clouthier, Shawn G; Xiao, Zhan; Wicha, Max S; Korkaya, Hasan; Hollingsworth, Robert E

    2016-01-15

    Elevated levels of the proinflammatory cytokine IL6 are associated with poor survival outcomes in many cancers. Antibodies targeting IL6 and its receptor have been developed for chronic inflammatory disease, but they have not yet been shown to clearly benefit cancer patients, possibly due to antibody potency or the settings in which they have been tested. In this study, we describe the development of a novel high-affinity anti-IL6 antibody, MEDI5117, which features an extended half-life and potent inhibitory effects on IL6 biologic activity. MEDI5117 inhibited IL6-mediated activation of STAT3, suppressing the growth of several tumor types driven by IL6 autocrine signaling. In the same models, MEDI5117 displayed superior preclinical activity relative to a previously developed anti-IL6 antibody. Consistent with roles for IL6 in promoting tumor angiogenesis, we found that MEDI5117 inhibited the growth of endothelial cells, which can produce IL6 and support tumorigenesis. Notably, in tumor xenograft assays in mice, we documented the ability of MEDI5117 to enhance the antitumor activities of chemotherapy or gefitinib in combination treatment regimens. MEDI5117 also displayed robust activity on its own against trastuzumab-resistant HER2(+) tumor cells by targeting the CD44(+)CD24(-) cancer stem cell population. Collectively, our findings extend the evidence of important pleiotropic roles of IL6 in tumorigenesis and drug resistance, and offer a preclinical proof of concept for the use of IL6 antibodies in combination regimens to heighten therapeutic responses and overcome drug resistance.

  12. Serious adverse event reporting in a medical device information system.

    PubMed

    Pecoraro, Fabrizio; Luzi, Daniela

    2011-01-01

    The paper describes the design of a module that manages Serious Adverse Events (SAEs) reporting within a Clinical investigation on Medical devices. This module is integrated in a Medical Device Information System (MEDIS) that collects data and documents exchanged between applicants and the National Competent Authority during the clinical investigation lifecycle. To improve information sharing among different stakeholders and systems MEDIS design and developed were based on the HL7 v.3 standards. The paper provides a conceptual model on SAEs based on HL7 RIM that underlines Medical Device characteristics.

  13. Apparent Motion of the Sun, Shadows of Objects and Measurement of Time in the View of Seventh Grade Students of Middle School. (Breton Title: Movimento Aparente do Sol, Sombras dos Objetos e Medição do Tempo na Visão de Alunos do Sétimo Ano do Ensino Fundamental.) Movimiento Aparente del Sol, Sombras de los Objetos y Medición del Tiempo en la Visión de Estudiantes del Séptimo Grado del Ciclo Pirmario

    NASA Astrophysics Data System (ADS)

    Iria Machado, Daniel

    2013-07-01

    The apparent motion of the Sun on the celestial sphere and the behavior of the shadows of objects over time are observable phenomena in everyday life. However, students often do not have a proper understanding of such occurrences, and can even display misconceptions about them. Therefore, we performed a research in order to know students' notions about these subjects and to evaluate the contribution to their understanding brought about by an activity performed with an interactive sundial in an informal learning environment. We investigated the ideas of 43 students from the seventh grade of middle school by applying a test with open questions before and after an activity with an analemmatic sundial, conducted by a monitor. A significant proportion of students were initially unaware of most of the phenomena treated. The intervention performed helped the students to assimilate new concepts, providing the contact with new phenomena and to a lesser degree, the development of explanations about them, indicating an educational potential of this action. However, the contribution to the understanding of some of the ideas explored was small, pointing to the need to make additional observations, studies and discussions. O movimento aparente do Sol na esfera celeste e o comportamento das sombras dos objetos com o passar do tempo são fenômenos observáveis no dia a dia. No entanto, muitas vezes os estudantes não possuem uma compreensão adequada de tais ocorrências, podendo inclusive exibir concepções alternativas a seu respeito. Por isso, efetuou-se uma pesquisa com o intuito de conhecer as noções dos alunos sobre esses temas e avaliar a contribuição para seu entendimento propiciada por uma atividade feita com um relógio de Sol interativo, em um ambiente de ensino informal. Foram investigadas as ideias de 43 alunos do sétimo ano do Ensino Fundamental mediante a aplicação de um teste com questões abertas antes e depois de uma atividade com um relógio de Sol analemático, conduzida por um monitor. Uma proporção significativa de estudantes desconhecia inicialmente a maioria dos fenômenos tratados. A intervenção realizada colaborou para uma parte dos alunos assimilar novos conceitos, propiciando o contato com novos fenômenos e, em menor grau, a elaboração de explicações a respeito destes, indicando um potencial educativo dessa ação. Porém, a contribuição para o entendimento de algumas das ideias exploradas foi pequena, apontando para a necessidade de se fazer observações, estudos e discussões complementares. El movimiento aparente del Sol en la esfera celeste y el comportamiento de las sombras de los objetos a lo largo del tiempo son fenómenos observables en la vida cotidiana. Sin embargo, los estudiantes a menudo no tienen una adecuada comprensión de dichos problemas, e incluso pueden mostrar conceptos erróneos acerca de ellos. Por lo tanto, se realizó una investigación a fin de conocer las nociones de los estudiantes acerca de estas cuestiones y evaluar la contribución a su comprensión proporcionada por una actividad realizada con un reloj de Sol interactivo, en un entorno informal de aprendizaje. Se investigaron las ideas de 43 estudiantes del séptimo grado del ciclo primario mediante la aplicación de un test con preguntas abiertas antes y después de una actividad con un reloj de Sol analemático, dirigida por un monitor. Una proporción significativa de los estudiantes inicialmente desconocía la mayoría de los fenómenos tratados. La intervención realizada contribuyó para que los estudiantes asimilasen nuevos conceptos, proporcionando el contacto con nuevos fenómenos y, en menor medida, desarrollasen explicaciones acerca de estos, lo que indica un potencial educativo de esta acción. Sin embargo, la contribución a la comprensión de algunas de las ideas exploradas fue pequeña, lo que apunta a la necesidad de hacer observaciones, estudios y debates adicionales.

  14. Low temperature grown ZnO@TiO{sub 2} core shell nanorod arrays for dye sensitized solar cell application

    SciTech Connect

    Goh, Gregory Kia Liang; Le, Hong Quang; Huang, Tang Jiao; Hui, Benjamin Tan Tiong

    2014-06-01

    High aspect ratio ZnO nanorod arrays were synthesized on fluorine-doped tin oxide glasses via a low temperature solution method. By adjusting the growth condition and adding polyethylenimine, ZnO nanorod arrays with tunable length were successfully achieved. The ZnO@TiO{sub 2} core shells structures were realized by a fast growth method of immersion into a (NH{sub 4}){sub 2}·TiF{sub 6} solution. Transmission electron microscopy, X-ray Diffraction and energy dispersive X-ray measurements all confirmed the existence of a titania shell uniformly covering the ZnO nanorod's surface. Results of solar cell testing showed that addition of a TiO{sub 2} shell to the ZnO nanorod significantly increased short circuit current (from 4.2 to 5.2 mA/cm{sup 2}), open circuit voltage (from 0.6 V to 0.8 V) and fill factor (from 42.8% to 73.02%). The overall cell efficiency jumped from 1.1% for bare ZnO nanorod to 3.03% for a ZnO@TiO{sub 2} core shell structured solar cell with a 18–22 nm shell thickness, a nearly threefold increase. - Graphical abstract: The synthesis process of coating TiO{sub 2} shell onto ZnO nanorod core is shown schematically. A thin, uniform, and conformal shell had been grown on the surface of the ZnO core after immersing in the (NH{sub 4}){sub 2}·TiF{sub 6} solution for 5–15 min. - Highlights: • ZnO@TiO{sub 2} core shell nanorod has been grown on FTO substrate using low temperature solution method. • TEM, XRD, EDX results confirmed the existing of titana shell, uniformly covered rod's surface. • TiO{sub 2} shell suppressed recombination, demonstrated significant enhancement in cell's efficiency. • Core shell DSSC's efficiency achieved as high as 3.03%, 3 times higher than that of ZnO nanorods.

  15. The Study of Child Language Brokering: Past, Current and Emerging Research

    ERIC Educational Resources Information Center

    Antonini, Rachele

    2010-01-01

    This special issue of "mediAzioni," the online journal of the Department of Interdisciplinary Studies on Translation, Languages and Culture (SITLeC) of the University of Bologna at Forli, derives from the "Study Day on Child Language Brokering" held in Forli in 2008. The Study Day began with a morning session during which…

  16. Long-Term Budgetary Pressures and Policy Options

    DTIC Science & Technology

    1998-05-01

    acute medical treatment , but a rapidly growing component of Medi- care spending is for home health care and skilled nursing facil- ity (SNF) services...Spending, 1975-1995 ance (SMI), covers services provided by physicians, limited-license practitioners (such as chiropractors and podiatrists), hospital

  17. The effect of moderate alcohol consumption on biomarkers of inflammation and hemostatic factors in postmenopausal women

    USDA-ARS?s Scientific Manuscript database

    Inflammation and hemostasis contribute to the etiology of cardiovascular disease. We previously demonstrated that moderate alcohol consumption (1-2 drinks/day) may decrease risk for cardiovascular disease due to an improved the lipid profile. In addition to these beneficial changes, the alcohol medi...

  18. Low levels of energy expenditure in childhood cancer survivors: Implications for obesity prevention

    USDA-ARS?s Scientific Manuscript database

    Childhood cancer survivors are at an increased risk of obesity but causes for this elevated risk are uncertain. We evaluated total energy expenditure in childhood cancer survivors using the doubly labeled water method in a cross-sectional study of 17 survivors of pediatric leukemia or lymphoma (medi...

  19. The Role of Pain Management in Recovery Following Trauma and Orthopaedic Surgery

    DTIC Science & Technology

    2012-01-01

    extremely challenging. This movement toward a more holistic, interdisciplinary, multimodal approach to pain medi- cine will be impossible without im...the global war on terrorism : 2001-2004. Ann Surg 2007; 245(6):986-991. 3. Buckenmaier CC III, Rupprecht C, McKnight G, et al: Pain following

  20. 76 FR 7225 - Center for Scientific Review; Notice of Closed Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-09

    ... Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is... Committee: Center for Scientific Review Special Emphasis Panel, Member Conflict: BMIT/CMIP/MEDI Imaging Applications. Date: February 23, 2011. Time: 1 p.m. to 3 p.m. Agenda: To review and evaluate grant...

  1. Ozone Induces a Proinflammatory Response in Primary Human Bronchial Epithelial Cells Through Mitogen-Activated Protein Kinase Activation Without Nuclear Factor-kB Activation

    EPA Science Inventory

    Ground-level ozone (O3) is a ubiquitous environmental air pollutant that is a potent inducer of airway inflammation and has been linked with both respiratory and cardiovascular morbidity and mortality. Some studies using transformed or immortalized cells have attributed O3-medi...

  2. Clinical Evaluation of an Acrylic Pontic ’Adhesively’ Bonded to Uncut Abutment Teeth: 18 Month Results

    DTIC Science & Technology

    1974-12-23

    prosthesis is as esthetieally pleasing, as effective, and as durable as the muco-adhesive partial denture it would presumably supplant. FINDINGS...anterior teeth. It is suggested that those dentists with complete laboratory support should consider this technique for those cases where treatment...temporary) partial dentures were previously constructed. ADMINISTRATIVE INFORMATION This investigation was conducted as part of Bureau of Medi- cine

  3. Multiple environmental contexts and preterm birth risks

    EPA Science Inventory

    Human health is affected by simultaneous exposure to numerous stressors and amenities, but research often focuses on single exposure models. To address this, a United States county-level Multiple Environmental Domain Index (MEDI) was constructed with data representing five envir...

  4. Youth Emancipating from Foster Care in California: Findings Using Linked Administrative Data.

    ERIC Educational Resources Information Center

    Needell, Barbara; Cuccaro-Alamin, Stephanie; Brookhart, Alan; Jackman, William; Shlonsky, Aron

    This study examined characteristics of youth emancipated from child welfare (ECW) and probation (EPR) supervised foster care; receipt of mental health services for emancipating youth; births to emancipating females; deaths of youth who emancipated from foster care; receipt of Medi-Cal due to AFDC/TANF, SSI/disability, or medical indigence after…

  5. Strengthening Statehood Capabilities for Successful Transitions in the Middle East/North Africa Region

    DTIC Science & Technology

    2015-04-01

    during each transition have reflected individual political, security, and social realities. However, one common lesson learned from their...Defence Academy reports, including reference papers on national and regional security issues in the GCC and the Medi - terranean region, and a...and limitations. Policy reforms during their transitions have reflected indi- vidual political, security, and social realities. While there was

  6. Service engineering for grid services in medicine and life science.

    PubMed

    Weisbecker, Anette; Falkner, Jürgen

    2009-01-01

    Clearly defined services with appropriate business models are necessary in order to exploit the benefit of grid computing for industrial and academic users in medicine and life sciences. In the project Services@MediGRID the service engineering approach is used to develop those clearly defined grid services and to provide sustainable business models for their usage.

  7. Multiple environmental contexts and preterm birth risks

    EPA Science Inventory

    Human health is affected by simultaneous exposure to numerous stressors and amenities, but research often focuses on single exposure models. To address this, a United States county-level Multiple Environmental Domain Index (MEDI) was constructed with data representing five envir...

  8. Environmental conditions and reproductive health outcomes

    EPA Science Inventory

    Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal compone...

  9. Medical Surveillance Monthly Report (MSMR). Volume 3, Number 7, October 1997

    DTIC Science & Technology

    1997-10-01

    MSMRVol. 03 / No. 07 7 Active Duty Other FIGURE II. Reportable sexually transmitted diseases, US Army medical treatment facilities* Cases per...Training Area in southeastern Queensland. Pre- exercise activities : Assessment of exer- cise-relevant medical threats identified the follow- ing: injuries...eastern Australia during the rainy season, the RRv threat was considered both operationally and medi- cally significant. Pre- exercise activities

  10. Was it really only a scant few years ago that Silicon Valley was booming, dot-coms were the next big things and Nortel shares were trading at more than $100?

    PubMed

    Menzies, David

    2003-01-01

    Alas, there's nothing like a pinch of reality to pop an overinflated hype bubble. Yet not all software vendors that have fallen on hard times in recent years have succumbed to bankruptcy. In fact, Canadian software firms--MediSolution and Ormed--are proof that turnarounds are possible.

  11. Hydroxycinnamoyl-CoA:Malate Hydroxycinnamoyl Transferase is Crucial for 2-O-Caffeoyl-L-Malate Biosynthesis in Red Clover and Defines a New Pathway for Hydroxycinnamoyl-Malate Ester Biosynthesis

    USDA-ARS?s Scientific Manuscript database

    Red clover (Trifolium pratense L.) leaves accumulate several µmol of phaselic acid [2-O-caffeoyl-L-malate] per gram fresh weight. Post-harvest oxidation of such o-diphenols to o-quinones by endogenous polyphenol oxidases prevents breakdown of forage protein during storage. Forages like alfalfa (Medi...

  12. Utilization of high resolution computed tomography to visualize the three dimensional structure and function of plant vasculature

    USDA-ARS?s Scientific Manuscript database

    High resolution x-ray computed tomography (HRCT) is a non-destructive diagnostic imaging technique with sub-micron resolution capability that is now being used to evaluate the structure and function of plant xylem network in three dimensions (3D). HRCT imaging is based on the same principles as medi...

  13. Environmental conditions and reproductive health outcomes

    EPA Science Inventory

    Environmental exposures range across multiple domains to affect human health. In an effort to learn how environmental factors combine to contribute to health outcomes we constructed a multiple environmental domain index (MEDI) for use in health research. We used principal compone...

  14. Mentoring to Help Prevent Physician Burnout.

    PubMed

    Herring, Malcolm; Forbes Kaufman, Rachel; Bogue, Richard

    2016-07-01

    The importance of a person's spirit and eternal destiny are eclipsed in American medi- cine. The most alarming effect of this eclipse is that the prevalence of burnout among physicians is high (about 46 percent) and growing.' It is alarming because trends that deplete the physician's spirit tragically impair the physician's capacity as a healer and as one who renews the spirit.

  15. Medicaid coverage of maternity care for aliens in California.

    PubMed

    Norton, S A; Kenney, G M; Ellwood, M R

    1996-01-01

    The quantity and cost-effectiveness of prenatal care is a critical reproductive health issue as federal and state legislators consider reducing publicly funded services to aliens. An analysis of data from medi-Cal, California's Medicaid program, shows that undocumented and legalized aliens who qualified for coverage under the provisions of federal legislation or the state's expansion of eligibility criteria accounted for 45% of deliveries financed by Medi-Cal in 1991; outlays for these deliveries are estimated at less than 2% of all Medi-Cal payments for that year. Most of these women also received prenatal care covered by Medi-Cal, but more than half were not enrolled in the program until after the first trimester of pregnancy (and thus may not have received adequate prenatal care). Alien women were enrolled for an average of 5-6 months of their pregnancy, whereas nonalien women who qualified for coverage were enrolled for about seven months. California's Proposition 187 would eliminate funding for prenatal care for undocumented aliens, but public outlays for labor and delivery could grow as a result of an increase in poor birth outcomes.

  16. Unreported Medications Used in Incapacitating Medical Conditions Found in Fatal Civil Aviation Accidents

    DTIC Science & Technology

    1994-08-01

    Carbamazepine 62 = Verapamil 21 = Diazepam 13 = Lidocaine 96 = Fluoxetine 72 = Propranolol 113 = Trazodone 30 = Metoprolol 116 = Sertraline 41 = Procainamid...examined by an aviation medi- Lopressor ( Metoprolol ) for the treatment of high cal examiner, the majority of the cardiovascular drugs blood pressure. In

  17. Discovery of chemicals that mediate mosquito host-seeking behavior

    USDA-ARS?s Scientific Manuscript database

    Since 1942, the United States Department of Agriculture (USDA) has developed repellents and insecticides for the U.S. military. A small thrust of this research program has been focused on discovery of attractants for use as lures in commercial traps designed to attract and capture arthropods of medi...

  18. RF-Medisys: a radio frequency identification-based electronic medical record system for improving medical information accessibility and services at point of care.

    PubMed

    Ting, Jacky S L; Tsang, Albert H C; Ip, Andrew W H; Ho, George T S

    2011-01-01

    This paper presents an innovative electronic medical records (EMR) system, RF-MediSys, which can perform medical information sharing and retrieval effectively and which is accessible via a 'smart' medical card. With such a system, medical diagnoses and treatment decisions can be significantly improved when compared with the conventional practice of using paper medical records systems. Furthermore, the entire healthcare delivery process, from registration to the dispensing or administration of medicines, can be visualised holistically to facilitate performance review. To examine the feasibility of implementing RF-MediSys and to determine its usefulness to users of the system, a survey was conducted within a multi-disciplinary medical service organisation that operates a network of medical clinics and paramedical service centres throughout Hong Kong Island, the Kowloon Peninsula and the New Territories. Questionnaires were distributed to 300 system users, including nurses, physicians and patients, to collect feedback on the operation and performance of RF-MediSys in comparison with conventional paper-based medical record systems. The response rate to the survey was 67%. Results showed a medium to high level of user satisfaction with the radiofrequency identification (RFID)-based EMR system. In particular, respondents provided high ratings on both 'user-friendliness' and 'system performance'. Findings of the survey highlight the potential of RF-MediSys as a tool to enhance quality of medical services and patient safety.

  19. JPRS Report, Near East & South Asia

    DTIC Science & Technology

    1989-08-10

    Yunis, ’Abdullah al-Shiti, ’Abdullah al-Qaq, Walid Abu-Bakr, Salih Nazzal, Salim Salim and Naji al-’Ali. In the medi- cal field, there are prominent...Palestinians: Our Hope Is That Our Children Will See Palestine"] [Text] In a small apartment in a building in Hassan Quarter of the city of Rabat

  20. Surgery in World War II. Orthopedic Surgery in the Zone of Interior

    DTIC Science & Technology

    1970-01-01

    Under Fluoroscopy .................................... 339 Selection of Techniques ....................... 3. 40 Prevention of Infection...trained in the specialties of medi- cine , surgery, and sanitation; trained nurses and adjunct medical personnel, hospitals and buildings available...darkrooms for quick development of films; provision for fluoroscopy for closed reduction of fracture in some hospitals, though this technique was

  1. Clover Biotechnology Research at FAPRU

    USDA-ARS?s Scientific Manuscript database

    Randy Dinkins (USDA-ARS-FAPRU) is conducting research to determine the utility of using the Medicago Affymetrix Genechip for use with red clover (Trifolium pretense). The Medicago Affymetrix Genechip contains approximately 51,000 probe sets that are derived from Medicago truncatula, 1,800 from Medi...

  2. Injury among Stimulant-Treated Youth with ADHD

    ERIC Educational Resources Information Center

    Marcus, Steven C.; Wan, George J.; Zhang, Huabin F.; Olfson, Mark

    2008-01-01

    Objective: To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. Method: An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and…

  3. Passage of Campylobacter jejuni and C. coli subtypes through 0.45 and 0.65 µm pore size nitro-cellulose filters

    USDA-ARS?s Scientific Manuscript database

    Campylobacter can be difficult to recover from complex samples due to overgrowth by background bacteria. A 0.45 or 0.65 µm pore size filter overlaid on agar plates can be used as a means to separate Campylobacter from confounding non-Campylobacter cells, facilitating detection on solid plating medi...

  4. [Development of telepathology systems between different types of terminals based on the standard for image collaboration command protocol].

    PubMed

    Tofukuji, Ikuo; Nakagawa, Shuji; Suzuki, Akitoshi; Saito, Makoto; Hara, Shigeji; Tsuchihashi, Yasunari; Shiraishi, Taizo; Ooshiro, Mariko; Sawai, Takashi; Kaihara, Shigekoto

    2003-01-01

    In Japan telepathology systems have been developed in medical or pathological environment such as a shortage and an uneven distribution of pathologists. More than 100 telepathology terminals are working mainly for intraoperative quick diagnosis. They cannot communicate with different types each other. In March 2000 the Medical Information System Development Center(MEDIS-DC) successfully demonstrated the interconnection between different types of telepathology terminals based on the Standard for Image Collaboration Command Protocol (SICCP). Nikon, NTTdata and Olympus had joined the development. In February 2002 MEDIS-DC examined these systems for pathological consultations in the fields of Okinawa-Kyoto, Kyoto-Mie and Mie-Okinawa. These successful examinations let us know that telepathology systems need new observation methodologies for telecytology and teleconsultation in addition to the flow for intraoperative quick diagnosis, new GUI guidelines for telepathology terminal design and, education and support for users of their smooth operation. Outcomes of MEDIS-DC activities encourageed us to challenge the next generation telepathology. We found some new trends in telepathology or pathology informatics such as virtual slide technologies and the internet applications in US and Europe. In order to keep Japanese priority, MEDIS-DC telepathology comittee has started investigations to construct a strategy for development of Japanese next generation telepathology.

  5. Ozone Induces a Proinflammatory Response in Primary Human Bronchial Epithelial Cells Through Mitogen-Activated Protein Kinase Activation Without Nuclear Factor-kB Activation

    EPA Science Inventory

    Ground-level ozone (O3) is a ubiquitous environmental air pollutant that is a potent inducer of airway inflammation and has been linked with both respiratory and cardiovascular morbidity and mortality. Some studies using transformed or immortalized cells have attributed O3-medi...

  6. Extraction and HPLC- UV Analysis of C60, C70, and [6,6]-phenyl C61-butyric acid methyl ester in Synthetic and Natural Waters

    EPA Science Inventory

    Studies have shown that C60 fullerene can form stable colloidal suspensions in water that result in C60 aqueous concentrations many orders of magnitude above C60's aqueous solubility; however, quantitative methods for the analysis of C60 and other fullerenes in environmental medi...

  7. Health is fine if pills are on time

    PubMed Central

    2016-01-01

    Medication non-adherence is a pervasive problem that can impact an individual’s health and wellness. MediSafe is a user-friendly and simple app that enables patients to improve their medication adherence by setting reminders, and enhance their provider relationships by sharing intake and health indicator history. PMID:28293612

  8. A New Test of Scanning and Monitoring Ability: Methods and Initial Results

    DTIC Science & Technology

    1992-03-01

    ADA 2 4 9 487 DOTFAMAM9212 A New Test of Scann Office of Aviation Medicine and monitoring Ability:. Washington, D.C. 20591 Methods and Initial...Areas, and effects of visual noise. fatigue, workshift changes, illness, drugs , medi- cations, environmental toxicants) (3). However, The results of the

  9. Extraction and HPLC- UV Analysis of C60, C70, and [6,6]-phenyl C61-butyric acid methyl ester in Synthetic and Natural Waters

    EPA Science Inventory

    Studies have shown that C60 fullerene can form stable colloidal suspensions in water that result in C60 aqueous concentrations many orders of magnitude above C60's aqueous solubility; however, quantitative methods for the analysis of C60 and other fullerenes in environmental medi...

  10. First report of bacterial blight of crucifers caused by Pseudomonas cannabina pv. alisalensis in Minnesota on arugula (Eruca vesicaria subsp. sativa)

    USDA-ARS?s Scientific Manuscript database

    In 2011, bacterial blight of arugula (Eruca vesicaria subsp. sativa; cv. Roquette) was observed in organically grown plants under overhead irrigation near Delano, MN. Approximately 80 to 100% of each planting was affected. Blue-green fluorescent pseudomonads were isolated consistently on King’s Medi...

  11. Injury among Stimulant-Treated Youth with ADHD

    ERIC Educational Resources Information Center

    Marcus, Steven C.; Wan, George J.; Zhang, Huabin F.; Olfson, Mark

    2008-01-01

    Objective: To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. Method: An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and…

  12. Mosquito Information Management Project (MIMP): Application of a Computerized General Purpose Information Management System (SELGEM) to Medically Important Arthropods (Diptera: culicidae).

    DTIC Science & Technology

    1984-08-01

    4 MOSQUITO INFORMATION MANAGEMENT PROJECT (MIMP): *APPLICATION OF A COMPUTERIZED GENERAL PURPOSE I INFORMATION MANAGEMENT SYSTEM (SELGEM) TO...1983 to August 1984 INFORMATION MANAGEMENT SYSTEM (SELGEM) TO MEDI- 6 EFRIGOG EOTNME * CALLY IMPORTANT ARTHROPODS (DIPTERA: CULICIDAE) .v PEnRMN OG

  13. Information Management in the Department of Defense: The Role of Librarians. Proceedings of the Military Librarians Workshop (24th) 15-17 October 1980, held at Monterey, California

    DTIC Science & Technology

    1983-07-01

    control system will be fully linked to the biblio - graphic database. This will insure that proper headings are assigned. When headings change, all...Library of Congress, the National Library of Medi- cine , and others, but when you think about a library with 6 to 20 thou- sand volumes, they are usually

  14. Modeling and Analysis Using SAINT: A Combined Discrete/Continuous Network Simulation Language,

    DTIC Science & Technology

    1977-09-01

    by the Marshall Space Fl ight Center to study the scheduling of experiments for the Spacelab. SAINT has been used by the School of Aerospace Medi cine ...Laboratory. We appreciate their efforts and acknowledge their contributions. BIBLIO GRAPHY 1. Askren , W.B., W.B. Cambell , D.J. Sei fert, T.H. Hall , R

  15. Study of Online Instruction Methodologies for the DTIC Training Program.

    DTIC Science & Technology

    1981-02-01

    background and policy analysis in- formation, references to Congressional actions, and a biblio - graphy. Citation File Abstracts and bibliographic data for...Management (GSLIM), (c) National Library of Medi- cine (NLM), (d) University of Dayton Research Institute (UDRI), (e) University of Pittsburgh On

  16. Annotated Bibliography of USAARL (United States Army Aeromedical Research Laboratory) Technical and Letter Reports, 1 June 1963 - 30 April 1983.

    DTIC Science & Technology

    1983-04-01

    this annotated bibliography. Subject areas covered include aviation medi- cine , bioengineering, bio-optics, acoustics, and aviation psychology...recommended that the noise inside this vehicle be reduced before further development. 76-17 Marijuana and human performance: An annotated biblio

  17. Journal of the United States Artillery. Volume 56, Number 2, February 1922

    DTIC Science & Technology

    1922-02-01

    students in the University’s School of Medi- cine . The records and any work done by the department prior to April 6, 1920,were destroyed by a fire...is included an analytical study of the Battle of Ravenna, while the useability of the work is increased by an index and a comprehensive biblio

  18. Long-Term Retention of Flying Skills: A Review of the Literature

    DTIC Science & Technology

    1976-10-01

    Retention of Flying Skills: An Annotated Biblio - graphy. HumRRO FR-ED(P)-76-36, Human Resources Research Organization, Alexandria, "A October 1976...and Accident Potential." Aerospace Medi- cine , 1962, 33, 222-225. Zeller, A.F., and Burke, J.M. "Relation of Time Between Flights to the Accident

  19. A Comparison of Military and Civilian Sector Pilot Careers

    DTIC Science & Technology

    1987-04-01

    the Air Foroe to ompete * the ~mrmctplsoe for trained pilots. 20, OISTRI8UTIONIAVAILABIL!YV Of ABSTRACT 21. ABSTRACT SECURIYY CLASSIFICATION...whatever (other than those declared above) and that I am not now under the care of a physician and am taking no medi. cine or drugs for any ailment, disease

  20. Physical and Psychological Health Following Military Sexual Assault: Recommendations for Care, Research, and Policy

    DTIC Science & Technology

    2013-01-01

    assault are more likely to experience chronic medi- cal conditions, such as fibromyalgia , gastrointestinal symptoms associated with irritable bowel...Physical Abuse in Women with Fibromyalgia Syndrome: A Test of the Trauma Hypothesis,” The Clinical Journal of Pain, Vol. 21, No. 5, September

  1. Macrophage and NK-mediated killing of precursor-B acute lymphoblastic leukemia cells targeted with a-fucosylated anti-CD19 humanized antibodies.

    PubMed

    Matlawska-Wasowska, K; Ward, E; Stevens, S; Wang, Y; Herbst, R; Winter, S S; Wilson, B S

    2013-06-01

    This work reports the tumoricidal effects of a novel investigational humanized anti-CD19 monoclonal antibody (Medi-551). An a-fucosylated antibody with increased affinity for human FcγRIIIA, Medi-551 is shown to mediate both antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP). Medi-551/CD19 complexes internalize slowly (>5 h) and thus remain accessible to effector cells for prolonged periods. We evaluated in vitro ADCC and ADCP activities of primary human natural killer (NK) cells and macrophages against precursor-B (pre-B) acute lymphoblastic leukemia (ALL) cell lines and pediatric patient blasts. Fluorescent imaging studies document immunological synapses formed between anti-CD19-bound target leukemia cells and effector cells and capture the kinetics of both NK-mediated killing and macrophage phagocytosis. Genetic polymorphisms in FcγRIIIA-158F/V modulate in vitro activities of effector cells, with FcγRIIIA-158V homozygotes or heterozygotes showing the strongest activity. Medi-551 treatment of severe combined immunodeficiency (SCID) mice engrafted with human pre-B cells led to prolonged animal survival and markedly reduced disease burden in blood, liver and bone marrow. These data show that anti-CD19 antibodies effectively recruit immune cells to pre-B ALL cells and support a move forward to early phase trials in this disease.

  2. Mediterranean diet habits in older individuals: associations with cognitive functioning and brain volumes.

    PubMed

    Titova, Olga E; Ax, Erika; Brooks, Samantha J; Sjögren, Per; Cederholm, Tommy; Kilander, Lena; Kullberg, Joel; Larsson, Elna-Marie; Johansson, Lars; Ahlström, Håkan; Lind, Lars; Schiöth, Helgi B; Benedict, Christian

    2013-12-01

    To examine the association between dietary habits, cognitive functioning and brain volumes in older individuals, data from 194 cognitively healthy individuals who participated in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort were used. At age 70, participants kept diaries of their food intake for 1week. These records were used to calculate a Mediterranean diet (MeDi) score (comprising dietary habits traditionally found in Mediterranean countries, e.g. high intake of fruits and low intake of meat), with higher scores indicating more pronounced MeDi-like dietary habits. Five years later, participants' cognitive capabilities were examined by the seven minute screening (7MS) (a cognitive test battery used by clinicians to screen for dementia), and their brain volumes were measured by volumetric magnetic resonance imaging. Multivariate linear regression analyses were constructed to examine the association between the total MeDi score and cognitive functioning and brain volumes. In addition, possible associations between MeDi's eight dietary features and cognitive functioning and brain volumes were investigated. From the eight dietary features included in the MeDi score, pertaining to a low consumption of meat and meat products was linked to a better performance on the 7MS test (P=0.001) and greater total brain volume (i.e. the sum of white and gray matter, P=0.03) when controlling for potential confounders (e.g. BMI) in the analysis. Integrating all dietary features into the total MeDi score explained less variance in cognitive functioning and brain volumes than its single dietary component meat intake. These observational findings suggest that keeping to a low meat intake could prove to be an impact-driven public health policy to support healthy cognitive aging, when confirmed by longitudinal studies. Further, they suggest that the MeDi score is a construct that may mask possible associations of single MeDi features with brain health

  3. Mediterranean diet and brain structure in a multiethnic elderly cohort.

    PubMed

    Gu, Yian; Brickman, Adam M; Stern, Yaakov; Habeck, Christian G; Razlighi, Qolamreza R; Luchsinger, José A; Manly, Jennifer J; Schupf, Nicole; Mayeux, Richard; Scarmeas, Nikolaos

    2015-11-17

    To determine whether higher adherence to a Mediterranean-type diet (MeDi) is related with larger MRI-measured brain volume or cortical thickness. In this cross-sectional study, high-resolution structural MRI was collected on 674 elderly (mean age 80.1 years) adults without dementia who participated in a community-based, multiethnic cohort. Dietary information was collected via a food frequency questionnaire. Total brain volume (TBV), total gray matter volume (TGMV), total white matter volume (TWMV), mean cortical thickness (mCT), and regional volume or CT were derived from MRI scans using FreeSurfer program. We examined the association of MeDi (scored as 0-9) and individual food groups with brain volume and thickness using regression models adjusted for age, sex, ethnicity, education, body mass index, diabetes, and cognition. Compared to lower MeDi adherence (0-4), higher adherence (5-9) was associated with 13.11 (p = 0.007), 5.00 (p = 0.05), and 6.41 (p = 0.05) milliliter larger TBV, TGMV, and TWMV, respectively. Higher fish (b = 7.06, p = 0.006) and lower meat (b = 8.42, p = 0.002) intakes were associated with larger TGMV. Lower meat intake was also associated with larger TBV (b = 12.20, p = 0.02). Higher fish intake was associated with 0.019 mm (p = 0.03) larger mCT. Volumes of cingulate cortex, parietal lobe, temporal lobe, and hippocampus and CT of the superior-frontal region were associated with the dietary factors. Among older adults, MeDi adherence was associated with less brain atrophy, with an effect similar to 5 years of aging. Higher fish and lower meat intake might be the 2 key food elements that contribute to the benefits of MeDi on brain structure. © 2015 American Academy of Neurology.

  4. [Trial manufacture of a plunger shield for a disposable plastic syringe].

    PubMed

    Murakami, Shigeki; Emoto, Takashi; Mori, Hiroshige; Fujita, Katsuhisa; Kubo, Naoki

    2008-08-20

    A syringe-type radiopharmaceutical being supplied by a manufacturer has a syringe shield and a plunger shield, whereas an in-hospital labeling radiopharmaceutical is administered by a disposable plastic syringe without the plunger shield. In cooperation with Nihon Medi-Physics Co. Ltd., we have produced a new experimental plunger shield for the disposable plastic syringe. In order to evaluate this shielding effect, we compared the leaked radiation doses of our plunger shield with those of the syringe-type radiopharmaceutical (Medi shield type). Our plunger shield has a lead plate of 21 mm in diameter and 3 mm thick. This shield is equipped with the plunger-end of a disposal plastic syringe. We sealed 99mTc solution into a plastic syringe (Terumo Co.) of 5 ml with our plunger shield and Medi shield type of 2 ml. We measured leaked radiation doses around syringes using fluorescent glass dosimeters (Dose Ace). The number of measure points was 18. The measured doses were converted to 70 microm dose equivalent at 740 MBq of radioactivity. The results of our plunger shield and the Medi shield type were as follows: 4-13 microSv/h and 3-14 microSv/h at shielding areas, 3-545 microSv/h and 6-97 microSv/h at non-shielding areas, 42-116 microSv/h and 88-165 microSv/h in the vicinity of the syringe shield, and 1071 microSv/h and 1243 microSv/h at the front of the needle. For dose rates of shielding areas around the syringe, the shielding effects were approximately the same as those of the Medi shield type. In conclusion, our plunger shield may be useful for reducing finger exposure during the injection of an in-hospital labeled radiopharmaceutical.

  5. Mediterranean Diet in patients with acute ischemic stroke: Relationships between Mediterranean Diet score, diagnostic subtype, and stroke severity index.

    PubMed

    Tuttolomondo, Antonino; Casuccio, Alessandra; Buttà, Carmelo; Pecoraro, Rosaria; Di Raimondo, Domenico; Della Corte, Vittoriano; Arnao, Valentina; Clemente, Giuseppe; Maida, Carlo; Simonetta, Irene; Miceli, Giuseppe; Lucifora, Benedetto; Cirrincione, Anna; Di Bona, Danilo; Corpora, Francesca; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio

    2015-11-01

    Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Adherence to a Mediterranean diet is associated with the presence and extension of atherosclerotic plaques in middle-aged asymptomatic adults: The Aragon Workers' Health Study.

    PubMed

    Mateo-Gallego, Rocío; Uzhova, Irina; Moreno-Franco, Belén; León-Latre, Montserrat; Casasnovas, José A; Laclaustra, Martín; Peñalvo, José L; Civeira, Fernando

    2017-08-24

    The Mediterranean diet (MeDi) is known to prevent cardiovascular events but the mechanisms mediating this association are not fully understood. The objective of the study was to examine the association between MeDi adherence and the presence and extent of atherosclerotic plaques in carotid, femoral, and aorta territories and its relationship with risk factors in asymptomatic middle-aged adults. Cross-sectional analysis of the Aragon Workers' Health Study, a cohort of 2588 subjects (94.9% men aged 51.3 ± 3.89 years) without previous cardiovascular history. Participants underwent carotid, femoral, and aorta ultrasound for the quantification of number and thickness of plaques and intima-media thickness. To estimate the participant's adherence to MeDi, we computed the Alternative MEDiterranean index (aMED). The overall aMED score was 4.19 ± 1.70, representing a moderate adherence to MeDi. aMED score was associated with the presence of plaque in femoral arteries (odds ratio highest vs lowest aMED score quartile: 0.63; 95% confidence interval: 0.48-0.83; P trend = .045) independently of risk factors and mediators. The strongest association between aMED quartiles and presence of plaque was found among smokers, both in femoral (0.39 [0.22-0.69]; P trend = .001) and in any territory (0.33 [0.14-0.79], P trend = .008). aMED was inversely associated with the number of plaques in all territories except for carotids. MeDi adherence showed a dose-dependent protective association with the presence, number, and thickness of plaques independent of other risk factors. The association was strongest for femoral arteries and among smokers. Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  7. 3D cardiovascular navigation system: accuracy and reduction in radiation exposure in left ventricular lead implant.

    PubMed

    Valderrabano, Miguel; Greenberg, Steven; Razavi, Hedi; More, Rohan; Ryu, Kyungmoo; Heist, E Kevin

    2014-01-01

    Cardiac resynchronization therapy implants entail significant radiation exposure for patients and physicians. A novel 3D electromagnetic cardiovascular navigation system (MediGuide™) was designed to superimpose the real-time location of sensors embedded in delivery tools on prerecorded coronary sinus (CS) venograms while adjusting for patient movement and variations in heart rate under different C-arm angulations. We studied the accuracy and efficacy of MediGuide™ in reducing radiation exposure during LV lead implants. Fluoroscopy durations and radiation exposures were measured in 6 canines undergoing both conventional and MediGuide™-guided LV lead implants. The in vivo accuracy of MediGuide™ was evaluated by obtaining CS venograms at 3 different C-arm angulations at 3 different heart rates and measuring the separation between the projected sensor icon of a MediGuide™ sensor-enabled guidewire and the encompassing branch on prerecorded venograms. Mediguide™-guided implants resulted in significant reductions in fluoroscopy time (52 ± 120 [median 6] vs 129 ± 118 [median 90] sec, P < 0.001) and radiation exposure (13.8 ± 32.4 [median 1.7] vs 49.2 ± 45.3 [median 27.2] μGym(2) , P = 0.03) compared to conventional implants. LV lead delivery time was not significantly different between the 2 implant techniques (P = 0.27). The mean separation between the projected guidewire sensor icon and its encompassing branch was 0.48 ± 0.94 (median 0.00) mm. System accuracy was not affected by variations in heart rate or C-arm angulations. The novel 3D cardiovascular navigation system enabled accurate and reliable tracking of sensor-enabled tools at varying heart rates and C-arm angulations with minimal need for fluoroscopy guidance, significantly reducing fluoroscopy time and radiation exposure. © 2014 Wiley Periodicals, Inc.

  8. Mediterranean diet and brain structure in a multiethnic elderly cohort

    PubMed Central

    Brickman, Adam M.; Stern, Yaakov; Habeck, Christian G.; Razlighi, Qolamreza R.; Luchsinger, José A.; Manly, Jennifer J.; Schupf, Nicole; Mayeux, Richard; Scarmeas, Nikolaos

    2015-01-01

    Objective: To determine whether higher adherence to a Mediterranean-type diet (MeDi) is related with larger MRI-measured brain volume or cortical thickness. Methods: In this cross-sectional study, high-resolution structural MRI was collected on 674 elderly (mean age 80.1 years) adults without dementia who participated in a community-based, multiethnic cohort. Dietary information was collected via a food frequency questionnaire. Total brain volume (TBV), total gray matter volume (TGMV), total white matter volume (TWMV), mean cortical thickness (mCT), and regional volume or CT were derived from MRI scans using FreeSurfer program. We examined the association of MeDi (scored as 0–9) and individual food groups with brain volume and thickness using regression models adjusted for age, sex, ethnicity, education, body mass index, diabetes, and cognition. Results: Compared to lower MeDi adherence (0–4), higher adherence (5–9) was associated with 13.11 (p = 0.007), 5.00 (p = 0.05), and 6.41 (p = 0.05) milliliter larger TBV, TGMV, and TWMV, respectively. Higher fish (b = 7.06, p = 0.006) and lower meat (b = 8.42, p = 0.002) intakes were associated with larger TGMV. Lower meat intake was also associated with larger TBV (b = 12.20, p = 0.02). Higher fish intake was associated with 0.019 mm (p = 0.03) larger mCT. Volumes of cingulate cortex, parietal lobe, temporal lobe, and hippocampus and CT of the superior-frontal region were associated with the dietary factors. Conclusions: Among older adults, MeDi adherence was associated with less brain atrophy, with an effect similar to 5 years of aging. Higher fish and lower meat intake might be the 2 key food elements that contribute to the benefits of MeDi on brain structure. PMID:26491085

  9. Distance traveled for Medicaid-covered abortion care in California.

    PubMed

    Johns, Nicole E; Foster, Diana Greene; Upadhyay, Ushma D

    2017-04-19

    Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

  10. Mediterranean diet and cognitive health: Initial results from the Hellenic Longitudinal Investigation of Ageing and Diet.

    PubMed

    Anastasiou, Costas A; Yannakoulia, Mary; Kosmidis, Mary H; Dardiotis, Efthimios; Hadjigeorgiou, Giorgos M; Sakka, Paraskevi; Arampatzi, Xanthi; Bougea, Anastasia; Labropoulos, Ioannis; Scarmeas, Nikolaos

    2017-01-01

    The Mediterranean dietary pattern has been associated with a decreased risk of many degenerative diseases and cognitive function in particular; however, relevant information from Mediterranean regions, where the prototype Mediterranean diet is typically adhered to, have been very limited. Additionally, predefined Mediterranean diet (MeDi) scores with use of a priori cut-offs have been used very rarely, limiting comparisons between different populations and thus external validity of the associations. Finally, associations between individual components of MeDi (i.e., food groups, macronutrients) and particular aspects of cognitive performance have rarely been explored. We evaluated the association of adherence to an a priori defined Mediterranean dietary pattern and its components with dementia and specific aspects of cognitive function in a representative population cohort in Greece. Participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), an on-going population-based study, exploring potential associations between diet and cognitive performance in a representative sample from Greek regions, were included in this analysis. Diagnosis of dementia was made by a full clinical and neuropsychological evaluation, while cognitive performance was assessed according to five cognitive domains (memory, language, attention-speed, executive functioning, visuospatial perception) and a composite cognitive score. Adherence to MeDi was evaluated by an a priori score (range 0-55), derived from a detailed food frequency questionnaire. Among 1,865 individuals (mean age 73±6 years, 41% male), 90 were diagnosed with dementia and 223 with mild cognitive impairment. Each unit increase in the Mediterranean dietary score (MedDietScore) was associated with a 10% decrease in the odds for dementia. Adherence to the MeDi was also associated with better performance in memory, language, visuospatial perception and the composite cognitive score; the associations were

  11. Mediterranean diet and cognitive health: Initial results from the Hellenic Longitudinal Investigation of Ageing and Diet

    PubMed Central

    Yannakoulia, Mary; Kosmidis, Mary H.; Dardiotis, Efthimios; Hadjigeorgiou, Giorgos M.; Sakka, Paraskevi; Arampatzi, Xanthi; Bougea, Anastasia; Labropoulos, Ioannis; Scarmeas, Nikolaos

    2017-01-01

    Background The Mediterranean dietary pattern has been associated with a decreased risk of many degenerative diseases and cognitive function in particular; however, relevant information from Mediterranean regions, where the prototype Mediterranean diet is typically adhered to, have been very limited. Additionally, predefined Mediterranean diet (MeDi) scores with use of a priori cut-offs have been used very rarely, limiting comparisons between different populations and thus external validity of the associations. Finally, associations between individual components of MeDi (i.e., food groups, macronutrients) and particular aspects of cognitive performance have rarely been explored. We evaluated the association of adherence to an a priori defined Mediterranean dietary pattern and its components with dementia and specific aspects of cognitive function in a representative population cohort in Greece. Methods Participants from the Hellenic Longitudinal Investigation of Ageing and Diet (HELIAD), an on-going population-based study, exploring potential associations between diet and cognitive performance in a representative sample from Greek regions, were included in this analysis. Diagnosis of dementia was made by a full clinical and neuropsychological evaluation, while cognitive performance was assessed according to five cognitive domains (memory, language, attention-speed, executive functioning, visuospatial perception) and a composite cognitive score. Adherence to MeDi was evaluated by an a priori score (range 0–55), derived from a detailed food frequency questionnaire. Results Among 1,865 individuals (mean age 73±6 years, 41% male), 90 were diagnosed with dementia and 223 with mild cognitive impairment. Each unit increase in the Mediterranean dietary score (MedDietScore) was associated with a 10% decrease in the odds for dementia. Adherence to the MeDi was also associated with better performance in memory, language, visuospatial perception and the composite cognitive

  12. Secure Grid Services for Cooperative Work in Medicine and Life Science

    NASA Astrophysics Data System (ADS)

    Weisbecker, Anette; Falkner, Jürgen

    MediGRID provides a grid infrastructure to solve challenging problems in medical and life sciences by enhancing the productivity and by enabling locationindependent, interdisciplinary collaboration. The usage of grid technology has enabled the development of new application and services for research in medical and life sciences. In order to enlarge the range of services and to get a broader range of users sustainable business models are needed. In Services@MediGRID methods for monitoring, accounting, and billing which fulfilled the high security demands within medicine and life sciences will be developed. Also different requirements of academic and industrial grid customers are considered in order to establish the sustainable business models for grid computing.

  13. Calif. Governor vetoes bill to furnish clean drinking water.

    PubMed

    1995-11-03

    Several water suppliers in California have detected cryptosporidium, a parasite, in the drinking water. This parasite causes a variety of medical problems for normally healthy people, but can prove fatal to those with compromised immune systems, such as AIDS patients. California legislators adopted A.B. 590, a bill which would have added bottled water and water filters to the list of medical benefits offered by Medi-Cal, the State's medical assistance program. When the legislation reached Governor Pete Wilson on October 12, 1995, it was vetoed. The governor stated that if a Medi-Cal beneficiary was unable to boil water or obtain boiled water from a family member, then that beneficiary was eligible for attendant services. AIDS advocates argued that it is more cost effective for the State to provide clean water and filters than attendant services.

  14. Enrollee satisfaction with three Florida Medicaid managed care programs.

    PubMed

    Hu, Hsou-mei; Duncan, R Paul; Porter, Colleen K

    2003-05-01

    A study was undertaken to compare adult enrollees' satisfaction with three Medicaid Programs operating in South Florida: (1) the provider service network (PSN), (2) MediPass, and (3) Medicaid HMOs. The Consumer Assessment of Health Plans Study 2.0 Medicaid Adult instrument was used to collect information on four global ratings and five composite ratings. MediPass enrollees were satisfied with their overall health care, whereas PSN enrollees gave only average scores for their doctors, specialists, overall health care, provider communication, and staff helpfulness. The HMO enrollees were satisfied with their specialists, health plan, access to care, promptness of care, staff helpfulness, and member/customer service. Improvements in satisfaction would require different interventions in each of the programs.

  15. Dietary habits in Parkinson's disease: Adherence to Mediterranean diet.

    PubMed

    Cassani, Erica; Barichella, Michela; Ferri, Valentina; Pinelli, Giovanna; Iorio, Laura; Bolliri, Carlotta; Caronni, Serena; Faierman, Samanta A; Mottolese, Antonia; Pusani, Chiara; Monajemi, Fatemeh; Pasqua, Marianna; Lubisco, Alessandro; Cereda, Emanuele; Frazzitta, Giuseppe; Petroni, Maria L; Pezzoli, Gianni

    2017-06-15

    Our objective is to describe the dietary habits, food preferences and adherence to Mediterranean diet (MeDi) of a large sample of Italian Parkinson's Disease (PD) patients compared to a group of controls. Dietary habits of 600 PD patients from throughout Italy and 600 controls matched by gender, age, education, physical activity level and geographical residence, were collected using the ON-GP Food Frequency Questionnaire. Then, we compared patients by disease duration and the presence of swallowing disturbances. Overall, adherence of PD patients (males, 53.8%; mean disease duration, 9.2 ± 7.0 years) to MeDi was similar to controls (score, 4.8 ± 1.7 vs. 4.9 ± 1.6; P = 0.294). Patients consumed less alcohol and fish and drank significantly less water, coffee, and milk which resulted also in lower total fluids intake. On the contrary, they ate more fruit, cooked vegetables, cereals and baked items, more dressings and more sweets in general. Disease duration was associated with increased intake of several food groups but it was not associated with changes in MeDi score (P = 0.721). Patients with swallowing disturbances (n = 72) preferred softer and more viscous food but preferences did not result in differences in dietary pattern. However, patients with dysphagia drank less fluids (P = 0.043). PD patients presented different dietary habits and food preferences compared to the general population and adherence to MeDi was not associated with disease duration. Self-reported dysphagia was associated with reduced intake of fluids. These aspects may be amenable to change in order to improve the management of nutritional issues in this patient population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Targeting Alpha Toxin and ClfA with a Multimechanistic Monoclonal-Antibody-Based Approach for Prophylaxis of Serious Staphylococcus aureus Disease

    PubMed Central

    Tkaczyk, C.; Hamilton, M. M.; Sadowska, A.; Shi, Y.; Chang, C.S.; Chowdhury, P.; Buonapane, R.; Xiao, X.; Warrener, P.; Mediavilla, J.; Kreiswirth, B.; Suzich, J.; Stover, C. K.

    2016-01-01

    ABSTRACT Staphylococcus aureus produces numerous virulence factors, each contributing different mechanisms to bacterial pathogenesis in a spectrum of diseases. Alpha toxin (AT), a cytolytic pore-forming toxin, plays a key role in skin and soft tissue infections and pneumonia, and a human anti-AT monoclonal antibody (MAb), MEDI4893*, has been shown to reduce disease severity in dermonecrosis and pneumonia infection models. However, interstrain diversity and the complex pathogenesis of S. aureus bloodstream infections suggests that MEDI4893* alone may not provide adequate protection against S. aureus sepsis. Clumping factor A (ClfA), a fibrinogen binding protein, is an important virulence factor facilitating S. aureus bloodstream infections. Herein, we report on the identification of a high-affinity anti-ClfA MAb, 11H10, that inhibits ClfA binding to fibrinogen, prevents bacterial agglutination in human plasma, and promotes opsonophagocytic bacterial killing (OPK). 11H10 prophylaxis reduced disease severity in a mouse bacteremia model and was dependent on Fc effector function and OPK. Additionally, prophylaxis with 11H10 in combination with MEDI4893* provided enhanced strain coverage in this model and increased survival compared to that obtained with the individual MAbs. The MAb combination also reduced disease severity in murine dermonecrosis and pneumonia models, with activity similar to that of MEDI4893* alone. These results indicate that an MAb combination targeting multiple virulence factors provides benefit over a single MAb neutralizing one virulence mechanism by providing improved efficacy, broader strain coverage, and protection against multiple infection pathologies. PMID:27353753

  17. AFRRI Annual Research Reports, Fiscal Year 1992

    DTIC Science & Technology

    1993-01-01

    damage in Anno GH, Baum SJ, Withers HR, Young RW the guinea pig hippocampal slice. Free Radical (1989) Symptomology of acute radiation ef- Biology and...phosphorothioate WR-3689 en- mimics. Free Radical Biology and Medicine hances survival of irradiated mice. In: Jacobs 9s 1:38 MM (ed) Vitamins and minerals...Eicosanoids and Other Bioac- reperfusion. Free Radical Biology and Medi- tive Lipids in Cancer. Inflammation. and Radi- cine 9s 1: 109, 5th Biennial

  18. Bibliography of Leishmania and Leishmanial Diseases. Volume 1

    DTIC Science & Technology

    1980-06-01

    DE ANATOMIA PATOLOGICA, ARCIJIVOS CARDIOLOGIA Y HEMATO- PATOLOGIA CORRELATIVA E NEURO- LOGIA. Madrid. ERGENOLOGIA. Coimbra. S ZR 1 AL P U BL I C A...VETERINARA. Publicatiune a DE ANATOMIA Normal y Paiolo’gica. Corpulul dida’ctic’ al Facultitei de Medi- Buenos Aires. cini Veterinarl BVCUREITI. Arch. Soc...ESPANOLA Trn DE BIOLOGIA.’ Madrid. BOLLETTINO DEI NICSEI-’Dl ZOOLOGIA E DI ANATOMIA COMPARATA DELLA REALE VNIVERSITA, DI TORINO. Bol. Soc. Esp. Hint. Nat

  19. A Mouse Model to Investigate Postmenopausal Biology as an Etiology of Ovarian Cancer Risk

    DTIC Science & Technology

    2007-11-01

    and an in- crease in pituitary gonadotropins follows because of the lack of feedback inhibition that is normally medi- ated through progesterone ...of pten in ovarian surface epithelial cells were found to develop endometriosis and endometrioid carcinomas.41 Because both mutations are present in... endometriosis and endo- metrioid ovarian cancer in humans, this model seems to recapitulate the genotype and histomorphology associ- ated with the

  20. Abstracts of the Annual Meeting of the Society of Engineering Science, Incorporated (20th) Held at Newark, Delaware on August 22, 23 and 24, 1983.

    DTIC Science & Technology

    1983-09-01

    Mass Transfer , 24, 1981, pp. 195-203. Kaviany, M., "Thermal Instabilities in Porous Medi- um,* Heat Transfer in Porous Media , ASME, HTD, 22, 1982, pp. 1...187 HT-I Heat Transfer in Porous Media -Experimental Aspects ...... 196 HT-2 Heat Transfer in Porous Media -Theoretical Aspects ....... 210 HT-3 Mixed...Minnesota 55455 Combined heat and mass trans for processes in porous media

  1. UTD at TREC 2014: Query Expansion for Clinical Decision Support

    DTIC Science & Technology

    2014-11-01

    Syntactically process the medical case descrip- tion with the shallow parser available from OpenNLP [1] and derive all the noun phrases , generating a...de- scribed in Section 2.1 leverages two sources of infor- mation to determine likely key- phrases : Wikipedia and syntactic noun phrases . This allows... phrase detec- tion, (2) an extended approach incorporating medi- cal knowledge bases for query expansion, (3) a fur- ther extended approach which

  2. A great honor and a huge challenge for China: You-you TU getting the Nobel Prize in Physiology or Medicine.

    PubMed

    Yuan, Da; Yang, Xue; Guo, Jun-Chao

    2016-05-01

    Public excitement over the award of the 2015 Nobel Prize in Physiology or Medicine to the Chinese medical scientist You-you TU for the discovery of a herbal anti-malarial, may mislead the Chinese people into believing that traditional Chinese herbal medi-cine can be used to cure all disease without any ad-verse effects. The aim of this paper is to explain the advantages and disadvantages of herbal traditional Chinese medicine (TCM) objectively.

  3. Rickettsial Infections of Fleas Collected From Small Mammals on Four Islands in Indonesia

    DTIC Science & Technology

    2010-01-01

    transmit rickettisae back to a rat host during subse- quent feeding (Azad 1990). In urban environments of Indonesia, R. rattus and R. norvegicus rats...1281-1283. Mahadevan, S., W. H. Cheong, and M. Wamin. 1969. Pic- torial key to some common fleas. Institute for Medical Research, Kuala Lumpur ...Jakarta, Indonesia. 2 Corresponding author: Navy Environmental Preventive, Medi- cine Unit 2, 1887 Powhatan Street, Norfolk, VA 23511 (e-mail

  4. Tyrosol and hydroxytyrosol, two main components of olive oil, protect N2a cells against amyloid-β-induced toxicity. Involvement of the NF-κB signaling.

    PubMed

    St-Laurent-Thibault, C; Arseneault, M; Longpré, F; Ramassamy, C

    2011-08-01

    Alzheimer's disease (AD) is the most common form of dementia. Recently, a number of epidemiological studies have evidence that some dietary factors such as low antioxidants and vitamins intake could increase the risk of AD. In the opposite, diets rich in unsaturated fatty acids, in polyphenols, vitamins and antioxidants were identified as preventive factors. Several studies have reported that adherence to the Mediterranean diet (MeDi) was associated with a reduction in incident of dementia. The beneficial effect of MeDi may be the result of the association of some individual and non-identified food components and high consumption of olive oil. In this study we have investigated the protective effects of two components of olive oil, tyrosol (Tyr) and hydroxytyrosol (OH-Tyr), against Aβ-induced toxicity. In cultured neuroblastoma N2a cells, we found that Aβ(25-35) (100 µg/ml) treatment induced a decrease of glutathione (GSH) and the activation of the transcription factor NF-κB and cell death. Our results demonstrated that the number of cell death decreased when cells were co-treated with Aβ and Tyr or OH-Tyr. However, neither of these phenolic compounds was able to prevent the decrease of GSH induced by H(2)O(2) or Aβ. We found that the increase in the nuclear translocation of the NF-κB subunits after Aβ exposure was attenuated in the presence of Tyr or OH-Tyr. These results identified two individual food components of the MeDi as neuroprotective agent against Aβ and their potential involvement in the beneficial effect of the MeDi for the prevention of AD.

  5. Medical Entomology Studies - VII. The Subgenus Stegomyia of Aedes in Southeast Asia. II - The Edwardsi Group of Species. III - The W-Albus Group of Species. (Diptera: Culicidae). VIII: Notes on the Taxonomic Status of Aedes Vittatus (Deptera: Culicidae) (Contributions of the American Entomological Institute. Volume 14, Number 1)

    DTIC Science & Technology

    1977-01-01

    School of Hygiene and Public Health ; California Aca- demy of Sciences; Medical Zoology Laboratory, The Institute of Medical Science, University of...public health importance. lThese specimens were probably perplexus and gardnerii imitator. Huang: Aedes (Stegomyia) in Southeast Asia 13 KEYS TO THE...University of Utah; Johns Hopkins School of Public Health ; California Academy of Sciences; Medi- cal Zoology Laboratory, The Institute for Medical

  6. Fish, Family, and Profit: Piracy and the Horn of Africa

    DTIC Science & Technology

    2009-01-01

    resonates with the nineteenth-century American experience against privateers and pirates based in northern Africa and the Caribbean Sea. Two hundred years...ago, the United States needed logistical bases so that its armed forces could operate in the Medi- terranean, thousands of miles from home. As the...nineteenth century dawned, British-held Gibraltar became an essential logistical base for U.S. operations during the Barbary Wars. In that same conflict

  7. Interpreting hypernymic propositions in an online medical encyclopedia.

    PubMed

    Fiszman, Marcelo; Rindflesch, Thomas C; Kilicoglu, Halil

    2003-01-01

    Interpretation of semantic propositions from bio-medical texts documents would provide valuable support to natural language processing (NLP) applications. We are developing a methodology to interpret a kind of semantic proposition, the hypernymic proposition, in MEDLINE abstracts. In this paper, we expanded the system to identify these structures in a different discourse domain: the Medical Encyclopedia from the National Library of Medi-cine's MEDLINEplus Website.

  8. European Science Notes. Volume 41, Number 7.

    DTIC Science & Technology

    1987-07-01

    physics, Mirko Orlic, who is a research scientist chemistry, biology, experimental medi- with the Geophysical Institute and a mem- cine , and marine...annihilation, are described below. The Dynamic Method. In the dynamic method of neutron raaiography--dynamic Neutron Radiography neutron fluoroscopy ...observed using Several examples of real-time dynamic x-rays. For example, H, Cd, Gd have very neutron fluoroscopy at NDT Harwell are high neutron

  9. Digital planning of high tibial osteotomy. Interrater reliability by using two different software.

    PubMed

    Schröter, Steffen; Ihle, Christoph; Mueller, Johannes; Lobenhoffer, Philipp; Stöckle, Ulrich; van Heerwaarden, Ronald

    2013-01-01

    The purpose of the study was to determine the interrater reliability as well as the correlation of mediCAD(®) and PreOPlan(®) in deformity analysis and digital planning of osteotomies. Digital radiographs were obtained from 81 patients planned to undergo an open wedge high tibial osteotomy. The JPEG files of the radiographs were imported to landmark-based software. Deformity analysis and planning of correction were performed by 1 experienced and 2 unexperienced observers. Osteotomy planning was aimed at correction to the predefined mechanical tibiofemoral angle of 3° valgus leg alignment. The interrater reliability of measurements was assessed using intraclass correlation coefficients (ICCs) and the confidence interval. The ICC of PreOPlan(®) was from 0.841 (mechanical lateral distal femur angle) to 0.993 (wedge-angle) and from 0.896 (joint line convergence angle) to 0.995 (mechanical tibiofemoral angle) of mediCAD(®). The ICC of height of wedge-base was 0.979 with PreOPlan(®) and 0.969 with mediCAD(®). Comparing PreOPlan(®) and mediCAD(®), the ICC of the height of wedge-base of the observers was 0.966, 0.956 and 0.969, respectively. The results show a high interrater reliability of digital planning software. Experience of the observer had no influence on results. Furthermore, a high interrater reliability and correlation of digital planning specific parameters was found. Surgeons need to master limb geometry measurements and osteotomy planning on digital radiographs as digital planning reports are used for intercolleagual correspondence, teaching purposes and as medicolegal documents. The digital planning software tested agrees with the actual demands and could be recommended for deformity analysis and planning of osteotomies. Diagnostic studies, Level I.

  10. Components of a Mediterranean diet and their impact on cognitive functions in aging

    PubMed Central

    Huhn, Sebastian; Kharabian Masouleh, Shahrzad; Stumvoll, Michael; Villringer, Arno; Witte, A. Veronica

    2015-01-01

    Background: Adhering to the Mediterranean diet (MeDi) is known to be beneficial with regard to many age-associated diseases including cardiovascular diseases and type 2 diabetes. Recent studies also suggest an impact on cognition and brain structure, and increasing effort is made to track effects down to single nutrients. Aims: We aimed to review whether two MeDi components, i.e., long-chain omega-3 fatty acids (LC-n3-FA) derived from sea-fish, and plant polyphenols including resveratrol (RSV), exert positive effects on brain health in aging. Content: We summarized health benefits associated with the MeDi and evaluated available studies on the effect of (1) fish-consumption and LC-n3-FA supplementation as well as (2) diet-derived or supplementary polyphenols such as RSV, on cognitive performance and brain structure in animal models and human studies. Also, we discussed possible underlying mechanisms. Conclusion: A majority of available studies suggest that consumption of LC-n3-FA with fish or fishoil-supplements exerts positive effects on brain health and cognition in older humans. However, more large-scale randomized controlled trials are needed to draw definite recommendations. Considering polyphenols and RSV, only few controlled studies are available to date, yet the evidence based on animal research and first interventional human trials is promising and warrants further investigation. In addition, the concept of food synergy within the MeDi encourages future trials that evaluate the impact of comprehensive lifestyle patterns to help maintaining cognitive functions into old age. PMID:26217224

  11. Experiments Have Not Demonstrated Success of Competitive Fixed-Price Contracting in Medicare.

    DTIC Science & Technology

    1981-12-01

    Claims Processingr (HRD-79-76). As requested, our review focused principally on the experimental contract in Illinois. We also addressed the Health Care ...fixed-price contracting on the Medi- care program. (See pp. 8 to 10.) The results of Medicare’s three fixed-price experiments have varied. Contractor...year of its fixed-price contract to process Medicare part B claims in Maine on September 30, 1981. The Health Care Financing Administration (HCFA

  12. Handbook for Construction of Task Inventories for Navy Enlisted Ratings

    DTIC Science & Technology

    1984-01-01

    with Bureau of Medi- cine and Surgery information for a cooperative occupational analysis of the a Hospital Corpsman (KH) rating. Magnetic tapes of...additional references, both official and unofficial, on hundreds of subjects. BIBLIO -1 ~~...... . ... .... . . .. ’ o...mediators. BIBLIO -2 . ..." , . . .. .. . . (9 Christal. R. E., & Welssmuller, J. J. New COig p~ograms for a alyIng . task factor Information (AFHRL

  13. Estimating Costs for Army Materiei Health Hazards.

    DTIC Science & Technology

    1997-03-01

    associated with Army materiel, it can be used in other areas of preventive medi- cine . The model estimates total medical costs based on the determination of a...ber 1996. Biblio . 1 Leutwyler, Kristin. "The Price of Prevention." Scientific American. April 1995. Logistics Management Institute...Hearing Loss Cases and Compensation for Veterans—1986-1994. Aberdeen Proving Ground, MD, Unpublished, undated. Biblio . 2 Bibliography U.S. Army

  14. The Physiological Effect of Compressive Forces on the Torso

    DTIC Science & Technology

    1946-12-19

    changes during impacto During the course of these experiments in which impact loads were cautiously and progressively inoreasedp it was learned that...34 especially when the sub~ 0 ject would not synchronize the forced expiratory maneuver with the e onset of impacto f There is an appreciable period...occur ~Q medie.tely after the impacto The increase in ear opacity during the two seconds before impact is probably due to increased intrathoracic pressure

  15. Status of Research in Underwater Physiology

    DTIC Science & Technology

    1956-03-01

    Considerable advances could be made if the precise mechanisms respon- sible for the toxic effects of oxygen, carbon dioxide, and nitrogen were under.- stood...in decompression include the re-solution of tissue bubbles and an elucidation of the mechanisms involved in aeroembolism, medi- astinal and...may be diffuse atelectasis . Since pulmonary changes can decrease the oxygenation of arterial blood, the central nervous form of oxygen toxicity may be

  16. Invisible Wounds of War. Summary and Recommendations for Addressing Psychological and Cognitive Injuries

    DTIC Science & Technology

    2008-01-01

    input and output characteristics, for which the inner workings are not visible, is a black box. With regard to psychotherapy , “black box” indicates...an Assessment of Out- patient Treatment at Walter Reed Army Medical Center and the National Naval Medi- cal Center. Tasked with identifying critical ...medications and psychotherapies is necessary, since many have concerns about the side effects of medications. We now consider the potential long-term

  17. Crystallization and preliminary X-ray diffraction analysis of the complex between a human anti-alpha toxin antibody fragment and alpha toxin.

    PubMed

    Oganesyan, Vaheh; Barnes, Arnita; Tkaczyk, Christine; Ferguson, Andrew; Wu, Herren; Dall'Acqua, William F

    2013-03-01

    Staphylococcus aureus alpha toxin (AT) has been crystallized in complex with the Fab fragment of a human antibody (MEDI4893). This constitutes the first reported crystals of AT bound to an antibody. The monoclinic crystals belonged to space group P2₁, with unit-cell parameters a=85.52, b=148.50, c=93.82 Å, β=99.82°. The diffraction of the crystals extended to 2.56 Å resolution. The asymmetric unit contained two MEDI4893 Fab-AT complexes. This corresponds to a crystal volume per protein weight (VM) of 2.3 Å3 Da(-1) and a solvent content of 47%. The three-dimensional structure of this complex will contribute to an understanding of the molecular basis of the interaction of MEDI4893 with AT. It will also shed light on the mechanism of action of this antibody, the current evaluation of which in the field of S. aureus-mediated diseases makes it a particularly interesting case study. Finally, this study will provide the three-dimensional structure of AT in a monomeric state for the first time.

  18. Electromechanical lever blocks for active vibration isolation

    NASA Astrophysics Data System (ADS)

    Zago, Lorenzo; Genequand, Pierre M.

    2000-04-01

    This paper is a follow-up of a presentation at the Smart Structures Symposium of 1998. There we described an innovative technical solution which provides a combined passive damping and isolation interface with the appropriate transmissibility characteristics between a vibrating base and a sensitive payload, typically an optical terminal/telescope. The particularity of the solution is primarily found in the implementation of energy dissipation by means linear electromagnetic linear motors leveraged by means of flexure elements, to constitute an integrated resistor-damped electromechanic lever block, which we called MEDI (Mechanical Elastic element for Damping and Isolation). Passive viscous damping with attenuation of the order of -20 dB at 50 Hz with respect to a hard fixation, is obtained by simply short- circuiting the electro-magnetic motor. The study and test program presented here extends the application of MEDIs to active vibration reduction systems. The study, contracted by the European Space Agency, aimed at investigating the possibility of using the MEDI as an active isolator for scientific experiments in the International Space Station. By controlling the current in the electromagnetic motor in closed loop with the signal from specially designed force sensor (with extremely low noise), we achieved attenuation of the order of -15 dB at 1 Hz, -30 dB at 10 Hz, -50 dB at 30 Hz, with the isolation slope starting as low as 0.1 Hz.

  19. Spanish-Language Community-Based Mental Health Treatment Programs, Policy-Required Language-Assistance Programming, and Mental Health Treatment Access Among Spanish-Speaking Clients

    PubMed Central

    McClellan, Sean R.

    2013-01-01

    Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P < .05). However, the increase was insufficient to significantly reduce language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663

  20. Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California.

    PubMed

    Eichner, J; Kahn, J G

    2001-08-01

    Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.

  1. Spanish-language community-based mental health treatment programs, policy-required language-assistance programming, and mental health treatment access among Spanish-speaking clients.

    PubMed

    Snowden, Lonnie R; McClellan, Sean R

    2013-09-01

    We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P < .05). However, the increase was insufficient to significantly reduce language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.

  2. LONG-TERM STABILITY OF THE LOCAL GROUND CONTROL NETWORK AT THE CO-LOCATION SITE OF MEDICINA

    NASA Astrophysics Data System (ADS)

    Abbondanza, C.; Sarti, P.; Legrand, J.

    2009-12-01

    ITRF combinations rely on the availability of accurate tie vectors linking reference points of space geodetic techniques. Co-located instruments are assumed to move consistently and no local relative motion is taken into account. Instabilities may degrade the quality of the co-location itself and perturb the result of ITRF combinations. This work aims to determine the stability of the local ground control network at Medicina (Italy) with independent surveying methods. The observatory hosts a co-location between a VLBI telescope and two GPS antennas, MEDI and MSEL. It is located in the Po Plain where thick layers of clays are the prevalent soil characteristics. Hence, provision of long term stability of geodetic monuments is a challenge and monitoring their stability is an issue. MEDI and the VLBI station regularly contribute to the determination of ITRF, while MSEL is part of the EUREF network. A set of five tie vectors observations linking the VLBI and MEDI reference points was acquired between 2001 and 2007. It is our main tool for performing local deformation analysis. Additionally, the GPS time series of MEDI and MSEL were used to cross check and confirm the local instability detected by terrestrial methods. To achieve a rigorous and reliable investigation of the local stability, multi-epoch terrestrial observations were homogeneously processed according to common parameterizations in a consistent reference frame. Similarly, continuous GPS observations from MEDI and MSEL were analysed according to the new EPN reprocessing strategy in order to monitor the short baseline between MEDI and MSEL; to spotlight any change in its length. Both approaches confirm differential motions at the site which can be related to monument instabilities originated by the particularly unfavourable local geological setting and the inapt design of the monuments foundation. The monuments move non homogeneously at rates reaching up to 1.6 mm/year, this value being comparable to intra

  3. The Hellenic Longitudinal Investigation of Aging and Diet (HELIAD): rationale, study design, and cohort description.

    PubMed

    Dardiotis, Efthimios; Kosmidis, Mary H; Yannakoulia, Mary; Hadjigeorgiou, Georgios M; Scarmeas, Nikolaos

    2014-01-01

    Accumulating epidemiological evidence from several populations supports the important role of the Mediterranean-type diet (MeDi) in reducing the risk for age-related diseases such as Alzheimer's disease (AD). However, the relevant literature is clearly deficient for most Mediterranean countries that more closely adhere to the originally described MeDi. Greece resides in the Mediterranean basin, and older generations traditionally adhere to a MeDi. We here present the design and the preliminary baseline characteristics of the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD). The HELIAD is a population-based, multidisciplinary, collaborative study designed to estimate the prevalence and incidence of AD, other dementias, mild cognitive impairment, and other neuropsychiatric conditions of aging in the Greek population and to investigate associations between nutrition and cognitive dysfunction/age-related neuropsychiatric diseases in this Mediterranean population. The study also ascertains several demographic, medical, social, environmental, clinical, nutritional, and neuropsychological determinants and lifestyle activities. In total, 1,050 participants of a random sample have already completed the initial evaluation. The subjects were, on average, 73.4 (SD = 6.0) years old, 60% of the sample were female, and most of the participants were poorly educated with an average of 5.41 (SD = 3.5) years of education. The performance on the neuropsychological tests was equivalent to the average scores of previous normative Greek samples. More than one third of the population under investigation was considered to be at high risk for malnutrition. The HELIAD may provide important data for expanding our knowledge regarding the prevalence, incidence, and risk factors of AD and several other neuropsychiatric diseases in the Mediterranean region. © 2014 S. Karger AG, Basel.

  4. Assessment of older adults' knowledge of and preferences for medication management tools and support systems.

    PubMed

    Lakey, Susan L; Gray, Shelly L; Borson, Soo

    2009-06-01

    A variety of strategies are available to assist older adults who have difficulties managing medications. Little is known about older adults' knowledge of or willingness to use these strategies. To assess older adults' current use of, knowledge of, and preferences for medication management tools and supports. A cross-sectional study was conducted at a continuing care retirement community. All 152 independent-living residents were approached for participation. We developed a 6-page survey to gather information about knowledge of and preferences for medication management tools (eg, medi-sets, bubblepacks) and supports (eg, family, caregivers, regimen simplification). Information on demographic variables, medication management capacity, cognition, self-reported difficulty taking medications, and medication use were collected along with survey answers during an in-home interview. chi(2) and t-tests were used to compare knowledge and preferences by complexity and organizer use. Our sample consisted of 109 participants ranging in age from 73 to 98 years (average 85.9). Most of the subjects were well educated (average 15.5 y of education), 98% were white, and 80% were female. The majority (82%) were using a medication tool, mainly simple, self-filled medi-sets (62%) and easy-open vials (55%). Knowledge about, use of, and preferences for other devices, including pharmacist-filled tools and programmable devices, were low. Participants who used medication organizers rated self-filled medi-sets higher than did non-users (4.7 vs 1.6; p < 0.01). Only 18% of participants had asked a provider to simplify their medications, while 40% did not realize that they could do so. Of those who did ask a provider, 80% asked a physician. Educational strategies are needed to increase awareness of the pharmacist's role in facilitating medication management and the option of simplifying complex regimens. It is within the scope of pharmacy to provide this type of medication education.

  5. [Validation of interaction databases in psychopharmacotherapy].

    PubMed

    Hahn, M; Roll, S C

    2017-07-24

    Drug-drug interaction databases are an important tool to increase drug safety in polypharmacy. There are several drug interaction databases available but it is unclear which one shows the best results and therefore increases safety for the user of the databases and the patients. So far, there has been no validation of German drug interaction databases. Validation of German drug interaction databases regarding the number of hits, mechanisms of drug interaction, references, clinical advice, and severity of the interaction. A total of 36 drug interactions which were published in the last 3-5 years were checked in 5 different databases. Besides the number of hits, it was also documented if the mechanism was correct, clinical advice was given, primary literature was cited, and the severity level of the drug-drug interaction was given. All databases showed weaknesses regarding the hit rate of the tested drug interactions, with a maximum of 67.7% hits. The highest score in this validation was achieved by MediQ with 104 out of 180 points. PsiacOnline achieved 83 points, arznei-telegramm® 58, ifap index® 54 and the ABDA-database 49 points. Based on this validation MediQ seems to be the most suitable databank for the field of psychopharmacotherapy. The best results in this comparison were achieved by MediQ but this database also needs improvement with respect to the hit rate so that the users can rely on the results and therefore increase drug therapy safety.

  6. Quantitative Susceptibility Mapping Using the Multiple Dipole-inversion Combination with k-space Segmentation Method.

    PubMed

    Sato, Ryota; Shirai, Toru; Taniguchi, Yo; Murase, Takenori; Bito, Yoshitaka; Ochi, Hisaaki

    2017-10-10

    Quantitative susceptibility mapping (QSM) is a new magnetic resonance imaging (MRI) technique for noninvasively estimating the magnetic susceptibility of biological tissue. Several methods for QSM have been proposed. One of these methods can estimate susceptibility with high accuracy in tissues whose contrast is consistent between magnitude images and susceptibility maps, such as deep gray-matter nuclei. However, the susceptibility of small veins is underestimated and not well depicted by using the above approach, because the contrast of small veins is inconsistent between a magnitude image and a susceptibility map. In order to improve the estimation accuracy and visibility of small veins without streaking artifacts, a method with multiple dipole-inversion combination with k-space segmentation (MUDICK) has been proposed. In the proposed method, k-space was divided into three domains (low-frequency, magic-angle, and high-frequency). The k-space data in low-frequency and magic-angle domains were obtained by L1-norm regularization using structural information of a pre-estimated susceptibility map. The k-space data in high-frequency domain were obtained from the pre-estimated susceptibility map in order to preserve small-vein contrasts. Using numerical simulation and human brain study at 3 Tesla, streaking artifacts and small-vein susceptibility were compared between MUDICK and conventional methods (MEDI and TKD). The numerical simulation and human brain study showed that MUDICK and MEDI had no severe streaking artifacts and MUDICK showed higher contrast and accuracy of susceptibility in small-veins compared to MEDI. These results suggest that MUDICK can improve the accuracy and visibility of susceptibility in small-veins without severe streaking artifacts.

  7. Medicaid and the Mainstream: Reassessment in the Context of the Taxpayer Revolt

    PubMed Central

    Myers, Beverlee A.; Leighton, Rigby

    1980-01-01

    California's Medicaid program—Medi-Cal—attempted to implement the ideal of mainstream medical care for the poor by giving program beneficiaries a “credit card” for use in the private health care marketplace. This exposed the program to the perverse economic incentives of the fee-for-service, costplus health care system, and contributed to a high rate of increase in program costs. Attempts to control costs have been equally perverse, resulting in low payment rates, the second-guessing of physician professional judgments, the probing of medical and fiscal records, and the use of computerized surveillance systems. Attempts to shift to the use of more efficient delivery systems have had small success. Attempts to attain cost containment through restructuring the Medi-Cal program have been rejected in the name of the mainstream ideal. Costs have continued to escalate, with annual increases as high as 20 percent in some years. Medi-Cal now costs $4 billion per year, the largest single program in California state government. The taxpayer revolt in California is creating a fiscal crisis that will force rethinking of the premises of publicly funded health care for the poor, and a restructuring of strategies for reaching that objective. In the short run, it appears that the issue may not be whether the indigent will have access to mainstream medical care, but whether they will have access to any medical care. In the longer run, the crisis should represent an opportunity for building a system of health care that can serve the financially disadvantaged at a cost tolerable to our society. PMID:6996334

  8. Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals.

    PubMed

    Allès, B; Samieri, C; Féart, C; Jutand, M-A; Laurin, D; Barberger-Gateau, P

    2012-12-01

    Cognitive decline may lead to dementia whose most frequent cause is Alzheimer's disease (AD). Among the many potential risk factors of cognitive decline and AD, diet raises increasing interest. Most studies considered diet in the frame of a single nutrient approach with inconsistent results. A novel approach to examine the link between nutrition and cognitive function is the use of dietary patterns. The aim of the present review was to update and complete the body of knowledge about dietary patterns in relationship with various cognitive outcomes in the elderly. Two approaches can be used: a priori and a posteriori patterns. A priori patterns are defined by the adhesion to a pre-defined healthy diet using a score such as the Mediterranean diet (MeDi) score, the Healthy Eating Index, the Canadian Healthy Eating Index, the French National Nutrition and Health Programme (Programme National Nutrition Santé) Guideline Score (PNNS-GS), the Recommended Food Score (RFS) and Dietary Approaches to Stop Hypertension (DASH). MeDi score, RFS, PNNS-GS and DASH have been associated with lower risks of cognitive impairment, cognitive decline, and dementia or AD. Principal components analysis, reduced rank regression and clustering methods allow the identification of 'healthy' patterns associated with lower risk of cognitive decline. However, some studies did not report any associations with cognitive outcomes and results are discordant especially regarding MeDi and the risk of dementia. Several methodological challenges should be overcome to provide a higher level of evidence supporting the development of nutritional policies to prevent cognitive decline and AD.

  9. Risk of Zika virus transmission in the Euro-Mediterranean area and the added value of building preparedness to arboviral threats from a One Health perspective.

    PubMed

    Escadafal, Camille; Gaayeb, Lobna; Riccardo, Flavia; Pérez-Ramírez, Elisa; Picard, Marie; Dente, Maria Grazia; Fernández-Pinero, Jovita; Manuguerra, Jean-Claude; Jiménez-Clavero, Miguel-Ángel; Declich, Silvia; Victoir, Kathleen; Robert, Vincent

    2016-12-03

    In the alarming context of risk of Zika virus (ZIKV) transmission in the Euro-Mediterranean area, there is a need to examine whether capacities to detect, diagnose and notify ZIKV infections in the region are in place and whether ongoing capacity-building initiatives are filling existing gaps.The MediLabSecure network, created in 2014, comprises 55 laboratories of virology and medical entomology and 19 public health institutions in 19 countries in the Balkans, North-Africa, the Middle-East and the Black Sea regions. It aims to set up awareness, risk assessment, monitoring and control of emerging and re-emerging vector-borne viruses. We here examine the actions and strategies that MediLabSecure has been implementing and how they will contribute to the prevention and control of the ZIKV threat in the Euro-Mediterranean area.Capacity-building for arbovirus diagnostics is a major objective of the project and follows a methodological rather than disease-driven approach. This enables the implementation of laboratory trainings on techniques that are common to several arboviruses, including ZIKV, and putting into action appropriate diagnostic tools in the target region.Moreover, by its One Health approach and the interaction of its four sub-networks in human virology, animal virology, medical entomology and public health, MediLabSecure is fostering intersectoral collaboration, expertise and sharing of information. The resulting exchanges (methodological, communication and operational) across disciplines and across countries, dedicated research on intersectoral collaboration and increasing diagnostic capacities are providing new paths and tools to public health professionals to face emerging viral threats such as a ZIKV epidemic in the Euro-Mediterranean region.

  10. EphA2 Targeted Chemotherapy Using an Antibody Drug Conjugate in Endometrial Carcinoma

    PubMed Central

    Lee, Jeong-Won; Stone, Rebecca L.; Lee, Sun Joo; Nam, Eun Ji; Roh, Ju-Won; Nick, Alpa M.; Han, Hee-Dong; Shahzad, Mian M.K.; Kim, Hye-Sun; Mangala, Lingegowda S.; Jennings, Nicholas B.; Mao, Shenlan; Gooya, John; Jackson, Dowdy; Coleman, Robert L.; Sood, Anil K.

    2013-01-01

    Purpose EphA2 overexpression is frequently observed in endometrial cancers, and is predictive of poor clinical outcome. Here, we utilize an antibody drug conjugate (MEDI-547) composed of a fully human monoclonal antibody against both human and murine EphA2 (1C1) and the tubulin polymerization inhibitor, monomethylauristatin F (MMAF). Experimental design EphA2 expression was examined in endometrial cancer cell lines by Western Blot. Specificity of MEDI-547 was examined by antibody degradation and internalization assays. Viability and apoptosis were investigated in endometrial cancer cell lines and orthotopic tumor models. Results EphA2 was expressed in the Hec-1A and Ishikawa cells, but was absent in the SPEC-2 cells. Antibody degradation and internalization assays showed that the antibody drug conjugate decreased EphA2 protein levels and was internalized in EphA2 positive cells (Hec-1A and Ishikawa). Moreover, in vitro cytotoxicity and apoptosis assays demonstrated that the antibody drug conjugate decreased viability and increased apoptosis of Hec-1A and Ishikawa cells. In vivo therapy experiments in mouse orthotopic models with this antibody drug conjugate resulted in 86 to 88% growth inhibition (P < 0.001) in the orthotopic Hec-1A and Ishikawa models compared to controls. Moreover, the mice treated with this antibody drug conjugate had a lower incidence of distant metastasis compared with controls. The anti-tumor effects of the therapy were related to decreased proliferation and increased apoptosis of tumor and associated endothelial cells. Conclusions The preclinical data for endometrial cancer treatment using MEDI-547 demonstrate substantial anti-tumor activity. PMID:20388851

  11. Development of Immunity in Natural Plasmodium falciparum Malaria: Antibodies to the Falciparum Sporozoite Vaccine 1 Antigen (R32tet32)

    DTIC Science & Technology

    1987-06-01

    thesis, New York University School of Medi- cine, New York, 1974). The level of anti-R32tet32 antibody response appeared not 1.6 to be related to...parasitemia the production of new 12. Mathews, H. M., and T. J. Dondero. 1982. A longitudinal study malaria-specific IgG antibody ceased. This was interpreted...human malaria vaccine. Sciemce 228:958- 45:524-529. %2. 27. Waldmann. T. A. 1969. Disorders of immunoglobulin metabo- 30. Zavala, F., A. H. Cochrane, E

  12. Oral contraceptives and venous thromboembolic disease. Analyses of the UK General Practice Research Database and the UK Mediplus database.

    PubMed

    Farmer, R D; Lawrenson, R A; Todd, J C; Williams, T J; MacRae, K

    1999-01-01

    The results of three independent studies of venous thromboembolic disease (VTE) and oral contraceptives are reviewed together with two further cohort/case-control studies which we conducted using the MediPlus and General Practice Research Database (GPRD) databases. These latter studies jointly involved 395 cases and uniquely examined the association between VTE and individual combined oral contraceptive (COC) formulations. The two studies yielded very similar results. Crude incidence rates for idiopathic VTE of 4.6 and 3.8 were found per 10,000 exposed woman-years (EWY), in the MediPlus and GPRD studies respectively. Incidence rates increased markedly with age, and in both databases the rates amongst users of levonorgestrel products were lower than those amongst users of desogestrel and gestodene products. A case fatality rate of 3% and a mortality rate of 10 per million EWY were estimated. Odds ratios (OR) were calculated for confounding variables and different COC formulations. Both database studies indicated an excess of current smokers and women with high body mass indices amongst cases. There were significantly more cases with asthma in the GPRD study and cases who had been using their COC for less than a year. No statistically significant differences between COC formulations were found in the analyses where controls were matched to cases by practice and year of birth in both the MediPlus and GPRD studies. In the GPRD study we also ran a study where controls were matched by practice and within 5 year age bands. In this study the OR were consistently higher for the newer or 'third generation' products than when controls were matched by year of birth. However only the acne formulation/OC containing cyproterone acetate and 35 microg ethinyloestradiol yielded a significant OR of 2.3. It may be concluded that improvements in prescribing are paramount as the results strongly indicate that overweight women and those who smoke are at a greater risk of VTE. Further

  13. [Evaluation of efficacy of selected antiseptics for hands disinfection before surgical procedures].

    PubMed

    Leksowski, K; Jasiński, A; Marszałek, A

    2001-08-01

    The most important in surgical hands washing and disinfections is long-term and effective reduction of bacteria number. The aim of this study was to compare the efficiency of some antiseptic fluids used for surgical hands disinfection's (AHD 2000, Biotensid, Manopronto and Medi-Scrub PVP Iodine). 62 doctors and surgical nurses were examined. The material for the bacteriological examination was collected before and after hands disinfection's. The bacterial flora reduction have been presented as a percent and a logarithmic reduction ratio. All estimated antiseptic fluids were very potent and provided prolonged efficiency when the operation team complied with orders of hands washing.

  14. Patterns of antibacterial use and impact of age, race/ethnicity, and geographic region on antibacterial use in an outpatient medicaid cohort.

    PubMed

    Gahbauer, Alice M; Gonzales, Marco L; Guglielmo, B Joseph

    2014-07-01

    To describe patterns of outpatient antibacterial use among California Medicaid (Medi-Cal) fee-for-service system beneficiaries, and to investigate the influence of demographic factors-age, race/ethnicity, state county, and population density-on those patterns. Retrospective analysis of administrative claims data. Medi-Cal fee-for-service system claims database. All outpatient Medi-Cal fee-for-service system beneficiaries enrolled between 2006 and 2011 who had at least one systemic antibacterial claim. Rates of antibacterial prescribing and the proportion of broad-spectrum antibacterial use were measured over the study period and among age, racial/ethnic, and geographic (county) groups. Of the 10,018,066 systemic antibacterial claims selected for analysis, antibacterial prescribing rates decreased from 542 claims/1000 beneficiaries in 2006 to 461 claims/1000 beneficiaries in 2011 (r = -0.971, p=0.0012; τ-b = -1.00, p=0.009). Among age groups, children had the highest rate of use (605 claims/1000 beneficiaries, χ(2) (2) = 320,000, p<0.001); among racial/ethnic groups, Alaskan Natives and Native Americans had the highest rate of use (1086/1000 beneficiaries, χ(2) (5) = 197,000, p<0.001). Broad-spectrum antibacterial prescribing increased from 28.1% (95% confidence interval [CI] 28.1-28.2%) to 32.7% (95% CI 32.6-32.8%) over the study period. Senior age groups and whites received the highest proportions of broad-spectrum agents (53.4% [95% CI 52.5-54.3%] and 36.6% [95% CI 36.6-36.7%], respectively). Population density was inversely related to both overall antibacterial use (ρ = -0.432, p=0.0018) and broad-spectrum antibacterial prescribing (ρ = -0.359, p<0.001). The rate of prescribing decreased over the study period for all antibacterial classes with the exception of macrolides and sulfonamides. Amoxicillin was the most frequently prescribed agent. Overall and broad-spectrum antibacterial use in the Medi-Cal fee-for-service program are less than that

  15. Mapping-guided characterization of mechanical and electrical activation patterns in patients with normal systolic function using a sensor-based tracking technology.

    PubMed

    Piorkowski, Christopher; Breithardt, Ole-A; Razavi, Hedi; Nabutovsky, Yelena; Rosenberg, Stuart P; Markovitz, Craig D; Arya, Arash; Rolf, Sascha; John, Silke; Kosiuk, Jedrzej; Olson, Eric; Eitel, Charlotte; Huo, Yan; Döring, Michael; Richter, Sergio; Ryu, Kyungmoo; Gaspar, Thomas; Prinzen, Frits W; Hindricks, Gerhard; Sommer, Philipp

    2016-10-12

    In times of evolving cardiac resynchronization therapy, intra-procedural characterization of left ventricular (LV) mechanical activation patterns is desired but technically challenging with currently available technologies. In patients with normal systolic function, we evaluated the feasibility of characterizing LV wall motion using a novel sensor-based, real-time tracking technology. Ten patients underwent simultaneous motion and electrical mapping of the LV endocardium during sinus rhythm using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, SJM). Epicardial motion data were also collected simultaneously at corresponding locations from accessible coronary sinus branches. Displacements at each mapping point and times of electrical and mechanical activation were combined over each of the six standard LV wall segments. Mechanical activation timing was compared with that from electrical activation and preoperative 2D speckle tracking echocardiography (echo). MediGuide-based displacement data were further analysed to estimate LV chamber volumes that were compared with echo and magnetic resonance imaging (MRI). The lateral and septal walls exhibited the largest (12.5 [11.6-15.0] mm) and smallest (10.2 [9.0-11.3] mm) displacement, respectively. Radial displacement was significantly larger endocardially than epicardially (endo: 6.7 [5.0-9.1] mm; epi: 3.8 [2.4-5.6] mm), while longitudinal displacement was significantly larger epicardially (endo: 8.0 [5.0-10.6] mm; epi: 10.3 [7.4-13.8] mm). Most often, the anteroseptal/anterior and lateral walls showed the earliest and latest mechanical activations, respectively. 9/10 patients had concordant or adjacent wall segments of latest mechanical and electrical activation, and 6/10 patients had concordant or adjacent wall segments of latest mechanical activation as measured by MediGuide and echo. MediGuide's LV chamber volumes were significantly correlated with MRI (R(2)= 0.73, P < 0.01) and

  16. Successful outpatient management of lymphoedema and lymphorrhoea with wrap around compression: a case study.

    PubMed

    Patullo, L; Rajagopalan, S

    2017-03-02

    Referral to specialist centres for treatment of lymphoedema can often have long waiting times. Management of a patient with massive lymphoedema and lymphorrhoea was provided in a vascular outpatient setting. A new form of compression using a wraparound system was used for the management (Juxta-Fit, Medi UK). Despite having previously been non-concordant with treatment options, the patient was independent with product use. Lymphorrhoea ceased and there was a marked decrease in girth size. The patient's quality of life improved and maintenance treatment was provided. The use of this compression system could be a valuable treatment alternative to compression bandaging for a select patient group for the treatment of lymphoedema.

  17. Developing e-Business Capabilities to Bridge the Knowledge Divide in Mediterranean Countries

    NASA Astrophysics Data System (ADS)

    Secundo, Giustina; Elia, Gianluca; Margherita, Alessandro; Passiante, Giuseppina

    This paper presents the results achieved in terms of e-business capabilities developed in an International Master framed within an Euro-Medi-terranean cooperation. In particular, an e-Business Design Laboratory is here described which has been set up for designing and implementing innovative solutions to bring digital and organizational innovation in traditional and new industries. The most significant highlights of the last two editions of the Master are also reported in terms of the human, social and structural capital being generated.

  18. CMMI Roadmaps

    DTIC Science & Technology

    2008-11-01

    van de Vorst—Ordina J. de Vries—LogicaCMG Nederland J.M. Wijsman—Sogeti J.H.G. Willemsen— Nederlandse Spoorwegen A.P.J.J. Zopfi—KZA Additional...Attendees of the SPIder Workshop D. Bierhuizen—Medis Medical Imaging Systems L. Braafhart—LogicaCMG Nederland H.J.J. Cannegieter—SYSQA W. den...Dekker—LogicaCMG Nederland L. Delmelk—LogicaCMG België A.J. Donderman—Transfer Solutions G.H.M. Friedhoff—SYSQA L.L. van der Giessen—ABN AMRO M

  19. Development and Testing of Iron Based Phantoms as Standards for the Diagnosis of Microbleeds and Oxygen Saturation with Applications in Dementia, Stroke, and Traumatic Brain Injury

    DTIC Science & Technology

    2014-10-01

    phase definition in Siemens MRI systems, we have in = p ( 3 cos2 -1) / (3a2) + f [1] 7 where  is the angle between the axis of the... head coil for imaging. The imaging parameters were: TE = 11 ms, 17 ms, and 20 ms, TR = 30 ms, flip angle = 20o, read bandwidth = 244.14 Hz/pixel, image...inversion (MEDI) algorithm for quantitative susceptibility mapping in MRI , IEEE Transactions on Medical Imaging 31( 3 ): 816-824, 2012. S. Liu, J

  20. Determination of the Cyanide Metabolite 2-Aminothiazoline-4-Carboxylic Acid in Urine and Plasma by Gas Chromatography-Mass Spectrometry

    DTIC Science & Technology

    2005-01-01

    plasma, or human plasma) then elevated at a rate of 15 °C/min up to 230 ’C. The gra- was diluted with 900 jiL of 0. 1 M HC 1 to ensure the ATCA dient was...Logue et al. / J. Cviomatogr. B 819 (2005) 237-244 administered by Battelle (Delivery Order 399, Contract No. [71 F. Moriya, Y. Hashimoto, J. Forensic ...Department of Defense through the Cyanide Medi- Pharmacol. 24 (1981) 135.[9] Y. Seto, J. Forensic Sci. 41 (1996) 465. cal Countermeasures and the

  1. The impact of new health insurance coverage on undocumented and other low-income children: lessons from three California counties.

    PubMed

    Howell, Embry; Trenholm, Christopher; Dubay, Lisa; Hughes, Dana; Hill, Ian

    2010-05-01

    Three California counties (Los Angeles, San Mateo, and Santa Clara) expanded health insurance coverage for undocumented children and some higher income children not covered by Medi-Cal (Medicaid) or Healthy Families (SCHIP). This paper presents findings from evaluations of all three programs. Results consistently showed that health insurance enrollment increased access to and use of medical and dental care, and reduced unmet need for those services. After one year of enrollment the programs also improved the health status of children, including reducing the percentage of children who missed school due to health.

  2. Aeromedical Disposition and Waiver Consideration for ISS Crewmembers

    NASA Technical Reports Server (NTRS)

    Taddeo, Terrance

    2012-01-01

    Aeromedical certification of astronauts and cosmonauts traveling to the International Space Station is a multi?-tiered process that involv es standards agreed to by the partner agencies, and participation by the individual agency aeromedical boards and a multilateral space medi cine board. Medical standards are updated continually by a multilater al working group. The boards operate by consensus and strive to achie ve effective decision making through experience, medical judgment, medical evidence and risk modeling. The aim of the certification process is to minimize the risk to the ISS program of loss of mission object ives due to human health issues.

  3. Rehabilitation of Visual and Perceptual Dysfunction after Severe Traumatic Brain Injury

    DTIC Science & Technology

    2013-03-01

    throughout year 2 we have continued to add additional enhancements to the program, fixes to previously hidden bugs, and modifications to allow...inv heral object taining fixa e last 12 mo significant n in the blin 1) to only 1. g and prism uraging. Figu (a) T mon perip back wear riving simu...s C. Co The large colli (up t rates Figu Partic real s butto figure total For c signi addit medi seein diffe adeq deve D. Ey Usin subje

  4. Mediterranean diet and leukocyte telomere length in a multi-ethnic elderly population.

    PubMed

    Gu, Yian; Honig, Lawrence S; Schupf, Nicole; Lee, Joseph H; Luchsinger, Jose A; Stern, Yaakov; Scarmeas, Nikolaos

    2015-01-01

    Leukocyte telomere length (LTL) is considered as the marker of biological aging and may be related to environmental factors. The current study aimed to examine the relation between Mediterranean-type diet and LTL. We used a cross-sectional study of 1743 multi-ethnic community residents of New York aged 65 years or older. Mediterranean-type diet (MeDi) was calculated from dietary information collected using a food frequency questionnaire. LTL was measured from leukocyte DNA using a real-time PCR method to measure T/S ratio, the ratio of telomere (T) to single-copy gene (S) sequence. Regression analysis showed that the MeDi score was not associated with LTL in the overall study population (β = 12.5; p = 0.32) after adjusting for age, sex, education, ethnicity, caloric intake, smoking, and physical and leisure activities. However, we found a significant association between MeDi and LTL among non-Hispanic whites (β = 48.3; p = 0.05), and the results held after excluding dementia subjects (β = 49.6; p = 0.05). We further found that, in the whole population, vegetable and cereal consumption above the sex-specific population median was associated with longer LTL (β = 89.1, p = 0.04) and shorter LTL (β = -93.5; p = 0.03), respectively. Among non-Hispanic whites, intake of meat or dairy below sex-specific population medians was associated with longer LTL (β = 154.7, p = 0.05; β = 240.5, p < 0.001, respectively). We found that higher adherence to a MeDi was associated with longer LTL among whites but not among African Americans and Hispanics. Additionally, a diet high in vegetables but low in cereal, meat, and dairy might be associated with longer LTL among healthy elderly.

  5. A panchromatic view of the evolution of Supermassive Black Holes

    NASA Astrophysics Data System (ADS)

    Lusso, E.; Brusa, M.; Comastri, A.; Vignali, C.; Gilli, R.

    2008-10-01

    Verranno presentati i risultati preliminari di uno studio sistematico delle distribuzioni di energia spettrale (SED) di un campione statisticamente significativo di alcune centinaia di AGN (sia di tipo 1 che di tipo 2) selezionati dalla survey XMM-COSMOS. La vasta mole di dati disponibili sull'intero spettro elettromagnetico permette di calcolare le SED medie per diversi intervalli di redshift e luminosita'. Una stima affidabile della SED e' di fondamentale importanza per il calcolo della luminosita' bolometrica e quindi per lo studio della fisica dei processi di accrescimento su SMBH, per la loro evoluzione con il tempo cosmico.

  6. Creating virtual humans for simulation-based training and planning

    SciTech Connect

    Stansfield, S.; Sobel, A.

    1998-05-12

    Sandia National Laboratories has developed a distributed, high fidelity simulation system for training and planning small team Operations. The system provides an immersive environment populated by virtual objects and humans capable of displaying complex behaviors. The work has focused on developing the behaviors required to carry out complex tasks and decision making under stress. Central to this work are techniques for creating behaviors for virtual humans and for dynamically assigning behaviors to CGF to allow scenarios without fixed outcomes. Two prototype systems have been developed that illustrate these capabilities: MediSim, a trainer for battlefield medics and VRaptor, a system for planning, rehearsing and training assault operations.

  7. From testicular biopsy to human embryo.

    PubMed

    Jezek, D; Knezević, N; Kalanj-Bognar, S; Vukelić, Z; Krhen, I

    2004-01-01

    The aim of the study was to investigate the role of a testicular biopsy in the diagnosis and therapy of infertile men with a non-obstructive azoospermia. Overall, 70 testicular biopsies from infertile men were analysed. Samples were obtained by the "open testicular biopsy" method. After dissection, several pieces of the tissue were immediately immersed into the Sperm Prep Medium (Medi-Cult) and fixative (5.5% buffered glutaraldehyde). Tissue samples transported in Sperm Prep Medium were plunged into Sperm Freezing Medium (Medi-Cult) and were stored in liquid nitrogen for potential in vitro fertilization procedures. The tissue was also processed for semithin sections and transmission electron microscopy. Semithin sections from 8 infertile patients demonstrated regular testis structure and fully preserved spermatogenesis (control biopsies). In the remaining 62 cases, spermatogenesis was impaired and a variety of pathological changes could be seen: disorganization and desquamation of spermatogenic cells, spermatid or spermatocyte "stop", spermatogonia only, "Sertoli cells only" or tubular fibrosis. However, in 65% of cases (despite the above mentioned changes of seminiferous epithelium) foci of preserved spermatogenesis could be detected. These cases were classified as "mixed atrophy" of seminiferous tubules. In 63% of infertile patients, a successful extraction of sperm from the biopsy could be performed. In azoospermic patients, histological analysis of testicular biopsy proved to be very useful in terms of diagnosis as well as therapy, i.e. for further in vitro fertilization procedures.

  8. Inhibition of CD73 AMP hydrolysis by a therapeutic antibody with a dual, non-competitive mechanism of action

    PubMed Central

    Geoghegan, James C.; Diedrich, Gundo; Lu, Xiaojun; Rosenthal, Kim; Sachsenmeier, Kris F.; Wu, Herren; Dall'Acqua, William F.; Damschroder, Melissa M.

    2016-01-01

    ABSTRACT CD73 (ecto-5′-nucleotidase) has recently been established as a promising immuno-oncology target. Given its role in activating purinergic signaling pathways to elicit immune suppression, antagonizing CD73 (i.e., releasing the brake) offers a complimentary pathway to inducing anti-tumor immune responses. Here, we describe the mechanistic activity of a new clinical therapeutic, MEDI9447, a human monoclonal antibody that non-competitively inhibits CD73 activity. Epitope mapping, structural, and mechanistic studies revealed that MEDI9447 antagonizes CD73 through dual mechanisms of inter-CD73 dimer crosslinking and/or steric blocking that prevent CD73 from adopting a catalytically active conformation. To our knowledge, this is the first report of an antibody that inhibits an enzyme's function through 2 distinct modes of action. These results provide a finely mapped epitope that can be targeted for selective, potent, and non-competitive inhibition of CD73, as well as establish a strategy for inhibiting enzymes that function in both membrane-bound and soluble states. PMID:26854859

  9. Inhibition of CD73 AMP hydrolysis by a therapeutic antibody with a dual, non-competitive mechanism of action.

    PubMed

    Geoghegan, James C; Diedrich, Gundo; Lu, Xiaojun; Rosenthal, Kim; Sachsenmeier, Kris F; Wu, Herren; Dall'Acqua, William F; Damschroder, Melissa M

    2016-01-01

    CD73 (ecto-5'-nucleotidase) has recently been established as a promising immuno-oncology target. Given its role in activating purinergic signaling pathways to elicit immune suppression, antagonizing CD73 (i.e., releasing the brake) offers a complimentary pathway to inducing anti-tumor immune responses. Here, we describe the mechanistic activity of a new clinical therapeutic, MEDI9447, a human monoclonal antibody that non-competitively inhibits CD73 activity. Epitope mapping, structural, and mechanistic studies revealed that MEDI9447 antagonizes CD73 through dual mechanisms of inter-CD73 dimer crosslinking and/or steric blocking that prevent CD73 from adopting a catalytically active conformation. To our knowledge, this is the first report of an antibody that inhibits an enzyme's function through 2 distinct modes of action. These results provide a finely mapped epitope that can be targeted for selective, potent, and non-competitive inhibition of CD73, as well as establish a strategy for inhibiting enzymes that function in both membrane-bound and soluble states.

  10. In vitro comparison of noise levels produced by different CPAP generators.

    PubMed

    Kirchner, Lieselotte; Wald, Martin; Jeitler, Valerie; Pollak, Arnold

    2012-01-01

    Minimization of noise exposure is an important aim of modern neonatal intensive care medicine. Binasal continuous positive airway pressure (CPAP) generators are among the most important sources of continuous noise in neonatal wards. The aim of this study was to find out which CPAP generator creates the least noise. In an experimental setup, two jet CPAP generators (Infant Flow® generator and MediJet®) and two conventional CPAP generators (Bubble CPAP® and Baby Flow®) were compared. Noise production was measured in decibels in an A-weighted scale [dB(A)] in a closed incubator at 2 mm lateral distance from the end of the nasal prongs. Reproduction of constant airway pressure and air leak was achieved by closure of the nasal prongs with a type of adhesive tape that is semipermeable to air. The noise levels produced by the four generators were significantly different (p < 0.001). Values measured at a continuous constant flow rate of 8 l/min averaged 83 dB(A) for the Infant Flow® generator with or without sound absorber, 72 dB(A) for the MediJet®, 62 dB(A) for the Bubble CPAP® and 55 dB(A) for the Baby Flow®. Conventional CPAP generators work more quietly than the currently available jet CPAP generators. Copyright © 2011 S. Karger AG, Basel.

  11. Engineering the surface properties of a human monoclonal antibody prevents self-association and rapid clearance in vivo

    PubMed Central

    Dobson, Claire L.; Devine, Paul W. A.; Phillips, Jonathan J.; Higazi, Daniel R.; Lloyd, Christopher; Popovic, Bojana; Arnold, Joanne; Buchanan, Andrew; Lewis, Arthur; Goodman, Joanne; van der Walle, Christopher F.; Thornton, Peter; Vinall, Lisa; Lowne, David; Aagaard, Anna; Olsson, Lise-Lotte; Ridderstad Wollberg, Anna; Welsh, Fraser; Karamanos, Theodoros K.; Pashley, Clare L.; Iadanza, Matthew G.; Ranson, Neil A.; Ashcroft, Alison E.; Kippen, Alistair D.; Vaughan, Tristan J.; Radford, Sheena E.; Lowe, David C.

    2016-01-01

    Uncontrolled self-association is a major challenge in the exploitation of proteins as therapeutics. Here we describe the development of a structural proteomics approach to identify the amino acids responsible for aberrant self-association of monoclonal antibodies and the design of a variant with reduced aggregation and increased serum persistence in vivo. We show that the human monoclonal antibody, MEDI1912, selected against nerve growth factor binds with picomolar affinity, but undergoes reversible self-association and has a poor pharmacokinetic profile in both rat and cynomolgus monkeys. Using hydrogen/deuterium exchange and cross-linking-mass spectrometry we map the residues responsible for self-association of MEDI1912 and show that disruption of the self-interaction interface by three mutations enhances its biophysical properties and serum persistence, whilst maintaining high affinity and potency. Immunohistochemistry suggests that this is achieved via reduction of non-specific tissue binding. The strategy developed represents a powerful and generic approach to improve the properties of therapeutic proteins. PMID:27995962

  12. Program Capacity to Eliminate Outcome Disparities in Addiction Health Services.

    PubMed

    Guerrero, Erick G; Aarons, Gregory A; Grella, Christine E; Garner, Bryan R; Cook, Benjamin; Vega, William A

    2016-01-01

    We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010 to 2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed.

  13. Program Capacity to Eliminate Outcome Disparities in Addiction Health Services

    PubMed Central

    Guerrero, Erick G.; Aarons, Gregory; Grella, Christine; Garner, Bryan R.; Cook, Benjamin; Vega, William A.

    2014-01-01

    We evaluated program capacity factors associated with client outcomes in publicly funded substance abuse treatment organizations in one of the most populous and diverse regions of the United States. Using multilevel cross-sectional analyses of program data (n = 97) merged with client data from 2010–2011 for adults (n = 8,599), we examined the relationships between program capacity (leadership, readiness for change, and Medi-Cal payment acceptance) and client wait time and treatment duration. Acceptance of Medi-Cal was associated with shorter wait times, whereas organizational readiness for change was positively related to treatment duration. Staff attributes were negatively related to treatment duration. Overall, compared to low program capacity, high program capacity was negatively associated with wait time and positively related to treatment duration. In conclusion, program capacity, an organizational indicator of performance, plays a significant role in access to and duration of treatment. Implications for health care reform implementation in relation to expansion of public health insurance and capacity building to promote health equities are discussed. PMID:25450596

  14. Health and Oral Health Care Needs and Health Care-Seeking Behavior Among Homeless Injection Drug Users in San Francisco

    PubMed Central

    Wenger, Lynn; Lorvick, Jennifer; Shiboski, Caroline; Kral, Alex H.

    2010-01-01

    Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics. PMID:20945108

  15. Two complementary personal medication management applications developed on a common platform: case report.

    PubMed

    Ross, Stephen E; Johnson, Kevin B; Siek, Katie A; Gordon, Jeffry S; Khan, Danish U; Haverhals, Leah M

    2011-07-12

    Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet). The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC. We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children. These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.

  16. Growth of Accountable Care Organizations in California: Number, Characteristics, and State Regulation.

    PubMed

    Fulton, Brent D; Pegany, Vishaal; Keolanui, Beth; Scheffler, Richard M

    2015-08-01

    Accountable care organizations (ACOs) result in physician organizations' and hospitals' receiving risk-based payments tied to costs, health care quality, and patient outcomes. This article (1) describes California ACOs within Medicare, the commercial market, and Medi-Cal and the safety net; (2) discusses how ACOs are regulated by the California Department of Managed Health Care and the California Department of Insurance; and (3) analyzes the increase of ACOs in California using data from Cattaneo and Stroud. While ACOs in California are well established within Medicare and the commercial market, they are still emerging within Medi-Cal and the safety net. Notwithstanding, the state has not enacted a law or issued a regulation specific to ACOs; they are regulated under existing statutes and regulations. From August 2012 to February 2014, the number of lives covered by ACOs increased from 514,100 to 915,285, representing 2.4 percent of California's population, including 10.6 percent of California's Medicare fee-for-service beneficiaries and 2.3 percent of California's commercially insured lives. By emphasizing health care quality and patient outcomes, ACOs have the potential to build and improve on California's delegated model. If recent trends continue, ACOs will have a greater influence on health care delivery and financial risk sharing in California.

  17. Medical instrument data exchange.

    PubMed

    Gumudavelli, Suman; McKneely, Paul K; Thongpithoonrat, Pongnarin; Gurkan, D; Chapman, Frank M

    2008-01-01

    Advances in medical devices and health care has been phenomenal during the recent years. Although medical device manufacturers have been improving their instruments, network connection of these instruments still rely on proprietary technologies. Even if the interface has been provided by the manufacturer (e.g., RS-232, USB, or Ethernet coupled with a proprietary API), there is no widely-accepted uniform data model to access data of various bedside instruments. There is a need for a common standard which allows for internetworking with the medical devices from different manufacturers. ISO/IEEE 11073 (X73) is a standard attempting to unify the interfaces of all medical devices. X73 defines a client access mechanism that would be implemented into the communication controllers (residing between an instrument and the network) in order to access/network patient data. On the other hand, MediCAN technology suite has been demonstrated with various medical instruments to achieve interfacing and networking with a similar goal in its open standardization approach. However, it provides a more generic definition for medical data to achieve flexibility for networking and client access mechanisms. In this paper, a comparison between the data model of X73 and MediCAN will be presented to encourage interoperability demonstrations of medical instruments.

  18. Dietary Factors and Cognitive Decline.

    PubMed

    Smith, P J; Blumenthal, J A

    2016-03-01

    Cognitive decline is an increasingly important public health problem, with more than 100 million adults worldwide projected to develop dementia by 2050. Accordingly, there has been an increased interest in preventive strategies that diminish this risk. It has been recognized that lifestyle factors including dietary patterns, may be important in the prevention of cognitive decline and dementia in later life. Several dietary components have been examined, including antioxidants, fatty acids, and B vitamins. In addition, whole dietary eating plans, including the Mediterranean diet (MeDi), and the Dietary Approaches to Stop Hypertension (DASH) diet, with and without weight loss, have become areas of increasing interest. Although prospective epidemiological studies have observed that antioxidants, fatty acids, and B vitamins are associated with better cognitive functioning, randomized clinical trials have generally failed to confirm the value of any specific dietary component in improving neurocognition. Several randomized trials have examined the impact of changing 'whole' diets on cognitive outcomes. The MeDi and DASH diets offer promising preliminary results, but data are limited and more research in this area is needed.

  19. Context-based ontology building support in clinical domains using formal concept analysis.

    PubMed

    Jiang, Guoqian; Ogasawara, Katsuhiko; Endoh, Akira; Sakurai, Tsunetaro

    2003-08-01

    Ontology in clinical domains is becoming a core research field in the realm of medical informatics. The objective of this study is to explore the potential role of formal concept analysis (FCA) in a context-based ontology building support in a clinical domain (e.g. cardiovascular medicine here). We developed an ontology building support system that integrated an FCA module with a natural language processing (NLP) module. The user interface of the system was developed as a Protégé-2000 JAVA tab plug-in. A collection of 368 textual discharge summaries and a standard dictionary of Japanese diagnostic terms (MEDIS ver2.0) were used as the main knowledge sources. A preliminary evaluation was taken to show the usefulness of the system. Stability was shown on the MEDIS-based medical concept extraction with high precision. 73+/-14% (mean+/-S.D.) of the compound medical phrases extracted were sufficiently meaningful to form a medical concept from a clinical perspective. Also, 57.7% of attribute implication pairs (i.e. medical concept pairs) extracted were identified as positive from a clinical perspective. Under the framework of our ontology building support system using FCA, the clinical experts could reach a mass of both linguistic information and context-based knowledge that was demonstrated as useful to support their ontology building tasks.

  20. Engineering the surface properties of a human monoclonal antibody prevents self-association and rapid clearance in vivo.

    PubMed

    Dobson, Claire L; Devine, Paul W A; Phillips, Jonathan J; Higazi, Daniel R; Lloyd, Christopher; Popovic, Bojana; Arnold, Joanne; Buchanan, Andrew; Lewis, Arthur; Goodman, Joanne; van der Walle, Christopher F; Thornton, Peter; Vinall, Lisa; Lowne, David; Aagaard, Anna; Olsson, Lise-Lotte; Ridderstad Wollberg, Anna; Welsh, Fraser; Karamanos, Theodoros K; Pashley, Clare L; Iadanza, Matthew G; Ranson, Neil A; Ashcroft, Alison E; Kippen, Alistair D; Vaughan, Tristan J; Radford, Sheena E; Lowe, David C

    2016-12-20

    Uncontrolled self-association is a major challenge in the exploitation of proteins as therapeutics. Here we describe the development of a structural proteomics approach to identify the amino acids responsible for aberrant self-association of monoclonal antibodies and the design of a variant with reduced aggregation and increased serum persistence in vivo. We show that the human monoclonal antibody, MEDI1912, selected against nerve growth factor binds with picomolar affinity, but undergoes reversible self-association and has a poor pharmacokinetic profile in both rat and cynomolgus monkeys. Using hydrogen/deuterium exchange and cross-linking-mass spectrometry we map the residues responsible for self-association of MEDI1912 and show that disruption of the self-interaction interface by three mutations enhances its biophysical properties and serum persistence, whilst maintaining high affinity and potency. Immunohistochemistry suggests that this is achieved via reduction of non-specific tissue binding. The strategy developed represents a powerful and generic approach to improve the properties of therapeutic proteins.

  1. Dietary Factors and Cognitive Decline

    PubMed Central

    Smith, P.J.; Blumenthal, J.A.

    2015-01-01

    Cognitive decline is an increasingly important public health problem, with more than 100 million adults worldwide projected to develop dementia by 2050. Accordingly, there has been an increased interest in preventive strategies that diminish this risk. It has been recognized that lifestyle factors including dietary patterns, may be important in the prevention of cognitive decline and dementia in later life. Several dietary components have been examined, including antioxidants, fatty acids, and B vitamins. In addition, whole dietary eating plans, including the Mediterranean diet (MeDi), and the Dietary Approaches to Stop Hypertension (DASH) diet, with and without weight loss, have become areas of increasing interest. Although prospective epidemiological studies have observed that antioxidants, fatty acids, and B vitamins are associated with better cognitive functioning, randomized clinical trials have generally failed to confirm the value of any specific dietary component in improving neurocognition. Several randomized trials have examined the impact of changing ‘whole’ diets on cognitive outcomes. The MeDi and DASH diets offer promising preliminary results, but data are limited and more research in this area is needed. PMID:26900574

  2. mJustice: Preliminary Development of a Mobile App for Medical-Forensic Documentation of Sexual Violence in Low-Resource Environments and Conflict Zones.

    PubMed

    Mishori, Ranit; Anastario, Michael; Naimer, Karen; Varanasi, Sucharita; Ferdowsian, Hope; Abel, Dori; Chugh, Kevin

    2017-03-24

    Digital health development and use has been expansive and operationalized in a variety of settings and modalities around the world, including in low- and middle-income countries. Mobile applications have been developed for a variety of health professionals and frontline health workers including physicians, midwives, nurses, and community health workers. However, there are no published studies on the development and use of digital health related to human rights fieldwork and to our knowledge no mobile health platforms exist specifically for use by frontline health workers to forensically and clinically document sexual violence. We describe a participatory development and user design process with Congolese end-users of a novel human rights app for clinicians intended to standardize the documentation of sexual violence evidence for forensic and legal purposes, called MediCapt. The app, yet to be launched and still in the future proofing phase, has included several development phases: (1) initial needs assessment conducted in 2011, (2) prototype development and field-testing in 2014 with 8 Congolese physicians, (3) prototype refinement and field-testing in 2015 with 9 clinicians. Feedback from the first field-testing phase was incorporated into the design of the second prototype; key features that were added to MediCapt include the ability for users to take photographs and draw on a pictogram to include as part of the evidence package, as well as the ability to print a form with the completed data. Questionnaires and key-informant interviews during the second and third field-testing phases revealed overall positive attitudes about MediCapt, but multiple perceived and actual barriers to implementation were identified, from personal behaviors, such as individual clinicians' comfort with new technology, to more systemic and infrastructure factors, such as strong cultural preferences for print documentation of evidence and limited Internet connectivity. Next phases of

  3. mJustice: Preliminary Development of a Mobile App for Medical-Forensic Documentation of Sexual Violence in Low-Resource Environments and Conflict Zones

    PubMed Central

    Mishori, Ranit; Anastario, Michael; Naimer, Karen; Varanasi, Sucharita; Ferdowsian, Hope; Abel, Dori; Chugh, Kevin

    2017-01-01

    ABSTRACT Digital health development and use has been expansive and operationalized in a variety of settings and modalities around the world, including in low- and middle-income countries. Mobile applications have been developed for a variety of health professionals and frontline health workers including physicians, midwives, nurses, and community health workers. However, there are no published studies on the development and use of digital health related to human rights fieldwork and to our knowledge no mobile health platforms exist specifically for use by frontline health workers to forensically and clinically document sexual violence. We describe a participatory development and user design process with Congolese end-users of a novel human rights app for clinicians intended to standardize the documentation of sexual violence evidence for forensic and legal purposes, called MediCapt. The app, yet to be launched and still in the future proofing phase, has included several development phases: (1) initial needs assessment conducted in 2011, (2) prototype development and field-testing in 2014 with 8 Congolese physicians, (3) prototype refinement and field-testing in 2015 with 9 clinicians. Feedback from the first field-testing phase was incorporated into the design of the second prototype; key features that were added to MediCapt include the ability for users to take photographs and draw on a pictogram to include as part of the evidence package, as well as the ability to print a form with the completed data. Questionnaires and key-informant interviews during the second and third field-testing phases revealed overall positive attitudes about MediCapt, but multiple perceived and actual barriers to implementation were identified, from personal behaviors, such as individual clinicians' comfort with new technology, to more systemic and infrastructure factors, such as strong cultural preferences for print documentation of evidence and limited Internet connectivity. Next

  4. The MoEDAL experiment at the LHC: status and results

    NASA Astrophysics Data System (ADS)

    Mitsou, Vasiliki A.; MoEDAL Collaboration

    2017-07-01

    The MoEDAL experiment at the LHC is optimised to detect highly ionising particles such as magnetic monopoles, dyons and (multiply) electrically charged stable massive particles predicted in a number of theoretical scenarios. MoEDAL, deployed in the LHCb cavern, combines passive nuclear track detectors with magnetic monopole trapping volumes (MMTs), while spallation-product backgrounds are being monitored with an array of MediPix pixel detectors. An introduction to the detector concept and its physics reach, complementary to that of the large general purpose LHC experiments ATLAS and CMS, will be given. Emphasis is given to the recent MoEDAL results at 13 TeV, where the null results from a search for magnetic monopoles in MMTs exposed in 2015 LHC collisions set the world-best limits on particles with magnetic charges more than 1.5 Dirac charge. The potential to search for heavy, long-lived supersymmetric electrically-charged particles is also discussed.

  5. Mediterranean diet adherence in the Mediterranean healthy eating, aging and lifestyle (MEAL) study cohort.

    PubMed

    Marventano, Stefano; Godos, Justyna; Platania, Alessio; Galvano, Fabio; Mistretta, Antonio; Grosso, Giuseppe

    2017-05-31

    A decline in adherence to the Mediterranean dietary pattern has been observed over the last years. The aim of this study was to assess the level of adherence to the Mediterranean diet and possible determinants in the Mediterranean healthy Eating, Aging and Lifestyle (MEAL) study cohort. Demographic and dietary data of 1937 individuals were collected in 2014-2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and the MEDI-LITE score were used to assess adherence to the Mediterranean diet. The score well characterised consumption of major food groups, micro- and macro-nutrients. The cohort had a general good adherence, but only a minority was highly adherent. High adherence was directly associated with education, non-smoking and physical activity and inversely with high occupational status. In conclusions, Mediterranean diet is still followed in Sicily; however, nutrition education campaigns should promote healthy traditional dietary patterns in certain groups of individuals.

  6. Developments towards the LHCb VELO upgrade

    NASA Astrophysics Data System (ADS)

    Cid Vidal, Xabier

    2016-09-01

    The Vertex Locator (VELO) is a silicon strip detector surrounding the interaction region of the LHCb experiment. The upgrade of the VELO is planned to be installed in 2019-2020, and the current detector will be replaced by a hybrid pixel system equipped with electronics capable of reading out at a rate of 40 MHz. The new detector is designed to withstand the radiation dose expected at an integrated luminosity of 50 fb-1. The detector will be composed of silicon pixel sensors, read out by the VeloPix ASIC that is being developed based on the TimePix/MediPix family. The prototype sensors for the VELO upgrade are being irradiated in five different facilities and the post-irradiation performance is being measured with testbeams, and in the lab. These proceedings present the VELO upgrade and briefly discuss the results of the sensor testing campaign.

  7. Automated detection of off-label drug use.

    PubMed

    Jung, Kenneth; LePendu, Paea; Chen, William S; Iyer, Srinivasan V; Readhead, Ben; Dudley, Joel T; Shah, Nigam H

    2014-01-01

    Off-label drug use, defined as use of a drug in a manner that deviates from its approved use defined by the drug's FDA label, is problematic because such uses have not been evaluated for safety and efficacy. Studies estimate that 21% of prescriptions are off-label, and only 27% of those have evidence of safety and efficacy. We describe a data-mining approach for systematically identifying off-label usages using features derived from free text clinical notes and features extracted from two databases on known usage (Medi-Span and DrugBank). We trained a highly accurate predictive model that detects novel off-label uses among 1,602 unique drugs and 1,472 unique indications. We validated 403 predicted uses across independent data sources. Finally, we prioritize well-supported novel usages for further investigation on the basis of drug safety and cost.

  8. Inebilizumab, a B Cell-Depleting Anti-CD19 Antibody for the Treatment of Autoimmune Neurological Diseases: Insights from Preclinical Studies

    PubMed Central

    Chen, Ding; Gallagher, Sandra; Monson, Nancy L.; Herbst, Ronald; Wang, Yue

    2016-01-01

    Exaggerated or inappropriate responses by B cells are an important feature in many types of autoimmune neurological diseases. The recent success of B-cell depletion in the treatment of multiple sclerosis (MS) has stimulated the development of novel B-cell-targeting therapies with the potential for improved efficacy. CD19 has emerged as a promising target for the depletion of B cells as well as CD19-positive plasmablasts and plasma cells. Inebilizumab (MEDI-551), an anti-CD19 antibody with enhanced antibody-dependent cell-mediated cytotoxicity against B cells, is currently being evaluated in MS and neuromyelitis optica. This review discusses the role of B cells in autoimmune neurological disorders, summarizes the development of inebilizumab, and analyzes the recent results for inebilizumab treatment in an autoimmune encephalitis mouse model. The novel insights obtained from these preclinical studies can potentially guide future investigation of inebilizumab in patients. PMID:27886126

  9. [Implementing population-based integrated care for a region: a work-in-progress report on the project "Gesundes Kinzigtal"].

    PubMed

    Hildebrandt, Helmut; Schmitt, Gwendolyn; Roth, Monika; Stunder, Brigitte

    2011-01-01

    The regional integrated care model "Gesundes Kinzigtal" pursues the idea of integrated health care with special focus on increasing the health gain of the served population. Physicians (general practitioners) and psychotherapists, physiotherapists, hospitals, nursing services, non-profit associations, fitness centers, and health insurance companies work closely together with a regional management company and its programs on prevention and care coordination and enhancement. The 10 year-project is run by a company that was founded by the physician network "MQNK" and "OptiMedis AG", a corporation with public health background specialising in integrated health care. The aim of this project is to enhance prevention and quality of health care for a whole region in a sustainable way, and to decrease costs of care. The article describes the special funding model of the project, the engagement of patients, and the different health and prevention programmes. The programmes and projects are developed, implemented, and evaluated by multidisciplinary teams.

  10. From bench to bedside: Therapeutic potential of interleukin-9 in the treatment of asthma

    PubMed Central

    Gong, Fang; Pan, Yu-Hong; Huang, Xuan; Zhu, Hua-Yan; Jiang, Dong-Lin

    2017-01-01

    Initially identified as a T cell and mast cell growth factor, interleukin (IL)-9 has long been recognized as an important mediator of asthma. Recently, accumulating results from transgenic mice demonstrated that systemic or lung-specific overexpression of IL-9 caused asthma-associated symptoms. Moreover, anti-mIL-9 antibody (Ab) blocking treatment alleviated disease in animal models of asthma. In light of the large quantity of data from the murine models, MEDI-528, a humanized anti-IL-9 monoclonal Ab has been produced to assess the activity of IL-9 on human asthma. In order to ascertain whether it is a successful translation from bench to bedside, the biological features of IL-9 were evaluated and up-to-date information regarding the role of IL-9 in different experimental murine models and human asthma were summarized.

  11. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets.

    PubMed

    Charles, Shana Alex; Ponce, Ninez; Ritley, Dominique; Guendelman, Sylvia; Kempster, Jennifer; Lewis, John; Melnikow, Joy

    2017-08-01

    Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.

  12. Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

    PubMed Central

    Sommer, Philipp; Kircher, Simon; Rolf, Sascha; Richter, Sergio; Doering, Micha; Arya, Arash; Bollmann, Andreas; Hindricks, Gerhard

    2015-01-01

    A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons. With this protocol, we demonstrate that even complex procedures such as ablations of atrial fibrillation, that are typically associated with fluoroscopy times of >30 min in conventional settings, can safely be performed with a reduction of >90% in fluoroscopy exposure by the additional use of NFCV. PMID:26066541

  13. [Personalized pharmacotherapy of digoxin].

    PubMed

    Grundmann, Milan; Kacířová, Ivana

    2015-05-01

    Therapeutic and toxic effects of digoxin are related to its serum concentrations, recent evidence suggests that a lower therapeutic range 0.5-0.9 ng/ml is associated with reduced mortality. To show the advantages of therapeutic drug monitoring for dosing of digoxin. Trough serum levels of digoxin were estimated by immunoassay MEIA (AxSym Abbott). The long term serum concentration - time profile of digoxin has been predicted by the Bayesian analysis computer program MW-Pharm 3.30 MediWare. Sex case reports of the patients between 71 to 92 years are presented to show the different doses to receive digoxin levels in the therapeutic range. The doses varies between 0.03-0.25 mg per day. Therapeutic drug monitoring is very usefull for prediction of serum level of digoxin. There is no need to wait for a steady-state condition before performing therapeutic drug monitoring.

  14. Automated Detection of Off-Label Drug Use

    PubMed Central

    Jung, Kenneth; LePendu, Paea; Chen, William S.; Iyer, Srinivasan V.; Readhead, Ben; Dudley, Joel T.; Shah, Nigam H.

    2014-01-01

    Off-label drug use, defined as use of a drug in a manner that deviates from its approved use defined by the drug's FDA label, is problematic because such uses have not been evaluated for safety and efficacy. Studies estimate that 21% of prescriptions are off-label, and only 27% of those have evidence of safety and efficacy. We describe a data-mining approach for systematically identifying off-label usages using features derived from free text clinical notes and features extracted from two databases on known usage (Medi-Span and DrugBank). We trained a highly accurate predictive model that detects novel off-label uses among 1,602 unique drugs and 1,472 unique indications. We validated 403 predicted uses across independent data sources. Finally, we prioritize well-supported novel usages for further investigation on the basis of drug safety and cost. PMID:24586689

  15. 5(th) European Conference on Advances in Wound Management.

    PubMed

    1995-11-01

    BEIERSDORF Stand 34/40 CENTROMED LTD Stand 44 COLOPLAST LTD Stand 11/12 CONVATEC LTD Stand 23 CROOKES HEALTHCARE Stand 30 EGERTON HOSPITAL EQUIPMENT LTD Stand 39 EUROMED Stand 25 GERALD SIMONDS Stand 43 HNE HUNTLEIGH Stand 2 HYOX SYSTEM LTD Stand 14 IATROS LTD Stand 26B INNOVATIVE TECHNOLOGIES LTD Stand 41 JOHNSON & JOHNSON MEDICAL Stand 15/16 KAROMED LTD Stand 45 KCI MEDISCUS Stand 36-38 KENDALL COMPANY LTD Stand 35 MEDICAL SUPPORT SYSTEMS Stand 3 MEDI UK LTD Stand 27 MÖLNLYCKE Stand 32 NIKOMED Stand 24 PARK HOUSE Stand 19 PEGASUS AIRWAVE LTD Stand I PERSTORP PHARMA LTD Stand 8 PHARMA-PLAST LTD Stand 28 POLAROID Stand 31 PRESSURE GUARD Stand 33 QUINODERM LTD Stand 34A SETON Stand 22 SMITH & NEPHEW Stand 18 SPENCO MEDICAL LTD Stand 7 TALLEY GROUP LTD Stand 4-6 3M HEALTH CARE LTD Stand 20/21 VERNON-CARUS LTD Stand 42.

  16. Women & smoking: becoming part of the solution.

    PubMed

    Suárez, Nery

    2011-10-01

    El hecho de que tantas enfermedades, ya sean graves o leves, estén relacionadas con el tabaquismo es una de las conclusiones más asombrosas de la investigación médica de este siglo; si bien es posible que no sea tan sorprendente como el hecho de que tantas personas lo hayan ignorado. —Sir Richard Doll, 1912–2005 Las empresas transnacionales del tabaco minimizan los peligros de fumar en poderosas campañas de publicidad desplegadas alrededor del mundo, al mismo tiempo que los organismos internacionales e instituciones sanitarias se esfuerzan por contrarrestar estos mensajes mediáticos con presupuestos ínfimos: una asimetría asombrosa que pone en peligro la salud de millones de personas.

  17. Disaster Averted, For Now: How the American Health Care Act Would Have Affected Californians.

    PubMed

    Rasmussen, Petra W

    2017-03-01

    Although the American Health Care Act (AHCA) was recently defeated, the policies in the bill represented a mix of ideas long favored by conservatives. If enacted, this repeal-and-replace bill would have had devastating consequences for most of the 5 million Californians currently receiving direct benefits from the Affordable Care Act (ACA), including more than 1 million who receive subsidies through Covered California and almost 4 million who have enrolled in the Medi-Cal expansion. Although the bill failed to garner enough votes for passage, it is likely that efforts to chip away at the ACA will continue and that some of the ideas contained within the AHCA will be revisited. This policy brief summarizes some of the most significant reversals that would have occurred under the Republican plan in the individual and small group insurance markets.

  18. Net clinical benefit of dabigatran vs. warfarin in venous thromboembolism: analyses from RE-COVER(®), RE-COVER™ II, and RE-MEDY™.

    PubMed

    Feuring, Martin; Schulman, Sam; Eriksson, Henry; Kakkar, Ajay J; Schellong, Sebastian; Hantel, Stefan; Schueler, Elke; Kreuzer, Jörg; Goldhaber, Samuel Z

    2017-05-01

    The direct oral anticoagulants, e.g., dabigatran etexilate (DE), are effective and well tolerated treatments for venous thromboembolism (VTE). Net clinical benefit (NCB) is a useful concept in weighing potential benefits against potential harm of comparator drugs. The NCB of DE vs. warfarin in VTE treatment was compared. Post-hoc analyses were performed on pooled data from the 6-month RE-COVER® and RE-COVER™ II trials, and data from the RE-MEDY™ trial (up to 36 months), to compare the NCB of DE (150 mg twice daily) and warfarin [target international normalized ratio (INR) 2.0-3.0]. Patients (≥18 years old) had symptomatic proximal deep vein thrombosis and/or pulmonary embolism. NCB was the composite of cardiovascular endpoints (non-fatal events of recurrent VTE, myocardial infarction, stroke or systemic embolism), all-cause death, and bleeding outcomes, all weighted equally. A broad definition of NCB included major bleeding events (MBE) and clinically relevant non-major bleeding events as bleeding outcomes, while a narrow definition included just MBE. The pooled dataset totalled 5107 patients from RE-COVER/RE-COVER II and 2856 patients from RE-MEDY. When NCB was narrowly defined, NCB was similar between DE and warfarin. When broadly defined, NCB was superior with DE vs. warfarin [RE-COVER/RE-COVER II, hazard ratio (HR) 0.80; 95% confidence interval (CI), 0.68-0.95 and RE-MEDY, HR 0.73; 95% CI 0.59-0.91]. These findings were unaffected by warfarin time in therapeutic range. The NCB of DE was similar or superior to warfarin, depending on the NCB definition used, regardless of the quality of INR control.

  19. The association between a Mediterranean-style diet and kidney function in the Northern Manhattan Study cohort.

    PubMed

    Khatri, Minesh; Moon, Yeseon P; Scarmeas, Nikolaos; Gu, Yian; Gardener, Hannah; Cheung, Ken; Wright, Clinton B; Sacco, Ralph L; Nickolas, Thomas L; Elkind, Mitchell S V

    2014-11-07

    Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function. This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR<60 ml/min per 1.73 m(2)using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline (≥ 2.5 ml/min per 1.73 m(2) per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors. Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m(2). Incident eGFR<60 ml/min per 1.73 m(2) developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR<60 ml/min per 1.73 m(2) (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98). A Mediterranean diet was associated with a reduced incidence of eGFR<60 ml/min per 1.73 m(2) and upper quartile of eGFR decline in a multiethnic cohort. Copyright © 2014 by the American Society of Nephrology.

  20. Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

    PubMed

    Rittenhouse, Diane R; Braveman, Paula; Marchi, Kristen

    2003-06-01

    To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

  1. Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

    PubMed

    Rittenhouse, Diane R; Robinson, James C

    2006-01-01

    Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

  2. Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: Clinical and radiological follow-up at 6 months().

    PubMed

    De Conti, G; Marchioro, U; Dorigo, A; Boscolo, N; Vio, S; Trevisan, M; Meneghini, A; Baldo, V; Angelini, F

    2010-12-01

    Sommario INTRODUZIONE: La tendinopatia calcifica di spalla è una condizione relativamente frequente caratterizzata, quando sintomatica, da dolore cronico e da fasi di dolore acuto molto intenso. MATERIALI E METODI: Da ottobre 2006 a marzo 2008 abbiamo trattato 126 spalle di 125 pazienti consecutivi. Tutti hanno eseguito Rx ed ecografia prima del trattamento ed il test di Constant prima del trattamento e a 6 mesi di distanza. 55 pazienti su 123 (42%) sono stati trattati due o più volte con infiltrazione intrabursale di corticosteroide. Tre pazienti hanno rifiutato altri trattamenti dopo il primo. Sono stati quindi raccolti i dati complessivamente di 123 spalle. È stata eseguita RM di controllo a sei mesi. RISULTATI: Incremento del Constant Score dopo la procedura in tutti i pazienti trattati una sola volta ed in quasi tutti i pazienti trattati due volte; i pazienti sono stati divisi in due classi, rispettivamente trattati una o due (o più) volte. In ciascuna delle due classi c’è stato un significativo incremento (p < 0,0001)delle medie dei Cs pre e post trattamento; nella classe dei pazienti trattati due volte significatività statistica (p < 0,0001) tra le medie dei Cs rispettivamente prima del trattamento iniziale e dopo il primo trattamento, e tra la media Cs di quest’ultimo e quella dopo 6 mesi dal primo trattamento. Il Cs dopo il trattamento è significativamente diverso nei pazienti con impingement (p < 0,001). CONCLUSION: Incremento del Cs, in più del 95% dei pazienti. Non lesioni tendinee ai controlli ecografici/RM. L’impingement è risultato un fattore di rischio per il risultato finale.

  3. Suboptimal perception of illness due to self-realization constraints impairs psychological welfare in surgical patients.

    PubMed

    Sak, Jarosław; Sagan, Dariusz; Wiechetek, Michał; Pawlikowski, Jakub

    2012-04-01

    Recognizing patients' psychological problems and understanding their social needs constitute important tasks for medical personnel, because these issues substantially contribute to overall outcome of treatment. People afflicted with surgical diseases need to determine the sense of everyday pursuits and activities and balance it against the therapeutic process. The aim of the study was to assess the relationships between the perception of illness, satisfaction with life and meaning of life among surgical patients. A total of 225 patients undergoing surgical treatment in the thoracic surgery department were enrolled in the questionnaire study using Multidimensional Essence of Disease and Illness Scale (MEDIS), Satisfaction With Life Scale (SWLS) and Life Meaningfulness Scale (LMS). Relationships between variables were assessed with Pearson's correlation. The analysis disclosed negative correlations between the perception of the disease in the light of self-realization constraints and the feeling of satisfaction with one's life (R = -0.25; P < 0.01), an affective component of the LMS (R = -0.29; P < 0.001) and the total result of the LMS (R = -0.21; P < 0.01). Similar relationships were observed between the MEDIS dimension describing a disease as a social withdrawal and the total result of the SWLS (R = -0.21; P < 0.05) and the affective component of the LMS (R = -0.23; P < 0.01). Suboptimal hospitalization-related perception of the disease due to self-realization constraints profoundly impairs psychological welfare of patients and may exert negative impact on the overall outcome of treatment. We believe that surgical patients require early psychological, social and spiritual support to prevent these harmful psycho-social consequences of illness and hospital stay. Preoperative clinical application of presented scales may be useful to select patients who require more psychological attention in providing information about planned surgical treatment and expected outcomes.

  4. Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California.

    PubMed

    Isquick, Sarah; Chang, Richard; Thiel de Bocanegra, Heike; Chabot, Marina; Brindis, Claire D

    2017-04-01

    Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California's 2008 birth records were linked to California's Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.

  5. EUS Needle Identification Comparison and Evaluation study (with videos).

    PubMed

    Tang, Shou-Jiang; Vilmann, Andreas S; Saftoiu, Adrian; Wang, Wanmei; Streba, Costin Teodor; Fink, Peter P; Griswold, Michael; Wu, Ruonan; Dietrich, Christoph F; Jenssen, Christian; Hocke, Michael; Kantowski, Marcus; Pohl, Jürgen; Fockens, Paul; Annema, Jouke T; van der Heijden, Erik H F M; Havre, Roald Flesland; Pham, Khanh Do-Cong; Kunda, Rastislav; Deprez, Pierre H; Mariana, Jinga; Vazquez-Sequeiros, Enrique; Larghi, Alberto; Buscarini, Elisabetta; Fusaroli, Pietro; Lahav, Maor; Puri, Rajesh; Garg, Pramod Kumar; Sharma, Malay; Maluf-Filho, Fauze; Sahai, Anand; Brugge, William R; Lee, Linda S; Aslanian, Harry R; Wang, Andrew Y; Shami, Vanessa M; Markowitz, Arnold; Siddiqui, Ali A; Mishra, Girish; Scheiman, James M; Isenberg, Gerard; Siddiqui, Uzma D; Shah, Raj J; Buxbaum, James; Watson, Rabindra R; Willingham, Field F; Bhutani, Manoop S; Levy, Michael J; Harris, Cynthia; Wallace, Michael B; Nolsøe, Christian Pállson; Lorentzen, Torben; Bang, Niels; Sørensen, Sten Mellerup; Gilja, Odd Helge; D'Onofrio, Mirko; Piscaglia, Fabio; Gritzmann, Norbert; Radzina, Maija; Sparchez, Zeno Adrian; Sidhu, Paul S; Freeman, Simon; McCowan, Timothy C; de Araujo, Cyrillo Rodrigues; Patel, Akash; Ali, Mohammad Adel; Campbell, Garth; Chen, Edward; Vilmann, Peter

    2016-09-01

    EUS-guided FNA or biopsy sampling is widely practiced. Optimal sonographic visualization of the needle is critical for image-guided interventions. Of the several commercially available needles, bench-top testing and direct comparison of these needles have not been done to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Descriptive bench-top testing and comparison of 8 commonly used EUS-FNA needles (all size 22 gauge): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition (Cook Medical); ClearView (Conmed); EZ Shot 2 (Olympus); and BNX (Beacon Endoscopic), and 2 new prototype needles, SonoCoat (Medi-Globe), coated by echogenic polymers made by Encapson. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in GI US examination who were unfamiliar with EUS needle devices. There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, 1 prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (P < .01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%-75% worse, P < .001). All FNA needles have their inherent and different echogenicities, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity. Copyright © 2016 American Society for Gastrointestinal Endoscopy. All rights reserved.

  6. Evaluation of medication safety in the discharge medication of 509 surgical inpatients using electronic prescription support software and an extended operational interaction classification.

    PubMed

    Frölich, Thomas; Zorina, Olesya; Fontana, Andrea O; Kullak-Ublick, Gerd A; Vollenweider, Andreas; Russmann, Stefan

    2011-12-01

    Our aim was to study drug interactions and dose adjustments in patients with renal impairment in the discharge medication of surgical inpatients and to evaluate the strengths and limitations of clinical decision support software (CDSS) for this task. This was a cross-sectional study involving 509 surgical patients of a primary care hospital. We developed a customized interface for the CDSS MediQ, which we used for automated retrospective identification of drug interactions in the patients' discharge medication. The clinical relevance of the interactions was evaluated based on the Zurich Interaction System (ZHIAS) that incorporates the operational classification of drug interactions (ORCA). Prescriptions were further analyzed for recommended dose adjustments in patients with a glomerular filtration rate <60 ml/min. For the total of 2,729 prescriptions written for the 509 patients enrolled in the study, MediQ generated 2,558 interaction alerts and 1,849 comments. Among these were ten "high danger" and 551 "average danger" alerts that we reclassified according to ORCA criteria. This reclassification resulted in ten contraindicated combinations, 77 provisionally contraindicated combinations, and 310 with a conditional and 164 with a minimal risk of adverse outcomes. The ZHIAS classification also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 56 prescriptions without a recommended dose adjustment for impaired renal function. CDSS identified a large number of drug interactions in surgical discharge medication, but according to ZHIAS criteria only a minor fraction of these appeared to involve a substantial risk to the patient. CDSS should therefore aim at reducing over-alerting and improve usability in order to become more efficacious in terms of the prevention of adverse drug events in clinical practice.

  7. Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system.

    PubMed

    Sommer, Philipp; Wojdyla-Hordynska, Agnieszka; Rolf, Sascha; Gaspar, Thomas; Eitel, Charlotte; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher

    2013-04-01

    Three-dimensional (3D) mapping has been established for clinical routine in an interventional electrophysiology (EP). Recently, a novel sensor-based 3D catheter tracking system has been introduced integrating 3D non-fluoroscopic catheter navigation into the environment of pre-recorded 2D fluoroscopy [MediGuide™ Technology (MG)]. We are reporting on the first clinical experience for ablation of typical atrial flutter. First we aimed to demonstrate safety and feasibility of this new technique. Secondly, procedural aspects such as effectiveness, procedure, and fluoroscopy time should be evaluated. Ten consecutive patients (100% male, age 68 ± 8 years) were ablated using MG technology. Two steerable diagnostic EP catheters (MediGuide Enabled Livewire™ Catheter, SJM) were used for coronary sinus cannulation and anatomical cavo-tricuspidal isthmus (CTI) reconstruction within the EnSite NavX™ System (NavX). Ablation was performed with a conventional 8 mm tip ablation catheter (IBI, SJM). In all 10 patients both sensor-equipped MG catheters could be tracked non-fluoroscopically. Successful anatomical CTI reconstruction was performed and complete isthmus block was documented after the ablation. Total procedure duration was comparable with conventional procedures (55 ± 8 min). Usage of the MG tracking system resulted in a fluoroscopy time of 2.5 ± 2 min. No adverse events occurred during the procedures. For the first clinical application of the MG technology in an interventional electrophysiology we found a stable system enabling excellent 3D orientation for spatial catheter positioning on the basis of underlying pre-recorded cine loops. Clinically, the MG technology allowed successful procedures with short fluoroscopy times, even though a sensor-equipped ablation catheter was not yet available for use in the study.

  8. Physico-Chemical Research on the Sounding Rocket Maser 13

    NASA Astrophysics Data System (ADS)

    Lockowandt, Christian; Kemi, Stig; Abrahamsson, Mattias; Florin, Gunnar

    MASER is a sounding rocket platform for short-duration microgravity experiments, providing the scientific community with an excellent microgravity tool. The MASER programme has been running by SSC from 1987 and has up to 2012 provided twelve successful flights for microgravity missions with 6-7 minutes of microgravity, the g-level is normally below 1x10-5 g. The MASER 13 is planned to be launched in spring 2015 from Esrange Space Center in Northern Sweden. The rocket will carry four ESA financed experiment modules. The MASER 13 vehicle will be propelled by the 2-stage solid fuel VSB-30 rocket motor, which provided the 390 kg payload with an apogee of 260 km and 6 and a half minutes of microgravity. Swedish Space Corporation carries out the MASER missions for ESA and the program is also available for other customers. The payload comprise four different experiment modules of which three could be defined as physic-chemical research; XRMON-SOL, CDIC-3, MEDI. It also comprises the Maser Service Module and the recovery system. The Service Module provided real-time 5 Mbps down-link of compressed experiment digital video data from the on-board cameras, as well as high-speed housekeeping telemetry data. XRMON-SOL In this experiment the influence of gravity on the formation of an equiaxed microstructure will be investigated. Special attention will be put on the aspect of nucleation, segregation and impingement. The experiment scope is to melt and solidify an AlCu-alloy sample in microgravity. The solidification will be performed in an isothermal environment. The solidification process will be monitored and recorded with X-ray image during the whole flight, images will also be down-linked to ground for real-time monitoring and possible interaction. CDIC-3 The goal is to study in migrogravity the spatio-temporal dynamics of a chemical front travelling in a thin solution layer open to the air and specifically the respective role of Marangoni and density-related hydrodynamic

  9. Impact of Compliance with a Sepsis Resuscitation Bundle in a Portuguese Emergency Department.

    PubMed

    Carvas, Joao Miguel; Canelas, Cátia; Montanha, Gustavo; Silva, Carlos; Esteves, Francisco

    2016-02-01

    Introdução: A sépsis severa e o choque sético são entidades clínicas frequentes com elevada morbi-mortalidade que superam os da doença cardíaca coronária ou do acidente vascular cerebral. A realidade da sépsis tratada no hospital fora das unidades de cuidados intensivos é amplamente desconhecida. Pretende-se neste trabalho estimar o cumprimento da bundle das 6-horas da Surviving Sepsis Campaign num serviço de urgência português e os resultados clínicos dos doentes. Material e Métodos: Estudo retrospetivo, observacional de coorte com 178 pacientes com sépsis severa/choque sético internados na unidade de cuidados intensivos e intermédios entre 1 de Janeiro de 2012 e 31 de Dezembro de 2012. Resultados: Durante o período estudado foi diagnosticado choque sético em 100 pacientes (56,2%) e sépsis severa em 78 pacientes (43,8%). O cumprimento com a bundle foi: (1) 62,9% para a medição de lactatos; (2) 62,9% para a colheita hemoculturas antes da antibioterapia; (3) 41,6% para a administração de antibióticos nas primeiras 3 horas; (4) 76,4% para a administração de fluidos; (5) 25% para a administração de vasopressores; (6) 37% for medição da pressão venosa central; (7) 39% para a medição da saturação venosa central de oxigénio. O cumprimento de todas as medidas foi observado em 22% dos pacientes. A medida 'colheita hemoculturas antes da antibioterapia' esteve significativamente associada a um menor risco de mortalidade na unidade de cuidados intensivos e aos 28 dias. Também se verificou uma tendência para uma correlação inversa entre cumprimento crescente da bundle e a mortalidade na unidade de cuidados intensivos e aos 28 dias. Discussão: A baixa adesão à bundle das 6-horas da Surviving Sepsis Campaign é um resultado que replica o de estudos internacionais semelhantes. A explicação para este fenómeno é complexa mas pode incluir a falta de monitorização da qualidade dos cuidados no serviço de urgência. Conclusões: O

  10. Characterization of Alpha-Toxin hla Gene Variants, Alpha-Toxin Expression Levels, and Levels of Antibody to Alpha-Toxin in Hemodialysis and Postsurgical Patients with Staphylococcus aureus Bacteremia

    PubMed Central

    Wu, Yuling; Tabor, David E.; Mok, Hoyin; Sellman, Bret R.; Jenkins, Amy; Yu, Li; Jafri, Hasan S.; Rude, Thomas H.; Ruffin, Felicia; Schell, Wiley A.; Park, Lawrence P.; Yan, Qin; Thaden, Joshua T.; Messina, Julia A.; Esser, Mark T.

    2014-01-01

    Alpha-toxin is a major Staphylococcus aureus virulence factor. This study evaluated potential relationships between in vitro alpha-toxin expression of S. aureus bloodstream isolates, anti-alpha-toxin antibody in serum of patients with S. aureus bacteremia (SAB), and clinical outcomes in 100 hemodialysis and 100 postsurgical SAB patients. Isolates underwent spa typing and hla sequencing. Serum anti-alpha-toxin IgG and neutralizing antibody levels were measured by using an enzyme-linked immunosorbent assay and a red blood cell (RBC)-based hemolysis neutralization assay. Neutralization of alpha-toxin by an anti-alpha-toxin monoclonal antibody (MAb MEDI4893) was tested in an RBC-based lysis assay. Most isolates encoded hla (197/200; 98.5%) and expressed alpha-toxin (173/200; 86.5%). In vitro alpha-toxin levels were inversely associated with survival (cure, 2.19 μg/ml, versus failure, 1.09 μg/ml; P < 0.01). Both neutralizing (hemodialysis, 1.26 IU/ml, versus postsurgical, 0.95; P < 0.05) and IgG (hemodialysis, 1.94 IU/ml, versus postsurgical, 1.27; P < 0.05) antibody levels were higher in the hemodialysis population. Antibody levels were also significantly higher in patients infected with alpha-toxin-expressing S. aureus isolates (P < 0.05). Levels of both neutralizing antibodies and IgG were similar among patients who were cured and those not cured (failures). Sequence analysis of hla revealed 12 distinct hla genotypes, and all genotypic variants were susceptible to a neutralizing monoclonal antibody in clinical development (MEDI4893). These data demonstrate that alpha-toxin is highly conserved in clinical S. aureus isolates. Higher in vitro alpha-toxin levels were associated with a positive clinical outcome. Although patients infected with alpha-toxin-producing S. aureus exhibited higher anti-alpha-toxin antibody levels, these levels were not associated with a better clinical outcome in this study. PMID:25392350

  11. The Association between a Mediterranean-Style Diet and Kidney Function in the Northern Manhattan Study Cohort

    PubMed Central

    Moon, Yeseon P.; Scarmeas, Nikolaos; Gu, Yian; Gardener, Hannah; Cheung, Ken; Wright, Clinton B.; Sacco, Ralph L.; Nickolas, Thomas L.; Elkind, Mitchell S.V.

    2014-01-01

    Background and objectives Various dietary strategies have been investigated to slow kidney function decline. However, it is unknown whether a Mediterranean diet, which has been associated with improved cardiovascular risk, is associated with change in kidney function. Design, setting, participants, & measurements This study used the Northern Manhattan Study, a prospective, multiethnic, observational cohort of participants who were stroke free at baseline. Data were collected between 1993 and 2008. Serum creatinine measurements were taken a mean 6.9 years apart. A baseline dietary questionnaire was extrapolated into a previously used 9-point scoring system (MeDi). The primary outcome was incident eGFR<60 ml/min per 1.73 m2using the Modification of Diet in Renal Disease formula. A secondary outcome was the upper quartile of annualized eGFR decline (≥2.5 ml/min per 1.73 m2 per year). Conditional logistic regression models adjusted for demographics and baseline vascular risk factors. Results Mean baseline age was 64 years, with 59% women and 65% Hispanics (N=900); mean baseline eGFR was 83.1 ml/min per 1.73 m2. Incident eGFR<60 ml/min per 1.73 m2 developed in 14% . In adjusted models, every 1-point increase in the MeDi score, indicating increasing adherence to a Mediterranean diet, was associated with decreased odds of incident eGFR<60 ml/min per 1.73 m2 (odds ratio, 0.83; 95% confidence interval, 0.71 to 0.96) and decreased odds of being in the upper quartile of eGFR decline (odds ratio, 0.88; 95% confidence interval, 0.79 to 0.98). Conclusions A Mediterranean diet was associated with a reduced incidence of eGFR<60 ml/min per 1.73 m2 and upper quartile of eGFR decline in a multiethnic cohort. PMID:25359387

  12. Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale.

    PubMed

    Thé, Karol Bezerra; Gazoni, Fernanda Martins; Cherpak, Guilherme Liausu; Lorenzet, Isabel Clasen; Santos, Luciana Alves Dos; Nardes, Edlene Maria; Santos, Fânia Cristina Dos

    2016-01-01

    To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese in demented elderly and to analyze its measurement properties. We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver's opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach's alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese had adequate measuring properties for use with elderly presenting limited communication. Validar o Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese em idosos dementados e analisar as propriedades de suas medições. Foram avaliados 50 idosos dementados, residentes de uma casa de repouso e com capacidade de comunicação verbal limitada, quando expostos a situações potencialmente dolorosas. A ferramenta foi utilizada em dois momentos diferentes. Primeiro, foi aplicada por dois entrevistadores simultaneamente, e a intensidade da dor foi questionada com base na opinião do cuidador. Depois de 14 dias, sem intervenção de analgésico, a ferramenta foi aplicada novamente por um dos entrevistadores. A amostra teve predominância de mulheres, acima de 80 anos de idade, com demência de Alzheimer, apresentando dores musculoesqueléticas com intensidade moderada a grave. As

  13. In vitro performance characteristics of valved holding chamber and spacer devices with a fluticasone metered-dose inhaler.

    PubMed

    Asmus, Michael J; Liang, Judy; Coowanitwong, Intira; Hochhaus, Gunther

    2004-02-01

    To compare the in vitro aerosol deposition characteristics of several commercially available valved holding chamber (VHC) and spacer devices used with a fluticasone metered-dose inhaler (MDI). In vitro aerosol deposition study University-affiliated research center. Seven VHC devices: BreatheRite, E-Z Spacer, EasiVent, AeroChamber, InspirEase, OptiChamber, and Space Chamber. Six spacer devices: OptiHaler, Aerosol Cloud Enhancer (ACE), Gentle-Haler, MediSpacer, Ellipse, and a 6-inch tube (1-inch inside diameter). The respirable dose (aerosol particles 1-5 microm) of fluticasone was determined by sampling 10 220-microg actuations from five runs with each spacer or VHC plus MDI combination, by using a well-established in vitro cascade impactor method. Fluticasone aerosol was washed from the impactor with methanol and quantified by means of high-performance liquid chromatography. Differences among outcomes were determined with analysis-of-variance testing. Among spacers, Ellipse had the highest respirable dose (104 microg, p < 0.01). Respirable doses for the 6-inch tube (74.3 microg), Gentle-Haler (81.7 microg), and MediSpacer (82.6 microg) were no different from that of the MDI (p > 0.05), whereas respirable doses of OptiHaler (44.6 microg) and ACE (47.2 microg) were less than those of all other spacers (p < 0.001). Among VHC devices, respirable doses from EasiVent (35.6 microg), AeroChamber (47.0 microg), InspirEase (52.7 microg), OptiChamber (53.1 microg), and Space Chamber (58.3 microg) were not different (p > 0.05), whereas BreatheRite (13.1 microg) and E-Z Spacer (27.3 microg) respirable doses were less than those of the other VHC devices (p < 0.05). Spacers and VHC devices available in the United States do not demonstrate equivalent in vitro performance with the fluticasone MDI. The difference between highest and lowest respirable doses in each device category would likely lead to clinically relevant differences in the quantity of fluticasone delivered to a

  14. No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques.

    PubMed

    Kovalik, E C; Schwab, S J; Gunnells, J C; Bowie, D; Smith, S R

    1996-06-01

    The previous methods to biopsy renal allografts at our institution involved the use of the Franklin-Silverman or Tru-Cut needles. Unfortunately they had a significant rate of post biopsy bleeding secondary to deep penetration when excess force was used to penetrate a tough transplant capsule. Although spring loaded biopsy devices have been widely used for native kidney biopsies over the past three years, the complication rate for renal allograft biopsies has not been sufficiently evaluated. We describe our experience using a disposable spring loaded biopsy device on transplanted renal grafts. Fifty-four biopsies were performed with the device, all under ultrasound guidance. The ASAP automatic biopsy system by Medi-tech was used comprising of a spring loaded gun with a 15 cm long 15 GA needle echogenic tip and 17 mm specimen notch. All patients were ultrasounded immediately post biopsy to look for hematomas. Compared to 55 previous biopsies performed using Tru-Cut needles, we conclude that the ASAP automated biopsy system proved equally effective in obtaining adequate tissue for diagnosis with fewer post-biopsy hematomas compared to traditional biopsy methods.

  15. Linear dimensions and volumes of human lungs

    SciTech Connect

    Hickman, David P.

    2012-03-30

    TOTAL LUNG Capacity is defined as “the inspiratory capacity plus the functional residual capacity; the volume of air contained in the lungs at the end of a maximal inspiration; also equals vital capacity plus residual volume” (from MediLexicon.com). Within the Results and Discussion section of their April 2012 Health Physics paper, Kramer et al. briefly noted that the lungs of their experimental subjects were “not fully inflated.” By definition and failure to obtain maximal inspiration, Kramer et. al. did not measure Total Lung Capacity (TLC). The TLC equation generated from this work will tend to underestimate TLC and does not improve or update total lung capacity data provided by ICRP and others. Likewise, the five linear measurements performed by Kramer et. al. are only representative of the conditions of the measurement (i.e., not at-rest volume, but not fully inflated either). While there was significant work performed and the data are interesting, the data does not represent a maximal situation, a minimal situation, or an at-rest situation. Moreover, while interesting, the linear data generated by this study is limited by the conditions of the experiment and may not be fully comparative with other lung or inspiratory parameters, measures, or physical dimensions.

  16. Using gait analysis to assess weight bearing in rats with Freund׳s complete adjuvant-induced monoarthritis to improve predictivity: Interfering with the cyclooxygenase and nerve growth factor pathways.

    PubMed

    Ängeby Möller, Kristina; Berge, Odd-Geir; Finn, Anja; Stenfors, Carina; Svensson, Camilla I

    2015-06-05

    Lack of predictive power for drug effects has been a major criticism against animal pain models. It is therefore important to define the utility and limitations of different models. The aim of this study was to extend previous work on gait analysis as a tool to investigate pharmacological effects in monoarthritic rats, specifically to test the hypothesis that monoarthritis induced by Freund׳s complete adjuvant (FCA) provides a better estimate of overall analgesic efficacy of established, and novel, clinically effective and ineffective therapeutic approaches. Male rats injected intra-articularly into one ankle joint with FCA (1.0mg/ml) were treated with the monoclonal antibody to nerve growth factor (NGF), MEDI-578, the inhibitors of tropomyosin receptor kinases A, B and C (pan-Trk) AZ6623 or AZ7092, the transient receptor potential vanilloid 1 (TRPV1) inhibitor AZD1386, or the cyclooxygenase (COX) inhibitors naproxen, ibuprofen, valdecoxib or rofecoxib. Effects on weight bearing during locomotion were tested using video capture of print images. The apparent efficacy in this model was Trk inhibitors≥anti-NGF antibody>COX inhibitors. The TRPV1 inhibitor was ineffective. Together with previous data, the results support using gait-related parameters in the monoarthritis model. FCA as induction agent seems to provide a good overall prediction of analgesic efficacy in disorders with inflammatory joint pain.

  17. [Hypolipidemic and antihypertensive therapy in diabetic patients in the Czech Republic: notes on the VZP (General Health Insurance Company) Data].

    PubMed

    Šnejdrlová, Michaela; Češka, Richard; Janíčková-Žďárská, Denisa; Honěk, Petr; Dušek, Pavel; Pavlík, Tomáš; Kvapil, Milan

    2015-11-01

    Diabetes mellitus and in particular type 2 diabetes mellitus is one of the most important risk factors of cardiovascular disease. To influence cardiovascular risk there is enormous important not only positive influence of glycemia, but also the treatment of diabetic dyslipidemia and hypertension. The present work provides an analysis of lipid-lowering and antihypertensive therapy for all diabetics registered with General Health Insurance Company in the period 2010-2013. In this time 866,570 patients with diabetes mellitus registered with General Health Insurance Company were treated, the majority of them were diabetics independent on insulin. Approximately half of the patients were observed by dialectologists and half of them by the doctors of other specialization. Out of antihypertensive medi-cation, patients were most often treated by drugs that affect the renin-angiotensin system, as well as beta-blockers and diuretics. Prescription of the lipid-lowering therapy, especially prescription of statins, in accordance with the guidelines, is increasing, but remains insufficient (at 2013 43.6% diabetics treated by dialectologists and 51.3% diabetics treated by GP´s didn´t have lipid lowering therapy). Inadequate use of combination lipid-lowering therapy was recorded too, still represented mainly by combination of statin and fibrate, but in coming years we expect (based on the positive results of the subanalysis IMPROVE-IT study), an increase of combination therapy statin and ezetimibe.

  18. The implementation of a tobacco dependence education curriculum in a Swiss Dental Hygiene School - an 8-year review.

    PubMed

    Ramseier, C A; Burri, M; Berres, F; Davis, J M

    2013-05-01

    The aim of our investigation was to review the implementation of a comprehensive tobacco dependence education (TDE) curriculum at the Medi School of Dental Hygiene (MSDH), Bern, Switzerland, 2001-2008. In 2001, new forms to record patients' tobacco use history and willingness to quit were created for all the MSDH patients. In 2002, a new theoretically based tobacco dependence treatment protocol was implemented into the MSDH curriculum. Students received instruction on how to provide brief tobacco use dependence interventions as well as maintain detailed records of patient tobacco use and cessation interventions for every smoker at all dental hygiene visits. In 2002, 17 lecture hours were added to the following subjects: pathology, periodontology, preventive dentistry, pharmacology and psychology. During the same time period, 2213 patients (56.9% women) have visited the MSDH. Smoking status was recorded in 85.7% of all the patients (30.2% smokers). Brief tobacco use interventions were recorded in 36.8% of all smokers while 7.6% of these have reported to quit smoking. Overall, the new TDE curriculum was successfully implemented and accepted by the MSDH faculty. Applications in the clinical practice, however, may still be improved to better identify smokers and increase initial and follow-up interventions potentially leading to higher quit rates. © 2012 John Wiley & Sons A/S.

  19. Association of hepatitis C virus with insulin resistance: evidences from animal studies and clinical studies.

    PubMed

    Badar, Sadaf; Khubaib, Bushra; Idrees, Muhammad; Hussain, Abrar; Awan, Zunaira; Butt, Sadia; Afzal, Samia; Akram, Madeeha; Fatima, Zareen; Aftab, Mahwish; Saleem, Sana; Munir, Sara; Rauff, Bisma; Naudhani, Mahrukh; Ali, Liaquat; Ali, Muhammaad; Rehman, Irshadul

    2012-01-01

    HCV infection is strongly associated with development of insulin resistance and type-2 diabetes, however molecular mechanism of these associations is not known. The aim of this review was to conduct a comprehensive literature search to understand the nature of the association between hepatitis C virus (HCV) infection and insulin resistance (IR). We also explored the role of HCV core protein and NS5a in modulating the course of the insulin-signaling pathway. We searched Directory of Open Access Journals (DOAJ) Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science (TS and PakMediNet). Emerging evidence suggests an association between HCV infection and carotid/coronary vascular disease. IR appears to be a dominant underlying cause of accelerated atherosclerosis in patients with chronic hepatitis C (CHC). HCV can induce IR directly through the stimulation of SOCS3 and PPA2, and both of these molecules have been shown to inhibit interferon-α signaling. Improvement of insulin sensitivity may increase the response rate to antiviral treatment and prevent IR complications, including vascular diseases. The results of several clinical trials that have used insulin sensitizers (metformin and PPAR-γ agonists) have been inconclusive. Beside the association between HCV and IR, the published data also have showed the possible association of HCV core and NS5A protein with IR.

  20. An overview of triple infection with hepatitis B, C and D viruses.

    PubMed

    Riaz, Mehwish; Idrees, Muhamad; Kanwal, Hifza; Kabir, Firoz

    2011-07-27

    Viral hepatitis is one of the major health problems worldwide, particularly in South East Asian countries including Pakistan where hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are highly endemic. Hepatitis delta virus (HDV) is also not uncommon world-wide. HCV, HBV, and HDV share parallel routes of transmission due to which dual or triple viral infection can occur in a proportion of patients at the same time. HBV and HCV are important factors in the development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). In addition to LC and HCC, chronic HDV infection also plays an important role in liver damage with oncogenic potential.The current article reviews the available literature about the epidemiology, pathogenesis, transmission, symptoms, diagnosis, replication, disease outcome, treatment and preventive measures of triple hepatitis infection by using key words; epidemiology of triple infection, risk factors, awareness status, treatment and replication cycle in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. Total data from 74 different studies published from 1983 to 2010 on triple hepatitis infections were reviewed and included in this study. The present article briefly describes triple infection with HCV, HBV and HDV.

  1. Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction

    PubMed Central

    Rozen, Warren Matthew; Marsh, Daniel; Chow, Whitney T.H.; Vickers, Tobias; Khan, Lubna; Miller, George S.; Hunter-Smith, David J.; Ramakrishnan, Venkat V.

    2016-01-01

    Background Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. Methods We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. Results The useful apps have been subdivided: (I) communication apps—multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps—Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps—FlapApp, Touch Surgery, PubMed on tap: step by step guides to surgical procedures to aid learning and medical journal database; (IV) flap monitoring app—SilpaRamanitor: free flap monitoring app based on photographic analysis for earlier detection of compromised flaps. Conclusions There has been remarkable growth in smartphones use among surgeons. Apps are being developed for every conceivable use. The future will be in wearable smart devices that allow continuous monitoring with the potential to instigate change should deviations from the norm occur. The smart watch is the start of this digital revolution. PMID:27047783

  2. Informing public policy toward binational health insurance: Empirical evidence from California

    PubMed Central

    Fulton, Brent D; Galárraga, Omar; Dow, William H

    2015-01-01

    Objective To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Materials and methods Data include 33 841 and 53 909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. Results SIMNSA’s physician reimbursement rates averaged 50.7% (95% CI: 34.5%–67.0%) of Medi-Cal’s, 28.3% (95% CI: 19.6%–37.0%) of Medicare’s, and 22% of US private plans’. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. Conclusion SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico. PMID:25153186

  3. Barriers to timely prenatal care among women with insurance: the importance of prepregnancy factors.

    PubMed

    Braveman, P; Marchi, K; Egerter, S; Pearl, M; Neuhaus, J

    2000-06-01

    This study, designed to avoid methodologic limitations of previous research, aimed to identify the important noninsurance barriers to timely prenatal care. We identified a subsample of a cross-sectional statewide representative postpartum survey conducted in California during 1994-1995, focusing on 3071 low-income women with Medi-Cal or private coverage throughout pregnancy. Twenty-eight percent of those women had untimely care, although only 6% were unaware of their pregnancies during the first trimester. Controlling for numerous sociodemographic factors; knowledge, attitudes, beliefs, and behaviors; stressful life circumstances; and logistic obstacles that might deter seeking or receiving care, the following risk factors for untimely care were significant and experienced by more than one fifth of women: unwanted or unplanned pregnancy (affecting 43% and 66% of women, respectively), no regular provider before pregnancy (affecting 22% of women), and no schooling beyond high school (affecting 76% of women). Transportation problems, affecting 8% of women, appeared to be the only significant logistic barrier to timely care. Improving timeliness of prenatal care among low-income women with third-party coverage is likely to require broad social and health policies that focus on factors affecting women before pregnancy. Assistance with transportation could contribute to more timely care for some low-income women, but programs focusing primarily on other noninsurance barriers during pregnancy might not substantially improve the timeliness of care, at least among low-income women with third-party coverage.

  4. Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens.

    PubMed

    Roberts, K J

    2000-03-01

    HIV-positive patients must strictly adhere to antiretroviral regimens for the medications to work properly. Little, however, is known about the obstacles that patients face in adhering to the regimens or what, if anything, helps patients to adhere. The goals of the project were to describe, from HIV-positive patients' own perspectives, the barriers they face in adhering to antiretroviral regimens and the strategies they use to maximize their adherence. Five main barriers (forgetfulness, social/physical environment, complexity of the regimens, medication side effects, and inadequate patient knowledge) to adherence and six main facilitators (mechanical devices, "making a commitment," "routinizing," health beliefs, social support, and professional support) emerged from the data. Patients may overcome some of these barriers by receiving better health education about the need for adherence, professional and lay support for their efforts, and mechanical devices such as alarm clocks and medi-sets. Other barriers, however, such as the complexity of the medications, highlight the need for simplified antiretroviral regimens.

  5. Benefits planning--what you must know: interview with Daniel Fortuno, AIDS Benefits Counselors. Interview by John S. James.

    PubMed

    Fortuno, D

    1996-09-20

    Daniel Fortuno, a counselor with AIDS Benefits Counselors (ABC), summarizes key insurance and benefits information for persons living with AIDS (PWAs), particularly those who reside in California. Fortuno explains the managed care concept and basic health insurance terms, such as pre-existing conditions, health maintenance organizations (HMOs), preferred provider organizations (PPOs), contestability, and the Consolidated Omnibus Budget Reconciliation Act (COBRA). Fortuno explains a California law that became effective in July 1993 that greatly restricts the ability of health insurance companies to refuse insurance due to preexisting conditions to small groups of persons. This law, AB 1672, makes health insurance available to the sick with little overall rises in prices. Federal insurance laws and regulations that impact PWAs and HIV-positive individuals are outlined. In the interview, Fortuno also discusses Medicaid/Medi-Cal (California's Medicaid), Social Security programs, State disability, and the AIDS Drug Assistance Program. Fortuno offers suggestions for obtaining good private insurance and evaluates the pros and cons of HMOs, PPOs, and indemnity insurance.

  6. State Medicaid abortion policies continue to be challenged; courts reach varying conclusions.

    PubMed

    1979-08-01

    There is no consensus by the courts on what states may or may not legally do with regard to Medicaid funding of abortion. In Georgia a federal judge ruled that the state may not limit coverage of Medicaid abortions to those reimbursable by the federal government under the Hyde Amendment. In California funding of Medi-Cal abortions is permitted only if the woman's life is endangered; pregnancy is ectopic; the woman was raped; a minor under age 16; a victim of incest; the fetus is abnormal; or woman will suffer physical health damage. In Michigan Government William G. Milliken vetoed an appropriation of $1 for therapeutic abortion attached to a bill for hospital, physicians, and pharmacological services. Circuit Judge Jack W. Warren held that the governor did not have the authority to veto just one portion of the appropriation but must veto the entire bill. A New Jersey superior court judge has held unconstitutional proposed state guidelines which restricted Medicaid funding of abortions to those situations covered by the Hyde Amendment. A Hawaii circuit court has ruled that the state Department of Social Services and Housing has the authority to use state funds to pay for elective abortions for Medicaid recipients.

  7. Voluntary psychiatric emergencies in Los Angeles County after funding of California's Mental Health Services Act.

    PubMed

    Bruckner, Tim A; Yonsu, Kim; Chakravarthy, Bharath; Brown, Timothy Tyler

    2012-08-01

    Since 2006, California's Mental Health Services Act (MHSA) has distributed an estimated $6 billion in new tax revenues to county mental health systems. Although evaluations of MHSA's effectiveness find favorable outcomes among high-risk individuals that represent 6% of all mental health clients, scant research has tested whether MHSA funds improve the overall functioning of the public mental health system. The authors analyzed whether the incidence of voluntary emergency psychiatric visits, a key gauge of the functioning of the mental health system, fell below expected levels after the disbursement of MHSA funds. Los Angeles County, the most populous county in California, was examined. The authors obtained the monthly incidence of emergency psychiatric visits among Medi-Cal patients for 96 months spanning July 2000 to June 2008 (5.9 million overall admissions, of which 47,328 were emergency visits). Time-series methods controlled for temporal patterns in emergency visits as well as other potential confounders (unemployment, for example) that could induce spurious associations. The incidence of voluntary psychiatric emergencies fell below expected levels eight to 12 months after the disbursement of MHSA funds. After one year, emergency visits returned to their long-term mean level. Results remained robust after analyses controlled for outliers and potential confounders. In the short term, an infusion of public funds devoted to mental health services appeared to reduce psychiatric emergency visits. Explanations for the transient nature of the decline in emergency visits in Los Angeles County are discussed.

  8. Injury among stimulant-treated youth with ADHD.

    PubMed

    Marcus, Steven C; Wan, George J; Zhang, Huabin F; Olfson, Mark

    2008-07-01

    To assess risk factors for injury among children and adolescents treated with stimulants for ADHD. An analysis was performed of pharmacy and service claims data from 2000-2003 California Medicaid (Medi-Cal) focusing on children and adolescents ages 6 to 17 years who initiated stimulant therapy for ADHD. Bivariate and multivariate analyses were performed to examine associations of demographic and clinical characteristics with injury. In a Cox proportional hazard model that controlled for background patient characteristics, patients ages 13 to 17 years, male gender, prescription of anxiolytic/hypnotic medications, and diagnosis of a mood disorder were each independently associated with increased risk of injury, whereas African American ancestry and other minority racial/ethnic ancestry were associated with lower risk. Youth with high stimulant medication possession ratios (MPR) had a nonsignificantly lower risk of injury as compared to those with a low stimulant MPR. These findings reveal several patient characteristics that may be associated with increased risk of injury among children and adolescents treated for ADHD.

  9. Prior Sexual Trauma and Adjustment Following the Virginia Tech Campus Shootings: Examination of the Mediating Role of Schemas.

    PubMed

    Littleton, Heather L; Grills-Taquechel, Amie E; Axsom, Danny; Bye, Kimberly; Buck, Katherine S

    2012-11-01

    A sizable body of research supports trauma's cumulative nature. However, few studies have evaluated potential mechanisms through which the experience of multiple traumas leads to elevated distress. The current study sought to evaluate differences between sexual trauma victims and women who had not experienced sexual trauma in their adjustment following a mass trauma (college women exposed to the 2007 Virginia Tech campus shooting). In addition, the study examined whether maladaptive schema change (lower self-worth and less belief in benevolence) and social support mediated the relationship between experiencing multiple traumas (sexual trauma and the campus shooting) and distress. The sample consisted of 215 college women who were assessed preshooting as well as two months and one year following the campus shooting. Women who had experienced sexual trauma (either contact sexual abuse or sexual assault) were compared to those who had not on their one-year postshooting PTSD and depressive symptoms. Results supported that sexual trauma victims reported significantly more depressive symptoms and shooting-related PTSD as well as less belief in benevolence and lower family support. Family support and benevolence beliefs at the two month postshooting assessment were significant medi-ators of the association between sexual trauma history and depression and PTSD. Implications of the findings for future research evaluating the cumulative impact of multiple traumatic experiences are discussed.

  10. Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome.

    PubMed Central

    Vogel, J; Görich, J; Kramme, E; Merkle, E; Sokiranski, R; Kern, P; Brambs, H J

    1996-01-01

    BACKGROUND AND AIMS: Infiltration of the hepatic veins in the alveolar echinococcosis can lead to the development of the Budd-Chiari syndrome. The medical and surgical treatment of this condition is generally unsatisfactory. The results of successful interventional treatment with percutaneous stent implantation in the hepatic veins are reported. METHODS: Using a transjugular approach, metal mesh stents (Boston Scientific, Medi-Tech Accuflex 8/60 mm) were placed in the median and left hepatic veins of a 53 year old woman. After the intervention, oral chemotherapy with albendazole (2 x 400 mg/day) was continued, but no anticoagulants were given. RESULTS: Stent placement was performed without complications. The clinical picture improved rapidly: normalisation of portal blood flow was confirmed by Doppler ultrasound and there was improvement of liver function, reduction of oesophageal varices, and disappearance of ascites. A follow-up examination at 15 months showed no evidence of stent occlusion. CONCLUSIONS: Treatment of portal hypertension in alveolar echinococcosis of the liver is problematic. In selected patients with portal hypertension secondary to hepatic vein stenoses but no cirrhosis, percutaneous stent placement in the hepatic veins represents a promising treatment alternative. Images Figure 1 Figure 2 PMID:9026484

  11. Intrasite motions and monument instabilities at Medicina ITRF co-location site

    NASA Astrophysics Data System (ADS)

    Sarti, Pierguido; Abbondanza, Claudio; Legrand, Juliette; Bruyninx, Carine; Vittuari, Luca; Ray, Jim

    2013-03-01

    We process the total-station surveys performed at the ITRF co-location site Medicina (Northern Italy) over the decade (2001-2010) with the purpose of determining the extent of local intrasite motions and relating them to local geophysical processes, the geological setting and the design of the ground pillars. In addition, continuous observations acquired by two co-located GPS stations (MEDI and MSEL separated by ≈27 m) are analysed and their relative motion is cross-checked with the total-station results. The local ground control network extends over a small area (<100 × 100 m) but the results demonstrate significant anisotropic deformations with rates up to 1.6 mm a-1, primarily horizontal, a value comparable to intraplate tectonic deformations. The results derived from GPS and total-station observations are consistent and point to the presence of horizontal intrasite motions over very short distances possibly associated with varying environmental conditions in a very unfavourable local geological setting and unsuitable monument design, these latter being crucial aspects of the realization and maintenance of global permanent geodetic networks and the global terrestrial reference frame.

  12. The association of socio-economic factors with physical fitness and activity behaviours, spinal posture and retinal vessel parameters in first graders in urban Switzerland.

    PubMed

    Imhof, Katharina; Faude, Oliver; Donath, Lars; Bean-Eisenhut, Salome; Hanssen, Henner; Zahner, Lukas

    2016-01-01

    Socio-economic status during childhood has been shown to be a strong predictor of adult health outcome. Therefore, we examined associations of parental educational level, household income and migrant background with physical fitness, spinal flexibility, spinal posture as well as retinal vessel diameters in children of an urban Swiss region. A total of 358 first graders of the Swiss canton Basel-Stadt (age: 7.3, SD: 0.4) were examined. Physical fitness (20 m shuttle run test, 20 m sprint, jumping sidewards and balancing backwards), spinal flexibility and spinal posture (MediMouse®, Idiag, Fehraltdorf, Switzerland) and retinal microcirculation (Static Retinal Vessel Analyzer, Imedos Systems UG, Jena, Germany) were assessed. Parental education, household income, migrant background and activity behaviour were evaluated with a questionnaire. Parental education was associated with child aerobic fitness (P = 0.03) and screen time (P < 0.001). Household income was associated with jumping sidewards (P = 0.009), balancing backwards (P = 0.03) and sports club participation (P = 0.02). Migrant background was associated with BMI (P = 0.001), body fat (P = 0.03), aerobic fitness (P = 0.007), time spent playing outdoors (P < 0.001) and screen time (P < 0.001). For spinal flexibility and retinal vessel diameter, no associations were found (0.06 < P < 0.8). Low parental education, low household income and a migrant background are associated with poor physical fitness, higher BMI and body fat percentage and low-activity behaviour.

  13. Linear dimensions and volumes of human lungs

    DOE PAGES

    Hickman, David P.

    2012-03-30

    TOTAL LUNG Capacity is defined as “the inspiratory capacity plus the functional residual capacity; the volume of air contained in the lungs at the end of a maximal inspiration; also equals vital capacity plus residual volume” (from MediLexicon.com). Within the Results and Discussion section of their April 2012 Health Physics paper, Kramer et al. briefly noted that the lungs of their experimental subjects were “not fully inflated.” By definition and failure to obtain maximal inspiration, Kramer et. al. did not measure Total Lung Capacity (TLC). The TLC equation generated from this work will tend to underestimate TLC and does notmore » improve or update total lung capacity data provided by ICRP and others. Likewise, the five linear measurements performed by Kramer et. al. are only representative of the conditions of the measurement (i.e., not at-rest volume, but not fully inflated either). While there was significant work performed and the data are interesting, the data does not represent a maximal situation, a minimal situation, or an at-rest situation. Moreover, while interesting, the linear data generated by this study is limited by the conditions of the experiment and may not be fully comparative with other lung or inspiratory parameters, measures, or physical dimensions.« less

  14. How to successfully incorporate antiaging and wellness into your practice: things you should know.

    PubMed

    Pontius, Allison T; Smith, Pamela W

    2010-02-01

    Antiaging medicine is the fastest growing medical specialty. It would behoove plastic surgeons to give serious consideration to extending their practices to incorporate antiaging medicine given the similarities in their patient populations, office settings, and fee-for-service practices. It is important to find a practitioner board-certified in antiaging and regenerative medicine that has done a 2-year fellowship in the specialty. Additionally, you must structure your business relationship appropriate to your needs and your practice. There are several options for the arrangement, including (1) having the antiaging physician use your office on your operative days or days off, (2) incorporating the antiaging physician as a part of your practice on a full-time or part-time basis, or (3) renting office space for the antiaging practice in your medi-spa, wellness center, or medical building. These are just some of the more common arrangements all with the ultimate goal of delineating your practice from others in your area, being a forerunner in the future of cutting-edge medical care and offering your patients the full array of aesthetic and health services. Thieme Medical Publishers.

  15. [Current Status and Future Perspectives of SCRUM-Japan].

    PubMed

    Ohtsu, Atsushi; Goto, Koichi; Yoshino, Takayuki; Okamoto, Wataru; Tsuchihara, Katsuya

    2017-08-01

    SCRUM-Japan was launched as a nation-wide genome screening consortium for recruiting patients to 35 sponsor-/investigator- initiated registration trials in collaboration with 15 pharmaceutical companies and 240 hospitals. During the first period between February 2015 and March 2017, a total of 4,805 patients have been enrolled. Genomic profiling of each cancer were analyzed and newdrug applications of label expansion are in preparation based on the results of several registration studies including investigator-initiated trial of vandetanib for RET fusion gene positive non-small cell lung cancer. In addition, on-time clinical-genome data sharing with industries and academic institutions and prospective cohort registry for new drug evaluation as a historical control data have already initiated, which will facilitate new agent development in Japan. In the second period started from April 2017, new studies using cutting-edge liquid biopsy and immune-genome panel for precision medi- cine will start soon. These efforts are attempted towards a leading group for innovative clinical/translations researches in the world.

  16. One-stop shopping: efforts to integrate physical and behavioral health care in five California community health centers.

    PubMed

    Pourat, Nadereh; Hadler, Max W; Dixon, Brittany; Brindis, Claire

    2015-01-01

    More than 70 percent of behavioral health conditions are first diagnosed in the primary care setting. Yet physical and behavioral health care are typically provided separately, compelling many vulnerable patients to navigate the complexities of two separate systems of care. This policy brief examines five community health centers (CHCs) in California that have taken preliminary steps toward creating "one-stop shopping" for both physical and behavioral health care. The steps taken to increase integration by the CHCs include employing behavioral health providers, using a single electronic health record that includes both physical and behavioral health data, transforming the physical space, and developing mechanisms for effective transition of patients between providers. The findings emphasize the importance of changes to Medi-Cal reimbursement policies to promote same-day visits, as well as the importance of cultural changes to integrate behavioral health. They also highlight the need for comprehensive tools to assess and promote integration and to identify solutions for the most challenging activities required to achieve full integration.

  17. Use of Postpartum Care: Predictors and Barriers

    PubMed Central

    DiBari, Jessica N.; Yu, Stella M.; Chao, Shin M.; Lu, Michael C.

    2014-01-01

    This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care. PMID:24693433

  18. The construction of a public key infrastructure for healthcare information networks in Japan.

    PubMed

    Sakamoto, N

    2001-01-01

    The digital signature is a key technology in the forthcoming Internet society for electronic healthcare as well as for electronic commerce. Efficient exchanges of authorized information with a digital signature in healthcare information networks require a construction of a public key infrastructure (PKI). In order to introduce a PKI to healthcare information networks in Japan, we proposed a development of a user authentication system based on a PKI for user management, user authentication and privilege management of healthcare information systems. In this paper, we describe the design of the user authentication system and its implementation. The user authentication system provides a certification authority service and a privilege management service while it is comprised of a user authentication client and user authentication serves. It is designed on a basis of an X.509 PKI and is implemented with using OpenSSL and OpenLDAP. It was incorporated into the financial information management system for the national university hospitals and has been successfully working for about one year. The hospitals plan to use it as a user authentication method for their whole healthcare information systems. One implementation of the system is free to the national university hospitals with permission of the Japanese Ministry of Education, Culture, Sports, Science and Technology. Another implementation is open to the other healthcare institutes by support of the Medical Information System Development Center (MEDIS-DC). We are moving forward to a nation-wide construction of a PKI for healthcare information networks based on it.

  19. California Public Hospitals Improved Quality of Care Under Medicaid Waiver Program.

    PubMed

    Pourat, Nederah

    2017-06-01

    California has 12 county-owned and operated hospital systems and 5 University of California hospitals designated as public hospitals. These organizations deliver the majority of inpatient care and a significant amount of outpatient care to Medicaid patients in the state. In 2010, California was the first state in the nation to implement a five-year Delivery System Reform Incentive Payment (DSRIP) program under the Section §1115 Medicaid "Bridge to Reform" waiver to improve the capacity of these hospitals to deliver high quality and more efficient care. The California DSRIP was the first program in a continuing national initiative to reform the Medicaid delivery system while remaining budget neutral. An extensive evaluation revealed major advances in infrastructure development, delivery of health care, and patient outcomes during the program. The results highlight the importance of joint federal and state investments in bolstering the capacity of safety net providers to deliver high-quality care, and they emphasize the need for continued investment in the safety net. The California DSRIP was followed by a program called Public Hospital Redesign and Incentives in Medi-Cal (PRIME), which incentivizes improvements in expanded and new areas of care not addressed by DSRIP

  20. The first synthesis of chem-prep varistor LAC (lightning arrestor connector) granules

    SciTech Connect

    Tuttle, B.A.; Voigt, J.A.; Andrews, L.A.

    1988-03-01

    ZnO variestor granules are the active medis for many lightning arrestor connectors (LACs). The 150 to 200 micron diameter granules provide a controlled electrical breakdown in the 400 micron gap between the electrically conductive pin and web of the connector. Tradiationally, the varistor granules are made from commercially available, reagent grade, mixed oxide powders that range in particle size from 1 to 20 microns. For the first time, we have synthesized varistor granules from chemically prepared powders developed at Sandia. These chem-prep varistor powders are more homogeneous and much finer than the mixed oxide powders; the mean particle size of the chem-prep powders is approximately 0.06 microns. LAC granules were formed from chemically prepared powders by traditional ceramic processing techniques. Although the chem-prep granules were not as spherical as the mixed oxide granules, the chem-prep granules did meet present LAC component requirements for fast-rise breakdown voltage and insulation resistance. The insulation resistance of chem-prep granules for a 200 volt pin-to-web voltage was 100 times less than for mixed oxide granules; however, both types of granules had similar insulation resistance for a 250 volt pin-to-web voltage.

  1. Diagnostic Value of Measurement Specific Gravity by Refractometric and Dipstick Method in Differentiation between Transudate and Exudate in Pleural and Peritoneal Fluid.

    PubMed

    Abdollahi, Alireza; Nozarian, Zohreh

    2016-01-01

    Accumulation of pleural and peritoneal fluid is seen in some diseases. In order to diagnose the disease and start the treatment, one of the most important actions will be to differentiate between exudates and transudates. The objective of this study was to determine the diagnostic value of measuring the specific gravity of the fluid through refractometer and strip in differentiation of exudates from transudates. The serum of patients was evaluated for protein, LDH, cholesterol, bilirubin and albumin. The fluid was evaluated for the number of white blood cells, protein, LDH, cholesterol, bilirubin and albumin. Then the fluids were divided into exduate and transudate categories based on Light and Gradient criteria. Finally, the specific gravity of the fluids was measured by refractometer, Erma, Japan and Medi-Test Combi II. The categorized fluids were compared with Gold Standards (final diagnosis) so that the sensitivity and specificity of Light and Gradient criteria in the transudate-exudate differentiation were specified. In comparison with Light criteria, the cut off level of 1022 specific gravity measured by refractometer for pleural effusion has sensitivity, specificity of 92.1%, 68.1%respectively. In evaluation of peritoneal fluid considering cut off point 1023, measured by refractometer has reliable sensitivity 92.4%, specificity 70.4 compared with standard gradient method. Differentiating transudate from exudates by measuring its special gravity by refractometer will have acceptable sensitivity and specificity, and when rapidity is necessary or access to lab equipment is limited, this method could be used.

  2. Protective Effect of Selenium-Based Medicines on Toxicity of Three Common Organophosphorus Compounds in Human Erythrocytes In Vitro

    PubMed Central

    Mostafalou, Sara; Navaei-Nigjeh, Mona; Baeeri, Maryam; Mohammadirad, Azadeh; Abdollahi, Mohammad

    2016-01-01

    Objective Organophosphorus (OP) compounds are used to control pests, however they can reach the food chain and enter the human body causing serious health problems by means of acetylcholinesterase (AChE) inhibition and oxidative stress (OS). Among the OPs, chlorpyrifos (CHP), malathion (MAL), and diazinon (DIA) are commonly used for commercial extermination purposes, in addition to veterinary practices, domestic, agricul- ture and public health applications. Two new recently registered medicines that contain selenium and other antioxidants, IMOD and angipars (ANG), have shown beneficial ef- fects for OS related disorders. This study examines the effect of selenium-based medi- cines on toxicity of three common OP compounds in erythrocytes. Materials and Methods In the present experimental study, we determined the ef- ficacy of IMOD and ANG on OS induced by three mentioned OP pesticides in human erythrocytes in vitro. After dose-response studies, AChE, lipid peroxidation (LPO), total antioxidant power (TAP) and total thiol molecules (TTM) were measured in eryth- rocytes after exposure to OPs alone and in combined treatment with IMOD or ANG. Results AChE activity, TAP and TTM reduced in erythrocytes exposed to CHP, MAL and DIA while they were restored in the presence of ANG and IMOD. ANG and IMOD reduced the OPs-induced elevation of LPO. Conclusion The present study shows the positive effects of IMOD and ANG in re- duction of OS and restoration of AChE inhibition induced by CHP, MAL and DIA in erythrocytes in vitro. PMID:26862533

  3. User attitudes toward end-user literature searching.

    PubMed Central

    Ludwig, L; Mixter, J K; Emanuele, M A

    1988-01-01

    A survey to determine attitudes toward end-user searching was made at Loyola University's Medical Center Library using MEDIS, an online full-text and bibliographic medical retrieval system. One hundred forty-one completed questionnaires were analyzed for this report. Information was collected on user familiarity with computers, end-user training, system use, mechanics of searching, and attitudes toward future use. Computer familiarity was highest among the faculty users. Ninety percent of the respondents saw librarians as a crucial agent in training and in providing end-user assistance. Respondents identified five major reasons for using the system: helpfulness, convenience, time savings, rapid feedback, and presentation of needed information. Searching the MEDLINE database rather than the full-text database was the search method of choice. Continued use of both mediated and end-user searching was intended by most of the respondents. Survey results support a perceived need for end-user searching and confirmed recommendations of the Association of American Medical Colleges on medical information science skills. PMID:3285930

  4. DICOM image communication in globus-based medical grids.

    PubMed

    Vossberg, Michal; Tolxdorff, Thomas; Krefting, Dagmar

    2008-03-01

    Grid computing, the collaboration of distributed resources across institutional borders, is an emerging technology to meet the rising demand on computing power and storage capacity in fields such as high-energy physics, climate modeling, or more recently, life sciences. A secure, reliable, and highly efficient data transport plays an integral role in such grid environments and even more so in medical grids. Unfortunately, many grid middleware distributions, such as the well-known Globus Toolkit, lack the integration of the world-wide medical image communication standard Digital Imaging and Communication in Medicine (DICOM). Currently, the DICOM protocol first needs to be converted to the file transfer protocol (FTP) that is offered by the grid middleware. This effectively reduces most of the advantages and security an integrated network of DICOM devices offers. In this paper, a solution is proposed that adapts the DICOM protocol to the Globus grid security infrastructure and utilizes routers to transparently route traffic to and from DICOM systems. Thus, all legacy DICOM devices can be seamlessly integrated into the grid without modifications. A prototype of the grid routers with the most important DICOM functionality has been developed and successfully tested in the MediGRID test bed, the German grid project for life sciences.

  5. Allergic rhinitis: impact of the disease and considerations for management.

    PubMed

    Greiner, Alexander N

    2006-01-01

    AR is a common condition affecting individuals of all ages. Those afflicted with AR often suffer from associated inflammatory conditions of the mucosa,such as AC, rhinosinusitis, asthma, otitis media with effusion, and other atopic conditions, such as eczema and food allergies. Lack of treatment or treatment with suboptimal therapy may result in reduced quality of life and compromise productivity at work or school. Although environmental controls may prove difficult to implement, and not all controls appear adequately to mitigate symptoms of AR, they continue to represent a foundation for treatment. Many different classes of medications are now available, and they have been shown to be effective and safe in a large number of well-designed, double-blind, placebo-controlled clinical trials. Some of the over-the-counter medi-cations have been associated with increased sedation, potentially leading to accidents and fatalities at work or while operating complex machinery, such as automobiles. Only immunotherapy with increasing doses of individually targeted allergens results in sustained changes in the immune system. Although anti-IgE is probably only the first successful immunomodulator commercially available to treat AR, monoclonal antibodies will remain too costly, at least in the near future, to find their way into routine AR treatment.

  6. Increased Medicaid Financing and Equalization of African Americans' and Whites' Outpatient and Emergency Treatment Expenditures.

    PubMed

    Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

    2016-09-01

    We investigated whether a new funding opportunity to finance mental health treatment, provided to autonomous county-level mental health systems without customary cost sharing requirements, equalized African American and White children's outpatient and emergency treatment expenditure inequalities. Using Whites as a benchmark, we considered expenditure patterns favoring Whites over African Americans ("disparities") and favoring African Americans over Whites ("reverse disparities"). Settlement-mandated Early Periodic Screening Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. We analyzed Medi-Cal paid claims for mental health services delivered to youth (under 18 years of age) over 64 quarters for a study period covering July 1, 1991 through June 30, 2007 in controlled cross-sectional (systems), longitudinal (quarters) analyses. Settlement-mandated increases in EPSDT treatment funding was associated with relatively greater African American vs. White expenditures for outpatient care when systems initially spent more on Whites. When systems initially spent more on African Americans, relative increases were greater for Whites for outpatient and emergency services. With new funding that requires no matching funds from the county, county mental health systems did reduce outpatient treatment expenditure inequalities. This was found to be true in counties that initially favored African Americans and in counties that initially favored Whites. Adopting a systems level perspective and taking account of initial conditions and trends can be critical for understanding inequalities.

  7. Informing public policy toward binational health insurance: empirical evidence from California.

    PubMed

    Fulton, Brent D; Galárraga, Omar; Dow, William H

    2013-01-01

    To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Data include 33,841 and 53,909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. SIMNSA's physician reimbursement rates averaged 50.7% (95% CI: 34.5%-67.0%) of Medi-Cal's, 28.3% (95% CI: 19.6%-37.0%) of Medicare's, and 22% of US private plans'. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico.

  8. Observations related to chronologic and gynecologic age in pregnant adolescents.

    PubMed Central

    Felice, M. E.; James, M.; Shragg, P.; Hollingsworth, D. R.

    1984-01-01

    A low chronologic age (less than or equal to 15 years) and low gynecologic age (less than or equal to 2 years) have been considered factors that increase medical complications among adolescent pregnant women. Gynecologic age (GA) is defined in this study as age in years at conception minus age at menarche. Two hundred twelve consecutive pregnant teenagers were followed prospectively in the Teen OB Clinic at the University of California, San Diego Medical Center, between August 1978 and July 1981. The clinic population consisted of 37.3 percent Whites, 35.8 percent Hispanics, 20.8 percent Blacks, and 6.1 percent other (mostly Indochinese). Sixty-eight percent of the patients were funded by MediCal. The patient population was divided by chronological age (CA) at conception into those 15 years or less or 16 years or older. A low chronological age was found to be a significant risk factor for premature rupture of membranes. Teenagers with a low gynecologic age (less than or equal to 2) had a lower mean pre-pregnancy weight and body mass index (Kg/M2) than teenagers with a higher gynecologic age. In this study, we did not find that a low CA or GA was correlated with a higher frequency of pregnancy-induced hypertension, prenatal medical problems, obstetrical problems at labor or delivery, or an excessive number of low-birthweight infants. PMID:6523906

  9. Diagnostic Value of Measurement Specific Gravity by Refractometric and Dipstick Method in Differentiation between Transudate and Exudate in Pleural and Peritoneal Fluid

    PubMed Central

    Abdollahi, Alireza; Nozarian, Zohreh

    2016-01-01

    Background: Accumulation of pleural and peritoneal fluid is seen in some diseases. In order to diagnose the disease and start the treatment, one of the most important actions will be to differentiate between exudates and transudates. The objective of this study was to determine the diagnostic value of measuring the specific gravity of the fluid through refractometer and strip in differentiation of exudates from transudates. Methods: The serum of patients was evaluated for protein, LDH, cholesterol, bilirubin and albumin. The fluid was evaluated for the number of white blood cells, protein, LDH, cholesterol, bilirubin and albumin. Then the fluids were divided into exduate and transudate categories based on Light and Gradient criteria. Finally, the specific gravity of the fluids was measured by refractometer, Erma, Japan and Medi-Test Combi II. The categorized fluids were compared with Gold Standards (final diagnosis) so that the sensitivity and specificity of Light and Gradient criteria in the transudate-exudate differentiation were specified. Results: In comparison with Light criteria, the cut off level of 1022 specific gravity measured by refractometer for pleural effusion has sensitivity, specificity of 92.1%, 68.1%respectively. In evaluation of peritoneal fluid considering cut off point 1023, measured by refractometer has reliable sensitivity 92.4%, specificity 70.4 compared with standard gradient method. Conclusion: Differentiating transudate from exudates by measuring its special gravity by refractometer will have acceptable sensitivity and specificity, and when rapidity is necessary or access to lab equipment is limited, this method could be used. PMID:28855928

  10. Development and Validation of a Standardized Tool for Prioritization of Information Sources.

    PubMed

    Akwar, Holy; Kloeze, Harold; Mukhi, Shamir

    2016-01-01

    To validate the utility and effectiveness of a standardized tool for prioritization of information sources for early detection of diseases. The tool was developed with input from diverse public health experts garnered through survey. Ten raters used the tool to evaluate ten information sources and reliability among raters was computed. The Proc mixed procedure with random effect statement and SAS Macros were used to compute multiple raters' Fleiss Kappa agreement and Kendall's Coefficient of Concordance. Ten disparate information sources evaluated obtained the following composite scores: ProMed 91%; WAHID 90%; Eurosurv 87%; MediSys 85%; SciDaily 84%; EurekAl 83%; CSHB 78%; GermTrax 75%; Google 74%; and CBC 70%. A Fleiss Kappa agreement of 50.7% was obtained for ten information sources and 72.5% for a sub-set of five sources rated, which is substantial agreement validating the utility and effectiveness of the tool. This study validated the utility and effectiveness of a standardized criteria tool developed to prioritize information sources. The new tool was used to identify five information sources suited for use by the KIWI system in the CEZD-IIR project to improve surveillance of infectious diseases. The tool can be generalized to situations when prioritization of numerous information sources is necessary.

  11. [High fidelity simulation : a new tool for learning and research in pediatrics].

    PubMed

    Bragard, I; Farhat, N; Seghaye, M-C; Schumacher, K

    2016-10-01

    Caring for a sick child represents a high risk activity that requires technical and non-technical skills related to several factors such as the rarity of certain events or the stress of caring for a child. As regard these conditions, medi¬cal simulation provides a learning environment without risk, the control of variables, the reproducibility of situations, and the confrontation with rare events. In this article, we des¬cribe the steps of a simulation session and outline the current knowledge of the use of simulation in paediatrics. A session of simulation includes seven phases following the model of Peter Dieckmann, particularly the scenario and the debriefing that form the heart of the learning experience. Several studies have shown the advantages of simulation for paediatric trai¬ning in terms of changes in attitudes, skills and knowledge. Some studies have demonstrated a beneficial transfer to prac¬tice. In conclusion, simulation provides great potential for training and research in paediatrics. The establishment of a collaborative research program by the whole simulation com¬munity would help ensure that this type of training improves the quality of care.

  12. Nurse Practitioner and Physician's Assistant Clinics in Rural California

    PubMed Central

    Morgan, Walter A.; Sullivan, Nancy D.

    1980-01-01

    The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP's) or physician's assistants (PA's). All of these have physician supervision and support. NP's and PA's have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported. NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician's assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California's Medicaid program). Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician's assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP's and PA's will serve an even greater role in rural areas. PMID:6104383

  13. Development and Validation of a Standardized Tool for Prioritization of Information Sources

    PubMed Central

    Akwar, Holy; Kloeze, Harold; Mukhi, Shamir

    2016-01-01

    Purpose: To validate the utility and effectiveness of a standardized tool for prioritization of information sources for early detection of diseases. Methods: The tool was developed with input from diverse public health experts garnered through survey. Ten raters used the tool to evaluate ten information sources and reliability among raters was computed. The Proc mixed procedure with random effect statement and SAS Macros were used to compute multiple raters’ Fleiss Kappa agreement and Kendall's Coefficient of Concordance. Results: Ten disparate information sources evaluated obtained the following composite scores: ProMed 91%; WAHID 90%; Eurosurv 87%; MediSys 85%; SciDaily 84%; EurekAl 83%; CSHB 78%; GermTrax 75%; Google 74%; and CBC 70%. A Fleiss Kappa agreement of 50.7% was obtained for ten information sources and 72.5% for a sub-set of five sources rated, which is substantial agreement validating the utility and effectiveness of the tool. Conclusion: This study validated the utility and effectiveness of a standardized criteria tool developed to prioritize information sources. The new tool was used to identify five information sources suited for use by the KIWI system in the CEZD-IIR project to improve surveillance of infectious diseases. The tool can be generalized to situations when prioritization of numerous information sources is necessary. PMID:27752297

  14. One-step endosonography-guided drainage of a pancreatic pseudocyst: a new technique of stent delivery through the echo endoscope.

    PubMed

    Vilmann, P; Hancke, S; Pless, T; Schell-Hincke, J D; Henriksen, F W

    1998-10-01

    We report here the first case of a one-step endosonography(EUS)-guided pseudocyst drainage. A prototype large channel curved array echo endoscope (Pentax FG-38 UX) and a prototype delivery system for placement of an endoprosthesis was used for the procedure. The delivery system (GIP MedicinTechnik GmbH/Medi-Globe Corporation) consists of a handle part with a piston, a metal ring sheath, a plastic catheter with a diathermy needle and a double pigtail endoprosthesis (8.5 Fr). When mounted on the endoscope the endoprosthesis can be advanced out of the distal end of the endoscope. The introduction of the stent as well as the stent release can be monitored entirely by ultrasound. The procedure was tested in a 76-year-old woman with a pseudocyst measuring 60 mm in diameter located in the tail of the pancreas. The procedure was well tolerated by the patient, and there were no procedural complications. The advantage of a large channel echo endoscope and our new prototype delivery system is that the endoprosthesis can be inserted in to a pancreatic cyst guided exclusively by EUS without exchange of endoscopes, catheters or guide wires. Further studies are warranted.

  15. Older adults challenged financially when adult children move home.

    PubMed

    Wallace, Steven P; Padilla-Frausto, D Imelda

    2014-02-01

    This policy brief looks at the financial burdens imposed on older Californians when adult children return home, often due to a crisis not of their own making, to live with their parents. The findings show that on average in California, the amount of money that older adults need in order to maintain a minimally decent standard of living while supporting one adult child in their home increases their expenses by a minimum of 50 percent. Low-income older adults are usually on fixed incomes, so helping an adult child can provide the child with a critical safety net but at the cost of the parents' own financial well-being. Policy approaches to assisting this vulnerable population of older adults include implementing reforms to increase Supplemental Security Income (SSI), improving the availability of affordable housing, assuring that all eligible nonelderly adults obtain health insurance through health care reform's expansion of Medi-Cal and subsidies, and increasing food assistance through SNAP and senior meal programs.

  16. Application of the Nd:YAG laser to intracranial tumor operations

    NASA Astrophysics Data System (ADS)

    Kopera, Marek; Majchrzak, Henryk

    1996-03-01

    From January 1989 to December 1993, in the Neurosurgery Department of Mine Hospital in Sosnowiec, a Nd:YAG mediLas 4060 N (MBB) laser with the radiation wavelength of 1.064 micrometer was used for operation of 104 patients with intracranial neoplasm. Fifty-five patients were operated on without any use of the Nd:YAG laser. The coagulation capabilities of the Nd:YAG made it possible to achieve the hemostasis sooner and more certainly that brought an opportunity operate in a dry field. The shrinkage of a tumor, especially in the cases of meningioma and metastases, facilitated their preparation to a great extent. Removal of a lesion took place with negligible mechanical damage of the surrounding cerebral tissue. The Nd:YAG laser is particularly useful in the cases of well vascularized brain meningiomas; in this way larger tumors can be removed radically with milder postoperational course and good results of therapy were achieved significantly more frequently than in the control group. It was clearly demonstrated with significantly less frequent bouts of consciousness disturbance and pareses. The application of this Nd:YAG laser does not influence upon the postoperational course, the tumor regrowth and the number of persons with the expanding process recurrence in the glioma cases.

  17. [Treatment outcome in primary testicular non-Hodgkin lymphoma].

    PubMed

    Iványi, János László; Marton, Eva; Plander, Márk; Engert, Zoltán Vendel; Tóth, Csaba

    2013-10-20

    Bevezetés: A primer herelymphoma ritkán előforduló extranodalis non-Hodgkin-lymphoma-entitás. Legtöbbször idős férfiakban fordul elő, nagy malignitású szövettani képpel és kedvezőtlen kórlefolyással. Az érintett here eltávolítása után alkalmazott immunkemoterápia ellenére a betegek kezelési eredményei elmaradnak más extranodalis lymphomásokétól. Célkitűzés: Retrospektív felmérésben a szerzők célul tűzték ki 2000 és 2012 között kórismézett és kezelt herelymphomás betegeik klinikopatológiai és kezelési eredményeinek felmérését. Módszer: Ezen időszak alatt 334 agresszív non-Hodgkin-lymphomás betegből nyolc esetben (8/334, 2,39%) kórisméztek primer herelymphomát (diffúz nagysejtes B-sejtes hét esetben, Burkitt-típusú egy esetben). A betegek medián életkora 60 év (23 és 86 év között) volt. Korai I–IIE hét betegben, előrehaladott stádium egy betegben fordult elő. Egy beteg kivételével (csak radioterápia) minden beteg kemoterápiát kapott (rituximab+CHOP, hat–nyolc ciklus 21 vagy 28 naponként). Mindössze egy beteg részesült központi idegrendszeri kemoterápiás profilaxisban, preventív ellenoldali hereirradiációt nem alkalmaztak. Eredmények: Ötven hónapos medián követés alatt semicastratiót követő rituximab- és CHOP-kúra után hét beteg került komplett remisszióba, két beteg elhunyt (egy beteg a lymphoma progressziója következtében, a remisszióban levő másik beteg szekunder tüdőtumor miatt). Komplett remissziót a betegek 87,5%-ában értek el. A betegségmentes túlélés 13–152 hónap között (medián 38 hónap), az összesített túlélés 17–156 hónap között (medián 43 hónap), az ötéves betegségmentes és összesített túlélés pedig egyaránt 37,5% volt. Következtetések: A viszonylag kedvező kezelési eredmények hátterében a korai stádium túlsúlya, a lymphoma urológiai sebészi eltávolítása, az immunkemoterápia hat

  18. Quantitative susceptibility mapping for investigating subtle susceptibility variations in the human brain.

    PubMed

    Schweser, Ferdinand; Sommer, Karsten; Deistung, Andreas; Reichenbach, Jürgen Rainer

    2012-09-01

    Quantitative susceptibility mapping (QSM) is a novel magnetic resonance-based technique that determines tissue magnetic susceptibility from measurements of the magnetic field perturbation. Due to the ill-posed nature of this problem, regularization strategies are generally required to reduce streaking artifacts on the computed maps. The present study introduces a new algorithm for calculating the susceptibility distribution utilizing a priori information on its regional homogeneity derived from gradient echo phase images and analyzes the impact of erroneous a priori information on susceptibility map fidelity. The algorithm, Homogeneity Enabled Incremental Dipole Inversion (HEIDI), was investigated with a special focus on the reconstruction of subtle susceptibility variations in a numerical model and in volunteer data and was compared with two recently published approaches, Thresholded K-space Division (TKD) and Morphology Enabled Dipole Inversion (MEDI). HEIDI resulted in susceptibility maps without streaking artifacts and excellent depiction of subtle susceptibility variations in most regions. By investigating HEIDI susceptibility maps acquired with the volunteers' heads in different orientations, it was demonstrated that the apparent magnetic susceptibility distribution of human brain tissue considerably depends on the direction of the main magnetic field.

  19. Indian Society for Apheresis and apheresis tourism in India--is there a future?

    PubMed

    Srivastava, R

    2006-04-01

    Apheresis has now become an internationally popular mode of treatment for multiple immune complex disorders. However, the treatment remains quite expensive in Western Europe and the US. Apheresis tourism is a part of medical tourism or medical tourism specially related to therapeutic apheresis (TA) treatment in a foreign country on a cost effective basis. In the last couple of years, 'Medical Tourism' has become an upcoming and growing enterprise in India. The Indian Society for Apheresis (ISA) has taken a plunge at the opportune time and is trying to promote apheresis tourism in India. ISA is a member of various international apheresis organizations globally including the World Apheresis Association (WAA), the International Society for Apheresis (ISFA), the International Society for Artificial Organs (ISAO) and an associate of other national apheresis societies. The Indian Society for Apheresis (ISA) and the Ludhiana MediCiti (LMC) at Ludhiana Punjab are taking a big step in this direction. The therapeutic apheresis (TA) center at LMC is being set up as a Therapeutic Apheresis Institute and Research Center of excellence. The potential future impacts on the apheresis scenario are summarized.

  20. Clinical trials: testing of adult chemical heating pad.

    PubMed

    Herman, J; Davis, C; Mackey, M; Fuller, S; Tavakoli, A

    1996-01-01

    Chemical packs are recent innovations in the delivery of dry heat. Because these delivery systems do not have any mechanism for verifying temperature during application, research to determine their safety seems warranted. The purpose of this study was to measure the skin temperature of adults during a 30-minute application of the MediHeat adult heating pad (MH-AHP). Seventy-seven subjects received a 30-minute application of the MH-AHP to their backs while lying in both supine and prone positions. The mean skin temperature in both positions was 101 degrees F. There were significant differences, however, in minimum and maximum skin temperature between positions. Subjects in the prone position had significantly higher maximum skin temperature and significantly lower minimum skin temperature than subjects in the supine position. It is possible that the prone position allows for more air flow over the MH-AHP and that more heat was generated causing the higher maximum temperature. This explanation does not account for the lower minimum temperature. There were no significant differences in perception of heat between the positions at either 5 minutes or 30 minutes. Findings suggest that caution is necessary when applying heating devices that depend on air circulation for heat generation.

  1. Innovative technique for large septal perforation repair and radiological evaluation.

    PubMed

    Mocella, S; Muia, F; Giacomini, P G; Bertossi, D; Residori, E; Sgroi, S

    2013-06-01

    La perforazione del setto nasale ha cause molteplici: traumatiche, iatrogene, infettive, degenerative, da abuso di vasocostrittori, da uso di cocaina e di recente anche da chemioterapici antineoplastici. Le perforazioni sono altresì classificate in funzione delle dimensioni e della tipologia del deficit cartilagineo o osteocartilagineo e della sede anteriore, mediana e posteriore. Molteplici tecniche di riparazione chirurgica del danno sono state proposte nel tempo e vengono riassunte nel presente lavoro per tipologia di approccio; i risultati conseguiti, sono soddisfacenti per le perforazioni di piccole e medie dimensioni, ma nelle grandi perforazioni non garantiscono sempre la permanente obliterazione del difetto. Spesso si rende necessario l'utilizzo di tessuti prelevati all'interno delle fosse nasali come i turbinati o il prelievo di cartilagine da altre sedi donatrici come l'orecchio o la costa; le varie tecniche vengono illustrate alla luce della più recente letteratura. Gli Autori hanno valutato i pazienti osservati negli ultimi 8 anni e i risultati chirurgici conseguiti in particolare considerando, gli approcci chirurgici effettuati in approccio aperto o chiuso, endoscopico ed i materiali impiegati. Gli autori propongono tra le varie tecniche impiegate in questa serie di pazienti, una tecnica innovativa utilizzabile con successo in molti dei casi considerati di perforazione settale iatrogena che prevede l'utilizzo del gibbo osteocartilagineo quale sede donatrice, nonché la rinosettoplastica riduttiva quale scelta mirata per ottenere agevolmente lembi di scorrimento mucopericondrale e talora produrre anche un miglioramento estetico morfologico.

  2. "Humanities in medicine".

    PubMed

    Odenbach, V

    1999-01-01

    Progress in medicine and medical technology along with economic constraints have led to increasing structural change in the hospital sector over the past years. As a result of these changes, the social needs of the patients are in danger of being eclipsed by the requirements of the optimization of hospital processes. Cultural activities can be a meaningful way to offset such changes. They stimulate individuals, promote well-being and prompt discussion. Cultural activities in hospitals are directed at patients, hospital employees and people in the community. In Germany, the 'National Association for Culture and Health MediArt' founded in 1995 has been responsible for the UNESCO project "Art in Hospitals" 1988-1997. This paper provides a snapshot of German hospitals that have integrated cultural activities in an exemplary fashion. The activities include such events as 'international cultural days', 'theatre groups', 'dance workshops', 'clinclowns'. Participants include professionals, employees, patients and visitors from the community. The activities are organized by individuals and/or cultural departments created to act as 'health centres' for musical, theatrical, dance and plastic art events.

  3. The economic value of contraception: a comparison of 15 methods.

    PubMed Central

    Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S

    1995-01-01

    OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2 PMID:7702112

  4. The economic value of contraception: a comparison of 15 methods.

    PubMed

    Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S

    1995-04-01

    The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

  5. [From freshmanship to the first "Staatsexamen"--increase of depression and decline in sense of coherence and mental quality of life in advanced medical students].

    PubMed

    Burger, Pascal H M; Tektas, Ozan Y; Paulsen, Friedrich; Scholz, Michael

    2014-08-01

    Psychiatric disorders (Burnout, depression, anxiety disorders) are common among medical students with a distinctly higher prevalence compared to the general public. Although medi-cal students show a normal health status at the beginning of their university study period, a deterioration of these aspects in higher semesters is evident and continues when they become residents. In our study ESTRELLAS we examined 530 medical students in the preclinical semesters (1st-4th) before their first "Staatsexamen" with validated psychological questionnaires for depression, anxiety, quality of life and sense of coherence. Students in their 1st semester show normal values like the general public. During the 4 semesters a slow and continuous rise of depressive symptoms and anxiety was detected. Quality of life and sense of coherence constantly deteriorated. An increase of physical symptoms was not detected. In the 4th semester the number of depressive students had already doubled. The development of worsening psychological problems and resulting psychiatric disorders seems to be a continuous process, starting with the beginning of the medical studies and growing continuously during the preclinical semesters. Effect-ive strategies for coping with distress should be integrated in the medical curriculum at universities from the very first semester on. Relaxation techniques could thus be an opportunity. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction.

    PubMed

    Patel, Nakul Gamanlal; Rozen, Warren Matthew; Marsh, Daniel; Chow, Whitney T H; Vickers, Tobias; Khan, Lubna; Miller, George S; Hunter-Smith, David J; Ramakrishnan, Venkat V

    2016-04-01

    Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. The useful apps have been subdivided: (I) communication apps-multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps-Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps-FlapApp, Touch Surgery, PubMed on tap: step by step guides to surgical procedures to aid learning and medical journal database; (IV) flap monitoring app-SilpaRamanitor: free flap monitoring app based on photographic analysis for earlier detection of compromised flaps. There has been remarkable growth in smartphones use among surgeons. Apps are being developed for every conceivable use. The future will be in wearable smart devices that allow continuous monitoring with the potential to instigate change should deviations from the norm occur. The smart watch is the start of this digital revolution.

  7. [Parkinsonian Syndromes: Direct Costs of Inpatient Neurological Rehabilitation].

    PubMed

    Bujan, B; Müller, M

    2016-02-01

    The Parkinsonian syndromes (PS) belong to the frequent chronic neurological disorders that, due to their progressive character and complex therapeutic options, pose a large economic burden. In a retrospective health economic study on the treatment of Parkinson's disease, various socioeconomic and clinical parameters were examined. In the years 2011-2012, a total of 29 patients with the diagnosis of a Parkinsonian syndrome who underwent an inpatient rehabilitation in the Department of Neurology of the Rehabilitation MediClin Center Bad Orb were recruited. For this group of patients, we calculated the direct treatment cost and also analyzed the treatment cost based on the German diagnosis-related groups (G-DRG, version 2012). The direct medical costs amounted to € 113.47±13.10 per patient per day. Furthermore, cost simulation and comparison revealed significantly higher cost per day for those patients insured via the German statutory health insurance who undergo inpatient care service based on the DRG-based payment (€ 241.77 vs. 171.74; p≤0.015). This study contributes to the achievement of transparency of the direct medical costs of Parkinson's disease treatment in the inpatient setting and emphasizes the cost differences compared to the G-DRG-based payment. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Medical liability insurance claims after treatment of varicose veins.

    PubMed

    Dickhoff, C; Cremers, J E L; Legemate, D A; Koelemay, M J W

    2014-06-01

    Since insight into the reason for filing claims after treatment of varicose veins of the lower extremity might help prevent future claims, we determined the incidence of and reasons for medical liability insurance claims after such treatments in the Netherlands. We performed a retrospective review of all medical liability insurance claims after varicose vein treatment handled by MediRisk between January 1993 and December 2007. A total of 144 claims were filed of which 104 were closed by the end of the study period. Nerve injury (n = 28), skin necrosis following sclerotherapy (n = 17), deep vein injury (n = 11) and insufficient communication (n = 9) accounted for more than 60% of all claims. Claims were equally distributed among registrars and consultants. Some 41 of the 104 closed claims were accepted. In 27 of the accepted cases, the physician had obviously failed in providing the care as expected from a medical practitioner allowed to perform these treatments. The majority of these 27 claims were due to injury of nerves (n = 11) or deep veins (n = 9). The incidence of claims after treatment of varicose veins in the Netherlands is low. Proper knowledge of anatomy and adequate communication, along with the introduction of less invasive treatments might prevent future claims. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Suzanne F. Delbanco on the Leapfrog Group and employer purchasing power. Interview by Pamela K. Scarrow.

    PubMed

    Delbanco, Suzanne F

    2004-01-01

    Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group's goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group's growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than 62 billion dollars on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community Liaison for Kaiser Permanente during the establishment of one of California's first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH from the School of Public Health at the University of California, Berkeley.

  10. Status of children’s blood lead levels in Pakistan: implications for research and policy

    PubMed Central

    Kadir, Muhammad Masood; Janjua, Naveed Zafar; Kristensen, Sibylle; Fatmi, Zafar; Sathiakumar, Nalini

    2008-01-01

    Summary Objectives Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. Methods A systematic review was conducted of published studies found through PubMed, an index of Pakistani medical journals PakMediNet and unpublished reports from governmental and non-governmental agencies in Pakistan. Results With the exception of a few studies that had adequate sample sizes and population-based samples, most studies were small and used convenience sampling methods to select study subjects. Overall, blood lead levels declined from 38 μg/dl in 1989 to 15 μg/dl in 2002. The major sources of lead that directly or indirectly resulted in lead exposure of children included: leaded petrol; father’s occupation in lead-based industry; leaded paint; traditional cosmetics; and remedies. Apart from leaded petrol, there was no information regarding the level of lead in other sources such as paints and the household environment. Very little information was available regarding the adverse health effects of lead among children. Conclusion The phasing out of leaded petrol was a commendable mitigation measure undertaken in July 2001 in Pakistan. A comprehensive assessment is now needed urgently to explore other sources of lead contributing to adverse health effects, and to plan intervention options with the ultimate goal of reducing the burden of disease due to lead exposure. PMID:18359052

  11. DlgR2 knockdown boosts dendritic cell activity and inhibits hepatocellular carcinoma tumor in-situ growth.

    PubMed

    Lu, Zhen; Xia, Yun-Hong; Zhao, Min; Zhang, Bing; Dai, Wen-Ting; Ding, Lu; Hu, Li-Xia; Bi, Jin-Ling; Jiang, Guo-Lin

    2017-08-15

    Tumor-specific hepatic stellate cells (tHSCs) positively participate in human hepatocellular carcinoma (HCC) tumorigenesis and progression. Our previous studies have shown that tHSCs co-culture with dendritic cells (DCs) induced DIgR2 (dendritic cell-derived immunoglobulin receptor 2) expression. The latter is a member of IgSF inhibitory receptor suppressing DCs-initiated antigen-specific T-cell responses. In the current study, we show that hepatic artery injection of DlgR2 siRNA significantly inhibited in-situ HCC xenograft growth in rat livers. Further, 5-FU-medied inhibition of in-situ HCC growth was dramatically sensitized with DlgR2 silence. DlgR2 siRNA injection indeed downregulated DlgR2 in ex-vivo cultured tumor-derived DCs (tDCs). More importantly, tDCs activity was boosted following DlgR2 siRNA. These cells presented with upregulated CD80, CD86 and MHC-II. Production of interleukin-12 and tumor necrosis factor-α was also increased in the DlgR2-silenced tDCs. We propose that DlgR2 knockdown likely boosts the activity of tumor-associated DCs, and inhibits growth of in-situ HCC xenografts.

  12. Association of mandated language access programming and quality of care provided by mental health agencies.

    PubMed

    McClellan, Sean R; Snowden, Lonnie

    2015-01-01

    This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP). In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years. On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days. This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

  13. The LHCb VELO upgrade

    NASA Astrophysics Data System (ADS)

    Dosil Suárez, Álvaro

    2016-07-01

    The upgrade of the LHCb experiment, planned for 2019, will transform the experiment to a trigger-less system reading out the full detector at 40 MHz event rate. All data reduction algorithms will be executed in a high-level software farm. The upgraded detector will run at luminosities of 2×1033 cm-2 s-1 and probe physics beyond the Standard Model in the heavy flavour sector with unprecedented precision. The Vertex Locator (VELO) is the silicon vertex detector surrounding the interaction region. The current detector will be replaced with a hybrid pixel system equipped with electronics capable of reading out at 40 MHz. The detector comprises silicon pixel sensors with 55×55 μm2 pitch, read out by the VeloPix ASIC, based on the TimePix/MediPix family. The hottest region will have pixel hit rates of 900 Mhits/s yielding a total data rate more than 3 Tbit/s for the upgraded VELO. The detector modules are located in a separate vacuum, separated from the beam vacuum by a thin custom made foil. The detector halves are retracted when the beams are injected and closed at stable beams, positioning the first sensitive pixel at 5.1 mm from the beams. The material budget will be minimised by the use of evaporative CO2 coolant circulating in microchannels within 400 μm thick silicon substrates.

  14. Medicaid beneficiaries in california reported less positive experiences when assigned to a managed care plan.

    PubMed

    McDonnell, Diana D; Graham, Carrie L

    2015-03-01

    In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Placebo-controlled study in neuromyelitis optica—Ethical and design considerations

    PubMed Central

    Cree, Bruce AC; Bennett, Jeffrey L; Sheehan, Mark; Cohen, Jeffrey; Hartung, Hans-Peter; Aktas, Orhan; Kim, Ho Jin; Paul, Friedemann; Pittock, Sean; Weinshenker, Brian; Wingerchuk, Dean; Fujihara, Kazuo; Cutter, Gary; Patra, Kaushik; Flor, Armando; Barron, Gerard; Madani, Soraya; Ratchford, John N; Katz, Eliezer

    2015-01-01

    Background: To date, no treatment for neuromyelitis optica (NMO) has been granted regulatory approval, and no controlled clinical studies have been reported. Objective: To design a placebo-controlled study in NMO that appropriately balances patient safety and clinical–scientific integrity. Methods: We assessed the “standard of care” for NMO to establish the ethical framework for a placebo-controlled trial. We implemented measures that balance the need for scientific robustness while mitigating the risks associated with a placebo-controlled study. The medical or scientific community, patient organizations, and regulatory authorities were engaged early in discussions on this placebo-controlled study, and their input contributed to the final study design. Results: The N-MOmentum study (NCT02200770) is a clinical trial that randomizes NMO patients to receive MEDI-551, a monoclonal antibody that depletes CD19+ B-cells, or placebo. The study design has received regulatory, ethical, clinical, and patient approval in over 100 clinical sites in more than 20 countries worldwide. Conclusion: The approach we took in the design of the N-MOmentum trial might serve as a roadmap for other rare severe diseases when there is no proven therapy and no established clinical development path. PMID:26666258

  16. Background noise analysis in urban airport surroundings of Brazilian cities, Congonhas Airport, São Paulo.

    PubMed

    Scatolini, Fabio; Alves, Cláudio Jorge Pinto

    2016-12-22

    To perform a quantitative analysis of the background noise at Congonhas Airport surroundings based on large sampling and measurements with no interruption. Measuring sites were chosen from 62 and 72 DNL (day-night-level) noise contours, in urban sites compatible with residential use. Fifteen sites were monitored for at least 168 hours without interruption or seven consecutive days. Data compilation was based on cross-reference between noise measurements and air traffic control records, and results were validated by airport meteorological reports. Preliminary diagnoses were established using the standard NBR-13368. Background noise values were calculated based on the Sound Exposure Level (SEL). Statistic parameters were calculated in one-hour intervals. Only four of the fifteen sites assessed presented aircraft operations as a clear cause for the noise annoyance. Even so, it is possible to detect background noise levels above regulation limits during periods of low airport activity or when it closes at night. All the sites monitored showed background noise levels above regulation limits between 7:00 and 21:00. In the intervals between 6:00-6:59 and 21:00-22:59 the noise data, when analyzed with the current airport operational characteristics, still allow the development of additional mitigating measures. Avaliar quantitativamente o ruído de fundo no entorno do aeroporto de Congonhas, com base em ampla amostragem e medições sem interrupção. Locais de medição escolhidos a partir de curvas de ruído de 62 e 72 LDN (day-night level), em equipamentos urbanos de uso compatível com o residencial. Quinze locais foram avaliados por mais de 168 horas consecutivas cada um (sete dias). A compilação baseou-se em cruzamentos de dados do controle de tráfego aéreo e os resultados foram validados por meio de relatórios meteorológicos do aeroporto. Diagnósticos preliminares foram estabelecidos utilizando a NBR-13368. O ruído de fundo foi calculado com base no Sound

  17. Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox.

    PubMed

    Gould, Jeffrey B; Madan, Ashima; Qin, Cheng; Chavez, Gilberto

    2003-06-01

    Previous studies have addressed perinatal outcomes in Hispanic, black, and white non-Hispanic women and demonstrated that although foreign-born Mexican American women have many demographic and socioeconomic risk factors, their rates of low birth weight (LBW) infants and infant mortality are similar to those of white women. This phenomenon has been termed an epidemiologic paradox. There have been no population-based studies on women of Asian Indian origin, a relatively new, highly educated, and affluent immigrant group that has been reported to have a high rate of LBW infants. The objective of this study was to define the sociodemographic risk profile and perinatal outcomes in women of Asian Indian birth and to compare these outcomes to foreign-born Mexican American and US-born black and white women. The vital records for self-reported foreign-born Asian Indian (0.8%) and Mexican women (26.7%) and US-born black (31.2%) and white women (31.2%) were extracted from California's 1 622 324 births, 1995-1997. Sociodemographic risk profiles; the percentage of LBW, very low birth weight (VLBW), prematurity, and intrauterine growth retardation (less than third percentile); and percentage of fetal, neonatal, and postneonatal death rates were compared. Logistic models were used to estimate the importance of selected sociodemographic and medical factors to the prediction of LBW infants in each racial/ethnic group. When compared with whites, US-born blacks and foreign-born Mexican mothers were at increased risk for adverse perinatal outcomes on the basis of higher levels of inadequate prenatal care, teen births, Medi-Cal paid delivery, and lower levels of maternal and paternal education. Foreign-born Asian Indian mothers had good prenatal care, were rarely teenagers, had dramatically higher levels of both maternal and paternal education, and had the lowest percentage of deliveries paid for by Medi-Cal. Black infants had the highest rates of prematurity; intrauterine growth

  18. Natural Language Processing-Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study.

    PubMed

    Kaufman, David R; Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark

    2016-10-28

    The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)-enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user's experience. The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods ("protocols") of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes

  19. Il ruolo svolto dall’attività lavorativa sull’ipertensione arteriosa

    PubMed Central

    Barbini, N.; Gorini, G.; Ferrucci, L.; Biggeri, A.

    2009-01-01

    RIASSUNTO Introduzione I parametri di pressione arteriosa, sistolica (PAS) o diastolica (PAD) hanno costituito I’oggetto di numerosi studi, alcuni dei quali stabiliscono un’associazione tra I’aumnto di tali parametri e la mortalità, in particolare alle età medie. I fattori di rischio di ipertensione più frequentemente studiati sono il consumo di alcol, il fumo e I’origine etnica in riferimento sia alle differenze genetiche che nella condotta alimentare, mentre i fattori di origine professionale sono stati presi in considerazione più raramente e in maniera poco approfondita, inoltre sono state riferite notevoli differenze nelle pressioni arteriose medie di individui che svolgono professioni diverse. Sembra infatti che i “colletti blu” siano più a rischio dei “colletti bianchi”. Obiettivi Il nostro scopo è valutare se determinati rischi o vincoli connessi con l’attività professionale o determinati stili di vita rappresentano un fattore di rischio per l’ipertensione arteriosa in considerazioni dell’aumentare dell’età. Elementi specifici che rendano conto di questa relazione non sono stati ancora completamente chiariti e soprattutto i dati sulla popolazione italiana sono molto limitati. Metodi La metodologia di ricerca utilizzata è stata quella dell’indagine francese ESTEV (Derriennic, Touranchet, Volkoff) - VISAT (Marquie, Janson), studio epidemiologico longitudinale su oltre 23000 lavoratori attivata in Francia nel 1990 al fine di indagare gli effetti a lungo termine delle condizioni di lavoro, riferite all’intera vita professionale, sia sull’invecchiamento sia sulla salute dei lavoratori. Analoga indagine è stata avviata in Italia, nel 2000, in 6 Regioni, prendendo in esame i lavoratori dipendenti di diversi settori produttivi appartenenti a 5 coorti di età: da 32 a 52 anni con intervallo di 5 anni. Le rilevazioni sono state effettuate dai medici del lavoro di azienda attraverso 3 questionari: 1. sulle condizioni

  20. Natural Language Processing–Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study

    PubMed Central

    Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark

    2016-01-01

    Background The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)–enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user’s experience. Objective The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. Methods This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods (“protocols”) of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. Results A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard

  1. Biological and clinical outcomes in the elderly with left ventricular dysfunction: Are there differences between on-pump and off-pump coronary artery bypass grafting?

    PubMed

    Concistrè, Giovanni; Dell'Aquila, Angelo Maria; Piccardo, Alessandro; Pansini, Stefano; Gargiulo, Raffaele; Gallo, Alina; Merlanti, Bruno; Passerone, Giancarlo; Regesta, Tommaso

    2015-01-01

    Il nostro studio ha lo scopo di confrontare gli eventi clinici ed i dati laboratoristici postoperatori di pazienti anziani coronaropatici con disfunzione ventricolare sinistra, sottoposti a rivascolarizzazione miocardica chirurgica eseguita con o senza ausilio della circolazione extracorporea. Studi recenti hanno evidenziato i vantaggi dell’intervento a cuore battente nei pazienti anziani, riportando una riduzione della morbidità postoperatoria e della disfunzione di organo. Tuttavia questi studi non analizzano l’impatto della disfunzione ventricolare sinistra sugli eventi postoperatori precoci e tardivi nei pazienti ad alto rischio. Abbiamo esaminato retrospettivamente 90 pazienti di età superiore ai 75 anni, con frazione di eiezione preoperatoria < 50%, sottoposti a bypass aortocoronarico, senza altre procedure cardiochirurgiche associate, tra Gennaio 2000 e Luglio 2009 presso il nostro Centro. I pazienti sono stati divisi in 2 gruppi: pazienti operati senza ausilio della circolazione extracorporea (a cuore battente) e pazienti operati con l’ausilio della circolazione extracorporea (a cuore fermo). Abbiamo confrontato I livelli sierici postoperatori degli enzimi CK, CK-MB e troponina T, indici di danno miocardico, e gli eventi cerebrovascolari. La mortalità intraospedaliera totale era del 2% (2 pazienti su 90) e simile in entrambi i gruppi (p=0.8336). I livelli medi di troponina T a 6, 24, 48 ore dopo l’intervento erano significativamente più bassi nei pazienti operati a cuore battente (p=0.0001; p=0.0021; p=0.0070). Non c’era una differenza statisticamente significativa nei 2 gruppi in termini di sopravvivenza (p=0.0764) e di eventi cerebrovascolari (p=0.3016) nell’immediato postoperatorio ed a 10 anni. I nostri risultati dunque mostrano che il non utilizzo della circolazione extracorporea nei pazienti ad alto rischio determinerebbe una più bassa incidenza di danno miocardico; tuttavia ciò sembra non influenzare a lungo termine la sopravvivenza

  2. Transcrestal sinus lift and implant placement using the sinus balloon technique

    PubMed Central

    Galán-Gil, Sónnica; Carrillo-García, Celia; Peñarrocha-Diago, David; Peñarrocha-Diago, Miguel

    2012-01-01

    Objective: A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Material and method: Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. Results: One patient was excluded due to Schneider’s membrane perforation as confirmed by endoscopy. Trans-crestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. Conclusions: Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone. Key words: Sinus lift, balloon, sinus complications. PMID:22157670

  3. Is There a Good App for That? Evaluating m-Health Apps for Strategies That Promote Pediatric Medication Adherence.

    PubMed

    Nguyen, Eve; Bugno, Lindsey; Kandah, Cassandra; Plevinsky, Jill; Poulopoulos, Natasha; Wojtowicz, Andrea; Schneider, Kristin L; Greenley, Rachel Neff

    2016-11-01

    Mobile health medication reminder apps may be a useful supplement to traditional adherence-promotion interventions for pediatric chronic illness populations because they can give real-time reminders and provide education and promote behavior modification (components known to enhance adherence in traditional interventions) in an engaging and developmentally acceptable way. Moreover, apps have the potential to be used by youth and parents, an important consideration given that shared involvement in condition management is associated with better adherence. This study evaluated the content and usability of existing medication reminder apps operating on the Apple platform. Two researchers coded 101 apps on 15 desirable reminder, educational, and behavioral modification features. Usability testing was conducted with the subset of apps (n = 8) that had the greatest number of content features using a validated measure. Apps contained an average of 4.21 of 15 content features, with medication reminder features being more common than either educational or behavioral modification features. Apps most commonly included a medication name storage feature (95%), a time-based reminder feature (87%), and a medication dosage storage feature (68%). Of the eight apps that had the highest number of content features, Mango Health, myRX Planner, and MediSafe evidenced the highest usability ratings. No apps identified were specifically designed for pediatric use. Most apps lacked content known to be useful in traditional pediatric adherence-promotion interventions. Greater attention to educational and behavioral modification features may enhance the usefulness of medication reminder apps for pediatric groups. Collaborations between behavioral medicine providers and app developers may improve the quality of medication reminder apps for use in pediatric populations.

  4. Population based surveillance in sickle cell disease: methods, findings and implications from the California registry and surveillance system in hemoglobinopathies project (RuSH).

    PubMed

    Paulukonis, Susan T; Harris, William T; Coates, Thomas D; Neumayr, Lynne; Treadwell, Marsha; Vichinsky, Elliott; Feuchtbaum, Lisa B

    2014-12-01

    There are no population-based surveillance systems to determine prevalence, impact or outcomes in sickle cell disease (SCD). Estimates of the SCD population in California range broadly from 4,500 to 7,000, and little is known about their health status, health care utilization or health outcomes. A surveillance strategy was implemented using diverse data sources to develop a multi-dimensional, state-based surveillance system for SCD that includes adults and children and describes utilization, treatment and outcomes. Data from California newborn screening, inpatient and emergency room records, Medi-Cal/Medicaid claims and two SCD special care centers were collected for 2004-2008. A multi-step, iterative linkage process was used to link and de-duplicate these data sources, and case definitions were used to categorize cases. After linking and de-duplicating, there were 1,975 confirmed cases of SCD, 3,159 probable cases as well as 8,024 possible cases. Among individual data sources, newborn screening and data from clinics contributed the greatest number of unique cases to the total. Select analyses of utilization and treatments for the population are described. Using linked existing data sources, an estimate of the statewide count of the SCD population is possible. The approach can be used to create an in-depth health status profile of the affected population by aggregating utilization, treatment, and outcomes data including mortality and morbidity information. This effort sets the stage for development of an on-going, state-based surveillance system. © 2014 Wiley Periodicals, Inc.

  5. Pakistan Journal of Medical Sciences: A bibliometric assessment 2001-2010.

    PubMed

    Baladi, Zameer Hussain; Umedani, Loung V

    2017-01-01

    The aim of this study was to measure the growth of scientific research, authors' productivity, affiliation with the institute and geographic locations published in the Pakistan Journal of Medical Sciences during the period of 2001 - 2010. This numerical analysis was conducted during mid-August 2016 to mid-October, 2016. The data for the study was downloaded from websites of e-journal of Pakistan Journal of Medical Sciences (PJMS) and Pak Medi-Net Com. A total number of 1199 articled were covered by PJMS in 10 volumes and 40 issues with contribution of 3798 (3%) authors during 2001 - 2010. The average number of papers per issue is 30%. A gender wise contribution of males was higher 3050 (80%) than the females 748 (20%). A majority of articles were multi-authored 1052 (87%) as opposed to single author contribution 147 (13%). All 1199 articles were covered under four major disciplines i.e Basic medical sciences, medicine & allied, surgery & allied and radiological sciences and 39 sub-specialties according to medical subject headings (MeSH). It observed that 467 (39%) articles were published in Pakistan and 732 (61%) articles produced by other 32 countries. The Karachi city of Pakistan has produced 199 (16%) articles as highest as its national level and followed by Tehran (Iran) 77 (6%) as followed internationally. This study reveals that the participation of 32 countries in the PJMS publications proves it to be an internationally circulated journal to support research with the constant approach of publishing articles to each volume in basic medical sciences, biomedical, clinical and public health sciences. Abbreviations: DOAJ: Directory of Open Access Journals IMEMR: Index Medicus Eastern Mediterranean Region HEC: Higher Education Commission (Pakistan) PJMS: Pakistan Journal of Medical Sciences MeSH: Medical Subject Headings PMDC: Pakistan Medical & Dental Council SCIE: Science Citation Index Expanded.

  6. Hepatitis B virus in Pakistan: a systematic review of prevalence, risk factors, awareness status and genotypes.

    PubMed

    Ali, Muhammad; Idrees, Muhammad; Ali, Liaqat; Hussain, Abrar; Ur Rehman, Irshad; Saleem, Sana; Afzal, Samia; Butt, Sadia

    2011-03-06

    In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were determined for each population group. The percentage of hepatitis B virus infection in general population was 4.3318% ± 1.644%, healthy blood donors (3.93% ± 1.58%), military recruits (4.276% ± 1.646%), healthcare persons (3.25% ± 1.202%), pregnant women (5.872% ± 4.984), prisoners (5.75% ± 0.212%), surgical patients (7.397% ± 2.012%), patients with cirrhosis (28.87% ± 11.90%), patients with HCC (22% ± 2.645%), patients with hepatitis (15.896% ± 14.824%), patients with liver diseases (27.54% ± 6.385%), multiple transfused patients (6.223% ± 2.121%), opthalmic patients (3.89% ± 1.004%) and users of injectable drugs (14.95% ± 10.536%). Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%.

  7. Pakistan Journal of Medical Sciences: A bibliometric assessment 2001-2010

    PubMed Central

    Baladi, Zameer Hussain; Umedani, Loung V.

    2017-01-01

    Objective: The aim of this study was to measure the growth of scientific research, authors’ productivity, affiliation with the institute and geographic locations published in the Pakistan Journal of Medical Sciences during the period of 2001 – 2010. Methods: This numerical analysis was conducted during mid-August 2016 to mid-October, 2016. The data for the study was downloaded from websites of e-journal of Pakistan Journal of Medical Sciences (PJMS) and Pak Medi-Net Com. Results: A total number of 1199 articled were covered by PJMS in 10 volumes and 40 issues with contribution of 3798 (3%) authors during 2001 – 2010. The average number of papers per issue is 30%. A gender wise contribution of males was higher 3050 (80%) than the females 748 (20%). A majority of articles were multi-authored 1052 (87%) as opposed to single author contribution 147 (13%). All 1199 articles were covered under four major disciplines i.e Basic medical sciences, medicine & allied, surgery & allied and radiological sciences and 39 sub-specialties according to medical subject headings (MeSH). It observed that 467 (39%) articles were published in Pakistan and 732 (61%) articles produced by other 32 countries. The Karachi city of Pakistan has produced 199 (16%) articles as highest as its national level and followed by Tehran (Iran) 77 (6%) as followed internationally. Conclusion: This study reveals that the participation of 32 countries in the PJMS publications proves it to be an internationally circulated journal to support research with the constant approach of publishing articles to each volume in basic medical sciences, biomedical, clinical and public health sciences. Abbreviations: DOAJ: Directory of Open Access Journals IMEMR: Index Medicus Eastern Mediterranean Region HEC: Higher Education Commission (Pakistan) PJMS: Pakistan Journal of Medical Sciences MeSH: Medical Subject Headings PMDC: Pakistan Medical & Dental Council SCIE: Science Citation Index Expanded PMID:28811801

  8. Anti program death-1/anti program death-ligand 1 in digestive cancers

    PubMed Central

    de Guillebon, Eléonore; Roussille, Pauline; Frouin, Eric; Tougeron, David

    2015-01-01

    Human tumors tend to activate the immune system regulatory checkpoints as a means of escaping immunosurveillance. For instance, interaction between program death-1 (PD-1) and program death-ligand 1 (PD-L1) will lead the activated T cell to a state of anergy. PD-L1 is upregulated on a wide range of cancer cells. Anti-PD-1 and anti-PD-L1 monoclonal antibodies (mAbs), called immune checkpoint inhibitors (ICIs), have consequently been designed to restore T cell activity. Accumulating data are in favor of an association between PD-L1 expression in tumors and response to treatment. A PD-L1 expression is present in 30% to 50% of digestive cancers. Multiple anti-PD-1 (nivolumab, pembrolizumab) and anti-PD-L1 mAbs (MPDL3280A, Medi4736) are under evaluation in digestive cancers. Preliminary results in metastatic gastric cancer with pembrolizumab are highly promising and phase II will start soon. In metastatic colorectal cancer (CRC), a phase III trial of MPDL3280A as maintenance therapy will shortly be initiated. Trials are also ongoing in metastatic CRC with high immune T cell infiltration (i.e., microsatellite instability). Major challenges are ahead in order to determine how, when and for which patients we should use these ICIs. New radiologic criteria to evaluate tumor response to ICIs are awaiting prospective validation. The optimal therapeutic sequence and association with cytotoxic chemotherapy needs to be established. Finally, biomarker identification will be crucial to selection of patients likely to benefit from ICIs. PMID:26306141

  9. Anti program death-1/anti program death-ligand 1 in digestive cancers.

    PubMed

    de Guillebon, Eléonore; Roussille, Pauline; Frouin, Eric; Tougeron, David

    2015-08-15

    Human tumors tend to activate the immune system regulatory checkpoints as a means of escaping immunosurveillance. For instance, interaction between program death-1 (PD-1) and program death-ligand 1 (PD-L1) will lead the activated T cell to a state of anergy. PD-L1 is upregulated on a wide range of cancer cells. Anti-PD-1 and anti-PD-L1 monoclonal antibodies (mAbs), called immune checkpoint inhibitors (ICIs), have consequently been designed to restore T cell activity. Accumulating data are in favor of an association between PD-L1 expression in tumors and response to treatment. A PD-L1 expression is present in 30% to 50% of digestive cancers. Multiple anti-PD-1 (nivolumab, pembrolizumab) and anti-PD-L1 mAbs (MPDL3280A, Medi4736) are under evaluation in digestive cancers. Preliminary results in metastatic gastric cancer with pembrolizumab are highly promising and phase II will start soon. In metastatic colorectal cancer (CRC), a phase III trial of MPDL3280A as maintenance therapy will shortly be initiated. Trials are also ongoing in metastatic CRC with high immune T cell infiltration (i.e., microsatellite instability). Major challenges are ahead in order to determine how, when and for which patients we should use these ICIs. New radiologic criteria to evaluate tumor response to ICIs are awaiting prospective validation. The optimal therapeutic sequence and association with cytotoxic chemotherapy needs to be established. Finally, biomarker identification will be crucial to selection of patients likely to benefit from ICIs.

  10. High-Resolution 125I Small Animal Imaging With a Coded Aperture and a Hybrid Pixel Detector

    NASA Astrophysics Data System (ADS)

    Accorsi, Roberto; Celentano, Luigi; Laccetti, Paolo; Lanza, Richard C.; Marotta, Marcello; Mettivier, Giovanni; Montesi, Maria Cristina; Roberti, Giuseppe; Russo, Paolo

    2008-02-01

    We report on tests of a radionuclide imaging system for in vivo investigations in small animals with low-energy photons as from 125I (27-35 keV). Imaging optics features a high-resolution coded aperture mask and a fine pitch hybrid pixel detector (silicon 300-mum or 700-mum thick, or CdTe 1 mm thick) of the Medipix2 series (55 mum pitch, 256 x 256 pixels). The coded aperture had 480 70-mum holes in 100-mum-thick tungsten. Laboratory tests with a 109Cd 22 keV source and a microfocus X-ray tube (35 kVp, Mo anode) show a system resolution of about 110 mum at magnification m = 2.12 and a sensitivity improvement of 30:1 as compared to a 300-mum pinhole collimator. The field of view also depends on magnification: in the experiments presented, it varied from 6 mm (m = 2.12) to 21 mm (m = 0.66). 125I in vivo mouse thyroid imaging with the 70 mum coded aperture, a 300 mum pinhole and a 100 mum parallel hole collimator was also performed to obtain a qualitative comparison. This low energy, semiconductor-based, compact gamma-ray imaging system can be used as a gamma-ray sub-millimeter resolution imager for energies below about 35 keV and it is the basic imaging unit of a small animal Single Photon Emission Computed Tomography system (MediSPECT) built at University of Napoli Federico II and Istituto Nazionale Fisica Nucleare (INFN), Napoli.

  11. A comprehensive operating room information system using the Kinect sensors and RFID.

    PubMed

    Nouei, Mahyar Taghizadeh; Kamyad, Ali Vahidian; Soroush, Ahmad Reza; Ghazalbash, Somayeh

    2015-04-01

    Occasionally, surgeons do need various types of information to be available rapidly, efficiently and safely during surgical procedures. Meanwhile, they need to free up hands throughout the surgery to necessarily access the mouse to control any application in the sterility mode. In addition, they are required to record audio as well as video files, and enter and save some data. This is an attempt to develop a comprehensive operating room information system called "Medinav" to tackle all mentioned issues. An integrated and comprehensive operating room information system is introduced to be compatible with Health Level 7 (HL7) and digital imaging and communications in medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. Besides, a natural user interface (NUI) is designed specifically for operating rooms where touch-less interactions with finger and hand tracking are in use. Further, the system could both record procedural data automatically, and view acquired information from multiple perspectives graphically. A prototype system is tested in a live operating room environment at an Iranian teaching hospital. There are also contextual interviews and usability satisfaction questionnaires conducted with the "MediNav" system to investigate how useful the proposed system could be. The results reveal that integration of these systems into a complete solution is the key to not only stream up data and workflow but maximize surgical team usefulness as well. It is now possible to comprehensively collect and visualize medical information, and access a management tool with a touch-less NUI in a rather quick, practical, and harmless manner.

  12. Catheter ablation of atrial fibrillation supported by novel nonfluoroscopic 4D navigation technology.

    PubMed

    Rolf, Sascha; John, Silke; Gaspar, Thomas; Dinov, Boris; Kircher, Simon; Huo, Yan; Bollmann, Andreas; Richter, Sergio; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher; Sommer, Philipp

    2013-09-01

    The MediGuide technology (MGT) represents a novel sensor-based electromagnetic 4-dimensional (4D) navigation system allowing real-time catheter tracking in the environment of prerecorded X-ray loops. To report on our clinical experience in atrial fibrillation (AF) ablation with recently available MGT-enabled ablation catheters. The MGT was used in addition to a conventional 3D mapping system in 80 patients with AF (age 61 ± 10 years; 47 men; 40 with persistent AF), who underwent circumferential pulmonary vein isolation and voltage mapping with and without substrate modification. Short native right anterior oblique/left anterior oblique loops were used as background movies for the nonfluoroscopic placement of sensor-equipped diagnostic catheters into the coronary sinus and the right ventricle. After single transseptal puncture, selective angiograms of the pulmonary veins were used as background movies for near nonfluoroscopic left atrial reconstruction. Computed tomography registration as well as mapping/ablation was performed by using the new open-irrigated MGT-enabled ablation catheter. MGT application was not associated with a change in established workflow. Large parts of the procedure (mean entire duration 167 ± 47 minutes) could be done without additional fluoroscopy, whereas median residual fluoroscopy duration of 4.6 (interquartile range: 2.9, 7.1) minutes was mainly used for the acquisition of background loops, transseptal puncture, occasional verification of transseptal sheath position, and manipulation of the circular mapping catheter. Three (4%) minor complications occurred. The MGT integrates easily into the workflow of standard AF ablation and allows for high-quality nonfluoroscopic 4D catheter tracking. This results in low radiation exposure for patients and staff without complicating the workflow of the procedure. Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  13. Viability of intratubular bacteria after chemomechanical caries removal.

    PubMed

    Hamama, Hamdi H; Yiu, Cynthia K; Burrow, Michael F

    2014-12-01

    The aim of this study was to assess the effect on bacterial viability within dentinal tubules after the application of sodium hypochlorite (NaOCl)- or enzyme-based chemomechanical caries removal agents. Twenty-five caries-free dentin discs prepared from 25 sound maxillary premolars were used. The discs were then infected with Streptococcus mutans suspension and randomly divided into the following 6 groups according to the dentin treatments: the negative control group: noninfected sound dentin discs, the positive control group: infected discs were left untreated; the NaOCl group: treated with 5% NaOCl solution, the chlorhexidine (CHX) group: 2% CHX solution, the Carisolv group: Carisolv gel (Medi Team Dentalutveckling AB, Savedalen, Sweden), and the Papacarie group: Papacarie gel (Formula & Acao, São Paulo, Brazil). All the agents were applied for 5 minutes. The dentin discs were fractured into 2 halves and stained with fluorescent LIVE/DEAD Stain (Molecular Probes, Eugene, OR). Each specimen was observed using confocal laser scanning microscopy at 5 different randomly selected sites. The results of 1-way analysis of variance revealed that 5% NaOCl solution achieved the highest intratubular antibacterial effect, whereas Carisolv gel had the lowest antibacterial effect (P < .05). No significant difference in antibacterial effect was observed between the Papacarie gel and 2% CHX solution (P > .05). The enzyme-based chemomechanical caries removal (Papacarie) was effective in the reduction of residual cariogenic bacteria in the dentinal tubules of coronal dentin. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Low-dose dobutamine adds incremental value to late gadolinium enhancement cardiac magnetic resonance in the prediction of adverse remodelling following acute myocardial infarction.

    PubMed

    Scott, Anne E; Semple, Scott I K; Redpath, Thomas W; Hillis, Graham S

    2013-09-01

    To examine the relative and combined value of late gadolinium enhancement (LGE) and low-dose dobutamine (LDD) cardiac magnetic resonance (CMR) to predict 'adverse remodelling' (AR) following acute myocardial infarction (AMI). Forty-five patients with AMI were recruited. CMR was performed 2-4 days after presentation and at 6 months. Ventricular wall motion and volume were recorded at rest and following dobutamine infusion. Measures of first pass perfusion, persistent microvascular obstruction (PMO), and LGE were obtained following contrast administration. Quantitation was performed using the MEDIS 6.2 software. Regression analysis was employed to determine the univariables and multivariate models most predictive of AR at 6 months. The incremental and relative value of LDD over LGE was investigated. The most predictive univariable was 'volume of PMO' (r = 0.51, r2 = 0.26, P < 0.001). The optimal 'combined' multivariate model, utilizing data from all components, was highly predictive of AR (r = 0.82, r2 = 0.67, P < 0.001). The optimal model using parameters only from the LGE component also predicted remodelling (r = 0.65, r2 = 42.0, P = 0.001) but with less accuracy. In contrast, the optimal model using variables from the LDD component alone predicted remodelling with a similar accuracy to the optimal combined model (r = 0.82, r2 = 0.67, P < 0.001). A comprehensive CMR examination accurately predicts AR following AMI. LDD is superior to LGE CMR in this respect. These data suggest that LDD not only adds incremental value to LGE in the prediction of remodelling post-AMI but also may be utilized alone with the same predictive power.

  15. Gateways to clinical trials.

    PubMed

    Tomillero, A; Moral, M A

    2010-01-01

    (-)-Epigallocatechin gallate, Abafungin, ACE-031, Adapalene/benzoyl peroxide, AE-37, Aflibercept, AGS-003, Albiglutide, Alemtuzumab, Aliskiren fumarate, ALT-801, AN-2728, Anacetrapib, API, Aprepitant, ARQ-197, Ascorbic acid, Atazanavir sulfate, ATN-224, AVI-4658, Azacitidine, Azelnidipine; Belinostat, Bevacizumab, BI-2536, Biphasic insulin aspart, Bortezomib, Bovine lactoferrin, Bryostatin 1, Budesonide/formoterol fumarate; cAC10, Canfosfamide hydrochloride, Cediranib, Clofarabine, Cocaine conjugate vaccine; Darbepoetin alfa, Dasatinib, Denosumab, Disomotide, Doripenem, Dovitinib Lactate, Dronedarone hydrochloride, Drospirenone/estradiol, Dutasteride; Ecogramostim, Entinostat, Enzastaurin hydrochloride, Erlotinib hydrochloride, Everolimus, Exenatide, Ezetimibe, Ezetimibe/simvastatin; Fampridine, Fenretinide LXS, FFR-factor VIIa, Fingolimod hydrochloride, Frovatriptan; Gefitinib, Gimatecan, GP-2/GM-CSF; Iloperidone, Imatinib mesylate, Indibulin, Ipilimumab, Ivabradine hydrochloride; Lactobacillus rhamnosus, Lapatinib ditosylate, LC-07, Lenalidomide, Linifanib, Liposomal doxorubicin, Liposomal vincristine, Litenimod, Lutein; M-118, MDX-1401, MEDI-528, Midostaurin, Miglustat, MK-0657; Natalizumab, Nesiritide, NGR-TNF, Niacin/simvastatin; Obatoclax mesylate, Olaparib, Omacetaxine mepesuccinate; Paclitaxel nanoparticles, Paclitaxel-eluting stent, Palonosetron hydrochloride, Pazopanib hydrochloride, Pegfilgrastim, Pemetrexed disodium, PER.C-flu, Perifosine, PF-02341066, Pimecrolimus, Pitrakinra, Plerixafor hydrochloride, Posaconazole; Rasburicase, Recombinant human relaxin H2, ReoT3D, Retaspimycin hydrochloride, Riferminogene pecaplasmid, Rindopepimut, Romiplostim, Ronacaleret hydrochloride, Rosuvastatin calcium, Rotigotine; Sagopilone, sALP-FcD10, SAR-245409, SCH-697243, Selumetinib, Sirolimus-eluting stent, SIR-Spheres, Sitagliptin phosphate monohydrate, Sitaxentan sodium, Sorafenib, Sunitinib malate; Tadalafil, Tandutinib, Tasimelteon, Temsirolimus, Teriparatide

  16. Comparing the effectiveness and wash-off resistance of skin barrier creams: a healthy volunteer study.

    PubMed

    Dykes, P; Bradbury, S

    2017-09-02

    Preventing moisture damage and breakdown of the skin can be a particular challenge for patients with incontinence. The level of protection offered by various skin protectant products can vary according to the chemical nature of the formulation and can decrease following wash procedures. The aim of this study was to compare five silicone-containing skin barrier creams indicated for use on incontinence-associated dermatitis (IAD) in terms of their resistance to a standardised wash cycle in healthy volunteer subjects. A skin surface hygrometer (Skicon 200EX) evaluated skin surface conduction non-invasively on 36 non-patient subjects using a high-frequency (3.5MHz) electric current. This provided an index of the degree of protection given by barrier products after a single application and also any reduction in barrier properties after a repeated wash procedure. Medi Derma-S barrier cream (MDS), Cavilon barrier cream (CBC) and LBF barrier cream (LBF) all demonstrated statistically significant differences (p<0.001) in the Skicon values following the first moisture challenge compared with Medihoney (MH), Remedy barrier cream (RBC) and the untreated control. All other comparisons were not significant (p>0.05). Statistical analysis following four moisture challenges reflected the results following the first, whereby Skicon values following treatment with MDS, CBC and LBF was significantly different compared with MH, RBC and the untreated control. Again, all other comparisons were not significant (p>0.05). When expressed as percentage barrier effectiveness, the results show a similar pattern to the absolute Skicon values. The results of this study show that there were differences between the barrier creams in terms of the initial moisture challenge and the resistance to wash-off following a repeated standardised wash procedure. It was concluded that MDS, CBC and LBF barrier cream all showed significant and equally effective moisture barrier protection and wash-off resistance.

  17. Measuring the impact of outreach and enrollment strategies for public health insurance in California.

    PubMed

    Cousineau, Michael R; Stevens, Gregory D; Farias, Albert

    2011-02-01

    OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Administrative enrollment databases. The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments. © Health Research and Educational Trust.

  18. Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands.

    PubMed

    Stevanović, J; de Jong, L A; Kappelhoff, B S; Dvortsin, E P; Voorhaar, M; Postma, M J

    2016-01-01

    Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RE-SONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving €1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at €2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at €33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands.

  19. Gang warfare: the medical repercussions.

    PubMed

    Song, D H; Naude, G P; Gilmore, D A; Bongard, F

    1996-05-01

    Gang related violence in Los Angeles County has increased, with homicides increasing from 205 in 1982 to 803 in 1992. This study examines the medical and financial consequences of such violence on a level I trauma center. Of 856 gunshot injuries over a 29-month period, 272 were gang related. There were 55 pediatric and 217 adult patients. Eighty-nine percent were male and 11% were female. Trauma Score averaged 14.7 +/- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mean Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gunshots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity musculoskeletal injury. Emergency surgery was performed on 43%, including laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vascular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. There were 25 deaths (9%), primarily caused by head injuries and exsanguinating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that preempted the use of facilities for other emergent patients. Charges totaled $4,828,828 (emergency room, surgical procedures, intensive care, and surgical ward stay) which equated to $5,550 per patient per day. Fifty-eight percent had no third party reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Because of dismal reimbursement rates, the costs of gang violence are passed on to the tax payer. The cost of gang related violence cannot be derived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social programs, and strict criminal justice laws and enforcement may decrease gang related violence and the drain it has on financial and medical resources.

  20. Environmental and individual attributes associated with child maltreatment resulting in hospitalization or death.

    PubMed

    Thurston, Holly; Freisthler, Bridget; Bell, Janice; Tancredi, Daniel; Romano, Patrick S; Miyamoto, Sheridan; Joseph, Jill G

    2017-05-01

    Maltreatment continues to be a leading cause of death for young children. Researchers are beginning to uncover which neighborhood attributes may be associated with maltreatment outcomes. However, few studies have been able to explore these influences while controlling for individual family attributes, and none have been able to parse out the most severe outcomes-injuries resulting in hospitalization or death. This study utilizes a retrospective, case-control design on a dataset containing both individual and environmental level attributes of children who have been hospitalized or died due to maltreatment to explore the relative influence of attributes inside and outside the household walls. Binary conditional logistic regression was used to model the outcome as a function of the individual and environmental level predictors. Separate analyses also separated the outcome by manner of maltreatment: abuse or neglect. Finally, a sub-analysis included protective predictors representing access to supportive resources. Findings indicate that neighborhood attributes were similar for both cases and controls, except in the neglect only model, wherein impoverishment was associated with higher odds of serious maltreatment. Dense housing increased risk in all models except the neglect only model. In a sub-analysis, distance to Family Resource Centers was inversely related to serious maltreatment. In all models, variables representing more extreme intervention and/or removal of the victim and/or perpetrator from the home (foster care or criminal court involvement) were negatively associated with the risk of becoming a case. Medi-Cal insurance eligibility of a child was also negatively associated with becoming a case. Government interventions may be playing a critical role in child protection. More research is needed to ascertain how these interventions assert their influence. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency.

    PubMed

    Gilmer, Todd P; Ojeda, Victoria D; Barrio, Concepcion; Fuentes, Dahlia; Garcia, Piedad; Lanouette, Nicole M; Lee, Kelly C

    2009-02-01

    The authors examined data for 7,784 Latino, Asian, and non-Latino white Medi-Cal beneficiaries with schizophrenia to determine the relationship between patients' preferred language for mental health services--English, Spanish, or an Asian language--and their adherence to treatment with antipsychotic medications. Data reflected 31,560 person-years from 1999 to 2004. Pharmacy records were analyzed to assess medication adherence by use of the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<.5), partially adherent (MPR=.5-<.8), or adherent (MPR=.8-1.1) or as an excess filler of prescriptions (MPR<1.1). Regression models were used to examine adherence, hospitalization, and costs by race-ethnicity and language status. Latinos with limited English proficiency were more likely than English-proficient Latinos to be medication adherent (41% versus 36%; p<.001) and less likely to be excess fillers (15% versus 20%; p<.001). Asians with limited English proficiency were less likely than English-proficient Asians to be adherent (40% versus 45%; p=.034), more likely to be nonadherent (29% versus 22%; p<.001), and less likely to be excess fillers (13% versus 17%; p=.004). When analyses controlled for adherence and comorbidities, clients with limited English proficiency had lower rates of hospitalization and lower health care costs than English-proficient and white clients. Adherence to antipsychotic medications varied by English proficiency among and within ethnic groups. Policies supporting the training of bilingual and multicultural providers from ethnic minority groups and interventions that capitalize on patients' existing social support networks may improve adherence to treatment in linguistically diverse populations.

  2. Barriers to contraceptive services.

    PubMed

    Silverman, J; Torres, A; Forrest, J D

    1987-01-01

    More than 1/2 of the pregnancies that occur each year in the US are unintended and 1/2 of these end in abortion. An attempt was made to determine the contraceptive availability, needs and preferences of low-income women via a telephone survey of 760 women, 18-35 years of age, living in 4 urban locations and a mail survey of all family planning clinics and private obstetrician-gynecologists in each of the 4 communities, as well as other physicians and clinics mentioned by the women. Although 94% of the women said they had used some contraceptive method at some time, 23% were not currently practicing contraception. Both nonuse and the use of less effective methods appear to be caused by method-related fears, dislike of available methods, and a general negative feeling about contraception. Less effective methods may be avoided because women view them as offering less protection and dislike their coitus-dependent qualities. Structural or provider-related concerns, such as cost, were seldom reported as barriers to contraceptive use. The primary barrier to clinic use is the apparent belief of many women that clinics do not offer personalized care and provide lower quality care than private physicians. Private physicians are avoided because of high cost and their lesser acceptance of Medicaid or Medi-Cal reimbursement. Encouraging more favorable attitudes toward contraceptive methods and improving access to and knowledge of inexpensive, personalized family planning services appear to be critical factors in fostering better contraceptive practice among low-income women in the US.

  3. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence.

    PubMed

    Fredericksen, R J; Gibbons, L; Brown, S; Edwards, T C; Yang, F M; Fitzsimmons, E; Alperovitz-Bichell, K; Godfrey, M; Wang, A; Church, A; Gutierrez, C; Paez, E; Dant, L; Loo, S; Walcott, M; Mugavero, M J; Mayer, K; Mathews, W C; Patrick, D L; Crane, P K; Crane, H M

    2017-06-20

    Low health literacy is associated with poor medication adherence and poor health outcomes. Limited understanding of prescribed medications may decrease validity of patient-reported adherence measures. To assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. Individual interviews were conducted with a convenience sample of patients from six U.S. primary care clinics. Participants (n = 57) were English and/or Spanish-speaking patients prescribed 3+ medications for chronic conditions, for which non-adherence may lead to disability or death. In individual interviews, patients were asked to name their medications, explain the purpose of each, and to explain how they distinguish them from one another. Interviews were audio recorded, transcribed, and coded; coded content was quantified by 1) whether or not the patient could name medications; 2) method of categorizing medications; 3) whether or not the purpose of the medication was understood. Descriptive statistics were compiled using Fisher's exact test to determine the relationship between patient knowledge and medication characteristics. Thirty percent of patients could not name at least one of their medications; 19% did not know their purpose; 30% held misconceptions about the purpose of one or more medications. There was no significant difference in ability to name medications or state their medication's purpose between patients using medi-sets, pre-packaged rolls, or blister packs, and patients who stored pills in their original containers (p = 0.56 and p = 0.73, respectively), or across demographic groups (p = 0.085 to 0.767). Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence

  4. Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency

    PubMed Central

    Gilmer, Todd P.; Ojeda, Victoria D.; Barrio, Concepcion; Fuentes, Dahlia; Garcia, Piedad; Lanouette, Nicole M.; Lee, Kelly C.

    2011-01-01

    OBJECTIVES We examined the relationship between preferred English, Spanish, or an Asian language for mental health services and adherence to treatment with antipsychotic medication and Medi-Cal beneficiaries with schizophrenia in San Diego, California. METHODS Data included 31,560 person-years from 1999–2004. Pharmacy records were analyzed to assess adherence to antipsychotic medication, based on the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<0.5), partially adherent (0.5<=MPR<0.8), adherent (0.8<=MPR<=1.1), or as an excess filler (MPR>1.1). Regression models were used to examine adherence, hospitalization, and costs by race/ethnicity and language status. RESULTS Limited English proficient Latinos were more likely to be adherent to antipsychotic medications than English proficient Latinos (40.8% vs. 35.9%, P<0.001). Limited English proficient Latinos were less likely to be excess fillers than English proficient Latinos (15.1% vs. 20.4%, P<0.001). Limited English proficient Asians were less likely to be adherent than English proficient Asians (40.1% vs. 45.1%, P=0.034). Compared to English proficient Asians, limited English proficient Asians were more likely to be nonadherent (28.7% vs. 22.0%, P<0.001) and less likely to be excess fillers (12.5% vs. 17.4%, P=0.004). Controlling for adherence and comorbidities, limited English proficient clients had lower rates of hospitalization and health care costs than English proficient and white clients. CONCLUSIONS Adherence to antipsychotic medications varies among and within ethnic groups by English proficiency. Policies supporting the training of bilingual and multicultural ethnic minority providers, and interventions that capitalize on existing social support networks, may improve adherence to treatment among linguistically diverse populations. PMID:19176410

  5. Radionavigated detection of sentinel nodes in breast carcinoma--first experiences of our department.

    PubMed

    Duchaj, B; Chvalny, P; Vesely, J; Makaiova, I; Durdik, S; Straka, V; Palaj, J; Procka, V; Aksamitova, K; Skraskova, S; Banki, P; Kovacova, S; Galbavy, S

    2010-01-01

    Biopsy and histological evaluation of sentinel lymphatic node limits the axillary node dissection only in cases of positive histological finding and decreases the occurrence of postoperative complications related to the axillary node dissection. We used radiotracer SentiScint, Medi-Radiopharma Ltd, Hungary and preoperatively administered blue dye--Blue Patenté V, Guebert, Aulnay-Sous-Bios, France. 11 (18%) patients were subdued to deep peritimorous application of radiotracer, 10 (16.4%) to sub/intradermal application over the lesions and n 40 (65.6%) patients the application was sub/intradermal and periareolar. The patients underwent an operation protocol of corresponding quadrantectomy, radionavigated blue-dye sentinel node biopsy and axillary dissection. From May 2006 to June 2008, we examined 61 patients with breast carcinoma. They underwent radionavigated and blue-dye sentinel node biopsy. We detected 57 (93.4%) sentinel nodes with preoperative scintigraphy, of which only 51 (83.6%) were detected peroperatively and underwent histological evaluation. In six (9.8%) cases, the "frozen cut" histology of the primary lesion had shown a benign lesion; hence no sentinel node biopsy or axillary disection was performed. 12 (19.7%) of 51 histologically evaluated sentinel nodes had metastatic invasion. We retrospectively compared the histological fund in sentinel and axillary nodes in patients with metastatic sentinel nodes. In 6 (16.6%) cases, the sentinel node was positive of metastatic invasion but axillary nodes were histologically negative, in 6 (16.6%) cases the sentinel node and axillary nodes were positive for metastatic invasion. We observed falsely negative findings in 3 (8.3%) patients with negative histological fund in the sentinel node, but positive axillary nodes (Tab. 3, Fig. 2, Ref. 11). Full Text (Free, PDF) www.bmj.sk.

  6. Epidemiologic analysis of an urban, public emergency department's frequent users.

    PubMed

    Mandelberg, J H; Kuhn, R E; Kohn, M A

    2000-06-01

    To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users.

  7. [Nursing students' satisfaction and perception of their first clinical placement: observational study].

    PubMed

    Comparcini, Dania; Simonetti, Valentina; Tomietto, Marco; Galli, Francesco; Fiorani, Catia; Di Labio, Luisa; Cicolini, Giancarlo

    2014-01-01

    Background. Gli ambienti di apprendimento clinico sono definiti come una rete di fattori interagenti nel contesto, in grado di influenzare gli esiti dell’apprendimento degli studenti. La soddisfazione degli studenti è considerata un indicatore del raggiungimento degli esiti dell’apprendimento ed è determinante a partire dalla prima esperienza di tirocinio. Scopo. Analizzare l’esperienza di apprendimento clinico degli studenti infermieri del primo anno di corso dopo il primo tirocinio clinico ed identificare i principali determinanti della soddisfazione degli studenti. Metodo. Lo studio osservazionale è stato realizzato in cinque sedi universitarie italiane del Corso di Laurea in Infermieristica. 420 studenti hanno compilato la versione italiana della “Clinical Learning Environment, Supervision and plus Nurse Teacher (CLES+T) scale” al termine del primo tirocinio clinico. Risultati. I punteggi medi assegnati alle dimensioni della scala variano da 4.02 (clima di apprendimento) a 3.30 (relazione di tutorato). La maggior parte degli studenti è soddisfatto della propria esperienza di tirocinio (75.6%), ma sono emerse differenze in relazione alle diverse sedi di tirocinio clinico. Discussione. I principali determinanti della soddisfazione sono lo stile di leadership del coordinatore infermieristico e l’integrazione teoria-pratica nella relazione fra tutor clinico, universitario e studente. Conclusioni. I risultati dello studio contribuiscono alla comprensione della prima esperienza di tirocinio degli studenti. Tuttavia, sono necessarie ulteriori ricerche per determinare le variabili organizzative specifiche e i modelli tutoriali in grado di aumentare la soddisfazione degli studenti, per sviluppare strategie formative basate sull’integrazione tra tutor universitari e guide di tirocinio.

  8. Wound 'dechronification' with negatively-charged polystyrene microspheres: a double-blind RCT.

    PubMed

    Shoham, Y; Kogan, L; Weiss, J; Tamir, E; Krieger, Y; Barnea, Y; Regev, E; Vigoda, D; Haikin, N; Inbal, A; Arnon, O; Bogdanov-Berezovsky, A; Silberstein, E

    2013-03-01

    To compare the efficacy and safety of negatively-charged polystyrene microspheres (NCM)with controls (saline soaks) in the treatment of hard-to-heal wounds of various aetiologies. Patients with one or more hard-to-heal wounds, defined as refractory to healing for at least 4 weeks, or those with exposed bone, tendon or ligament, were eligible for inclusion and were randomised to either NCM (PolyHeal; MediWound Ltd.) or controls, both applied twice daily for 4 weeks. Patients were monitored bi-weekly for an additional 8 weeks, while treated by standard wound care, at the investigators' discretion, and were re-evaluated 2 years after inclusion. The primary endpoint was defined as coverage of> 75% of the wound area by light-red granulation tissue after 4 weeks of treatment. Fifty-eight patients completed the study, 32 in the NCM group and 26 in the control group. The two most common wound types were those with primary etiologies of venous insufficiency and postoperative/post trauma. In the NCM group 47% of patients achieved > 75% light red granulation tissue after 4 weeks compared with 15% of patients in the control group (p=O.O I). The mean wound surface area in the NCM group was reduced by 39.0% after 4 weeks compared with 14.9% in the control group (p=0.02).The achievement of> 75% light red granulation tissue and reduction of mean wound surface area was also observed in the two main sub-groups (venous insufficiency and postoperative/post trauma), although it was not statistically significant, possibly due to the small sample size in each sub-group. This study demonstrates that compared to control treatment, NCM treatment of hard to-heal and chronic wounds improves formation of healthy granulation tissue and reduces wound size thus in fact 'kick-starting' the healing process and 'dechronifying' chronic wounds.

  9. Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract

    PubMed Central

    H., Hildebrandt; C., Hermann; R., Knittel; M., Richter-Reichhelm; A., Siegel; W., Witzenrath

    2010-01-01

    Introduction Integrated care solutions need supportive financial incentives. In this paper, we describe the financial architecture and operative details of the integrated pilot Gesundes Kinzigtal. Description of integrated care case Located in Southwest Germany, Gesundes Kinzigtal is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The system serving around half of the population of the region is run by a regional health management company (Gesundes Kinzigtal GmbH) in cooperation with the physicians' network in the region (MQNK), a German health care management company with a background in medical sociology and health economics (OptiMedis AG) and with two statutory health insurers (among them is the biggest health insurer in Southwest Germany: AOK Baden-Württemberg). Discussion and (preliminary) conclusion The shared savings contract between Gesundes Kinzigtal GmbH and the two health insurers, providing financial incentives for managers and health care providers to realize a substantial efficiency gain, could be an appropriate contractual base of Gesundes Kinzigtal's population health gain approach. This approach is based on the assumption that a more effective trans-sector organization of Germany's health care system and increased investments in well-designed preventive programmes will lead to a reduction in morbidity, and in particular to a reduced incidence and prevalence of chronic diseases. This, in turn, is to lead to a comparative reduction in health care cost. Although the comparative cost in the Kinzigtal region has been reduced from the onset of Gesundes Kinzigtal Integrated Care, only future research will have to demonstrate whether—and to what extent—cost reduction may be attributed to a real population health gain. PMID:20689772

  10. [FAMILY EATING HABITS AND PERCEPTION OF RISK IN EATING DISORDERS].

    PubMed

    Rodríguez Lazo, María; Hernández Camacho, Juan Diego; Bolaños Ríos, Patricia; Ruiz-Prieto, Inmaculada; Jáuregui Lobera, Ignacio

    2015-10-01

    Introducción: los aspectos relacionados con la comida, la figura, el peso y el ejercicio físico, transmitidos de padres a hijos, y los factores socioculturales de índole mediática, como las redes sociales, pueden influir en el desarrollo de Trastornos de la Conducta Alimentaria (TCA). Objetivos: analizar la influencia de la alimentación familiar y la percepción de esta sobre la influencia de las redes sociales en el inicio y mantenimiento del TCA. Método: 30 padres de pacientes con TCA participaron voluntariamente en este estudio cumplimentando una serie de cuestionarios, y recogiéndose su peso y talla. Resultados: se observa una subestimación del peso en casos de sobrepeso (33,33%) y obesidad (25%), ya que ni siquiera se plantean realizar una dieta futura (91,67% y 25%, respectivamente) (2 = 11,31; p < 0,01). Destaca un exceso en el consumo de carnes, snacks y dulces. Durante el fin de semana hay un incremento en el consumo de kcal y azúcar (p < 0,01) y colesterol (p < 0,05), disminuyendo la ingesta de fibra, Fe, Zn y Mg (p < 0,01). Asimismo, se consume menos agua y pan, aumentando el picoteo (p < 0,01) y la frecuencia de aparición de un único plato (p < 0,05). Discusión y conclusiones: los hábitos alimentarios de estos familiares mejoran gracias a la educación nutricional incluida en el tratamiento. Los familiares no perciben adecuadamente el riesgo de las redes sociales en sus hijos, pudiendo contribuir al mantenimiento y a futuras recaídas del TCA.

  11. Performance of QuantiFERON TB Gold test in detecting latent tuberculosis infection in brain-dead organ donors in Iran: a brief report.

    PubMed

    Tabarsi, Payam; Yousefzadeh, Amir; Najafizadeh, Katayoun; Droudinia, Atousa; Bayati, Rouzbeh; Marjani, Majid; Shafaghi, Shadi; Farokhzad, Banafsheh; Javanmard, Pedram; Velayati, Ali Akbar

    2014-11-01

    With regard to the significant morbidity and mortality due to tuberculosis in lung transplant recipients, the identification of brain-dead organ donors with latent tuberculosis by use of the QuantiFERON TB Gold (QFT-G) test may be of help to reduce the risk of TB reactivation and mortality in lung recipients. This study was conducted in the National Research Institute of Tuber-culosis and Lung Diseases (NRITLD) in Iran, from January to March 2013. A total of 38 conse-cutive brain-dead donors, not currently infected with active tuberculosis, were recruited. The medi-cal records of all the study enrollees were reviewed. A whole-blood IFN- release assay (IGRA) in reaction to early secreted antigenic target 6 (ESAT-6), culture filtrate protein 10 (CFP-10), and TB7.7 antigens, was performed and the released Interferon- was measured via enzyme-linked immunosorbent assay (ELISA). The data was analyzed with QFT-G software which was provided by the company. The demographic, characteristics and other variables were entered into SPSS version 11.5. The QFT-G test results of three donors (7.9%) turned out to be positive, negative for 24 donors (63.1%), and indeterminate for 11 cases (28.9%). Our study revealed the potential advantages of QFT-G in lowering the incidence of donor-derived post-transplant tuberculosis among lung recipients. However, a high rate of indeterminate results restricted the performance of QFT-G in this study.

  12. Perceived treatment assignment and smoking cessation in a clinical trial of bupropion versus placebo.

    PubMed

    Buchanan, Taneisha S; Sanderson Cox, Lisa; Thomas, Janet L; Nollen, Nicole L; Berg, Carla J; Mayo, Matthew S; Ahluwalia, Jasjit S

    2013-02-01

    Psychoactive effects of smoking cessation medi cations such as bupropion may allow participants in smoking cessation clinical trials to correctly guess their treatment assignment at rates greater than chance. Previous research has found an association between perceived treatment assignment and smoking cessation rates among moderate to heavy smokers (≥ 10 cigarettes per day [cpd]) in two bupropion clinical trials. The aim of this study was to determine the impact of perceived treatment assignment on end-of-treatment cotinine-verified smoking abstinence at Week 7 and Week 26 among African American light smokers (≤ 10 cpd) enrolled in a double-blind, placebo-controlled study of bupropion. Participants (n = 390) included in this study reported their perceived treatment assignment on the end-of-treatment (Week 7) survey. Participants were predominantly female (63.1%), 48.1 years of age (SD = 11.2), and smoked an average of 8 cpd (SD = 2.5). Participants given bupropion were more likely to correctly guess their treatment assignment (69%; 140/203) than those assigned to placebo (51.3%; 96/187) (p < .0001). After adjusting for treatment condition, participants who perceived assignment to bupropion versus placebo were not more likely to be abstinent than those who perceived assignment to placebo at Week 7 or at Week 26. The interaction between treatment and perceived treatment assignment was also nonsignificant. Consistent with two previous studies testing bupropion, participants assigned to bupropion were more likely to correctly guess their treatment assignment than those assigned to placebo. However, in contrast to previous studies with heavier smokers, perceived treatment assignment did not significantly impact cotinine-verified abstinence in light smokers.

  13. The risks of venous thromboembolic disease among German women using oral contraceptives: a database study.

    PubMed

    Farmer, R D; Todd, J C; Lewis, M A; MacRae, K D; Williams, T J

    1998-02-01

    This study investigated the risk of venous thromboembolic disease (VTE) between second and third generation combined oral contraceptives, using the German MediPlus database of patient records. Women studied included 42 patients between the ages of 18 and 49 years, with a diagnosis of VTE treated with an anticoagulant, who were exposed to an oral contraceptive (OC). Four controls per patient (168), matched by year of birth and exposure to an OC on the even day, were identified. More women were users of second generation than third generation OC, and none were using progestogen-only pills. There was no significant difference between patients and control subjects with respect to the type of OC used on the event day (unadjusted odds ratio for third versus second generation users was 0.77; 95% confidence interval [CI] 0.38-1.57). There was no significant age difference between second and third generation users among patients or control subjects. Between January 1 and the event date, there was no significant difference between the patients and control subjects in terms of the number of oral contraceptive prescriptions, number of consultations for psychotherapeutic complaints, or mixed physical and psychotherapeutic consultations; however, patients did demonstrate significantly more consultations for purely physical complaints compared with control subjects (p < 0.0001). There were no significant consultation differences between patients with pulmonary emboli (n = 6) and other VTE patients (n = 36). No significant differences with respect to VTE risk between users of second and third generation oral contraceptives were found in this study. Consultations (physical) for patients were higher than for control subjects before the VTE event. If consultation rate relates to the general health status of a person, this might indicate that VTE risk is higher among women of poorer health, but that this is not related to the type of progestogen in the oral contraceptive that they use.

  14. Rehabilitation of hand function after spinal cord injury using a novel handgrip device: a pilot study.

    PubMed

    Hoffman, Haydn; Sierro, Tiffany; Niu, Tianyi; Sarino, Melanie E; Sarrafzadeh, Majid; McArthur, David; Edgerton, V Reggie; Lu, Daniel C

    2017-03-21

    Activity-based therapy (ABT) for patients with spinal cord injury (SCI), which consists of repetitive use of muscles above and below the spinal lesion, improves locomotion and arm strength. Less data has been published regarding its effects on hand function. We sought to evaluate the effects of a weekly hand-focused therapy program using a novel handgrip device on grip strength and hand function in a SCI cohort. Patients with SCI were enrolled in a weekly program that involved activities with the MediSens (Los Angeles, CA) handgrip. These included maximum voluntary contraction (MVC) and a tracking task that required each subject to adjust his/her grip strength according to a pattern displayed on a computer screen. For the latter, performance was measured as mean absolute accuracy (MAA). The Spinal Cord Independence Measure (SCIM) was used to measure each subject's independence prior to and after therapy. Seventeen patients completed the program with average participation duration of 21.3 weeks. The cohort included patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (n = 12), AIS B (n = 1), AIS C (n = 2), and AIS D (n = 2) injuries. The average MVC for the cohort increased from 4.1 N to 21.2 N over 20 weeks, but did not reach statistical significance. The average MAA for the cohort increased from 9.01 to 21.7% at the end of the study (p = .02). The cohort's average SCIM at the end of the study was unchanged compared to baseline. A weekly handgrip-based ABT program is feasible and efficacious at increasing hand task performance in subjects with SCI.

  15. Sensor-based electromagnetic navigation to facilitate implantation of left ventricular leads in cardiac resynchronization therapy.

    PubMed

    Döring, Michael; Sommer, Philipp; Rolf, Sascha; Lucas, Johannes; Breithardt, Ole A; Hindricks, Gerhard; Richter, Sergio

    2015-02-01

    Implantation of cardiac resynchronization therapy (CRT) devices can be challenging, time consuming, and fluoroscopy intense. To facilitate placement of left ventricular (LV) leads, a novel electromagnetic navigation system (MediGuide™, St. Jude Medical, St. Paul, MN, USA) has been developed, displaying real-time 3-D location of sensor-embedded delivery tools superimposed on prerecorded X-ray cine-loops of coronary sinus venograms. We report our experience and advanced progress in the use of this new electromagnetic tracking system to guide LV lead implantation. Between January 2012 and December 2013, 71 consecutive patients (69 ± 9 years, 76% male) were implanted with a CRT device using the new electromagnetic tracking system. Demographics, procedural data, and periprocedural adverse events were gathered. The impact of the operator's experience, optimized workflow, and improved software technology on procedural data were analyzed. LV lead implantation was successfully achieved in all patients without severe adverse events. Total procedure time measured 87 ± 37 minutes and the median total fluoroscopy time (skin-to-skin) was 4.9 (2.5-7.8) minutes with a median dose-area-product of 476 (260-1056) cGy*cm(2) . An additional comparison with conventional CRT device implantations showed a significant reduction in fluoroscopy time from 8.0 (5.8; 11.5) to 4.5 (2.8; 7.3) minutes (P = 0.016) and radiation dose from 603 (330; 969) to 338 (176; 680) cGy*cm(2) , respectively (P = 0.044 ). Use of the new navigation system enables safe and successful LV lead placement with improved orientation and significantly reduced radiation exposure during CRT implantation. © 2014 Wiley Periodicals, Inc.

  16. Mycobactericidal activity of selected disinfectants using a quantitative suspension test.

    PubMed

    Griffiths, P A; Babb, J R; Fraise, A P

    1999-02-01

    In this study, a quantitative suspension test carried out under both clean and dirty conditions was used to assess the activity of various instrument and environmental disinfectants against the type strain NCTC 946 and an endoscope washer disinfector isolate of Mycobacterium chelonae, Mycobacterium fortuitum NCTC 10,394, Mycobacterium tuberculosis H37 Rv NCTC 7416 and a clinical isolate of Mycobacterium avium-intracellulare (MAI). The disinfectants tested were; a chlorine releasing agent, sodium dichloroisocyanurate (NaDCC) at 1000 ppm and 10,000 ppm av Cl; chlorine dioxide at 1100 ppm av ClO2 (Tristel, MediChem International Limited); 70% industrial methylated spirits (IMS); 2% alkaline glutaraldehyde (Asep, Galan); 10% succinedialdehyde and formaldehyde mixture (Gigasept, Schulke & Mayr); 0.35% peracetic acid (NuCidex, Johnson & Johnson); and a peroxygen compound at 1% and 3% (Virkon, Antec International). Results showed that the clinical isolate of MAI was much more resistant than M. tuberculosis to all the disinfectants, while the type strains of M. chelonae and M. fortuitum were far more sensitive. The washer disinfector isolate of M. chelonae was extremely resistant to 2% alkaline activated glutaraldehyde and appeared to be slightly more resistant than the type strain to Nu-Cidex, Gigasept, Virkon and the lower concentration of NaDCC. This study has shown peracetic acid (Nu-Cidex), chlorine dioxide (Tristel), alcohol (IMS) and high concentrations of a chlorine releasing agent (NaDCC) are rapidly mycobactericidal. Glutaraldehyde, although effective, is a slow mycobactericide. Gigasept and Virkon are poor mycobactericidal agents and are not therefore recommended for instruments or spillage if mycobacteria are likely to be present.

  17. A morphological and micro-tensile bond strength evaluation of a single-bottle adhesive to caries-affected human dentine after four different caries removal techniques.

    PubMed

    Cehreli, Zafer C; Yazici, A Rüya; Akca, Taner; Ozgünaltay, Gül

    2003-08-01

    This study evaluated the influence of different caries removal techniques (conventional bur; chemomechanical removal/Carisolv()-MediTeam; a sonic preparation system/SonicsysMicro-Kavo and air abrasion/PrepStar-Danville Engineering) on microtensile bond strength to caries-affected human dentine. Occlusal surfaces of extracted human permanent third molars with coronal dentine caries extending approximately halfway through the dentine was ground perpendicular to the long axis of the tooth to expose a flat surface of normal dentine surrounding the carious lesion with laser fluorescence values of approximately 30 (DIAGNODent), KaVo). Carious lesions were excavated with one of the four techniques until laser fluorescence values decreased to 15 in the center of the lesions. An ethanol-based dentine adhesive (Single Bond, 3M) was used to bond composite resin (P60, 3M) to the substrate. Vertical slices (n=11/group), approximately 0.8 mm thick were made through the caries-affected portions of each tooth, perpendicular to the bonding surface. Specimens were subjected to tensile stress at a crosshead speed of 1 mm/min. Data were analyzed by Kruskal-Wallis test. SEM investigation was performed for the qualitative evaluation of resin-dentine hybridization. The microtensile bond strengths were as follows (mean+/-SD in MPa): 6.4+/-5.3 (bur), 8.4+/-3.3 (Carisolv), 8.5+/-5.9 (Sonicsys Micro), and 8.8+/-8.8 (air abrasion). Statistical analysis did not show significant differences between any of the treatment modalities (p=0.160). Tensile fracture was cohesive within caries-affected dentine in all specimens. The four different caries removal techniques used within this study did not influence the bond strength of the tested dentine adhesive to caries-affected human dentine.

  18. A model for simulating the active dispersal of juvenile sea turtles with a case study on western Pacific leatherback turtles

    PubMed Central

    Lalire, Maxime

    2017-01-01

    Oceanic currents are known to broadly shape the dispersal of juvenile sea turtles during their pelagic stage. Accordingly, simple passive drift models are widely used to investigate the distribution at sea of various juvenile sea turtle populations. However, evidence is growing that juveniles do not drift purely passively but also display some swimming activity likely directed towards favorable habitats. We therefore present here a novel Sea Turtle Active Movement Model (STAMM) in which juvenile sea turtles actively disperse under the combined effects of oceanic currents and habitat-driven movements. This model applies to all sea turtle species but is calibrated here for leatherback turtles (Dermochelys coriacea). It is first tested in a simulation of the active dispersal of juveniles originating from Jamursba-Medi, a main nesting beach of the western Pacific leatherback population. Dispersal into the North Pacific Ocean is specifically investigated. Simulation results demonstrate that, while oceanic currents broadly shape the dispersal area, modeled habitat-driven movements strongly structure the spatial and temporal distribution of juveniles within this area. In particular, these movements lead juveniles to gather in the North Pacific Transition Zone (NPTZ) and to undertake seasonal north-south migrations. More surprisingly, juveniles in the NPTZ are simulated to swim mostly towards west which considerably slows down their progression towards the American west coast. This increases their residence time, and hence the risk of interactions with fisheries, in the central and eastern part of the North Pacific basin. Simulated habitat-driven movements also strongly reduce the risk of cold-induced mortality. This risk appears to be larger among the juveniles that rapidly circulate into the Kuroshio than among those that first drift into the North Equatorial Counter Current (NECC). This mechanism might induce marked interannual variability in juvenile survival as the

  19. COMPARISON OF TWO MINIMALLY INVASIVE METHODS ON THE LONGEVITY OF GLASS IONOMER CEMENT RESTORATIONS: SHORT-TERM RESULTS OF A PILOT STUDY

    PubMed Central

    Barata, Terezinha Jesus Esteves; Bresciani, Eduardo; Mattos, Maria Cecília Ribeiro; Lauris, José Roberto Pereira; Ericson, Dan; Navarro, Maria Fidela de Lima

    2008-01-01

    The purpose of this study was to evaluate the clinical performance of glass ionomer cement (GIC) restorations comparing two minimally invasive methods in permanent teeth after 12 months. Fifty pregnant women (second trimester of pregnancy), mean age 22 ± 5.30 years, were treated by two previously trained operators. The treatment approaches tested were: chemomechanical method (CarisolvTM; MediTeam) and atraumatic restorative treatment (ART). A split-mouth study design was used in which the two treatments were randomly placed in 50 matched pairs of permanent teeth. The chemomechanical method (CM) was the test group and the ART was the control group. The treatments were performed in Public Health Centers. The tested restorative material was a high-strength GIC (Ketac Molar; 3M/ESPE). The restorations were placed according to the ART guidelines. Two calibrated independent examiners evaluated the restorations in accordance with ART criteria. The interexaminer kappa was 0.97. Data were analyzed using 95% confidence interval on the binomial distribution and Fisher's exact test at 5% significance level. In a 12-month follow-up, 86% of the restorations were evaluated. In the test group (CM), 100% (CI=93.3-100%) of the restorations were considered successful. In the control group (ART) 97.6% (CI=87.4-99.9%) of the restorations were considered successful and 2.4% unsuccessful (marginal defect >0.5 mm). There was no statistically significant difference between the 12-mounth success rate for both groups (Fisher's exact test: P=0.49) and between the two operators (Fisher's exact test: P=1.00). Both minimally invasive methods, chemomechanical method and ART, showed a similar clinical performance after 12 months of follow up. PMID:19089209

  20. Reducing radiation exposure during CRT implant procedures: early experience with a sensor-based navigation system.

    PubMed

    Thibault, Bernard; Andrade, Jason G; Dubuc, Marc; Talajic, Mario; Guerra, Peter G; Dyrda, Katia; Macle, Laurent; Rivard, Léna; Roy, Denis; Mondésert, Blandine; Khairy, Paul

    2015-01-01

    Cardiac resynchronization therapy (CRT) implant procedures are often complex and prolonged, resulting in significant ionizing radiation (IR) exposure to the patient and operator. We report our early experience working with a novel sensor-based electromagnetic tracking system (MediGuide™, MDG, St. Jude Medical Inc., St. Paul, MN, USA), in terms of procedural IR exposure reduction. Information regarding patient demographics, procedural details, procedural duration, and IR exposure were prospectively collected on 130 consecutive CRT procedures performed between January 2013 and January 2014. Sixty procedures were performed with MDG guidance, and 70 were performed without MDG guidance. Despite a nonsignificant trend toward shorter procedure duration with the use of MDG (120 minutes vs 138 minutes with non-MDG, P = 0.088), a 66% reduction in total IR exposure (median 769 μGray · m(2) vs 2,608 μGray · m(2), P < 0.001) was found. This reduction was primarily driven by a >90% reduction in IR dose required to cannulate the coronary sinus (median 80 μGray · m(2) vs 922 μGray · m(2), P < 0.001), and to a lesser extent from a reduction in IR dose required for LV lead placement (median 330 μGray·m(2) vs 737 μGray · m(2), P = 0.059). In addition, a significant learning curve effect was observed with a significantly shorter procedural duration for the last 15 cases compared to the first 15 cases (median 98 minutes vs 175 minutes, P < 0.001). The nonfluoroscopic MDG positioning system is associated with a dramatic reduction in exposure to IR during CRT implant procedures, with a 90% decrease in the IR dose required to cannulate the coronary sinus. A steep learning curve was quantified. ©2014 Wiley Periodicals, Inc.

  1. Should Providers Give Women Advance Provision of Emergency Contraceptive Pills? A Cost-Effectiveness Analysis

    PubMed Central

    Foster, Diana G.; Raine, Tina R.; Brindis, Claire; Rostovtseva, Daria P.; Darney, Philip D.

    2011-01-01

    Purpose We sought to determine the potential effect and cost-effectiveness of different means of accessing emergency contraceptive pills (ECP) on unintended pregnancy rates in sexually active women. Methods We used a computer simulation model to compare the effects of advance provision, on-demand provision, and no use of ECP on unintended pregnancies and costs of care in three hypothetical cohorts of 1 million sexually active women. Data on effectiveness of ECP from the single-use clinical trials, and costs from Medi-Cal, California’s Medicaid program were used for the model. Findings Advance provision of ECP is projected to avert a greater or the same percentage of unintended pregnancies compared with on-demand provision, with the greatest percentage of pregnancies averted (66%) in low-risk women with advance provision. In the simulation model, the percentage of pregnancies averted decreases as the frequency of unprotected intercourse increases and ECP use decreases. In all scenarios, the cost-savings ratio—the number of dollars saved on averted pregnancy expenditures for each dollar spent on advance ECP—is greater than one. Conclusion Advance provision of ECP has the potential to avert unintended pregnancies and reduce medical expenditures. The most likely reason that the advance provision trials fail to demonstrate reductions in pregnancy rates is a result of a combination of small study sizes, the use of ECP in both treatment and control groups, and a failure to take into account a realistic range of rates of unprotected intercourse and imperfect ECP use. PMID:20620913

  2. Effects of short-term chemical disinfection of gutta-percha cones: identification of affected microbes and alterations in surface texture and physical properties.

    PubMed

    Pang, Nan-Shim; Jung, Il-Young; Bae, Kwang-Shik; Baek, Seung-Ho; Lee, Woo-Cheol; Kum, Kee-Yeon

    2007-05-01

    The aims of this study were to identify microorganisms on the surface of gutta-percha (GP) cones using a polymerase chain reaction (PCR) and to evaluate the sterilization effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), and ChloraPrep on these bacteria. Alterations of the surface texture and physical properties of GP cone after chemical sterilization were compared. A total of 150 GP cones were randomly selected in endodontic clinics, and a PCR assay was performed to identify the contaminating microorganisms. After inoculation with the same microorganisms followed by drying for 1 day, the GP cones were immersed in the three chemical disinfectants. The sterilization effects were assessed by measuring the turbidity and through subculturing. The changes in surface texture were observed by scanning electron microscopy, and Instron 5500 (Instron Corp, Canton, MA) was used to measure the tensile strength and elongation rate of the GP cones after chemical sterilization. Statistical analysis was performed. Results indicate that 19.4% of GP cones from the clinic were contaminated, and all the species belonged to the genus Staphylococcus. Three chemical disinfectants were all effective in the rapid disinfection of GP cones against Staphylococcus spp, and 1-minute immersion of the GP cones was adequate for disinfection. Microphotographs of the NaOCl-soaked cone showed a cluster of cuboidal crystals. The tensile strength between the NaOCl- and CHX-soaked groups was significantly different (p<0.05), but there was no significant difference between the NaOCl- and ChloraPrep-soaked groups (p>0.05). All disinfectants significantly increased the elongation rate of the GP cones compared with fresh GP cones (p<0.05), especially in the ChloraPrep (Medi-flex, Leawood, KS). These results show that the three chemical disinfectants are effective agents for the rapid sterilization of GP cones. However, further research will be needed to determine the clinical relevance of

  3. [Drug-drug interactions: interactions between xenobiotics].

    PubMed

    Haen, E

    2014-04-01

    Drug-drug interactions (DDI) are a major topic in programs for continuous medical education (CME). Many physicians are afraid of being trapped into charges of malpractice; however, DDI cannot be avoided in many cases. They belong to routine medical practice and it is often impossible to avoid them. Moreover, they do not just occur between drugs but between any kind of foreign substance (xenobiotica), such as food (e.g. grapefruit juice, broccoli, barbecue) as well as legal (e.g. tobacco smoke, caffeine and alcohol) and illegal drugs. Therefore, the medical challenge is not just to avoid any interaction. Instead the physician faces the question of how to proceed with drug treatment in the presence of such interactions. Based on the medical education a physician has to judge first of all whether there is a risk for interactions in the prescription being planned for an individual patient. The classification of interactions proposed in this article (PD1-PD4, PK1-PK3) might help as a sort of check list. For more detailed information the physician can then consult one of the many databases available on the internet, such as PSIAConline (http://www.psiac.de) and MediQ (http://www.mediq.ch). Pharmacokinetic interactions can be easily assessed, monitored and controlled by therapeutic drug monitoring (TDM). Besides these tools it is important to keep in mind that nobody knows everything; even physicians do not know everything. So take pride in asking someone who might help and for this purpose AGATE offers a drug information service AID (http://www.amuep-agate.de). Just good for nothing, without being based on any kind of medical approach are computer programs that judge prescriptions without taking into account a patient's individual peculiarities. In case these types of programs produce red exclamation marks or traffic lights to underline their judgment, they might even work in a contrapuntal way by just eliciting insecurity and fear.

  4. Pollution, Poverty, and Potentially Preventable Childhood Morbidity in Central California.

    PubMed

    Lessard, Lauren N; Alcala, Emanuel; Capitman, John A

    2016-01-01

    To measure ecological relationships between neighborhood pollution burden, poverty, race/ethnicity, and pediatric preventable disease hospitalization rates. Preventable disease hospitalization rates were obtained from the 2012 California Office of Statewide Health Planning and Development database, for 8 Central Valley counties. US Census Data was used to incorporate zip code level factors including racial diversity and poverty rates. The pollution burden score was calculated by the California Office of Environmental Health Hazard Assessment using 11 indicators. Poisson-based negative binomial regression was used for final analysis. Stratification of sample by age, race/ethnicity, and insurance coverage was also incorporated. Children experiencing potentially preventable hospitalizations are disproportionately low income and under the age of 4 years. With every unit increase in pollution burden, preventable disease hospitalizations rates increase between 21% and 32%, depending on racial and age subgroups. Although living in a poor neighborhood was not associated with potentially avoidable hospitalizations, children enrolled in Medi-Cal who live in neighborhoods with lower pollution burden and lower levels of poverty, face 32% lower risk for ambulatory care sensitive condition hospitalization. Children living in primary care shortage areas are at increased risk of preventable hospitalizations. Preventable disease hospitalizations increase for all subgroups, except white/non-Hispanic children, as neighborhoods became more racially diverse. Understanding the geographic distribution of disease and impact of individual and community level factors is essential to expanding access to care and preventive resources to improve the health of children in California's most polluted and underserved region. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. In vitro comparison of the efficacy of Carisolv and conventional rotary instrument in caries removal.

    PubMed

    Yazici, A R; Atílla, P; Ozgünaltay, G; Müftüoglu, S

    2003-12-01

    The purpose of this in vitro study was to compare the efficacy of a new chemomechanical caries removal agent, Carisolv (MediTeam AB, Sävedalen, Sweden), with conventional slow-speed rotary instrument (bur). Fourteen extracted human molar teeth with deep dentine caries and no enamel coverage were selected for the study. Their laser fluorescence values were over 30 (DIAGNOdent; KaVo, Biberach, Germany). After the teeth were sectioned through the centre of the carious lesion, one half was removed with conventional drilling (bur); the other half was removed with Carisolv gel. Removal of carious dentine was continued until the lesion was deemed caries-free by visual and tactile criteria. The preparation time for each caries removal technique was also noted. The two halves of each tooth were fixed in 10% buffered-formaldehyde for 1 week. They were then decalcified, dehydrated and embedded in paraffin blocks for histological studies. After taking serial sections of 5 microm thickness, sections were mounted on glass slides, deparaffinized, dehydrated and stained with toluidine blue for observation under a light microscope. Each section was examined for the presence of bacteria. Complete removal of caries was achieved in 13 (93%) of 14 conventionally prepared teeth, and 5 (36%) of 14 chemomechanically prepared teeth (P < 0.05). Mean (+/-SD) time for caries removal was 272 s (+/-53.3) with Carisolv, and 116 s (+/-49.4) with drilling. The results of this study suggest that conventional rotary instrument (bur) was more effective than Carisolv in removal of carious tissue and also takes shorter time.

  6. Transcrestal sinus lift and implant placement using the sinus balloon technique.

    PubMed

    Peñarrocha-Diago, María; Galán-Gil, Sónnica; Carrillo-García, Celia; Peñarrocha-Diago, David; Peñarrocha-Diago, Miguel

    2012-01-01

    A description is made of transcrestal sinus lift using the sinus balloon technique, evaluating the bone height achieved and implant success one year after prosthetic loading. Between January and July 2007, transcrestal sinus lift using the sinus balloon technique for dental implant placement was carried out in 6 patients. A panoramic X-ray study and maxillary computed tomography scan were carried out before the operation, in order to discard possible sinus pathology. During the intervention, the integrity of the sinus membrane was evaluated using a Medi Pack Pal endoscope (Farol Store and Co., Tuttlingen, Germany), and the intraoperative complications were analyzed. The dental implants were placed in the same surgical step in the presence of 3 mm or more of residual bone. Following the operation, panoramic X-rays were used to assess the bone height gained. One year after prosthetic loading, the implant success rate was determined based on the criteria of Buser. One patient was excluded due to Schneider's membrane perforation as confirmed by endoscopy. Transcrestal sinus lift was carried out in 5 males with a mean age of 41.6 years (range 27-51), without antecedents of sinus disease. There were no intraoperative complications. In four patients the implants were placed simultaneous to sinus lift, while in another case implant placement was postponed due to insufficient remaining bone height. The mean gain in height after the operation was 8.7 mm. One year after prosthetic loading, the implant success rate was 100%. Transcrestal sinus lift using the sinus balloon technique is a minimally invasive procedure. In 5 patients the bone height gained proved sufficient to allow implant placement even in the presence of 3 mm of residual bone.

  7. Gateways to clinical trials.

    PubMed

    Moral, M A; Tomillero, A

    2008-03-01

    Gateways to Clinical Trials are a guide to the most recent clinical trials in current literature and congresses. The data in the following tables has been retrieved from the Clinical Trials Knowledge Area of Prous Science Integrity, the drug discovery and development portal, http://integrity.prous.com. This issue focuses on the following selection of drugs: 131-I-Chlorotoxin, 423557; Abatacept, Ad.Egr.TNF.11D, Adalimumab, AE-941, Ambrisentan, AMR-001, Anacetrapib, Anakinra, Aripiprazole, Atazanavir sulfate; BAY-639044, Bazedoxifene acetate, Belimumab, Bevacizumab, Bortezomib, Botulinum toxin type B, Brivaracetam, Bucindolol hydrochloride; Carfilzomib, Carisbamate, CCX-282, CD20Bi, Ceftobiprole, Certolizumab pegol, CF-101, Cinacalcet hydrochloride, Cypher; Darifenacin hydrobromide, Degarelix acetate, Denosumab, Desvenlafaxine succinate, Dexlansoprazole, Dexverapamil, Drotrecogin alfa (activated), Duloxetine hydrochloride, Dutasteride; Efalizumab, EPs-7630, Escitalopram oxalate, Etoricoxib; Fluticasone furoate, Fondaparinux sodium, Fospropofol disodium; Hexadecyloxypropyl-cidofovir, HIV gp120/NefTat/AS02A, HPV-6/11/16/18; INCB-18424, Incyclinide, Inhalable human insulin, Insulin detemir; KNS-760704, KW-0761; Lacosamide, Lenalidomide, Levetiracetam, Licofelone, Lidocaine/prilocaine; mAb 216, MEDI-528, Men ACWY, Meningococcal C-CRM197 vaccine, Methylnaltrexone bromide; Nemifitide ditriflutate, Nicotine conjugate vaccine, Nilotinib hydrochloride monohydrate; Octaparin; Parathyroid hormone (human recombinant), Pegaptanib octasodium, Pitrakinra, Prasterone, Pregabalin; Ranelic acid distrontium salt, Rasagiline mesilate, Retigabine, Rimonabant, RTS,S/AS02D; Sarcosine, Sitaxentan sodium, Solifenacin succinate, Sunitinib malate; Taranabant, Taxus, Teduglutide, Teriparatide, Ticagrelor, Travoprost, TRU-015; USlipristal acetate, Urocortin 2; Vardenafil hydrochloride hydrate; YM-155, Yttrium 90 (90Y) ibritumomab tiuxetan; Zanolimumab, Zoledronic acid monohydrate, Zotarolimus

  8. Accuracy and efficiency of full-arch digitalization and 3D printing: A comparison between desktop model scanners, an intraoral scanner, a CBCT model scan, and stereolithographic 3D printing.

    PubMed

    Wesemann, Christian; Muallah, Jonas; Mah, James; Bumann, Axel

    2017-01-01

    The primary objective of this study was to compare the accuracy and time efficiency of an indirect and direct digitalization workflow with that of a three-dimensional (3D) printer in order to identify the most suitable method for orthodontic use. A master model was measured with a coordinate measuring instrument. The distances measured were the intercanine width, the intermolar width, and the dental arch length. Sixty-four scans were taken with each of the desktop scanners R900 and R700 (3Shape), the intraoral scanner TRIOS Color Pod (3Shape), and the Promax 3D Mid cone beam computed tomography (CBCT) unit (Planmeca). All scans were measured with measuring software. One scan was selected and printed 37 times on the D35 stereolithographic 3D printer (Innovation MediTech). The printed models were measured again using the coordinate measuring instrument. The most accurate results were obtained by the R900. The R700 and the TRIOS intraoral scanner showed comparable results. CBCT-3D-rendering with the Promax 3D Mid CBCT unit revealed significantly higher accuracy with regard to dental casts than dental impressions. 3D printing offered a significantly higher level of deviation than digitalization with desktop scanners or an intraoral scanner. The chairside time required for digital impressions was 27% longer than for conventional impressions. Conventional impressions, model casting, and optional digitization with desktop scanners remains the recommended workflow process. For orthodontic demands, intraoral scanners are a useful alternative for full-arch scans. For prosthodontic use, the scanning scope should be less than one quadrant and three additional teeth.

  9. The RESET Mindset Model applied on decreasing antibiotic usage in dairy cattle in the Netherlands.

    PubMed

    Lam, T J G M; Jansen, J; Wessels, R J

    2017-01-01

    Prudent use of antibiotics is important to prevent antibiotic resistance in humans and in animals. For this reason politicians demanded a decrease of total antibiotic use and of use of critically important antibiotics in animal husbandry in the Netherlands. In the dairy sector the use of antibiotics almost halved in the years 2009-2015, with a decrease of the use of critically important antibiotics to very low levels. To realize a sustainable decrease in antibiotic usage, the mindset towards the subject was considered crucial. Based on several models from social psychology, the RESET Mindset Model was used. This model contains the most important cues to change human behaviour, being Rules and regulations, Education and information, Social pressure, Economics, and Tools. To change behaviour of groups in order to reach a tipping point, it is of utmost importance to not choose among the different cues, but to use them all. In order to decrease antibiotic usage in dairy cattle in the Netherlands several actions, obliged as well as voluntary, were undertaken. An independent veterinary medicine authority was founded that became active for all animal sectors. In the dairy sector a national database on antibiotic usage called MediRund was developed, which made transparency and benchmarking on antibiotic usage at the national and the herd level possible. Several other activities are described, such as herd health and treatment plans, selective dry cow therapy, and the strong limitation on the use of critically important antibiotics. Antibiotic usage at the herd level, referred to as the 'antibiotic number', became an important and socially accepted herd level parameter. The actions undertaken worked through different cues, all part of the RESET Mindset Model. As such, different types of dairy farmers sensitive to different types of cues were motivated to change their behaviour. Antibiotic usage in dairy cattle in the Netherlands decreased significantly by intense

  10. Mediguide-Assisted Transseptal Puncture without Echocardiographic Guidance.

    PubMed

    Ballesteros, Gabriel; Ramos Ardanaz, Pablo; Neglia, Renzo; Palacio Solís, Marcel; Díaz Fernández, Cristina; López González, Graciela; Janiashvili, Elene; García-Bolao, Ignacio

    2017-05-01

    First description of a technique for left atrium transseptal puncture (TSP) with minimal radiation exposure by using the nonfluoroscopic MediGuide™ tracking system (MG; St. Jude Medical, St. Paul, MN, USA) without the assistance of intracardiac echocardiography. This study included 31 consecutive patients with atrial fibrillation undergoing an MG-assisted percutaneous catheter ablation procedure. A Brockenbrough transseptal needle (BRK) is connected to a standard pressure transducer through a two-input valve. Then, an MG-enabled guidewire is inserted so that its tip exactly matches the BRK's distal tip. After the acquisition of two short radioscopic cine-loops we are able to trace the needle tip on the MG screen, performing the usual TSP maneuver but without fluoroscopy. Successful left atrium access is confirmed by noticing the change in the pressure curve and by advancing the guidewire into the left pulmonary veins. As a control group, 31 matched patients who underwent atrial fibrillation ablation with fluoroscopically guided, pressure-monitored TSP were included. Sixty-two MG-assisted TSP attempts were performed; all but two were successfully accomplished without changing to the conventional technique (96.7%). The mean total fluoroscopy time, until the double transseptal access was performed, was 26.65 ± 37.97 seconds in the MG group and 129.13 ± 37.77 seconds in the conventional-TSP group (P < 0.001). No major complications occurred during any of the procedures. This new technique for TSP using MG is feasible and can be performed with minimal radiation exposure without the need for additional imaging techniques, achieving a significant reduction of fluoroscopy time. © 2017 Wiley Periodicals, Inc.

  11. Ablation of atrial fibrillation using novel 4-dimensional catheter tracking within autoregistered left atrial angiograms.

    PubMed

    Rolf, Sascha; Sommer, Philipp; Gaspar, Thomas; John, Silke; Arya, Arash; Hindricks, Gerhard; Piorkowski, Christopher

    2012-08-01

    We describe a novel fluoroscopy coregistered, 4-dimensional catheter tracking technology (MediGuide Technology [MGT]) used for treatment of patients with atrial fibrillation. The aim of the study was to investigate (1) the feasibility of nonfluoroscopic catheter manipulation within dynamic left atrial chamber models; (2) the integration of the technology into an established electroanatomical mapping system; and (3) potential clinical impact. Forty-nine patients received atrial fibrillation ablation using MGT-enabled NavX-EnSite. Matched patients ablated with a conventional NavX-EnSite system served as a control group. MGT was used for the deployment of diagnostic catheters within preacquired cine loops, for nonfluoroscopic chamber mapping within dynamic angiograms, and for 4-dimensional tagging of anatomical landmarks. Integration with the electroanatomical mapping system allowed correction of field distortions and a reference tool to detect and correct map shifts. Catheter ablation was done without MGT because the ablation catheter was not MGT enabled. MGT worked safely and stably in all 49 patients. Catheter deployment within the preacquired cine loops was successfully performed in 45 of 49 (92%) patients. Catheter tracking within dynamic left atrial angiograms allowed nearly nonfluoroscopic creation of NavX-EnSite geometries with subsequent computed tomography model registration in all 49 patients. Overall, MGT significantly reduced total procedural fluoroscopy time (median [quartiles]) from 31 minutes (25, 43 minutes) to 16 minutes (10, 23 minutes) and irradiation dose from 14 453±7403 to 7363±5827 cGy*cm(2) (mean±SD), respectively (P<0.001). MGT is a tracking technology that allows 4-dimensional visualization of dedicated catheters within moving chamber models. Integration of the MGT with an established electroanatomical mapping system provided algorithms to facilitate mapping in the electroanatomical mapping system environment. As a first measurable

  12. Electromagnetic Reciprocity.

    SciTech Connect

    Aldridge, David F.

    2014-11-01

    A reciprocity theorem is an explicit mathematical relationship between two different wavefields that can exist within the same space - time configuration. Reciprocity theorems provi de the theoretical underpinning for mod ern full waveform inversion solutions, and also suggest practical strategies for speed ing up large - scale numerical modeling of geophysical datasets . In the present work, several previously - developed electromagnetic r eciprocity theorems are generalized to accommodate a broader range of medi um, source , and receiver types. Reciprocity relations enabling the interchange of various types of point sources and point receivers within a three - dimensional electromagnetic model are derived. Two numerical modeling algorithms in current use are successfully tested for adherence to reciprocity. Finally, the reciprocity theorem forms the point of departure for a lengthy derivation of electromagnetic Frechet derivatives. These mathe matical objects quantify the sensitivity of geophysical electromagnetic data to variatio ns in medium parameters, and thus constitute indispensable tools for solution of the full waveform inverse problem. ACKNOWLEDGEMENTS Sandia National Labor atories is a multi - program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the US Department of Energy's National Nuclear Security Administration under contract DE - AC04 - 94AL85000. Signif icant portions of the work reported herein were conducted under a Cooperative Research and Development Agreement (CRADA) between Sandia National Laboratories (SNL) and CARBO Ceramics Incorporated. The author acknowledges Mr. Chad Cannan and Mr. Terry Pa lisch of CARBO Ceramics, and Ms. Amy Halloran, manager of SNL's Geophysics and Atmospheric Sciences Department, for their interest in and encouragement of this work. Special thanks are due to Dr . Lewis C. Bartel ( recently retired from Sandia National Labo ratories and now a

  13. N-terminal or signal peptide sequence engineering prevents truncation of human monoclonal antibody light chains.

    PubMed

    Gibson, S J; Bond, N J; Milne, S; Lewis, A; Sheriff, A; Pettman, G; Pradhan, R; Higazi, D R; Hatton, D

    2017-03-28

    Monoclonal antibodies (mAbs) contain short N-terminal signal peptides on each individual polypeptide that comprises the mature antibody, targeting them for export from the cell in which they are produced. The signal peptide is cleaved from each heavy chain (Hc) and light chain (Lc) polypeptide after translocation to the ER and prior to secretion. This process is generally highly efficient, producing a high proportion of correctly cleaved Hc and Lc polypeptides. However, mis-cleavage of the signal peptide can occur, resulting in truncation or elongation at the N-terminus of the Hc or Lc. This is undesirable for antibody manufacturing as it can impact efficacy and can result in product heterogeneity. Here, we describe a truncated variant of the Lc that was detected during a routine developability assessment of the recombinant human IgG1 MEDI8490 in Chinese hamster ovary cells. We found that the truncation of the Lc was caused due to the use of the murine Hc signal peptide together with a lambda Lc containing an SYE amino acid motif at the N-terminus. This truncation was not caused by mis-processing of the mRNA encoding the Lc and was not dependent on expression platform (transient or stable), the scale of the fed-batch culture or clonal lineage. We further show that using alternative signal peptides or engineering the Lc SYE N-terminal motif prevented the truncation and that this strategy will improve Lc homogeneity of other SYE lambda Lc-containing mAbs. This article is protected by copyright. All rights reserved.

  14. Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program.

    PubMed

    Schwarz, Eleanor Bimla; Braughton, Monica Y; Riedel, Julie Cross; Cohen, Susannah; Logan, Julia; Howell, Mike; Thiel de Bocanegra, Heike

    2017-08-24

    To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus. A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception. Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=<.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33). Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies. Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following

  15. Feasibility of coblation versus laser resection in recurrent nasal polyps

    NASA Astrophysics Data System (ADS)

    Ilgner, Justus; Schramm, Karsten; Duwel, Philip; Donner, Andreas; Westhofen, Martin

    2005-04-01

    Introduction: Chronic sinusitis with nasal polyps is one of the commonest diseases of the upper airways, with a recurrence rate of about 15%. Minimally-invasive endoscopic laser procedures have been established to reduce the need for conventional revision surgery whenever medical follow-up fails. However, laser surgery requires special considerations for surgical, safety and economic aspects. This study evaluates the feasibility of coblation versus laser resection for recurrent nasal polyps. Material and methods: 6 nasal polyps were harvested each from the ostiomeatal complex of patients undergoing microscopic endonasal surgery for chronic sinusitis. 3 were dissected using a Neodymium:YAG laser system (Dornier MediLas 5060N) set at 10, 20 and 30w in cw mode with a 600μm bare fiber in contact mode with negative feedback power control, while further 3 polyps were dissected using a Coblation system (ArthroCare® Coblator® I) with a 30° angled and a 0° straight probe with 2.4 mm outer diameter. The specimens were examined histologically for carbonization and coagulation as well as unaltered tissue. Results: Laser resection resulted in a carbonization zone of 30μm in depth plus a coagulation zone of about 100μm, depending on the water content and type of tissue. While the carbonization zone was smaller with coblation, coagulation zones were comparable, leaving ample amount of unaltered tissue available for further diagnosis. Conclusion: Both resection techniques are generally feasible to be used in day case surgery for recurrent polyps. While the coblation system required no special safety requirements, accessibility of the sinuses was limited by the rigidity of applicators that are available.

  16. Evaluation of different emission inventories on the O3 and CO evolution within the CTM MOCAGE during the Pre-ChArMEx TRAQA campaign

    NASA Astrophysics Data System (ADS)

    Parmentier, Jonathan; El Amraoui, Laaziz; Attié, Jean-Luc; Josse, Béatrice; Arteta, Joaquim; Joly, Mathieu; Marécal, Virginie; Plu, Matthieu

    2014-05-01

    The chemistry-transport model MOCAGE, using meteorological forcings can use different emission inventories to describe and model numerous trace gases in the atmosphere. Each emission inventory has its specific resolution and its own variability. We present a study of the influence of two different inventories on the MOCAGE simulations. We use the IPCC (Intergovernmental Panel on Climate Change) and the MACC (Monitoring Atmospheric Composition and Climate) inventories. This comparison concerns the atmospheric species of ozone and carbon monoxide. For this study, we performed a new nested domain within the version of MOCAGE at global scale(called MEDI02). This new domain has high horizontal resolution (0.2°x0.2°) and is centred on the Mediterranean basin. To guarantee the consistency of different chemical species in both domains, the boarders of the nested domain are controlled by the global domain. The evaluation of both emission inventories will be done by comparing MOCAGE fields to those measured during the Pre-ChArMEx TRAQA campaign 2012. The TRAQA (TRAnsport à longue distance et Qualité de l'Air sur le bassin méditerranéen) campaign took place on the Mediterranean basin from June 26 to July 11, 2012. During this experiment the ATR-42 aircraft of Météo-France and atmospheric balloons, operated by CNES, have been used to measure trace gases and aerosols. More than 60h of flight measurements and as many as during 7 Intensive Observation Periods (IOPs) with radio-sounding balloons and Boundary Layer Pressurized Balloons (BLPB).

  17. Incidence of emergency department visits and complications after abortion.

    PubMed

    Upadhyay, Ushma D; Desai, Sheila; Zlidar, Vera; Weitz, Tracy A; Grossman, Daniel; Anderson, Patricia; Taylor, Diana

    2015-01-01

    To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. A total of 54,911 abortions among 50,273 fee-for-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n=3,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n=478) resulted in an ED visit for an abortion-related complication. Approximately 1 of 5,491 (0.03%, n=15) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n=126, 1/436): 0.31% (n=35) for medication abortion, 0.16% (n=57) for first-trimester aspiration abortion, and 0.41% (n=34) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n=1,156): 5.2% (n=588) for medication abortion, 1.3% (n=438) for first-trimester aspiration abortion, and 1.5% (n=130) for second-trimester or later procedures. Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. II.

  18. Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses.

    PubMed

    Höhle, Philip; Schröder, Simon M; Pfeil, Joachim

    2015-01-01

    Preservation of hip geometry is important for treatment success in endoprosthesis implantation. Digital planning can be used to estimate postoperative hip geometry. This study examined whether digital planning accurately predicts surgical outcomes for two femoral neck resecting short stem implants, Mayo® (Zimmer) and Metha® (Aesculap). Preoperative digital planning of the short stem and acetabular cup was performed for 191 patients (197 endoprostheses) with hip osteoarthritis. Digital planning was done with mediCAD II (Hectec) to evaluate types of prosthesis stems and sizes, leg lengthening and offset, and angle of stem inclination within the femur. The predicted values for these parameters were compared to the postoperative measurements. A double coordinate system was developed to measure pelvic and femoral distances separately. Individual scale factors were applied to minimize measurement bias. Implantation of the planned short stem prostheses resulted in a mean femoro-acetabular leg lengthening of 4.2mm (SD 5.8mm) and a mean femoro-acetabular offset-reduction of 4.2mm (SD 5.9mm) in comparison with preoperative planning. Implantation of both stems resulted in increased valgization compared to planning (Metha®, mean 5.4° (SD 3.7°); Mayo®, mean -3.2° (SD 3.4°)). Differences between preoperative planning and postoperative outcomes were greater for femoro-acetabular than for cup-related leg length and offset. On average, leg length was longer than predicted and there was loss of femoro-acetabular offset. Compared with the planning, valgization of the implanted stems was frequently observed. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California

    PubMed Central

    Cousineau, Michael R; Stevens, Gregory D; Farias, Albert

    2011-01-01

    Objective and Study Setting To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative. Data Source Administrative enrollment databases. Study Design The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children. Data Collection Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter. Principal Findings Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies. Conclusions and Implications National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments. PMID:21054378

  20. Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea.

    PubMed

    Pereira, Effie J; Driver, Helen S; Stewart, Steven C; Fitzpatrick, Michael F

    2013-12-15

    Questionnaires have been validated as screening tools in adult populations at risk for obstructive sleep apnea (OSA). Portable monitors (PM) have gained acceptance for confirmation of OSA in some patients with a high pretest probability of the disorder. We evaluated the combined diagnostic utility of 3 validated questionnaires and a Level III PM in the diagnosis and exclusion of OSA, as compared with in-laboratory polysomnography (PSG) derived apnea hypopnea index (AHI). Consecutive patients referred to the Sleep Disorders Clinic completed 3 testing components: (1) 3 questionnaires (Berlin, STOP-Bang, and Sleep Apnea Clinical Score [SACS]); (2) Level III at-home PM (MediByte) study; and (3) Level I in-laboratory PSG. The utility of individual questionnaires, the Level III device alone, and the combination of questionnaires and the Level III device were compared with the PSG. One hundred twenty-eight patients participated in the study (84M, 44F), mean ± SD age 50 ± 12.3years, BMI 31 ± 6.6 kg/m(2). At a PSG threshold AHI = 10, the PM derived respiratory disturbance index (RDI) had a sensitivity and specificity of 79% and 86%, respectively. The sensitivity and specificity for the other screening tools were: Berlin 88%, 25%; STOP-Bang 90%, 25%; SACS 33%, 75%. The sensitivity and specificity at a PSG AHI = 15 were: PM 77%, 95%; Berlin 91%, 28%; STOP-Bang 93%, 28%; SACS 35%, 78%. Questionnaires alone, possibly given a reliance on sleepiness as a symptom, cannot reliably rule out the presence of OSA. Objective physiological measurement is critical for the diagnosis and exclusion of OSA.

  1. Vena cava filter performance based on hemodynamics and reported thrombosis and pulmonary embolism patterns.

    PubMed

    Harlal, Aneal; Ojha, Matadial; Johnston, K Wayne

    2007-01-01

    Three inferior vena cava (IVC) filters of different designs were studied to identify the potential links between published clinical results for thrombosis and recurrent pulmonary embolism (PE) rates and in vitro hemodynamics patterns in the region of the filters. The filters studied were the Greenfield over-the-wire filter (Medi-tech/Boston Scientific, Watertown, Mass), TrapEase filter (Cordis Europa, Roden, the Netherlands), and Mobin-Uddin umbrella filter (Edwards Laboratories, Santa Ana, Calif). To assess hemodynamics, velocity contour maps were generated for each filter by using the in vitro photochromic flow visualization technique. Results were obtained for both the unoccluded and partially occluded states. Steady flow (R(e) = 600) was used to model physiologic conditions. To estimate the rates of IVC occlusion and recurrent PE, the authors analyzed published clinical studies spanning more than 30 years and a U.S. Food and Drug Administration database. For both the unoccluded and partially occluded Mobin-Uddin and TrapEase filters, regions of flow stagnation and/or recirculation and turbulence developed downstream of the filter. The Greenfield filter did not produce any prothrombotic flow patterns for either the unoccluded or partially occluded states. Results of published clinical studies supported the hemodynamic findings, with the TrapEase and Mobin-Uddin filters having high rates of IVC occlusion and recurrent PE compared with those of the Greenfield filter. Flow stagnation or recirculation and turbulence have been linked to thrombosis and thrombus and/or PE formation. Thus, the hemodynamic results from this study may help explain the relatively higher rates of filter thrombosis and PE for the Mobin-Uddin and TrapEase filters versus the Greenfield filter.

  2. Cigarette Smoking and Cardiovascular Risk in Young Women with Polycystic Ovary Syndrome

    PubMed Central

    Morotti, Elena; Battaglia, Bruno; Fabbri, Raffaella; Paradisi, Roberto; Venturoli, Stefano; Battaglia, Cesare

    2014-01-01

    Background: To verify if in lean polycystic ovary syndrome (PCOS) patients, the smok- ing habitude might increase the risk of cardiovascular (CV) disease. Materials and Methods: In this prospective observational study, eighty-one women were divided into the following three groups: group I with 27 non-smokers, group II with 26 light-smokers (1-10 cigarettes/day), and group III with 28 heavy smokers (>10 cigarettes/ day). They were submitted to fasting blood sampling; blood measurement of nitrites/ni- trates (NO2-/ NO3), biochemical and hormonal parameters; ovarian ultrasonographic (US) analysis; doppler evaluation of uterine and ophthalmic arteries; brachial artery flow-medi- ated vasodilatation; 24-hour ambulatory blood pressure monitoring; and oral glucose toler- ance test (OGTT). Results: Doppler analysis revealed higher uterine and ophthalmic arteries pulsatility in- dex (PI) and ophthalmic artery back pressure in group III compared with group I. The brachial artery diameter and PI, at baseline, was similar among all groups. After the re- active hyperemia, a more intense vasodilatation was observed in group I in comparison with group III. The 24-hour blood pressure demonstrated that, in group III patients, the 24-hour, day- and night-time diastolic blood pressure (DBP), was higher in comparison with non-smokers. The atherogenic index of plasma (AIP) was higher in heavy smokers than in non-smokers. The leukocytes and homocysteine (HCY) values were increased in group III. The NO2-/ NO3- plasma levels were reduced in heavy smokers in compari- son with non-smokers. The insulin, glucose and C-peptide plasma values were higher in group III than in other groups. In heavy smokers, the estimates of insulin sensitivity (ISI) and pancreatic β-cell function (HOMA-B) were higher compared to the other groups. Conclusion: Smoking habitude in lean PCOS patients may increase the soft markers of CV risk. PMID:24520500

  3. Hematological Parameters in Severe Complicated Plasmodium falciparum Malaria among Adults in Aden.

    PubMed

    Bakhubaira, Sawsan

    2013-12-01

    Amaç: Komplike ağır sıtmalı hastalarda bazı hematolojik parametrelerin klinik sonuç ile ilişkisinin incelenmesi. Gereç ve Yöntemler: Aden vilayetinde iki yıllık sürede (2010-2012) tanı alan 77 komplike ağır sıtma hastasını içine alan prospektif bir çalışma yapıldı. Bulgular: Ağır sıtmanın çeşitli komplikasyonlarında hemoglobin konsantrasyonları önemli ölçüde farklı idi, bununla birlikte trombosit ve lökosit sayıları bu farklılığı göstermedi. Yaş ortalaması ölen hastalar arasında büyüktü. Hematolojik parametreler, ölen ya da hayatta kalan hastalar arasında önemli derecede farklı değildi. Trombositopeni oranı %42,9 idi ve bunların %18,2’sinde sayı 50,0 x109/L’den küçüktü. Ancak hiçbirinde kanama gelişmedi. Sonuç: Bu çalışma ile, hematolojik değişikliklerin ağır sıtmada sık karşılaşılan komplikasyonlar olduğu fakat klinik sonuç ile ilişkili olmadığı sonucuna varılmıştır.

  4. Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided.

    PubMed

    Kutzner, Karl Philipp; Pfeil, Joachim; Kovacevic, Mark Predrag

    2017-07-01

    Modern total hip arthroplasty is largely dependent on the successful preservation of hip geometry. Thus, a successful implementation of the preoperative planning is of great importance. The present study evaluates the accuracy of anatomic hip reconstruction predicted by 2D digital planning using a calcar-guided short stem of the newest generation. A calcar-guided short stem was implanted in 109 patients in combination with a cementless cup using the modified anterolateral approach. Preoperative digital planning was performed including implant size, caput-collum-diaphyseal angle, offset, and leg length using mediCAD II software. A coordinate system and individual scale factors were implemented. Postoperative outcome was evaluated accordingly and was compared to the planning. Intraoperatively used stem sizes were within one unit of the planned stem sizes. The postoperative stem alignment showed a minor and insignificant (p = 0.159) mean valgization of 0.5° (SD 3.79°) compared to the planned caput-collum-diaphyseal angles. Compared to the planning, mean femoral offset gained 2.18 (SD 4.24) mm, while acetabular offset was reduced by 0.78 (SD 4.36) mm during implantation resulting in an increased global offset of 1.40 (SD 5.51) mm (p = 0.0094). Postoperative femoroacetabular height increased by a mean of 5.00 (SD 5.98) mm (p < 0.0001) compared to preoperative measures. Two-dimensional digital preoperative planning in calcar-guided short-stem total hip arthroplasty assures a satisfying implementation of the intended anatomy. Valgization, which has been frequently observed in previous short-stem designs, negatively affecting offset, can be avoided. However, surgeons have to be aware of a possible leg lengthening.

  5. Dabigatran etexilate: a review of its use in the treatment of acute venous thromboembolism and prevention of venous thromboembolism recurrence.

    PubMed

    Greig, Sarah L; McKeage, Kate

    2014-10-01

    Dabigatran etexilate (Pradaxa(®), Prazaxa(®)) has recently been approved for the treatment of acute venous thromboembolism (VTE) and prevention of VTE recurrence. Dabigatran etexilate is an oral prodrug of dabigatran, a selective, reversible, competitive, direct thrombin inhibitor. Dabigatran etexilate has a wide therapeutic range that allows for fixed-dose administration without the need for routine monitoring, a requirement of standard vitamin K antagonist (VKA) therapy. In randomized phase III trials in patients with acute VTE (RE-COVER and RE-COVER II), long-term treatment with oral dabigatran etexilate 150 mg twice daily for 6 months after initial parenteral anticoagulation was noninferior to dose-adjusted warfarin with regard to the incidence of recurrent symptomatic VTE or related death. In randomized trials of patients with previously treated VTE, extended dabigatran etexilate treatment was noninferior to warfarin (RE-MEDY) and significantly more effective than placebo (RE-SONATE) with regard to the incidence of recurrent VTE or related death. Dabigatran etexilate was generally well tolerated, with a similar incidence of major bleeding to that with warfarin in individual studies (although pooled data showed a significantly lower incidence in patients with acute VTE), and significantly lower incidences of the combined endpoint of major or clinically relevant nonmajor bleeding and of any bleeding than with warfarin. However, in the RE-SONATE trial, dabigatran etexilate was associated with a higher risk of bleeding than placebo. In conclusion, dabigatran etexilate is a valuable treatment option for acute VTE and prevention of VTE recurrence, providing an effective and convenient alternative to standard VKA therapy with the potential for a lower overall rate of bleeding.

  6. Scenarios of Future Water use on Mediterranean Islands based on an Integrated Assessment of Water Management

    NASA Astrophysics Data System (ADS)

    Lange, M. A.

    2006-12-01

    The availability of water in sufficient quantities and adequate quality presents considerable problems on Mediterranean islands. Because of their isolation and thus the impossibility to draw on more distant or more divers aquifers, they rely entirely on precipitation as natural replenishing mechanism. Recent observations indicate decreasing precipitation, increasing evaporation and steadily growing demand for water on the islands. Future climate change will exacerbate this problem, thus increasing the already pertinent vulnerability to droughts. Responsible planning of water management strategies requires scenarios of future supply and demand through an integrated assessment including climate scenarios based on regional climate modeling as well as scenarios on changes in societal and economical determinants of water demand. Constructing such strategies necessitates a thorough understanding about the interdependencies and feedbacks between physical/hydrological and socio-economic determinants of water balances on an island. This has to be based on a solid understanding of past and present developments of these drivers. In the framework of the EU-funded MEDIS project (Towards sustainable water use on Mediterranean Islands: addressing conflicting demands and varying hydrological, social and economic conditions, EVK1-CT-2001-00092), detailed investigations on present vulnerabilities and adaptation strategies to droughts have been carried out on Mallorca, Corsica, Sicily, Crete and Cyprus. This was based on an interdisciplinary study design including hydrological, geophysical, agricultural-, social and political sciences investigations. A central element of the study has been the close interaction with stakeholders on the islands and their contribution to strategy formulation. An important result has been a specification of vulnerability components including: a physical/environmental-, an economical/regulatory- and a social/institutional/political component. Their

  7. Modelling nutritional services in relation to the health status of older individuals living on Mediterranean islands.

    PubMed

    Tyrovolas, S; Polychronopoulos, E; Tountas, Y; Panagiotakos, D B

    2011-01-01

    The world's population is ageing and it has been suggested that improvements to health, wellbeing and lifespan can be attributed to improved standards of living, especially regarding diet and nutritional status. The impact of nutritional services provided by a dietician on an older population's health status has not been well evaluated or documented. This study sought to determine whether an association exists between available nutritional services and older people's health status in selected Greek islands and the Cyprus Republic. During 2010, information on nutritional services provided in 9 Greek Islands and the Cyprus Republic was retrieved through interviews of almost all dieticians (n=88) working on these islands. The health status (ie prevalence of hypertension, diabetes, hypercholesterolemia, obesity) of the older population studied (aged >65 years) was retrieved from the Mediterranean Islands Study (MEDIS). The main reasons for an older person's visit to a dietician was for the treatment of diabetes (79%), hypercholesterolemia (75%) and obesity (70%); 90% of older individuals visited the dietician on a physician's recommendation and 45% of them completed their consultations. The longer the presence of a dietician on an island, the lower the likelihood of observing the prevalence of hypertension (OR=0.59, 95% CI=0.36-0.94), hypercholesterolemia (OR=0.66, 95%CI=0.46-0.95), diabetes (OR=0.77, 95%CI=0.61-0.96) and obesity (OR=0.66, 95%CI=0.45-0.95) above the median rate of the population studied. Financial concerns and a long distance from home to the dieticians' office were the major reasons for ceasing visits to the dietician. Enhancing nutritional services within the healthcare system may contribute to reducing the burden of disease among older adults and, consequently, improve their quality of life.

  8. Validation of Watch-PAT-200 Against Polysomnography During Pregnancy

    PubMed Central

    O'Brien, Louise M.; Bullough, Alexandra S.; Shelgikar, Anita V.; Chames, Mark C.; Armitage, Roseanne; Chervin, Ronald D.

    2012-01-01

    Study Objectives: To determine the relationships between key variables obtained from ambulatory polysomnography (PSG) and the wrist-worn Watch-PAT 200 device in pregnant women. Methods: In this prospective cohort study, women in their third trimester of pregnancy underwent full overnight home PSG using the 22-channel MediPalm system and the Watch-PAT 200 device. PSGs were scored by a blinded, experienced technologist using AASM 2007 criteria; the Watch-PAT was scored automatically by the manufacturer's proprietary software. Results: A total of 31 pregnant women were studied. Mean age was 30.2 ± 7.1 years; mean gestational age was 33.4 ± 3.0 weeks; mean BMI was 31.9 ± 8.1 kg/m2; 39% of women were nulliparous. Key variables generated by PSG and Watch-PAT correlated well over a wide range, including the apnea-hypopnea index (AHI, r = 0.76, p < 0.001); respiratory disturbance index (RDI, r = 0.68, p < 0.001), mean oxygen saturation (r = 0.94, p < 0.001), and minimum oxygen saturation (r = 0.88, p < 0.001). The area under the curve for AHI ≥ 5 and RDI ≥ 10 were 0.96 and 0.94, respectively. Association between stage 3 sleep on PSG and deep sleep on Watch-PAT was poor. Watch-PAT tended to overscore RDI, particularly as severity increased. Conclusions: Among pregnant women, Watch-PAT demonstrates excellent sensitivity and specificity for identification of obstructive sleep apnea, defined as AHI ≥ 5 on full PSG. Watch-PAT may overestimate RDI somewhat, especially at high RDI values. Citation: O'Brien LM; Bullough AS; Shelgikar AV; Chames MC; Armitage R; Chervin RD. Validation of Watch-Pat-200 against polysomnography during pregnancy. J Clin Sleep Med 2012;8(3):287-294. PMID:22701386

  9. Hepatitis B virus in Pakistan: A systematic review of prevalence, risk factors, awareness status and genotypes

    PubMed Central

    2011-01-01

    In Pakistan, there are estimated 7-9 million carriers of hepatitis B virus (HBV) with a carrier rate of 3-5%. This article reviews the available literature about the prevalence, risk factors, awareness status and genotypes of the HBV in Pakistan by using key words; HBV prevalence, risk factors, awareness status and genotypes in Pakistani population in PubMed, PakMediNet, Directory of Open Access Journals (DOAJ) and Google Scholar. One hundred and six different studies published from 1998 to 2010 were included in this study. Weighted mean and standard deviation were determined for each population group. The percentage of hepatitis B virus infection in general population was 4.3318% ± 1.644%, healthy blood donors (3.93% ± 1.58%), military recruits (4.276% ± 1.646%), healthcare persons (3.25% ± 1.202%), pregnant women (5.872% ± 4.984), prisoners (5.75% ± 0.212%), surgical patients (7.397% ± 2.012%), patients with cirrhosis (28.87% ± 11.90%), patients with HCC (22% ± 2.645%), patients with hepatitis (15.896% ± 14.824%), patients with liver diseases (27.54% ± 6.385%), multiple transfused patients (6.223% ± 2.121%), opthalmic patients (3.89% ± 1.004%) and users of injectable drugs (14.95% ± 10.536%). Genotype D (63.71%) is the most prevalent genotype in Pakistani population. Mass vaccination and awareness programs should be initiated on urgent basis especially in populations with HBV infection rates of more than 5%. PMID:21375760

  10. A model for simulating the active dispersal of juvenile sea turtles with a case study on western Pacific leatherback turtles.

    PubMed

    Gaspar, Philippe; Lalire, Maxime

    2017-01-01

    Oceanic currents are known to broadly shape the dispersal of juvenile sea turtles during their pelagic stage. Accordingly, simple passive drift models are widely used to investigate the distribution at sea of various juvenile sea turtle populations. However, evidence is growing that juveniles do not drift purely passively but also display some swimming activity likely directed towards favorable habitats. We therefore present here a novel Sea Turtle Active Movement Model (STAMM) in which juvenile sea turtles actively disperse under the combined effects of oceanic currents and habitat-driven movements. This model applies to all sea turtle species but is calibrated here for leatherback turtles (Dermochelys coriacea). It is first tested in a simulation of the active dispersal of juveniles originating from Jamursba-Medi, a main nesting beach of the western Pacific leatherback population. Dispersal into the North Pacific Ocean is specifically investigated. Simulation results demonstrate that, while oceanic currents broadly shape the dispersal area, modeled habitat-driven movements strongly structure the spatial and temporal distribution of juveniles within this area. In particular, these movements lead juveniles to gather in the North Pacific Transition Zone (NPTZ) and to undertake seasonal north-south migrations. More surprisingly, juveniles in the NPTZ are simulated to swim mostly towards west which considerably slows down their progression towards the American west coast. This increases their residence time, and hence the risk of interactions with fisheries, in the central and eastern part of the North Pacific basin. Simulated habitat-driven movements also strongly reduce the risk of cold-induced mortality. This risk appears to be larger among the juveniles that rapidly circulate into the Kuroshio than among those that first drift into the North Equatorial Counter Current (NECC). This mechanism might induce marked interannual variability in juvenile survival as the

  11. The role of the Pharmaceuticals and Medical Devices Agency and healthcare professionals in post-marketing safety.

    PubMed

    Mori, Kazuhiko; Watanabe, Meguru; Horiuchi, Naoya; Tamura, Atsushi; Kutsumi, Hiromu

    2014-04-01

    The development of drugs and medical devices is necessary for medical progress; however, safety measures need to be put in place to protect the health of the population. In order to ensure the safety of drugs and medical devices, it is important to determine measures for appropriate management of risks at any time during the development phase, the regulatory review and the post-marketing phase. Adverse events detected in clinical trials are limited due to the restricted numbers of patients enrolled in the trials. Therefore, it is almost impossible to predict rare serious adverse events during the post-marketing phase. The revised Pharmaceutical Affairs Act was established in Japan in November 20, 2013. The new act focuses on increased safety of drugs and medical devices. The Pharmaceuticals and Medical Devices Agency (PMDA) is the regulatory authority in Japan that promotes safety measures from the development phase through to the post-marketing phase. In the post-marketing phase, the PMDA collects information from the medical product companies and healthcare professionals, as well as instructing and advising them with regard to post-marketing safety measures for each drug and medical device. Since Japan has a national health insurance system, a new drug or a medical device is available throughout the country when the drug price or medical fee is listed in the National Health Insurance price list. Healthcare professionals in medical institutions must learn about the drugs and medical devices they handle, and should make an effort to maintain patient safety. The PMDA medi-navi is a very useful electronic mail delivery service that provides critical information for protecting patients from health hazards caused by adverse events. The 'risk management plan' is also important as it contains important information about safety profile and post-marketing measures of a new drug.

  12. [Flowmetric assessment of coronary bypass grafts in the conditions of artificial circulation and on the beating heart].

    PubMed

    Bazylev, V V; Nemchenko, E V; Karnakhin, V A; Pavlov, A A; Mikulyak, A I

    2016-01-01

    Advantages and shortcomings of aortocoronary bypass grafting on the beating heart and in the conditions of artificial circulation (AC) have long been discussed. The data on patency of bypass grafts in the remote period are indicative of comparable results of operations with and without AC or advantages of using AC. In order to determine benefits of each method it is necessary to reveal intraoperative predictors of bypass grafts occlusion in the remote period. We analyzed the results of ultrasound flowmetry of the blood flow through the left internal thoracic artery during bypass grafting of the anterior descending artery with the use of AC and on the beating heart. A retrospective study included a total of 352 patients subdivided into 2 groups: Group One was composed of 120 patients undergoing surgery in the conditions of AC and Group Two comprised 232 patients subjected to similar operations on the beating heart. Blood flow was measured with the help of flowmeter VeryQ MediStim® after termination of AC and inactivation of heparin by protamine, with systolic pressure of 100-110 mm Hg. There were no statistically significant differences between the groups by the diameter and degree of stenosis of the anterior descending artery, diameter of the left internal thoracic artery. The mean volumetric blood flow velocity (Qmean) along the shunts in Group One was higher (p=0.01). No statistically significant differences by the pulsatility index (PI) between the groups were revealed (p=0.2). A conclusion was drawn that coronary bypass grafting of the anterior descending artery by the left internal thoracic artery in the conditions of artificial circulation made it possible to achieve higher volumetric velocity of blood flow through the conduit as compared with operations on the beating heart, with similar resistance index. The immediate results of the operations with the use of the both techniques did not differ.

  13. [Computerized decision support systems: EBM at the bedside].

    PubMed

    Capobussi, Matteo; Banzi, Rita; Moja, Lorenzo; Bonovas, Stefanos; González-Lorenzo, Marien; Liberati, Elisa Giulia; Polo Friz, Hernan; Nanni, Oriana; Mangia, Massimo; Ruggiero, Francesca

    2016-11-01

    One of the aims of Evidence-Based Medicine is to improve quality and appropriateness of care by the expedition of the knowledge transfer process. Computerized Decision Support Systems (CDSSs) are computer programs that provide alerts to the prescribing doctor directly at the moment of medical examination. In fact, alerts are integrated within the single patient electronic health record. CDSS based on the best available and updated evidence and guidelines may be an efficient tool to facilitate the transfer of the latest results from clinical research directly at the bedside, thus supporting decision-making. The CODES (COmputerized DEcision Support) trial is a research program funded by the Italian Ministry of Health and the Lombardy Region. It aims to evaluate the feasibility of the implementation of a CDSS at the hospital level and to assess its efficacy in daily clinical practice. The CODES project includes two pragmatic RCTs testing a CDSS (i.e. the EBMeDS - MediDSS) in two large Italian hospitals: the first is a general hospital in Vimercate (Lombardy), the second is an oncologic research center in Meldola (Emilia Romagna). The CDSS supports a full spectrum of decisions: therapy, drug interactions, diagnosis, and management of health care services are covered by a hundreds of reminders. However only few reminders are activated per patient, highlighting crucial problems in the delivery of high-quality care. The two trials have similar design and primary outcome, the rate at which alerts detected by the software are resolved by a decision of the clinicians. The project also includes the assessment of barriers and facilitators in the adoption of these new technologies by hospital staff members and the retrospective evaluation of the repeated risks in prescription habits. The trials are ongoing and currently more than 10,000 patients have been randomized. The qualitative analysis revealed a progressive shift in the perception of the tool. Doctors are now seeing it

  14. How does parents' visual perception of their child's weight status affect their feeding style?

    PubMed

    Yilmaz, Resul; Erkorkmaz, Ünal; Ozcetin, Mustafa; Karaaslan, Erhan

    2013-01-01

    Introducción: El estilo de alimentación es uno de los factores prominentes que determina la ingesta de energía. Uno de los factores que influyen en el estilo de alimentación paterna es la percepción de los padres del estado de peso del niño. Objetivo: El propósito de este estudio fue evaluar la relación entre la percepción visual de la madre del estado de peso de su hijo y su estilo de alimentación. Método: Se realizó un estudio transversal con madres de 380 niños preescolares de 5 a 7 (6,14 años). Las puntuaciones de la percepción visual se midieron mediante unos dibujos y el estilo de alimentación materna se medió con el cuestionario validado “Parental Feeding Style Questionnaire”. Resultados: Las puntuaciones de las subescalas de las dimensiones de alimentación parental “alimentación emocional” y “animar a comer” eran bajas en niños con sobrepeso de acuerdo con la clasificación de la percepción visual. Las puntuaciones de las subescalas “alimentación emocional” y “control permisivo” eran estadísticamente distintas en los niños clasificados como correctamente percibidos e incorrectamente percibidos bajos por una mala percepción materna. Conclusión: Diversos estilos de alimentación se relacionaban con la percepción visual materna. El mejor abordaje para evitar la obesidad y el peso bajo podría estar en centrarse en conseguir una correcta percepción parental del estado de peso de sus hijos, mejorando así las habilidades paternas y conllevando la implantación de unos estilos de alimentación adecuados.

  15. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study.

    PubMed

    Schoene, Katharina; Rolf, Sascha; Schloma, Denis; John, Silke; Arya, Arash; Dinov, Borislav; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Sommer, Philipp

    2015-07-01

    Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter. We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P < 0.001). This resulted in a significant reduction in radiation dose in patients randomized to NFCT [17.4 (IQR 11; 206.6) cGy cm(2)] vs. the CONV group [418.4 (IQR 277; 812.2) cGy cm(2)] (P < 0.001). There were no significant differences in procedure duration between the NFCT group [49.5 (IQR 37; 65) min] when compared with the CONV group [33.5 (IQR 26.3; 55.5) min] (P = 0.053). No adverse events were recorded. Freedom from atrial flutter at 6 months of follow-up was 19/20 (95%) in the NFCT and 18/20 (90%) in the CONV group (n.s.). In this first prospective randomized study, by comparing NFCT with standard fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use. Published on behalf of the European Society of Cardiology. All rights reserved. © The

  16. [Normative Database of Optical Coherence Tomography Parameters in Childhood].

    PubMed

    Queirós, Tatiana; Freitas, Cristina; Guimarães, Sandra

    2015-01-01

    Introdução: A tomografia de coerência óptica é um exame que permite obter imagens de alta resolução dos tecidos in vivo, possibilitando a medição das estruturas oculares, nomeadamente a camada de fibras nervosas da retina e a espessura macular. Como método não invasivo torna-se particularmente útil em crianças, contudo a sua aplicabilidade está limitada pela existência de valores normativos apenas para adultos.Objetivo: Estabelecer na idade pediátrica valores normativos para a espessura da camada de fibras nervosas da retina e espessura macular, averiguando a sua influência com o género, idade, refração, lateralidade e dominância ocular.Material e Métodos: Foram submetidas a exame oftalmológico e a Cirrus HD-tomografia de coerência óptica (Carl Zeiss Meditec) 153 crianças dos quatro aos 17 anos.Resultados: Obtiveram-se valores da espessura média global da camada de fibras nervosas da retina de 97,90 μm. Não se detectaram diferenças entre géneros e com a idade, mas sim consoante a lateralidade e dominância ocular. Verificou-se um aumento da espessura com refrações positivas. Com o protocolo Macular Cube 512 x 128 verificou-se que o campo central apresentou a menor espessura (250,35 μm), apresentando os rapazes maior espessura macular.Discussão: Os valores da espessura da camada de fibras nervosas da retina e da espessura macular obtidos são comparáveis a estudos recentes. A distribuição da espessura por quadrantes respeita a distribuição normal da camada de fibras nervosas da retina. A espessura macular revelou-se superior no género masculino (campo central e anel interno), dados estes também concordantes com estudos prévios.Conclusão: Estabelecemos as normativas da espessura da camada de fibras nervosas da retina e espessura macular em crianças portuguesas saudáveis, dados estes que reestruturam a avaliação e interpretação dos parâmetros obtidos pela tomografia de coerência óptica no diagnóstico de

  17. A systematic review of treatment response rates in Pakistani hepatitis C virus patients; current prospects and future challenges.

    PubMed

    Ali, Muhammad; Afzal, Samia; Zia, Asad; Hassan, Ahmed; Khalil, Ali Talha; Ovais, Muhammad; Shinwari, Zabta Khan; Idrees, Muhammad

    2016-12-01

    The estimated hepatitis C virus (HCV) carriers are approximately 10 million in Pakistan which usually progresses to chronic hepatitis, with rare cases of spontaneous viral eradication. The present article reviews the treatment status of HCV infection in Pakistani population and various factors associated with the treatment response rates. Literature on anti-HCV therapy was searched in PubMed, Google Scholar and PakMediNet. Thirty three different studies representing different geographic regions of Pakistan published from 2002 to 2016 were included in the present review. Weighted mean, standard error estimates (SE) and standard deviation (SD) were determined for each population group. Mean value for sustained virological response (SVR) for standard IFN plus ribavirin (RBV) combination therapy was 68.38% ± 14.13% (range 33.8%-87.10%; SE 3.08) and pegylated-IFN plus RBV combination therapy 64.38% ± 8.68% (range 55.0%-76.00%; SE 3.88). The lowest value for SVR has been reported to be 24.3% (for genotype 1; administering INF-α 2b 3MU 3 times/week and RBV 1000-1200 mg/day for 48 weeks) while highest of 87.5% (genotype 3a; INF-α 2a 3MU 3 times/week and RBV 1000-1200 mg/day for 24 weeks). The mean value for rapid virological response (RVR) was found to be 48.18% ± 29.20% (SE 9.73). As PEG-interferon and direct acting antivirals (DAAs) are relatively expensive, interferon-alfa (IFN-α) and RBV combination therapy have been used widely to treat HCV infected patients in Pakistan for the last one and half decade. On average, 2.45% of the patients discontinued treatment due to severe side effects. We encourage further studies on understanding host and viral factors associated with specific focus on harder to treat viral variants (relapsers and nonresponders). These variants are currently rising in the country.

  18. Do experiences consistent with a medical-home model improve diabetes care measures reported by adult Medicaid patients?

    PubMed

    Stevens, Gregory D; Shi, Leiyu; Vane, Christina; Peters, Anne L

    2014-09-01

    The patient-centered medical home has gained much traction. Little is known about the relationship between the model and specific health care processes for chronic diseases such as diabetes. This study assesses the impact of features of a medical home on diabetes care. A cross-sectional survey of 540 patients with Medicaid (Medi-Cal) health insurance and type 2 diabetes in Los Angeles County was performed. The Primary Care Assessment Tools was used to measure seven features of medical-home performance. The response rate of the patient survey was 68.9%. Patient-reported medical-home performance averaged a score of 2.85 ± 0.29 (on a 1-4 scale, with 4 equaling the best care). Patients who received more timely and thorough diabetes care reported higher medical-home performance in every feature except for the comprehensiveness-services available. For example, the first-contact access feature score was higher among patients who had an HbA1c test in the past 6 months versus those who did not (2.38 vs. 2.25; P < 0.05). Before and after adjusting for sociodemographics and health status, total medical-home performance was positively associated with each diabetes care measure. A 1-point increase in total medical-home score was associated with 4.53 higher odds of an HbA1c test in the past 6 months and 1.88 higher odds of an eye exam in the past year. Features consistent with higher medical-home performance are associated with improvements in patient-reported diabetes care process measures, even in this low socioeconomic status setting. The patient-centered medical-home model may help in caring for people with type 2 diabetes. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  19. Predicting 1-Year Statin Adherence Among Prevalent Users: A Retrospective Cohort Study.

    PubMed

    Krumme, Alexis A; Franklin, Jessica M; Isaman, Danielle L; Matlin, Olga S; Tong, Angela Y; Spettell, Claire M; Brennan, Troyen A; Shrank, William H; Choudhry, Niteesh K

    2017-04-01

    Brigham and Women's Hospital. Shrank, Brennan, and Matlin were employees and shareholders at CVS Health at the time of this manuscript preparation; they report no financial interests in products or services that are related to the subject of the manuscript. Franklin has received consulting fees from Aetion. Chourdry has received grants from the National Heart, Lung, and Blood Institute, PhRMA Foundation, Merck, Sanofi, AstraZeneca, and MediSafe. Spettell is an employee of, and shareholder in, Aetna. The other authors have nothing to disclose. Krumme, Choudhry, Tong, and Franklin contributed to the study design, interpretation of results, and manuscript drafting. Tong prepared and analyzed the data. Isaman, Spettell, Shrank, Brennan, and Matlin provided interpretation of results and critical manuscript revisions.

  20. Bioavailability of a new generic formulation of mycophenolate mofetil MMF 500 versus CellCept in healthy adult volunteers.

    PubMed

    Masri, M A; Rizk, S; Attia, M L E; Barbouch, H; Rost, M

    2007-05-01

    Several studies have revealed a decreased incidence of early graft rejection with the use of mycophenate mofetil (MMF). The cost of the drug is, however, prohibitive especially in developing countries with limited resources. We compared the pharmacokinetic profile of a new MMF generic formulation (MMF 500 batch number: 06T3001; Medis Tunis) with those of Cellcept, (batch number: M1427; Hoffmann La Roche, Switzerland) in healthy volunteers. The study was double-blinded to investigator and volunteers. It had a balanced randomized, two-treatment, two-period, two-sequence, single-dose, crossover, comparative oral bioavailability design in adult healthy human volunteers. The study was designed, performed, and monitored by CRO Transmedical s.a.l International (Beirut, Lebanon) in accordance with the Basic Principals defined in the US 21 CFR Part 312.20, and the principals enunciated in the World Medical Association Declaration of Helsinki. We included nonsmoking healthy volunteers between the ages of 22 and 45 years. The subjects were admitted to the hospital one night prior to blood sampling. After volunteers received the same dinner, they were fasted overnight and for 2 hours postdosing. At 8 am each person received a single oral dose of 500 mg of either formulation. Blood samples were collected to construct the pharmacokinetic profiles as follows: 0, 0.15, 0.30, 0.45 minutes and 1, 1.15, 1.30, 2, 4, 6, 10, 12, and 24 hours. Water and food intake were the same for all volunteers during the whole study period. Following an 8-day washout period, the subjects were crossed over. Plasma mycophenolic acid concentrations were determined using a high-performance liquid chromatography validated enzyme-linked immunosorbent assay-based method (TransMedical, Beirut Lebanon). Physical examinations, hematology, urinanalysis, serum chemistry tests, and liver enzymes were performed at screening and at the end of each period. Subjects were monitored for safety and adverse events

  1. Organic wastes decomposition technology, perspective for long-term autonomous missions

    NASA Astrophysics Data System (ADS)

    Viacheslav, Ilyin; Korshunov, Denis; Mardanov, Robert; Starkova, Lyubov; Deshevaya, Elena; Smirnov, Igor

    At present time there is no large problem in waste management in ISS space flight conditions, since spacecrafts "Progress" is used for it's removal from orbital station and the wastes burns in dense layers of Earth's atmosphere. However such method does not approach for far inter-planetary flights since interplanetary quarantine desires do not allow to deposit contaminated wastes outside the spacecraft. Essential part of wastes is formed by disposed means of personal hygiene and greenhouse wastes which are not safe from sanitary-epidemiological aspect. Above mentioned materials have one common feature: they can be subjected to biodegradation using different microbial compositions. Microbial decomposition of wastes as meets the main crite-ria of safety and power consumption. We investigated the effectiveness of method of disposed personal hygiene means biodegradation by anaerobic thermophiles with further purification of obtained decomposition products from chemical solvents with the help of mesophilic isolates in microaerophile conditions. Bacteria of Clostridium genera were selected for cellulolysis be-cause of their high specific endoglucanasic activity which less depends on substrate nature and relatively high growth rate on cellulose contaning substrates. As result some strains in case of optimal conditions (substrata pretreating, pH correction) decomposed means of personal hygiene with level of biodegradation up to 90With the purpose of purification, liqiud medi-ums originating from Closrtidium sp. exhibiting used like substrates for cellololitic fungi. It was shown that the cultures are able to change pH of media from slow-acid to neutral. Also the effectiveness of plant wastes biodegradation (vegetables homogenates) was studied using associations of mesophile aerobes trophically adapted to substrates. Rate of biodestruction of dry mass varied near 76To purify liquid products of biodegradation from chemicals cellulolytic fungal strains as well as bacterial

  2. Perioperative patient safety indicators and hospital surgical volumes.

    PubMed

    Kitazawa, Takefumi; Matsumoto, Kunichika; Fujita, Shigeru; Yoshida, Ai; Iida, Shuhei; Nishizawa, Hirotoshi; Hasegawa, Tomonori

    2014-02-28

    Since the late 1990s, patient safety has been an important policy issue in developed countries. To evaluate the effectiveness of the activities of patient safety, it is necessary to quantitatively assess the incidence of adverse events by types of failure mode using tangible data. The purpose of this study is to calculate patient safety indicators (PSIs) using the Japanese Diagnosis Procedure Combination/per-diem payment system (DPC/PDPS) reimbursement data and to elucidate the relationship between perioperative PSIs and hospital surgical volume. DPC/PDPS data of the Medi-Target project managed by the All Japan Hospital Association were used. An observational study was conducted where PSIs were calculated using an algorithm proposed by the US Agency for Healthcare Research and Quality. We analyzed data of 1,383,872 patients from 188 hospitals who were discharged from January 2008 to December 2010. Among 20 provider level PSIs, four PSIs (three perioperative PSIs and decubitus ulcer) and mortality rates of postoperative patients were related to surgical volume. Low-volume hospitals (less than 33rd percentiles surgical volume per month) had higher mortality rates (5.7%, 95% confidence interval (CI), 3.9% to 7.4%) than mid- (2.9%, 95% CI, 2.6% to 3.3%) or high-volume hospitals (2.7%, 95% CI, 2.5% to 2.9%). Low-volume hospitals had more deaths among surgical inpatients with serious treatable complications (38.5%, 95% CI, 33.7% to 43.2%) than high-volume hospitals (21.4%, 95% CI, 19.0% to 23.9%). Also Low-volume hospitals had lower proportion of difficult surgeries (54.9%, 95% CI, 50.1% to 59.8%) compared with high-volume hospitals (63.4%, 95% CI, 62.3% to 64.6%). In low-volume hospitals, limited experience may have led to insufficient care for postoperative complications. We demonstrated that PSIs can be calculated using DPC/PDPS data and perioperative PSIs were related to hospital surgical volume. Further investigations focusing on identifying risk factors for poor

  3. Social support and cancer screening among older black Americans.

    PubMed

    Kang, S H; Bloom, J R

    1993-05-05

    Age-adjusted cancer mortality is 27% higher for Black Americans than for the general U.S. population, which may result from inappropriate use of cancer detection tests. Social support has been shown to affect adjustment to breast cancer and survival, but it has not been studied as a predictor of use of preventive health care services in the older population. Our hypothesis is that larger social networks are associated with greater utilization of cancer-screening tests in the older population. The objective of this study was to examine the relationship between social support and use of cancer-screening tests among older Black Americans. Data for this study were obtained from a 1986 baseline survey evaluation of a community intervention program to increase cancer awareness and a 1991 end-point survey of use of cancer detection tests. Our study sample consisted of 617 Black Americans aged 55 years or older who lived in San Francisco (Calif.), the control community, and in Oakland (Calif.), the target community for intervention. The survey included measures of 1) social network characteristics, as determined by a modified version of Berkman and Syme's Social Network Index; 2) demographic characteristics; and 3) use of six cancer-screening tests--mammography, occult blood stool examination, cervical smear, clinical breast examination, digital rectal examination, and sigmoidoscopy. Multiple logistic regression analysis of the Social Network Index results indicated statistically significant positive associations of social support with the use of mammography and occult blood stool examination but not with the other cancer-screening tests. There were statistically significant associations between having HMO (Health Maintenance Organization) insurance and increased use of mammography and occult blood stool examination, compared with having Medi-Cal or other insurance. The interval between the surveys had a statistically significant positive association with use of

  4. Cost-effectiveness of tuberculosis evaluation and treatment of newly-arrived immigrants

    PubMed Central

    Porco, Travis C; Lewis, Bryan; Marseille, Elliot; Grinsdale, Jennifer; Flood, Jennifer M; Royce, Sarah E

    2006-01-01

    Background Immigrants to the U.S. are required to undergo overseas screening for tuberculosis (TB), but the value of evaluation and treatment following entry to the U.S. is not well understood. We determined the cost-effectiveness of domestic follow-up of immigrants identified as tuberculosis suspects through overseas screening. Methods Using a stochastic simulation for tuberculosis reactivation, transmission, and follow-up for a hypothetical cohort of 1000 individuals, we calculated the incremental cost-effectiveness of follow-up and evaluation interventions. We utilized published literature, California Reports of Verified Cases of Tuberculosis (RVCTs), demographic estimates from the California Department of Finance, Medicare reimbursement, and Medi-Cal reimbursement rates. Our target population was legal immigrants to the United States, our time horizon is twenty years, and our perspective was that of all domestic health-care payers. We examined the intervention to offer latent tuberculosis therapy to infected individuals, to increase the yield of domestic evaluation, and to increase the starting and completion rates of LTBI therapy with INH (isoniazid). Our outcome measures were the number of cases averted, the number of deaths averted, the incremental dollar cost (year 2004), and the number of quality-adjusted life-years saved. Results Domestic follow-up of B-notification patients, including LTBI treatment for latently infected individuals, is highly cost-effective, and at times, cost-saving. B-notification follow-up in California would reduce the number of new tuberculosis cases by about 6–26 per year (out of a total of approximately 3000). Sensitivity analysis revealed that domestic follow-up remains cost-effective when the hepatitis rates due to INH therapy are over fifteen times our best estimates, when at least 0.4 percent of patients have active disease and when hospitalization of cases detected through domestic follow-up is no less likely than

  5. A review of accessibility of administrative healthcare databases in the Asia-Pacific region.

    PubMed

    Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

    2015-01-01

    We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3-6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted

  6. A systematic review of treatment response rates in Pakistani hepatitis C virus patients; current prospects and future challenges

    PubMed Central

    Ali, Muhammad; Afzal, Samia; Zia, Asad; Hassan, Ahmed; Khalil, Ali Talha; Ovais, Muhammad; Shinwari, Zabta Khan; Idrees, Muhammad

    2016-01-01

    Abstract Background: The estimated hepatitis C virus (HCV) carriers are approximately 10 million in Pakistan which usually progresses to chronic hepatitis, with rare cases of spontaneous viral eradication. The present article reviews the treatment status of HCV infection in Pakistani population and various factors associated with the treatment response rates. Methods: Literature on anti-HCV therapy was searched in PubMed, Google Scholar and PakMediNet. Thirty three different studies representing different geographic regions of Pakistan published from 2002 to 2016 were included in the present review. Weighted mean, standard error estimates (SE) and standard deviation (SD) were determined for each population group. Results: Mean value for sustained virological response (SVR) for standard IFN plus ribavirin (RBV) combination therapy was 68.38% ± 14.13% (range 33.8%–87.10%; SE 3.08) and pegylated-IFN plus RBV combination therapy 64.38% ± 8.68% (range 55.0%–76.00%; SE 3.88). The lowest value for SVR has been reported to be 24.3% (for genotype 1; administering INF-α 2b 3MU 3 times/week and RBV 1000–1200 mg/day for 48 weeks) while highest of 87.5% (genotype 3a; INF-α 2a 3MU 3 times/week and RBV 1000–1200 mg/day for 24 weeks). The mean value for rapid virological response (RVR) was found to be 48.18% ± 29.20% (SE 9.73). As PEG-interferon and direct acting antivirals (DAAs) are relatively expensive, interferon-alfa (IFN-α) and RBV combination therapy have been used widely to treat HCV infected patients in Pakistan for the last one and half decade. On average, 2.45% of the patients discontinued treatment due to severe side effects. Conclusion: We encourage further studies on understanding host and viral factors associated with specific focus on harder to treat viral variants (relapsers and nonresponders). These variants are currently rising in the country. PMID:27977575

  7. Antihypertensive and Statin Medication Use and Motor Function in Community-Dwelling Older Adults

    PubMed Central

    Perlman, Amichai; Shah, Raj C.; Bennett, David A.; Buchman, Aron S.; Matok, Ilan

    2015-01-01

    Objectives To investigate whether the use of antihypertensive and statin medication in very old adults is associated with the level of motor performance. Design Cross sectional study. Settings A community-based study recruited from over 40 residential facilities across the metropolitan Chicago area. Participants Community dwelling very old adults (n=1520; mean age 80.2; SD 7.7). Measurements Eleven motor performances were summarized using a composite motor score. All prescription and over the counter medications taken by participants were inspected and coded using the Medi-Span Data Base System. Demographic characteristics and medical history were obtained via detailed interview and medical exams. Results In multiple linear regression models, antihypertensive medications were associated with global motor score (β=−0.075, S.E. 0.011, p<0.001). Thus, motor function in an individual with antihypertensive medication, was on average, about 7.5% lower than an age, sex and education matched individual without antihypertensive medication. The number of antihypertensive medications which were being used had an additive effect, such that a reduction in the level of motor function was observed with each additional medication, and receiving three or more antihypertensive medications was associated with about a 15% reduction in the level of motor function. The association between antihypertensive medications and motor function was robust, and remained unchanged after adjusting for confounding by indication using several potentially confounding variables: smoking, hypertension, diabetes, stroke, congestive heart-failure, myocardial infarction, and intermittent claudication (β=−0.05, S.E. 0.015, p=0.001). In contrast, the use of statin medications was not related to motor function (unadjusted: β=0.003, S.E.=0.015, p=0.826; fully adjusted: β=0.018, S.E. 0.014, p=0.216). Conclusion The use of antihypertensive medications is associated with a lower level of motor function in

  8. Evaluation of a CdTe semiconductor based compact gamma camera for sentinel lymph node imaging

    SciTech Connect

    Russo, Paolo; Curion, Assunta S.; Mettivier, Giovanni; Esposito, Michela; Aurilio, Michela; Caraco, Corradina; Aloj, Luigi; Lastoria, Secondo

    2011-03-15

    Purpose: The authors assembled a prototype compact gamma-ray imaging probe (MediPROBE) for sentinel lymph node (SLN) localization. This probe is based on a semiconductor pixel detector. Its basic performance was assessed in the laboratory and clinically in comparison with a conventional gamma camera. Methods: The room-temperature CdTe pixel detector (1 mm thick) has 256x256 square pixels arranged with a 55 {mu}m pitch (sensitive area 14.08x14.08 mm{sup 2}), coupled pixel-by-pixel via bump-bonding to the Medipix2 photon-counting readout CMOS integrated circuit. The imaging probe is equipped with a set of three interchangeable knife-edge pinhole collimators (0.94, 1.2, or 2.1 mm effective diameter at 140 keV) and its focal distance can be regulated in order to set a given field of view (FOV). A typical FOV of 70 mm at 50 mm skin-to-collimator distance corresponds to a minification factor 1:5. The detector is operated at a single low-energy threshold of about 20 keV. Results: For {sup 99m}Tc, at 50 mm distance, a background-subtracted sensitivity of 6.5x10{sup -3} cps/kBq and a system spatial resolution of 5.5 mm FWHM were obtained for the 0.94 mm pinhole; corresponding values for the 2.1 mm pinhole were 3.3x10{sup -2} cps/kBq and 12.6 mm. The dark count rate was 0.71 cps. Clinical images in three patients with melanoma indicate detection of the SLNs with acquisition times between 60 and 410 s with an injected activity of 26 MBq {sup 99m}Tc and prior localization with standard gamma camera lymphoscintigraphy. Conclusions: The laboratory performance of this imaging probe is limited by the pinhole collimator performance and the necessity of working in minification due to the limited detector size. However, in clinical operative conditions, the CdTe imaging probe was effective in detecting SLNs with adequate resolution and an acceptable sensitivity. Sensitivity is expected to improve with the future availability of a larger CdTe detector permitting operation at shorter

  9. Pediatric cardiothoracic program in Malaysia: a study based on the outcome of the program

    PubMed Central

    Piros Kulandasamy Pillai, Cornelius; Yoshida, Yoshitoku; Justin Lawrence, Patrick; Yamamoto, Eiko; Reyer, Joshua A.; Hamajima1, Nobuyuki

    2016-01-01

    ABSTRACT Vulnerable communities in Malaysia have been facing issues of accessibility and availability for pediatric cardiac services for years due to long waiting times, high costs and a lack of pediatric cardiothoracic surgeons. To ease this situation, the government has allocated a certain amount of funds, introduced through the Pediatric Cardiothoracic Program (PCP), in which the patients are transported to the Narayana Health Institute of Cardiac Science (NH) in India to receive a heart operation following an eligibility check at MediAssist4U Sdn Bhd in Selangor, Malaysia, a facility appointed by the NH. This study aimed to determine the demographic incidence of congenital heart diseases of patients in this program and to evaluate the outcome of the program in association with post-operative mortality rate and the beneficial factors of the program. In this study, 241 patients who participated in this program from August 2008 to September 2012 were reviewed. Fisher’s exact tests were applied to calculate p-values of categorical data. Out of 241, 11 patients were rejected because of their poor health condition for flight transportation to India, leaving 230 patients for analysis. The majority of patients were 1 to 4 years of age (57.8%), Malays (61.7%), from families of monthly household income less than RM 1,500 (86.5%) and with primary school-educated parents (86.5%). Patients could apply from any government hospital in Malaysia, but 34.8% of the patients were from the state of Johor. The region (Peninsular Malaysia and East Malaysia) of patients seeking pediatric cardiac services was significantly associated with race (p<0.001), low household income (p<0.001) and low education background of parents (p=0.004). The associations between the age group and diagnosis group (p=0.010) and between duration of hospitalization and outcome of medical management (p=0.013) were significant. Post-operative mortality rate was 1.7% (95% confidence interval, 0.5–4.4). In

  10. Correlates for Completion of 3-Dose Regimen of HPV Vaccine in Female Members of a Managed Care Organization

    PubMed Central

    Chao, Chun; Velicer, Christine; Slezak, Jeff M.; Jacobsen, Steven J.

    2009-01-01

    OBJECTIVE: To examine the rate and correlates of completion of the quadrivalent human papillomavirus vaccine (HPV4) 3-dose regimen because nonadherence to the regimen may adversely affect vaccine efficacy. PARTICIPANTS AND METHODS: Female members of Kaiser Permanente Southern California who were 9 to 26 years old, received the first dose of HPV4 between October 2006 and March 2007, and maintained health plan membership 12 months afterward were identified and followed up for regimen completion. We examined the following: (1) demographics/socioeconomic status, (2) primary care physician characteristics, (3) historical health service utilization, (4) women's health-related conditions, and (5) selected immune-related conditions for their association with completion in 2 age groups: 9 to 17 years and 18 to 26 years. Multivariable log-binomial regression was used to directly estimate relative risk (RR). RESULTS: Of the 34,193 females who initiated HPV4, the completion rate was 41.9% in the 9- to 17-year-old group and 47.1% in the 18- to 26-year-old group. Black race (RR, 0.70; 95% confidence interval [CI], 0.64-0.77) and lower neighborhood education level were associated with lower regimen completion. However, those in the 9- to 17-year-old group who were covered by the state-subsidized program Medi-Cal were more likely to complete the regimen (RR, 1.14; 95% CI, 1.07-1.22). Historical hospitalizations and emergency department visits (RR, 0.92; 95% CI, 0.87-0.96; and RR, 0.96; 95% CI, 0.94-0.98 per visit, respectively) and having a pediatrician were also predictors of noncompletion. A history of sexually transmitted diseases, abnormal Papanicolaou test results, and immune-related conditions (eg, asthma/infections) were not associated with regimen completion. CONCLUSION: These findings suggest that factors such as race or socioeconomic status should be considered when human papillomavirus vaccination programs are being designed and evaluated. PMID:19797775

  11. Morphological changes in hard dental tissues prepared by Er:YAG laser (LiteTouch, Syneron), Carisolv and rotary instruments. A scanning electron microscopy evaluation.

    PubMed

    Tsanova, Snejana Ts; Tomov, Georgi T

    2010-01-01

    This in vitro investigation aimed to study by means of scanning electron microscope the morphological changes in hard dental tissues after using several different methods for caries removal and cavity preparation. Twenty freshly extracted human teeth with carious lesions were used in the study. They were assigned to four groups depending on the method used for preparation: Group 1--Cavity preparation using Er: YAG laser (LiteTouch, Syneron, Israel). Group 2--Chemomechanical preparation using colourless Carisolv gel (MediTeam AB, Savedalen, Sweden). Group 3--Mechanical rotary preparation using diamond burs and air turbine. Group 4--Mechanical rotary preparation using by steel burs and micromotor. The preparations were performed strictly according to the manufacturer's instructions for proper use of instruments. The teeth samples were prepared for histological study and investigated by a scanning electron microscope at different magnification; the morphological changes in the tissues were registered and compared. There were considerable differences in the surface characteristics of the dental tissues when we analysed the photomicrographs of the specimens obtained using scanning electron microscopy (SEM). The surface after laser treatment remained highly retentive with no residual smear layer; the second best results in this respect were registered when teeth were chemomechanically excavated with Carisolv gel. The mechanical methods of cavity preparation resulted in surfaces with a smear layer of dentin without any microretentions. The scanning electron microscopy of hard dental tissues prepared using steel and diamond burs showed surfaces covered with a thick smear layer that may be relevant to the subsequent bonding of adhesive restorative materials to the prepared cavity. In preparing the surface using a turbine with diamond burs the smear layer was thinner and part of the dentinal tubules orifices were open in the area of water turbulence. SEM analysis of hard

  12. Tonsillectomy for periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA).

    PubMed

    Burton, Martin J; Pollard, Andrew J; Ramsden, James D

    2010-09-08

    PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis syndrome) is a rare clinical syndrome of unknown cause usually identified in children. To assess the efficacy of tonsillectomy (with or without adenoidectomy) in children with PFAPA. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 1); MEDLINE (PubMed); EMBASE; CINAHL; mRCT (metaRegister of clinical trials, including ClinicalTrials.gov); NRR (National Research Register); LILACS; KoreaMed; IndMed; PakMediNet; China Knowledge Network; CAB Abstracts; Web of Science; BIOSIS Previews; ICTRP (International Clinical Trials Registry Platform) and Google. The date of the last search was 21 January 2010. Randomised studies comparing adeno-/tonsillectomy with non-surgical treatment. Two authors independently assessed trial quality and extracted data. Two trials involving 67 children were included. One high quality study demonstrated a dramatic benefit of adenotonsillectomy in children with PFAPA diagnosed according to rigid, standard criteria with a relative 'risk' (RR) of symptom resolution after 18 months of 12.63 (95% CI 1.81 to 87.98) and a lower rate of episodes per patient-month (rate ratio 0.07; 95% CI 0.04 to 0.13). A less methodologically rigorous study enrolled some children with PFAPA, but probably included others with alternative types of recurrent pharyngitis, and performed tonsillectomy alone. This also demonstrated a significant benefit for surgery at six months: RR 1.93 (95% CI 1.11 to 3.36); rate ratio episodes per patient-month 0.10 (95% CI 0.04 to 0.28). The pooled relative risk of symptom resolution was 3.25 (95% CI 1.78 to 5.92) and the resulting number needed to treat (NNT) 2 (95% CI 1 to 3). The trials included in this review reported follow up at 18 and six months respectively but it is well-established that children with PFAPA recover spontaneously and treatment can be administered to try and reduce the

  13. Micro-tensile bond strength and interfacial characterization of an adhesive bonded to dentin prepared by contemporary caries-excavation techniques.

    PubMed

    Neves, Aline de A; Coutinho, Eduardo; Cardoso, Marcio V; de Munck, Jan; Van Meerbeek, Bart

    2011-06-01

    To evaluate the micro-tensile bond strength (μTBS) and interfacial characteristics of adhesive-dentin bonds produced after caries-removal with contemporary techniques. Carious molars were cut at the base of the fissure, exposing 'sound' and 'carious' dentin at different spots. After caries-excavation, a composite was bonded using a 2-step self-etch adhesive. The μTBS was measured and the mode of fracture analyzed using a stereomicroscope and imaged by Feg-SEM, while additional non-fractured specimens were histologically analyzed after Masson's trichrome staining in order to identify potentially incompletely resin-enveloped collagen. μTBS to residual caries-excavated dentin was lower than to sound dentin. The different caries-removing techniques had a significant effect on the μTBS. Er:YAG laser guided by a LIF-feedback system (Kavo) resulted in the lowest μTBS (26.8% lower than to 'sound' dentin) and a distinct layer of incompletely resin-enveloped collagen at the interface. Although different degrees of collagen exposure were seen for other caries-removing techniques, such as a thick layer for CeraBur (Komet-Brasseler), some unprotected collagen areas for Cariex (Kavo), or completely resin-enveloped collagen for a tungsten-carbide-bur (Komet), the μTBS appeared not directly affected (10%, 16.6%, and 15.3% lower than to 'sound' dentin, respectively). Carisolv (MediTeam) resulted in the highest μTBS (only 1% reduction compared to that to 'sound' dentin), followed by the tungsten-carbide-bur aided by Caries Detector (Kuraray) (4.8% reduction). Enzymatic caries excavation using the experimental SFC-VIII (3M-ESPE) aided by a disposable plastic instrument resulted in a 19.4% reduction in μTBS as compared to that to 'sound' dentin. The dentin bonding receptiveness depends to a large extent on the caries-excavation method employed. Copyright © 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  14. Health care resource utilization and costs of California Medicaid patients with schizophrenia treated with paliperidone palmitate once monthly or atypical oral antipsychotic treatment.

    PubMed

    Pesa, Jacqueline A; Doshi, Dilesh; Wang, Li; Yuce, Huseyin; Baser, Onur

    2017-04-01

    To compare all-cause health care utilization and costs between patients with schizophrenia treated with once monthly paliperidone palmitate (PP1M; Invega Sustenna (1) ) and atypical oral antipsychotic therapy (OAT). This was a retrospective claims-based analysis among adult California Medicaid (Medi-Cal) patients with schizophrenia having ≥2 claims for PP1M or OAT from 1 July 2009 to 31 December 2013 and continuous health plan enrollment for ≥1 year pre- and post-index date (PP1M or OAT initiation date). Baseline characteristics were reported descriptively. Propensity score matching with a 1:1 greedy match method was used to create two matched cohorts. Treatment patterns, all-cause health care utilization, and costs for the 12 month follow-up period were compared between the two matched cohorts. Two well matched cohorts of 722 patients were produced with similar baseline characteristics. During the 12 month follow-up period, PP1M patients were significantly less likely to discontinue treatment (30.6% vs. 39.5%, p < .001) or switch to a new therapy (21.6% vs. 27.7%, p = .007). PP1M patients had fewer inpatient visits (5.0 vs. 7.9, p < .001), lower mean hospitalization days (15.0 vs. 27.7 days, p < .001) and inpatient costs ($5060 vs. $10,880, p < .001). While pharmacy costs were significantly higher in the PP1M cohort ($16,347 vs. $9115, p < .001), total costs were not significantly different between the matched cohorts ($25,546 vs. $25,307, p = 0.853). Patients with schizophrenia treated with PP1M had significantly fewer inpatient hospitalizations and associated costs with no significant difference in the total costs between the two cohorts. This study is subject to limitations associated with claims data such as miscoding, inability to examine clinical severity, etc.

  15. Tezepelumab in Adults with Uncontrolled Asthma.

    PubMed

    Corren, Jonathan; Parnes, Jane R; Wang, Liangwei; Mo, May; Roseti, Stephanie L; Griffiths, Janet M; van der Merwe, René

    2017-09-07

    In some patients with moderate-to-severe asthma, particularly those with noneosinophilic inflammation, the disease remains uncontrolled. This trial evaluated the efficacy and safety of tezepelumab (AMG 157/MEDI9929), a human monoclonal antibody specific for the epithelial-cell-derived cytokine thymic stromal lymphopoietin (TSLP), in patients whose asthma remained uncontrolled despite treatment with long-acting beta-agonists and medium-to-high doses of inhaled glucocorticoids. In this phase 2, randomized, double-blind, placebo-controlled trial, we compared subcutaneous tezepelumab at three dose levels with placebo over a 52-week treatment period. The primary end point was the annualized rate of asthma exacerbations (events per patient-year) at week 52. The use of tezepelumab at a dose of 70 mg every 4 weeks (low dose; 145 patients), 210 mg every 4 weeks (medium dose; 145 patients), or 280 mg every 2 weeks (high dose; 146 patients) resulted in annualized asthma exacerbation rates at week 52 of 0.26, 0.19, and 0.22, respectively, as compared with 0.67 in the placebo group (148 patients). Thus, exacerbation rates in the respective tezepelumab groups were lower by 61%, 71%, and 66% than the rate in the placebo group (P<0.001 for all comparisons). Similar results were observed in patients regardless of blood eosinophil counts at enrollment. The prebronchodilator forced expiratory volume in 1 second at week 52 was higher in all tezepelumab groups than in the placebo group (difference, 0.12 liters with the low dose [P=0.01], 0.11 liters with the medium dose [P=0.02], and 0.15 liters with the high dose [P=0.002]). A total of 2 patients in the medium-dose group, 3 in the high-dose group, and 1 in the placebo group discontinued the trial regimen because of adverse events. Among patients treated with long-acting beta-agonists and medium-to-high doses of inhaled glucocorticoids, those who received tezepelumab had lower rates of clinically significant asthma exacerbations than

  16. Respiratory Syncytial Virus Modified by Deletions of the NS2 Gene and Amino Acid S1313 of the L Polymerase Protein Is a Temperature-Sensitive, Live-Attenuated Vaccine Candidate That Is Phenotypically Stable at Physiological Temperature

    PubMed Central

    Luongo, Cindy; Winter, Christine C.; Collins, Peter L.

    2013-01-01

    Human respiratory syncytial virus (RSV) is the leading viral cause of lower respiratory tract disease in infants and children worldwide. In previous work to develop point mutations in RSV with improved genetic stability, we observed that an attenuating mutation at amino acid position 1321 in the L polymerase protein was subject to deattenuation by a spontaneous second-site compensatory mutation at position 1313 (C. Luongo, C. C. Winter, P. L. Collins, and U. J. Buchholz, J. Virol. 86:10792–10804, 2012). In the present study, we found that deletion of position 1313 (Δ1313), irrespective of the presence of an attenuating mutation at position 1321, provided a new attenuating mutation. RSV bearing Δ1313 replicated in cell culture as efficiently as wild-type virus at 32°C, was restricted for replication at 37°C, and was restricted 50-fold and 150-fold in the upper and lower respiratory tracts, respectively, of mice. We combined the Δ1313 deletion with the previously described, attenuating NS2 gene deletion (ΔNS2) to produce the recombinant live-attenuated RSV vaccine candidate ΔNS2/Δ1313. During in vitro stress tests involving serial passage at incrementally increasing temperatures, a second-site compensatory mutation was detected in close proximity of Δ1313, namely, I1314T. This site was genetically and phenotypically stabilized by an I1314L substitution. Combination of I1314L with ΔNS2/Δ1313 yielded a virus, ΔNS2/Δ1313/1314L, with genetic stability at physiological temperature. This stabilized vaccine candidate was moderately temperature sensitive and had a level of restriction in chimpanzees comparable to that of MEDI-559, a promising RSV vaccine candidate that presently is in clinical trials but lacks stabilized attenuating mutations. The level of attenuation and genetic stability identify ΔNS2/Δ1313/1314L as a promising candidate for evaluation in pediatric phase I studies. PMID:23236065

  17. [Adherence to the Mediterranean diet and its relation to nutritional status in older people].

    PubMed

    Zaragoza Martí, Ana; Ferrer Cascales, Rosario; Cabañero Martínez, María José; Hurtado Sánchez, Jose Antonio; Laguna Pérez, Ana

    2015-04-01

    Introducción: la Dieta Mediterránea (DM) como modelo de dieta de calidad se asocia con una reducción de la mortalidad y con una mejora en la calidad de vida en personas mayores. Objetivo: evaluar la relación entre el estado nutricional y los estilos de vida con el grado de adherencia a la DM en personas mayores Métodos: Muestra compuesta por 60 sujetos que acudían a la consulta de enfermería de un cetro de salud de Alicante con un Índice de Masa Corporal mayor a 24.9. Se utilizó el cuestionario de frecuencia de consumo de alimentos MEDIS-FFQ, el cuestionario de adherencia a la Dieta Mediterránea PREDIMED y la valoración antropométrica. Resultados: El 83.3% de la población presentó sobrepeso frente a un 16.7% de obesidad, sin diferencias significativas entre sexos. El porcentaje de grasa corporal fue del 40.3% en las mujeres y 29.5% en los hombres (p=0.001). El 65.2% de la mujeres presentó riesgo cardiovascular frente al 81.8% de los hombres (p=0.001). Se observó bajo cumplimento de las recomendaciones alimentarias en los cereales integrales, fruta y frutos secos. Los sujetos con baja adherencia a la DM presentaron mayores índices de obesidad (OR= 1.46; IC 95%, 0.89-2.40), un mayor consumo de tabaco (OR= 1.65; IC 95%, 1.05-2.60) y de alcohol (OR=1.53; IC 95%, 0.91-2.55), un mayor índice cintura-cadera (OR= 2.57; IC 95%, 1.3-4.9) y mayor porcentaje de grasa corporal (OR= 5.3; IC 95%, 1.02-6.48). Conclusión: Los sujetos con una buena adherencia a la (DM) presentaron un menor índice cintura-cadera y un menor porcentaje de grasa corporal.

  18. Reassessing the Association between WIC and Birth Outcomes Using a Fetuses-at-Risk Approach.

    PubMed

    Fingar, Kathryn R; Lob, Sibylle H; Dove, Melanie S; Gradziel, Pat; Curtis, Michael P

    2017-04-01

    Objectives Women with longer, healthier pregnancies have more time to enroll in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), biasing associations between WIC and birth outcomes. We examined the association between WIC and preterm birth (PTB), low birth weight (LBW), and perinatal death (PND) using a fetuses-at-risk approach to address this bias, termed gestational age bias. Methods We linked California Medi-Cal recipients with a singleton live birth or fetal death from the 2010 Birth Cohort to WIC participant data (n = 236,564). We implemented a fetuses-at-risk approach using survival analysis, which compared, in each week of gestation, women whose pregnancies reached the same length and who had the same opportunity to utilize WIC. In each gestational week, we assessed WIC enrollment and the number of food packages redeemed thus far and computed hazard ratios (HR) using survival models with time-varying exposures and effects. Results Adjusting for maternal socio-demographic and health characteristics, WIC enrollment was associated with a lower risk of PTB from week 29-36 (HR29 = 0.71; HR36 = 0.52); LBW from week 26-40 (HR26 = 0.77; HR40 = 0.64); and PND from week 29-43 (HR29 = 0.78; HR43 = 0.69) (p < 0.05). The number of food packages redeemed was associated with a lower risk of PTB from week 27-36 (HR27 = 0.90; HR36 = 0.84); LBW from week 25-42 (HR25 = 0.93; HR42 = 0.88); and PND from week 27-46 (HR27 = 0.94; HR46 = 0.91) (p < 0.05). Conclusions for Practice To our knowledge this is the first study to examine the association between WIC and birth outcomes using this approach. We found that beginning from about 29 weeks, WIC enrollment was associated with a reduced risk of PTB by 29-48 %, LBW by 23-36 %, and PND by 22-31 %.

  19. Clinical evaluation of compounds targeting PD-1/PD-L1 pathway for cancer immunotherapy.

    PubMed

    Lu, Jing; Lee-Gabel, Linda; Nadeau, Michelle C; Ferencz, Thomas M; Soefje, Scott A

    2015-12-01

    Significant enthusiasm currently exists for new immunotherapeutic strategies: blocking the interaction between programmed death-1 receptor on T-cells and programmed death-ligand 1 on tumor cells to boost immune system stimulation to fight cancer. Immunomodulation with the antiprogrammed death-1/programmed death-ligand 1 monoclonal antibodies has shown to mediate tumor shrinkage and extend overall survival from several pivotal phase I/II studies in melanoma, renal cell carcinoma, and non-small cell lung cancer. This has prompted multiple large ongoing phase III trials with the expectation for fast-track FDA approvals to satisfy unmet medical needs. Compounds targeting the programmed death-1 pathway that are in clinical trials fall into two major categories, namely antiprogrammed death-1 antibodies: Nivolumab, MK-3475, and pidilizumab; and antiprogrammed death-ligand 1 antibodies: MPDL3280A, BMS-936559, MEDI4736, and MSB0010718C. We reviewed the clinical efficacy and safety of each compound based upon major registered clinical trials and published clinical data. Overall, response rate of more than 20% is consistently seen across all these trials, with maximal response of approximately 50% achieved by certain single antiprogrammed death-1 agents or when used in combination with cytotoxic T-lymphocyte antigen-4 blockade. The responses seen are early, durable, and have continued after treatment discontinuation. Immune-related adverse events are the most common side effects seen in these clinical trials. Overall, the skin and gastrointestinal tract are the most common organ systems affected by these compounds while hepatic, endocrine, and neurologic events are less frequent. These side effects are low grade, manageable, and typically resolve within a relatively short time frame with a predictable resolution pattern given proper management. We therefore propose detailed guidelines for management of major immune-related adverse events that are anticipated with

  20. The Effect of Traditional Cupping on Pain and Mechanical Thresholds in Patients with Chronic Nonspecific Neck Pain: A Randomised Controlled Pilot Study

    PubMed Central

    Lauche, Romy; Cramer, Holger; Hohmann, Claudia; Choi, Kyung-Eun; Rampp, Thomas; Saha, Felix Joyonto; Musial, Frauke; Langhorst, Jost; Dobos, Gustav

    2012-01-01

    Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: −17.9 mm VAS, 95%CI −29.2 to −6.6; PM: −19.7, 95%CI −32.2 to −7.2; PaDi: −1.5 points on NRS, 95%CI −2.5 to −0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP. PMID:22203873

  1. Association of metabolic syndrome and its components with arterial stiffness in Caucasian subjects of the MARK study: a cross-sectional trial.

    PubMed

    Gomez-Sanchez, Leticia; Garcia-Ortiz, Luis; Patino-Alonso, M Carmen; Recio-Rodriguez, Jose I; Fernando, Rigo; Marti, Ruth; Agudo-Conde, Cristina; Rodriguez-Sanchez, Emiliano; Maderuelo-Fernandez, Jose A; Ramos, Rafel; Gomez-Marcos, Manuel A

    2016-10-24

    The cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV) can reflect both central and peripheral arterial stiffness. Metabolic syndrome (MetS) and its components may increase arterial stiffness and the risk of cardiovascular diseases. However, the correlation of MetS and its components with arterial stiffness is still not clear. The primary aim of this study is thus the relationship using baPWV and CAVI in Caucasian adults with intermediate cardiovascular risk. The secondary aim is to analyze sex differences. This study analyzed 2351 subjects aged 35-74 years (mean, 61.4 ± 7.7 years) comprising 61.7 % males and enrolled in the improving interMediAte Risk management (MARK) study. CAVI was measured using a VaSera VS-1500 (®) device, and baPWV was calculated using a validated equation. MetS was defined based on the Joint Scientific Statement National Cholesterol Education Program III. Waist circumference, blood pressure, fasting plasma glucose, and lipid profile were measured. MetS was found in 51.9 % of the subjects. All MetS components except reduced HDL-cholesterol (p = 0.578) were associated with CAVI. High density lipoprotein cholesterol (p = 0.075) and waist circumference (p = 0.315) were associated with baPWV. The different MetS components that assess dyslipidemia using the stiffness measures show different associations according to patient sex. The high blood pressure component had a greater odds ratio (OR) for both baPWV ≥ 17.5 m/sec (OR = 6.90, 95 % CI 3.52-13.519) and CAVI ≥ 9 (OR = 2.20, 95 % CI 1.63-1.90). MetS and all its components (except HDL-cholesterol with baPWV and CAVI and WC with baPWV) were associated with baPWV and CAVI. However, there were sex differences in the association of MetS and its components with baPWV and CAVI. Data from this study suggest a greater association of CAVI and baPWV values with MetS components in males than in females and indicate greater arterial stiffness in the

  2. Evaluation of the effects of insufficient blood volume samples on the performance of blood glucose self-test meters.

    PubMed

    Pfützner, Andreas; Schipper, Christina; Ramljak, Sanja; Flacke, Frank; Sieber, Jochen; Forst, Thomas; Musholt, Petra B

    2013-11-01

    Accuracy of blood glucose readings is (among other things) dependent on the test strip being completely filled with sufficient sample volume. The devices are supposed to display an error message in case of incomplete filling. This laboratory study was performed to test the performance of 31 commercially available devices in case of incomplete strip filling. Samples with two different glucose levels (60-90 and 300-350 mg/dl) were used to generate three different sample volumes: 0.20 µl (too low volume for any device), 0.32 µl (borderline volume), and 1.20 µl (low but supposedly sufficient volume for all devices). After a point-of-care capillary reference measurement (StatStrip, NovaBiomedical), the meter strip was filled (6x) with the respective volume, and the response of the meters (two devices) was documented (72 determinations/meter type). Correct response was defined as either an error message indicating incomplete filling or a correct reading (±20% compared with reference reading). Only five meters showed 100% correct responses [BGStar and iBGStar (both Sanofi), ACCU-CHEK Compact+ and ACCU-CHEK Mobile (both Roche Diagnostics), OneTouch Verio (LifeScan)]. The majority of the meters (17) had up to 10% incorrect reactions [predominantly incorrect readings with sufficient volume; Precision Xceed and Xtra, FreeStyle Lite, and Freedom Lite (all Abbott); GlucoCard+ and GlucoMen GM (both Menarini); Contour, Contour USB, and Breeze2 (all Bayer); OneTouch Ultra Easy, Ultra 2, and Ultra Smart (all LifeScan); Wellion Dialog and Premium (both MedTrust); FineTouch (Terumo); ACCU-CHEK Aviva (Roche); and GlucoTalk (Axis-Shield)]. Ten percent to 20% incorrect reactions were seen with OneTouch Vita (LifeScan), ACCU-CHEK Aviva Nano (Roche), OmniTest+ (BBraun), and AlphaChek+ (Berger Med). More than 20% incorrect reactions were obtained with Pura (Ypsomed), GlucoCard Meter and GlucoMen LX (both Menarini), Elite (Bayer), and MediTouch (Medisana). In summary, partial and

  3. Boosting the coagulation restores haemostasis in ticagrelor-treated mice.

    PubMed

    Pehrsson, Susanne; Hansson, Kenny; Nelander, Karin; Nylander, Sven

    2016-12-01

    Antiplatelet therapy is given to patients with acute coronary syndrome to reduce the risk for thrombotic events, but may increase the risk for bleeding. Ticagrelor was administered intravenously to mice. Cumulative blood loss and bleeding time were measured after cutting 5 mm of the tail, 20 min after the start of ticagrelor infusion. The tail was placed in a hemoglobin-sensitive device measuring light absorbance (abs) over time for 35 min. Activated recombinant human factor VII (rhFVIIa; NovoSeven; NovoNordisk A/S, Bagsvaerd, Denmark) 1 mg/kg (study 1); recombinant human prothrombin (rhFII, MEDI8111) 10 mg/kg (study 2); or vehicle was given intravenously once bleeding had commenced, within 90s after tail cut. Ticagrelor resulted in more than 98% inhibition of ex-vivo ADP-induced platelet aggregation. In study 1, the median blood loss in the ticagrelor, vehicle, and rhFVIIa groups were 909, 122, and 397 abs*s, respectively (P < 0.05 for both comparisons, including the ticagrelor group). Similar pattern was seen for bleeding time. The median bleeding time in the ticagrelor, vehicle, and rhFVIIa groups were 2003, 449, and 884s, respectively (P < 0.05 for both comparisons, including the ticagrelor group). In study 2, the median blood loss and bleeding time in the ticagrelor group were 362 abs*s and 1847s. The corresponding numbers for the vehicle and rhFII groups were 71 abs*s and 613s, and 178 abs*s and 701s, respectively (P < 0.05 for comparisons between ticagrelor and vehicle for both blood loss and bleeding time). In mice dosed to complete P2Y12 inhibition, boosting coagulation by administration of rhFVIIa or rhFII within 90s after bleeding initiation can partly reverse ticagrelor-enhanced bleeding.

  4. Assessing Medicare's prospective payment system for hospitals.

    PubMed

    Chulis, G S

    1991-01-01

    inpatient hospital spending, PPS has increased the share of Medicare spending under SMI, where beneficiaries have higher coinsurance. The short-run beneficiary response appears to be an increase in demand for Medi-gap health insurance rather than a dampening of demand for services. To this point it appears that Medicare's PPS has been successful in containing the growth in hospital costs while avoiding, or managing, unwanted consequences. (ABSTRACT TRUNCATED AT 400 WORDS)

  5. Assessment of Worldwide Acute Kidney Injury, Renal Angina and Epidemiology in Critically Ill Children (AWARE): A Prospective Study to Improve Diagnostic Precision

    PubMed Central

    Basu, Rajit K; Kaddourah, Ahmad; Terrell, Tara; Mottes, Theresa; Arnold, Patricia; Jacobs, Judd; Andringa, Jennifer; Armor, Melissa; Hayden, Lauren; Goldstein, Stuart L

    2015-01-01

    Background Acute kidney injury (AKI) is associated with poor outcomes in critically ill children. Recent international consensus panels recommend standardized classification systems to improve the precision of AKI diagnosis, but there is a paucity of data to enable this refinement, particularly in pediatric critical care. Methods/Design This is a prospective observational study. We anticipate collecting data from more than 5500 critically ill children admitted to 32 pediatric intensive care units (PICUs) across the world, during the calendar year of 2014. Data will be collected continuously for three months at each center on all children older than 90 days and younger than 25 years admitted to the ICU. Demographic, resuscitative, and daily physiological and lab data will be captured at individual centers using MediData Rave™, a commercial system designed to manage and report clinical research data. Kidney specific measured variables include changes in serum creatinine and urine output, cumulative fluid overload (%), serum creatinine corrected for fluid balance, and KDIGO AKI stage. Urinary AKI biomarkers to be measured include: urinary neutrophil gelatinase lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (l-FABP), and interleukin-18 (IL-18). Biomarker combinations will be created from different pairs and triplets of urinary biomarkers. The primary analysis will compare the discrimination of these panels versus changes in creatinine for prediction of severe AKI by Day 7 of ICU admission. Secondary analysis will investigate the prediction of biomarkers for injury ‘time based phenotypes’: duration (>2 days), severity (KDIGO stage, use of renal replacement therapy), reversibility (time to return of serum creatinine to baseline), association with fluid overload > 10%, and disease association (sepsis, hypovolemia, hypoxemia, or nephrotoxic). Discussion The Assessment of Worldwide Acute Kidney Injury, Renal Angina and

  6. Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands

    PubMed Central

    Stevanović, J.; de Jong, L. A.; Kappelhoff, B. S.; Dvortsin, E. P.; Voorhaar, M.; Postma, M. J.

    2016-01-01

    Background Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Methods Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RE-SONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). Results In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving €1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at €2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at €33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. Conclusion From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the

  7. Mediterranean lifestyle and cardiovascular disease prevention

    PubMed Central

    Georgousopoulou, Ekavi N.; Mellor, Duane D.; Naumovski, Nenad; Polychronopoulos, Evangelos; Tyrovolas, Stefanos; Piscopo, Suzanne; Valacchi, Giuseppe; Anastasiou, Foteini; Zeimbekis, Akis; Bountziouka, Vassiliki; Gotsis, Efthimios; Metallinos, George; Tyrovola, Dimitra; Foscolou, Alexandra; Tur, Josep-Antoni; Matalas, Antonia-Leda; Lionis, Christos; Sidossis, Labros

    2017-01-01

    Background Adherence to a Mediterranean dietary pattern is a well-established protective factor against cardiovascular disease (CVD). However, diet quality is only one aspect of the overall healthy lifestyle adopted by Mediterranean populations. The latter has never been evaluated as a multi-factorial composite lifestyle. Thus, the aim of the present study was to provide a broader picture of the Mediterranean lifestyle and its effects on CVD risk, among elderly individuals. Methods During 2005–2015, 2,749 older (aged 65–100 years) from 21 Mediterranean islands (MEDIS) and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled onto the study. Dietary habits, physical activity status, socio-demographic characteristics, lifestyle parameters (sleep, smoking habits, social life and educational status) and clinical profile aspects were derived through standard procedures. Results The overall prevalence of the traditional CVD risk factors were 62.3% for hypertension, 22.3% for diabetes mellitus (type 2) and 47.7% for hypercholesterolemia. The presence of diabetes mellitus was positively predicted by the geriatric depression scale (GDS) [odds ratio (OR) =1.13, 95% confidence interval (CI): 1.02–1.25] and by an urban residential environment (OR =2.57, 95% CI: 1.10–6.06) after adjusting for several confounders. Presence of hypertension was predicted by increasing age (OR =1.07, 95% CI: 1.02–1.12), increasing body mass index (BMI) (OR =1.12, 95% CI: 1.04–1.21), the habit of midday sleep (OR =2.07, 95% CI: 1.07–4.02) and inversely predicted by the frequency of socializing with friends (OR =0.767, 95% CI: 0.616–0.955). The estimated score in the GDS was the only independent positive predictor for the presence of hypercholesterolemia (OR =1.10, 95% CI: 1.01–1.21). Conclusions Lifestyle parameters such as social life, midday sleep (siesta) and residential environment are strongly associated with the presence of CVD risk factors in elderly and

  8. Racial Disparities in Completion Rates from Publicly Funded Alcohol Treatment: Economic Resources Explain More Than Demographics and Addiction Severity

    PubMed Central

    Jacobson, Jerry O; Robinson, Paul L; Bluthenthal, Ricky N

    2007-01-01

    Objectives To assess racial and ethnic differences in rates of completion from publicly funded alcohol treatment programs, and to estimate the extent to which any identified racial differences in completion rates are related to differences in patient characteristics. Data Sources Administrative intake and discharge records from all publicly funded outpatient and residential alcohol treatment recovery programs in Los Angeles County (LAC) during 1998–2000. Study participants (N = 10,591) are African American, Hispanic, and white patients discharged from these programs, ages 18 or older, who reported alcohol as their primary substance abuse problem. Study Design Bivariate tests identified racial and ethnic differences in rates of treatment completion and patient characteristics. Logistic regression models assessed the contribution of differences in patient characteristics to differences in completion. Principal Findings Significantly lower completion rates by African Americans (17.5 percent) relative to whites (26.7 percent) (odds ratio [OR] = 0.58, 95 percent confidence interval [CI]: 0.50–0.68) are partially explained (40 percent) by differences in patient characteristics in outpatient care (adjusted OR = 0.75, 95 percent CI: 0.63–0.90), mostly by indicators of economic resources (i.e., employment, homelessness, and Medi-Cal beneficiary). In residential care, only 7 percent of differences in completion (30.7 versus 46.1 percent) could be explained by the patient-level measures available (OR = 0.52, 95 percent CI: 0.45–0.59; AOR = 0.55, 95 percent CI: 0.47–0.65). Differences in completion rates between Hispanic and white patients were not detected. Conclusions Large differences in rates of outpatient and residential alcohol treatment completion between African American and white patients at publicly funded programs in LAC, the nation's second largest, publicly funded alcohol and drug treatment system, are partially because of economic differences among

  9. [Localization and distribution of human olfactory mucosa in the nasal cavities].

    PubMed

    Escada, Pedro

    2013-01-01

    Introdução: A distribuição da mucosa olfactiva humana só pode ser determinada em estudos que avaliem a totalidade da região olfactiva. O objectivo deste trabalho é determinar a distribuição da mucosa olfactiva humana a partir do estudo histológico, por microscopia óptica, de peças anatómicas da região olfactiva obtidas do cadáver.Material e Métodos: Utilizaram-se peças anatómicas da região olfactiva colhidas durante a autópsia de cadáveres recentes. Em cada uma das peças foi determinada a distância entre a lâmina crivosa e o limite inferior da região olfactiva em três localizações diferentes da parede septal e da parede lateral.Resultados: das 230 peças anatómicas disponíveis, 217 foram excluídas por razões clínicas ou técnicas. Realizaram-se estudosmorfométricos em 13 peças num total de 156 medições. O limite inferior da mucosa olfactiva no septo nasal estava a 15,9 ± 3,2 mm, a 15,3 ± 3 mm e a 16 ± 2,8 mm nas porções anterior, média e posterior da região olfactiva. O limite inferior da mucosa olfactiva na parede turbinal estava a 15,3 ± 2,4 mm, a 14,8 ± 2,3 mm e a 12,3 ± 1,9 mm nas mesmas localizações. O valor mínimo observado foi de 12 mm.Conclusões: A mucosa olfactiva estende-se pelo corneto superior e médio e pelo septo nasal confrontante numa distância que nunca é inferior a 12 mm e que pode ultrapassar os 16 mm. O conhecimento da distribuição exacta da mucosa olfactiva nas fossas nasais pode ser útil para orientar a colheita em seres humanos, com propósitos diagnósticos ou terapêuticos.

  10. Prevalence of Hepatitis C Virus Genotypes Among Patients in Countries of the Eastern Mediterranean Regional Office of WHO (EMRO): A Systematic Review and Meta-Analysis

    PubMed Central

    Sadeghi, Farzin; Salehi-Vaziri, Mostafa; Almasi-Hashiani, Amir; Gholami-Fesharaki, Mohammad; Pakzad, Reza; Alavian, Seyed Moayed

    2016-01-01

    Context Hepatitis C virus (HCV) infection is a major global public health issue. The Eastern Mediterranean regional office (EMRO) of the world health organization (WHO) seems to have one of the highest prevalence rates worldwide, with at least 21.3 million HCV-infected patients. Objectives The aim of the present study was to review systematically all epidemiological data related to the prevalence of HCV genotypes in infected patients in EMRO countries. Data Sources A systematic search was conducted of peer-reviewed journals indexed in electronic databases (PubMed, Scopus, ISI, PakMediNet, and IMEMR, and Persian-specific databases including SID, Iran Medex, and MagIran). Study Selection A systematic search was performed with temporal limits (papers published between January 2000 up to June 2015), regarding the prevalence and distribution of HCV genotypes in EMRO countries. Data Extraction The prevalence rates of HCV genotypes were pooled by metan command in Stata 14. Statistical heterogeneity was explored using the I-square at the 5% significance level. Publication bias was assessed, graphically and statistically, by funnel plot and Begg and Egger tests. Results A total of 563 records were identified through the electronic search. Of these records, 134 studies comprising 67681 HCV-infected individuals were included in the meta-analysis. In Iran, subtype 1a was the predominant subtype with a rate of 42% (95% CI, 39 - 46), followed by subtype 3a, 35% (95% CI, 31 - 38). In Pakistan, Subtype 3a was the most common subtype with a rate of 56% (95% CI, 49 - 62), followed by subtype 3b, 10% (95% CI, 7 - 12). In Saudi Arabia and Egypt, genotype 4 was the most prevalent genotype with a rate of 65% (95% CI, 59 - 72) and 69% (95% CI, 36 - 100) respectively. In Tunisia and Morocco, subtype 1b was the most common subtype with a rate of 69% (95% CI, 50 - 88) and 32% (95% CI, 7 - 56) respectively. Conclusions The genotype distribution of HCV takes diverse patterns in EMRO countries

  11. A review of accessibility of administrative healthcare databases in the Asia-Pacific region

    PubMed Central

    Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

    2015-01-01

    Objective We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. Methods The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Results Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3–6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but

  12. Classificação geométrica de galáxias bianeladas através do metódo CART (Classification And Regression Trees)

    NASA Astrophysics Data System (ADS)

    Ormeño, M. I.; Faúndez-Abans, M.; Cavada, G.

    2003-08-01

    A importância deste trabalho deve-se à seleção de objetos ainda não tratados particularmente como uma família e ao emprego de procedimento estatístico robusto que não precisa de pressupostos ou condições de contorno. Contribui, assim, ao melhor entendimento do cenário das Galáxias Aneladas do diagrama de Hubble via classificação e estudo de subclasses. Selecionaram-se 100 galáxias possuidoras de dois anéis do Catalog of Southern Ringed Galaxies compilado por Ronald Buta, de modo a construir uma amostra completa em termos de conhecimento dos semi-eixos dos anéis interno e externo projetados no plano do céu. Visando uma possível classificação destas galáxias aneladas normais em famílias de acordo com as características geométricas dos anéis, empregou-se primeiramente a Análise de Aglomerados (ferramenta de classificação: medições de semelhança em um espaço bidimensional) para explorar a possível existência de famílias. As variáveis analisadas foram: os diâmetros interiores menores d(I) e maiores D(I), os diâmetros exteriores menores d(E) e maiores D(E), e os ângulos de inclinação dos semi-eixos maiores interiores q(I) e exteriores q(E) dos anéis. Como metodologia de discriminação, empregou-se a construção de Árvores de Classificação. As árvores de classificação constituem um método de discriminação alternativo aos modelos clássicos, tais como a Análise Discriminante e a Regressão Logística, onde uma base de dados é dividida em partições (subgrupos) da árvore por ação de um predictor (variável específica). Os pacotes estatísticos utilizados para o processamento da informação foram: SAS versão 8.0 (Statistical Analisys System) e CART versão 3.6.3. Esta análise estatística sugere a existência de três possíveis famílias de galáxias bianeladas, com base apenas na geometria dos anéis. Como forma exploratória inicial deste resultado, a construção de um diagrama BT (magnitude total) versus o

  13. Evolution of Nox levels measured by means of passive samplers at a mediterranean coastal area

    NASA Astrophysics Data System (ADS)

    Delgado, J. M.; Esteve, V.

    2003-04-01

    of Nox about 20 ug/m3, The highest levels of Nox are measured at the expressway, at roads and at the main city, Castellón, with levels açup to 100 ug/m3 . The trend of evolution of NOx levels measured in years 2001 and 2002 is increasing. The value of the increase depends on the area measured varying form 3 per cent in areas not so far from roads, to 10 per cent in city areas. Nevertheless, in far inner areas (110 km far from the coast) where there is not much vehicle traffic, the trend of the evolution is decreasing about a 10 per cent from year 2001 to year 2002. Acknowledgements : We would like to thank Dr. M. Wolfson (Harvard Universty), Dr. C. Felis (Conselleria de Medi Ambient) and Ms. C. Clemente (Universitat Jaume I) for their contribution and work on this project as well as to Generalitat Valenciana for the FPI grant. References: Cocheo, V., Quaglio, F., Pagani, D.; Simultaneous sampling of NO, NO2 and SO2 by means of Radiello® and their separated measurement; Air quality in Europe: Challenges for the 2000's; 1999; 173-73.

  14. Development and validation of the Hospitality Axiological Scale for Humanization of Nursing Care.

    PubMed

    Galán González-Serna, José María; Ferreras-Mencia, Soledad; Arribas-Marín, Juan Manuel

    2017-08-03

    to develop and validate a scale to evaluate nursing attitudes in relation to hospitality for the humanization of nursing care. Participants: the sample consisted of 499 nursing professionals and undergraduate students of the final two years of the Bachelor of Science in Nursing program. the instrument has been developed and validated to evaluate the ethical values related to hospitality using a methodological approach. Subsequently, a model was developed to measure the dimensions forming the construct hospitality. the Axiological Hospitality Scale showed a high internal consistency, with Cronbach's Alpha=0.901. The validation of the measuring instrument was performed using factorial, exploratory and confirmatory analysis techniques with high goodness of fit measures. the developed instrument showed an adequate validity and a high internal consistency. Based on the consistency of its psychometric properties, it is possible to affirm that the scale provides a reliable measurement of the hospitality. It was also possible to determine the dimensions or sources that embrace it: respect, responsibility, quality and transpersonal care. desenvolver e validar uma escala que permita avaliar a atitude dos enfermeiros em termos de hospitalidade, visando a humanização da enfermagem.Participantes: a amostra foi constituída por 499 profissionais e estudantes de enfermagem dos dois últimos anos do curso de graduação em Enfermagem. utilizando-seuma abordagem metodológica, foi desenvolvido e validado um instrumento para avaliar os valores éticos relacionados com a hospitalidade. Subsequentemente, foi formulado um modelo para mediras dimensões que constituem o construto hospitalidade. a Escala Axiológica de Hospitalidade mostrou uma consistência interna elevada, com Alfa de Cronbach=0,901. A validação do instrumento de medição foi realizada usando-se métodos de análise fatorial, exploratória e confirmatória, que apresentaram bons índices de qualidade de ajuste. o

  15. Monte Carlo study of LDR seed dosimetry with an application in a clinical brachytherapy breast implant

    SciTech Connect

    Furstoss, C.; Reniers, B.; Bertrand, M. J.; Poon, E.; Carrier, J.-F.; Keller, B. M.; Pignol, J. P.; Beaulieu, L.; Verhaegen, F.

    2009-05-15

    A Monte Carlo (MC) study was carried out to evaluate the effects of the interseed attenuation and the tissue composition for two models of {sup 125}I low dose rate (LDR) brachytherapy seeds (Medi-Physics 6711, IBt InterSource) in a permanent breast implant. The effect of the tissue composition was investigated because the breast localization presents heterogeneities such as glandular and adipose tissue surrounded by air, lungs, and ribs. The absolute MC dose calculations were benchmarked by comparison to the absolute dose obtained from experimental results. Before modeling a clinical case of an implant in heterogeneous breast, the effects of the tissue composition and the interseed attenuation were studied in homogeneous phantoms. To investigate the tissue composition effect, the dose along the transverse axis of the two seed models were calculated and compared in different materials. For each seed model, three seeds sharing the same transverse axis were simulated to evaluate the interseed effect in water as a function of the distance from the seed. A clinical study of a permanent breast {sup 125}I implant for a single patient was carried out using four dose calculation techniques: (1) A TG-43 based calculation, (2) a full MC simulation with realistic tissues and seed models, (3) a MC simulation in water and modeled seeds, and (4) a MC simulation without modeling the seed geometry but with realistic tissues. In the latter, a phase space file corresponding to the particles emitted from the external surface of the seed is used at each seed location. The results were compared by calculating the relevant clinical metrics V{sub 85}, V{sub 100}, and V{sub 200} for this kind of treatment in the target. D{sub 90} and D{sub 50} were also determined to evaluate the differences in dose and compare the results to the studies published for permanent prostate seed implants in literature. The experimental results are in agreement with the MC absolute doses (within 5% for EBT

  16. Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010).

    PubMed

    Marcus, Logan P; McCutcheon, Brandon A; Noorbakhsh, Abraham; Parina, Ralitza P; Gonda, David D; Chen, Clark; Chang, David C; Carter, Bob S

    2014-05-01

    Hospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US and is also a major indicator of patient care quality. The purpose of this study was to investigate the incidence, causes, and predictors of 30-day readmission following craniotomy for malignant supratentorial tumor resection. The longitudinal California Office of Statewide Health Planning & Development inpatient-discharge administrative database is a data set that consists of 100% of all inpatient hospitalizations within the state of California and allows each patient to be followed throughout multiple inpatient hospital stays, across multiple institutions, and over multiple years (from 1995 to 2010). This database was used to identify patients who underwent a craniotomy for resection of primary malignant brain tumors. Causes for unplanned 30-day readmission were identified by principle ICD-9 diagnosis code and multivariate analysis was used to determine the independent effect of various patient factors on 30-day readmissions. A total of 18,506 patients received a craniotomy for the treatment of primary malignant brain tumors within the state of California between 1995 and 2010. Four hundred ten patients (2.2%) died during the index surgical admission, 13,586 patients (73.4%) were discharged home, and 4510 patients (24.4%) were transferred to another facility. Among patients discharged home, 1790 patients (13.2%) were readmitted at least once within 30 days of discharge, with 27% of readmissions occurring at a different hospital than the initial surgical institution. The most common reasons for readmission were new onset seizure and convulsive disorder (20.9%), surgical infection of the CNS (14.5%), and new onset of a motor deficit (12.8%). Medi-Cal beneficiaries were at increased odds for readmission relative to privately insured patients (OR 1.52, 95% CI 1.20-1.93). Patients with a history of prior myocardial infarction were at an increased risk of

  17. End-of-life decision-making for patients admitted through the emergency department: hospital variability, patient demographics, and changes over time.

    PubMed

    Richardson, Derek K; Zive, Dana M; Newgard, Craig D

    2013-04-01

    .70, 95% CI = 0.59 to 0.82; reference = white), ethnicity (Hispanic OR = 0.61, 95% CI = 0.55 to 0.68), sex (male OR = 0.90, 95% CI = 0.88 to 0.92), and MediCal insurance (OR = 0.70, 95% CI = 0.57 to 0.85). Statewide rates of DNAR steadily increased from 12.2% in 2002 to 14.3% in 2010, although this trend occurred primarily among white and Asian patients. While statewide rates of DNAR use have increased over time among patients admitted through the ED, there is variable penetrance of this practice by hospital types, patient race, and patient ethnicity. These patterns may suggest barriers to end-of-life discussions, differences in hospital case mix, and variation in cultural or institutional beliefs and practices. © 2013 by the Society for Academic Emergency Medicine.

  18. Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

    PubMed

    Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

    2017-09-01

    Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

  19. [Diagnosis of osteoporosis occurring in autoimmune thyroid gland disease].

    PubMed

    Radojković, Ivan; Radojković, Jana; Djurica, Snezana

    2005-10-01

    accurate results can not be achieved. But, this is not considered so important. Values that are to be compared are available anyway. Therapy, if adequate, will show certain improvement which can not be detected even by osteometers. Following the physiatrist treatment, particularly by exercise of muscle strength, the muscle structure will be enhanced and, consequently, a part of pressure will be handled, which would be otherwise taken over by the bone. The movements of the patients will be better in coordinated, which undoubtedly reduces the number of falls and fractures. Results of the research that was conducted at the Clinical Hospital Centre "Dr. Dragisa Misovic" in Belgrade, with over 200 cases, two years, are compatible with literature data. Working with MediTech osteometer DTU ONE that uses ultrasound source in demineralized medium, with indispensable US gel, on constant temperatures, yielded results corresponding to those in patients that were treated by Bisphosphonates, Alphacalcidol and Calcium therapy.

  20. Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial.

    PubMed

    Kazui, Hiroaki; Miyajima, Masakazu; Mori, Etsuro; Ishikawa, Masatsune

    2015-06-01

    months after surgery was similar between the two groups: 30 (67%) of 45 patients in the immediate group vs 22 (58%) of 38 in the postponed group (difference 9% [95% CI -14 to 31]; p=0·496). The proportions of patients with serious adverse events did not differ significantly between the groups during the 3 months post-randomisation (7 [15%] of 46 in the immediate group vs 1 [2%] of 42 in the postponed group; p=0·060). During the 12 months after surgery, 19 (22%) of 87 patients had serious adverse events, the most common of which was cerebral infarction (six patients [7%]). Our results suggest that lumboperitoneal shunt surgery might be beneficial for patients with idiopathic normal pressure hydrocephalus and, if these findings are confirmed in larger studies, could be a first-line treatment option for this disease. Johnson & Johnson and Nihon Medi-Physics. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Psychological Therapy for People with Tinnitus: A Scoping Review of Treatment Components.

    PubMed

    Thompson, Dean M; Hall, Deborah A; Walker, Dawn-Marie; Hoare, Derek J

    Tinnitus is associated with depression and anxiety disorders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiologists across the whole UK public healthcare system and similar systems elsewhere across the world. The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, dissertations, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews-of the search results. Records were included in which a psychological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback

  2. Psychological Therapy for People with Tinnitus: A Scoping Review of Treatment Components

    PubMed Central

    Hall, Deborah A.; Walker, Dawn-Marie; Hoare, Derek J.

    2017-01-01

    Background: Tinnitus is associated with depression and anxiety disorders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiologists across the whole UK public healthcare system and similar systems elsewhere across the world. Objectives: The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. Design: The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, dissertations, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews—of the search results. Records were included in which a psychological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the

  3. Optimal cut-off value for homeostasis model assessment (HOMA) index of insulin-resistance in a population of patients admitted electively in a Portuguese cardiology ward.

    PubMed

    Timóteo, Ana Teresa; Miranda, Fernando; Carmo, Miguel Mota; Ferreira, Rui Cruz

    2014-01-01

    Introdução: A resistência à insulina é a chave fisiopatológica de explicação da Síndrome Metabólica. Apesar de claramente útil, o índice Homeostasis Model Assessment (uma medição da resistência à insulina) não tem sido aplicado sistematicamente na prática clínica. Uma das principais razões relaciona-se com a discrepância de valores limiares reportados em diferentes populações. Procurámos avaliar uma população portuguesa o valor limiar ideal e avaliar a sua relação com a Síndrome Metabólica. Material e Métodos: Selecionámos uma coorte de indivíduos admitidos eletivamente numa enfermaria de cardiologia com um IMC < 25 Kg/m2 e sem anomalias do metabolismo da glicose (glicémia em jejum < 100 mg/dL e sem diabetes). Utilizámos o percentil 90 da distribuição do índice Homeostasis Model Assessment para seleção do limiar adequado para resistência à insulina. Selecionouse também uma coorte de validação composta por 300 indivíduos, sem aplicação dos critérios de exclusão referidos anteriormente. Resultados: De uma população de 7 000 indivíduos e após aplicação dos critérios de exclusão, ficámos com 1 784 indivíduos para análise. O percentil 90 do índice foi 2,33. Na coorte de validação, aplicando esse limiar, 49,3% dos indivíduos apresentam resistência à insulina. Contudo, apenas 69,9% dos doentes com síndrome metabólica apresentam resistência à insulina com esse limiar. Por análise das curvas ROC, o limiar ideal para síndrome metabólica é 2,41. O índice Homeostasis Model Assessment correlacionou-se com o IMC (r = 0,371, p < 0,001) e é um preditor independente de presença de síndrome metabólica (OR 19,4, IC 95% 6,6 – 57,2, p < 0,001). Discussão: O nosso estudo mostrou que numa população portuguesa de doentes admitidos eletivamente numa enfermaria de cardiologia, o limiar pelo índice Homeostasis Model Assessment para resistência à insulina é 2,33 e para síndrome metabólica é 2

  4. [Cystic fibrosis -- disease burden and health-related quality of life of patients and their caregivers: results of the European BURQOL-RD survey in Hungary].

    PubMed

    Péntek, Márta; Kosztolányi, György; Melegh, Béla; Halász, Adrienn; Pogány, Gábor; Baji, Petra; Brodszky, Valentin; Vártokné Hevér, Noémi; Boncz, Imre; Gulácsi, László

    2014-10-19

    Bevezetés: Magyarországon kevéssé ismertek a cystás fibrosis betegség egyéni és társadalmi terhei. Célkitűzés: A cystás fibrosissal élő betegek és gondozóik egészséggel összefüggő életminőségének és terheinek felmérése. Módszer: Az európai BURQOL-RD-projekt keretében keresztmetszeti kérdőíves felmérést végeztek EQ-5D-5L-kérdőívvel és retrospektíven vizsgálták az egészségügyi ellátások igénybevételét. Eredmények: 110 beteg (korcsoportok, év: 0–13, N = 48; 14–17, N = 12; ≥18, N = 50) vett részt a vizsgálatban, a diagnózis felállításakor az életkor medián 1 év volt. Az EQ-5D-5L-indexérték szignifikánsan alacsonyabb volt a 18–24 és 25–34 éves korosztályban a hazai populációs átlagnál (p<0,05). Tüdőgyógyászati szakvizsgálaton 75 beteg (68%) járt, kórházi felvételre 55 beteg (50%) került az elmúlt 6, illetve 12 hónapban, dornase alfa-kezelést 57 beteg (52%) kapott. Öt felnőtt beteget (10%) segített közeli családtag nem hivatásos gondozóként. Következtetések: A cystás fibrosis jelentős életminőség-csökkenéssel jár. A kutatás elsőként nyújt alapadatokat a kelet-közép-európai régióból a cystásfibrosis-ellátás egészség-gazdaságtani elemzéseihez. Orv. Hetil., 2014, 155(42), 1673–1684.

  5. Efficacy of a single evening dose of syrup containing paracetamol, dextromethorphan hydrobromide, doxylamine succinate and ephedrine sulfate in subjects with multiple common cold symptoms.

    PubMed

    Mizoguchi, H; Wilson, A; Jerdack, G R; Hull, J D; Goodale, M; Grender, J M; Tyler, B A

    2007-04-01

    The aim of this study was to evaluate the efficacy of a single night-time dose of a syrup containing paracetamol, dextromethorphan hydrobromide, doxylamine succinate and ephedrine sulfate in subjects with multiple cold symptoms. A syrup containing 15 mg dextromethorphan hydrobromide, 7.5 mg doxylamine succinate, 600 mg paracetamol and 8 mg ephedrine sulfate (Wick MediNait produced by WICK Pharma, Germany, a subsidiary of Procter & Gamble GmbH; test syrup) or placebo (placebo syrup) for oral administration. This was a randomized, double-blind, placebo-controlled, multi-center, parallel design study. At enrollment, eligible subjects had to have at least moderate nasal congestion and a runny nose, at least mild cough and at least mild pain with one or more of the following: sore throat, sore chest, headache or body pain/aches. Subjects were randomized into either Group T (test syrup) or Group P (placebo syrup). On the evening of enrollment, subjects rated baseline symptoms, ingested the assigned study product and completed symptom-relief assessments at 3 hours post-dosing. Within one hour of awakening the following morning, subjects completed night-time symptom relief and sleep satisfaction assessments. All symptoms were recorded using an Interactive Voice Response system. Treatment comparisons were made after adjusting for the severity of baseline symptom using analysis of covariance. Of 485 subjects who took the study product, 432 (224 in Group T; 208 in Group P) were evaluable for analysis. For the primary endpoint (composite of nasal congestion/runny nose/cough/pain relief scores 3 hours post-dosing), subjects in Group T had clinically and statistically significantly greater relief than Group P (p = 0.0002). Each individual symptom score also showed statistically significant improvement at this time point (p < or = 0.017). The next morning, Group T continued to show clinically and statistically significant benefits over Group P on the composite score and each of

  6. [Fiability Study of Diabetes Empowerment Scale: Short Version].

    PubMed

    Aveiro, Marcelo; Santiago, Luiz Miguel; Ferreira, Pedro Lopes; Simões, José Augusto

    2015-01-01

    Objetivo: Avaliar a correlação entre o valor obtido pelo instrumento de medição Diabetes Empowerment Scale - Short Form e o controlo da pessoa com diabetes medido pelo valor da hemoglobina glicada A1c.Material e Métodos: Estudo observacional transversal pela aplicação do Diabetes Empowerment Scale - Short Form a pessoas com diabetes de três Unidades de Saúde Familiar da Região Centro de Portugal após realização de teste e reteste (primeiro por escrito e, passados cinco minutos, oralmente) para determinação da coerência interna através do valor de alfa de Cronbach em 20 elementos que não foram depois estudados. A aplicação a pacientes diabéticos foi feita após a consulta de enfermagem e antes da entrada na consulta médica. Foi realizada estatística descritiva e inferencial apos verificação da normalidade dos dados.Resultados: Na primeira fase o valor de alfa de Cronbach de 0,90 a 1,00 relativamente aos oito itens da escala. Na aplicação escrita, a média de resultados foi de 3,78 ± 0,71 e na aplicação oral de 3,79 ± 0,65, p = 0,629. A amostra da segunda fase foi de 81 pessoas com diabetes, sendo 55,6% do sexo masculino. A idade média foi de 68,5 ± 1,1 anos com uma HbA1c média de 6,8 ± 0,2 e um tempo de evolução desde o diagnóstico de 9,2 ± 0,9 anos. A média da pontuação final da escala foi de 4,1 ± 0,8. Verificou-se uma correlação significativa entre a pontuação final e os níveis de Hba1C (ÏÅ = -0,114; p = 0,312).Conclusão: A Escala de Capacidade de Controlo da Diabetes âÄì Versão Breve revelou ser uma escala fiável para medir a capacitação em doentes diabéticos em Portugal. Confirmou-se a presença de uma correlação estatisticamente significativa entre o resultado obtido no final da escala e o valor de HbA1c.

  7. The Role of Haemoglobin A1c in Screening Obese Children and Adolescents for Glucose Intolerance and Type 2 Diabetes.

    PubMed

    Galhardo, Júlia; Shield, Julian

    2015-01-01

    Introdução: Em 2012, um comité internacional de peritos em diabetes aconselhou a hemoglobina glicada como teste de rastreio de intolerância à glicose e diabetes mellitus tipo 2 no adulto e em idade pediátrica. O objetivo deste estudo foi avaliar a utilidade deste exame numa população de crianças e adolescentes obesos, maioritariamente de etnia caucasiana.Material e Métodos: Foram recrutados 226 doentes [índice de massa corporal z-score 3,35 ± 0,59, 90% caucasianos, 55% do sexo feminino, idade mediana de 12,3 (âmbito: 8,9 â 17,6) anos] referenciados à consulta de obesidade pediátrica de um hospital terciário, com critérios para rastreio de diabetes mellitus tipo 2. Situações de hemoglobinopatia ou de alteração da sobrevida eritrocitária foram excluídas. Todos os indivíduos foram submetidos a uma prova de tolerância à glicose oral e à medição da hemoglobina glicada.Resultados: Segundo a prova de tolerância à glicose oral, 13 (4,9%) eram pré-diabéticos e nenhum diabético. De acordo com a hemoglobina glicada, 32 seriam pré-diabéticos (29 falsos-positivos) e um diabético (falso positivo, sendo este, na realidade, apenas intolerante à glicose). Por outro lado, 10 pré-diabéticos não seriam identificados (falsos-negativos). A área sob a curva receiver operator characteristic analysis da hemoglobina glicada foi 0,59 (IC 95% 0,40 - 0,78), confirmando a sua reduzida capacidade de discriminação parapré-diabetes. Mais promissoras foram as áreas sob as curvas receiver operator characteristic analysis da glicemia em jejum (0,76; IC 95% 0,66 - 0,87), homeostasis model assessment for insulin resistance (0,77; IC 95% 0,64 - 0,90) e razão triglicerídeos:colesterol HDL (0,81; IC 95% 0,66 - 0,96).Discussão: Em Pediatria, particularmente em populações maioritariamente caucasianas, a hemoglobina glicada parece ser uma má ferramenta para diagnóstico de pré-diabetes.Conclusão: Pelo exposto, parece-nos prematura a utilização da

  8. [Contribution for the validation of the Portuguese version of EQ-5D].

    PubMed

    Ferreira, Pedro Lopes; Ferreira, Lara Noronha; Pereira, Luis Nobre

    2013-01-01

    doença.Conclusão: A versão portuguesa do EQ-5D tem uma boa aceitabilidade, fiabilidade e validade na medição do estado de saúde.

  9. [EEG changes during sedation with gamma-hydroxybutyric acid].

    PubMed

    Entholzner, E; Mielke, L; Pichlmeier, R; Weber, F; Schneck, H

    1995-05-01

    Gamma-hydroxybutyric acid (GHB) is a naturally occurring transmitter in the mammalian brain, related to sleep regulation and possibly to energy balance in diving or hibernating animals. It has been used for almost 35 years as an intravenous agent for induction of anaesthesia and for long-term sedation. Its convincing pharmacological properties, without serious adverse effects on circulation or respiration, are compromised by its unpredictable duration of action. This is not a major problem with long-term sedation during ICU treatment. GHB has been used with good results for sedation of patients with severe brain injury, where it compares favourably with barbiturates. In animal studies, it seems to possess a protective action against hypoxia on a cellular and whole organ level. However, in some experimental animals GHB has been shown to produce seizure-like activities, and the compound is being used to produce absence-like seizures. GHB has been used in our ICU for years to provide adequate sedation for patients under controlled ventilation or for patients fighting the respirator during spontaneous respiration. No serious side effects were observed in these patients, while in some patients under haemodialysis hypernatraemia and metabolic alkalosis developed; both were reversible after discontinuation of GHB and restriction of additional sodium input (Somsanit, the commercially available GHB preparation in Germany, contains 9.2 mmol sodium/g; the daily dose averages 20-40 g GHB, i.e. 180-370 mmol sodium). PATIENTS AND METHODS. In 31 patients after major abdominal surgery, sedation was established with GHB 50 mg/kg BW injected via perfusion pump over a 20-min period. No centrally acting medication had been given for at least 2 h. A computer-based multichannel EEG system (CATEEM, MediSyst, Linden) was used, allowing for fast Fourier transformation, spectral analysis and topographical brain mapping. EEG during induction of sedation was followed after a baseline EEG (10

  10. [Fractional exhaled nitric oxide in monitoring and therapeutic management of asthma].

    PubMed

    Melo, Bruno; Costa, Patrício; Afonso, Ariana; Machado, Vânia; Moreira, Carla; Gonçalves, Augusta; Gonçalves, Jean-Pierre

    2014-01-01

    Introdução: A asma é uma doença respiratória crónica caracterizada pela hiper-reactividade e inflamação brônquica. A inflamação brônquica destes doentes pode ser monitorizada através da medição da fração exalada de óxido nítrico. Este estudo tem por objetivo determinar a associação do valor da fração exalada de óxido nítrico com o débito expiratório máximo instantâneo e com o controlo da asma determinado pela Classificação da Iniciativa Global para a Asma.Material e Métodos: Estudo observacional, analítico e transversal de crianças com asma, 6-12 anos, seguidas na Consulta Externa de Patologia Respiratória do Hospital de Braga. Informação sociodemográfica e clínica colhida através de um questionário. Determinado o valor da fração exalada de óxido nítrico, através do analisador portátil Niox Mino®, e do débito expiratório máximo instantâneo,através do debitómetro.Resultados: A amostra é constituída por 101 crianças asmáticas, 63 (62,4%) do sexo masculino e 38 (37,6%) do sexo feminino. A idade média dos participantes na amostra é de 9,18 (1,99) anos. A regressão logística, realizada com o valor de cutoff obtido pela curva de ROC, revelou que a fração exalada de óxido nítrico tem um efeito estatisticamente significativo (bNíveis do FENO = 0,85; χ2Wald (1) = 8,71; OR = 2,33; p = 0,003) sobre a probabilidade de mudar de nível de controlo da asma. Por cada nível de fração exalada de óxido nítrico incrementado o odds de passar a não controlada é 2,33 vezes superior.Discussão e Conclusão: A probabilidade de uma criança asmática mudar o seu nível de controlo da asma, de ‘controlada’ para ‘parcialmente controlada/não controlada’, tendo em consideração uma alteração no seu nível da fração exalada de óxido nítrico, aumenta 133%.

  11. 12th WINFOCUS world congress on ultrasound in emergency and critical care.

    PubMed

    Acar, Yahya; Tezel, Onur; Salman, Necati; Cevik, Erdem; Algaba-Montes, Margarita; Oviedo-García, Alberto; Patricio-Bordomás, Mayra; Mahmoud, Mustafa Z; Sulieman, Abdelmoneim; Ali, Abbas; Mustafa, Alrayah; Abdelrahman, Ihab; Bahar, Mustafa; Ali, Osama; Lester Kirchner, H; Prosen, Gregor; Anzic, Ajda; Leeson, Paul; Bahreini, Maryam; Rasooli, Fatemeh; Hosseinnejad, Houman; Blecher, Gabriel; Meek, Robert; Egerton-Warburton, Diana; Ćuti, Edina Ćatić; Belina, Stanko; Vančina, Tihomir; Kovačević, Idriz; Rustemović, Nadan; Chang, Ikwan; Lee, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Cheng, Chi-Yung; Pan, Hsiu-Yung; Kung, Chia-Te; Ćurčić, Ela; Pritišanac, Ena; Planinc, Ivo; Medić, Marijana Grgić; Radonić, Radovan; Fasina, Abiola; Dean, Anthony J; Panebianco, Nova L; Henwood, Patricia S; Fochi, Oliviero; Favarato, Moreno; Bonanomi, Ezio; Tomić, Ivan; Ha, Youngrock; Toh, Hongchuen; Harmon, Elizabeth; Chan, Wilma; Baston, Cameron; Morrison, Gail; Shofer, Frances; Hua, Angela; Kim, Sharon; Tsung, James; Gunaydin, Isa; Kekec, Zeynep; Ay, Mehmet Oguzhan; Kim, Jinjoo; Kim, Jinhyun; Choi, Gyoosung; Shim, Dowon; Lee, Ji-Han; Ambrozic, Jana; Prokselj, Katja; Lucovnik, Miha; Simenc, Gabrijela Brzan; Mačiulienė, Asta; Maleckas, Almantas; Kriščiukaitis, Algimantas; Mačiulis, Vytautas; Macas, Andrius; Mohite, Sharad; Narancsik, Zoltan; Možina, Hugon; Nikolić, Sara; Hansel, Jan; Petrovčič, Rok; Mršić, Una; Orlob, Simon; Lerchbaumer, Markus; Schönegger, Niklas; Kaufmann, Reinhard; Pan, Chun-I; Wu, Chien-Hung; Pasquale, Sarah; Doniger, Stephanie J; Yellin, Sharon; Chiricolo, Gerardo; Potisek, Maja; Drnovšek, Borut; Leskovar, Boštjan; Robinson, Kristine; Kraft, Clara; Moser, Benjamin; Davis, Stephen; Layman, Shelley; Sayeed, Yusef; Minardi, Joseph; Pasic, Irmina Sefic; Dzananovic, Amra; Pasic, Anes; Zubovic, Sandra Vegar; Hauptman, Ana Godan; Brajkovic, Ana Vujaklija; Babel, Jaksa; Peklic, Marina; Radonic, Vedran; Bielen, Luka; Ming, Peh Wee; Yezid, Nur Hafiza; Mohammed, Fatahul Laham; Huda, Zainal Abidin; Ismail, Wan Nasarudin Wan; Isa, W Yus Haniff W; Fauzi, Hashairi; Seeva, Praveena; Mazlan, Mohd Zulfakar

    2016-09-01

    veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrest

  12. Allergen-specific oral immunotherapy for peanut allergy.

    PubMed

    Nurmatov, Ulugbek; Venderbosch, Iris; Devereux, Graham; Simons, F Estelle R; Sheikh, Aziz

    2012-09-12

    Peanut allergy is one of the most common forms of food allergy encountered in clinical practice.  In most cases, it does not spontaneously resolve; furthermore, it is frequently implicated in acute life-threatening reactions. The current management of peanut allergy centres on meticulous avoidance of peanuts and peanut-containing foods. Allergen-specific oral immunotherapy (OIT) for peanut allergy aims to induce desensitisation and then tolerance to peanut, and has the potential to revolutionise the management of peanut allergy. However, at present there is still considerable uncertainty about t