Prescribing Patterns of Intravenous Golimumab for Rheumatoid Arthritis.

PubMed

Brady, Brenna L; Tkacz, Joseph P; Lofland, Jennifer; Meyer, Roxanne; Bolge, Susan C

2015-09-01

The use of intravenous golimumab (GLM-IV), in combination with methotrexate, was approved by the US Food and Drug Administration in July 2013 for the treatment of moderate to severe, active rheumatoid arthritis (RA). GLM-IV is available in 50-mg vials, and the prescribing information specifies a dosing regimen of 2 mg/kg at 0 and 4 weeks and then every 8 weeks thereafter. The purpose of this study was to examine the patterns of prescribing and administration of GLM-IV, including the demographic, clinical, and utilization characteristics of patients with RA newly treated with GLM-IV. Rheumatology practices across the continental United States were solicited for a chart-review study. Inclusion criteria were: (1) diagnosis of RA; (2) current treatment with GLM-IV; (3) age ≥18 years; and (4) lack of pregnancy (in female patients). Physicians were offered a monetary incentive for each eligible chart provided. An electronic case-report form was developed to aid in the chart data extraction and included fields for demographic characteristics, available comorbid diagnoses, prior RA treatments, and doses and dates of GLM-IV administration. A total of 117 eligible patient charts from 15 rheumatologist practices were reviewed. The patient sample was predominantly female (81.2%), with a mean (SD) age of 55.4 (14.5) years. A total of 55.6% of patients had evidence of biologic treatment before receiving GLM-IV, and 53% had at least 1 comorbid condition. In total, 300 individual GLM-IV infusions from this sample were reviewed. Due to the relatively recent approval of GLM-IV use by the US Food and Drug Administration, the majority of patients in this sample (69.2%) had received only between 2 and 4 infusions at the time of the review. For infusion records with valid dose data, the mean number of administered vials was 3.6 (0.8) (total dose, 180 mg); the majority of patients received a dose consistent with the prescribed dose of 2 mg/kg. Combination therapy with methotrexate was observed in the charts of a minority of patients (27.4%). The mean interval between induction and the first follow-up infusion was 32.9 (11.4) days, with a mean maintenance interval of 56.5 (13.3) days. This analysis provides an early glimpse of the patterns of prescribing GLM-IV. Overall, patients appeared to have been receiving GLM-IV in accordance with Food and Drug Administration labeling; although the rate of prescribing methotrexate was low, dosages and administration intervals were within the expected ranges. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Phase IV of Early Restoration | NOAA Gulf Spill Restoration

Science.gov Websites

Trustees published the Final Phase IV Early Restoration Plan and Environmental Assessments. The plan habitats. Useful Links: Final Phase IV Early Restoration Plan and Environmental Assessments (pdf, 4.8 MB ) Final Phase IV Early Restoration Plan and Environmental Assessments Executive Summary (pdf, 729 KB

Multiple Intravenous Infusions Phase 2b: Laboratory Study

PubMed Central

Pinkney, Sonia; Fan, Mark; Chan, Katherine; Koczmara, Christine; Colvin, Christopher; Sasangohar, Farzan; Masino, Caterina; Easty, Anthony; Trbovich, Patricia

2014-01-01

Background Administering multiple intravenous (IV) infusions to a single patient via infusion pump occurs routinely in health care, but there has been little empirical research examining the risks associated with this practice or ways to mitigate those risks. Objectives To identify the risks associated with multiple IV infusions and assess the impact of interventions on nurses’ ability to safely administer them. Data Sources and Review Methods Forty nurses completed infusion-related tasks in a simulated adult intensive care unit, with and without interventions (i.e., repeated-measures design). Results Errors were observed in completing common tasks associated with the administration of multiple IV infusions, including the following (all values from baseline, which was current practice): setting up and programming multiple primary continuous IV infusions (e.g., 11.7% programming errors) identifying IV infusions (e.g., 7.7% line-tracing errors) managing dead volume (e.g., 96.0% flush rate errors following IV syringe dose administration) setting up a secondary intermittent IV infusion (e.g., 11.3% secondary clamp errors) administering an IV pump bolus (e.g., 11.5% programming errors) Of 10 interventions tested, 6 (1 practice, 3 technology, and 2 educational) significantly decreased or even eliminated errors compared to baseline. Limitations The simulation of an adult intensive care unit at 1 hospital limited the ability to generalize results. The study results were representative of nurses who received training in the interventions but had little experience using them. The longitudinal effects of the interventions were not studied. Conclusions Administering and managing multiple IV infusions is a complex and risk-prone activity. However, when a patient requires multiple IV infusions, targeted interventions can reduce identified risks. A combination of standardized practice, technology improvements, and targeted education is required. PMID:26316919

Performing both propensity score and instrumental variable analyses in observational studies often leads to discrepant results: a systematic review.

PubMed

Laborde-Castérot, Hervé; Agrinier, Nelly; Thilly, Nathalie

2015-10-01

Propensity score (PS) and instrumental variable (IV) are analytical techniques used to adjust for confounding in observational research. More and more, they seem to be used simultaneously in studies evaluating health interventions. The present review aimed to analyze the agreement between PS and IV results in medical research published to date. Review of all published observational studies that evaluated a clinical intervention using simultaneously PS and IV analyses, as identified in MEDLINE and Web of Science. Thirty-seven studies, most of them published during the previous 5 years, reported 55 comparisons between results from PS and IV analyses. There was a slight/fair agreement between the methods [Cohen's kappa coefficient = 0.21 (95% confidence interval: 0.00, 0.41)]. In 23 cases (42%), results were nonsignificant for one method and significant for the other, and IV analysis results were nonsignificant in most situations (87%). Discrepancies are frequent between PS and IV analyses and can be interpreted in various ways. This suggests that researchers should carefully consider their analytical choices, and readers should be cautious when interpreting results, until further studies clarify the respective roles of the two methods in observational comparative effectiveness research. Copyright © 2015 Elsevier Inc. All rights reserved.

Practice patterns for the use of iodinated i.v. contrast media for pediatric CT studies: a survey of the Society for Pediatric Radiology.

PubMed

Callahan, Michael J; Servaes, Sabah; Lee, Edward Y; Towbin, Alexander J; Westra, Sjirk J; Frush, Donald P

2014-04-01

There are limited data available on the use of i.v. contrast media for CT studies in the pediatric population. The purpose of this study is to determine the practice patterns of i.v. contrast media usage for pediatric CT by members of the Society for Pediatric Radiology (SPR). SPR members were surveyed regarding the use of i.v. contrast media for pediatric CT studies. Questions pertained to information required before administering i.v. contrast media, types of central catheters for injecting i.v. contrast media, injection rates based on angiocatheter size and study type, and management of i.v. contrast media extravasation. The response rate of 6% (88/1545) represented practice patterns of 26% (401/1545) of the SPR membership. Most respondents thought the following clinical information was mandatory before i.v. contrast media administration: allergy to i.v. contrast media (97%), renal insufficiency (97%), current metformin use (72%), significant allergies (61%), diabetes (54%), and asthma (52%). Most administered i.v. contrast media through nonimplanted central venous catheters (78%), implanted venous ports (78%), and peripherally inserted central catheters (72%). The most common maximum i.v. contrast media injection rates were 5.0 mL/s or greater for a 16-gauge angiocatheter, 4.0 mL/s for an 18-gauge angiocatheter, 3.0 mL/s for a 20-gauge angiocatheter, and 2.0 mL/s for a 22-gauge angiocatheter. For soft-tissue extravasation of i.v. contrast media, 95% elevate the affected extremity, 76% use ice, and 45% use heat. The results of this survey illustrate the collective opinion of a subset of SPR members relating to the use of i.v. contrast media in pediatric CT, providing guidelines for clinical histories needed before i.v. contrast media, maximum i.v. contrast injection rates for standard angiocatheters, contrast media injection rates for specific CT studies, and management of i.v. contrast media soft-tissue extravasation.

Inadvertent venous air embolism during cesarean section: collapsible intravenous fluid bags without self-sealing outlet have risks. Case report.

PubMed

Bakan, Mefkur; Topuz, Ufuk; Esen, Asim; Basaranoglu, Gokcen; Ozturk, Erdogan

2013-01-01

The anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag. 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Inadvertent venous air embolism during cesarean section: Collapsible intravenous fluid bags without self-sealing outlet have risks. Case report.

PubMed

Bakan, Mefkur; Topuz, Ufuk; Esen, Asim; Basaranoglu, Gokcen; Ozturk, Erdogan

2013-01-01

The anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

The use of online methodologies in studying paraphilias - A review.

PubMed

Griffiths, Mark D

2012-12-01

Aims The paper outlines the advantages, disadvantages, and other implications of using the Internet to collect data from those people displaying sexually paraphilic behavior. Method Using empirical and clinical studies published in the paraphilia literature, the main issues concerning online paraphilic data collection are reviewed and discussed. Results The specific online data collection methods examined included the collection of paraphilic data via (i) online questionnaires, (ii) online forums, (iii) online interviews, and (iv) online participant observation. Conclusions It is concluded that there are many useful and practical advantages of using online research methodologies to examine sexually paraphilic behavior.

[Clinical usefulness of IDEA and CARS: concordance with DSM-IV-TR in children and adolescents with suspicion of PDD].

PubMed

García-López, C; Narbona, J

2014-02-01

Observational scales are useful to estimate the severity of symptoms in PDD as well as to monitor their evolution. a) To analyze the concordance between diagnoses based on the Autism Spectrum Inventory (Inventario del Espectro Autista, IDEA)) and the Childhood Autism Rating Scale (CARS), compared to DSM-IV-TR criteria, in subjects with a suspicion of pervasive developmental disorders (PDD), and b) to study the discrimination power of both scales to differentiate between a clinical diagnosis situated in the autism spectrum. Fifty-six children and adolescents, between 2 and 20 years-old, who attended our Neuropediatric Unit due to suspicion of PDD. Independently, two clinicians evaluated the presence of PDD symptoms; one of them according to DSM-IV-TR criteria and the other one based on the application of IDEA and CARS. The concordance of IDEA and CARS when compared to DSM-IV-TR classification was 73 and 82%, respectively, with a sensitivity of 1 and 0,83 and a specificity of 0,61 and 0,82, respectively. Both scales correctly discriminated between autistic disorder and other clinical diagnoses. Both IDEA and CARS are useful instruments to detect and monitor autism symptoms in the context of routine clinical practice. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

DSM-V Changes for Autism Spectrum Disorder (ASD): Implications for Diagnosis, Management, and Care Coordination for Children With ASDs.

PubMed

Lobar, Sandra L

2016-01-01

The purpose of this article is to highlight issues about diagnosis and management of autism spectrum disorders (ASDs) in all settings, along with care coordination for all children with ASDs. The article outlines differences between the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised (DSM-IV-TR) and the newer version (DSM-V) for ASDs. These changes may limit the eligibility of some children for services in school, leading to poorer social/academic outcomes, lower rates of employment, and decreased assistance in eventual independent living. Primary care providers identified a lack of knowledge regarding ASDs before the DSM-V was published, describing difficulty in making ASD diagnoses, recognizing early symptoms of developmental concern, and managing care. Care coordination is part of the role of the advanced practice nurse, and lack of understanding of ASD changes in the DSM-V may diminish the ability of advanced practice nurses to screen for ASDs and make the appropriate referrals. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Engagement of groups in family medicine board maintenance of certification.

PubMed

Fisher, Dena M; Brenner, Christopher J; Cheren, Mark; Stange, Kurt C

2013-01-01

The American Board of Medical Specialties' Performance in Practice ("Part IV") portion of Maintenance of Certification (MOC) requirement provides an opportunity for practicing physicians to demonstrate quality improvement (QI) competence. However, specialty boards' certification of one physician at a time does not tap into the potential of collective effort. This article shares learning from a project to help family physicians work in groups to meet their Part IV MOC requirement. A year-long implementation and evaluation project was conducted. Initially, 348 members of a regional family physician organization were invited to participate. A second path was established through 3 health care systems and a county-wide learning collaborative. Participants were offered (1) a basic introduction to QI methods, (2) the option of an alternative Part IV MOC module using a patient experience survey to guide QI efforts, (3) practice-level improvement coaching, (4) support for collaboration and co-learning, and (5) provision of QI resources. More physicians participated through group (66) than individual (12) recruitment, for a total of 78 physicians in 20 practices. Participation occurred at 3 levels: individual, intrapractice, and interpractice. Within the 1-year time frame, intrapractice collaboration occurred most frequently. Interpractice and system-level collaboration has begun and continues to evolve. Physicians felt that they benefited from access to a practice coach and group process. Practice-level collaboration, access to a practice coach, flexibility in choosing and focusing improvement projects, tailored support, and involvement with professional affiliations can enhance the Part IV MOC process. Specialty boards are likely to discover productive opportunities from working with practices, professional organizations, and health care systems to support intra- and interpractice collaborative QI work that uses Part IV MOC requirements to motivate practice improvement.

European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--First Revision.

PubMed

2010-03-01

Consensus guidelines on the definition, investigation, and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) have been published (J Peripher Nerv Syst 2005; 10: 220-228, Eur J Neurol 2006; 13: 326-332). To revise these guidelines. Disease experts, including a representative of patients, considered references retrieved from MEDLINE and Cochrane Systematic Reviews published between August 2004 and July 2009 and prepared statements that were agreed in an iterative fashion. The Task Force agreed on Good Practice Points to define clinical and electrophysiological diagnostic criteria for CIDP with or without concomitant diseases and investigations to be considered. The principal treatment recommendations were: (i) intravenous immunoglobulin (IVIg) (Recommendation Level A) or corticosteroids (Recommendation Level C) should be considered in sensory and motor CIDP; (ii) IVIg should be considered as the initial treatment in pure motor CIDP (Good Practice Point); (iii) if IVIg and corticosteroids are ineffective, plasma exchange (PE) should be considered (Recommendation Level A); (iv) if the response is inadequate or the maintenance doses of the initial treatment are high, combination treatments or adding an immunosuppressant or immunomodulatory drug should be considered (Good Practice Point); (v) symptomatic treatment and multidisciplinary management should be considered (Good Practice Point).

Assessing Intellectual Functioning in Young Adolescents: How Do the WISC-IV and SB5 Compare?

ERIC Educational Resources Information Center

Wilson, Kimberley; Gilmore, Linda

2012-01-01

The Wechsler Intelligence Scale for Children--Fourth Edition (WISC-IV) and the Stanford-Binet--Fifth Edition (SB5) are two of the most commonly used intelligence tests for children and adolescents. No comparative studies of the WISC-IV and SB5 have yet been published. In the current study the WISC-IV and SB5 were administered in counterbalanced…

How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care.

PubMed

Paul, Christine L; Ryan, Annika; Rose, Shiho; Attia, John R; Kerr, Erin; Koller, Claudia; Levi, Christopher R

2016-04-08

Thrombolysis using intravenous (IV) tissue plasminogen activator (tPA) is one of few evidence-based acute stroke treatments, yet achieving high rates of IV tPA delivery has been problematic. The 4.5-h treatment window, the complexity of determining eligibility criteria and the availability of expertise and required resources may impact on treatment rates, with barriers encountered at the levels of the individual clinician, the social context and the health system itself. The review aimed to describe health system factors associated with higher rates of IV tPA administration for ischemic stroke and to identify whether system-focussed interventions increased tPA rates for ischemic stroke. Published original English-language research from four electronic databases spanning 1997-2014 was examined. Observational studies of the association between health system factors and tPA rates were described separately from studies of system-focussed intervention strategies aiming to increase tPA rates. Where study outcomes were sufficiently similar, a pooled meta-analysis of outcomes was conducted. Forty-one articles met the inclusion criteria: 7 were methodologically rigorous interventions that met the Cochrane Collaboration Evidence for Practice and Organization of Care (EPOC) study design guidelines and 34 described observed associations between health system factors and rates of IV tPA. System-related factors generally associated with higher IV tPA rates were as follows: urban location, centralised or hub and spoke models, treatment by a neurologist/stroke nurse, in a neurology department/stroke unit or teaching hospital, being admitted by ambulance or mobile team and stroke-specific protocols. Results of the intervention studies suggest that telemedicine approaches did not consistently increase IV tPA rates. Quality improvement strategies appear able to provide modest increases in stroke thrombolysis (pooled odds ratio = 2.1, p = 0.05). In order to improve IV tPA rates in acute stroke care, specific health system factors need to be targeted. Multi-component quality improvement approaches can improve IV tPA rates for stroke, although more thoughtfully designed and well-reported trials are required to safely increase rates of IV tPA to eligible stroke patients.

Campaign best practice in intravenous therapy.

PubMed

Baldwin, Wayne; Murphy, Jayne; Shakespeare, David; Kelly, Chris; Fox, Louise; Kelly, Matthew

Intravenous therapy is an integral part of nursing care but is associated with a high risk of infection. This article outlines a campaign that aimed to increase awareness of best practice for IV therapy and reduce the risks of healthcare-associated IV infections in hospital and community settings.

Intravenous Therapy Instruction for Licensed Practical Nurses. Instructor's Guide.

ERIC Educational Resources Information Center

Springer, Pam; Carey, Jean

This Idaho instructor's guide lists tasks and enabling objectives, outlines instruction, and provides handout masters, overhead masters, and tests for intravenous therapy (IV) instruction for licensed practical nurses. Following an introduction and a list of criteria for successful completion of IV therapy courses, the document lists tasks and…

Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review.

PubMed

Stamatakis, Emmanuel; Weiler, Richard; Ioannidis, John P A

2013-05-01

Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions. We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by Blackwell Publishing Ltd.

Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research.

PubMed

Land, Victoria; Parry, Ruth; Seymour, Jane

2017-12-01

Shared decision making (SDM) is generally treated as good practice in health-care interactions. Conversation analytic research has yielded detailed findings about decision making in health-care encounters. To map decision making communication practices relevant to health-care outcomes in face-to-face interactions yielded by prior conversation analyses, and to examine their function in relation to SDM. We searched nine electronic databases (last search November 2016) and our own and other academics' collections. Published conversation analyses (no restriction on publication dates) using recordings of health-care encounters in English where the patient (and/or companion) was present and where the data and analysis focused on health/illness-related decision making. We extracted study characteristics, aims, findings relating to communication practices, how these functioned in relation to SDM, and internal/external validity issues. We synthesised findings aggregatively. Twenty-eight publications met the inclusion criteria. We sorted findings into 13 types of communication practices and organized these in relation to four elements of decision-making sequences: (i) broaching decision making; (ii) putting forward a course of action; (iii) committing or not (to the action put forward); and (iv) HCPs' responses to patients' resistance or withholding of commitment. Patients have limited opportunities to influence decision making. HCPs' practices may constrain or encourage this participation. Patients, companions and HCPs together treat and undertake decision making as shared, though to varying degrees. Even for non-negotiable treatment trajectories, the spirit of SDM can be invoked through practices that encourage participation (eg by bringing the patient towards shared understanding of the decision's rationale). © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Underutilization of IV nitrates in the treatment of acute heart failure.

PubMed

Mohan, Mohapradeep; Hawkey, Sean; Baig, Fatima; Choy, Anna Maria; Lang, Chim C

2015-08-01

Acute heart failure (AHF) is a growing public health concern with high inhospital mortality and costs. Clinical practice guidelines, underpinned by positive randomized controlled trials, recommend the early use of intravenous (IV) nitrates in the treatment of AHF. However, the "real-world" usage of IV nitrates has not been clearly defined. The objective of this study was to examine the use of IV nitrates in the treatment of AHF as recommended by clinical practice guidelines. A case-record analysis was conducted of all admissions with AHF at a large teaching hospital. Of the 81 AHF patients (mean age 77 ± 11, mean SBP 130 ± 27 mmHg) enrolled for this analysis, only 5 (6%) received IV nitrates at the time of AHF admission. Forty (49%, mean age 77 ± 11, mean SBP 131 ± 27 mmHg) of these 81 patients met the guideline criteria for suitability for IV nitrates and only 5 (12%) of these received them during this admission. Patients who received IV nitrates were more likely to have higher blood pressure and all had myocardial ischemia as a precipitant. Seventy-five (93%) of the total population received loop diuretics on admission. Overall, this study shows that loop diuretics remain the first-line therapy in AHF with little use of IV nitrates, despite recommendations from clinical practice guidelines. © 2015 John Wiley & Sons Ltd.

Autism spectrum disorders in the DSM-V: better or worse than the DSM-IV?

PubMed

Wing, Lorna; Gould, Judith; Gillberg, Christopher

2011-01-01

The DSM-V-committee has recently published proposed diagnostic criteria for autism spectrum disorders. We examine these criteria in some detail. We believe that the DSM-committee has overlooked a number of important issues, including social imagination, diagnosis in infancy and adulthood, and the possibility that girls and women with autism may continue to go unrecognised or misdiagnosed under the new manual. We conclude that a number of changes need to be made in order that the DSM-V-criteria might be used reliably and validly in clinical practice and research. Copyright © 2010 Elsevier Ltd. All rights reserved.

Intravenous Fluid Therapy Course for the Licensed Practical Nurse. Instructor Guide.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Instructional Materials Lab.

This curriculum guide provides materials for a 10-unit intravenous (IV) therapy course for licensed practical nurses. Units contain from one to nine lessons. The first unit provides an introduction and orientation to the course. Subsequent units concern documentation, anatomy and physiology as applied to IV therapy, fundamental aspects of fluid…

Subcutaneous Rituximab for the Treatment of B-Cell Hematologic Malignancies: A Review of the Scientific Rationale and Clinical Development.

PubMed

Davies, Andrew; Berge, Claude; Boehnke, Axel; Dadabhoy, Anjum; Lugtenburg, Pieternella; Rule, Simon; Rummel, Mathias; McIntyre, Christine; Smith, Rodney; Badoux, Xavier

2017-10-01

Rituximab (MabThera ® /Rituxan ® ), a chimeric murine/human monoclonal antibody that binds specifically to the transmembrane antigen CD20, was the first therapeutic antibody to enter clinical practice for the treatment of cancer. As monotherapy and in combination with chemotherapy, rituximab has been shown to prolong progression-free survival and, in some indications overall survival, in patients with various B-cell malignancies, while having a well-established and manageable safety profile and a wide therapeutic window. As a result, rituximab is considered to have revolutionized treatment practices for patients with B-cell malignancies. A subcutaneous (SC) formulation of rituximab has been developed, comprising the same monoclonal antibody as the originally marketed formulation [rituximab concentrate for solution for intravenous (IV) infusion], and has undergone a detailed, sequential clinical development program. This program demonstrated that, at fixed doses, rituximab SC achieves non-inferior serum trough concentrations in patients with non-Hodgkin lymphoma and chronic lymphocytic leukemia, with comparable efficacy and safety relative to the IV formulation. The added benefit of rituximab SC was demonstrated in dedicated studies showing that rituximab SC allows for simplified and shortened drug preparation and administration times resulting in a reduced treatment burden for patients as well as improved resource utilization (efficiency) at the treatment facility. The improved efficiency of delivering rituximab's benefit to patients may broaden patient access to rituximab therapy in areas with low levels of healthcare resources, including IV-chair capacity constraints. This article is a companion paper to G. Salles, et al., which is also published in this issue. F. Hoffmann-La Roche Ltd.

Development of operationalized intravenous to oral antibiotic switch criteria.

PubMed

Akhloufi, H; Hulscher, M; Melles, D C; Prins, J M; van der Sijs, H; Verbon, A

2017-02-01

Despite huge overlap in suggested criteria for a safe intravenous (iv)-to-oral antibiotic switch, there is considerable variation in their operationalization. The objective of this study was to develop a set of measurable conditions that should be met in adult hospitalized patients for a safe iv-to-oral switch. A RAND-modified Delphi procedure was performed to develop a set of operationalized iv-to-oral switch criteria. Switch criteria and their accompanying suggested measurable conditions were extracted from the literature and appraised by a multidisciplinary expert panel during two questionnaire rounds with a face-to-face meeting between these two rounds. In a final step, the experts could approve the set of developed operationalized switch criteria. Seven switch criteria and 41 accompanying measurable conditions extracted from the literature were appraised. Sixteen measurable conditions that operationalize six switch criteria were selected: (i) stable systolic blood pressure; and the absence of (ii) fever, (iii) temperature <36°C, (iv) malabsorption syndrome, (v) short bowel syndrome, (vi) severe gastroparesis, (vii) ileus, (viii) continuous nasogastric suction, (ix) vomiting, (x) (severe) sepsis, (xi) fasciitis necroticans, (xii) CNS infection, (xiii) Staphylococcus aureus bacteraemia, and (xiv) endovascular infection. In addition, (xv) the patient should be cooperative and (xvi) adequate antimicrobial concentration should be achievable at the site of infection by oral administration. These operationalized criteria can be used in daily clinical practice. Future use of these criteria in audits and as rules in clinical decision support systems will facilitate the performance and evaluation of iv-oral switch programmes. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Review of Best Practices for Intravenous Push Medication Administration.

PubMed

Lenz, Janelle R; Degnan, Daniel D; Hertig, John B; Stevenson, James G

In 2015, the Institute for Safe Medication Practices (ISMP) released safe practice guidelines for adult intravenous (IV) push medications. ISMP's most recent set of guidelines has added to a growing list of recommendations from professional groups on the safe use of IV medications. These recommendations and guidelines vary with regard to their audience, scope, and terminology. In some ways, these variations may contribute to confusion and delayed adoption of the standards. This report attempts to provide clarity about the rationale and background regarding the need for practice improvement, discussion of various guidelines, and practice mitigation strategies to improve patient safety.

Validity of the WISC-IV Spanish for a clinically referred sample of Hispanic children.

PubMed

San Miguel Montes, Liza E; Allen, Daniel N; Puente, Antonio E; Neblina, Cris

2010-06-01

The Wechsler Intelligence Scale for Children (WISC) is the most commonly used intelligence test for children. Five years ago, a Spanish version of the WISC-IV was published (WISC-IV Spanish; Wechsler, 2005), but a limited amount of published information is available regarding its utility when assessing clinical samples. The current study included 107 children who were Spanish speaking and of Puerto Rican descent that had been administered the WISC-IV Spanish. They were subdivided into a clinical sample of 35 children with diagnoses of various forms of brain dysfunction (primarily learning disability, attention-deficit/hyperactivity disorder, and epilepsy) and a comparison group made up of 72 normal children who were part of the WISC-IV Spanish version standardization sample. Comparisons between these groups and the standardization sample were performed for the WISC-IV Spanish index and subtest scores. Results indicated that the clinical sample performed worse than the comparison samples on the Working Memory and Processing Speed Indexes, although findings varied to some extent depending on whether the clinical group was compared with the normal comparison group or the standardization sample. These findings provide support for the criterion validity of the WISC-IV Spanish when it is used to assess a clinically referred sample with brain dysfunction.

A more reactive trigonal-bipyramidal high-spin oxoiron(IV) complex with a cis-labile site.

PubMed

England, Jason; Guo, Yisong; Van Heuvelen, Katherine M; Cranswick, Matthew A; Rohde, Gregory T; Bominaar, Emile L; Münck, Eckard; Que, Lawrence

2011-08-10

The trigonal-bipyramidal high-spin (S = 2) oxoiron(IV) complex [Fe(IV)(O)(TMG(2)dien)(CH(3)CN)](2+) (7) was synthesized and spectroscopically characterized. Substitution of the CH(3)CN ligand by anions, demonstrated here for X = N(3)(-) and Cl(-), yielded additional S = 2 oxoiron(IV) complexes of general formulation [Fe(IV)(O)(TMG(2)dien)(X)](+) (7-X). The reduced steric bulk of 7 relative to the published S = 2 complex [Fe(IV)(O)(TMG(3)tren)](2+) (2) was reflected by enhanced rates of intermolecular substrate oxidation. © 2011 American Chemical Society

The Education of Royalty in the Eighteenth Century: George IV and William IV

ERIC Educational Resources Information Center

Clarke, M. L.

1978-01-01

George IV, the Prince of Wales, and William IV, his younger brother, both the sons of George III, were given all the educational advantage one could be granted in the eighteenth century. The precise curriculum and practices of their teachers are discussed with an evaluation of both students as a moral for future consideration. (RK)

Test Review: Schrank, F. A., McGrew, K. S., & Mather, N. (2014). Woodcock-Johnson IV Tests of Cognitive Abilities

ERIC Educational Resources Information Center

Reynolds, Matthew R.; Niileksela, Christopher R.

2015-01-01

"The Woodcock-Johnson IV Tests of Cognitive Abilities" (WJ IV COG) is an individually administered measure of psychometric intellectual abilities designed for ages 2 to 90+. The measure was published by Houghton Mifflin Harcourt-Riverside in 2014. Frederick Shrank, Kevin McGrew, and Nancy Mather are the authors. Richard Woodcock, the…

WISC-IV and Clinical Validation of the Four- and Five-Factor Interpretative Approaches

ERIC Educational Resources Information Center

Weiss, Lawrence G.; Keith, Timothy Z.; Zhu, Jianjun; Chen, Hsinyi

2013-01-01

The purpose of this study was to determine the constructs measured by the WISC-IV and the consistency of measurement across large normative and clinical samples. Competing higher order four- and five-factor models were analyzed using the WISC-IV normative sample and clinical subjects. The four-factor solution is the model published with the test…

Overview of phase IV clinical trials for postmarket drug safety surveillance: a status report from the ClinicalTrials.gov registry.

PubMed

Zhang, Xinji; Zhang, Yuan; Ye, Xiaofei; Guo, Xiaojing; Zhang, Tianyi; He, Jia

2016-11-23

Phase IV trials are often used to investigate drug safety after approval. However, little is known about the characteristics of contemporary phase IV clinical trials and whether these studies are of sufficient quality to advance medical knowledge in pharmacovigilance. We aimed to determine the fundamental characteristics of phase IV clinical trials that evaluated drug safety using the ClinicalTrials.gov registry data. A data set of 19 359 phase IV clinical studies registered in ClinicalTrials.gov was downloaded. The characteristics of the phase IV trials focusing on safety only were compared with those evaluating both safety and efficacy. We also compared the characteristics of the phase IV trials in three major therapeutic areas (cardiovascular diseases, mental health and oncology). Multivariable logistic regression was used to evaluate factors associated with the use of blinding and randomisation. A total of 4772 phase IV trials were identified, including 330 focusing on drug safety alone and 4392 evaluating both safety and efficacy. Most of the phase IV trials evaluating drug safety (75.9%) had enrolment <300 with 96.5% <3000. Among these trials, 8.2% were terminated or withdrawn. Factors associated with the use of blinding and randomisation included the intervention model, clinical specialty and lead sponsor. Phase IV trials evaluating drug safety in the ClinicalTrials.gov registry were dominated by small trials that might not have sufficient power to detect less common adverse events. An adequate sample size should be emphasised for phase IV trials with safety surveillance as main task. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Ototoxic effect of erythromycin therapy.

PubMed

Schweitzer, V G; Olson, N R

1984-04-01

Thirty-two cases of sudden, symmetrical, high-frequency, sensorineural hearing loss associated with intravenous (IV) and oral erythromycin therapy have been published since 1973. We treated a patient with reversible ototoxicity associated with IV erythromycin for the treatment of legionnaire's disease.

Placebo-controlled pilot trial testing dose titration and intravenous, intramuscular and subcutaneous routes for ketamine in depression.

PubMed

Loo, C K; Gálvez, V; O'Keefe, E; Mitchell, P B; Hadzi-Pavlovic, D; Leyden, J; Harper, S; Somogyi, A A; Lai, R; Weickert, C S; Glue, P

2016-07-01

This pilot study assessed the feasibility, efficacy and safety of an individual dose-titration approach, and of the intravenous (IV), intramuscular (IM) and subcutaneous (SC) routes for treating depression with ketamine. Fifteen treatment-refractory depressed participants received ketamine or midazolam (control treatment) in a multiple crossover, double-blind study. Ketamine was administered by IV (n = 4), IM (n = 5) or SC (n = 6) injection. Dose titration commenced at 0.1 mg/kg, increasing by 0.1 mg/kg up to 0.5 mg/kg, given in separate treatment sessions separated by ≥1 week, with one placebo control treatment randomly inserted. Mood, psychotomimetic and hemodynamic effects were assessed and plasma ketamine concentrations assayed. Twelve participants achieved response and remission criteria, achieved at doses as low as 0.1 mg/kg. All three routes of administration resulted in comparable antidepressant effects. Fewest adverse effects were noted with the SC route. Antidepressant response, adverse effects and ketamine concentrations were dose-related. Antidepressant response occurred at a range of doses and at <0.5 mg/kg. The dose-titration approach is a practical method for optimizing the efficacy - side-effects trade-off on an individual patient basis. This pilot study provides preliminary evidence for SC injection as a practical, feasible and efficacious treatment approach. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Discrepancies between meeting abstracts and subsequent full text publications in hand surgery.

PubMed

Theman, Todd A; Labow, Brian I; Taghinia, Amir

2014-08-01

Research abstracts presented during the proceedings of an annual meeting are often cited and can influence clinical practice. Prior studies show that roughly 50% of abstracts at American Society for Surgery of the Hand meetings are eventually published. Yet, it is unknown how often the results or conclusions of published studies differ from the podium presentation. The objective of this study was to quantify the differences between abstracts presented during the annual meeting of the American Society for Surgery of the Hand and the resulting manuscripts. We retrospectively reviewed every abstract delivered as a podium presentation at the American Society for Surgery of the Hand annual meeting from 2000 to 2010. We searched the PubMed database for matching publications and compared authorship, country of origin, hypothesis, study design and methodology, changes in study groups or populations, results, and conclusions. Of 798 total abstracts, we analyzed 719 involving the hand, wrist, and brachial plexus. Fifty-six different journals published 393 of the abstracts, for a 49% publication rate. Mean time to publication was 18 months with a median of 14 and maximum of 122 months. There were inconsistencies between the results and/or conclusions in 14% of full-length articles compared with the abstract presented at the meeting. A total of 9% of articles were published with fewer subjects. Authorships changes were noted in 54% of publications. Abstracts represent preliminary investigations and major and minor changes occur before subsequent publication. Caution should be exercised in referencing abstracts or altering clinical practice based on their content. Economic/decision analysis IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

40 CFR 147.2200 - State-administered program-Class I, III, IV, and V wells.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the in situ combustion of coal are regulated by the Rail Road Commission of Texas under a separate UIC... program for Class I, III, IV, and V wells in the State of Texas, except for those wells on Indian lands... (SDWA). Notice of the original approval for Class I, III, IV, and V wells was published in the Federal...

40 CFR 147.2200 - State-administered program-Class I, III, IV, and V wells.

Code of Federal Regulations, 2012 CFR

2012-07-01

... the in situ combustion of coal are regulated by the Rail Road Commission of Texas under a separate UIC... program for Class I, III, IV, and V wells in the State of Texas, except for those wells on Indian lands... (SDWA). Notice of the original approval for Class I, III, IV, and V wells was published in the Federal...

International VLBI Service for Geodesy and Astrometry: 1999 Annual Report

NASA Technical Reports Server (NTRS)

Vandenberg, Nancy R. (Editor)

1999-01-01

This volume of reports is the 1999 Annual Report of the International VLBI Service for Geodesy and Astrometry -IVS. The individual reports were contributed by VLBI groups in the international geodetic community who constitute the components of IVS. The 1999 Annual Report documents the work of the IVS components for the year ending March 1, 1999, the official inauguration date of IVS. As the newest of the space technique services, IVS decided to publish this Annual Report as a reference to our organization and its components. The entire contents of this Annual Report also appear on the IVS website at: http://ivscc.gsfc.nasa.gov/pub/arl999. The IVS 1999 Annual Report will be a valuable reference for information about IVS and its components. This Annual Report will serve as a baseline from which we can measure the anticipated progress of IVS in coming years.

Primary Health Care Reform in the cities of Lisbon and Rio de Janeiro: context, strategies, results, learning and challenges.

PubMed

Soranz, Daniel; Pisco, Luís Augusto Coelho

2017-03-01

On the 30th anniversary of Alma-Ata, the World Health Organization published in 2008 the "Primary Health Care Now More Than Ever" Report, calling on all governments to reflect on the need to reflect on four sets of reforms. These included: (i) universal coverage reforms; (ii) service delivery reforms; (iii) public policies reforms that would ensure healthier communities; and (iv) leadership reforms. In this context, in the period 2005-2016, the cities of Rio de Janeiro and Lisbon developed a profound primary healthcare reform, and did so by sharing many of the solutions based on the best internationally recognized organizational practices. Several factors were fundamental throughout Lisbon and Rio de Janeiro's path of reforms, namely: (i) teamwork with professional motivation; (ii) internal and external communication; (iii) strengthening of training activities; (iv) investment in facilities and equipment; (v) commitment to the information system and computerization; (vi) pay-for-performance; (vii) health care contractualisation between funders and providers; (viii) technical leadership; (ix) political leadership; and finally (x) quality and accreditation of facilities by public agency.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

PubMed

Ozbek, O; Kaya, H E; Nayman, A; Saritas, T B; Guler, I; Koc, O; Karakus, H

2017-04-01

The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis. Copyright © 2016 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Semiparametric methods for estimation of a nonlinear exposure-outcome relationship using instrumental variables with application to Mendelian randomization.

PubMed

Staley, James R; Burgess, Stephen

2017-05-01

Mendelian randomization, the use of genetic variants as instrumental variables (IV), can test for and estimate the causal effect of an exposure on an outcome. Most IV methods assume that the function relating the exposure to the expected value of the outcome (the exposure-outcome relationship) is linear. However, in practice, this assumption may not hold. Indeed, often the primary question of interest is to assess the shape of this relationship. We present two novel IV methods for investigating the shape of the exposure-outcome relationship: a fractional polynomial method and a piecewise linear method. We divide the population into strata using the exposure distribution, and estimate a causal effect, referred to as a localized average causal effect (LACE), in each stratum of population. The fractional polynomial method performs metaregression on these LACE estimates. The piecewise linear method estimates a continuous piecewise linear function, the gradient of which is the LACE estimate in each stratum. Both methods were demonstrated in a simulation study to estimate the true exposure-outcome relationship well, particularly when the relationship was a fractional polynomial (for the fractional polynomial method) or was piecewise linear (for the piecewise linear method). The methods were used to investigate the shape of relationship of body mass index with systolic blood pressure and diastolic blood pressure. © 2017 The Authors Genetic Epidemiology Published by Wiley Periodicals, Inc.

The Dental Solid Waste Management in Different Categories of Dental Laboratories in Abha City, Saudi Arabia

PubMed Central

Haralur, Satheesh B.; Al-Qahtani, Ali S.; Al-Qarni, Marie M.; Al-Homrany, Rami M.; Aboalkhair, Ayyob E.; Madalakote, Sujatha S.

2015-01-01

Aim: To study the awareness, attitude, practice and facilities among the different categories of dental laboratories in Abha city. Materials and Methods: A total of 80 dental technicians were surveyed in the study. The dental laboratories included in the study were teaching institute (Group I), Government Hospital (Group II), Private Dental Clinic (Group III) and Independent laboratory (Group IV). The pre-tested anonymous questionnaire was used to understand knowledge, attitude, facilities, practice and orientation regarding biomedical waste management. Results: The knowledge of biomedical waste categories, colour coding and segregation was better among Group I (55-65%) and Group II (65-75%). The lowest standard of waste disposal was practiced at Group IV (15-20%) and Group III (25-35%). The availability of disposal facilities was poor at Group IV. The continuous education on biomedical waste management lacked in all the Groups. Conclusion: The significant improvement in disposal facilities was required at Group III and Group IV laboratories. All dental technicians were in need of regular training of biomedical waste management. Clinical Significance: The dental laboratories are an integral part of dental practice. The dental laboratories are actively involved in the generation, handling and disposal of biomedical waste. Hence, it is important to assess the biomedical waste management knowledge, attitude, facilities and practice among different categories of dental laboratories. PMID:26962373

Advancing knowledge in work-related rehabilitation - review of research published in the journal of WORK.

PubMed

Prodinger, Birgit; Magalhães, Lilian

2010-01-01

Many studies published in the journal WORK in the recent decades have discussed work and employment trends. However, the dimensions of these contributions over time have not been reviewed. The main objective of this study was to investigate the knowledge development in regard to work-related rehabilitation in WORK over the last two decades. A scoping review was conducted using the following five stages: (i) identifying research question, (ii) identifying relevant studies, (iii) study selection, (iv) charting, summarizing, and collating the data, and (v) reporting the results. Studies were selected from the WORK ARTicle Database. Seventy-five relevant studies were identified. The findings reflect that WORK has published papers from across the world, with most of the studies from the United States, Sweden, Canada, and Hong Kong. The complexity and multi-factorial nature of work-related rehabilitation was reflected in the application of quantitative, qualitative, and mixed method research approaches, as well as case studies. Study participants were characterized by work, and non-work related injuries, systematic diseases/chronic illness, fulfilled certain socio-demographic characteristic, and represented various stakeholders. Fewer studies drew on secondary resources. In the findings one re-occurring theme has been noted: 'maintaining/obtaining/returning to secure and stable employment/work'. Four key-reflections evolved from this scoping review that provide potential avenues for future research. These key-reflections include (i) the national, transnational and international dimension of the reviewed studies, (ii) the various societal levels informing work-related rehabilitation practices, (iii) the diversity of methodologies applied in current research, and (iv) the variability of terminology used within the reviewed studies. The journal WORK has published a variety of research over the last two decades and contributed significantly to our current understanding of work-related rehabilitation. However, further research in these reflective areas would expand the current knowledge base.

Variation in intravenous iron use internationally and over time: the Dialysis Outcomes and Practice Patterns Study (DOPPS).

PubMed

Bailie, George R; Larkina, Maria; Goodkin, David A; Li, Yun; Pisoni, Ronald L; Bieber, Brian; Mason, Nancy; Tong, Lin; Locatelli, Francesco; Marshall, Mark R; Inaba, Masaki; Robinson, Bruce M

2013-10-01

To examine patterns of intravenous (IV) iron use across 12 countries from 1999 to 2011. Trends in iron use are described among 32 192 hemodialysis (HD) patients in the Dialysis Outcomes and Practice Patterns Study. Adjusted associations of IV iron dose with serum ferritin and transferrin saturation (TSAT) values were also studied. IV iron was administered to 50% of patients over 4 months in 1999, increasing to 71% during 2009-11, with increasing use in most countries. Among patients receiving IV iron, the mean monthly dose increased from 232 ± 167 to 281 ± 211 mg. Most countries used 3 to 4 doses/month, but Canada used about 2 doses/month, Italy increased from 3 to almost 6 doses/month and Germany used 5 to 6 doses/month. The USA and most European countries predominantly used iron sucrose and sodium ferric gluconate. A significant use of iron dextran was limited to Canada and France; iron polymaltose was used in Australia and New Zealand; and Japan used ferric oxide saccharate, chondroitin polysulfate iron complex and cideferron. Ferritin values rose in most countries: 22% of patients had ≥ 800 ng/mL in the recent years of study. TSAT levels increased to a lesser degree over time. Japan had much lower IV iron dosing and ferritin levels, but similar TSAT levels. In adjusted analyses, serum ferritin and TSAT levels increased signifcantly by 14 ng/mL and 0.16%, respectively, for every 100 mg/month higher mean monthly iron dose. IV iron prescription patterns varied between countries and changed over time from 1999 to 2011. IV iron use and dose increased in most countries, with notable increases in ferritin but not TSAT levels. With rising cumulative IV iron doses, studies of the effects of changing IV iron dosing and other anemia management practices on clinical outcomes should be a high priority.

Terminal ileum gangrene secondary to a type IV paraesophageal hernia.

PubMed

Hsu, Ching Tsai; Hsiao, Po Jen; Chiu, Chih Chien; Chan, Jenq Shyong; Lin, Yee Fung; Lo, Yuan Hung; Hsiao, Chia Jen

2016-02-28

Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.

Skin bleaching: highlighting the misuse of cutaneous depigmenting agents.

PubMed

Dadzie, O E; Petit, A

2009-07-01

Hydroquinone and other cutaneous depigmenting agents are widely used by dermatologists to treat pigmentary disorders. On 29 August 2006, the US Food and Drug Administration (FDA) published a monograph in the US Federal Register proposing to ban all hydroquinone products that have not been approved via a New Drug Application process. Reports in the scientific literature on the occurrence of exogenous ochronosis, in relation to the use of hydroquinone, was one of the concerns expressed by the FDA in relation to this agent. However, a review of the English-language scientific literature reveals that most of the reported cases of hydroquinone-induced exogenous ochronosis occurs in Africa, where the cultural practice of skin bleaching is highly prevalent. Skin bleaching is the practice of applying hydroquinone and/or other depigmenting agents to specific or widespread areas of the body, the primary function being to lighten normally dark skin. This practice typically occurs in men and women with Fitzpatrick skin phototypes IV to VI. It is a dangerous practice associated with a diverse range of side-effects, including mercury poisoning. Thus, this current discussion within the dermatological community on the safety of hydroquinone provides a unique opportunity to raise awareness about skin bleaching.

Concept analysis: lack of anonymity.

PubMed

Swan, Marilyn A; Hobbs, Barbara B

2017-05-01

To re-examine and expand understanding of the concept 'lack of anonymity' as a component of rural nursing theory. Early healthcare literature reports lack of anonymity as part of social and working environments, particularly rural nursing. Rural nursing theory included the first published concept analysis on lack of anonymity but lacked empirical referents. Workforce, societal and rural healthcare changes support an updated analysis. To further understand lack of anonymity, its present day use and applicability to diverse environments, research from multiple disciplines was reviewed. Concept analysis. A literature search using eight terms in eleven databases was conducted of literature published between 2008-2013. Walker and Avant's concept analysis methodology guided the analysis. The previous concept analysis is supported in part by current literature. The defining attributes, 'identifiable', 'establishing boundaries for public and private self and interconnectedness' in a community were updated. Updated antecedents include: (i) environmental context; (ii) opportunities to become visible; (iii) developing relationships and (iv) unconscious or limited awareness of public or personal privacy. Consequences are: (i) familiarity; (ii) visibility; (iii) awareness of privacy and (iv) manage or balance of lack of anonymity. Cases were constructed and empirical referents identified. The concept of lack of anonymity was updated; portions of the original definition remain unchanged. Empirical referents reveal the defining attributes in daily life and may guide future research on the effect of lack of anonymity on nursing practice. This analysis advances the conceptual understanding of rural nursing theory. © 2016 John Wiley & Sons Ltd.

Thai Undergraduate Chemistry Practical Learning Experiences Using the Jigsaw IV Method

ERIC Educational Resources Information Center

Jansoon, Ninna; Somsook, Ekasith; Coll, Richard K.

2008-01-01

The research reported in this study consisted of an investigation of student learning experiences in Thai chemistry laboratories using the Jigsaw IV method. A hands-on experiment based on the Jigsaw IV method using a real life example based on green tea beverage was designed to improve student affective variables for studying topics related to…

Instrumental variable specifications and assumptions for longitudinal analysis of mental health cost offsets.

PubMed

O'Malley, A James

2012-12-01

Instrumental variables (IVs) enable causal estimates in observational studies to be obtained in the presence of unmeasured confounders. In practice, a diverse range of models and IV specifications can be brought to bear on a problem, particularly with longitudinal data where treatment effects can be estimated for various functions of current and past treatment. However, in practice the empirical consequences of different assumptions are seldom examined, despite the fact that IV analyses make strong assumptions that cannot be conclusively tested by the data. In this paper, we consider several longitudinal models and specifications of IVs. Methods are applied to data from a 7-year study of mental health costs of atypical and conventional antipsychotics whose purpose was to evaluate whether the newer and more expensive atypical antipsychotic medications lead to a reduction in overall mental health costs.

Genetics Home Reference: mucolipidosis type IV

MedlinePlus

... PubMed Vergarajauregui S, Puertollano R. Mucolipidosis type IV: the importance of functional lysosomes for efficient autophagy. Autophagy. 2008 ... Reviewed : August 2013 Published : June 26, 2018 The resources on this site should not be used as a substitute ... Department of Health & Human Services National Institutes of Health National Library of ...

76 FR 39991 - Introduction to the Unified Agenda of Federal Regulatory and Deregulatory Actions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

... Deregulatory Actions. SUMMARY: The Regulatory Flexibility Act requires that agencies publish semiannual... agencies have chosen to publish their regulatory agendas as part of the Unified Agenda. Editions of the... Published? III. How Is the Unified Agenda Organized? IV. What Information Appears for Each Entry? V...

Installation Restoration Program. Phase I. Records. Loring AFB, Maine.

DTIC Science & Technology

1984-01-01

forest, mixed forest, forested bogs, streams, and ponds. Managed timber lands total 4,635 acres on Loring AFB. Major harvested tree species include...Habitat 111-22 2. Threatened and Endangered Species 111-23 IV. FINDINGS IV-1 A. Activity Review IV-l 1. Industrial Waste Disposal Practices IV-1 2...Site No. 13, the BX Service Station, a number of cedar trees in the area of the fuel-saturated soil appear to have been dead for several years. 3

Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm.

PubMed

Youshani, Amir Saam; Mehta, Bimal; Davies, Katharine; Beer, Helen; De, Sujata

2015-04-01

We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals. A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery. The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals. At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Venous envy: the post-World War II debate over IV nursing.

PubMed

Sandelowski, M

1999-09-01

After World War II, a debate ensued over whether nurses should perform intravenous (IV) therapy. The debate was resolved by permitting nurses to do venipunctures as physicians' agents and by recirculating the familiar tautology: if nurses were already doing venipunctures, they must be simple enough for nurses to do. The vein was a portal of entry for nurses, but one with limited access. What was ultimately ceded to nurses was not full jurisdiction over a domain of nursing practice, but rather a limited settlement in a domain of medical practice. The debate over IV therapy demonstrated how technology, in combination with ideology, can both create and destroy nursing jurisdictions.

Design, synthesis and biological evaluation of novel pyrazolo-pyrimidinones as DPP-IV inhibitors in diabetes.

PubMed

Sagar, Sneha R; Agarwal, Jessica K; Pandya, Dhaivat H; Dash, Ranjeet Prasad; Nivsarkar, Manish; Vasu, Kamala K

2015-10-15

We report the design, synthesis, biological activity and docking studies of series of novel pyrazolo[3,4-d]pyrimidinones as DPP-IV inhibitors in diabetes. Molecules were synthesized and evaluated for their DPP-IV inhibition activity. Compounds 5e, 5k, 5o and 6a were found to be potent inhibitors of DPP-IV enzyme. Amongst all the synthesized compounds, 6-methyl-5-(4-methylpyridin-2-yl)-1-phenyl-1H-pyrazolo[3,4-d]pyrimidin-4(5H)-one (5k) was found to be the most active based on in vitro DPP-IV studies and also exhibited promising in vivo blood glucose lowering activity in male Wistar rats. Copyright © 2015. Published by Elsevier Ltd.

Test Review: Wechsler Preschool and Primary Scale of Intelligence-

ERIC Educational Resources Information Center

Syeda, Maisha M.; Climie, Emma A.

2014-01-01

The "Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition" (WPPSI-IV; Wechsler, 2012a, 2012b) is a comprehensive clinical tool, intended for assessing cognitive functioning among children aged 2 years 6 months through 7 years 7 months. Published by Pearson, the WPPSI-IV is an individually administered tool, to be used by…

Effectiveness of non-pharmacological interventions for the prevention of bloodstream infections in infants admitted to a neonatal intensive care unit: A systematic review.

PubMed

Helder, Onno; van den Hoogen, Agnes; de Boer, Coby; van Goudoever, Johannes; Verboon-Maciolek, Malgosia; Kornelisse, René

2013-06-01

Bloodstream infections are associated with increased morbidity and mortality in very low birth weight infants admitted to neonatal intensive care units. To evaluate the available evidence for the effectiveness of non-pharmacological bloodstream infection-preventive measures in infants admitted to a neonatal intensive care unit. A systematic review of randomized, controlled trials, controlled clinical trials, interrupted time series and pretest-posttest studies. PubMed, CINAHL, Web-of-Science, Cochrane Central Register of Controlled Trials, and Embase were searched. The systematic review was carried out according to the guidelines of the Center for Reviews and Dissemination. The methodological quality of the individual studies was evaluated with the quantitative evaluation form of McMaster University. The review included randomized, controlled trials, controlled clinical trials, interrupted time series, and pre-posttest studies published from January 1990 to January 2011. Quantitative pooling of the results was not feasible due to the high heterogeneity of the interventions, methods and outcome measures. Instead, we present the studies in tabular form and provide a narrative account of the study characteristics and results. Fifteen studies out of 288 generated hits were selected and categorized as research on: hand hygiene (5), intravenous (IV) bundles (4), closed IV sets/patches/filters (4), surveillance (1), and percutaneously inserted central catheter teams (1). IV bundles including proper insertion and proper maintenance showed to be the most effective intervention for preventing bloodstream infection in infants; in three out of four studies on IV bundles, a statistically significant reduction of bloodstream infections was mentioned. Although the methodological quality of most studies was not very robust, we conclude that IV bundles may decrease bloodstream infections in infants. However, differences in IV bundle components and in practices limited the underpinning evidence. There is limited evidence that the introduction of a percutaneously inserted central catheter team results in bloodstream infection reduction. Hand hygiene promotion increases hand hygiene among healthcare workers, but there is inconclusive evidence that this intervention subsequently leads to a bloodstream infection reduction in infants. Future studies must be well designed, with standardized outcome measures. Copyright © 2012 Elsevier Ltd. All rights reserved.

The fiduciary obligation of the physician-researcher in phase IV trials

PubMed Central

2014-01-01

Background In this manuscript, we argue that within the context of phase IV, physician-researchers retain their fiduciary obligation to treat the patient-participants. Discussion We first clarify why the perspective that research ethics ought to be differentiated from clinical ethics is not applicable in phase IV, and therefore, why therapeutic orientation is most convivial in this phase. Next, assuming that ethics guidelines may be representative of common morality, we show that ethics guidelines see physician-researchers primarily as physicians and only secondarily as researchers. We then elaborate on what a fiduciary obligation is and how some of the obligations are default duties. Lastly, we look at the fiduciary obligation of the physician-researcher in phase IV interventional trials. Conclusion The fiduciary obligation to treat is not as easily waived as in earlier trials. Assuming the entwinement of research and practice in phase IV, physician-researchers, in collaboration with other researchers, investigators, and research ethics committees, should ensure that in terms of study design, methodology, and research practice, the therapeutic value of the research to the patient-participants is not diminished. PMID:24507449

49 CFR 240.125 - Criteria for testing knowledge.

Code of Federal Regulations, 2010 CFR

2010-10-01

... practices for the safe operation of trains. (c) The testing methods selected by the railroad shall be: (1) Designed to examine a person's knowledge of the railroad's rules and practices for the safe operation of...) Personal safety practices; (ii) Operating practices; (iii) Equipment inspection practices; (iv) Train...

The National Adult Reading Test: restandardisation against the Wechsler Adult Intelligence Scale-Fourth edition.

PubMed

Bright, Peter; Hale, Emily; Gooch, Vikki Jayne; Myhill, Thomas; van der Linde, Ian

2018-09-01

Since publication in 1982, the 50-item National Adult Reading Test (NART; Nelson, 1982; NART-R; Nelson & Willison, 1991) has remained a widely adopted method for estimating premorbid intelligence both for clinical and research purposes. However, the NART has not been standardised against the most recent revisions of the Wechsler Adult Intelligence Scale (WAIS-III; Wechsler, 1997, and WAIS-IV; Wechsler, 2008). Our objective, therefore, was to produce reliable standardised estimates of WAIS-IV IQ from the NART. Ninety-two neurologically healthy British adults were assessed and regression equations calculated to produce population estimates of WAIS-IV full-scale IQ (FSIQ) and constituent index scores. Results showed strong NART/WAIS-IV FSIQ correlations with more moderate correlations observed between NART error and constituent index scores. FSIQ estimates were closely similar to the published WAIS and WAIS-R estimates at the high end of the distribution, but at the lower end were approximately equidistant from the highly discrepant WAIS (low) and WAIS-R (high) values. We conclude that the NART is likely to remain an important tool for estimating the impact of neurological damage on general cognitive ability. We advise caution in the use of older published WAIS and/or WAIS-R estimates for estimating premorbid WAIS-IV FSIQ, particularly for those with low NART scores.

Genetic markers as instrumental variables.

PubMed

von Hinke, Stephanie; Davey Smith, George; Lawlor, Debbie A; Propper, Carol; Windmeijer, Frank

2016-01-01

The use of genetic markers as instrumental variables (IV) is receiving increasing attention from economists, statisticians, epidemiologists and social scientists. Although IV is commonly used in economics, the appropriate conditions for the use of genetic variants as instruments have not been well defined. The increasing availability of biomedical data, however, makes understanding of these conditions crucial to the successful use of genotypes as instruments. We combine the econometric IV literature with that from genetic epidemiology, and discuss the biological conditions and IV assumptions within the statistical potential outcomes framework. We review this in the context of two illustrative applications. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

The contested space: The impact of competency-based education and accreditation on dietetic practice in Australia.

PubMed

Ash, Susan; Palermo, Claire; Gallegos, Danielle

2018-05-06

Competency-based Education (CBE) has underpinned the education of dietitians in Australia since the first Competency Standards (CS) were published; however, little is known about how CBE has influenced dietetic practice. The aim of this paper is to explore how a CBE framework and the CS have influenced dietetic practice in Australia since 1990. A qualitative investigation explored concepts of dietetic practice. Data analysed were original interviews previously undertaken with recent graduate dietitians during 1991 (n = 26), 1998 (n = 23) and 2007 (n = 19) and seven guided discussions with dietitians and employers (n = 28) conducted in 2014 to identify themes. The DAA Competency Standards and Accreditation Manuals/Standards since 1990 were also analysed to triangulate the interview data and to investigate how the CS were interpreted. Themes identified from interviews included: (i) communicating for better care, (ii) scientific enquiry for effective practice, (iii) critical thinking and evidence-based practice and (iv) professionalism, which remained core to dietetic practice over time, but leadership, advocacy, business management and entrepreneurial skills have emerged more strongly as the scope of practice has diversified. The landscape in which dietitians' practice showed increasing complexity and clear boundaries separating professional roles were disappearing. The 2015 CS and the 2017 Accreditation Standards highlighted that competency remains a shifting construct and that professional behaviours change depending on economic and political reasons in the play of power. Accreditation policy and current standards have successfully maintained a standard of dietetic practice across a diverse country but have the potential to constrain innovation. © 2018 Dietitians Association of Australia.

Compliance with a pediatric clinical practice guideline for intravenous fluid and electrolyte administration.

PubMed

Hurdowar, Amanda; Urmson, Lynn; Bohn, Desmond; Geary, Denis; Laxer, Ronald; Stevens, Polly

2009-01-01

The occurrence of acute hyponatremia associated with cerebral edema in hospitalized children has been increasingly recognized, with over 50 cases of neurological morbidity and mortality reported in the past decade. This condition most commonly occurs in previously healthy children where maintenance intravenous (IV) fluids have been prescribed in the form of hypotonic saline (e.g., 0.2 or 0.3 NaCl). In response to similar problems at The Hospital for Sick Children (six identified through hospital morbidity and mortality reviews and safety reports prior to fall 2007), an interdisciplinary clinician group from our institution developed a clinical practice guideline (CPG) to guide fluid and electrolyte administration for pediatric patients. This article reviews the evaluation of one patient safety improvement to change the prescribing practice for IV fluids in an acute care pediatric hospital, including the removal of the ability to prescribe hypotonic IV solutions with a sodium concentration of < 75 mmol/L. The evaluation of key components of the CPG included measuring practice and process changes pre- and post-implementation. The evaluation showed that the use of restricted IV fluids was significantly reduced across the organization. Success factors of this safety initiative included the CPG development, forcing functions, reminders, team engagement and support from the hospital leadership. A key learning was that a project leader with considerable dedicated time is required during the implementation to develop change concepts, organize and liaise with stakeholders and measure changes in practice. This project highlights the importance of active implementation for policy and guideline documents.

Bowel perforation in type IV vascular Ehlers-Danlos syndrome. A systematic review.

PubMed

El Masri, H; Loong, T-H; Meurette, G; Podevin, J; Zinzindohoue, F; Lehur, P-A

2018-05-01

Spontaneous gastrointestinal (GI) perforation is a well-known complication occurring in patients suffering from Type IV vascular Ehlers-Danlos syndrome (EDS IV). The aim of the present study was to review the current literature on spontaneous GI perforation in EDS IV and illustrate the surgical management and outcome when possible. A systematic review of all the published data on EDS IV patients with spontaneous GI perforation between January 2000 and December 2015 was conducted using three major databases PUBMED, EMBASE, and Cochrane Central Register of Controlled Trails. References of the selected articles were screened to avoid missing main articles. Twenty-seven published case reports and four retrospective studies, including 31 and 527 cases, respectively, matched the search criteria. A case from our institution was added. Mean age was 26 years (range 6-64 years). The most frequent site of perforation was the colon, particularly the sigmoid, followed by small bowel, upper rectum, and finally stomach. The majority of cases were initially managed with Hartmann's procedure. In recurrent perforations, total colectomy was performed. The reperforation rate was considerably higher in the "partial colectomy with anastomosis" group than in the Hartmann group. Colonic perforation is the most common spontaneous GI perforation in EDS IV patients. An unexpected fragility of the tissues should raise the possibility of a connective tissue disorder and prompt further investigation with eventual management of these high-risk patients with a multidisciplinary team approach in dedicated centres. In the emergency setting, a Hartmann procedure should be performed.

Instrumental variable methods in comparative safety and effectiveness research.

PubMed

Brookhart, M Alan; Rassen, Jeremy A; Schneeweiss, Sebastian

2010-06-01

Instrumental variable (IV) methods have been proposed as a potential approach to the common problem of uncontrolled confounding in comparative studies of medical interventions, but IV methods are unfamiliar to many researchers. The goal of this article is to provide a non-technical, practical introduction to IV methods for comparative safety and effectiveness research. We outline the principles and basic assumptions necessary for valid IV estimation, discuss how to interpret the results of an IV study, provide a review of instruments that have been used in comparative effectiveness research, and suggest some minimal reporting standards for an IV analysis. Finally, we offer our perspective of the role of IV estimation vis-à-vis more traditional approaches based on statistical modeling of the exposure or outcome. We anticipate that IV methods will be often underpowered for drug safety studies of very rare outcomes, but may be potentially useful in studies of intended effects where uncontrolled confounding may be substantial.

Decision-making theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2011-06-01

What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery. © 2011 Blackwell Publishing Asia Pty Ltd.

Detecting and avoiding likely false-positive findings - a practical guide.

PubMed

Forstmeier, Wolfgang; Wagenmakers, Eric-Jan; Parker, Timothy H

2017-11-01

Recently there has been a growing concern that many published research findings do not hold up in attempts to replicate them. We argue that this problem may originate from a culture of 'you can publish if you found a significant effect'. This culture creates a systematic bias against the null hypothesis which renders meta-analyses questionable and may even lead to a situation where hypotheses become difficult to falsify. In order to pinpoint the sources of error and possible solutions, we review current scientific practices with regard to their effect on the probability of drawing a false-positive conclusion. We explain why the proportion of published false-positive findings is expected to increase with (i) decreasing sample size, (ii) increasing pursuit of novelty, (iii) various forms of multiple testing and researcher flexibility, and (iv) incorrect P-values, especially due to unaccounted pseudoreplication, i.e. the non-independence of data points (clustered data). We provide examples showing how statistical pitfalls and psychological traps lead to conclusions that are biased and unreliable, and we show how these mistakes can be avoided. Ultimately, we hope to contribute to a culture of 'you can publish if your study is rigorous'. To this end, we highlight promising strategies towards making science more objective. Specifically, we enthusiastically encourage scientists to preregister their studies (including a priori hypotheses and complete analysis plans), to blind observers to treatment groups during data collection and analysis, and unconditionally to report all results. Also, we advocate reallocating some efforts away from seeking novelty and discovery and towards replicating important research findings of one's own and of others for the benefit of the scientific community as a whole. We believe these efforts will be aided by a shift in evaluation criteria away from the current system which values metrics of 'impact' almost exclusively and towards a system which explicitly values indices of scientific rigour. © 2016 The Authors. Biological Reviews published by John Wiley & Sons Ltd on behalf of Cambridge Philosophical Society.

40 CFR 147.2550 - State-administered program-Class I, III, IV and V wells.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Rules and Regulations, Wyoming Department of Environmental Quality, Chapter XXI: In Situ Mining... program for Class I, III, IV and V wells in the State of Wyoming, except those on Indian lands is the... section 1422 of the SDWA. Notice of this approval was published in the Federal Register on July 15, 1983...

40 CFR 147.2550 - State-administered program-Class I, III, IV and V wells.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Rules and Regulations, Wyoming Department of Environmental Quality, Chapter XXI: In Situ Mining... program for Class I, III, IV and V wells in the State of Wyoming, except those on Indian lands is the... section 1422 of the SDWA. Notice of this approval was published in the Federal Register on July 15, 1983...

Parents' and children's knowledge of oral health: a qualitative study of children with cleft palate.

PubMed

Davies, Karen; Lin, Yin-Ling; Callery, Peter

2017-07-01

Children with cleft lip and/or palate (CLP) are prone to poorer oral health outcomes than their peers, with serious implications for treatment. Little is known of the knowledge and practice of children with CLP in caring for teeth and how these contribute to oral health. To investigate (i) parents' and children's knowledge of oral health, (ii) how knowledge is acquired, and (iii) how knowledge is implemented. A qualitative design was used to investigate knowledge, beliefs, and practices reported by parents and children, age 5-11 years with CLP. Data were collected from 22 parents and 16 children and analysed using thematic analysis. Four themes were derived as follows: (i) implicit knowledge: children express simple knowledge underpinned by basic rationales, (ii) situated knowledge: children gain skills as part of everyday childhood routines, (iii) maintaining good practice in oral health: parents take a lead role in motivating, monitoring, and maintaining children's toothbrushing, and (iv) learning opportunities: pivotal moments provide opportunities for children to extend their knowledge. Developers of oral health education interventions should take account of children's implicit knowledge and the transmission of beliefs between generations that influence toothbrushing behaviours. This could enhance interventions to support parents and children's practice. © 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

PubMed Central

Wright, Alexi A.; Cronin, Angel; Milne, Dana E.; Bookman, Michael A.; Burger, Robert A.; Cohn, David E.; Cristea, Mihaela C.; Griggs, Jennifer J.; Keating, Nancy L.; Levenback, Charles F.; Mantia-Smaldone, Gina; Matulonis, Ursula A.; Meyer, Larissa A.; Niland, Joyce C.; Weeks, Jane C.; O'Malley, David M.

2015-01-01

Purpose A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice. Patients and Methods Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score–matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias. Results Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score–matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47). Conclusion Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes. PMID:26240233

Low immunogenicity of tocilizumab in patients with rheumatoid arthritis.

PubMed

Burmester, Gerd R; Choy, Ernest; Kivitz, Alan; Ogata, Atsushi; Bao, Min; Nomura, Akira; Lacey, Stuart; Pei, Jinglan; Reiss, William; Pethoe-Schramm, Attila; Mallalieu, Navita L; Wallace, Thomas; Michalska, Margaret; Birnboeck, Herbert; Stubenrauch, Kay; Genovese, Mark C

2017-06-01

Subcutaneous (SC) and intravenous formulations of tocilizumab (TCZ) are available for the treatment of patients with rheumatoid arthritis (RA), based on the efficacy and safety observed in clinical trials. Anti-TCZ antibody development and its impact on safety and efficacy were evaluated in adult patients with RA treated with intravenous TCZ (TCZ-IV) or TCZ-SC as monotherapy or in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Data from 5 TCZ-SC and 8 TCZ-IV phase III clinical trials and 1 TCZ-IV clinical pharmacology safety study (>50 000 samples) were pooled to assess the immunogenicity profile of TCZ-SC and TCZ-IV (8974 total patients). The analysis included antidrug antibody (ADA) measurement following TCZ-SC or TCZ-IV treatment as monotherapy or in combination with csDMARDs, after dosing interruptions or in TCZ-washout samples, and the correlation of ADAs with clinical response, adverse events or pharmacokinetics (PK). The proportion of patients who developed ADAs following TCZ-SC or TCZ-IV treatment was 1.5% and 1.2%, respectively. ADA development was also comparable between patients who received TCZ monotherapy and those who received concomitant csDMARDs (0.7-2.0%). ADA development did not correlate with PK or safety events, including anaphylaxis, hypersensitivity or injection-site reactions, and no patients who developed ADAs had loss of efficacy. The immunogenicity risk of TCZ-SC and TCZ-IV treatment was low, either as monotherapy or in combination with csDMARDs. Anti-TCZ antibodies developed among the small proportion of patients had no evident impact on PK, efficacy or safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

Higher Order, Multisample, Confirmatory Factor Analysis of the Wechsler Intelligence Scale for Children--Fourth Edition: What Does It Measure?

ERIC Educational Resources Information Center

Keith, Timothy Z.; Fine, Jodene Goldenring; Taub, Gordon E.; Reynolds, Matthew R.; Kranzler, John H.

2006-01-01

The recently published fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) represents a considerable departure from previous versions of the scale. The structure of the instrument has changed, and some subtests have been added and others deleted. The technical manual for the WISC-IV provided evidence supporting this new…

[Economic Evaluation of Integrated Care Systems - Scientific Standard Specifications, Challenges, Best Practice Model].

PubMed

Pimperl, A; Schreyögg, J; Rothgang, H; Busse, R; Glaeske, G; Hildebrandt, H

2015-12-01

 Transparency of economic performance of integrated care systems (IV) is a basic requirement for the acceptance and further development of integrated care. Diverse evaluation methods are used but are seldom openly discussed because of the proprietary nature of the different business models. The aim of this article is to develop a generic model for measuring economic performance of IV interventions.  A catalogue of five quality criteria is used to discuss different evaluation methods -(uncontrolled before-after-studies, control group-based approaches, regression models). On this -basis a best practice model is proposed.  A regression model based on the German morbidity-based risk structure equalisation scheme (MorbiRSA) has some benefits in comparison to the other methods mentioned. In particular it requires less resources to be implemented and offers advantages concerning the relia-bility and the transparency of the method (=important for acceptance). Also validity is sound. Although RCTs and - also to a lesser -extent - complex difference-in-difference matching approaches can lead to a higher validity of the results, their feasibility in real life settings is limited due to economic and practical reasons. That is why central criticisms of a MorbiRSA-based model were addressed, adaptions proposed and incorporated in a best practice model: Population-oriented morbidity adjusted margin improvement model (P-DBV(MRSA)).  The P-DBV(MRSA) approach may be used as a standardised best practice model for the economic evaluation of IV. Parallel to the proposed approach for measuring economic performance a balanced, quality-oriented performance measurement system should be introduced. This should prevent incentivising IV-players to undertake short-term cost cutting at the expense of quality. © Georg Thieme Verlag KG Stuttgart · New York.

Web GIS in practice IV: publishing your health maps and connecting to remote WMS sources using the Open Source UMN MapServer and DM Solutions MapLab

PubMed Central

Boulos, Maged N Kamel; Honda, Kiyoshi

2006-01-01

Open Source Web GIS software systems have reached a stage of maturity, sophistication, robustness and stability, and usability and user friendliness rivalling that of commercial, proprietary GIS and Web GIS server products. The Open Source Web GIS community is also actively embracing OGC (Open Geospatial Consortium) standards, including WMS (Web Map Service). WMS enables the creation of Web maps that have layers coming from multiple different remote servers/sources. In this article we present one easy to implement Web GIS server solution that is based on the Open Source University of Minnesota (UMN) MapServer. By following the accompanying step-by-step tutorial instructions, interested readers running mainstream Microsoft® Windows machines and with no prior technical experience in Web GIS or Internet map servers will be able to publish their own health maps on the Web and add to those maps additional layers retrieved from remote WMS servers. The 'digital Asia' and 2004 Indian Ocean tsunami experiences in using free Open Source Web GIS software are also briefly described. PMID:16420699

77 FR 55180 - Notice of Proposed Changes to Section IV of the Virginia State Technical Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

... DEPARTMENT OF AGRICULTURE Natural Resources Conservation Service Notice of Proposed Changes to Section IV of the Virginia State Technical Guide AGENCY: Natural Resources Conservation Service (NRCS), U..., Virginia 23229-5014; Telephone number (804) 287-1691 or [email protected] Copies of the practice...

Instrumental variable methods in comparative safety and effectiveness research†

PubMed Central

Brookhart, M. Alan; Rassen, Jeremy A.; Schneeweiss, Sebastian

2010-01-01

Summary Instrumental variable (IV) methods have been proposed as a potential approach to the common problem of uncontrolled confounding in comparative studies of medical interventions, but IV methods are unfamiliar to many researchers. The goal of this article is to provide a non-technical, practical introduction to IV methods for comparative safety and effectiveness research. We outline the principles and basic assumptions necessary for valid IV estimation, discuss how to interpret the results of an IV study, provide a review of instruments that have been used in comparative effectiveness research, and suggest some minimal reporting standards for an IV analysis. Finally, we offer our perspective of the role of IV estimation vis-à-vis more traditional approaches based on statistical modeling of the exposure or outcome. We anticipate that IV methods will be often underpowered for drug safety studies of very rare outcomes, but may be potentially useful in studies of intended effects where uncontrolled confounding may be substantial. PMID:20354968

Incidence of intravenous contrast extravasation: increased risk for patients with deep brachial catheter placement from the emergency department.

PubMed

Hardie, Andrew D; Kereshi, Borko

2014-06-01

Deep brachial intravenous catheter (IV) placement can be performed in emergency department patients with difficult vascular access, but the safety of deep brachial IV for iodinated contrast administration has not been assessed. This study compares the relative risk for extravasation of deep brachial IV compared with antecubital IV during power injected computed tomography (CT) examinations. A departmental practice quality improvement was performed to assess the rate of IV extravasation for all CT examinations during a 1 year period. De-identified data was analyzed with a waiver of informed consent to identify the rate and relative risk of iodinated contrast extravasation by catheter type. A total of 10,750 injections were performed, with 82 extravasation events (0.8 %). There were 51 extravasations of antecubital IV from approximately 8,599 placed (0.6 %). For 123 deep brachial IV placed, there were eight extravasations (6.5 %). The relative risk of a deep brachial IV extravasation was 9.4 compared to 0.4 for antecubital placement. Deep brachial IV demonstrated a markedly higher rate of contrast extravasation than antecubital IV. For power injected iodinated contrast administration, it is recommended to avoid the use of deep brachial IV whenever possible.

45 CFR 1388.6 - Program criteria-services and supports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... according to accepted practices of scientific evaluation; (iv) Research methods that are used to test hypotheses, validate procedures, and field test projects; and (v) Direct service and project practices and...

75 FR 62759 - Notice of Proposed Change to Section IV of the Virginia State Technical Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

... following practice standards: 314, Brush Management, 324, Deep Tillage, 330, Contour Farming, 332, Contour.... These practices will be used to plan and install conservation practices. DATES: Comments will be...-1737. Copies of the practice standards will be made available upon written request to the address shown...

No bacterial growth found in spiked intravenous fluids over an 8-hour period.

PubMed

Haas, Richard E; Beitz, Edwin; Reed, Amy; Burtnett, Howard; Lowe, Jason; Crist, Arthur E; Stierer, Kevin A; Birenberg, Allan M

2017-04-01

Protocol changes prompted by the Joint Commission mandating intravenous (IV) fluid bags to be used within 1 hour of spiking because of possible bacterial contamination have sparked clinical and economic concerns. This study investigated the degree of bacterial growth in which samples were obtained from spiked IV fluid bags at the time of spiking and 1, 2, 4, and 8 hours after spiking. No bacterial growth occurred in any of the 80 bags of Lactated Ringer's (LR) IV solutions sampled. This study demonstrated that LR IV bags do not support any bacterial growth for up to 8 hours after spiking. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Effects of DSM-5 Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorder: A Systematic Review

ERIC Educational Resources Information Center

Smith, Isaac C.; Reichow, Brian; Volkmar, Fred R.

2015-01-01

A growing body of research has raised concerns about the number of individuals diagnosed with autism spectrum disorder (ASD) according to DSM-IV-TR who may no longer qualify for diagnoses under the new DSM-5 criteria, published in May 2013. The current study systematically reviews 25 articles evaluating samples according to both DSM-IV-TR and…

20 CFR 410.591 - Eligibility for services and supplies under part C of title IV of the act.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of... DOL regulations covering the time period in which the miner must file with DOL for these benefits are published at 20 CFR part 725. (Sec. 411, Federal Coal Mine Health and Safety Act of 1969, as amended; 85...

Outpatient management of febrile neutropenia associated with cancer chemotherapy: risk stratification and treatment review.

PubMed

Pherwani, Nisha; Ghayad, Joanna M; Holle, Lisa M; Karpiuk, Emilie L

2015-04-15

Strategies for the management of chemotherapy-induced febrile neutropenia (FN), including assessment tools for determining which patients are at low risk for FN complications and can be treated in the outpatient setting, are discussed. Due to the potential for life-threatening complications, the development of FN in patients receiving cancer chemotherapy traditionally prompted hospitalization and i.v. antimicrobial therapy, but there is convincing published evidence that an identifiable subset of patients can be safely treated as outpatients. Two validated assessment tools recommended for identifying patients at low risk for FN complications are the Talcott classification system and the Multinational Association for Supportive Care in Cancer (MASCC) risk index; the MASCC index is superior in terms of sensitivity and negative predictive value but has lower specificity. In low-risk FN cases, outpatient oral antimicrobial therapy has been shown to be a safe and effective alternative to i.v. therapy for both inpatients and outpatients; current practice guidelines recommend an oral fluoroquinolone (e.g., ciprofloxacin) in combination with oral amoxicillin-clavulanate. The guidelines emphasize that in certain cases of FN (e.g., those involving prolonged or pronounced neutropenia or serious comorbidities), inpatient i.v. therapy is required. Pharmacists can play an important role in the management of chemotherapy-associated FN through involvement in risk assessment to identify candidates for outpatient oral antimicrobial therapy, selection of appropriate pharmacotherapy, drug therapy monitoring, and development of institutional guidelines or pathways. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department.

PubMed

Whalen, Madeleine; Maliszewski, Barbara; Sheinfeld, Rebecca; Gardner, Heather; Baptiste, Diana

2018-04-25

Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. This was a quasi-experimental study in an urban emergency department. Researchers performed chart audits of staff-identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics. Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order-to-lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use. The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient- and department-level care. Copyright © 2018 Elsevier Inc. All rights reserved.

Indian Vacuum Society: The Indian Vacuum Society

NASA Astrophysics Data System (ADS)

Saha, T. K.

2008-03-01

The Indian Vacuum Society (IVS) was established in 1970. It has over 800 members including many from Industry and R & D Institutions spread throughout India. The society has an active chapter at Kolkata. The society was formed with the main aim to promote, encourage and develop the growth of Vacuum Science, Techniques and Applications in India. In order to achieve this aim it has conducted a number of short term courses at graduate and technician levels on vacuum science and technology on topics ranging from low vacuum to ultrahigh vacuum So far it has conducted 39 such courses at different parts of the country and imparted training to more than 1200 persons in the field. Some of these courses were in-plant training courses conducted on the premises of the establishment and designed to take care of the special needs of the establishment. IVS also regularly conducts national and international seminars and symposia on vacuum science and technology with special emphasis on some theme related to applications of vacuum. A large number of delegates from all over India take part in the deliberations of such seminars and symposia and present their work. IVS also arranges technical visits to different industries and research institutes. The society also helped in the UNESCO sponsored post-graduate level courses in vacuum science, technology and applications conducted by Mumbai University. The society has also designed a certificate and diploma course for graduate level students studying vacuum science and technology and has submitted a syllabus to the academic council of the University of Mumbai for their approval, we hope that some colleges affiliated to the university will start this course from the coming academic year. IVS extended its support in standardizing many of the vacuum instruments and played a vital role in helping to set up a Regional Testing Centre along with BARC. As part of the development of vacuum education, the society arranges the participation of expert members on the subject to deliver lectures and take part in devising courses in the universities. IVS publishes a quarterly called the `Bulletin of Indian Vacuum Society' since its inception, in which articles on vacuum and related topics are published. NIRVAT, news, announcements, and reports are the other features of the Bulletin. The articles in the Bulletin are internationally abstracted. The Bulletin is distributed free to all the members of the society. The society also publishes proceedings of national/international symposia and seminars, manuals, lecture notes etc. It has published a `Vacuum Directory' containing very useful information on vacuum technology. IVS has also set up its own website http://www.ivsnet.org in January 2002. The website contains information about IVS, list of members, list of EC members, events and news, abstracts of articles published in the `Bulletin of Indian Vacuum Society', utilities, announcements, reports, membership and other forms which can be completed online and also gives links to other vacuum societies. Our Society has been a member of the executive council of the International Union of Vacuum Science, Techniques and Applications (IUVSTA) and its various committees since 1970. In 1983 IVS conducted an International Symposium on Vacuum Technology and Nuclear Applications in BARC, Mumbai, under the sponsorship of IUVSTA. In 1987 IVS arranged the Triennial International Conference on Thin Films in New Delhi, where more than 200 foreign delegates participated. IVS also hosted the IUVSTA Executive Council Meeting along with the conference. The society organized yet again an International Conference on Vacuum Science and Technology and SRS Vacuum Systems at CAT, Indore in1995. IVS arranges the prestigious Professor Balakrishnan Memorial Lecture in memory of its founder vice-president. Leading scientists from India and abroad in the field are invited to deliver the talks. So far 23 lectures have been held in this series. IVS has instituted the `IVS- Professor D Y Phadke Memorial Prize' in memory of our founder president, the late Professor D Y Phadke at the University of Mumbai. The prize is given every year to the student ranked top in the MSc (PHY.) examination conducted by the university. The IVS Kolkata Chapter has established the Dr A S Divatia Memorial Trust with the objective of organizing the Dr A S Divatia Memorial Lecture and a seminar once a year and to set up a vacuum testing and calibration facility. IVS has instituted an award in memory of the late Shri C Ambasankaran, its past president and pioneer of vacuum technology in India. This award is given to one of the best papers presented in the national symposium conducted by IVS. One more best paper award `Smt. Shakuntalabai Vyawahare Memorial Prize' is established from a donation given by Shri Mohan R Vyawahare, a life member and a present EC member of the society, in memory of his mother. During the symposia, IVS felicitates two of its members, one from Industry and one from an R & D Institution for their lifetime contribution to vacuum science and technology. Dr A K Gupta, Ex BARC, Ex Generla Manager, IBP, Head, Energy Group, Shapoorji Pallonji & Co Ltd (Industry), and Dr S R Gowariker, Ex BARC, Ex Director, CSIO, Chandigarh, Director, Tolani Education Foundation (R & D) are being honoured this year. T K Saha Geneneral Secretary, IVS

37 CFR 1.105 - Requirements for information.

Code of Federal Regulations, 2011 CFR

2011-07-01

... literature, published application, or patent (U.S. or foreign), by any of the inventors, that relates to the claimed invention. (iv) Information used to draft application: A copy of any non-patent literature... used in invention process: A copy of any non-patent literature, published application, or patent (U.S...

37 CFR 1.105 - Requirements for information.

Code of Federal Regulations, 2012 CFR

2012-07-01

... literature, published application, or patent (U.S. or foreign), by any of the inventors, that relates to the claimed invention. (iv) Information used to draft application: A copy of any non-patent literature... used in invention process: A copy of any non-patent literature, published application, or patent (U.S...

37 CFR 1.105 - Requirements for information.

Code of Federal Regulations, 2013 CFR

2013-07-01

... literature, published application, or patent (U.S. or foreign), by any of the inventors, that relates to the claimed invention. (iv) Information used to draft application: A copy of any non-patent literature... used in invention process: A copy of any non-patent literature, published application, or patent (U.S...

37 CFR 1.105 - Requirements for information.

Code of Federal Regulations, 2014 CFR

2014-07-01

... literature, published application, or patent (U.S. or foreign), by any of the inventors, that relates to the claimed invention. (iv) Information used to draft application: A copy of any non-patent literature... used in invention process: A copy of any non-patent literature, published application, or patent (U.S...

Emergency department management of gastro-enteritis in Australia and New Zealand.

PubMed

Schutz, Jacquie; Babl, Franz E; Sheriff, Nisa; Borland, Meredith

2008-10-01

Comparison of clinical practice guideline (CPG) recommendations and reported physician management of gastro-enteritis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network sites as a baseline for further randomised controlled trials. Two part survey comprising: (i) review of CPGs from PREDICT sites for gastro-enteritis; and (ii) survey of senior emergency department physicians regarding the management of gastro-enteritis. All 11 PREDICT sites participated. Nine CPGs were available with three sites using a common CPG. For moderate dehydration, eight CPGs advocated nasogastric (NG) rehydration in preference to intravenous (IV) rehydration. The IV route was reserved for severe dehydration or failed NG rehydration. In the second component of the survey, 78 of 83 (94%) physicians responded. In moderate dehydration, 82% of respondents used NG rehydration. In severe dehydration, 86% used IV fluids; 12% used NG and 3% an initial IV bolus followed by NG fluid. Serum electrolytes were measured universally with IV fluid use and by 22% using NG rehydration. The IV fluid bolus was with normal saline (86%). Fifty-four per cent used anti-emetics 'rarely' or 'sometimes'. The commonest agents were ondansetron (60%) and metoclopramide (29%). CPG recommendations and physician practice for the management of gastro-enteritis were similar across PREDICT sites with a focus on NG for moderate dehydration and IV for severe dehydration. A variety of fluids and administration rates were used. Anti-emetics were used infrequently. The efficacy and safety of newer anti-emetics should be explored in collaborative studies. Collaborative development of new CPGs should be considered to simplify fluid regimens.

Pneumocystis carinii pneumonia: a late presentation following treatment for stage IV neuroblastoma.

PubMed

Clarke, Edward; Glaser, Adam W; Picton, Susan V

2003-09-01

This report describes a child who develops Pneumocystis carinii pneumonia 7 months after high-dose chemotherapy for stage IV neuroblastoma. In addition to chemotherapy the child had also been treated with abdominal radiotherapy and 13-cis-retinoic acid. Standard practice has been to treat patients with prophylactic co-trimoxazole for 3 months after high-dose therapy, but this report highlights the intensity and complexity of current treatment for stage IV neuroblastoma and the need to be aware of prolonged lymphopenia after such treatment.

Patronage Versus Professionalism in New Security Institutions

DTIC Science & Technology

2011-09-01

27–IV-30. 49 Ibid., IV-27–IV-28. 50 Charles F. Wald , “New Thinking at USEUCOM: The Phase Zero Campaign,” Joint Force Quarterly 43 (4th Quarter, 2006...Stability Operations Require More U.S. Focus, Gates Says,” American Forces Press Service, April 14, 2009. 53 Wald , 73. 54 JP 3–0, VII-10. 55 Defense...friendly and a potential bulwark against the brutal Interior Ministry police. Yet the Egyptian military is known to practice patronage. Analyst Lisa

[Addictive behaviours from DSM-IV to DSM-5].

PubMed

van den Brink, W

2014-01-01

The 5th edition of the DSM was published in May, 2013. The new edition incorporates important changes in the classification of addiction. To compare the classification of addictive behaviours presented in DSM-IV with the classification presented in DSM-5 and to comment on the changes introduced into the new version. First of all, the historical developments of the concept of addiction and the classification of addictive behaviours up to DSM-IV are summarised. Then the changes that have been incorporated into DSM-5 are described. The main changes are: (1) DSM-IV substance related disorders and DSM-IV pathological gambling have been combined into one new DSM-5 category, namely 'Substance Related and Addictive Disorders'; (2) DSM-IV abuse and dependence have been combined into one new DSM-5 diagnosis, namely 'Substance Use Disorder'; (2a) the DSM-IV abuse criterion 'recurrent substance-related legal problems' and the DSM-5 criterion 'craving' has been introduced; and (2b) the criteria for (partial) remission have been sharpened. DSM-5 is an improvement on DSM-IV, but for the diagnosis of a psychiatric disorder and the treatment of a psychiatric patient, classification needs to be complemented with staging and profiling.

Setting stroke research priorities: The consumer perspective.

PubMed

Sangvatanakul, Pukkaporn; Hillege, Sharon; Lalor, Erin; Levi, Christopher; Hill, Kelvin; Middleton, Sandy

2010-12-01

To test a method of engaging consumers in research priority-setting using a quantitative approach and to determine consumer views on stroke research priorities for clinical practice recommendations with lower levels of evidence (Level III and Level IV) and expert consensus opinion as published in the Australian stroke clinical practice guidelines. Survey Urban community Eighteen stroke survivors (n = 12) and carers (n = 6) who were members of the "Working Aged Group - Stroke" (WAGS) consumer support group. Phase I: Participants were asked whether recommendations were "worth" researching ("yes" or "no"); and, if researched, what potential impact they likely would have on patient outcomes. Phase II: Participants were asked to rank recommendations rated by more than 75% of participants in Phase I as "worth" researching and "highly likely" or "likely" to generate research with a significant effect on patient outcomes (n = 13) in order of priority for future stroke research. All recommendations were rated by at least half (n = 9, 50%) of participants as "worth" researching. The majority (67% to 100%) rated all recommendations as "highly likely" or "likely" that research would have a significant effect on patient outcomes. Thirteen out of 20 recommendations were ranked for their research priorities. Recommendations under the topic heading Getting to hospital were ranked highest and Organization of care and Living with stroke were ranked as a lower priority for research. This study provided an example of how to involve consumers in research priority setting successfully using a quantitative approach. Stroke research priorities from the consumer perspective were different from those of health professionals, as published in the literature; thus, consumer opinion should be considered when setting research priorities. Copyright © 2010 Society for Vascular Nursing, Inc. Published by Mosby, Inc. All rights reserved.

5 CFR 1203.11 - Request for regulation review.

Code of Federal Regulations, 2010 CFR

2010-01-01

... PROCEDURES FOR REVIEW OF RULES AND REGULATIONS OF THE OFFICE OF PERSONNEL MANAGEMENT Procedures for Review... reasons why the regulation would require an employee to commit a prohibited personnel practice; or the... practice; (iv) Specific identification of the prohibited personnel practice at issue; and (v) A description...

International Myeloma Working Group Recommendations for the Treatment of Multiple Myeloma–Related Bone Disease

PubMed Central

Terpos, Evangelos; Morgan, Gareth; Dimopoulos, Meletios A.; Drake, Matthew T.; Lentzsch, Suzanne; Raje, Noopur; Sezer, Orhan; García-Sanz, Ramón; Shimizu, Kazuyuki; Turesson, Ingemar; Reiman, Tony; Jurczyszyn, Artur; Merlini, Giampaolo; Spencer, Andrew; Leleu, Xavier; Cavo, Michele; Munshi, Nikhil; Rajkumar, S. Vincent; Durie, Brian G.M.; Roodman, G. David

2013-01-01

Purpose The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) –related bone disease. Methodology An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members. Recommendations Bisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability. PMID:23690408

75 FR 47259 - Notice of Proposed Change to Section IV of the Virginia State Technical Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-05

... DEPARTMENT OF AGRICULTURE Natural Resources Conservation Service Notice of Proposed Change to Section IV of the Virginia State Technical Guide AGENCY: Natural Resources Conservation Service (NRCS), U..., Virginia 23229-5014; Telephone number (804) 287-1691; Fax number (804) 287-1737. Copies of the practice...

Christian Ethics. A Teacher Information Bulletin for Division IV.

ERIC Educational Resources Information Center

Saskatchewan Dept. of Education, Regina.

Listed are print and audiovisual materials that support the "Curriculum Guide for Division IV: Christian Ethics" intended for use in grades 10, 11, and 12. The course is designed to help students articulate, reflect upon, and understand what they believe and practice. Cited in this resource manual are textbooks, teacher's guides,…

Rapid and sensitive detection of early esophageal squamous cell carcinoma with fluorescence probe targeting dipeptidylpeptidase IV

PubMed Central

Onoyama, Haruna; Kamiya, Mako; Kuriki, Yugo; Komatsu, Toru; Abe, Hiroyuki; Tsuji, Yosuke; Yagi, Koichi; Yamagata, Yukinori; Aikou, Susumu; Nishida, Masato; Mori, Kazuhiko; Yamashita, Hiroharu; Fujishiro, Mitsuhiro; Nomura, Sachiyo; Shimizu, Nobuyuki; Fukayama, Masashi; Koike, Kazuhiko; Urano, Yasuteru; Seto, Yasuyuki

2016-01-01

Early detection of esophageal squamous cell carcinoma (ESCC) is an important prognosticator, but is difficult to achieve by conventional endoscopy. Conventional lugol chromoendoscopy and equipment-based image-enhanced endoscopy, such as narrow-band imaging (NBI), have various practical limitations. Since fluorescence-based visualization is considered a promising approach, we aimed to develop an activatable fluorescence probe to visualize ESCCs. First, based on the fact that various aminopeptidase activities are elevated in cancer, we screened freshly resected specimens from patients with a series of aminopeptidase-activatable fluorescence probes. The results indicated that dipeptidylpeptidase IV (DPP-IV) is specifically activated in ESCCs, and would be a suitable molecular target for detection of esophageal cancer. Therefore, we designed, synthesized and characterized a series of DPP-IV-activatable fluorescence probes. When the selected probe was topically sprayed onto endoscopic submucosal dissection (ESD) or surgical specimens, tumors were visualized within 5 min, and when the probe was sprayed on biopsy samples, the sensitivity, specificity and accuracy reached 96.9%, 85.7% and 90.5%. We believe that DPP-IV-targeted activatable fluorescence probes are practically translatable as convenient tools for clinical application to enable rapid and accurate diagnosis of early esophageal cancer during endoscopic or surgical procedures. PMID:27245876

A survey of critical care nurses' practices and perceptions surrounding early intravenous antibiotic initiation during septic shock.

PubMed

Roberts, Russel J; Alhammad, Abdullah M; Crossley, Lindsay; Anketell, Eric; Wood, LeeAnn; Schumaker, Greg; Garpestad, Erik; Devlin, John W

2017-08-01

Delays in antibiotic administration after severe sepsis recognition increases mortality. While physician and pharmacy-related barriers to early antibiotic initiation have been well evaluated, those factors that affect the speed by which critical care nurses working in either the emergency department or the intensive care unit setting initiate antibiotic therapy remains poorly characterized. To evaluate the knowledge, practices and perceptions of critical care nurses regarding antibiotic initiation in patients with newly recognised septic shock. A validated survey was distributed to 122 critical care nurses at one 320-bed academic institution with a sepsis protocol advocating intravenous(IV) antibiotic initiation within 1hour of shock recognition. Among 100 (82%) critical care nurses responding, nearly all (98%) knew of the existence of the sepsis protocol. However, many critical care nurses stated they would optimise blood pressure [with either fluid (38%) or both fluid and a vasopressor (23%)] before antibiotic initiation. Communicated barriers to rapid antibiotic initiation included: excessive patient workload (74%), lack of awareness IV antibiotic(s) ordered (57%) or delivered (69%), need for administration of multiple non-antibiotic IV medications (54%) and no IV access (51%). Multiple nurse-related factors influence IV antibiotic(s) initiation speed and should be incorporated into sepsis quality improvement efforts. Copyright © 2017 Elsevier Ltd. All rights reserved.

DSM-5 and Mental Disorders in Older Individuals: An Overview.

PubMed

Sachdev, Perminder S; Mohan, Adith; Taylor, Lauren; Jeste, Dilip V

2015-01-01

After participating in this activity, learners should be better able to:• Assess the changes in DSM-5 relative to earlier versions.• Evaluate the implications of the DSM-5 for practicing geriatric psychiatrists. About every 20 years, the American Psychiatric Association revises its official classification of mental disorders. The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, prompting considerable commentary, debate, and criticism. This article briefly describes the process leading up to DSM-5 and the main changes from the previous version (DSM-IV) that would be of interest to a geriatric psychiatrist. The changes in the areas of schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders have been many, but the majority of them are minor and unlikely to have major treatment implications. The classification of neurocognitive disorders, however, has seen a major revision and elaboration in comparison to DSM-IV; of special note is the introduction of "mild and major neurocognitive disorders," the latter equated with dementia. A common language has also been introduced for the criteria for the various etiological subtypes of neurocognitive disorders. All physicians treating patients with neurocognitive disorders should familiarize themselves with these criteria. Their use in research has the potential to harmonize the field.

Report on World Workshops on Oral Medicine (WWOM) IV and V: research themes and citation impact: WWOM VI steering committee.

PubMed

Peterson, D E; Lodi, G; Beier Jensen, S; Greenberg, M S; Hodgson, T; Kerr, A R; Wray, D; Lockhart, P B

2015-05-01

The first World Workshop on Oral Medicine (WWOM) was held in 1988. The portfolio has continued to expand in scope and impact over the past 26 years. Five World Workshops were conducted between 1988 and 2010, focusing on creation of systematic reviews in biomedicine and health care of importance to the international oral medicine community. WWOM VI was conducted in April 2014 and further extended this modeling. This most recent Workshop also fostered creation of the inaugural joint meeting between the American Academy of Oral Medicine and the European Association of Oral Medicine, together with The British Society for Oral Medicine and the Oral Medicine Academy of Australasia. The goal of the WWOM portfolio is to strategically enhance international oral medicine research, education, and clinical practice. To this end, this report summarizes subject areas for WWOM IV (2004) and research recommendations for WWOM V (2010), as well as citation metrics relative to publications from these two conferences. The information is designed to provide research and clinical context for key issues in oral medicine as delineated by the WWOM portfolio over the past 10 years, as well as for projected outcomes of WWOM VI over the next 12 months. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Can managed care organizations partner with manufacturers for comparative effectiveness research?

PubMed

Luce, Bryan R; Paramore, L Clark; Parasuraman, Bhash; Liljas, Bengt; de Lissovoy, Gregory

2008-03-01

To describe 2 published pragmatic or practical clinical trials (PCTs) as case studies illustrating successful partnerships between managed care organizations (MCOs) and pharmaceutical manufacturers. In today's environment, there is increasing concern about the comparative effectiveness of medical interventions. Various opinion leaders and stakeholders lament the dearth of such evidence and are calling for the public and private sectors to invest up to billions of dollars to create better comparative evidence. We selected 2 PCTs conducted at different points in the drug life cycle to highlight strengths, limitations, and policy implications. The phase IV study compared fluoxetine hydrochloride vs 2 generic tricyclic antidepressants in selected primary care clinics of a health maintenance organization from 1992 through 1994. The phase IIIb study compared daily budesonide via dry powder inhaler vs triamcinolone acetonide metered-dose inhaler in adult patients with persistent asthma in 25 MCOs from 1995 through 1998. Both PCTs were successfully sponsored and funded by pharmaceutical manufacturers in collaboration with MCOs and provided potentially useful evidence of real-world effectiveness and evidence of value to healthcare decision makers. Industry-sponsored PCTs in managed care are feasible when manufacturer and MCO incentives align and can provide real-world evidence of comparative effectiveness and value for money. These trials can be conducted successfully in the phase IIIb and phase IV environments.

Endangered species and nature conservation: science issues and challenges.

PubMed

Szaro, Robert C

2008-06-01

The issues and challenges facing us in ensuring the survival of as many species and ecosystems as possible call for a renewed research focus to address how to improve management strategies and policy making now and into the future. The key issues to be addressed by activities of the International Union of Forest Research Organization's (IUFRO) Task Force on Endangered Species and Nature Conservation include such issues as: (i) preventing species from being listed by maintaining species populations at sufficient levels that they do not require listing; (ii) recovering threatened and endangered species; (iii) developing management practices and strategies; (iv) balancing actions affecting suites of threatened or endangered species; (v) developing conservation strategies for species without definitive taxonomic treatments; (vi) dealing with global change; (vii) dealing with invasive species; and (viii) restoring critical habitats. © 2008 ISZS, Blackwell Publishing and IOZ/CAS.

Technical communication: new teaching model for practicing ultrasound-guided regional anesthesia techniques: no perishable food products!

PubMed

Liu, Yang; Glass, Nancy L; Power, Robert W

2010-04-01

There is a pronounced learning curve for the technique of ultrasound-guided regional anesthesia. Practicing with a simulator model has been shown to speed the acquisition of these skills for various ultrasound-guided procedures. However, commercial models for ultrasound-guided regional anesthesia may be too costly or not readily available. Models using turkey breasts or tofu blocks have the disadvantage of containing perishable food products that can be a source for infection. We describe an alternative inexpensive model that is made from nonperishable components readily available in the operating room. The materials required include 1 clean used 500-mL bag of IV fluids, a bottle of Premisorb (TYCO Healthcare Group, Mansfield, MA), and a piece of foam material approximately 0.3 cm in diameter and 5 cm in length trimmed from operating room foam pads. After filling the IV bag with tap water and inserting the foam into the IV bag from the outlet port of the IV bag, one-third of a bottle of Premisorb (approximately 15 g) is poured into the IV bag. The outlet port of the bag is then sealed by taping the rubber stopper that originally came with the bag. Premisorb, a solidifying agent frequently used to absorb irrigating fluids or blood in operating room suction canisters, produces a gel-like material in the IV bag. The foam inserted into the bag creates a relatively hyperechoic target. This gel-like substance in the bag will seal the holes created after multiple practice needle insertions, resulting in minimal leakage. The semitransparent nature of the gel allows the trainee to visualize the target directly and on the ultrasound screen. The model we describe is inexpensive and easy to make from materials readily available in the operating room with the advantages of being nonperishable, easy to carry, and reusable.

Evidence-Based Diagnosis: Incorporating Diagnostic Instruments into Clinical Practice

ERIC Educational Resources Information Center

Doss, Amanda Jensen

2005-01-01

This article is intended to serve as a practical guide for practitioners interested in incorporating evidence-based diagnosis (EBD) instruments into their clinical practices to refine the diagnostic process. Three measures are used to illustrate this process, the DISC-IV (Shaffer et al., 2000), the Schedule for Affective Disorders and…

75 FR 52627 - Disenrollment Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... program that has been discontinued. It also amends the regulation to reflect current VA practice and to... conform with current VA practice, which does not disenroll veterans based on their failure to file VA Form 10-10EZ. Current practice is reflected in current paragraph (d)(3)(iv). Removing paragraph (d)(5)(iii...

Test result communication in primary care: clinical and office staff perspectives.

PubMed

Litchfield, Ian J; Bentham, Louise M; Lilford, Richard J; Greenfield, Sheila M

2014-10-01

To understand how the results of laboratory tests are communicated to patients in primary care and perceptions on how the process may be improved. Qualitative study employing staff focus groups. Four UK primary care practices. Staff involved in the communication of test results. Five main themes emerged from the data: (i) the default method for communicating results differed between practices; (ii) clinical impact of results and patient characteristics such as anxiety level or health literacy influenced methods by which patients received their test result; (iii) which staff member had responsibility for the task was frequently unclear; (iv) barriers to communicating results existed, including there being no system or failsafe in place to determine whether results were returned to a practice or patient; (v) staff envisaged problems with a variety of test result communication methods discussed, including use of modern technologies, such as SMS messaging or online access. Communication of test results is a complex yet core primary care activity necessitating flexibility by both patients and staff. Dealing with the results from increasing numbers of tests is resource intensive and pressure on practice staff can be eased by greater utilization of electronic communication. Current systems appear vulnerable with no routine method of tracing delayed or missing results. Instead, practices only become aware of missing results following queries from patients. The creation of a test communication protocol for dissemination among patients and staff would help ensure both groups are aware of their roles and responsibilities. © The Author 2014. Published by Oxford University Press.

Overview of the gene ontology task at BioCreative IV.

PubMed

Mao, Yuqing; Van Auken, Kimberly; Li, Donghui; Arighi, Cecilia N; McQuilton, Peter; Hayman, G Thomas; Tweedie, Susan; Schaeffer, Mary L; Laulederkind, Stanley J F; Wang, Shur-Jen; Gobeill, Julien; Ruch, Patrick; Luu, Anh Tuan; Kim, Jung-Jae; Chiang, Jung-Hsien; Chen, Yu-De; Yang, Chia-Jung; Liu, Hongfang; Zhu, Dongqing; Li, Yanpeng; Yu, Hong; Emadzadeh, Ehsan; Gonzalez, Graciela; Chen, Jian-Ming; Dai, Hong-Jie; Lu, Zhiyong

2014-01-01

Gene ontology (GO) annotation is a common task among model organism databases (MODs) for capturing gene function data from journal articles. It is a time-consuming and labor-intensive task, and is thus often considered as one of the bottlenecks in literature curation. There is a growing need for semiautomated or fully automated GO curation techniques that will help database curators to rapidly and accurately identify gene function information in full-length articles. Despite multiple attempts in the past, few studies have proven to be useful with regard to assisting real-world GO curation. The shortage of sentence-level training data and opportunities for interaction between text-mining developers and GO curators has limited the advances in algorithm development and corresponding use in practical circumstances. To this end, we organized a text-mining challenge task for literature-based GO annotation in BioCreative IV. More specifically, we developed two subtasks: (i) to automatically locate text passages that contain GO-relevant information (a text retrieval task) and (ii) to automatically identify relevant GO terms for the genes in a given article (a concept-recognition task). With the support from five MODs, we provided teams with >4000 unique text passages that served as the basis for each GO annotation in our task data. Such evidence text information has long been recognized as critical for text-mining algorithm development but was never made available because of the high cost of curation. In total, seven teams participated in the challenge task. From the team results, we conclude that the state of the art in automatically mining GO terms from literature has improved over the past decade while much progress is still needed for computer-assisted GO curation. Future work should focus on addressing remaining technical challenges for improved performance of automatic GO concept recognition and incorporating practical benefits of text-mining tools into real-world GO annotation. http://www.biocreative.org/tasks/biocreative-iv/track-4-GO/. Published by Oxford University Press 2014. This work is written by US Government employees and is in the public domain in the US.

Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.

PubMed

Ray-Barruel, Gillian; Cooke, Marie; Mitchell, Marion; Chopra, Vineet; Rickard, Claire M

2018-06-04

Millions of acute care hospital patients need a peripheral intravenous catheter (PIVC) each year. However, up to half of PIVCs remain in situ when not being used, and 30%-50% of intravenous (IV) catheters develop complications or stop working before treatment is finished, requiring the insertion of a new device. Improved assessment could prompt timely removal of redundant catheters and prevent IV complications. This study aims to validate an evidence-based PIVC assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice. The protocol outlines a prospective, multicentre, mixed-methods study using an interrupted time-series (multiple measures preintervention and postintervention) implementation at three Australian hospitals between August 2017 and July 2018. The study will examine the effectiveness of the I-DECIDED assessment and decision-making tool in clinical practice on prompting timely PIVC removal and early detection of complications. Primary outcomes are prevalence of redundant PIVCs (defined as device in situ without a clear purpose), IV complications (occlusion, dislodgement, infiltration, extravasation and phlebitis) and substandard dressings (loose, lifting, moist or soiled); device utilisation ratios; and primary bloodstream infection rates. Secondary outcomes including staff barriers and enablers to PIVC assessment and removal, patient participation, documentation of PIVC assessment and decisions taken to continue or remove the PIVC will be recorded. Using the Promoting Action on Research Implementation in Health Services framework, we will undertake staff focus groups, bedside patient interviews and PIVC assessments and chart audits. Patients aged 18 years or more with a PIVC will be eligible for inclusion. Ethical approval from Queensland Health (HREC/17/QPCH/47), Griffith University (Ref No. 2017/152) and St Vincent's Health and Aged Care Human Research and Ethics Committee (Ref No. 17/28). Results will be published. ANZCTR: 12617000067370; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

DIET@NET: Best Practice Guidelines for dietary assessment in health research.

PubMed

Cade, Janet E; Warthon-Medina, Marisol; Albar, Salwa; Alwan, Nisreen A; Ness, Andrew; Roe, Mark; Wark, Petra A; Greathead, Katharine; Burley, Victoria J; Finglas, Paul; Johnson, Laura; Page, Polly; Roberts, Katharine; Steer, Toni; Hooson, Jozef; Greenwood, Darren C; Robinson, Sian

2017-11-15

Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report. The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131 experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines. Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases. The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGs provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies. These guidelines will be accessible through the Nutritools website, www.nutritools.org .

Alumni of a BSW-Level Specialized Title IV-E Program Voice Their Experiences in the Workplace

ERIC Educational Resources Information Center

Falk, Diane S.

2015-01-01

This study surveyed 289 alumni of a specialized Title IV-E program that prepares undergraduate social work students for careers in public child welfare, examining factors such as turnover rates, adherence to strengths-based practice principles, perceptions of work conditions, and intent to stay. Findings indicate that graduates of this program…

75 FR 33761 - Notice of Proposed Change to Section IV of the Virginia State Technical Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... Section IV of the Virginia State Technical Guide AGENCY: Natural Resources Conservation Service (NRCS), U... Rosa Road, Suite 209, Richmond, Virginia 23229-5014; Telephone number (804) 287-1691; Fax number (804) 287-1737. Copies of the practice standards will be made available upon written request to the address...

Deciphering the Diagnostic Codes: A Guide for School Counselors. Practical Skills for Counselors.

ERIC Educational Resources Information Center

Jones, W. Paul

Although school counselors have more contact with children and adolescents than most other human service professionals, they are frequently left out of discussions on diagnostic coding. Ways in which school counselors can use the codes in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) are explored in this text. The book…

Period variations of Algol-type eclipsing binaries AD And, TWCas and IV Cas

NASA Astrophysics Data System (ADS)

Parimucha, Štefan; Gajdoš, Pavol; Kudak, Viktor; Fedurco, Miroslav; Vaňko, Martin

2018-04-01

We present new analyses of variations in O – C diagrams of three Algol-type eclipsing binary stars: AD And, TW Cas and IV Cas. We have used all published minima times (including visual and photographic) as well as newly determined ones from our and SuperWasp observations. We determined orbital parameters of 3rd bodies in the systems with statistically significant errors, using our code based on genetic algorithms and Markov chain Monte Carlo simulations. We confirmed the multiple nature of AD And and the triple-star model of TW Cas, and we proposed a quadruple-star model of IV Cas.

Cognitive benefits of Angiotensin IV and Angiotensin-(1-7): a systematic review of experimental studies.

PubMed

Ho, Jean K; Nation, Daniel A

2018-05-04

To explore effects of the brain renin-angiotensin system (RAS) on cognition. Systematic review of experimental (non-human) studies assessing cognitive effects of RAS peptides angiotensin-(3-8) [Ang IV] and angiotensin-(1-7) [Ang-(1-7)] and their receptors, the Ang IV receptor (AT4R) and the Mas receptor. Of 450 articles identified, 32 met inclusion criteria. Seven of 11 studies of normal animals found Ang IV had beneficial effects on tests of passive or conditioned avoidance and object recognition. In models of cognitive deficit, eight of nine studies found Ang IV and its analogs (Nle 1 -Ang IV, dihexa, LVV-hemorphin-7) improved performance on spatial working memory and passive avoidance tasks. Two of three studies examining Ang-(1-7) found it benefited memory. Mas receptor removal was associated with reduced fear memory in one study. Studies of cognitive impairment show salutary effects of acute administration of Ang IV and its analogs, as well as AT4R activation. Brain RAS peptides appear most effective administered intracerebroventricularly, close to the time of learning acquisition or retention testing. Ang-(1-7) shows anti-dementia qualities. Copyright © 2018. Published by Elsevier Ltd.

Building Analytic Capacity and Statistical Literacy Among Title IV-E MSW Students

PubMed Central

LERY, BRIDGETTE; PUTNAM-HORNSTEIN, EMILY; WIEGMANN, WENDY; KING, BRYN

2016-01-01

Building and sustaining effective child welfare practice requires an infrastructure of social work professionals trained to use data to identify target populations, connect interventions to outcomes, adapt practice to varying contexts and dynamic populations, and assess their own effectiveness. Increasingly, public agencies are implementing models of self-assessment in which administrative data are used to guide and continuously evaluate the implementation of programs and policies. The research curriculum described in the article was developed to provide Title IV-E and other students interested in public child welfare systems with hands-on opportunities to become experienced and “statistically literate” users of aggregated public child welfare data from California’s administrative child welfare system, attending to the often missing link between data/research and practice improvement. PMID:27429600

78 FR 69604 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-20

... Manufacturing Practice and Hazard Analysis and Risk- Based Preventive Controls for Human Food; Extension of... Hazard Analysis and Risk- Based Preventive Controls for Human Food'' and its information collection... Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for Human Food.'' IV. How To...

The Capsicum annuum class IV chitinase ChitIV interacts with receptor-like cytoplasmic protein kinase PIK1 to accelerate PIK1-triggered cell death and defence responses.

PubMed

Kim, Dae Sung; Kim, Nak Hyun; Hwang, Byung Kook

2015-04-01

The pepper receptor-like cytoplasmic protein kinase, CaPIK1, which mediates signalling of plant cell death and defence responses was previously identified. Here, the identification of a class IV chitinase, CaChitIV, from pepper plants (Capsicum annuum), which interacts with CaPIK1 and promotes CaPIK1-triggered cell death and defence responses, is reported. CaChitIV contains a signal peptide, chitin-binding domain, and glycol hydrolase domain. CaChitIV expression was up-regulated by Xanthomonas campestris pv. vesicatoria (Xcv) infection. Notably, avirulent Xcv infection rapidly induced CaChitIV expression in pepper leaves. Bimolecular fluorescence complementation and co-immunoprecipitation revealed that CaPIK1 interacts with CaChitIV in planta, and that the CaPIK1-CaChitIV complex is localized mainly in the cytoplasm and plasma membrane. CaChitIV is also localized in the endoplasmic reticulum. Transient co-expression of CaChitIV with CaPIK1 enhanced CaPIK1-triggered cell death response and reactive oxygen species (ROS) and nitric oxide (NO) bursts. Co-silencing of both CaChitIV and CaPIK1 in pepper plants conferred enhanced susceptibility to Xcv infection, which was accompanied by a reduced induction of cell death response, ROS and NO bursts, and defence response genes. Ectopic expression of CaPIK1 in Arabidopsis enhanced basal resistance to Hyaloperonospora arabidopsidis infection. Together, the results suggest that CaChitIV positively regulates CaPIK1-triggered cell death and defence responses through its interaction with CaPIK1. © The Author 2015. Published by Oxford University Press on behalf of the Society for Experimental Biology.

The use of old and recent DSM definitions of premature ejaculation in observational studies: a contribution to the present debate for a new classification of PE in the DSM-V.

PubMed

Waldinger, Marcel D; Schweitzer, Dave H

2008-05-01

The DSM-III definition of premature ejaculation (PE) contains the criterion "control" but not that of "ejaculation time." In contrast, the Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision) (DSM-IV-TR) contains the criterion "short ejaculation time," while it lacks "control." To review the adequacy and consequent use of all criteria of the DSM-IV-TR definition in previously published PE Internet surveys. Reviewing all published cohort studies on PE from 2004 to 2007. MEDLINE and EMBASE computer bibliographies were used. Definitions of DSM-III, DSM-IV-TR, and International Classification of Diseases. Five papers, of which three are original studies, reported inclusion of men with PE according to DSM-IV-TR definition but omitted to apply the required "short ejaculation time" criterion. These studies, which have defined PE according to subjective criteria such as control, actually referred to the DSM-III definition. Using DSM-III-like definitions in three different studies revealed a highly variable prevalence of PE (32.5%, 27.6%, and 13.0%). In contrast, based on studies using a 1-minute cutoff point, being the time that is required to call ejaculation time "short" or using the criterion "persistent occurrence," PE revealed to be far less prevalent (5-6%). Unacceptable discrepancies of PE definitions according to DSM-III (abandoned but still used) and DSM-IV-TR argue strongly in favor of a multidimensional new classification of PE for the DSM-V.

Professional karate-do and mixed martial arts fighters present with a high prevalence of temporomandibular disorders.

PubMed

Bonotto, Daniel; Namba, Eli Luis; Veiga, Danielle Medeiros; Wandembruck, Fernanda; Mussi, Felipe; Afonso Cunali, Paulo; Ribeiro Rosa, Edvaldo Antonio; Azevedo-Alanis, Luciana Reis

2016-08-01

Facial trauma in sports has been associated with temporomandibular disorders. Because of the intensity and duration of training needed for elite-level competitions, high-performance athletes can have two to five times more traumatic injuries than recreational athletes. This study aimed to investigate the prevalence of temporomandibular disorders in high-performance martial arts fighters and compare it with the prevalence in recreational athletes and non-athletes. The Research Diagnostic Criteria for Temporomandibular Disorders was used to diagnose and classify professional karate-do practitioners (group I; n = 24), amateur karate-do practitioners (group II; n = 17), high-performance mixed martial arts fighters (group III; n = 13), and non-athletes (n = 28). The groups were compared with the chi-square test and tested for the difference between two proportions using a significance level of 5% (P < 0.05). The prevalence of temporomandibular disorders in groups I (54.2%; P = 0.003) and III (61.5%; P = 0.002) was significantly higher than in group IV (14.3%). The prevalence in group II was similar to that in group IV (P > 0.05). A diagnosis of arthralgia from disk displacement was made more frequently in groups I (45.8%; P = 0.013) and III (38.5%; P = 0.012) than in group IV (7.1%). The chronic pain associated with TMD was low intensity and low disability. While there was a high prevalence of temporomandibular disorders in the professional athletes in our study, the prevalence of the condition in recreational athletes was similar to that in individuals who did not practice martial arts. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Health Occupations Education I. Module No. IV-A to IV-F.

ERIC Educational Resources Information Center

Dunmeyer, Kathryn; And Others

This set of 6 modules on patient body mechanics is 1 of 11 sets in the Health Occupations Education I instructional package for the first year of a 2-year course of study. The materials are designed to prepare students through individualized instruction for entry-level job opportunities on health care teams in a variety of practice settings. Each…

Multiple Intravenous Infusions Phase 1b

PubMed Central

Cassano-Piché, A; Fan, M; Sabovitch, S; Masino, C; Easty, AC

2012-01-01

Background Minimal research has been conducted into the potential patient safety issues related to administering multiple intravenous (IV) infusions to a single patient. Previous research has highlighted that there are a number of related safety risks. In Phase 1a of this study, an analysis of 2 national incident-reporting databases (Institute for Safe Medical Practices Canada and United States Food and Drug Administration MAUDE) found that a high percentage of incidents associated with the administration of multiple IV infusions resulted in patient harm. Objectives The primary objectives of Phase 1b of this study were to identify safety issues with the potential to cause patient harm stemming from the administration of multiple IV infusions; and to identify how nurses are being educated on key principles required to safely administer multiple IV infusions. Data Sources and Review Methods A field study was conducted at 12 hospital clinical units (sites) across Ontario, and telephone interviews were conducted with program coordinators or instructors from both the Ontario baccalaureate nursing degree programs and the Ontario postgraduate Critical Care Nursing Certificate programs. Data were analyzed using Rasmussen’s 1997 Risk Management Framework and a Health Care Failure Modes and Effects Analysis. Results Twenty-two primary patient safety issues were identified with the potential to directly cause patient harm. Seventeen of these (critical issues) were categorized into 6 themes. A cause-consequence tree was established to outline all possible contributing factors for each critical issue. Clinical recommendations were identified for immediate distribution to, and implementation by, Ontario hospitals. Future investigation efforts were planned for Phase 2 of the study. Limitations This exploratory field study identifies the potential for errors, but does not describe the direct observation of such errors, except in a few cases where errors were observed. Not all issues are known in advance, and the frequency of errors is too low to be observed in the time allotted and with the limited sample of observations. Conclusions The administration of multiple IV infusions to a single patient is a complex task with many potential associated patient safety risks. Improvements to infusion and infusion-related technology, education standards, clinical best practice guidelines, hospital policies, and unit work practices are required to reduce the risk potential. This report makes several recommendations to Ontario hospitals so that they can develop an awareness of the issues highlighted in this report and minimize some of the risks. Further investigation of mitigating strategies is required and will be undertaken in Phase 2 of this research. Plain Language Summary Patients, particularly in critical care environments, often require multiple intravenous (IV) medications via large volumetric or syringe infusion pumps. The infusion of multiple IV medications is not without risk; unintended errors during these complex procedures have resulted in patient harm. However, the range of associated risks and the factors contributing to these risks are not well understood. Health Quality Ontario’s Ontario Health Technology Advisory Committee commissioned the Health Technology Safety Research Team at the University Health Network to conduct a multi-phase study to identify and mitigate the risks associated with multiple IV infusions. Some of the questions addressed by the team were as follows: What is needed to reduce the risk of errors for individuals who are receiving a lot of medications? What strategies work best? The initial report, Multiple Intravenous Infusions Phase 1a: Situation Scan Summary Report, summarizes the interim findings based on a literature review, an incident database review, and a technology scan. The Health Technology Safety Research Team worked in close collaboration with the Institute for Safe Medication Practices Canada on an exploratory study to understand the risks associated with multiple IV infusions and the degree to which nurses are educated to help mitigate them. The current report, Multiple Intravenous Infusions Phase 1b: Practice and Training Scan, presents the findings of a field study of 12 hospital clinical units across Ontario, as well as 13 interviews with educators from baccalaureate-level nursing degree programs and postgraduate Critical Care Nursing Certificate programs. It makes 9 recommendations that emphasize best practices for the administration of multiple IV infusions and pertain to secondary infusions, line identification, line set-up and removal, and administering IV bolus medications. The Health Technology Safety Research Team has also produced an associated report for hospitals entitled Mitigating the Risks Associated With Multiple IV Infusions: Recommendations Based on a Field Study of Twelve Ontario Hospitals, which highlights the 9 interim recommendations and provides a brief rationale for each one. PMID:23074426

Safety and Efficacy of Once-Daily Intravenous Busulfan in Allogeneic Transplantation: A Matched-Pair Analysis.

PubMed

Kako, Shinichi; Fujiwara, Shinichiro; Sato, Miki; Kimura, Shun-Ichi; Nakasone, Hideki; Ohashi, Kazuteru; Kawakita, Toshiro; Maeda, Tetsuo; Morishita, Takanobu; Suzuki, Ritsuro; Fukuda, Takahiro; Ichinohe, Tatsuo; Kurata, Mio; Atsuta, Yoshiko; Kanda, Yoshinobu

2018-04-19

Compared with 4-times-daily infusion of intravenous busulfan (ivBU4), the safety and efficacy of once-daily infusion of ivBU (ivBU1) has not been fully clarified. We have been routinely using ivBU1 in a conditioning regimen in adult patients with myeloid malignancy who undergo allogeneic hematopoietic stem cell transplantation. In this study, a total of 91 patients who received ivBU1 for 2 days (n = 18) or 4 days (n = 73) in our institutions were compared with 273 control patients who received ivBU4, who were matched for age, sex, performance status, disease risk, conditioning regimen, and donor type, selected from the database of the Japanese Society for Hematopoietic Cell Transplantation using optimal matching algorithms. One-year overall survival (56.8% versus 57.1%, P = .94), disease-free survival (51.6% versus 50.8%, P = .73), relapse rate (28.5% versus 26.2%, P = .94), nonrelapse mortality (19.9% versus 23.0%, P = .71), and the incidence of graft-versus-host disease were not significantly different between the ivBU1 and ivBU4 groups. In patients who received ivBU1, neutrophil recovery was slower (median days: 22 versus 17, P = .001), and the incidence of veno-occlusive disease was lower (2.6% versus 17.4%, P = .04). In conclusion, ivBU1 can be safely administered with clinical outcomes similar to those with ivBU4. Copyright © 2018 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters.

PubMed

Loubani, Osama M; Green, Robert S

2015-06-01

The aim of this study was to collect and describe all published reports of local tissue injury or extravasation from vasopressor administration via either peripheral intravenous (IV) or central venous catheter. A systematic search of Medline, Embase, and Cochrane databases was performed from inception through January 2014 for reports of adults who received vasopressor intravenously via peripheral IV or central venous catheter for a therapeutic purpose. We included primary studies or case reports of vasopressor administration that resulted in local tissue injury or extravasation of vasopressor solution. Eighty-five articles with 270 patients met all inclusion criteria. A total of 325 separate local tissue injury and extravasation events were identified, with 318 events resulting from peripheral vasopressor administration and 7 events resulting from central administration. There were 204 local tissue injury events from peripheral administration of vasopressors, with an average duration of infusion of 55.9 hours (±68.1), median time of 24 hours, and range of 0.08 to 528 hours. In most of these events (174/204, 85.3%), the infusion site was located distal to the antecubital or popliteal fossae. Published data on tissue injury or extravasation from vasopressor administration via peripheral IVs are derived mainly from case reports. Further study is warranted to clarify the safety of vasopressor administration via peripheral IVs. Copyright © 2015 Elsevier Inc. All rights reserved.

The Role of Independent V&V in Upstream Software Development Processes

NASA Technical Reports Server (NTRS)

Easterbrook, Steve

1996-01-01

This paper describes the role of Verification and Validation (V&V) during the requirements and high level design processes, and in particular the role of Independent V&V (IV&V). The job of IV&V during these phases is to ensure that the requirements are complete, consistent and valid, and to ensure that the high level design meets the requirements. This contrasts with the role of Quality Assurance (QA), which ensures that appropriate standards and process models are defined and applied. This paper describes the current state of practice for IV&V, concentrating on the process model used in NASA projects. We describe a case study, showing the processes by which problem reporting and tracking takes place, and how IV&V feeds into decision making by the development team. We then describe the problems faced in implementing IV&V. We conclude that despite a well defined process model, and tools to support it, IV&V is still beset by communication and coordination problems.

Independent verification and validation for Space Shuttle flight software

NASA Technical Reports Server (NTRS)

1992-01-01

The Committee for Review of Oversight Mechanisms for Space Shuttle Software was asked by the National Aeronautics and Space Administration's (NASA) Office of Space Flight to determine the need to continue independent verification and validation (IV&V) for Space Shuttle flight software. The Committee found that the current IV&V process is necessary to maintain NASA's stringent safety and quality requirements for man-rated vehicles. Therefore, the Committee does not support NASA's plan to eliminate funding for the IV&V effort in fiscal year 1993. The Committee believes that the Space Shuttle software development process is not adequate without IV&V and that elimination of IV&V as currently practiced will adversely affect the overall quality and safety of the software, both now and in the future. Furthermore, the Committee was told that no organization within NASA has the expertise or the manpower to replace the current IV&V function in a timely fashion, nor will building this expertise elsewhere necessarily reduce cost. Thus, the Committee does not recommend moving IV&V functions to other organizations within NASA unless the current IV&V is maintained for as long as it takes to build comparable expertise in the replacing organization.

Reminiscences From a Career in Geomicrobiology

NASA Astrophysics Data System (ADS)

Ehrlich, Henry L.

2012-05-01

This is a memoir relating how the author became a geomicrobiologist and how he practiced his specialty. Born in Germany and receiving his early schooling in Berlin, he completed his secondary education, followed by college and graduate school training, after emigration to the United States in 1940. After attaining a PhD degree in 1951, he spent his entire professional career as a faculty member of the Department of Biology at Rensselaer Polytechnic Institute (RPI) in Troy, New York. He was introduced to geomicrobiology in 1959 by a question from a colleague in the Department of Geology at RPI concerning the recent discovery of acidophilic iron-oxidizing, autotrophic bacteria in acid coal mine drainage. This led him to investigate bacterial interaction with metal sulfides, Mn(II) and Mn(IV) on land and in the sea, chromate, and bauxite; to teach a course in geomicrobiology; and to write a textbook on the subject, first published in 1981.

Estimating the Economic Benefits of Eliminating Job Strain as a Risk Factor for Depression.

PubMed

Cocker, Fiona; Sanderson, Kristy; LaMontagne, Anthony D

2017-01-01

The aim of this study was to quantify the economic benefits of eliminating job strain as a risk factor for depression, using published population-attributable risk estimates of depression attributable to job strain (13.2% for men, 17.2% for women). Cohort simulation using state-transition Markov modeling estimated costs and health outcomes for employed persons who met criteria for lifetime DSM-IV major depression. A societal perspective over 1-year and lifetime time horizons was used. Among employed Australians, $890 million (5.8%) of the annual societal cost of depression was attributable to job strain. Employers bore the brunt of these costs, as they arose from lost productive time and increased risk of job turnover among employees experiencing depression. Proven, practicable means exist to reduce job strain. The findings demonstrate likely financial benefits to employers for expanding psychosocial risk management, providing a financial incentive to complement and reinforce legal and ethical directives.

Tourette's: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria.

PubMed

Robertson, Mary May; Eapen, Valsamma

2014-10-01

The fifth version of the Diagnostic and statistical manual of mental disorders (DSM-5) was released in May 2013 after 14 years of development and almost two decades after the last edition DSM-IV was published in 1994. We review the DSM journey with regards to Tourette Syndrome from the original publication of DSM 1 in 1952 till date. In terms of changes in DSM 5, the major shift has come in the placement of Tourette Syndrome under the 'Neurodevelopmental Disorders' alongside other disorders with a developmental origin. This review provides an overview of the changes in DSM-5 highlighting key points for clinical practice and research along with a snap shot of the current use of DSM as a classificatory system in different parts of the world and suggestions for improving the subtyping and the diagnostic confidence. Copyright © 2014 Elsevier B.V. All rights reserved.

Review of Prescribing Practices for Intermittent Bolus Administration of Morphine

PubMed Central

Sine, Keith; Vaillancourt, Régis; Pascuet, Elena; Martelli, Brenda; Lamontagne, Christine; Ellis, Jacqueline; Wong, Elaine; Gaboury, Isabelle

2011-01-01

Background: Several changes to medication safety practices were proposed in a pediatric hospital, including changing the period of patient observation after administration of opioids and limiting the availability of various concentrations of morphine in the patient care unit. Objective: To document and review postoperative pain management for children on a surgical ward, specifically with regard to intermittent IV bolus administration of morphine, to help in assessing the impact of the proposed nursing practice changes. Methods: Data were collected from records for narcotics and controlled drugs for the surgical ward over a 3-month period (April to June 2006). For each patient, data had been recorded for up to 7 consecutive days after surgery. A patient’s data were included in the review if he or she had received at least 2 doses of morphine by IV bolus, except for the review of weight-based dosing pattern (mg/kg), for which all patients who had received at least one dose of IV morphine were included. Results: Charts for 193 patients were audited. Of these, 163 patients (84.5%) had recieved up to 0.1 mg/kg per dose, and 53 (27.5%) had received only one dose of morphine. Among patients who received more than one dose, the median dose was 0.080 mg/kg on day 1, with a decrease by day 5 to 0.065 mg/kg. Most patients received morphine over the first 2 days after surgery. The median time elapsed between doses was 4.3 h on day 1 and 6.2 h on day 2. Of the 1020 doses included in the analysis, most (801 [78.5%]) were 4 mg or less. Conclusion: The intermittent administration of IV bolus doses of morphine at the study hospital followed common standards for the treatment of postoperative pain. Most doses were no more than 4 mg. On the basis of this information, only 2-mg vials of morphine are now stocked on the ward. The hospital’s change in monitoring practices will increase the surveillance of patients receiving IV bolus doses of morphine. PMID:22479025

Mariner IV Mission to Mars. Part I

NASA Technical Reports Server (NTRS)

James, Jack N.

1965-01-01

This technical report is a series of individual papers documenting the Mariner-Mars project from its beginning in 1962 following the successful Mariner-Venus mission. Part I is pre-encounter data. It includes papers on the design, development, and testing of Mariner IV, as well as papers detailing methods of maintaining communication with and obtaining data from the spacecraft during flight, and expected results during encounter with Mars. Part 11, post-encounter data, to be published later, will consist of documentation of the events taking place during Mariner IV's encounter with Mars and thereafter. The Mariner-Mars mission, the culmination of an era of spacecraft development, has contributed much new technology to be used in future projects.

Cost-effectiveness of oral ibandronate compared with intravenous (i.v.) zoledronic acid or i.v. generic pamidronate in breast cancer patients with metastatic bone disease undergoing i.v. chemotherapy.

PubMed

De Cock, E; Hutton, J; Canney, P; Body, J J; Barrett-Lee, P; Neary, M P; Lewis, G

2005-12-01

Ibandronate is the first third-generation bisphosphonate to have both oral and intravenous (i.v.) efficacy. An incremental cost-effectiveness model compared oral ibandronate with i.v. zoledronic acid and i.v. generic pamidronate in female breast cancer patients with metastatic bone disease, undergoing i.v. chemotherapy. A global economic model was adapted to the UK National Health Service (NHS), with primary outcomes of direct healthcare costs and quality-adjusted life years (QALYs). Efficacy, measured as relative risk reduction of skeletal-related events (SREs), was obtained from clinical trials. Resource use data for i.v. bisphosphonates and the cost of managing SREs were obtained from published studies. Hospital management and SRE treatment costs were taken from unit cost databases. Monthly drug acquisition costs were obtained from the British National Formulary. Utility scores were applied to time with/without an SRE to adjust survival for quality of life. Model design and inputs were validated through expert UK clinician review. Total cost, including drug acquisition, was pound 386 less per patient with oral ibandronate vs. i.v. zoledronic acid and pound 224 less vs. i.v. generic pamidronate. Oral ibandronate gained 0.019 and 0.02 QALYs vs. i.v. zoledronic acid and i.v. pamidronate, respectively, making it the economically dominant option. At a threshold of pound 30,000 per QALY, oral ibandronate was cost-effective vs. zoledronic acid in 85% of simulations and vs. pamidronate in 79%. Oral ibandronate is a cost-effective treatment for metastatic bone disease from breast cancer due to reduced SREs, bone pain, and cost savings from avoidance of resource use commonly associated with bisphosphonate infusions.

Intravenous Therapy.

ERIC Educational Resources Information Center

Galliart, Barbara

Intended for teaching licensed practical nurses, this curriculum guide provides information related to the equipment and skills required for nursing care of patients needing intravenous (IV) therapy. It also explains the roles and responsibilities of the licensed practical nurse with regard to intravenous therapy. Each of the 15 instructional…

Glycated Apolipoprotein A-IV Induces Atherogenesis in Patients With CAD in Type 2 Diabetes.

PubMed

Dai, Yang; Shen, Ying; Li, Qing Run; Ding, Feng Hua; Wang, Xiao Qun; Liu, Hong Juan; Yan, Xiao Xiang; Wang, Ling Jie; Yang, Ke; Wang, Hai Bo; Chen, Qiu Jing; Shen, Wei Feng; Zhang, Rui Yan; Lu, Lin

2017-10-17

Nonenzymatic glycation of apolipoproteins plays a role in the pathogenesis of the vascular complications of diabetes. This study investigated whether apolipoprotein (apo) A-IV was glycated in patients with type 2 diabetes mellitus (T2DM) and whether apoA-IV glycation was related to coronary artery disease (CAD). The study also determined the biological effects of glycated apoA-IV. The authors consecutively enrolled 204 patients with T2DM without CAD (Group I), 515 patients with T2DM with CAD (Group II), and 176 healthy subjects (control group) in this study. ApoA-IV was precipitated from ultracentrifugally isolated high-density lipoprotein, and its glycation level was determined based on Western blotting densitometry (relative intensity of apoA-IV glycation). ApoA-IV NƐ-(carboxylmethyl) lysine (CML) modification sites were identified by mass spectrometry in 37 control subjects, 63 patients in Group I, and 138 patients in Group II. Saline or glycated apoA-IV (g-apoA-IV) generated by glyoxal culture was injected into apoE -/- mice to evaluate atherogenesis, and was also used for the cell experiments. The relative intensity and the abundance of apoA-IV glycation were associated with the presence and severity of CAD in patients with T2DM (all p < 0.05). The experiments showed that g-apoA-IV induced proinflammatory reactions in vitro and promoted atherogenesis in apoE -/- mice through the nuclear receptor NR4A3. G-apoA-IV with mutations (K-A) at high-frequency glycation sites exhibited more weakened proinflammatory and atherogenic effects than did g-apoA-IV both in vitro and in vivo. ApoA-IV glycation is associated with CAD severity in patients with T2DM, and g-apoA-IV induces atherogenesis through NR4A3 in apoE -/- mice. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Math anxiety differentially affects WAIS-IV arithmetic performance in undergraduates.

PubMed

Buelow, Melissa T; Frakey, Laura L

2013-06-01

Previous research has shown that math anxiety can influence the math performance level; however, to date, it is unknown whether math anxiety influences performance on working memory tasks during neuropsychological evaluation. In the present study, 172 undergraduate students completed measures of math achievement (the Math Computation subtest from the Wide Range Achievement Test-IV), math anxiety (the Math Anxiety Rating Scale-Revised), general test anxiety (from the Adult Manifest Anxiety Scale-College version), and the three Working Memory Index tasks from the Wechsler Adult Intelligence Scale-IV Edition (WAIS-IV; Digit Span [DS], Arithmetic, Letter-Number Sequencing [LNS]). Results indicated that math anxiety predicted performance on Arithmetic, but not DS or LNS, above and beyond the effects of gender, general test anxiety, and math performance level. Our findings suggest that math anxiety can negatively influence WAIS-IV working memory subtest scores. Implications for clinical practice include the utilization of LNS in individuals expressing high math anxiety.

Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

PubMed

Sotto, Juan Alejandro R; Ayuste, Eduardo C; Bowyer, Mark W; Almonte, Josefina R; Dofitas, Rodney B; Lapitan, Marie C M; Pimentel, Elisabeth A; Ritter, E Matthew; Wherry, David C

2009-01-01

This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense.

Identification of dipeptidyl peptidase-IV inhibitory peptides from mare whey protein hydrolysates.

PubMed

Song, J J; Wang, Q; Du, M; Ji, X M; Mao, X Y

2017-09-01

Inhibition of dipeptidyl peptidase-IV (DPP-IV) activity is a promising strategy for treatment of type 2 diabetes. In the current study, DPP-IV inhibitory peptides were identified from mare whey protein hydrolysates obtained by papain. The results showed that all the mare whey protein hydrolysates obtained at various hydrolysis durations possessed more potent DPP-IV inhibitory activity compared with intact whey protein. The 4-h hydrolysates showed the greatest DPP-IV inhibitory activity with half-maximal inhibitory concentration of 0.18 mg/mL. The 2 novel peptides from 4-h hydrolysate fractions separated by successive chromatographic steps were characterized by liquid chromatography-electrospray ionization tandem mass spectrometry. The novel peptides Asn-Leu-Glu-Ile-Ile-Leu-Arg and Thr-Gln-Met-Val-Asp-Glu-Glu-Ile-Met-Glu-Lys-Phe-Arg, which corresponded to β-lactoglobulin 1 f(71-77) and β-lactoglobulin 1 f(143-155), demonstrated DPP-IV inhibitory activity with half-maximal inhibitory concentrations of 86.34 and 69.84 μM, respectively. The DPP-IV inhibitory activity of the 2 peptides was retained or even improved after simulated gastrointestinal digestion in vitro. Our findings indicate that mare whey protein-derived peptides may possess potential as functional food ingredients in the management of type 2 diabetes. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The developmental origin of zygodactyl feet and its possible loss in the evolution of Passeriformes.

PubMed

Botelho, João Francisco; Smith-Paredes, Daniel; Nuñez-Leon, Daniel; Soto-Acuña, Sergio; Vargas, Alexander O

2014-08-07

The zygodactyl orientation of toes (digits II and III pointing forwards, digits I and IV pointing backwards) evolved independently in different extant bird taxa. To understand the origin of this trait in modern birds, we investigated the development of the zygodactyl foot of the budgerigar (Psittaciformes). We compared its muscular development with that of the anisodactyl quail (Galliformes) and show that while the musculus abductor digiti IV (ABDIV) becomes strongly developed at HH36 in both species, the musculus extensor brevis digiti IV (EBDIV) degenerates and almost disappears only in the budgerigar. The asymmetric action of those muscles early in the development of the budgerigar foot causes retroversion of digit IV (dIV). Paralysed budgerigar embryos do not revert dIV and are anisodactyl. Both molecular phylogenetic analysis and palaeontological information suggest that the ancestor of passerines could have been zygodactyl. We followed the development of the zebra finch (Passeriformes) foot muscles and found that in this species, both the primordia of the ABDIV and of the EBDIV fail to develop. These data suggest that loss of asymmetric forces of muscular activity exerted on dIV, caused by the absence of the ABDIV, could have resulted in secondary anisodactyly in Passeriformes. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Infusion volume control and calculation using metronome and drop counter based intravenous infusion therapy helper.

PubMed

Park, Kyungnam; Lee, Jangyoung; Kim, Soo-Young; Kim, Jinwoo; Kim, Insoo; Choi, Seung Pill; Jeong, Sikyung; Hong, Sungyoup

2013-06-01

This study assessed the method of fluid infusion control using an IntraVenous Infusion Controller (IVIC). Four methods of infusion control (dial flow controller, IV set without correction, IV set with correction and IVIC correction) were used to measure the volume of each technique at two infusion rates. The infused fluid volume with a dial flow controller was significantly larger than other methods. The infused fluid volume was significantly smaller with an IV set without correction over time. Regarding the concordance correlation coefficient (CCC) of infused fluid volume in relation to a target volume, IVIC correction was shown to have the highest level of agreement. The flow rate measured in check mode showed a good agreement with the volume of collected fluid after passing through the IV system. Thus, an IVIC could assist in providing an accurate infusion control. © 2013 Wiley Publishing Asia Pty Ltd.

Spray Drying as a Reliable Route to Produce Metastable Carbamazepine Form IV.

PubMed

Halliwell, Rebecca A; Bhardwaj, Rajni M; Brown, Cameron J; Briggs, Naomi E B; Dunn, Jaclyn; Robertson, John; Nordon, Alison; Florence, Alastair J

2017-07-01

Carbamazepine (CBZ) is an active pharmaceutical ingredient used in the treatment of epilepsy that can form at least 5 polymorphic forms. Metastable form IV was originally discovered from crystallization with polymer additives; however, it has not been observed from subsequent solvent-only crystallization efforts. This work reports the reproducible formation of phase pure crystalline form IV by spray drying of methanolic CBZ solution. Characterization of the material was carried out using diffraction, scanning electron microscopy, and differential scanning calorimetry. In situ Raman spectroscopy was used to monitor the spray-dried product during the spray drying process. This work demonstrates that spray drying provides a robust method for the production of form IV CBZ, and the combination of high supersaturation and rapid solid isolation from solution overcomes the apparent limitation of more traditional solution crystallization approaches to produce metastable crystalline forms. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Effects of practice on the Wechsler Adult Intelligence Scale-IV across 3- and 6-month intervals.

PubMed

Estevis, Eduardo; Basso, Michael R; Combs, Dennis

2012-01-01

A total of 54 participants (age M = 20.9; education M = 14.9; initial Full Scale IQ M = 111.6) were administered the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) at baseline and again either 3 or 6 months later. Scores on the Full Scale IQ, Verbal Comprehension, Working Memory, Perceptual Reasoning, Processing Speed, and General Ability Indices improved approximately 7, 5, 4, 5, 9, and 6 points, respectively, and increases were similar regardless of whether the re-examination occurred over 3- or 6-month intervals. Reliable change indices (RCI) were computed using the simple difference and bivariate regression methods, providing estimated base rates of change across time. The regression method provided more accurate estimates of reliable change than did the simple difference between baseline and follow-up scores. These findings suggest that prior exposure to the WAIS-IV results in significant score increments. These gains reflect practice effects instead of genuine intellectual changes, which may lead to errors in clinical judgment.

Pharmacokinetics of paroxetine, a selective serotonin reuptake inhibitor, in Grey parrots (Psittacus erithacus erithacus): influence of pharmaceutical formulation and length of dosing.

PubMed

van Zeeland, Y R A; Schoemaker, N J; Haritova, A; Smit, J W; van Maarseveen, E M; Lumeij, J T; Fink-Gremmels, J

2013-02-01

Paroxetine, a selective serotonin reuptake inhibitor, may be beneficial in the treatment of behavioural disorders in pet birds. The lack of pharmacokinetic data and clinical trials currently limits the use of this drug in clinical avian practice. This paper evaluates the pharmacokinetic properties and potential side effects of single and repeated dosing of paroxetine in Grey parrots (Psittacus erithacus erithacus). Paroxetine pharmacokinetics were studied after single i.v. and single oral dosing, and after repeated oral administration during 1 month. Plasma paroxetine concentrations were determined by liquid chromatography-tandem mass spectrometry. No undesirable side effects were observed during the study. Pharmacokinetic analysis revealed a quick distribution and rapid elimination after i.v. administration. Oral administration of paroxetine HCl dissolved in water resulted in a relatively slow absorption (T(max)=5.9±2.6 h) and a low bioavailability (31±15%). Repeated administration resulted in higher rate of absorption, most likely due to a saturation of the cytochrome P450-mediated first-pass metabolism. This study shows that oral administration of paroxetine HCl (4 mg/kg twice daily) in parrots results in plasma concentrations within the therapeutic range recommended for the treatment of depressions in humans. Further studies are needed to demonstrate the clinical efficacy of this dosage regimen in parrots with behavioural disorders. © 2012 Blackwell Publishing Ltd.

Muscle RAS oncogene homolog (MRAS) recurrent mutation in Borrmann type IV gastric cancer.

PubMed

Yasumoto, Makiko; Sakamoto, Etsuko; Ogasawara, Sachiko; Isobe, Taro; Kizaki, Junya; Sumi, Akiko; Kusano, Hironori; Akiba, Jun; Torimura, Takuji; Akagi, Yoshito; Itadani, Hiraku; Kobayashi, Tsutomu; Hasako, Shinichi; Kumazaki, Masafumi; Mizuarai, Shinji; Oie, Shinji; Yano, Hirohisa

2017-01-01

The prognosis of patients with Borrmann type IV gastric cancer (Type IV) is extremely poor. Thus, there is an urgent need to elucidate the molecular mechanisms underlying the oncogenesis of Type IV and to identify new therapeutic targets. Although previous studies using whole-exome and whole-genome sequencing have elucidated genomic alterations in gastric cancer, none has focused on comprehensive genetic analysis of Type IV. To discover cancer-relevant genes in Type IV, we performed whole-exome sequencing and genome-wide copy number analysis on 13 patients with Type IV. Exome sequencing identified 178 somatic mutations in protein-coding sequences or at splice sites. Among the mutations, we found a mutation in muscle RAS oncogene homolog (MRAS), which is predicted to cause molecular dysfunction. MRAS belongs to the Ras subgroup of small G proteins, which includes the prototypic RAS oncogenes. We analyzed an additional 46 Type IV samples to investigate the frequency of MRAS mutation. There were eight nonsynonymous mutations (mutation frequency, 17%), showing that MRAS is recurrently mutated in Type IV. Copy number analysis identified six focal amplifications and one homozygous deletion, including insulin-like growth factor 1 receptor (IGF1R) amplification. The samples with IGF1R amplification had remarkably higher IGF1R mRNA and protein expression levels compared with the other samples. This is the first report of MRAS recurrent mutation in human tumor samples. Our results suggest that MRAS mutation and IGF1R amplification could drive tumorigenesis of Type IV and could be new therapeutic targets. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Traveling Wave Amplifier Driven by a Large Diameter Annular Electron Beam in a Disk-Loaded Structure

DTIC Science & Technology

2015-10-30

IV MARY LOU ROBINSON, DR-IV Project Officer Chief, High Power Electromagnetics Division This report is published in the interest of scientific and...unlimited. 13. SUPPLEMENTARY NOTES OPS-15-9244 14. ABSTRACT This project studies the viability of a high - power traveling wave tube (TWT) using a novel...CHRISTINE codes. Fair agreement was observed. The preliminary conclusion is that the disk-on-rod TWT is a viable, high - power extension to the conventional

Instrumental variables analysis using multiple databases: an example of antidepressant use and risk of hip fracture.

PubMed

Uddin, Md Jamal; Groenwold, Rolf H H; de Boer, Anthonius; Gardarsdottir, Helga; Martin, Elisa; Candore, Gianmario; Belitser, Svetlana V; Hoes, Arno W; Roes, Kit C B; Klungel, Olaf H

2016-03-01

Instrumental variable (IV) analysis can control for unmeasured confounding, yet it has not been widely used in pharmacoepidemiology. We aimed to assess the performance of IV analysis using different IVs in multiple databases in a study of antidepressant use and hip fracture. Information on adults with at least one prescription of a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) during 2001-2009 was extracted from the THIN (UK), BIFAP (Spain), and Mondriaan (Netherlands) databases. IVs were created using the proportion of SSRI prescriptions per practice or using the one, five, or ten previous prescriptions by a physician. Data were analysed using conventional Cox regression and two-stage IV models. In the conventional analysis, SSRI (vs. TCA) was associated with an increased risk of hip fracture, which was consistently found across databases: the adjusted hazard ratio (HR) was approximately 1.35 for time-fixed and 1.50 to 2.49 for time-varying SSRI use, while the IV analysis based on the IVs that appeared to satisfy the IV assumptions showed conflicting results, e.g. the adjusted HRs ranged from 0.55 to 2.75 for time-fixed exposure. IVs for time-varying exposure violated at least one IV assumption and were therefore invalid. This multiple database study shows that the performance of IV analysis varied across the databases for time-fixed and time-varying exposures and strongly depends on the definition of IVs. It remains challenging to obtain valid IVs in pharmacoepidemiological studies, particularly for time-varying exposure, and IV analysis should therefore be interpreted cautiously. Copyright © 2016 John Wiley & Sons, Ltd.

Software IV and V Research Priorities and Applied Program Accomplishments Within NASA

NASA Technical Reports Server (NTRS)

Blazy, Louis J.

2000-01-01

The mission of this research is to be world-class creators and facilitators of innovative, intelligent, high performance, reliable information technologies that enable NASA missions to (1) increase software safety and quality through error avoidance, early detection and resolution of errors, by utilizing and applying empirically based software engineering best practices; (2) ensure customer software risks are identified and/or that requirements are met and/or exceeded; (3) research, develop, apply, verify, and publish software technologies for competitive advantage and the advancement of science; and (4) facilitate the transfer of science and engineering data, methods, and practices to NASA, educational institutions, state agencies, and commercial organizations. The goals are to become a national Center Of Excellence (COE) in software and system independent verification and validation, and to become an international leading force in the field of software engineering for improving the safety, quality, reliability, and cost performance of software systems. This project addresses the following problems: Ensure safety of NASA missions, ensure requirements are met, minimize programmatic and technological risks of software development and operations, improve software quality, reduce costs and time to delivery, and improve the science of software engineering

Joint Services Electronics Program.

DTIC Science & Technology

1981-12-01

102 APPENDIX III: REPORTS PUBLISHED BY ESL OCTOBER 1980 TO OCTOBER 1981 104 APPENDIX IV: ESL PAPERS PUBLISHED OCTOBER 1980 TO OCTOBER 1981 108 I 1 I...and papers published by the Laboratory during the past year are J given in the appendices. I I I I1 11. SIGNIFICANT ACCOMPLISHMENTS The study of the...level in the E-plane. The curved transition also helps to match the wavegulde feed to the horn and the aperture of the I horn to free space resulting in

75 FR 70217 - Defense Transportation Regulation, Part IV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... comments received in connection with the Defense Personal Property Program (DP3), Phase III Final-Draft.... Any subsequent changes will be published in a Federal Register Announcement and incorporated into the...

Hospital-based financial analysis of endovascular therapy and intravenous thrombolysis for large vessel acute ischemic strokes: the 'bottom line'.

PubMed

Rai, Ansaar T; Evans, Kim

2015-02-01

Economic viability is important to any hospital striving to be a comprehensive stroke center. An inability to recover cost can strain sustained delivery of advanced stroke care. To carry out a comparative financial analysis of intravenous (IV) recombinant tissue plasminogen activator and endovascular (EV) therapy in treating large vessel strokes from a hospital's perspective. Actual hospital's charges, costs, and payments were analyzed for 265 patients who received treatment for large vessel strokes. The patients were divided into an EV (n=141) and an IV group (n=124). The net gain/loss was calculated as the difference between payments received and the total cost. The charges, costs, and payments were significantly higher for the EV than the IV group (p<0.0001 for all). Medicare A was the main payer. Length of stay was inversely related to net gain/loss (p<0.0001). Favorable outcome was associated with a net gain of $3853 (±$21,155) and poor outcome with a net deficit of $2906 (±$15,088) (p=0.003). The hospital showed a net gain for the EV group versus a net deficit for the IV group in patients who survived the admission (p=0.04), had a favorable outcome (p=0.1), or were discharged to home (p=0.03). There was no difference in the time in hospital based on in-hospital mortality for the EV group but patients who died in the IV group had a significantly shorter length of stay than those who survived (p=0.04). The favorable outcome of 42.3% in the EV group was significantly higher than the 29.4% in the IV group (p=0.03). Endovascular therapy was associated with better outcomes and higher cost-recovery than IV thrombolysis in patients with large vessel strokes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Does intravenous contrast-enhanced computed tomography cause acute kidney injury? Protocol of a systematic review of the evidence

PubMed Central

2014-01-01

Background Contrast-induced acute kidney injury is a common cause of iatrogenic acute kidney injury (AKI). Most of the published estimates of AKI after contrast use originate from the cardiac catheterization literature despite contrast-enhanced computed tomography (CT) scans being the more common setting for contrast use. This systematic review aims to summarize the current evidence about (1)the risk of AKI following intravenous (IV) contrast-enhanced CT scans and(2) the risk of clinical outcomes (i.e. death, hospitalization and need for renal replacement therapy) due to IV contrast-enhanced CT scans. Methods/Design A systematic literature search for published studies will be performed using MEDLINE, EMBASE and The COCHRANE Library databases. Unpublished studies will be identified by searching through grey literature. No language restriction will be applied. The review will consider all studies that have examined the association between IV contrast media and AKI. To be selected, the study should include two arms: one group of exposed patients who received IV contrast material before CT scans and one group of unexposed group who did not receive contrast material before CT scans. Two authors will independently screen titles and abstracts obtained from electronic databases, extract data and will assess the quality of the studies selected using the Cochrane's ‘Risk of Bias’ assessment tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. A random-effects meta-analysis will be performed if there is no remarkable heterogeneity between studies. Discussion This systematic review will provide synthesis of current evidence around the effect of IV contrast material on AKI and other clinical outcomes. Results will be helpful for making evidence-based recommendations and guidelines for clinical and radiologic settings. Systematic review registration PROSPERO CRD42013003799. PMID:25148933

Pros and cons of intraperitoneal chemotherapy in the treatment of epithelial ovarian cancer.

PubMed

Zeimet, Alain G; Reimer, Daniel; Radl, Alice C; Reinthaller, Alexander; Schauer, Christian; Petru, Edgar; Concin, Nicole; Braun, Stephan; Marth, Christian

2009-07-01

Development of the pros and cons of intraperitoneal (IP) chemotherapy in the treatment of epithelial ovarian cancer based on the most prominent data published on the evolution of IP chemotherapy and on experience with this therapeutic strategy in clinical routine. The literature published on IP chemotherapy in ovarian cancer between 1970 and 2008 was identified systematically by computer-based searches in MEDLINE and the Cochrane Library. Furthermore, a preliminary analysis of data recorded during an observational nationwide multicenter study of the Austrian AGO on IP-IV chemotherapy using the GOG-172 treatment regimen was performed. The literature review unequivocally revealed a significantly greater toxicity for IP than for intravenous (IV) cisplatin-based chemotherapy. However, according to a Cochrane meta-analysis, IP-IV administration of chemotherapy is associated with a 21.6% decrease in the risk for death. In agreement with earlier reports, the most frequently mentioned side-effects in the Austria-wide observational study were long-lasting neurotoxicity, abdominal pain, fatigue, gastrointestinal and metabolic toxicities, and catheter-related complications. Most of these toxicities were identified as mirroring the toxicity profile of high-dose IV cisplatin (>or=100 mg/m(2)). In some patients, the classic IP-IV regimen with cisplatin/paclitaxel was changed to an alternative schedule comprising carboplatin AUC 5 (d1) and weekly paclitaxel 60 mg/m(2) (d1, 8, 15) completely administered via the IP route. This treatment was better tolerated and quality of life was significantly less compromised. However, neutropenia and thrombocytopenia were the limiting side-effects of this IP regimen. In cases where optimal cytoreduction with residual disease

Prevention of Contrast-Induced AKI: A Review of Published Trials and the Design of the Prevention of Serious Adverse Events following Angiography (PRESERVE) Trial

PubMed Central

Gallagher, Martin; Kaufman, James; Cass, Alan; Parikh, Chirag R.; Chertow, Glenn M.; Shunk, Kendrick A.; McCullough, Peter A.; Fine, Michael J.; Mor, Maria K.; Lew, Robert A.; Huang, Grant D.; Conner, Todd A.; Brophy, Mary T.; Lee, Joanne; Soliva, Susan; Palevsky, Paul M.

2013-01-01

Summary Contrast-induced AKI (CI-AKI) is a common condition associated with serious, adverse outcomes. CI-AKI may be preventable because its risk factors are well characterized and the timing of renal insult is commonly known in advance. Intravenous (IV) fluids and N-acetylcysteine (NAC) are two of the most widely studied preventive measures for CI-AKI. Despite a multitude of clinical trials and meta-analyses, the most effective type of IV fluid (sodium bicarbonate versus sodium chloride) and the benefit of NAC remain unclear. Careful review of published trials of these interventions reveals design limitations that contributed to their inconclusive findings. Such design limitations include the enrollment of small numbers of patients, increasing the risk for type I and type II statistical errors; the use of surrogate primary endpoints defined by small increments in serum creatinine, which are associated with, but not necessarily causally related to serious, adverse, patient-centered outcomes; and the inclusion of low-risk patients with intact baseline kidney function, yielding low event rates and reduced generalizability to a higher-risk population. The Prevention of Serious Adverse Events following Angiography (PRESERVE) trial is a randomized, double-blind, multicenter trial that will enroll 8680 high-risk patients undergoing coronary or noncoronary angiography to compare the effectiveness of IV isotonic sodium bicarbonate versus IV isotonic sodium chloride and oral NAC versus oral placebo for the prevention of serious, adverse outcomes associated with CI-AKI. This article discusses key methodological issues of past trials investigating IV fluids and NAC and how they informed the design of the PRESERVE trial. PMID:23660180

Managing type II and type IV Lauge-Hansen supination external rotation ankle fractures: current orthopaedic practice.

PubMed

Kosuge, D D; Mahadevan, D; Chandrasenan, J; Pugh, H

2010-11-01

Differentiating supination external rotation (SER) type II and IV ankle injuries is challenging in the absence of a medial malleolar fracture or talar shift on radiographs. The accurate differentiation between a stable SER-II from an unstable SER-IV injury would allow implementation of the appropriate management plan from diagnosis. The aim of this study was to ascertain the practice of orthopaedic surgeons in dealing with these injuries. A postal survey was undertaken on 216 orthopaedic consultants from three regions. In the presence of medial-sided clinical signs (tenderness, swelling, ecchymosis), 22% of consultants would perform surgical fixation. 53% would choose non-operative treatment and the majority would monitor these fractures through serial radiographs. The remaining 25% of consultants would perform an examination under anaesthesia (EUA; 15%), request stress radiographs (9%) or an MRI scan (1%). Without medial-sided signs, 85% would advocate non-operative treatment and, of these, 74% would perform weekly radiographs. Interestingly, 6% would perform immediate surgical fixation. Stress radiographs (6%) and EUAs (2%) were advocated in the remaining group of consultants. Foot and ankle surgeons utilised stress radiographs more frequently and were more likely to proceed to surgical fixation should talar shift be demonstrated. Clinical practice is varied amongst the orthopaedic community. This may lead to unnecessary surgery in SER-II injuries and delay in diagnosis and operative management of SER-IV injuries. We have highlighted the various investigative modalities available that may be used in conjunction with clinical signs to make a more accurate diagnosis.

Analysis of effectiveness, safety and optimization of tocilizumab in a cohort of patients with rheumatoid arthritis in clinical practice.

PubMed

Mena-Vázquez, Natalia; Manrique-Arija, Sara; Rojas-Giménez, Marta; Ureña-Garnica, Inmaculada; Jiménez-Núñez, Francisco G; Fernández-Nebro, Antonio

2017-07-01

To evaluate the effectiveness and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) in clinical practice, establishing the optimized regimen and switching from intravenous (IV) to subcutaneous (SC) therapy. Retrospective observational study. We included 53 RA patients treated with TCZ. The main outcome was TCZ effectiveness at week 24. Secondary outcome variables included effectiveness at week 52, therapeutic maintenance, physical function and safety. The effectiveness of optimization and the switch from IV to SC was evaluated at 3 and 6 months. The efficacy was measured with the Disease Activity Score. Paired t-tests or Wilcoxon were used to evaluate effectiveness and survival time using Kaplan-Meier. The proportion of patients who achieved remission or low disease activity at weeks 24 and 52 was 75.5% and 87.3%, respectively. The mean retention time (95% confidence interval [95% CI] was 81.7 months [76.6-86.7]). Twenty-one of 53 patients (39.6%) optimized the TCZ dose and 35 patients switched from IV TCZ to SC, with no changes in effectiveness. The adverse event rate was 13.6 events/100 patient-years. Tocilizumab appears to be effective and safe in RA in clinical practice. The optimized regimen appears to be effective in most patients in remission, even when they change from IV to SC. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Challenging a dogma; AJCC 8th staging system is not sufficient to predict outcomes of patients with malignant pleural mesothelioma.

PubMed

Abdel-Rahman, Omar

2017-11-01

The 8th edition of malignant pleural mesothelioma (MPM) American Joint Committee on Cancer (AJCC) staging system has been published. The current analysis aims to evaluate its performance in a population-based setting among patients recorded within the surveillance, epidemiology and end results (SEER) database. SEER database (2004-2013) has been accessed through SEER*Stat program and AJCC 8th edition stage groups were reconstructed. Survival analyses (overall and cancer-specific) were conducted according to 6th and 8th editions through Kaplan-Meier analysis. Cox-regression multivariate model was also utilized for pair wise comparisons between different prognostic groups for overall and cancer-specific survival. A total of 5382 patients with MPM were identified in the period from 2004 to 2013. According to the 6th edition, significant pair wise P values for overall survival included: IA vs. III (P=0.027); IA vs. IV: P<0.0001; IB vs. IV: P<0.0001; II vs. III: P<0.0001; II vs. IV: P<0.0001; III vs. IV: P<0.0001). According to the 8th edition, significant pair wise P values for overall survival included: all stages vs. IV: P<0.0001; IA vs. II: P=0.046; IA vs. IIIA: P=0.022; IA vs. IIIB: P <0.0001; IB vs. II: P<0.0001; IB vs. IIIB: P<0.0001; II vs. IIIA: P<0.0001; IIIA vs. IIIB: P<0.0001). C-index for 6th edition was 0.539 (SE: 0.008; 95% CI: 0.524-0.555); while C-index for 8th edition was 0.540 (SE: 0.008; 95% CI: 0.525-0.556). Based on the above findings, a simplified staging system was proposed and overall and cancer-specific survivals were evaluated according to the simplified system. For overall and cancer-specific survival assessment, P values for all pair wise comparisons among different stages were significant (<0.01). The prognostic performance of both the 6th and 8th AJCC editions is unsatisfactory; there is a need for a more practical and prognostically relevant staging system for MPM. Copyright © 2017 Elsevier B.V. All rights reserved.

Global megatrends and their implications for environmental assessment practice

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

Retief, Francois, E-mail: francois.retief@nwu.ac.za; Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University

This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication andmore » participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.« less

A reflective analysis of medical education research on self-regulation in learning and practice.

PubMed

Brydges, Ryan; Butler, Deborah

2012-01-01

In the health professions we expect practitioners and trainees to engage in self-regulation of their learning and practice. For example, doctors are responsible for diagnosing their own learning needs and pursuing professional development opportunities; medical residents are expected to identify what they do not know when caring for patients and to seek help from supervisors when they need it, and medical school curricula are increasingly called upon to support self-regulation as a central learning outcome. Given the importance of self-regulation in both health professions education and ongoing professional practice, our aim was to generate a snapshot of the state of the science in medical education research in this area. To achieve this goal, we gathered literature focused on self-regulation or self-directed learning undertaken from multiple perspectives. Then, with support from a multi-component theoretical framework, we created an overarching map of the themes addressed thus far and emerging findings. We built from that integrative overview to consider contributions, connections and gaps in research on self-regulation to date. Based on this reflective analysis, we conclude that the medical education community's understanding about self-regulation will continue to advance as we: (i) consider how learning is undertaken within the complex social contexts of clinical training and practice; (ii) think of self-regulation within an integrative perspective that allows us to combine disparate strands of research and to consider self-regulation across the training continuum in medicine, from learning to practice; (iii) attend to the grain size of analysis both thoughtfully and intentionally, and (iv) most essentially, extend our efforts to understand the need for and best practices in support of self-regulation. © Blackwell Publishing Ltd 2012.

Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence

PubMed Central

2012-01-01

Background Mental disorders are classified by two major nosological systems, the ICD-10 and the DSM-IV-TR, consisting of different diagnostic criteria. The present study investigated the diagnostic concordance between the two systems for anxiety disorders in childhood and adolescence, in particular for separation anxiety disorder (SAD), specific phobia, social phobia, and generalized anxiety disorder (GAD). Methods A structured clinical interview, the Kinder-DIPS, was administered to 210 children and 258 parents. The percentage of agreement, kappa, and Yule’s Y coefficients were calculated for all diagnoses. Specific criteria causing discrepancies between the two classification systems were identified. Results DSM-IV-TR consistently classified more children than ICD-10 with an anxiety disorder, with a higher concordance between DSM-IV-TR and the ICD-10 child section (F9) than with the adult section (F4) of the ICD-10. This result was found for all four investigated anxiety disorders. The results revealed low to high levels of concordance and poor to good agreement between the classification systems, depending on the anxiety disorder. Conclusions The two classification systems identify different children with an anxiety disorder. However, it remains an open question, whether the research results can be generalized to clinical practice since DSM-IV-TR is mainly used in research while ICD-10 is widely established in clinical practice in Europe. Therefore, the population investigated by the DSM (research population) is not identical with the population examined using the ICD (clinical population). PMID:23267678

Rapid Intravenous Rehydration Therapy in Children With Acute Gastroenteritis: A Systematic Review.

PubMed

Toaimah, Fatihi Hassan Soliman; Mohammad, Hala Mohammad Fathi

2016-02-01

Rapid intravenous (IV) rehydration is commonly used for the management of pediatric gastroenteritis in the emergency department. The current practice shows wide variation in the volume and rate of rapid IV hydration. The aim of this review was to assess the efficacy of rapid IV rehydration compared with standard method in children with gastroenteritis. MEDLINE (1946-2014), EMBASE (1974-2014), and CENTRAL via the Cochrane Library (Issue 8, 2014) were systematically searched to identify eligible studies. Inclusion criteria were randomized controlled trials of rapid IV rehydration in children with gastroenteritis. A total of 1513 articles were retrieved, and our inclusion criteria were met by 3 studies, with a total of 464 participants. The percentage of children who were successfully rehydrated and tolerated oral fluids at 2 to 4 hours after starting IV fluid therapy ranged from 69% to 100% in both rapid IV rehydration and standard method. Time to discharge ranged from 2 to 6 hours (rapid rehydration) versus 2 to 5 hours (standard rehydration). Emergency department revisits ranged from 3% to 16% (rapid rehydration) versus 5% to 14% (standard). Summarized results suggested that rapid IV rehydration may be associated with longer time-to-discharge and higher readmission rates. The new evidence fails to demonstrate superiority of large-volume (60 mL/kg/h) over standard (20 mL/kg/h) IV rehydration. Standard volume IV rehydration for 1 to 4 hours followed by oral hydration or maintenance IV fluids seems sufficient for most children with gastroenteritis requiring IV fluid administration. However, more evidence is needed to establish an optimal IV rehydration regimen.

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

17 CFR 201.102 - Appearance and practice before the Commission.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., opinion or other paper by any attorney, accountant, engineer or other professional or expert, filed with... rules and regulations thereunder. (iv) With respect to persons licensed to practice as accountants... accountant knows, or should know, that heightened scrutiny is warranted. (2) Repeated instances of...

Ground glass opacities management in the lung cancer screening era

PubMed Central

Fornito, Mariaconcetta; Palazzolo, Manuela; Criscione, Alessandra; Gangemi, Mariapia; Borrata, Francesco; Vigneri, Paolo; Nardini, Marco; Dunning, Joel

2018-01-01

Pulmonary ground glass opacity (GGO) is becoming an important clinical dilemma in oncology as its diagnosis in clinical practice is increasing due to the introduction of low dose computed tomography (CT) scan and screening. The incidence of cancer in GGO has been reported as high as 63%. The purpose of this manuscript is to review best available evidence papers on management of GGO in lung cancer to address the following questions: (I) how to correlate CT findings with malignancy; (II) when and who operate? (III) how to perform intraoperative detection of intrapulmonary GGO? (IV) wedge, segmentectomy or lobectomy? Taking a cue from a clinical scenario, a review on PubMed was conducted. The words search included: “Lung ground glass opacity”. The research was limited to human and adults. We considered all published articles from 1990 to April 2017, which reported on at least sufficient data, to be eligible. The literature search was limited to articles in English. A total of 1,211 articles have been found. Interestingly, while in 1991, only one paper was published on low-dose high-resolution CT, in 2016, 126 papers have been published. Most cited and recent papers have been chosen for discussion. Many recent papers have been published from Asian groups. It is clearly not possible to conclude from these data what is the best strategy for GGO in the lung cancer screening era. Certainly, when there is uncertainty, personal opinion and experience should not influence decision making, on the contrary decision should be taken by a multidisciplinary team. PMID:29666813

Undergraduate degree projects in the Swedish dental schools: a documentary analysis.

PubMed

Franzén, C; Brown, G

2013-05-01

Undergraduate degree projects have currently been introduced into courses in the four Swedish dental schools. The rationale for research projects is that they enable students to develop research expertise skills and to show their ability to apply and develop knowledge relevant to professional practice. This paper reports a qualitative analysis of the curriculum documents and handbooks including the criteria used to assess the students' research reports. The aim was to investigate commonalities and differences in the design of degree projects between the four Swedish dental schools and to explore any inconsistencies within the documents. The documentary analysis was based on the constant comparison method. Four overarching themes emerged from the analysis: (i) developing scientific expertise, (ii) developing professional expertise, (iii) following rules and (iv) fostering creativity. The documents from the four dental schools revealed similar views on the purposes of the projects and provided similar assessment criteria. The students were requested to formulate an odontological problem, apply a relevant scientific method, analyse texts and empirical data, express critical reflections and write a short thesis. The students were free to choose topics. There were differences between the dental schools on the emphasis placed on practical uses of the projects and theoretical background of the projects. Two of the schools insisted on rigid rules of completing and writing the project yet paradoxically emphasised creativity. There were wide variations in the required length of the project report. The report may prove useful to dental schools in other countries who are about to design undergraduate research projects. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Can we improve C IV-based single epoch black hole mass estimations?

NASA Astrophysics Data System (ADS)

Mejía-Restrepo, J. E.; Trakhtenbrot, B.; Lira, P.; Netzer, H.

2018-05-01

In large optical surveys at high redshifts (z > 2), the C IV broad emission line is the most practical alternative to estimate the mass (MBH) of active super-massive black holes (SMBHs). However, mass determinations obtained with this line are known to be highly uncertain. In this work we use the Sloan Digital Sky Survey Data Release 7 and 12 quasar catalogues to statistically test three alternative methods put forward in the literature to improve C IV-based MBH estimations. These methods are constructed from correlations between the ratio of the C IV line-width to the low ionization line-widths (Hα, Hβ and Mg II) and several other properties of rest-frame UV emission lines. Our analysis suggests that these correction methods are of limited applicability, mostly because all of them depend on correlations that are driven by the linewidth of the C IV profile itself and not by an interconnection between the linewidth of the C IV line with the linewidth of the low ionization lines. Our results show that optical C IV-based mass estimates at high redshift cannot be a proper replacement for estimates based on IR spectroscopy of low ionization lines like Hα, Hβ and Mg II.

Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits.

PubMed

Gardiner, Sharon J; Metcalf, Sarah Cl; Chin, Paul Kl; Doogue, Matthew P; Dalton, Simon C; Chambers, Stephen T

2018-04-13

To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.

Why we prefer levetiracetam over phenytoin for treatment of status epilepticus.

PubMed

Zaccara, G; Giorgi, F S; Amantini, A; Giannasi, G; Campostrini, R; Giovannelli, F; Paganini, M; Nazerian, P

2018-06-01

Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine-resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time-consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine-resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

How Is the Practice of Yoga Related to Weight Status? Population-Based Findings From Project EAT-IV.

PubMed

Neumark-Sztainer, Dianne; MacLehose, Richard F; Watts, Allison W; Eisenberg, Marla E; Laska, Melissa N; Larson, Nicole

2017-12-01

Yoga may provide a strategy for healthy weight management in young adults. This study examined prevalence and characteristics of young adults' yoga practice and associations with changes in body mass index. Surveys were completed by 1830 young adults (31.1 ± 1.6 y) participating in Project EAT-IV. Cross-sectional and 5-year longitudinal analyses were conducted stratified by initial weight status. Two-thirds (66.5%) of nonoverweight women and 48.9% of overweight women reported ever doing yoga, while 27.2% of nonoverweight women and 16.4% of overweight women practiced regularly (≥30 min/wk). Fewer men practiced yoga. Among young adults practicing regularly (n = 294), differences were identified in intensity, type, and location of yoga practice across weight status. Young adults who were overweight and practiced yoga regularly showed a nonsignificant 5-year decrease in their body mass index (-0.60 kg/m 2 ; P = .49), whereas those not practicing regularly had significant increases in their body mass index (+1.37 kg/m 2 ; P < .01). Frequency of yoga was inversely associated with weight gain among both overweight and nonoverweight young adults practicing yoga regularly. Young adults of different body sizes practice yoga. Yoga was associated with less weight gain over time, particularly in overweight young adults. Practicing yoga on a regular basis may help with weight gain prevention.

How to Retain Postgraduate Students in Engineering Programmes: A Practical Perspective

ERIC Educational Resources Information Center

Le, Khoa N.; Tam, Vivian W. Y.

2008-01-01

Six factors for pursuing an engineering postgraduate programme at Griffith University including (i) programme quality; (ii) employment prospects; (iii) practicality; (iv) personal interest; (v) popularity; and (vi) reputation; and 11 factors for not pursuing this engineering programme including (i) employment prospects; (ii) degree of difficulty;…

75 FR 62759 - Notice of Proposed Change to Section IV of the Virginia State Technical Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

..., Roof Runoff Structure; 600, Terrace; 620, Underground Outlet; 313, Waste Storage Facility; 359, Waste Treatment Lagoon; 633, Waste Utilization; 638, Water and Sediment Control Basin. These practices will be used to plan and install conservation practices on cropland, pastureland, woodland, and wildlife land...

Utilisation of prehospital intravenous access.

PubMed

Bester, B H; Sobuwa, Simpiwe

2014-07-22

To describe the use of intravenous (IV) therapy in the South African (SA) prehopsital setting, and to determine the proportion of prehopsital cannulations considered unnecessary when graded against the South African Triage Score (SATS) chart. The study was conducted in the prehospital emergency medical care setting in the Western Cape Province, SA. Using a descriptive research design, we looked at the report forms of patients treated and transported by personnel currently employed in the public sector, serving the urban and rural areas stipulated by the municipal boundaries. All medical and trauma cases in which establishment of IV access was documented for the month of April 2013 were included. Interhospital transfers, unsuccessful attempts at IV access and intraosseous cannulation were excluded. When graded against the SATS, prophylactic IV access was not justified in 42.3% of the total number of cases (N=149) in which it was established, and therefore added no direct benefit to the continuum of patient care. It is worth noting that 18.8% (n=39) of the IV lines were utilised for fluid administration, as opposed to 9.2% (n=19) for the administration of IV medications. In view of the paucity of studies indicating a direct benefit of out-of-hospital IV intervention, the practice of precautionary, protocol-driven prophylactic establishment of IV access should be evaluated. Current data suggest that in the absence of scientific evidence, IV access should only be initiated when it will benefit the patient immediately, and precautionary IV access, especially in non-injured patients, should be re-evaluated.

Implementing smart infusion pumps with dose-error reduction software: real-world experiences.

PubMed

Heron, Claire

2017-04-27

Intravenous (IV) drug administration, especially with 'smart pumps', is complex and susceptible to errors. Although errors can occur at any stage of the IV medication process, most errors occur during reconstitution and administration. Dose-error reduction software (DERS) loaded on to infusion pumps incorporates a drug library with predefined upper and lower drug dose limits and infusion rates, which can reduce IV infusion errors. Although this is an important advance for patient safety at the point of care, uptake is still relatively low. This article discuses the challenges and benefits of implementing DERS in clinical practice as experienced by three UK trusts.

Understanding the Recent Increase in Ferritin Levels in United States Dialysis Patients: Potential Impact of Changes in Intravenous Iron and Erythropoiesis-Stimulating Agent Dosing.

PubMed

Karaboyas, Angelo; Zee, Jarcy; Morgenstern, Hal; Nolen, Jacqueline G; Hakim, Raymond; Kalantar-Zadeh, Kamyar; Zager, Philip; Pisoni, Ronald L; Port, Friedrich K; Robinson, Bruce M

2015-10-07

Anemia management changed substantially among dialysis patients in the United States around the time of implementation of the new Centers for Medicare & Medicaid Services bundled payment system and erythropoiesis-stimulating agent (ESA) label change in 2011. Among these, average ferritin levels increased dramatically and have remained high since; this study sought to gain understanding of this sustained rise in ferritin levels. Trends in mean ferritin, hemoglobin, IV iron dose, and ESA dose from 2009 to 2013 were examined in 9735 patients from 91 United States Dialysis Outcomes and Practice Patterns Study facilities. Linear mixed models were used to assess the extent to which intravenous (IV) iron and ESA dose accounted for patients' changes in ferritin over time. Mean ESA dose and hemoglobin levels declined throughout the study. Mean IV iron dose increased from 210 mg/mo in 2009-2010 to a peak of 280 mg/mo in 2011, then declined back to 200 mg/mo and remained stable from 2012 to 2013. Mean ferritin increased from 601 ng/ml in the third quarter of 2009 to 887 ng/ml in the first quarter of 2012; models suggest that higher IV iron dosing was a primary determinant during 2011, but lower ESA doses contributed to the sustained high ferritin levels thereafter. In a subset of 17 facilities that decreased IV iron dose in 2011, mean ferritin rose by 120 ng/ml to 764 ng/ml, which appeared to be primarily due to ESA reduction. Together, changes in IV iron and ESA doses accounted for 46% of the increase in ferritin over the study period. In contrast to expectations, the rise in average IV iron dose did not persist beyond 2011. The sustained rise in ferritin levels in United States dialysis patients after policy changes in 2011, to average levels well in excess of 800 ng/ml, appeared to be partly due to reductions in ESA dosing and not solely IV iron dosing practices. The effect of these changes in ferritin on health outcomes requires further investigation. Copyright © 2015 by the American Society of Nephrology.

Understanding the Recent Increase in Ferritin Levels in United States Dialysis Patients: Potential Impact of Changes in Intravenous Iron and Erythropoiesis-Stimulating Agent Dosing

PubMed Central

Zee, Jarcy; Morgenstern, Hal; Nolen, Jacqueline G.; Hakim, Raymond; Kalantar-Zadeh, Kamyar; Zager, Philip; Pisoni, Ronald L.; Port, Friedrich K.; Robinson, Bruce M.

2015-01-01

Background and objectives Anemia management changed substantially among dialysis patients in the United States around the time of implementation of the new Centers for Medicare & Medicaid Services bundled payment system and erythropoiesis-stimulating agent (ESA) label change in 2011. Among these, average ferritin levels increased dramatically and have remained high since; this study sought to gain understanding of this sustained rise in ferritin levels. Design, setting, participants, & measurements Trends in mean ferritin, hemoglobin, IV iron dose, and ESA dose from 2009 to 2013 were examined in 9735 patients from 91 United States Dialysis Outcomes and Practice Patterns Study facilities. Linear mixed models were used to assess the extent to which intravenous (IV) iron and ESA dose accounted for patients’ changes in ferritin over time. Results Mean ESA dose and hemoglobin levels declined throughout the study. Mean IV iron dose increased from 210 mg/mo in 2009–2010 to a peak of 280 mg/mo in 2011, then declined back to 200 mg/mo and remained stable from 2012 to 2013. Mean ferritin increased from 601 ng/ml in the third quarter of 2009 to 887 ng/ml in the first quarter of 2012; models suggest that higher IV iron dosing was a primary determinant during 2011, but lower ESA doses contributed to the sustained high ferritin levels thereafter. In a subset of 17 facilities that decreased IV iron dose in 2011, mean ferritin rose by 120 ng/ml to 764 ng/ml, which appeared to be primarily due to ESA reduction. Together, changes in IV iron and ESA doses accounted for 46% of the increase in ferritin over the study period. Conclusions In contrast to expectations, the rise in average IV iron dose did not persist beyond 2011. The sustained rise in ferritin levels in United States dialysis patients after policy changes in 2011, to average levels well in excess of 800 ng/ml, appeared to be partly due to reductions in ESA dosing and not solely IV iron dosing practices. The effect of these changes in ferritin on health outcomes requires further investigation. PMID:26286925

Best Practice Guidelines on Publication Ethics: a Publisher's Perspective

PubMed Central

Graf, Chris; Wager, Elizabeth; Bowman, Alyson; Fiack, Suzan; Scott-Lichter, Diane; Robinson, Andrew

2007-01-01

These Best Practice Guidelines on Publication Ethics describe Blackwell Publishing's position on the major ethical principles of academic publishing and review factors that may foster ethical behavior or create problems. The aims are to encourage discussion, to initiate changes where they are needed, and to provide practical guidance, in the form of Best Practice statements, to inform these changes. Blackwell Publishing recommends that editors adapt and adopt the suggestions outlined to best fit the needs of their own particular publishing environment. PMID:17206953

Best Practice Guidelines on Publication Ethics: a publisher's perspective.

PubMed

Graf, Chris; Wager, Elizabeth; Bowman, Alyson; Fiack, Suzan; Scott-Lichter, Diane; Robinson, Andrew

2007-01-01

These Best Practice Guidelines on Publication Ethics describe Blackwell Publishing's position on the major ethical principles of academic publishing and review factors that may foster ethical behavior or create problems. The aims are to encourage discussion, to initiate changes where they are needed, and to provide practical guidance, in the form of Best Practice statements, to inform these changes. Blackwell Publishing recommends that editors adapt and adopt the suggestions outlined to best fit the needs of their own particular publishing environment.

Efficacy and safety of a modified intravenous recombinant tissue plasminogen activator regimen in Chinese patients with acute ischemic stroke.

PubMed

Pan, Shu-Ming; Liu, Jia-Fu; Liu, Ming; Shen, Sa; Li, Hao-Jun; Dai, Li-Hua; Chen, Xiang-Jun

2013-07-01

Thrombolytic treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA; 0.90 mg/kg, with a maximum dose of 90 mg) has been recommended as the standard management for acute ischemic stroke (AIS) thrombolysis. However, the dose of IV rtPA in Asia remains controversial. This study was designed to verify the safety and efficacy of IV rtPA treatment for AIS with a lower dosage (0.90 mg/kg, with a maximum dose of 50 mg). Patients were divided into 3 dosage groups according to body weight (BW): group 1, <55 kg for 0.90 mg/kg; group 2, 55 to 67 kg for 0.75 to 0.90 mg/kg; and group 3, >67 kg for <0.75 mg/kg. The following data were collected: patient demographics, vascular risk factors, neuroimaging results, time of rtPA administration, National Institutes of Health Stroke Scale score before treatment and at 24 hours, and a modified Rankin Scale (mRS) score at 3 months. Eighty-three AIS patients who were of Han Chinese descent were included in the study. The baseline characteristics of the 3 dosage groups were well matched. In group 1 (BW <55 kg for 0.90 mg/kg; n = 19), 57.1% had a favorable outcome at 3 months, compared with 61.2% of patients in group 2 (BW 55-67 kg for 0.75-0.90 mg/kg; n = 33) and 51.5% in group 3 (BW >67 kg for <0.75 mg/kg; n = 31; P = .362). There were no significantly statistical differences in the incidence of symptomatic intracerebral hemorrhage and mortality rate. This IV rtPA regimen (0.90 mg/kg, with a maximum dose of 50 mg) not only shows sufficient favorable outcome in clinical practice in Chinese patients with AIS but also good health economic savings. This regimen could be suitable for many developing countries. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

An evaluation of ferrihydrite- and Metsorb™-DGT techniques for measuring oxyanion species (As, Se, V, P): effective capacity, competition and diffusion coefficients.

PubMed

Price, Helen L; Teasdale, Peter R; Jolley, Dianne F

2013-11-25

This study investigated several knowledge gaps with respect to the diffusive gradients in thin films (DGT) technique for measurement of oxyanions (As(III), As(V), Se(IV), Se(VI), PO4(3-), and V(V)) using the ferrihydrite and Metsorb™ binding layers. Elution efficiencies for each binding layer were higher with 1:20 dilutions, as analytical interferences for ICP-MS were minimised. Diffusion coefficients measured by diffusion cell and by DGT time-series experiments were found to agree well and generally agreed with previously reported values, although a range of diffusion coefficients have been reported for inorganic As and Se species. The relative binding affinity for both ferrihydrite and Metsorb™ was PO4(3-) ≈ As(V)>V(V) ≈ As(III)>Se(IV) > Se(VI) and effective binding capacities were measured in single ion solutions, and spiked synthetic freshwater and seawater, advising practical decisions about DGT monitoring. Under the conditions tested the performance of both ferrihydrite and Metsorb™ binding layers was directly comparable for As(V), As(III) Se(IV), V(V) and PO4(3-) over a deployment spanning ≤ 2 days for both freshwater and seawater. In order to return quantitative data for several analytes we recommend that the DGT method using either ferrihydrite or Metsorb™ be deployed for a maximum of 2 days in marine waters likely to contain high levels of the most strongly adsorbing oxyanions contaminants. The high pH, the competitive ions present in seawater and the identity of co-adsorbing ions affect the capacity of each binding layer for the analytes of interest. In freshwaters, longer deployment times can be considered but the concentration and identity of co-adsorbing ions may impact on quantitative uptake of Se(IV). This study found ferrihydrite-DGT outperformed Metsorb-DGT while previous studies have found the opposite, with variation in binding materials masses used being a likely reason. Clearly, preparation of both binding layers should always be optimised to produce the highest capacity possible, especially for seawater deployments. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide.

PubMed

Maraiki, Fatma; Farooq, Faiyaz; Ahmed, Mohamed

2016-08-01

To identify the intravenous (IV) medications that are prepared in glass bottles at the institution and establish which of these medications can be prepared in flexible IV bags such as polyvinyl chloride (PVC) or non-PVC instead of glass bottles. The cost implication of switching from glass bottles to flexible IV bags was calculated. A study using FOCUS-PDCA model to identify IV medications prepared in glass bottles and establish which of these medications could be prepared in IV bags (PVC or non-PVC). The cost impact of switching from glass bottles to IV plastic bags (including PVC or non-PVC) was calculated. The stability data obtained were used as a reference for updating pharmacy internal IV preparation charts. A total of 17 IV medications were found to be prepared in IV glass bottles. Of these 17 medications, only 8 (47%) were prepared in IV glass bottles due to incompatibility with PVC bags. For 7 (41%) of the medications, of which 6 were monoclonal antibodies (MABs), the reason for preparation in glass bottles was unclear as these medications are compatible with either PVC or non-PVC or both. The potential cost savings associated with switching all of the identified medications to IV plastic bags (either non-PVC or PVC) exceeded $200 000. The elimination of glass bottles within the institution resulted in a significant cost saving. The use of FOCUS-PDCA model can help healthcare institution achieve significant improvements in process and realize significant cost savings. © 2016 Royal Pharmaceutical Society.

Instrumental Variable Methods for Continuous Outcomes That Accommodate Nonignorable Missing Baseline Values.

PubMed

Ertefaie, Ashkan; Flory, James H; Hennessy, Sean; Small, Dylan S

2017-06-15

Instrumental variable (IV) methods provide unbiased treatment effect estimation in the presence of unmeasured confounders under certain assumptions. To provide valid estimates of treatment effect, treatment effect confounders that are associated with the IV (IV-confounders) must be included in the analysis, and not including observations with missing values may lead to bias. Missing covariate data are particularly problematic when the probability that a value is missing is related to the value itself, which is known as nonignorable missingness. In such cases, imputation-based methods are biased. Using health-care provider preference as an IV method, we propose a 2-step procedure with which to estimate a valid treatment effect in the presence of baseline variables with nonignorable missing values. First, the provider preference IV value is estimated by performing a complete-case analysis using a random-effects model that includes IV-confounders. Second, the treatment effect is estimated using a 2-stage least squares IV approach that excludes IV-confounders with missing values. Simulation results are presented, and the method is applied to an analysis comparing the effects of sulfonylureas versus metformin on body mass index, where the variables baseline body mass index and glycosylated hemoglobin have missing values. Our result supports the association of sulfonylureas with weight gain. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Astragaloside suppresses apoptosis of the podocytes in rats with diabetic nephropathy via miR-378/TRAF5 signaling pathway.

PubMed

Lei, Xiao; Zhang, Bo-da; Ren, Ji-Gang; Luo, Fang-Li

2018-05-21

Apoptosis of podocytes plays a crucial role in diabetic nephropathy (DN) development, and astragaloside (AS-IV) has a significant impact on podocyte apoptosis. This study aims to explore the effect of AS-IV on diabetic nephropathy progression. The diabetic nephropathy model was established in rats with streptozotocin (STZ) injection. The albuminuria was examined by using the enzyme linked immunosorbent assay (ELISA). The expression of miR-378, tumor-necrosis factor (TNF) receptor (TNFR)-associated factor 5 (TRAF5) mRNA and protein was analyzed by qRT-PCR and western blot, respectively. Cell transfection was conducted for modulating endogenous expression of miR-378. Dual luciferase reporter assay was used to evaluate the interaction between miR-378 and TRAF5. The terminal deoxynucleotidy transferase dUTP nick end labeling (TUNEL) staining assay was performed for apoptosis detection. AS-IV protected diabetic rats from developing into diabetic nephropathy. The expression of miR-378 was down-regulated in diabetic nephropathy rats, which was reversed by AS-IV. AS-IV enhanced the expression of miR-378 in podocytes treated with high glucose. MiR-378 negatively regulated TRAF5. AS-IV inhibited the expression of TRAF5 through miR-378. AS-IV suppressed apoptosis of podocytes via targeting miR-378. AS-IV suppresses apoptosis of the podocytes through the miR-378/TRAF5 signaling pathway, and thereby repressing diabetic nephropathy development. Copyright © 2017. Published by Elsevier Inc.

Reliability and validity of the DSM-IV diagnostic category of schizoaffective disorder: preliminary data.

PubMed

Maj, M; Pirozzi, R; Formicola, A M; Bartoli, L; Bucci, P

2000-01-01

Concerns have been expressed about the reliability and validity of the DSM-IV criteria for schizoaffective disorder, but no systematic study has been published up to now. The Cohen's kappa for the individual items of the DSM-IV definition of schizoaffective disorder, manic episode and major depressive episode was evaluated in 150 patients independently interviewed by two psychiatrists using the Composite International Diagnostic Interview. The two-year outcome of patients with a consensus DSM-IV diagnosis of schizoaffective disorder was compared to that of patients with DSM-IV schizophrenia and schizophreniform disorder, using the Strauss-Carpenter Outcome Scale. The Cohen's kappa was 0.22 for the diagnosis of schizoaffective disorder, 0.71 for that of manic episode, and 0.82 for that of major depressive episode. Schizoaffective patients had a significantly better outcome than those with schizophrenia but a worse outcome than those with schizophreniform disorder. The inter-rater reliability of the DSM-IV criteria for schizoaffective disorder is not satisfactory. The better outcome of DSM-IV schizoaffective disorder compared with schizophrenia seems to depend more on the inclusion, in the definition of schizophrenia but not in that of schizoaffective disorder, of the six-month duration and functional impairment criteria than on the different symptomatological patterns of the two conditions. The size of the sample of patients fulfilling DSM-IV criteria for schizoaffective disorder was small. The study suggests that the clinical implications of the currently problematic diagnosis of schizoaffective disorder may be modest.

Effects of intraosseous epinephrine in a cardiac arrest swine model.

PubMed

Wong, Marc R; Reggio, Matt J; Morocho, Freddy R; Holloway, Monica M; Garcia-Blanco, Jose C; Jenkins, Constance; Johnson, Arthur D

2016-04-01

Interruptions in cardiopulmonary resuscitation (CPR) to obtain vascular access reduces blood flow to vital organs. Tibial intraosseous (TIO) access may be a faster alternative to intravenous (IV) access for delivery of vasoactive medications. The purpose of this study was to examine the differences in pharmacokinetics and pharmacodynamics of TIO- and IV-delivered epinephrine. A prospective, between subjects, experimental design comparing Cmax, Tmax, return of spontaneous circulation (ROSC), and time to ROSC. Adult male swine were divided into three equal groups (n = 7) all received CPR and defibrillation: the second group received IV epinephrine and the third group received tibial intraosseous epinephrine. Swine were placed in cardiac arrest for 2 min before CPR was initiated. After 2 min of CPR, epinephrine was delivered by IV or TIO, and serial blood samples were collected over 4 min. There were no significant differences between IV versus TIO epinephrine in achieving ROSC, time to ROSC, and Cmax. A one-way analysis of variance demonstrated a significant difference between the IV and TIO groups in Tmax (P = 0.025). A Fisher exact test demonstrated a significant difference between IV epinephrine versus CPR/Defib only (P = 0.035) and TIO epinephrine versus CPR/Defib only (P = 0.010) in achieving ROSC. A multivariate analysis of variance showed significant differences in IV versus intraosseous epinephrine concentration at specific time intervals: 60 (P = 0.023), 90 (P = 0.001), and 120 (P < 0.000) sec. In the context of ROSC, epinephrine delivered via TIO route is a clinically relevant alternative to IV administration. When IV access cannot be immediately obtained in cardiac arrest patients, TIO access should be considered. Published by Elsevier Inc.

CMS-G from Beta vulgaris ssp. maritima is maintained in natural populations despite containing an atypical cytochrome c oxidase.

PubMed

Meyer, Etienne H; Lehmann, Caroline; Boivin, Stéphane; Brings, Lea; De Cauwer, Isabelle; Bock, Ralph; Kühn, Kristina; Touzet, Pascal

2018-02-23

While mitochondrial mutants of the respiratory machinery are rare and often lethal, cytoplasmic male sterility (CMS), a mitochondrially inherited trait that results in pollen abortion, is frequently encountered in wild populations. It generates a breeding system called gynodioecy. In Beta vulgaris ssp. maritima , a gynodioecious species, we found CMS-G to be widespread across the distribution range of the species. Despite the sequencing of the mitochondrial genome of CMS-G, the mitochondrial sterilizing factor causing CMS-G is still unknown. By characterizing biochemically CMS-G, we found that the expression of several mitochondrial proteins is altered in CMS-G plants. In particular, Cox1, a core subunit of the cytochrome c oxidase (complex IV), is larger but can still assemble into complex IV. However, the CMS-G-specific complex IV was only detected as a stabilized dimer. We did not observe any alteration of the affinity of complex IV for cytochrome c ; however, in CMS-G, complex IV capacity is reduced. Our results show that CMS-G is maintained in many natural populations despite being associated with an atypical complex IV. We suggest that the modified complex IV could incur the associated cost predicted by theoretical models to maintain gynodioecy in wild populations. © 2018 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program.

PubMed

Hicks, Rodney W; Becker, Shawn C

2006-01-01

Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.

Biological regeneration of manganese (IV) and iron (III) for anaerobic metal oxide-mediated removal of pharmaceuticals from water.

PubMed

Liu, Wenbo; Langenhoff, Alette A M; Sutton, Nora B; Rijnaarts, Huub H M

2018-05-18

Applying manganese(IV)- or iron(III)-(hydr)oxides to remove pharmaceuticals from water could be attractive, due to the capacity of these metal oxides to remove pharmaceuticals and be regenerated. As pharmaceutical removal under anaerobic conditions is foreseen, Mn(IV) or Fe(III) regeneration under anaerobic conditions, or with minimum oxygen dosage, is preferred. In this study, batch experiments are performed to investigate (1) Mn(IV) and Fe(III) regeneration from Mn(II) and Fe(II); (2) the pharmaceutical removal during biological Mn(IV) and Fe(III) regeneration; and (3) anaerobic abiotic pharmaceutical removal with different Mn(IV) or Fe(III) species. Results show that biological re-oxidation of reduced Mn(II) to Mn(IV) occurs under oxygen-limiting conditions. Biological re-oxidation of Fe(II) to Fe(III) is obtained with nitrate under anaerobic conditions. Both bio-regenerated Mn(IV)-oxides and Fe(III)-hydroxides are amorphous. The pharmaceutical removal is insignificant by Mn(II)- or Fe(II)-oxidizing bacteria during regeneration. Finally, pharmaceutical removal is investigated with various Mn(IV) and Fe(III) sources. Anaerobic abiotic removal using Mn(IV) produced from drinking water treatment plants results in 23% metoprolol and 44% propranolol removal, similar to chemically synthesized Mn(IV). In contrast, Fe(III) from drinking water treatment plants outperformed chemically or biologically synthesized Fe(III); Fe (III) from drinking water treatment can remove 31-43% of propranolol via anaerobic abiotic process. In addition, one of the Fe(III)-based sorbents tested, FerroSorp ® RW, can also remove propranolol (20-25%). Biological regeneration of Mn(IV) and Fe(III) from the reduced species Mn(II) and Fe(II) could be more effective in terms of cost and treatment efficiency. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Lack of promoter IV-driven BDNF transcription results in depression-like behavior.

PubMed

Sakata, K; Jin, L; Jha, S

2010-10-01

Transcription of Bdnf is controlled by multiple promoters, in which promoter IV contributes significantly to activity-dependent Bdnf transcription. We have generated promoter IV mutant mice [brain-derived neurotrophic factor (BDNF)-KIV] in which promoter IV-driven expression of BDNF is selectively disrupted by inserting a green fluorescent protein (GFP)-STOP cassette within the Bdnf exon IV locus. BDNF-KIV animals exhibited depression-like behavior as shown by the tail suspension test (TST), sucrose preference test (SPT) and learned helplessness test (LHT). In addition, BDNF-KIV mice showed reduced activity in the open field test (OFT) and reduced food intake in the novelty-suppressed feeding test (NSFT). The mutant mice did not display anxiety-like behavior in the light and dark box test and elevated plus maze tests. Interestingly, the mutant mice showed defective response inhibition in the passive avoidance test (PAT) even though their learning ability was intact when measured with the active avoidance test (AAT). These results suggest that promoter IV-dependent BDNF expression plays a critical role in the control of mood-related behaviors. This is the first study that directly addressed the effects of endogenous promoter-driven expression of BDNF in depression-like behavior. © 2010 The Authors. Genes, Brain and Behavior © 2010 Blackwell Publishing Ltd and International Behavioural and Neural Genetics Society.

Female genital mutilation in children presenting to Australian paediatricians.

PubMed

Zurynski, Yvonne; Phu, Amy; Sureshkumar, Premala; Cherian, Sarah; Deverell, Marie; Elliott, Elizabeth J

2017-06-01

The WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children. Cross-sectional survey conducted in April-June 2014. Paediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged <18 years with FGM/C seen in the last 5 years, and to provide data for demographics, FGM/C type, complications and referral for each case. Of 1311 eligible paediatricians/child health specialists, 1003 (76.5%) responded. Twenty-three (2.3%) respondents had seen 59 children with FGM/C and provided detailed data for 31. Most (89.7%) were identified during refugee screening and were born in Africa. Three (10.3%) were born in Australia: two had FGM/C in Australia and one in Indonesia. All parents were born overseas, mainly Africa (98.1%). Ten children had WHO FGM/C type I, five type II, five type III and six type IV. Complications in eight children included recurrent genitourinary infections, menstrual, sexual, fertility and psychological problems. Nineteen children (82.6%) were referred to obstetrics/gynaecology: 16 (69.9%) to social work and 13 (56.5%) to child protection. This study confirms that FGM/C is seen in paediatric clinical practice within Australia. Paediatricians need cultural awareness, education and resources to help them identify children with FGM/C and/or at risk of FGM/C, to enable appropriate referral and counselling of children, families and communities to assist in the prevention of this practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

7 CFR 1468.21 - Contract requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... provisions of § 1468.24 of this part; (iv) Agree to forego participation in CRP, EQIP, and the cost-share... those practices transferred from terminated CRP and EQIP contracts and WRP cost-share agreements. For persons wishing to transfer from CRP, EQIP, or WRP to CFO, practices included in CRP or EQIP contracts or...

40 CFR 63.11148 - What are the standards and compliance requirements for existing sources using batch copper...

Code of Federal Regulations, 2013 CFR

2013-07-01

... acid plant prior to discharge to the atmosphere. (iv) For each secondary capture system that is used to... practicable, maintain and operate any affected source, including associated air pollution control equipment, in a manner consistent with good air pollution control practice for minimizing emissions...

40 CFR 63.11148 - What are the standards and compliance requirements for existing sources using batch copper...

Code of Federal Regulations, 2014 CFR

2014-07-01

... acid plant prior to discharge to the atmosphere. (iv) For each secondary capture system that is used to... practicable, maintain and operate any affected source, including associated air pollution control equipment, in a manner consistent with good air pollution control practice for minimizing emissions...

40 CFR 63.11148 - What are the standards and compliance requirements for existing sources using batch copper...

Code of Federal Regulations, 2011 CFR

2011-07-01

... acid plant prior to discharge to the atmosphere. (iv) For each secondary capture system that is used to... practicable, maintain and operate any affected source, including associated air pollution control equipment, in a manner consistent with good air pollution control practice for minimizing emissions...

40 CFR 63.11148 - What are the standards and compliance requirements for existing sources using batch copper...

Code of Federal Regulations, 2010 CFR

2010-07-01

... acid plant prior to discharge to the atmosphere. (iv) For each secondary capture system that is used to... practicable, maintain and operate any affected source, including associated air pollution control equipment, in a manner consistent with good air pollution control practice for minimizing emissions...

40 CFR 63.11148 - What are the standards and compliance requirements for existing sources using batch copper...

Code of Federal Regulations, 2012 CFR

2012-07-01

... acid plant prior to discharge to the atmosphere. (iv) For each secondary capture system that is used to... practicable, maintain and operate any affected source, including associated air pollution control equipment, in a manner consistent with good air pollution control practice for minimizing emissions...

Exercise-based treatments for substance use disorders: evidence, theory, and practicality

PubMed Central

Linke, Sarah E.; Ussher, Michael

2016-01-01

Background Epidemiological studies reveal that individuals who report risky substance use are generally less likely to meet physical activity guidelines (with the exception of certain population segments, such as adolescents and athletes). A growing body of evidence suggests that individuals with substance use disorders (SUDs) are interested in exercising and that they may derive benefits from regular exercise, in terms of both general health/fitness and SUD recovery. Objectives The aims of this paper were to: (i) summarize the research examining the effects of exercise-based treatments for SUDs; (ii) discuss the theoretical mechanisms and practical reasons for investigating this topic; (iii) identify the outstanding relevant research questions that warrant further inquiry; and (iv) describe potential implications for practice. Methods The following databases were searched for peer-reviewed original and review papers on the topic of substance use and exercise: PubMed Central, MEDLINE, EMBASE, PsycINFO, and CINAHL Plus. Reference lists of these publications were subsequently searched for any missed but relevant manuscripts. Identified papers were reviewed and summarized by both authors. Results The limited research conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical reasons supporting the investigation of this topic has been published. Conclusions Definitive conclusions are difficult to draw due to diverse study protocols and low adherence to exercise programs, among other problems. Despite the currently limited and inconsistent evidence, numerous theoretical and practical reasons support exercise-based treatments for SUDs, including psychological, behavioral, neurobiological, nearly universal safety profile, and overall positive health effects. PMID:25397661

Increased levels of circulating platelet-derived microparticles are associated with metastatic cutaneous melanoma.

PubMed

Moreau, Joséphine; Pelletier, Fabien; Biichle, Sabeha; Mourey, Guillaume; Puyraveau, Marc; Badet, Nicolas; Caubet, Matthieu; Laresche, Claire; Garnache-Ottou, Francine; Saas, Philippe; Seilles, Estelle; Aubin, François

2017-10-01

We investigated the plasma levels of PMPs in patients with 45 stage III and 45 stage IV melanoma. PMPs were characterised by flow cytometry and their thrombogenic activity. We also investigated the link between PMPs circulating levels and tumor burden. The circulating levels of PMPs were significantly higher in stage IV (8500 μL -1 ) than in patients with stage III (2041 μL -1 ) melanoma (P=.0001). We calculated a highly specific (93.3%) and predictive (91.7%) cut-off value (5311 μL -1 ) allowing the distinction between high-risk stage III and metastatic stage IV melanoma. The thrombogenic activity of PMPs was significantly higher in patients with stage IV melanoma (clotting time: 40.7 second vs 65 second, P=.0001). There was no significant association between the radiological tumoral syndrome and the plasma level of PMPs. Our data suggest the role of PMPs in metastatic progression of melanoma. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A Quantitative Description of Suicide Inhibition of Dichloroacetic Acid in Rats and Mice

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

Keys, Deborah A.; Schultz, Irv R.; Mahle, Deirdre A.

Dichloroacetic acid (DCA), a minor metabolite of trichloroethylene (TCE) and water disinfection byproduct, remains an important risk assessment issue because of its carcinogenic potency. DCA has been shown to inhibit its own metabolism by irreversibly inactivating glutathione transferase zeta (GSTzeta). To better predict internal dosimetry of DCA, a physiologically based pharmacokinetic (PBPK) model of DCA was developed. Suicide inhibition was described dynamically by varying the rate of maximal GSTzeta mediated metabolism of DCA (Vmax) over time. Resynthesis (zero-order) and degradation (first-order) of metabolic activity were described. Published iv pharmacokinetic studies in native rats were used to estimate an initial Vmaxmore » value, with Km set to an in vitro determined value. Degradation and resynthesis rates were set to estimated values from a published immunoreactive GSTzeta protein time course. The first-order inhibition rate, kd, was estimated to this same time course. A secondary, linear non-GSTzeta-mediated metabolic pathway is proposed to fit DCA time courses following treatment with DCA in drinking water. The PBPK model predictions were validated by comparing predicted DCA concentrations to measured concentrations in published studies of rats pretreated with DCA following iv exposure to 0.05 to 20 mg/kg DCA. The same model structure was parameterized to simulate DCA time courses following iv exposure in native and pretreated mice. Blood and liver concentrations during and postexposure to DCA in drinking water were predicted. Comparisons of PBPK model predicted to measured values were favorable, lending support for the further development of this model for application to DCA or TCE human health risk assessment.« less

Improving Efficiency using a Hybrid Approach: Revising an IV/Blood Workshop in a Clinical Research Environment

PubMed Central

Parchen, Debra A.; Phelps, Sandra E.; Johnson, Eunice M.; Fisher, Cheryl A.

2016-01-01

Orienting to a new job can be overwhelming, especially if the nurse is required to develop or refine new skills, such as intravenous (IV) therapy or blood administration. At the National Institutes of Health Clinical Center Nursing Department, a group of nurse educators redesigned the IV/Blood Workshop to prepare nurses with skills needed when caring for patients on protocol in a research intensive environment. Innovative teaching strategies and a hybrid instructional approach were utilized along with a pre-workshop activity, skills lab practice, and follow up skill validation at the unit level to provide a comprehensive curriculum while decreasing resource utilization. PMID:27187829

Development of Methodologies for IV and V of Neural Networks

NASA Technical Reports Server (NTRS)

Taylor, Brian; Darrah, Marjorie

2003-01-01

Non-deterministic systems often rely upon neural network (NN) technology to "lean" to manage flight systems under controlled conditions using carefully chosen training sets. How can these adaptive systems be certified to ensure that they will become increasingly efficient and behave appropriately in real-time situations? The bulk of Independent Verification and Validation (IV&V) research of non-deterministic software control systems such as Adaptive Flight Controllers (AFC's) addresses NNs in well-behaved and constrained environments such as simulations and strict process control. However, neither substantive research, nor effective IV&V techniques have been found to address AFC's learning in real-time and adapting to live flight conditions. Adaptive flight control systems offer good extensibility into commercial aviation as well as military aviation and transportation. Consequently, this area of IV&V represents an area of growing interest and urgency. ISR proposes to further the current body of knowledge to meet two objectives: Research the current IV&V methods and assess where these methods may be applied toward a methodology for the V&V of Neural Network; and identify effective methods for IV&V of NNs that learn in real-time, including developing a prototype test bed for IV&V of AFC's. Currently. no practical method exists. lSR will meet these objectives through the tasks identified and described below. First, ISR will conduct a literature review of current IV&V technology. TO do this, ISR will collect the existing body of research on IV&V of non-deterministic systems and neural network. ISR will also develop the framework for disseminating this information through specialized training. This effort will focus on developing NASA's capability to conduct IV&V of neural network systems and to provide training to meet the increasing need for IV&V expertise in such systems.

Continuing education for maternal child health nurses: a means to improve the health care of mothers and children.

PubMed Central

Bolte, I M; Presler, E P

1983-01-01

The University of Kentucky College of Nursing is in the 7th year of implementing a 7-year federally funded continuing education project. The major goal of MCH (maternal child health) Project 969, which is scheduled to terminate Sept. 30, 1984, is to develop and offer a series of quality continuing education courses for three distinct populations--practicing maternal child health nurses, State nurse consultants, and nurse supervisors at county or district levels. The purpose of these courses is to improve the practice of the participating nurses and thereby ultimately to improve the health status of mothers and children in Region IV of the Department of Health and Human Services. Evaluation of the project by its staff after its first 5 years showed that (a) it has provided a series of continuing education courses of high quality; (b) met its goals and objectives; (c) provided continuing education for practicing maternal child health nurses that has improved MCH nursing practice in Region IV; (d) provided continuing education for State nurse consultants that has enabled them to become more effective leaders in their respective States; (e) used previously untapped resources in Region IV to make the concept of regional continuing education in maternal child health nursing a reality; and (f) generated a networking system among State nurse consultants, nurse educators, and nurse leaders in other service-oriented Title V programs that has been most effective in meeting the learning needs of the three distinct populations it serves. PMID:6419272

Implementation of a protocol for the prevention and management of extravasation injuries in the neonatal intensive care patient.

PubMed

Warren, Diane

2011-06-01

This project sought to determine nurses' understanding and management of infants with intravenous (IV) therapy. There were three specific aims: • To improve identification and management of extravasation injuries in neonates • To ensure management of extravasation injuries in neonates is classified according to IV extravasation staging guidelines • To develop a protocol that outlined actions required to manage extravasation injuries. This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute (JBI) Getting Research into Practice (GRIP) program. This method has been used to improve clinical practice by utilising an audit, feedback and re-audit sequence. The project was implemented in four stages over a 7-month period from 21 October 2009 to 30 May 2010. Initially, there was poor compliance with all four criteria, ranging from zero to 63%. The GRIP phase of the project identified five barriers which were addressed throughout this project. These related to education of staff and the development of a protocol for the prevention and management of extravasation injuries in the neonatal population. Following implementation of best practice, the second audit showed a marked improvement in all four criteria, ranging from 70 to 100% compliance. Overall, this project has led to improvements in clinical practice in line with current evidence. This has resulted in enhanced awareness of the risks associated with IV therapy and of measures to prevent an injury occurring within this clinical setting. © 2011 The Author. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

The Generation in Between: A Perspective from the Keystone IV Conference.

PubMed

Chen, Frederick M; Bliss, Erika; Dunn, Aaron; Edgoose, Jennifer; Elliott, Tricia C; Maxwell, Lisa C; Morris, Carl G; Phillips, Robert L

2016-01-01

Keystone IV affirmed the value of relationships in family medicine, but each generation of family physicians took away different impressions and lessons. "Generation III," between the Baby Boomers and Millennials, reported conflict between their professional ideal of family medicine and the realities of current practice. But the Keystone conference also helped them appreciate core values of family medicine, their shared experience, and new opportunities for leadership. © Copyright 2016 by the American Board of Family Medicine.

76 FR 25622 - Energy Conservation Program for Certain Industrial Equipment: Energy Conservation Standards for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... comments and additional information on the rulemaking process, see section IV of this document (Public... process of reviewing the changes to ASHRAE Standard 90.1, EPCA directs DOE to publish in the Federal...

Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.

PubMed

Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

2017-07-01

The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA). A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3. There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P < 0.05). Subgroup analysis of total blood loss based on times of IV TXA administration showed that repeat dose of IV TXA had a higher total blood loss and postoperative hemoglobin drop (P < 0.05) than IA TXA. However, single dose of IV TXA had a similar efficacy on total blood loss and postoperative hemoglobin drop (P > 0.05) when compared with IA TXA. Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.

Astragaloside-IV Alleviates Heat-Induced Inflammation by Inhibiting Endoplasmic Reticulum Stress and Autophagy.

PubMed

Dong, Zhiwei; Zhou, Jian; Zhang, Ying; Chen, Yajie; Yang, Zichen; Huang, Guangtao; Chen, Yu; Yuan, Zhiqiang; Peng, Yizhi; Cao, Tongtong

2017-01-01

Thermal injury is the main cause of pulmonary disease in stroke after burn and can be life threatening. Heat-induced inflammation is an important factor that triggers a series of induces pathological changes. However, this mechanism underlying heat-induced inflammation in thermal inhalation injury remains unclear. Studies have revealed that astragaloside-IV (AS-IV), a natural compound extracted from Astragalus membranaceus, has protective effects in inflammatory diseases. Here, we investigated whether the protective effects of AS-IV occur because of the suppression of heat-induced endoplasmic reticulum (ER) stress and excessive autophagy Methods: AS-IV was administered to Wistar rats after thermal inhalation injury and 16HBE140-cells were treated with AS-IV. TNF-α, IL-6, and IL-8 levels were determined by ELISA and real-time PCR. ER stress and autophagy were determined by western blot. Autophagic flux was measured by recording the fluorescence emission of the fusion protein mRFP-GFP-LC3 by dynamic live-cell imaging. AS-IV had protective effects against heat-induced reactive oxygen species production and attenuated ER stress. AS IV alleviated heat-induced excessive autophagy in vitro and in vivo. Excessive autophagy was attenuated by the PERK inhibitor GSK2656157 and eIF2α siRNA, suggesting that heat stress-induced autophagy can activate the PERK-eIF2α pathway. Beclin 1 and Atg5 siRNAs inhibited the upregulation of the inflammatory cytokines TNF-α, IL-6, and IL-8 after heat exposure. Thus, AS-IV may attenuate inflammatory responses by disrupting the crosstalk between autophagy and the PERK-eIF2α pathway and may be an ideal agent for treating inflammatory pulmonary diseases. © 2017 The Author(s). Published by S. Karger AG, Basel.

Outerbridge Grade IV Cartilage Lesions in the Hip Identified at Arthroscopy.

PubMed

Bhatia, Sanjeev; Nowak, Douglas D; Briggs, Karen K; Patterson, Diana C; Philippon, Marc J

2016-05-01

To determine factors associated with grade IV cartilage defects in the hip in patients undergoing hip arthroscopy with joint pain. Data from consecutive patients who underwent hip arthroscopy performed by a single surgeon over a period of 4 years were included in this study. The study group included 1,097 patients (491 women and 606 men; mean age, 37 years) who underwent hip arthroscopy for pain, had no prior hip surgery, and were aged 18 years or older. Preoperative radiographs, patient demographic characteristics, and operative details were used to identify risk factors for cartilage defects. Grade IV chondral defects were present in 308 of 1,097 hips (28%). Isolated chondral lesions were more frequently observed on the acetabulum (76%) than on the femoral head (24%). Defects of the acetabulum were more commonly anterosuperior (94.7%) and less commonly posterolateral (5.3%). Patients with less than 2 mm of joint space on preoperative radiographs were 8 times more likely to have a grade IV lesion than those with more than 2 mm. Men were more likely than women to have grade IV lesions (35% v 19%, P = .0001); patients with grade IV lesions were older than those without (42 years v 34 years, P = .0001). Hips with grade IV lesions had significantly higher alpha angles than those without (74° v 70°, P = .0001). Patients with grade IV defects reported a longer duration of symptoms than those without (37 months v 27 months, P = .007). Independent risk factors for the presence of grade IV chondral defects were less than 2 mm of joint space, male gender, increasing age, larger alpha angle, and longer duration of symptoms. Grade IV chondral defects in patients undergoing hip arthroscopy were associated with decreased joint space, increased time from symptom onset to arthroscopy, male gender, and larger alpha angles associated with femoroacetabular impingement. Level IV, prognostic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A national survey on the pediatric cardiologist's clinical approach for patients with Kawasaki disease.

PubMed

Kahwaji, I Y; Connuck, D M; Tafari, N; Dahdah, N S

2002-01-01

In 1994, the American Heart Association (AHA) published the most recent guidelines for long-term cardiovascular management of Kawasaki disease. Since then, recent publications have shed new light on different diagnostic, prognostic, and management issues. We sought the opinion of pediatric cardiologists practicing in U.S. fellowship programs on the subject by means of a multiple-choice survey. Two questions addressed therapy in the acute phase, each preceded by a statement from related literature. Ten duplicate questions addressed the long-term cardiovascular management in five sets of paired questions; each question was first given in reminiscence of a clinical situation and then preceded by a statement from particular publications representative of new information that has become available since the publication of the 1994 AHA guidelines. All questions were provided in the same mailing. Replies were received from 97 participants practicing at 29 institutions. For the acute illness, 21% of respondents do not use high-dose aspirin, and 50% support reassessment of current guidelines. Universal intravenous immune globulin (IVIG) administration is followed by 97%, among whom 20% agree that evaluation of selection criteria is needed. For long-term management, 60-75% advocate regular follow-up of risk level I patients, and 80% favor periodic follow-up, with stress imaging (34-40%), for risk level II. For risk level IV more respondents favor stress echocardiography as opposed to nuclear imaging, in consonance with recent literature. For risk levels III and IV, 36-40% perform coronary angiography on a regular basis, whereas 60% do so when coronary symptoms are present or when stress imaging suggests myocardial ischemia. Finally, 19-25% of respondents do not routinely advise healthy lifestyle to patients free of coronary artery lesions. In conclusion, the guidelines for conventional therapy in the acute phase and long-term cardiovascular management need to be revised.

Change in genotype of methicillin-resistant Staphylococcus aureus (MRSA) affects the antibiogram of hospital-acquired MRSA.

PubMed

Harada, Dai; Nakaminami, Hidemasa; Miyajima, Eri; Sugiyama, Taku; Sasai, Nao; Kitamura, Yoshinobu; Tamura, Taku; Kawakubo, Takashi; Noguchi, Norihisa

2018-07-01

Recently, the dissemination of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) into hospitals has frequently been reported worldwide. Hospital-acquired MRSA (HA-MRSA) strains exhibit high-level resistance to multiple antimicrobial agents, whereas CA-MRSA strains are usually susceptible to non-β-lactams. Thus, it is predicted that the antibiogram of the HA-MRSA population would change along with the change in genotype of MRSA. Here, we investigated the changes in the MRSA population along with the MRSA antibiogram in a hospital between 2010 and 2016. Staphylococcal cassette chromosome (SCC) mec typing showed that the predominant HA-MRSA strains in the hospital dramatically changed from SCCmec type II, which is the major type of HA-MRSA, to SCCmec type IV, which is the major type of CA-MRSA. Multilocus sequence typing revealed that the predominant SCCmec type IV strain was a clonal complex (CC) 8 clone, which is mainly found among CA-MRSA. Furthermore, the CC1-SCCmec type IV (CC1-IV) clone significantly increased. Both the CC8-IV and CC1-IV clones exhibited high antimicrobial susceptibility. The antibiogram change of the HA-MRSA population was consistent with the antimicrobial susceptibilities and increased prevalence of the CC8-IV and CC1-IV clones. Our data reveal that the change in the genotypes of MRSA strains could impact the antibiogram of HA-MRSA population. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Intravenous lacosamide in seizure emergencies: Observations from a hospitalized in-patient adult population.

PubMed

d'Orsi, Giuseppe; Pascarella, Maria Grazia; Martino, Tommaso; Carapelle, Elena; Pacillo, Francesca; Di Claudio, Maria Teresa; Mancini, Daniela; Trivisano, Marina; Avolio, Carlo; Specchio, Luigi M

2016-11-01

to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients. we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200-400mg and the maintenance dose was 200-400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion. an acute anti-seizure effect after IV LCM was especially evident when it was first used - (SC) or second line (established SE) treatment. In particular, 87% of SC patients (13/15) and 80% of established SE (8/10) demonstrated response to LCM treatment, while no patients with super-refractory SE (0/8) responded to IV LCM according to our criteria. The loading of IV LCM was well tolerated, with mild adverse effects (2/38 temporary dizziness). In most patients, during and after administration of the loading dose of IV LCM a temporary (30min-1h) sedation was observed. No ECG and laboratory values-changes were documented in any of the patients. LCM is an effective and well-tolerated treatment when used to treat SC in hospitalized adult patients. As add-on therapy, it may be useful to stop seizure activity in patients with focal SE not responding to first/second-line intravenous AEDs. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Quality of research and level of evidence in foot and ankle publications.

PubMed

Barske, Heather L; Baumhauer, Judith

2012-01-01

The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

An office model of outpatient parenteral antibiotic therapy.

PubMed

Tice, A D

1991-01-01

This office-based program for parenteral therapy began with the im administration of therapy to outpatients in 1981. Since then it has expanded in scope and staff and has provided more than 1,200 courses of i.v. antibiotics. The success of the program is dependent on patients' ability to provide i.v. medication to themselves. These patients are trained and cared for by a team consisting of a physician who specializes in infectious diseases, nurses trained in i.v. techniques, a pharmacist, and microbiologists who are all part of a practice of the subspecialty of infectious diseases. This office model has resulted in excellent quality of care for patients who have experienced few adverse effects or complications. The cost savings of an office program are significant compared to hospitalization for i.v. administration of antibiotics, but issues related to reimbursement are a constant issue.

The incidence of phlebitis with intravenous amiodarone at guideline dose recommendations.

PubMed

Slim, Ahmad M; Roth, Jason E; Duffy, Benjamin; Boyd, Sheri Y N; Rubal, Bernard J

2007-12-01

Postoperative atrial fibrillation following cardiothoracic surgery is common and frequently managed with intravenous (IV) amiodarone. Phlebitis is the most common complication with peripheral infusion of this agent. Current practice guidelines for peripheral IV administration of <2 mg/mL amiodarone were established to reduce the risk of phlebitis. The present study examines the incidence of phlebitis in a postoperative patient population given current dose recommendations. A total of 273 patient charts were reviewed. The incidence of phlebitis in patients given IV amiodarone (n = 36) was 13.9% (95% confidence interval, 2.6-25.2%; p = 0.001). Logistic regression analysis with backward elimination of other therapeutic risk factors suggests that the odds ratio for phlebitis using current dose regimens without IV filters is 19-fold greater than baseline risk in this population. Phlebitis remains a significant complication associated with peripheral infusion of amiodarone within recommended dosing limits.

Career paths and contributions of four cohorts of IV-E funded MSW child welfare graduates.

PubMed

Robin, Sandra C; Hollister, C David

2002-01-01

For the last decade the federal government has provided financial support through Title IV-E of the Social Security Act to schools of social work to provide professional education in child welfare. This study looks at the first four cohorts of graduates who received IV-E funding from one school of social work. Data on MSW graduates from 1993-1996 (N = 73), as well as survey responses (N = 32), were analyzed to ascertain dimensions of their career development in, and contributions to, child welfare social work. Results indicate that the vast majority of graduates funded by IV-E dollars became employed in and stayed in child welfare focused social work, with a strong percentage in public child welfare services, and that these social work-educated social workers are actively involved in shaping the practice, policies and administration of child welfare services.

Diversity, assembly and regulation of archaeal type IV pili-like and non-type-IV pili-like surface structures.

PubMed

Lassak, Kerstin; Ghosh, Abhrajyoti; Albers, Sonja-Verena

2012-01-01

Archaea have evolved fascinating surface structures allowing rapid adaptation to changing environments. The archaeal surface appendages display such diverse biological roles as motility, adhesion, biofilm formation, exchange of genetic material and species-specific interactions and, in turn, increase fitness of the cells. Intriguingly, despite sharing the same functions with their bacterial counterparts, the assembly mechanism of many archaeal surface structures is rather related to assembly of bacterial type IV pili. This review summarizes our state-of-the-art knowledge about unique structural and biochemical properties of archaeal surface appendages with a particular focus on archaeal type IV pili-like structures. The latter comprise not only widely distributed archaella (formerly known as archaeal flagella), but also different highly specialized archaeal pili, which are often restricted to certain species. Recent findings regarding assembly mechanisms, structural aspects and physiological roles of these type IV pili-like structures will be discussed in detail. Recently, first regulatory proteins involved in transition from both planktonic to sessile lifestyle and in assembly of archaella were identified. To conclude, we provide novel insights into regulatory mechanisms underlying the assembly of archaeal surface structures. Copyright © 2012. Published by Elsevier Masson SAS.

Catalytic properties of RNA polymerases IV and V: accuracy, nucleotide incorporation and rNTP/dNTP discrimination.

PubMed

Marasco, Michelle; Li, Weiyi; Lynch, Michael; Pikaard, Craig S

2017-11-02

All eukaryotes have three essential nuclear multisubunit RNA polymerases, abbreviated as Pol I, Pol II and Pol III. Plants are remarkable in having two additional multisubunit RNA polymerases, Pol IV and Pol V, which synthesize noncoding RNAs that coordinate RNA-directed DNA methylation for silencing of transposons and a subset of genes. Based on their subunit compositions, Pols IV and V clearly evolved as specialized forms of Pol II, but their catalytic properties remain undefined. Here, we show that Pols IV and V differ from one another, and Pol II, in nucleotide incorporation rate, transcriptional accuracy and the ability to discriminate between ribonucleotides and deoxyribonucleotides. Pol IV transcription is considerably more error-prone than Pols II or V, which may be tolerable in its synthesis of short RNAs that serve as precursors for siRNAs targeting non-identical members of transposon families. By contrast, Pol V exhibits high fidelity transcription, similar to Pol II, suggesting a need for Pol V transcripts to faithfully reflect the DNA sequence of target loci to which siRNA-Argonaute silencing complexes are recruited. © The Author(s) 2017. Published by Oxford University Press on behalf of Nucleic Acids Research.

The relationship between seven health practices and oral health status in community-dwelling elderly Thai.

PubMed

Samnieng, Patcharaphol; Ueno, Masayuki; Zaitsu, Takashi; Shinada, Kayoko; Wright, Fredrick A C; Kawaguchi, Yoko

2013-12-01

This study aims to analyse the relationship between seven health practices, oral health behaviors, and oral health status in community dwelling elderly Thai. The subjects were 612 elderly people (mean age = 68.8 ± 5.9 years). Questionnaires survey about sociodemographics, self-reported seven health practices and oral health behaviors were conducted by trained interviewers. Oral examinations investigated the number of teeth present, decayed teeth, periodontal status and functional tooth units (FTUs). Oral malodor was assessed by Organoleptic Test, and unstimulated saliva was collected for 5 min. Five health practices (smoking, drinking, physical activity, breakfast and weight maintenance) were significantly related with oral health behaviors. ancova analysis demonstrated the following significant associations: (i) smoking behavior with number of teeth present, number of FTUs, decayed teeth, periodontal disease, oral malodor and salivary flow rate, (ii) drinking alcohol behavior with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (iii) eating breakfast behavior with periodontal disease, oral malodor and salivary flow rate, (iv) eating between-meal snack with number of teeth present, number of FTUs, decayed teeth and periodontal disease, (v) maintaining weight with number of teeth present, number of FTUs, periodontal disease and oral malodor, (vi) sleeping with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (vii) physical activity with periodontal disease and salivary flow rate. Good health practices were related with good oral health behaviors. Moreover, general health practices were associated with the clinical oral health status such as number of teeth present, decayed teeth, FTUs, periodontal disease, oral malodor and salivary flow rate. The elderly with good general health practices were considered to have good oral health status. Improving general health habits are suggested to lead to better oral health for the elderly, and vice versa. © 2012 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

Research ethics committee decision-making in relation to an efficient neonatal trial.

PubMed

Gale, C; Hyde, M J; Modi, N

2017-07-01

Randomised controlled trials, a gold-standard approach to reduce uncertainties in clinical practice, are growing in cost and are often slow to recruit. We determined whether methodological approaches to facilitate large, efficient clinical trials were acceptable to UK research ethics committees (RECs). We developed a protocol in collaboration with parents, for a comparative-effectiveness, randomised controlled trial comparing two widely used blood transfusion practices in preterm infants. We incorporated four approaches to improve recruitment and efficiency: (i) point-of-care design using electronic patient records for patient identification, randomisation and data acquisition, (ii) short two-page information sheet; (iii) explicit mention of possible inclusion benefit; (iv) opt-out consent with enrolment as the default. With the support of the UK Health Research Authority, we submitted an identical protocol to 12 UK REC. RECs in the UK. Number of REC granting favourable opinions. The use of electronic patient records was acceptable to all RECs; one REC raised concerns about the short parent information sheet, 10 about inclusion benefit and 9 about opt-out consent. Following responses to queries, nine RECs granted a favourable final opinion and three rejected the application because they considered the opt-out consent process invalid. A majority of RECs in this study consider the use of electronic patient record data, short information sheets, opt-out consent and mention of possible inclusion benefit to be acceptable in neonatal comparative-effectiveness research. We identified a need for guidance for RECs in relation to opt-out consent processes. These methods provide opportunity to facilitate large randomised controlled trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Adherence to AIOM (Italian Association of Medical Oncology) lung cancer guidelines in Italian clinical practice: Results from the RIGHT-3 (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) study.

PubMed

Barni, Sandro; Maiello, Evaristo; Di Maio, Massimo; Ardizzoni, Andrea; Cappuzzo, Federico; Maranzano, Ernesto; Novello, Silvia; Bennati, Chiara; Ori, Alessandra; Rizzoli, Sara; Crinò, Lucio

2015-11-01

Clinical practice guidelines represent a key tool to improve quality and reduce variability of cancer care. In 2004, Italian Association of Medical Oncology (AIOM) launched the RIGHT (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) program. The third step, RIGHT-3, evaluated the concordance between AIOM lung cancer guidelines and Italian clinical practice. RIGHT-3 was a retrospective observational study, conducted in 53 Italian centers treating lung cancer. Sampling from AIOM database of 230 centers was stratified by presence of thoracic surgery and geographic distribution. To describe the adherence to AIOM guidelines (2009 edition), 11 indicators regarding diagnostic and treatment procedures were identified. Patients with non-small-cell lung cancer (NSCLC) diagnosis who had first visit in 2010 were divided into 3 groups, based on TNM stage: I-II-IIIA (5 indicators), IIIB (3 indicators) and IV (3 indicators). 708 patients were enrolled; 680 were eligible: 225 patients in stage I-II-IIIA; 156 patients in stage IIIB; 299 patients in stage IV. Cyto-histological diagnosis was available in 96%, 97%, 96% of stage I-II-IIIA, IIIB, IV respectively. Positron-emission tomography was performed in 64% of stage I-II-IIIA and 46% of stage IIIB. 88% of stage I-II patients eligible for surgery underwent lobectomy; after surgery, 61% of stage II and 57% of stage IIIA patients received adjuvant chemotherapy. Among stage IIIB patients who received combined chemo- radiotherapy, sequential approach was more common than concomitant treatment (86% vs. 14%). Among stage IV patients, 87% received platinum-based first-line treatment, and 70% received second-line. The RIGHT-3 study showed that, in 2010, adherence to Italian NSCLC guidelines was high for many indicators (including those related to treatment of stage IV patients), but lower for some diagnostic procedures. Guidelines adherence monitoring can be useful to reduce variability in cancer care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Focus on increased serum angiotensin-converting enzyme level: From granulomatous diseases to genetic mutations.

PubMed

Lopez-Sublet, Marilucy; di Lanzacco, Lorenzo Caratti; Jan Danser, A H; Lambert, Michel; Elourimi, Ghassan; Persu, Alexandre

2018-06-18

Angiotensin I-converting enzyme (ACE) is a well-known zinc-metallopeptidase that converts angiotensin I to the potent vasoconstrictor angiotensin II and degrades bradykinin, a powerful vasodilator, and as such plays a key role in the regulation of vascular tone and cardiac function. Increased circulating ACE (cACE) activity has been reported in multiple diseases, including but not limited to granulomatous disorders. Since 2001, genetic mutations leading to cACE elevation have also been described. This review takes advantage of the identification of a novel ACE mutation (25-IVS25 + 1G > A) in two Belgian pedigrees to summarize current knowledge about the differential diagnosis of cACE elevation, based on literature review and the experience of our centre. Furthermore, we propose a practical approach for the evaluation and management of patients with elevated cACE and discuss in which cases search for genetic mutations should be considered. Copyright © 2018. Published by Elsevier Inc.

Cleaning and other control and validation strategies to prevent allergen cross-contact in food-processing operations.

PubMed

Jackson, Lauren S; Al-Taher, Fadwa M; Moorman, Mark; DeVries, Jonathan W; Tippett, Roger; Swanson, Katherine M J; Fu, Tong-Jen; Salter, Robert; Dunaif, George; Estes, Susan; Albillos, Silvia; Gendel, Steven M

2008-02-01

Food allergies affect an estimated 10 to 12 million people in the United States. Some of these individuals can develop life-threatening allergic reactions when exposed to allergenic proteins. At present, the only successful method to manage food allergies is to avoid foods containing allergens. Consumers with food allergies rely on food labels to disclose the presence of allergenic ingredients. However, undeclared allergens can be inadvertently introduced into a food via cross-contact during manufacturing. Although allergen removal through cleaning of shared equipment or processing lines has been identified as one of the critical points for effective allergen control, there is little published information on the effectiveness of cleaning procedures for removing allergenic materials from processing equipment. There also is no consensus on how to validate or verify the efficacy of cleaning procedures. The objectives of this review were (i) to study the incidence and cause of allergen cross-contact, (ii) to assess the science upon which the cleaning of food contact surfaces is based, (iii) to identify best practices for cleaning allergenic foods from food contact surfaces in wet and dry manufacturing environments, and (iv) to present best practices for validating and verifying the efficacy of allergen cleaning protocols.

The Reinforcing Effects of Nicotine in Humans and Nonhuman Primates: A Review of Intravenous Self-Administration Evidence and Future Directions for Research.

PubMed

Goodwin, Amy K; Hiranita, Takato; Paule, Merle G

2015-11-01

Cigarette smoking is largely driven by the reinforcing properties of nicotine. Intravenous (IV) self-administration procedures are the gold standard for investigating the reinforcing effects of psychoactive drugs. The goal of this review was to examine the results of published investigations of the reinforcing effects of nicotine measured using IV self-administration procedures in humans and nonhuman primates. The body of literature using nonhuman primate subjects indicates nicotine functions as a positive reinforcer when available for self-administration via IV catheters. However, it can also be difficult to establish IV nicotine self-administration in nonhuman primates and sometimes supplemental strategies have been required (e.g., priming injections or food deprivation) before subjects acquire the behavior. Although the body of literature using human subjects is limited, the evidence indicates nicotine functions as a reinforcer via the IV route of administration in adult cigarette smokers. Rates of nicotine self-injection can be variable across subjects and responding is sometimes inconsistent across sessions in both humans and nonhuman primates. The Family Smoking Prevention and Tobacco Control Act, enacted in 2009, gave the Food and Drug Administration regulatory authority over the manufacture, marketing, and distribution of tobacco products. Research examining the threshold reinforcing doses for initiation and maintenance of nicotine self-administration, comparisons of the reinforcing effects of nicotine in adolescent versus adult subjects, investigations of gender differences in the reinforcing effects of nicotine, and studies of the abuse liability of non-nicotine tobacco product constituents and their ability to alter the reinforcing effects of nicotine will inform potential tobacco regulatory actions. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Standards for Clinical Trials in Male and Female Sexual Dysfunction: I. Phase I to Phase IV Clinical Trial Design.

PubMed

Fisher, William A; Gruenwald, Ilan; Jannini, Emmanuele A; Lev-Sagie, Ahinoam; Lowenstein, Lior; Pyke, Robert E; Reisman, Yakov; Revicki, Dennis A; Rubio-Aurioles, Eusebio

2016-12-01

This series of articles outlines standards for clinical trials of treatments for male and female sexual dysfunctions, with a focus on research design and patient-reported outcome assessment. These articles consist of revision, updating, and integration of articles on standards for clinical trials in male and female sexual dysfunction from the 2010 International Consultation on Sexual Medicine developed by the authors as part of the 2015 International Consultation on Sexual Medicine. We are guided in this effort by several principles. In contrast to previous versions of these guidelines, we merge discussion of standards for clinical trials in male and female sexual dysfunction in an integrated approach that emphasizes the common foundational practices that underlie clinical trials in the two settings. We present a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for selection of study population and study duration in male and female sexual dysfunction. We present a focused discussion of fundamental principles in patient- (and partner-) reported outcome assessment and complete this series of articles with specific discussions of selected aspects of clinical trials that are unique to male and to female sexual dysfunction. Our consideration of standards for clinical trials in male and female sexual dysfunction attempts to embody sensitivity to existing and new regulatory guidance and to address implications of the evolution of the diagnosis of sexual dysfunction that have been brought forward in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The first article in this series focuses on phase I to phase IV clinical trial design considerations. Subsequent articles in this series focus on the measurement of patient-reported outcomes, unique aspects of clinical trial design for men, and unique aspects of clinical trial design for women. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Seasonal influenza vaccine dose distribution in 157 countries (2004-2011).

PubMed

Palache, Abraham; Oriol-Mathieu, Valerie; Abelin, Atika; Music, Tamara

2014-11-12

Globally there are an estimated 3-5 million cases of severe influenza illness every year, resulting in 250,000-500,000 deaths. At the World Health Assembly in 2003, World Health Organization (WHO) resolved to increase influenza vaccine coverage rates (VCR) for high-risk groups, particularly focusing on at least 75% of the elderly by 2010. But systematic worldwide data have not been available to assist public health authorities to monitor vaccine uptake and review progress toward vaccination coverage targets. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations Influenza Vaccine Supply task force (IFPMA IVS) developed a survey methodology to assess global influenza vaccine dose distribution. The current survey results represent 2011 data and demonstrate the evolution of the absolute number distributed between 2004 and 2011 inclusive, and the evolution in the per capita doses distributed in 2008-2011. Global distribution of IFPMA IVS member doses increased approximately 86.9% between 2004 and 2011, but only approximately 12.1% between 2008 and 2011. The WHO's regions in Eastern Mediterranean (EMRO), Southeast Asian (SEARO) and Africa (AFRO) together account for about 47% of the global population, but only 3.7% of all IFPMA IVS doses distributed. While distributed doses have globally increased, they have decreased in EURO and EMRO since 2009. Dose distribution can provide a reasonable proxy of vaccine utilization. Based on the dose distribution, we conclude that seasonal influenza VCR in many countries remains well below the WHA's VCR targets and below the recommendations of the Council of the European Union in EURO. Inter- and intra-regional disparities in dose distribution trends call into question the impact of current vaccine recommendations at achieving coverage targets. Additional policy measures, particularly those that influence patients adherence to vaccination programs, such as reimbursement, healthcare provider knowledge, attitudes, practices, and communications, are required for VCR targets to be met and benefit public health. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Mouse Geneticist’s Practical Guide to CRISPR Applications

PubMed Central

Singh, Priti; Schimenti, John C.; Bolcun-Filas, Ewelina

2015-01-01

CRISPR/Cas9 system of RNA-guided genome editing is revolutionizing genetics research in a wide spectrum of organisms. Even for the laboratory mouse, a model that has thrived under the benefits of embryonic stem (ES) cell knockout capabilities for nearly three decades, CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)/Cas9 technology enables one to manipulate the genome with unprecedented simplicity and speed. It allows generation of null, conditional, precisely mutated, reporter, or tagged alleles in mice. Moreover, it holds promise for other applications beyond genome editing. The crux of this system is the efficient and targeted introduction of DNA breaks that are repaired by any of several pathways in a predictable but not entirely controllable manner. Thus, further optimizations and improvements are being developed. Here, we summarize current applications and provide a practical guide to use the CRISPR/Cas9 system for mouse mutagenesis, based on published reports and our own experiences. We discuss critical points and suggest technical improvements to increase efficiency of RNA-guided genome editing in mouse embryos and address practical problems such as mosaicism in founders, which complicates genotyping and phenotyping. We describe a next-generation sequencing strategy for simultaneous characterization of on- and off-target editing in mice derived from multiple CRISPR experiments. Additionally, we report evidence that elevated frequency of precise, homology-directed editing can be achieved by transient inhibition of the Ligase IV-dependent nonhomologous end-joining pathway in one-celled mouse embryos. PMID:25271304

Vaginal microbiota and sexually transmitted infections that may influence transmission of cell-associated HIV.

PubMed

Cone, Richard A

2014-12-15

Vaginal microbiota and sexually transmitted infections (STIs) are likely to influence the transmission of cell-associated human immunodeficiency virus (HIV). Lactic acid produced by Lactobacillus-dominated microbiota (Nugent score 0-3) will likely inhibit transmission, especially female-to-male transmission. In contrast, polymicrobial microbiota (Nugent score 4-10), community state types IV-A and IV-B, and STIs will likely increase transmission of cell-associated HIV. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Successful treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV without arterial puncture: the transvenous triple-overlay embolization (TAILOREd) technique.

PubMed

Huynh, Thien J; Morton, Ryan P; Levitt, Michael R; Ghodke, Basavaraj V; Wink, Onno; Hallam, Danial K

2017-08-18

We report successful transvenous treatment of direct carotid-cavernous fistula in a patient with Ehlers-Danlos syndrome type IV using a novel triple-overlay embolization (TAILOREd) technique without the need for arterial puncture, which is known to be highly risky in this patient group. The TAILOREd technique allowed for successful treatment using preoperative MR angiography as a three-dimensional overlay roadmap combined with cone beam CT and live fluoroscopy, precluding the need for an arterial puncture. 2017 BMJ Publishing Group Ltd.

Recurrent angioedema associated with pharmacological inhibition of dipeptidyl peptidase IV.

PubMed

Hermanrud, Thorbjørn; Bygum, Anette; Rasmussen, Eva Rye

2017-01-10

Angioedema (AE) of the upper airways is a severe and potentially life-threatening condition. The incidence has been increasing in the past two decades, primarily due to increased use of medications inhibiting the degradation of vasoactive peptides. Acquired angioedema related to angiotensin-converting enzyme inhibitors (ACEI-AAE) is well known, but other pharmaceutical agents also affect the degradation of bradykinin and substance P. We present a middle-aged man with recurrent episodes of severe AE of the oral cavity, hypopharynx and larynx due to pharmacological inhibition of dipeptidyl peptidase IV. 2017 BMJ Publishing Group Ltd.

Sustainable Efficacy of Switching From Intravenous to Subcutaneous Tocilizumab Monotherapy in Patients With Rheumatoid Arthritis.

PubMed

Ogata, Atsushi; Atsumi, Tatsuya; Fukuda, Takaaki; Hirabayashi, Yasuhiko; Inaba, Masaaki; Ishiguro, Naoki; Kai, Motokazu; Kawabata, Daisuke; Kida, Daihei; Kohsaka, Hitoshi; Matsumura, Ryutaro; Minota, Seiji; Mukai, Masaya; Sumida, Takayuki; Takasugi, Kiyoshi; Tamaki, Shigenori; Takeuchi, Tsutomu; Ueda, Atsuhisa; Yamamoto, Kazuhiko; Yamanaka, Hisashi; Yoshifuji, Hajime; Nomura, Akira

2015-10-01

To evaluate the efficacy and safety of switching from intravenous (IV) tocilizumab (TCZ) to subcutaneous (SC) TCZ monotherapy in rheumatoid arthritis patients. Patients who had completed 24 weeks of TCZ-SC (162 mg/2 weeks) or TCZ-IV (8 mg/kg/4 weeks) monotherapy in the double-blind period of the MUSASHI study were enrolled in an 84-week open-label extension period. All received TCZ-SC (162 mg/2 weeks) monotherapy. Effects of the IV to SC switch were evaluated at week 36 (12 weeks after switching). Overall, 319 patients received ≥1 dose of TCZ-SC during the open-label extension period; 160 switched from TCZ-IV to TCZ-SC (TCZ IV/SC) and 159 continued TCZ-SC (TCZ SC/SC). Disease Activity Score in 28 joints using the erythrocyte sedimentation rate clinical remission rates were 62.5% (100 of 160) for TCZ IV/SC and 50.0% (79 of 158) for TCZ SC/SC at week 24, and were maintained at 62.5% (100 of 160) and 57.0% (90 of 158), respectively, at week 36. In the TCZ IV/SC group, 9% of patients (9 of 100) who had achieved remission at week 24 could not maintain remission at week 36. In TCZ IV/SC patients weighing ≥70 kg, the percentage with a sufficient serum TCZ concentration (≥1 μg/ml) decreased from 90.9% (10 of 11) at week 24 to 45.5% (5 of 11) at week 36. Overall safety profiles were similar in TCZ IV/SC and TCZ SC/SC except for mild injection site reactions in TCZ IV/SC. Efficacy is adequately maintained in most patients switching from TCZ-IV (8 mg/kg/4 weeks) to TCZ-SC (162 mg/2 weeks) monotherapy. Patients receiving TCZ-IV can switch to TCZ-SC without serious safety concerns. Clinical efficacy may be reduced after switching in some patients with high body weight. © 2015 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

An outbreak of post-partum breast abscesses in Mumbai, India caused by ST22-MRSA-IV: genetic characteristics and epidemiological implications

PubMed Central

MANOHARAN, A.; ZHANG, L.; POOJARY, A.; BHANDARKAR, L.; KOPPIKAR, G.; ROBINSON, D. A.

2012-01-01

SUMMARY A cluster of methicillin-resistant Staphylococcus aureus (MRSA) breast abscesses in women who had given birth at a hospital in Mumbai, India was investigated retrospectively. Nineteen of twenty cases were caused by a single clone: pvl-positive, spa type 648 (Ridom t852), ccrB:dru subtype 3:0, ST22-MRSA-IV. Despite the presence of pvl and SCCmec type IV, which are common genetic markers among community-associated MRSA, this outbreak was caused by a healthcare-associated, community-onset MRSA that was common in the hospital environment. Thus, infection control practices may have an important role in limiting the spread of this virulent clone. PMID:22475374

Inter-rater agreement of comorbid DSM-IV personality disorders in substance abusers.

PubMed

Hesse, Morten; Thylstrup, Birgitte

2008-05-17

Little is known about the inter-rater agreement of personality disorders in clinical settings. Clinicians rated 75 patients with substance use disorders on the DSM-IV criteria of personality disorders in random order, and on rating scales representing the severity of each. Convergent validity agreement was moderate (range for r = 0.55, 0.67) for cluster B disorders rated with DSM-IV criteria, and discriminant validity was moderate for eight of the ten personality disorders. Convergent validity of the rating scales was only moderate for antisocial and narcissistic personality disorder. Dimensional ratings may be used in research studies and clinical practice with some caution, and may be collected as one of several sources of information to describe the personality of a patient.

77 FR 59768 - Shipping and Transportation; Technical, Organizational, and Conforming Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

.... Abbreviations II. Regulatory History III. Basis and Purpose IV. Background V. Regulatory Analyses A. Regulatory....S.C. United States Code II. Regulatory History We did not publish a notice of proposed rulemaking... its place, the text ``(CG-ENG)''. [[Page 59778

38 CFR 17.33 - Patients' rights.

Code of Federal Regulations, 2010 CFR

2010-07-01

... matter concerning Department of Veterans Affairs benefits, shall not be reviewed. (ii) A patient may... instructions concerning patients' mail published by the Veterans Health Administration, Department of Veterans Affairs, and/or the local health care facility. (iv) Each patient shall be afforded the opportunity to...

Civil Aviation and Facilities. Aerospace Education II. Instructional Unit IV.

ERIC Educational Resources Information Center

Elmer, James D.

This publication accompanies the textbook entitled "Civil Aviation and Facilities," published in the Aerospace Education II series. It provides teacher guidelines with regard to objectives (traditional and behavioral), suggested outlines, orientation, suggested key points, suggestions for teaching, instructional aids, projects, and…

Educational Programs That Work. Volume IV.

ERIC Educational Resources Information Center

Far West Lab. for Educational Research and Development, San Francisco, CA.

This catalog is published as one of many mechanisms to stimulate and facilitate continuing communication among the federal, state, intermediate, and local agencies that share responsibility for educational program improvement through nationwide dissemination activities. All the projects cited have undergone close scrutiny by the Joint…

The Use of Office-Based Sedation and General Anesthesia by Board Certified Pediatric Dentists Practicing in the United States

PubMed Central

Olabi, Nassim F.; Jones, James E.; Saxen, Mark A.; Sanders, Brian J.; Walker, LaQuia A.; Weddell, James A.; Schrader, Stuart M.; Tomlin, Angela M.

2012-01-01

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available. PMID:22428969

The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

PubMed

Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M

2012-01-01

The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros.

PubMed

Ghoshal, Uday C

2017-07-30

A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain ("disorders of gut-brain interaction" not "brain-gut interaction"). The word "functional" is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I-II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.

Establish a perioperative check forum for peripheral intravenous access to prevent the occurrence of phlebitis.

PubMed

Chiu, Po-Chun; Lee, Ya-Hui; Hsu, Hung-Te; Feng, Yu-Tung; Lu, I-Cheng; Chiu, Shun-Li; Cheng, Kuang-I

2015-04-01

The prevalence of intravenous (IV) catheter-related infections is 0.5 per 1000 device days, and these infections cause tenderness, erythema, swelling and phlebitis. Catheter-related bloodstream infections (CRBSI) may independently increase hospital costs and length of stay; the aim of the study was to set up a standard operating procedure (SOP) for the maintenance of peripheral vein catheter patency and the prevention of IV catheter-related complications. This is a retrospective study, enrolling patients who received anesthesia between April 2010 and January 2011. The study included 1 month of pretest phase, and 3 months each of "notification" phase, "observation" phase and "end" phase, respectively. The cannulations were set up by surgical ward nurses following the SOP on establishing peripheral intravenous catheter in our hospital. The cannulation sites were then examined before surgery and postoperatively by registered nurse anesthetists using the Baxter Scale. We also tried to set up a feedback circuit to let ward nurses know about the IV patency rate. As a result, 14,682 patients were enrolled in the study. The incidence of IV therapy-related adverse events was 0.78% in the notification phase, 0.43% in the observation phase, and 0.13% in the end phase. Overall IV therapy-related events declined significantly (p < 0.01), and the presence of phlebitis was associated with age (p < 0.05). An SOP established to assess IV patency through a checklist can reduce phlebitis and improve quality. The checklist increases ward nurses' and nurse anesthetists' awareness of IV patency, and the feedback circuit substantially reduces IV event rate. Copyright © 2015. Published by Elsevier Taiwan.

Later Onset Fabry Disease, Cardiac Damage Progress in Silence: Experience With a Highly Prevalent Mutation.

PubMed

Hsu, Ting-Rong; Hung, Sheng-Che; Chang, Fu-Pang; Yu, Wen-Chung; Sung, Shih-Hsien; Hsu, Chia-Lin; Dzhagalov, Ivan; Yang, Chia-Feng; Chu, Tzu-Hung; Lee, Han-Jui; Lu, Yung-Hsiu; Chang, Sheng-Kai; Liao, Hsuan-Chieh; Lin, Hsiang-Yu; Liao, Tsan-Chieh; Lee, Pi-Chang; Li, Hsing-Yuan; Yang, An-Hang; Ho, Hui-Chen; Chiang, Chuan-Chi; Lin, Ching-Yuang; Desnick, Robert J; Niu, Dau-Ming

2016-12-13

Recently, several studies revealed a much higher prevalence of later onset Fabry disease (FD) than previously expected. It suggested that later onset FD might present as an important hidden health issue in certain ethnic or demographic populations in the world. However, the natural history of its phenotype has not been systemically investigated, especially the cardiac involvement. The study analyzed a large-scale newborn screening program for FD to understand the natural course of later onset FD. To date, 916,383 newborns have been screened for FD in Taiwan, including more than 1,200 individuals with the common, later onset IVS4+919G>A (IVS4) mutation. Echocardiography was performed in 620 adults with the IVS4 mutation to analyze the prevalence of left ventricular hypertrophy (LVH), and gadolinium-enhanced cardiac magnetic resonance imaging was performed in 129 patients with FD, including 100 IVS4 adults. LVH was observed in 67% of men and 32% of women older than 40 years. Imaging evidenced significant late gadolinium enhancement in 38.1% of IVS4 men and 16.7% of IVS4 women with the IVS4 mutation but without LVH. Seventeen patients underwent endomyocardial biopsies, which revealed significant globotriaosylceramide substrate accumulation in their cardiomyocytes. Significant cardiomyocyte substrate accumulation in IVS4 patients led to severe and irreversible cardiac fibrosis before development of LVH or other significant cardiac manifestations. Thus, it might be too late to start enzyme replacement therapy after the occurrence of LVH or other significant cardiac manifestations in patients with later onset FD. This study also indicated the importance of newborn screening for early detection of the insidious, ongoing, irreversible cardiac damage in patients with later onset FD. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Retrospective review of intravenous pentamidine for Pneumocystis pneumonia prophylaxis in allogeneic hematopoietic stem cell transplantation.

PubMed

Diri, R; Anwer, F; Yeager, A; Krishnadasan, R; McBride, A

2016-02-01

Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk of numerous opportunistic infections. Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that can develop in immunocompromised individuals. Current prophylaxis for PJP includes trimethoprim-sulfamethoxazole (TMP-SMX), dapsone, atovaquone, or inhaled pentamidine (PEN), often with varying breakthrough rates. The use of intravenous (IV) PEN for PJP prophylaxis has been evaluated in pediatric patients. A single-institution retrospective review of electronic medical records was conducted for patients who underwent allo-HSCT between January 2001 and May 2013 and who had received at least 1 dose of IV PEN for PJP prophylaxis. Data collected included patient demographics, diagnosis, previous chemotherapy, pre-transplant conditioning regimen, other medications, microbiology test results, and clinical outcomes. A total of 113 patients were included in the study. The median number of PEN doses administered per patient was 3 (range 1-23). IV PEN was primary PJP prophylaxis in 74 of the patients (65%) and second-line prophylaxis in 39 (35%) post transplant, with the majority switching from oral TMP-SMX. Side effects of IV PEN administration were minimal. No patients who received IV PEN prophylaxis developed PJP infection. No case of PJP was seen in patients who received other agents for PJP prophylaxis. This retrospective study showed that IV PEN is very effective and well-tolerated prophylaxis for PJP; IV PEN can be considered a favorable alternative for PJP in situations where other agents might be contraindicated. Our findings provide strong support for prospective studies of IV PEN for PJP prophylaxis in adult HSCT recipients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Concordance between DSM-5 and DSM-IV nicotine, alcohol, and cannabis use disorder diagnoses among pediatric patients.

PubMed

Kelly, Sharon M; Gryczynski, Jan; Mitchell, Shannon Gwin; Kirk, Arethusa; O'Grady, Kevin E; Schwartz, Robert P

2014-07-01

The recently published Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) includes several major revisions to substance use diagnoses. Studies have evaluated the impact of these changes among adult samples but research with adolescent samples is lacking. 525 adolescents (93% African American) awaiting primary care appointments in Baltimore, Maryland were recruited for a study evaluating a substance use screening instrument. Participants were assessed for DSM-5 nicotine, alcohol, and cannabis use disorder, DSM-IV alcohol and cannabis abuse, and DSM-IV dependence for all three substances during the past year using the modified Composite International Diagnostic Interview-2, Substance Abuse Module. Contingency tables examining DSM-5 vs. DSM-IV joint frequency distributions were examined for each substance. Diagnoses were more prevalent using DSM-5 criteria compared with DSM-IV for nicotine (4.0% vs. 2.7%), alcohol (4.6% vs. 3.8%), and cannabis (10.7% vs. 8.2%). Cohen's κ, Somers' d, and Cramer's V ranged from 0.70 to 0.99 for all three substances. Of the adolescents categorized as "diagnostic orphans" under DSM-IV, 7/16 (43.8%), 9/29 (31.0%), and 13/36 (36.1%) met criteria for DSM-5 disorder for nicotine, alcohol, and cannabis, respectively. Additionally, 5/17 (29.4%) and 1/21 (4.8%) adolescents who met criteria for DSM-IV abuse did not meet criteria for a DSM-5 diagnosis for alcohol and cannabis, respectively. Categorizing adolescents using DSM-5 criteria may result in diagnostic net widening-particularly for cannabis use disorders-by capturing adolescents who were considered diagnostic orphans using DSM-IV criteria. Future research examining the validity of DSM-5 substance use disorders with larger and more diverse adolescent samples is needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Concordance between DSM-5 and DSM-IV nicotine, alcohol, and cannabis use disorder diagnoses among pediatric patients

PubMed Central

Kelly, Sharon M.; Gryczynski, Jan; Mitchell, Shannon Gwin; Kirk, Arethusa; O’Grady, Kevin E.; Schwartz, Robert P.

2014-01-01

Background The recently published Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) includes several major revisions to substance use diagnoses. Studies have evaluated the impact of these changes among adult samples but research with adolescent samples is lacking. Methods 525 adolescents (93% African American) awaiting primary care appointments in Baltimore, Maryland were recruited for a study evaluating a substance use screening instrument. Participants were assessed for DSM-5 nicotine, alcohol, and cannabis use disorder, DSM-IV alcohol and cannabis abuse, and DSM-IV dependence for all three substances during the past year using the modified Composite International Diagnostic Interview-2, Substance Abuse Module. Contingency tables examining DSM-5 vs. DSM-IV joint frequency distributions were examined for each substance. Results Diagnoses were more prevalent using DSM-5 criteria compared with DSM-IV for nicotine (4.0% vs. 2.7%), alcohol (4.6% vs. 3.8%), and cannabis (10.7% vs. 8.2%). Cohen's κ, Somers' d, and Cramer's V ranged from 0.70-0.99 for all three substances. Of the adolescents categorized as “diagnostic orphans” under DSM-IV, 7/16 (43.8%), 9/29 (31.0%), and 13/36 (36.1%) met criteria for DSM-5 disorder for nicotine, alcohol, and cannabis, respectively. Additionally, 5/17 (29.4%) and 1/21 (4.8%) adolescents who met criteria for DSM-IV abuse did not meet criteria for a DSM-5 diagnosis for alcohol and cannabis, respectively. Conclusions Categorizing adolescents using DSM-5 criteria may result in diagnostic net widening-particularly for cannabis use disorders-by capturing adolescents who were considered diagnostic orphans using DSM-IV criteria. Future research examining the validity of DSM-5 substance use disorders with larger and more diverse adolescent samples is needed. PMID:24793367

Practical Nursing Curriculum Guide. Including the Expanded Functions of I.V. Therapy and LPN Management. Invest in Success.

ERIC Educational Resources Information Center

Idaho State Dept. of Education, Boise. Div. of Vocational Education.

Under the Idaho state system for curriculum development in vocational education, Technical Committees made up solely of industry personnel are responsible for drawing up task lists for each program. The first part of this guide contains a curriculum for instruction of practical nurses who are eligible to sit for the license examination upon…

Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers.

PubMed

Hargis, Mitch; Shah, Jharna N; Mazabob, Janine; Rao, Chethan Venkatasubba; Suarez, Jose I; Bershad, Eric M

2015-08-01

The logistics involved in administration of IV tPA for acute ischemic stroke patients are complex, and may contribute to variability in door-to-needle times between different hospitals. We sought to identify practice patterns in stroke centers related to IV tPA use. We hypothesized that there would be significant variability in logistics related to ancillary staff (i.e. nursing, pharmacists) processes in the emergency room setting. A 21 question survey was distributed to attendees of the AHA/ASA Southwest Affiliate Stroke Coordinators Conference to evaluate potential barriers and delays with regards to thrombolysis for acute strokes patients in the Emergency Department setting. Answers were anonymous and aggregated to examine trends in responses. Responses were obtained from 37 of 67 (55%) stroke centers, which were located mainly in the Southwest United States. Logistical processes differed between facilities. Nursing and pharmacy carried stroke pagers in only 19% of the centers, and pharmacy responded to stroke alerts only one-third of centers. Insertion of Foley catheters and nasogastric tubes prior to tPA was routine in some of the sites. Other barriers to IV tPA administration included physician reluctance and inadequate communication between health care providers. Practices regarding logistics for giving IV tPA may be variable amongst different stroke centers. Given this potential variability, prospective evaluation to confirm these preliminary findings is warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

Perceived preparedness for physiatric specialization and future career goals of graduating postgraduate year IV residents during the 2004-2005 academic year.

PubMed

Raj, Vishwa S; Rintala, Diana H

2007-12-01

The purpose of this study was to evaluate trends among postgraduate year (PGY) IV physiatry residents, at the time of graduation from residency, in terms of their perceived experiences in the core clinical areas, confidence with procedural subspecialization, choice in career specialization, and desire to pursue clinical fellowship. Surveys were distributed to 386 PGY IV residents in physiatry at the end of the 2004-2005 academic year. Ninety-three residents (24%) completed responses in a confidential manner. Residents who were generally more confident in core clinical areas, as defined by the Self-Assessment Examination, and specialty prescription writing also believed themselves to be more prepared to practice these topics in their careers. Overall levels of confidence and perceived preparedness correlated positively with months of training and negatively with the belief in the need for postresidency fellowship training to incorporate these areas into clinical practice. Positive correlations also existed among perceived levels of preparedness in performing various physiatric procedures. Statistically significant differences in levels of confidence and preparedness existed among geographic regions when evaluating core physiatric subject matter. Fifty-six percent of residents who responded planned to pursue fellowship training, and a majority of residents intended to perform interventional procedures and musculoskeletal medicine in their practices. These results provide insight into how trainees perceive their current clinical education. With validation of measures for confidence and preparedness, this survey may be useful as an adjunct resource for residency programs to evaluate their trainees.

A unique evolution of the kidney phenotype in a patient with autosomal recessive Alport syndrome.

PubMed

Vischini, Gisella; Kapp, Meghan E; Wheeler, Ferrin C; Hopp, Laszlo; Fogo, Agnes B

2018-03-09

Alport syndrome is due to mutations in one of the genes encoding (α3,4,5) type IV collagen resulting in defective type IV collagen, a key component of the glomerular basement membrane (GBM). The GBM is initially thin, and with ongoing remodeling, develops a thickened basket-woven appearance. We report a unique case of a 9-year-old boy who was biopsied for hematuria and proteinuria, diagnosed as IgA nephropathy, with normal GBM appearance and thickness. Due to a family history of hematuria and chronic kidney disease, he subsequently underwent genetic evaluation and a mutation of α3 type IV collagen (COL4A3) was detected. Additional studies of the initial biopsy demonstrated abnormal type IV collagen immunostaining. A repeat biopsy 4years later showed characteristic glomerular basement membrane morphology of Alport syndrome, and scarring consistent with sequelae of IgA nephropathy. This is the first description of this unusual transition from an initial normal appearance of the glomerular basement membrane to the classic Alport phenotype. Copyright © 2018. Published by Elsevier Inc.

The pediatric Rome IV criteria: what's new?

PubMed

Koppen, Ilan J N; Nurko, Samuel; Saps, Miguel; Di Lorenzo, Carlo; Benninga, Marc A

2017-03-01

Functional gastrointestinal disorders (FGIDs) are common in children of all ages and comprise of a wide range of conditions related to the gastrointestinal tract that cannot be attributed to structural or biochemical abnormalities. FGIDs are diagnosed according to the symptom-based Rome criteria. Areas covered: In 2016, the revised pediatric Rome IV criteria were published, these revised criteria are discussed in this review article. For the youngest age group (neonates/toddlers), the criteria for infant colic have undergone the most notable revisions. The most prominent changes in Rome IV were made in the criteria for children/adolescents, with the definition of two new FGIDs (functional nausea and functional vomiting) and the restructuring of the criteria for functional abdominal pain disorders, including the definition of FGID subtypes for functional dyspepsia and irritable bowel syndrome. Expert commentary: Overall, the Rome IV have been refined and are expected to improve the process of diagnosing FGIDs in the pediatric population and to better facilitate the healthcare professional in distinguishing different clinical entities. These changes will likely benefit future research and clinical care.

Dyadic Short Forms of the Wechsler Adult Intelligence Scale-IV.

PubMed

Denney, David A; Ringe, Wendy K; Lacritz, Laura H

2015-08-01

Full Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) administration can be time-consuming and may not be necessary when intelligence quotient estimates will suffice. Estimated Full Scale Intelligence Quotient (FSIQ) and General Ability Index (GAI) scores were derived from nine dyadic short forms using individual regression equations based on data from a clinical sample (n = 113) that was then cross validated in a separate clinical sample (n = 50). Derived scores accounted for 70%-83% of the variance in FSIQ and 77%-88% of the variance in GAI. Predicted FSIQs were strongly associated with actual FSIQ (rs = .73-.88), as were predicted and actual GAIs (rs = .80-.93). Each of the nine dyadic short forms of the WAIS-IV was a good predictor of FSIQ and GAI in the validation sample. These data support the validity of WAIS-IV short forms when time is limited or lengthier batteries cannot be tolerated by patients. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury.

PubMed

Mittmann, Nicole; Chan, Brian C; Craven, B Cathy; Isogai, Pierre K; Houghton, Pamela

2011-06-01

To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective. A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted. The perspective of this analysis is from a Canadian public health system payer. Model target population was an SCI cohort with grade III/IV PUs. Not applicable. Incremental cost per PU healed. ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC. The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Survey of pain specialists regarding conversion of high-dose intravenous to neuraxial opioids

PubMed Central

Gorlin, Andrew W; Rosenfeld, David M; Maloney, Jillian; Wie, Christopher S; McGarvey, Johnathan; Trentman, Terrence L

2016-01-01

The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there is little evidence to guide practice. Expert opinion varies, though a 100 IV:10:EP:1 IT conversion ratio is commonly cited in the literature, especially for morphine. In this study, the authors surveyed 724 pain specialists to elucidate the ratios that respondents apply to convert high-dose IV morphine, hydromorphone, and fentanyl to both EP and IT routes. Eighty-three respondents completed the survey. Conversion ratios were calculated and entered into graphical scatter plots. The data suggest that there is wide variation in how pain specialists convert high-dose IV opioids to EP and IT routes. The 100 IV:10 EP:1 IT ratio was the most common answer of survey respondent, especially for morphine, though also for hydromorphone and fentanyl. Furthermore, more respondents applied a more aggressive conversion strategy for hydromorphone and fentanyl, likely reflecting less spinal selectivity of those opioids compared with morphine. The authors conclude that there is little consensus on this issue and suggest that in the absence of better data, a conservative approach to opioid conversion between IV and neuraxial routes is warranted. PMID:27703394

From Cholera to Burns: A Role for Oral Rehydration Therapy

PubMed Central

Green, W.B.; Asuku, M.E.; Feldman, M.; Makam, R.; Noppenberger, D.; Price, L.A.; Prosciak, M.; van Loon, I.N.

2011-01-01

According to the practice guidelines of the American Burn Association on burn shock resuscitation, intravenous (IV) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of ≥20% of the total body surface area. However, in mass burn casualties, IV fluid resuscitation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte®90 could replace fluid losses requiring IV fluid therapy in thermal injury. The requirement of the continuing IV fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to IV fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where IV fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification. PMID:22283039

Wechsler Intelligence Scale for Children 4th edition-Chinese version index scores in Taiwanese children with attention-deficit/hyperactivity disorder.

PubMed

Yang, Pinchen; Cheng, Chung-Ping; Chang, Chen-Lin; Liu, Tai-Ling; Hsu, Hsiu-Yi; Yen, Cheng-Fang

2013-02-01

The Wechsler Intelligence Scale for Children 4th edition-Chinese version (WISC-IV-Chinese) has been in clinical use in Taiwan since 2007. Research is needed to determine how the WISC-IV, modified from its earlier version, will affect its interpretation in clinical practice in a Mandarin-speaking context. We attempted to use WISC-IV-Chinese scores to identify the cognitive strengths and weaknesses in 334 Taiwanese children with attention-deficit/hyperactivity disorder (ADHD). Comparison of cognitive profiles of WISC-IV-Chinese scores between subtypes of ADHD was also performed. The results indicated that the four-factor model of the WISC-IV-Chinese fitted well for Taiwanese children with ADHD. The profiles showed that performance in the index score of the Processing Speed Index was the weakness domain for the Taiwanese children with ADHD, as confirmed by two different kinds of analytic methods. Cognitive profile analysis of ADHD subtypes revealed children with inattentive subtypes to have a greater weakness in processing speed performance. The implications of the profiles of the index scores on the WISC-IV-Chinese version for Taiwanese children with ADHD were explored. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

Selective Mutism: Definition, Issues, and Treatment.

ERIC Educational Resources Information Center

Brigham, Frederick J.; Cole, Jane E.

This paper reviews definitions and issues in selective mutism in children and summarizes results of interventions conducted and published since 1982. Definitions and diagnostic criteria of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (1994)" and the World Health Organization's…

77 FR 53873 - Defense Transportation Regulation, Part IV

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

...: The Department of Defense has published draft Direct Procurement Method (DPM) business rules for the....9R). These business rules will encompass Transportation Service Providers (TSP) participation and... Personal Property Program (DP3). The DPM business rules will replace the currently approved Domestic Small...

Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology.

PubMed

Gronseth, Gary S; Paduga, Remia

2012-11-27

To review evidence published since the 2001 American Academy of Neurology (AAN) practice parameter regarding the effectiveness, safety, and tolerability of steroids and antiviral agents for Bell palsy. We searched Medline and the Cochrane Database of Controlled Clinical Trials for studies published since January 2000 that compared facial functional outcomes in patients with Bell palsy receiving steroids/antivirals with patients not receiving these medications. We graded each study (Class I-IV) using the AAN therapeutic classification of evidence scheme. We compared the proportion of patients recovering facial function in the treated group with the proportion of patients recovering facial function in the control group. Nine studies published since June 2000 on patients with Bell palsy receiving steroids/antiviral agents were identified. Two of these studies were rated Class I because of high methodologic quality. For patients with new-onset Bell palsy, steroids are highly likely to be effective and should be offered to increase the probability of recovery of facial nerve function (2 Class I studies, Level A) (risk difference 12.8%-15%). For patients with new-onset Bell palsy, antiviral agents in combination with steroids do not increase the probability of facial functional recovery by >7%. Because of the possibility of a modest increase in recovery, patients might be offered antivirals (in addition to steroids) (Level C). Patients offered antivirals should be counseled that a benefit from antivirals has not been established, and, if there is a benefit, it is likely that it is modest at best.

Solution and surface chemistry of the Se(IV)-Fe(0) reactions: Effect of initial solution pH.

PubMed

Xia, Xuefen; Ling, Lan; Zhang, Wei-Xian

2017-02-01

Aspects of solution and solid-phase reactions between selenite (Se(IV)) and nanoscale zero-valent iron (nZVI) were investigated. Experimental results on the effects of initial solution pH, formation and evolution of nZVI corrosion products, and speciation of selenium in nZVI were presented. In general, the rate of Se(IV) removal decreases with increasing initial pH. The observed rate constants of Se(IV) removal decreased from 0.3530 to 0.0364 min -1 as pH increased from 4.0 to 10.0. Composition and morphology of nZVI corrosion products and selenium species were characterized using scanning electron microscopy (SEM), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). Results confirmed that Se(IV) was reduced to Se(0) and Se(-II) by nZVI. Lower solution pH favored further reduction of Se(0) to Se(-II). Amorphous FeOOH, magnetite/maghemite (Fe 3 O 4 /γ-Fe 2 O 3 ) and ferrous hydroxide (Fe(OH) 2 ) were identified as the main corrosion products. Under alkaline conditions, the corrosion products were mainly of Fe(OH) 2 along with small amounts of Fe 3 O 4 , while nZVI in acidic solutions was oxidized to mostly Fe 3 O 4 and amorphous FeOOH. Furthermore, these corrosion products acted as intermediates for electron transfer and reactive/sorptive sites for Se(IV) adsorption and reduction, thus played a crucial role in the removal of aqueous Se(IV). Copyright © 2016. Published by Elsevier Ltd.

Renal tubular acidosis type IV in hyperkalaemic patients--a fairy tale or reality?

PubMed

Haas, Christian S; Pohlenz, Inga; Lindner, Ulrich; Muck, Philip M; Arand, Jovana; Suefke, Sven; Lehnert, Hendrik

2013-05-01

Hyperkalaemia is a common feature in hospitalized patients and often attributed to drugs antagonizing the renin-angiotensin-aldosterone system (RAAS) and/or acute kidney injury (AKI), despite significantly preserved glomerular filtration rate (GFR). The objective of this study was to determine the prevalence and role of renal tubular acidosis type IV (RTA IV) in the development of significant hyperkalaemia. A single-centre retrospective study. Patients admitted to a University Hospital over 12 months. Patients with a potassium value > 6·0 mm were identified. Clinical and laboratory data were revisited, and patients with a normal anion gap metabolic acidosis were evaluated for the existence of RTA IV. A total of 57 patients having significant hyperkalaemia (>6·0 mm) were identified. Twelve patients had end-stage renal disease, while 21 patients had solely AKI or progressive chronic renal failure. RTA IV was present in 24 patients (42%), of whom 71% had pre-existing renal insufficiency because of diabetic nephropathy or tubulointerstitial nephritis. All hyperkalaemic patients with urinary/serum electrolytes suggestive of RTA IV had evidence of AKI, but creatinine levels were significantly lower (P < 0·05), while the number of drugs antagonizing the RAAS was comparable. We demonstrated that RTA IV (i) is very common in patients with hyperkalaemia; (ii) should always be suspected in hyperkalaemic patients with only moderately impaired GFR; and (iii) may result in significant hyperkalaemia in the presence of both AKI and drugs antagonizing the RAAS. © 2012 Blackwell Publishing Ltd.

Perspectives on Subcutaneous Route of Administration as an Immunogenicity Risk Factor for Therapeutic Proteins.

PubMed

Hamuro, Lora; Kijanka, Grzegorz; Kinderman, Francis; Kropshofer, Harald; Bu, De-Xiu; Zepeda, Monica; Jawa, Vibha

2017-10-01

An increasing number of therapeutic proteins are being developed for delivery through the subcutaneous (SC) route of administration. Relative to intravenous (IV) administration, the SC route offers more convenience to patients, flexibility in dosing, and potential to reduce health care costs. There is a perception that SC administration can pose a higher immunogenicity risk than IV administration for a given protein. To evaluate whether there is a difference in therapeutic protein immunogenicity associated with administration routes, a more detailed understanding of the interactions with the immune system by each route is needed. Few approved therapeutic proteins have available clinical immunogenicity data sets in the public domain that represent both IV and SC administration routes. This has prevented a direct comparison of the 2 routes of administration across a large sample size. Of the 6 marketed products where SC and IV route-related incidences of anti-drug antibody (ADA) were available, 4 were associated with higher immunogenicity incidence with SC. In other cases, there was no apparent difference between the SC and IV routes. Overall, the ADA incidence was low (<15%) with no impact on safety or efficacy. The challenges associated with identifying specific risk factors unique to SC administration are discussed. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Catalase-loaded cisplatin-prodrug-constructed liposomes to overcome tumor hypoxia for enhanced chemo-radiotherapy of cancer.

PubMed

Zhang, Rui; Song, Xuejiao; Liang, Chao; Yi, Xuan; Song, Guosheng; Chao, Yu; Yang, Yu; Yang, Kai; Feng, Liangzhu; Liu, Zhuang

2017-09-01

Aiming at improved therapeutic efficacies, the combination of chemotherapy and radiotherapy (chemo-radiotherapy) has been widely studied and applied in clinic. However, the hostile characteristics of tumor microenvironment such as hypoxia often limit the efficacies in both types of cancer therapies. Herein, catalase (CAT), an antioxidant enzyme, is encapsulated inside liposomes constituted by cisplatin (IV)-prodrug-conjugated phospholipid, forming CAT@Pt (IV)-liposome for enhanced chemo-radiotherapy of cancer. After being loaded inside liposomes, CAT within CAT@Pt (IV)-liposome shows retained and well-protected enzyme activity, and is able to trigger decomposition of H 2 O 2 produced by tumor cells, so as to produce additional oxygen for hypoxia relief. As the result, treatment of CAT@Pt (IV)-liposome induces the highest level of DNA damage in cancer cells after X-ray radiation compared to the control groups. In vivo tumor treatment further demonstrates a remarkably improved therapeutic outcome in chemo-radiotherapy with such CAT@Pt (IV)-liposome nanoparticles. Hence, an exquisite type of liposome-based nanoparticles is developed in this work by integrating cisplatin-based chemotherapy and catalase-induced tumor hypoxia relief together for combined chemo-radiotherapy with great synergistic efficacy, promising for clinical translation in cancer treatment. Copyright © 2017. Published by Elsevier Ltd.

The First Detection of [O IV] from an Ultraluminous X-ray Source with Spitzer. II. Evidence for High Luminosity in Holmberg II ULX

NASA Technical Reports Server (NTRS)

Berghea, C. T.; Dudik, R. P.; Weaver, K. A.; Kallman, T. R.

2009-01-01

This is the second of two papers examining Spitzer Infrared Spectrograph (IRS) observations of the ultraluminous X-ray source (ULX) in Holmberg II. Here we perform detailed photoionization modeling of they infrared lines. Our analysis suggests that the luminosity and morphology of the [O IV] 25.89 micron emission line is consistent with photoionization by the soft X-ray and far ultraviolet (FUV) radiation from the accretion disk of the binary system and inconsistent with narrow beaming. We show that the emission nebula is matter-bounded both in the line of sight direction and to the east, and probably radiation-bounded to the west. A bolometric luminosity in excess of 1040 erg per second would be needed to produce the measured [O IV] flux. We use modeling and previously published studies to conclude that shacks likely contribute very little, if at all, to the high excitation line fluxes observed in the Holmberg II ULX. Additionally, we find that the spectral type of the companion star has a surprisingly strong effect on they predicted strength of the [O IV] emission. This finding could explain the origin of [O IV] hi some starburst systems containing black hole binaries.

Impact of the DSM-5 attention-deficit/hyperactivity disorder age-of-onset criterion in the US adolescent population.

PubMed

Vande Voort, Jennifer L; He, Jian-Ping; Jameson, Nicole D; Merikangas, Kathleen R

2014-07-01

The present study aims to compare the prevalence and clinical correlates of DSM-IV versus DSM-5-defined attention-deficit/hyperactivity disorder (ADHD) and subtypes in a nationally representative sample of US youth based on the age-of-onset criterion. The sample includes 1,894 participants 12 to 15 years of age from cross-sectional National Health and Nutrition Examination Survey (NHANES) surveys conducted from 2001 to 2004. Data on DSM-IV and DSM-5 criteria for ADHD were derived from administration of the parental ADHD module of the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Extension of the age-of-onset criterion from 7 to 12 years led to an increase in the prevalence rate of ADHD from 7.38% (DSM-IV) to 10.84% (DSM-5). Youth with later age of onset did not differ from those with earlier age of onset in terms of severity and patterns of comorbidity. However, the group with later age of onset was more likely to be from lower income and ethnic minority families. The comparability of the clinical significance of the early and later age-of-onset groups supports the DSM-5 extension of the age-of-onset criterion in ADHD. Published by Elsevier Inc.

The First Detection of [O IV] from an Ultraluminous X-ray Source with Spitzer. 2; Evidence for High Luminosity in Holmberg II ULX

NASA Technical Reports Server (NTRS)

Berghea, C. T.; Dudik, R. P.; Weaver, K. A.; Kallman, T. R.

2009-01-01

This is the second of two papers examining Spitzer Infrared Spectrograph (IRS) observations of the ultraluminous X-ray source (ULX) in Holmberg II. Here we perform detailed photoionization modeling of the infrared lines. Our analysis suggests that the luminosity and morphology of the [O IV] 25.89 micron emission line is consistent with photoionization by the soft X-ray and far ultraviolet (FUV) radiation from the accretion disk of the binary system and inconsistent with narrow beaming. We show that the emission nebula is matter-bounded both in the line of sight direction and to the east, and probably radiation-bounded to the west. A bolometric luminosity in excess of 10(exp 40) erg/s would be needed to produce the measured [O IV] flux. We use modeling and previously published studies to conclude that shocks likely contribute very little, if at all, to the high-excitation line fluxes observed in the Holmberg II ULX. Additionally, we find that the spectral type of the companion star has a surprisingly strong effect on the predicted strength of the [O IV] emission. This finding could explain the origin of [O IV] in some starburst systems containing black hole binaries.

Alport syndrome: a unified classification of genetic disorders of collagen IV α345: a position paper of the Alport Syndrome Classification Working Group.

PubMed

Kashtan, Clifford E; Ding, Jie; Garosi, Guido; Heidet, Laurence; Massella, Laura; Nakanishi, Koichi; Nozu, Kandai; Renieri, Alessandra; Rheault, Michelle; Wang, Fang; Gross, Oliver

2018-05-01

Mutations in the genes COL4A3, COL4A4, and COL4A5 affect the synthesis, assembly, deposition, or function of the collagen IV α345 molecule, the major collagenous constituent of the mature mammalian glomerular basement membrane. These mutations are associated with a spectrum of nephropathy, from microscopic hematuria to progressive renal disease leading to ESRD, and with extrarenal manifestations such as sensorineural deafness and ocular anomalies. The existing nomenclature for these conditions is confusing and can delay institution of appropriate nephroprotective therapy. Herein we propose a new classification of genetic disorders of the collagen IV α345 molecule with the goal of improving renal outcomes through regular monitoring and early treatment. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Theory analysis of the Dental Hygiene Human Needs Conceptual Model.

PubMed

MacDonald, L; Bowen, D M

2017-11-01

Theories provide a structural knowing about concept relationships, practice intricacies, and intuitions and thus shape the distinct body of the profession. Capturing ways of knowing and being is essential to any professions' practice, education and research. This process defines the phenomenon of the profession - its existence or experience. Theory evaluation is a systematic criterion-based assessment of a specific theory. This study presents a theory analysis of the Dental Hygiene Human Needs Conceptual Model (DH HNCM). Using the Walker and Avant Theory Analysis, a seven-step process, the DH HNCM, was analysed and evaluated for its meaningfulness and contribution to dental hygiene. The steps include the following: (i) investigate the origins; (ii) examine relationships of the theory's concepts; (iii) assess the logic of the theory's structure; (iv) consider the usefulness to practice; (v) judge the generalizability; (vi) evaluate the parsimony; and (vii) appraise the testability of the theory. Human needs theory in nursing and Maslow's Hierarchy of Need Theory prompted this theory's development. The DH HNCM depicts four concepts based on the paradigm concepts of the profession: client, health/oral health, environment and dental hygiene actions, and includes validated eleven human needs that evolved overtime to eight. It is logical, simplistic, allows scientific predictions and testing, and provides a unique lens for the dental hygiene practitioner. With this model, dental hygienists have entered practice, knowing they enable clients to meet their human needs. For the DH HNCM, theory analysis affirmed that the model is reasonable and insightful and adds to the dental hygiene professions' epistemology and ontology. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Clinical Practice Guideline: Irritable bowel syndrome with constipation and functional constipation in the adult.

PubMed

Mearin, Fermín; Ciriza, Constanza; Mínguez, Miguel; Rey, Enrique; Mascort, Juan José; Peña, Enrique; Cañones, Pedro; Júdez, Javier

2016-06-01

In this Clinical Practice Guideline we discuss the diagnostic and therapeutic approach of adult patients with constipation and abdominal complaints at the confluence of the irritable bowel syndrome spectrum and functional constipation. Both conditions are included among the functional bowel disorders, and have a significant personal, healthcare, and social impact, affecting the quality of life of the patients who suffer from them. The first one is the irritable bowel syndrome subtype, where constipation represents the predominant complaint, in association with recurrent abdominal pain, bloating, and abdominal distension. Constipation is characterized by difficulties with or low frequency of bowel movements, often accompanied by straining during defecation or a feeling of incomplete evacuation. Most cases have no underlying medical cause, and are therefore considered as a functional bowel disorder. There are many clinical and pathophysiological similarities between both disorders, and both respond similarly to commonly used drugs, their primary difference being the presence or absence of pain, albeit not in an "all or nothing" manner. Severity depends not only upon bowel symptom intensity but also upon other biopsychosocial factors (association of gastrointestinal and extraintestinal symptoms, grade of involvement, and perception and behavior variants). Functional bowel disorders are diagnosed using the Rome criteria. This Clinical Practice Guideline has been made consistent with the Rome IV criteria, which were published late in May 2016, and discuss alarm criteria, diagnostic tests, and referral criteria between Primary Care and gastroenterology settings. Furthermore, all the available treatment options (exercise, fluid ingestion, diet with soluble fiber-rich foods, fiber supplementation, other dietary components, osmotic or stimulating laxatives, probiotics, antibiotics, spasmolytics, peppermint essence, prucalopride, linaclotide, lubiprostone, biofeedback, antidepressants, psychological therapy, acupuncture, enemas, sacral root neurostimulation, surgery) are discussed, and practical recommendations are made regarding each of them.

Midwifery students' evaluation of team-based academic assignments involving peer-marking.

PubMed

Parratt, Jenny A; Fahy, Kathleen M; Hastie, Carolyn R

2014-03-01

Midwives should be skilled team workers in maternity units and in group practices. Poor teamwork skills are a significant cause of adverse maternity care outcomes. Despite Australian and International regulatory requirements that all midwifery graduates are competent in teamwork, the systematic teaching and assessment of teamwork skills is lacking in higher education. How do midwifery students evaluate participation in team-based academic assignments, which include giving and receiving peer feedback? First and third year Bachelor of Midwifery students who volunteered (24 of 56 students). Participatory Action Research with data collection via anonymous online surveys. There was general agreement that team based assignments; (i) should have peer-marking, (ii) help clarify what is meant by teamwork, (iii) develop communication skills, (iv) promote student-to-student learning. Third year students strongly agreed that teams: (i) are valuable preparation for teamwork in practice, (ii) help meet Australian midwifery competency 8, and (iii) were enjoyable. The majority of third year students agreed with statements that their teams were effectively coordinated and team members shared responsibility for work equally; first year students strongly disagreed with these statements. Students' qualitative comments substantiated and expanded on these findings. The majority of students valued teacher feedback on well-developed drafts of the team's assignment prior to marking. Based on these findings we changed practice and created more clearly structured team-based assignments with specific marking criteria. We are developing supporting lessons to teach specific teamwork skills: together these resources are called "TeamUP". TeamUP should be implemented in all pre-registration Midwifery courses to foster students' teamwork skills and readiness for practice. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

[Adjustment disorders with anxiety. Clinical and psychometric characteristics in patients consulting a general practitioner].

PubMed

Servant, D; Pelissolo, A; Chancharme, L; Le Guern, M-E; Boulenger, J-P

2013-10-01

The DSM-IV and ICD-10 descriptions of adjustment disorders are broadly similar. Their main features are the following: the symptoms arise in response to a stressful event; the onset of symptoms is within 3 months (DSM-IV) or 1 month (ICD-10) of exposure to the stressor; the symptoms must be clinically significant, in that they are distressing and in excess of what would be expected by exposure to the stressor and/or there is significant impairment in social or occupational functioning (the latter is mandatory in ICD-10); the symptoms are not due to another axis I disorder (or bereavement in DSM-IV); the symptoms resolve within 6 months, once the stressor or its consequences are removed. Adjustment disorders are divided into subgroups based on the dominant symptoms of anxiety, depression or behaviour. Adjustment disorder with anxiety (ADA) is a very common diagnosis in primary care, liaison and general psychiatry services but we still lack data about its specificity as a clinical entity. Current classifications fail to provide guidance on distinguishing these disorders from normal adaptive reactions to stress. Ninety-seven patients with ADA according DSM-IV were recruited in this primary care study and compared with 30 control subjects matched for age and sex. The diagnosis was made according to the MINI questionnaire completed with a standardized research of stressful events and an assessment of anxiety symptoms using different scales: the Hamilton Anxiety rating Scale (HAM-A), the Hospital Anxiety and Depression scale (HAD), The Penn-State Worry Questionnaire (PSWQ), the Positive and Negative Emotionality scale, 31 items (EPN-31 scale) and the State-Trait Anxiety Inventory (STAI-S). Life events in relation to work were the most frequent (43%). In terms of symptomatology, results showed that ADA is associated with a level of anxiety close to those obtained in other anxiety disorders, particularly GAD, in relation to general symptoms (physical and somatic) as well as anxious rumination and negative emotions. Further research is needed to better understand the disorder and clarify its frontiers, which still remain a controversial issue with regard to the homeostatic response to stress and other types of anxiety disorders. The results of our study suggest that this sub syndromic entity should be recognized and adequately treated, especially in general practice where it is very common. Copyright © 2012. Published by Elsevier Masson SAS.

V&V of Fault Management: Challenges and Successes

NASA Technical Reports Server (NTRS)

Fesq, Lorraine M.; Costello, Ken; Ohi, Don; Lu, Tiffany; Newhouse, Marilyn

2013-01-01

This paper describes the results of a special breakout session of the NASA Independent Verification and Validation (IV&V) Workshop held in the fall of 2012 entitled "V&V of Fault Management: Challenges and Successes." The NASA IV&V Program is in a unique position to interact with projects across all of the NASA development domains. Using this unique opportunity, the IV&V program convened a breakout session to enable IV&V teams to share their challenges and successes with respect to the V&V of Fault Management (FM) architectures and software. The presentations and discussions provided practical examples of pitfalls encountered while performing V&V of FM including the lack of consistent designs for implementing faults monitors and the fact that FM information is not centralized but scattered among many diverse project artifacts. The discussions also solidified the need for an early commitment to developing FM in parallel with the spacecraft systems as well as clearly defining FM terminology within a project.

Vented spikes improve delivery from intravenous bags with no air headspace.

PubMed

Galush, William J; Horst, Travis A

2015-07-01

Flexible plastic bags are the container of choice for most intravenous (i.v.) infusions. Under certain circumstances, however, the air-liquid interface present in these i.v. bags can lead to physical instability of protein biopharmaceuticals, resulting in product aggregation. In principle, the air headspace present in the bags can be removed to increase drug stability, but experiments described here show that this can result in incomplete draining of solution from the bag using gravity delivery, or generation of negative pressure in the bag when an infusion pump is used. It is expected that these issues could lead to incomplete delivery of medication to patients or pump-related problems, respectively. However, here it is shown that contrary to the standard pharmacy practice of using nonvented spikes with i.v. bags, the use of vented spikes with i.v. bags that lack air headspace allows complete delivery of the dose solution without impacting the physical stability of a protein-based drug. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association.

Ultrathin inorganic molecular nanowire based on polyoxometalates

PubMed Central

Zhang, Zhenxin; Murayama, Toru; Sadakane, Masahiro; Ariga, Hiroko; Yasuda, Nobuhiro; Sakaguchi, Norihito; Asakura, Kiyotaka; Ueda, Wataru

2015-01-01

The development of metal oxide-based molecular wires is important for fundamental research and potential practical applications. However, examples of these materials are rare. Here we report an all-inorganic transition metal oxide molecular wire prepared by disassembly of larger crystals. The wires are comprised of molybdenum(VI) with either tellurium(IV) or selenium(IV): {(NH4)2[XMo6O21]}n (X=tellurium(IV) or selenium(IV)). The ultrathin molecular nanowires with widths of 1.2 nm grow to micrometre-scale crystals and are characterized by single-crystal X-ray analysis, Rietveld analysis, scanning electron microscopy, X-ray photoelectron spectroscopy, ultraviolet–visible spectroscopy, thermal analysis and elemental analysis. The crystals can be disassembled into individual molecular wires through cation exchange and subsequent ultrasound treatment, as visualized by atomic force microscopy and transmission electron microscopy. The ultrathin molecular wire-based material exhibits high activity as an acid catalyst, and the band gap of the molecular wire-based crystal is tunable by heat treatment. PMID:26139011

Simultaneous spectrophotometric determination of trace amounts of uranium, thorium, and zirconium using the partial least squares method after their preconcentration by alpha-benzoin oxime modified Amberlite XAD-2000 resin.

PubMed

Ghasemi, Jahan B; Zolfonoun, E

2010-01-15

A new solid phase extraction method for separation and preconcentration of trace amounts of uranium, thorium, and zirconium in water samples is proposed. The procedure is based on the adsorption of U(VI), Th(IV) and Zr(IV) ions on a column of Amberlite XAD-2000 resin loaded with alpha-benzoin oxime prior to their simultaneous spectrophotometric determination with Arsenazo III using orthogonal signal correction partial least squares method. The enrichment factor for preconcentration of uranium, thorium, and zirconium was found to be 100. The detection limits for U(VI), Th(IV) and Zr(IV) were 0.50, 0.54, and 0.48microgL(-1), respectively. The precision of the method, evaluated as the relative standard deviation obtained by analyzing a series of 10 replicates, was below 4% for all elements. The practical applicability of the developed sorbent was examined using synthetic seawater, natural waters and ceramic samples.

Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice.

PubMed

Cohn, David E; Havrilesky, Laura J; Osann, Kathryn; Lipscomb, Joseph; Hsieh, Susie; Walker, Joan L; Wright, Alexi A; Alvarez, Ronald D; Karlan, Beth Y; Bristow, Robert E; DiSilvestro, Paul A; Wakabayashi, Mark T; Morgan, Robert; Mukamel, Dana B; Wenzel, Lari

2015-09-01

To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy. A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers. The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%). Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Astragaloside IV attenuates injury caused by myocardial ischemia/reperfusion in rats via regulation of toll-like receptor 4/nuclear factor-κB signaling pathway.

PubMed

Lu, Meili; Tang, Futian; Zhang, Jing; Luan, Aina; Mei, Meng; Xu, Chonghua; Zhang, Suping; Wang, Hongxin; Maslov, Leonid N

2015-04-01

Myocardial ischemia/reperfusion (MI/R) injury, in which inflammatory response and cell apoptosis play a vital role, is frequently encountered in clinical practice. Astragaloside IV (AsIV), a small molecular saponin of Astragalus membranaceus, has been shown to confer protective effects against many cardiovascular diseases. The present study was aimed to investigate the antiinflammatory and antiapoptotic effects and the possible mechanism of AsIV on MI/R injury in rats. Rats were randomly divided into sham operation group, MI/R group and groups with combinations of MI/R and different doses of AsIV. The results showed that the expressions of myocardial toll-like receptor 4 (TLR4) and nuclear factor-κB (NF-κB) were significantly increased, and apoptosis of cardiomyocytes was induced in MI/R group compared with that in sham operation group. Administration of AsIV attenuated MI/R injury, downregulated the expressions of TLR4 and NF-κB and inhibited cell apoptosis as evidenced by decreased terminal deoxynucleotidyl transferase dUTP nick end labeling positive cells, B-cell lymphoma-2 associated X protein and caspase-3 expressions and increased B-cell lymphoma-2 expression compared with that in MI/R group. In addition, AsIV treatment reduced levels of inflammatory cytokines induced by MI/R injury. In conclusion, our results demonstrated that AsIV downregulates TLR4/NF-κB signaling pathway and inhibits cell apoptosis, subsequently attenuating MI/R injury in rats. Copyright © 2015 John Wiley & Sons, Ltd.

44 CFR 9.9 - Analysis and reevaluation of practicable alternatives.

Code of Federal Regulations, 2010 CFR

2010-10-01

...; (ii) Reduce the risk of flood loss; (iii) Minimize the impact of floods on human safety, health and... wetlands; (iii) Minimize the destruction, loss or degradation of wetlands; and (iv) Preserve and enhance...

30 CFR 250.916 - What are the CVA's primary duties during the design phase?

Code of Federal Regulations, 2014 CFR

2014-07-01

... the design phase? (a) The CVA must use good engineering judgment and practices in conducting an...; (iv) Load determinations; (v) Stress analyses; (vi) Material designations; (vii) Soil and foundation...

30 CFR 250.916 - What are the CVA's primary duties during the design phase?

Code of Federal Regulations, 2012 CFR

2012-07-01

... the design phase? (a) The CVA must use good engineering judgment and practices in conducting an...; (iv) Load determinations; (v) Stress analyses; (vi) Material designations; (vii) Soil and foundation...

30 CFR 250.916 - What are the CVA's primary duties during the design phase?

Code of Federal Regulations, 2013 CFR

2013-07-01

... the design phase? (a) The CVA must use good engineering judgment and practices in conducting an...; (iv) Load determinations; (v) Stress analyses; (vi) Material designations; (vii) Soil and foundation...

SOF Language Transformation Strategy Needs Assessment Project: SOF Operator Survey Report

DTIC Science & Technology

2004-10-01

CAT III/IV Language More difficult languages to acquire for native English speakers. Examples: Cantonese , Japanese, Arabic, Dari, Pashto, Turkish...simple conversations on familiar topics (M = 68.4) and less confident in their ability participate in informal conversations on practical, social , and...familiar topics (M = 59.6), and to participate in informal conversations on practical, social , and professional topics (M = 40.3) than personnel

Sampling Extreme Groups Invalidates Research on the Paraphilias: Implications for DSM-5 and Sex Offender Risk Assessments.

PubMed

Wollert, Richard; Cramer, Elliot

2011-01-01

Psychiatrist and Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) text editor Michael First has criticized the addition of victim counts to criteria proposed by the Paraphilia Sub-Workgroup for inclusion in DSM-5 because they will increase false-positive diagnoses. Psychologist and Chair of the DSM-5 Paraphilia Sub-Workgroup, Ray Blanchard, responded by publishing a study of pedohebephiles and teleiophiles which seemed to show that victim counts could accurately identify pedohebephiles who were selected per self-report and phallometric testing. His analysis was flawed because it did not conform to conventional clinical practice and because he sampled groups at opposite ends of the clinical spectrum. In an analysis of his full sample, we found the false-positive rate for pedohebephilia at the recommended victim count selection points was indeed very large. Why? Because data analyses that eliminate intermediate data points will generate inflated estimates of correlation coefficients, base rates, and the discriminative capacity of predictor variables. This principle is also relevant for understanding the flaws in previous research that led Hanson and Bussiere to conclude that sexual recidivism was correlated with "sexual interest in children as measured by phallometric assessment." The credibility of mental health professionals rests on the reliability of their research. Conducting, publishing, and citing research that reflects Copyright © 2011 John Wiley & Sons, Ltd.

The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part I: A summary of the current state for clinicians.

PubMed

de Leon, Jose

2015-01-01

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. This is part i of a comprehensive review on antiepileptic drug (AED) inducers using both mechanistic pharmacological and evidence-based medicine to provide practical recommendations to neurologists and psychiatrists concerning how to control for them. Carbamazepine, phenobarbital and phenytoin, are clinically relevant AED inducers; correction factors were calculated for studied induced drugs. These correction factors are rough simplifications for orienting clinicians, since there is great variability in the population regarding inductive effects. As new information is published, the correction factors may need to be modified. Some of the correction factors are so high that the drugs (e.g., bupropion, quetiapine or lurasidone) should not co-prescribed with potent inducers. Clobazam, eslicarbazepine, felbamate, lamotrigine, oxcarbazepine, rufinamide, topiramate, vigabatrin and valproic acid are grouped as mild inducers which may (i)be inducers only in high doses; (ii)frequently combine with inhibitory properties; and (iii)take months to reach maximum effects or de-induction, definitively longer than the potent inducers. Potent inducers, definitively, and mild inducers, possibly, have relevant effects in the endogenous metabolism of (i)sexual hormones, (ii) vitamin D, (iii)thyroid hormones, (iv)lipid metabolism, and (v)folic acid. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Tubing misconnections: normalization of deviance.

PubMed

Simmons, Debora; Symes, Lene; Guenter, Peggi; Graves, Krisanne

2011-06-01

Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient-related threats; patient outcomes; and recommendations. A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.

Diversity of methicillin-resistant Staphylococcus aureus CC22-MRSA-IV from Saudi Arabia and the Gulf region.

PubMed

Senok, Abiola; Somily, Ali; Raji, Adeola; Gawlik, Darius; Al-Shahrani, Fatimah; Baqi, Shehla; Boswihi, Samar; Skakni, Leila; Udo, Edet E; Weber, Stefan; Ehricht, Ralf; Monecke, Stefan

2016-10-01

CC22-MRSA-IV, UK-EMRSA-15/Barnim EMRSA, is a common and pandemic strain of methicillin-resistant Staphylococcus aureus (MRSA) that has been found mainly in Western Europe, but also in other parts of the world including some Gulf countries. One suspected case of an infection with this strain in a patient who was admitted to the surgical unit in Riyadh, Kingdom of Saudi Arabia (KSA) was investigated in order to check whether this strain has reached KSA. Besides the index isolate, 46 additional isolates of CC22-MRSA-IV from patients from KSA, Abu Dhabi, Kuwait, and Germany (patients with a history of travel in the Middle East), were characterized by microarray hybridization. The study revealed a regional presence of as many as six distinct 'strains' of CC22-MRSA-IV that could be distinguished based on carriage of SCCmec IV subtypes and virulence factors. No true UK-EMRSA-15/Barnim EMRSA was identified in Riyadh; all suspected isolates from Riyadh were assigned to other, albeit related strains. However, this strain was identified in Abu Dhabi and Kuwait. CC22-MRSA-IV from KSA could be linked to other epidemic strains from the Middle East and possibly India, rather than to the Western European UK-EMRSA-15/Barnim EMRSA. High-resolution typing methods, including SCCmec subtyping, might help to differentiate related epidemic strains and to monitor routes of transmission. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part I--validity of DSM-IV-TR.

PubMed

Waldinger, Marcel D; Schweitzer, Dave H

2006-07-01

In former days, information obtained from randomized well-controlled clinical trials and epidemiological studies on premature ejaculation (PE) was not available, thereby hampering the efforts of the consecutive DSM Work Groups on Sexual Disorders to formulate an evidence-based definition of PE. The current DSM-IV-TR definition of PE is still nonevidence based. In addition, the requirement that persistent self-perceived PE, distress, and interpersonal difficulties, in absence of a quantified ejaculation time, are necessary to establish the diagnosis remains disputable. To investigate the validity and reliability of DSM and ICD diagnosis of premature ejaculation. The historical development of DSM and ICD classification of mental disorders is critically reviewed, and two studies using the DSM-IV-TR definition of PE is critically reanalyzed. Reanalysis of two studies using the DSM-IV-TR definition of PE has shown that DSM-diagnosed PE can be accompanied by long intravaginal ejaculation latency time (IELT) values. The reanalysis revealed a low positive predictive value for the DSM-IV-TR definition when used as a diagnostic test. A similar situation pertains to the American Urological Association (AUA) definition of PE, which is practically a copy of the DSM-IV-TR definition. It should be emphasized that any evidence-based definition of PE needs objectively collected patient-reported outcome (PRO) data from epidemiological studies, as well as reproducible quantifications of the IELT.

HER2 overexpression and amplification as a potential therapeutic target in colorectal cancer: analysis of 3256 patients enrolled in the QUASAR, FOCUS and PICCOLO colorectal cancer trials.

PubMed

Richman, Susan D; Southward, Katie; Chambers, Philip; Cross, Debra; Barrett, Jennifer; Hemmings, Gemma; Taylor, Morag; Wood, Henry; Hutchins, Gordon; Foster, Joseph M; Oumie, Assa; Spink, Karen G; Brown, Sarah R; Jones, Marc; Kerr, David; Handley, Kelly; Gray, Richard; Seymour, Matthew; Quirke, Philip

2016-03-01

HER2 overexpression/amplification is linked to trastuzumab response in breast/gastric cancers. One suggested anti-EGFR resistance mechanism in colorectal cancer (CRC) is aberrant MEK-AKT pathway activation through HER2 up-regulation. We assessed HER2-amplification/overexpression in stage II-III and IV CRC patients, assessing relationships to KRAS/BRAF and outcome. Pathological material was obtained from 1914 patients in the QUASAR stage II-III trial and 1342 patients in stage IV trials (FOCUS and PICCOLO). Tissue microarrays were created for HER2 immunohistochemistry. HER2-amplification was assessed using FISH and copy number variation. KRAS/BRAF mutation status was assessed by pyrosequencing. Progression-free survival (PFS) and overall survival (OS) data were obtained for FOCUS/PICCOLO and recurrence and mortality for QUASAR; 29/1342 (2.2%) stage IV and 25/1914 (1.3%) stage II-III tumours showed HER2 protein overexpression. Of the HER2-overexpressing cases, 27/28 (96.4%) stage IV tumours and 20/24 (83.3%) stage II-III tumours demonstrated HER2 amplification by FISH; 41/47 (87.2%) also showed copy number gains. HER2-overexpression was associated with KRAS/BRAF wild-type (WT) status at all stages: in 5.2% WT versus 1.0% mutated tumours (p < 0.0001) in stage IV and 2.1% versus 0.2% in stage II-III tumours (p = 0.01), respectively. HER2 was not associated with OS or PFS. At stage II-III, there was no significant correlation between HER2 overexpression and 5FU/FA response. A higher proportion of HER2-overexpressing cases experienced recurrence, but the difference was not significant. HER2-amplification/overexpression is identifiable by immunohistochemistry, occurring infrequently in stage II-III CRC, rising in stage IV and further in KRAS/BRAF WT tumours. The value of HER2-targeted therapy in patients with HER2-amplified CRC must be tested in a clinical trial. © 2015 The Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. © 2015 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Evaluation of the effectiveness of an intravenous line and fluid bottle fixation design.

PubMed

Chiou, Piao-Yi; Chien, Chih-Yin; Shiu, Ting-Ru; Lin, Pei-Jiun; Lin, Wan-Yu; Jiang, Yi-Rung

2015-01-01

It's important to improve the stability of intravenous (IV) lines and bottles during patient activity and nursing care. We developed an intravenous line and fluid bottle fixation design (ILFBFD) which includes a bottle retaining clip and line fixation kit. We randomly assigned 60 participants each to the experimental and control groups. Participants were asked to push an IV stand without and with ILFBFD 11 meters on uneven pavement and a sloping floor. The distance the IV bottle moved was recorded. Self-administered questionnaires were used to collect the opinions of the participants. Use of ILFBFD, resulted in less movement in the anteroposterior and left/right directions (differences of 46.98 cm2, t= 12.80, p < 0.000 and 39.24 cm2, t= 8.01, p< 0.000, respectively) compared with not using ILFBFD. The average scores for bottle movement when participants walked on a flat floor, uneven pavement and sloping floor, IV line tangling and dropping, and organization of Liv lines were significantly better in those using than not using ILFBFD. The results can be used in clinical practice to reduce knotting of IV lines, and to enhance the safety and quality of patient care.

Factor structure of the Childhood Autism Rating Scale as per DSM-5.

PubMed

Park, Eun-Young; Kim, Joungmin

2016-02-01

The DSM-5 recently proposed new diagnostic criteria for autism spectrum disorder (ASD). Although many new or updated tools have been developed since the DSM-IV was published in 1994, the Childhood Autism Rating Scale (CARS) has been used consistently in ASD diagnosis and research due to its technical adequacy, cost-effectiveness, and practicality. Additionally, items in the CARS did not alter following the release of the revised DSM-IV because the CARS factor structure was found to be consistent with the revised criteria after factor analysis. For that reason, in this study confirmatory factor analysis was used to identify the factor structure of the CARS. Participants (n = 150) consisted of children with an ASD diagnosis or who met the criteria for broader autism or emotional/behavior disorder with comorbid disorders such as attention-deficit hyperactivity disorder, bipolar disorder, intellectual or developmental disabilities. Previous studies used one-, two-, and four-factor models, all of which we examined to confirm the best-fit model on confirmatory factor analysis. Appropriate comparative fit indices and root mean square errors were obtained for all four models. The two-factor model, based on DSM-5 criteria, was the most valid and reliable. The inter-item consistency of the CARS was 0.926 and demonstrated adequate reliability, thereby supporting the validity and reliability of the two-factor model of CARS. Although CARS was developed prior to the introduction of DSM-5, its psychometric properties, conceptual relevance, and flexible administration procedures support its continued role as a screening device in the diagnostic decision-making process. © 2015 Japan Pediatric Society.

Economic evaluation of intravenous iodinated contrast media in Italy.

PubMed

Iannazzo, Sergio; Vandekerckhove, Stijn; De Francesco, Maria; Nayak, Akash; Ronco, Claudio; Morana, Giovanni; Valentino, Massimo

2014-01-01

Contrast-induced acute kidney injury (CI-AKI) is defined as a deterioration in renal function after administration of radiologic iodinated contrast media (CM). Iodixanol, showed a lower CI-AKI incidence than low-osmolar contrast media (LOCM). A cost-effectiveness analysis was performed comparing iodixanol and LOCM in intravenous (IV) setting in Italy. A Markov model was developed. Patients moved across four health states: CI-AKI free, CI-AKI, myocardial infarction, and death. The simulation horizon was lifetime with 1-month cycles. Costs and outcomes were discounted at 3.5 percent rate. CI-AKI incidence was considered from published literature across different definitions. Cost-effectiveness of iodixanol was assessed in terms of incremental cost per life-year gained. Net monetary benefit (NMB) was also calculated. Both deterministic and probabilistic sensitivity analyses were performed. Base-case results showed an average survival increase of 0.51 life-years and a savings of €7.25 for iodixanol versus LOCM. The cost-effectiveness of iodixanol was confirmed when other scenarios were explored, such as varying CI-AKI definition, sub-populations with specified risk factors, CM hospital bids prices, and inclusion of adverse drug reactions of allergic nature. An NMB ranging between €6,007.25 and €30,007.25 was calculated. Base-case results show that IV iodixanol is cost-effective compared with LOCM in the Italian clinical setting of a hospital computed tomography radiology practice. However, some caution is due, mainly linked to inherent limitations of the modeling technique and to the lack of agreement on CI-AKI incidence data in the clinical literature.

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

Nahar, Sultana N., E-mail: nahar@astronomy.ohio-state.edu

The atomic parameters–oscillator strengths, line strengths, radiative decay rates (A), and lifetimes–for fine structure transitions of electric dipole (E1) type for the astrophysically abundant ion Ne IV are presented. The results include 868 fine structure levels with n≤ 10, l≤ 9, and 1/2≤J≤ 19/2 of even and odd parities, and the corresponding 83,767 E1 transitions. The calculations were carried out using the relativistic Breit–Pauli R-matrix method in the close coupling approximation. The transitions have been identified spectroscopically using an algorithm based on quantum defect analysis and other criteria. The calculated energies agree with the 103 observed and identified energies to withinmore » 3% or better for most of the levels. Some larger differences are also noted. The A-values show good to fair agreement with the very limited number of available transitions in the table compiled by NIST, but show very good agreement with the latest published multi-configuration Hartree–Fock calculations. The present transitions should be useful for diagnostics as well as for precise and complete spectral modeling in the soft X-ray to infra-red regions of astrophysical and laboratory plasmas. -- Highlights: •The first application of BPRM method for accurate E1 transitions in Ne IV is reported. •Amount of atomic data (n going up to 10) is complete for most practical applications. •The calculated energies are in very good agreement with most observed levels. •Very good agreement of A-values and lifetimes with other relativistic calculations. •The results should provide precise nebular abundances, chemical evolution etc.« less

Complications of wrist arthroscopy.

PubMed

Ahsan, Zahab S; Yao, Jeffrey

2012-06-01

The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

7 CFR 1781.6 - Loan purposes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... conservation and water control facilities such as dikes, terraces, detention reservoirs, stream channels... vegetative measures to stabilize stream channels and gullies. (iv) Basic farm conservation practices to control runoff, erosion, and sedimentation. (6) Installing, repairing, and improving water storage...

Publishing Ethics and Predatory Practices: A Dilemma for All Stakeholders of Science Communication.

PubMed

Gasparyan, Armen Yuri; Yessirkepov, Marlen; Diyanova, Svetlana N; Kitas, George D

2015-08-01

Publishing scholarly articles in traditional and newly-launched journals is a responsible task, requiring diligence from authors, reviewers, editors, and publishers. The current generation of scientific authors has ample opportunities for publicizing their research. However, they have to selectively target journals and publish in compliance with the established norms of publishing ethics. Over the past few years, numerous illegitimate or predatory journals have emerged in most fields of science. By exploiting gold Open Access publishing, these journals paved the way for low-quality articles that threatened to change the landscape of evidence-based science. Authors, reviewers, editors, established publishers, and learned associations should be informed about predatory publishing practices and contribute to the trustworthiness of scholarly publications. In line with this, there have been several attempts to distinguish legitimate and illegitimate journals by blacklisting unethical journals (the Jeffrey Beall's list), issuing a statement on transparency and best publishing practices (the Open Access Scholarly Publishers Association's and other global organizations' draft document), and tightening the indexing criteria by the Directory of Open Access Journals. None of these measures alone turned to be sufficient. All stakeholders of science communication should be aware of multiple facets of unethical practices and publish well-checked and evidence-based articles.

Publishing Ethics and Predatory Practices: A Dilemma for All Stakeholders of Science Communication

PubMed Central

Yessirkepov, Marlen; Diyanova, Svetlana N.; Kitas, George D.

2015-01-01

Publishing scholarly articles in traditional and newly-launched journals is a responsible task, requiring diligence from authors, reviewers, editors, and publishers. The current generation of scientific authors has ample opportunities for publicizing their research. However, they have to selectively target journals and publish in compliance with the established norms of publishing ethics. Over the past few years, numerous illegitimate or predatory journals have emerged in most fields of science. By exploiting gold Open Access publishing, these journals paved the way for low-quality articles that threatened to change the landscape of evidence-based science. Authors, reviewers, editors, established publishers, and learned associations should be informed about predatory publishing practices and contribute to the trustworthiness of scholarly publications. In line with this, there have been several attempts to distinguish legitimate and illegitimate journals by blacklisting unethical journals (the Jeffrey Beall's list), issuing a statement on transparency and best publishing practices (the Open Access Scholarly Publishers Association's and other global organizations' draft document), and tightening the indexing criteria by the Directory of Open Access Journals. None of these measures alone turned to be sufficient. All stakeholders of science communication should be aware of multiple facets of unethical practices and publish well-checked and evidence-based articles. PMID:26240476

42 CFR 483.70 - Physical environment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... any changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted... resident; (ii) A clean, comfortable mattress; (iii) Bedding appropriate to the weather and climate; and (iv...

33 CFR 72.05-1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., with the exception of Volume V, which is published biennially, covering the waters of the United States... River, South Carolina. (3) Volume III, Atlantic and Gulf Coasts, from Little River, South Carolina, to Econfina River, Florida, including Puerto Rico and the U.S. Virgin Islands. (4) Volume IV, Gulf of Mexico...

33 CFR 72.05-1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., with the exception of Volume V, which is published biennially, covering the waters of the United States... River, South Carolina. (3) Volume III, Atlantic and Gulf Coasts, from Little River, South Carolina, to Econfina River, Florida, including Puerto Rico and the U.S. Virgin Islands. (4) Volume IV, Gulf of Mexico...

33 CFR 72.05-1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., with the exception of Volume V, which is published biennially, covering the waters of the United States... River, South Carolina. (3) Volume III, Atlantic and Gulf Coasts, from Little River, South Carolina, to Econfina River, Florida, including Puerto Rico and the U.S. Virgin Islands. (4) Volume IV, Gulf of Mexico...

34 CFR 600.20 - Application procedures for establishing, reestablishing, maintaining, or expanding institutional...

Code of Federal Regulations, 2010 CFR

2010-07-01

... accordance with Generally Accepted Accounting Principles (GAAP) published by the Financial Accounting... accreditation status, including approval of any non-degree programs it offers; (iii) Audited financial... accordance with the requirements of 34 CFR 668.23; and (iv) Audited financial statements of the institution's...

Introduction to The Regulatory Plan and the Unified Agenda of Federal...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... Unified Agenda 79451 Published? III. How Are The Regulatory Plan and the Unified Agenda 79451 Organized? IV. What Information Appears for Each Entry? 79452 V. Abbreviations 79454 VI. How Can Users Get... Department of Defense 79504 Department of Education 79509 Department of Energy 79512 Department of Health and...

20 CFR 638.524 - Allowances and allotments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 638.524 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR JOB CORPS PROGRAM UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.524 Allowances and... students pursuant to section 429 (a), (c), and (d) of the Act, and the Job Corps Director shall publish...

Education Scholars' Perceptions and Practices toward Open Access Publishing

ERIC Educational Resources Information Center

Ellingford, Lori Michelle

2012-01-01

Although open access publishing has been available since 1998, we know little regarding scholars' perceptions and practices toward publishing in open access outlets, especially in the social science community. Open access publishing has been slow to penetrate the field of education, yet the potential impact of open access could make this…

Effectiveness of IV Cannulation Skills Laboratory Training and Its Transfer into Clinical Practice: A Randomized, Controlled Trial

PubMed Central

Lund, Frederike; Schultz, Jobst-Hendrik; Maatouk, Imad; Krautter, Markus; Möltner, Andreas; Werner, Anne; Weyrich, Peter; Jünger, Jana; Nikendei, Christoph

2012-01-01

Background The effectiveness of skills laboratory training is widely recognized. Yet, the transfer of procedural skills acquired in skills laboratories into clinical practice has rarely been investigated. We conducted a prospective, randomised, double-blind, controlled trial to evaluate, if students having trained intravenous (IV) cannulation in a skills laboratory are rated as more professional regarding technical and communication skills compared to students who underwent bedside teaching when assessed objectively by independent video assessors and subjectively by patients. Methodology and Principal Findings 84 volunteer first-year medical students were randomly assigned to one of two groups. Three drop-outs occurred. The intervention group (IG; n = 41) trained IV cannulation in a skills laboratory receiving instruction after Peyton's ‘Four-Step Approach’. The control group (CG; n = 40) received a bedside teaching session with volunteer students acting as patients. Afterwards, performance of IV cannulation of both groups in a clinical setting with students acting as patients was video-recorded. Two independent, blinded video assessors scored students' performance using binary checklists (BC) and the Integrated Procedural Protocol Instrument (IPPI). Patients assessed students' performance with the Communication Assessment Tool (CAT) and a modified IPPI. IG required significantly shorter time needed for the performance on a patient (IG: 595.4 SD(188.1)s; CG: 692.7 SD(247.8)s; 95%CI 23.5 s to 45.1 s; p = 0.049) and completed significantly more single steps of the procedure correctly (IG: 64% SD(14) for BC items; CG: 53% SD(18); 95%CI 10.25% to 11.75%; p = 0.004). IG also scored significantly better on IPPI ratings (median: IG: 3.1; CG: 3.6; p = 0.015;). Rated by patients, students' performance and patient-physician communication did not significantly differ between groups. Conclusions Transfer of IV cannulation-related skills acquired in a skills laboratory is superior to bedside teaching when rated by independent video raters by means of IPPI and BC. It enables students to perform IV cannulation more professionally on volunteer students acting as patients. PMID:22427895

Involvement of DPP-IV catalytic residues in enzyme–saxagliptin complex formation

PubMed Central

Metzler, William J.; Yanchunas, Joseph; Weigelt, Carolyn; Kish, Kevin; Klei, Herbert E.; Xie, Dianlin; Zhang, Yaqun; Corbett, Martin; Tamura, James K.; He, Bin; Hamann, Lawrence G.; Kirby, Mark S.; Marcinkeviciene, Jovita

2008-01-01

The inhibition of DPP-IV by saxagliptin has been proposed to occur through formation of a covalent but reversible complex. To evaluate further the mechanism of inhibition, we determined the X-ray crystal structure of the DPP-IV:saxagliptin complex. This structure reveals covalent attachment between S630 and the inhibitor nitrile carbon (C–O distance <1.3 Å). To investigate whether this serine addition is assisted by the catalytic His-Asp dyad, we generated two mutants of DPP-IV, S630A and H740Q, and assayed them for ability to bind inhibitor. DPP-IVH740Q bound saxagliptin with an ∼1000-fold reduction in affinity relative to DPP-IVWT, while DPP-IVS630A showed no evidence for binding inhibitor. An analog of saxagliptin lacking the nitrile group showed unchanged binding properties to the both mutant proteins, highlighting the essential role S630 and H740 play in covalent bond formation between S630 and saxagliptin. Further supporting mechanism-based inhibition by saxagliptin, NMR spectra of enzyme–saxagliptin complexes revealed the presence of three downfield resonances with low fractionation factors characteristic of short and strong hydrogen bonds (SSHB). Comparison of the NMR spectra of various wild-type and mutant DPP-IV:ligand complexes enabled assignment of a resonance at ∼14 ppm to H740. Two additional DPP-IV mutants, Y547F and Y547Q, generated to probe potential stabilization of the enzyme–inhibitor complex by this residue, did not show any differences in inhibitor binding either by ITC or NMR. Together with the previously published enzymatic data, the structural and binding data presented here strongly support a histidine-assisted covalent bond formation between S630 hydroxyl oxygen and the nitrile group of saxagliptin. PMID:18227430

Involvement of DPP-IV Catalytic Residues in Enzyme-Saxagliptin Complex Formation

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

Metzler,W.; Yanchunas, J.; Weigelt, C.

The inhibition of DPP-IV by saxagliptin has been proposed to occur through formation of a covalent but reversible complex. To evaluate further the mechanism of inhibition, we determined the X-ray crystal structure of the DPP-IV:saxagliptin complex. This structure reveals covalent attachment between S630 and the inhibitor nitrile carbon (C-O distance <1.3 Angstroms). To investigate whether this serine addition is assisted by the catalytic His-Asp dyad, we generated two mutants of DPP-IV, S630A and H740Q, and assayed them for ability to bind inhibitor. DPP-IVH740Q bound saxagliptin with an {approx}1000-fold reduction in affinity relative to DPP-IVWT, while DPP-IVS630A showed no evidence formore » binding inhibitor. An analog of saxagliptin lacking the nitrile group showed unchanged binding properties to the both mutant proteins, highlighting the essential role S630 and H740 play in covalent bond formation between S630 and saxagliptin. Further supporting mechanism-based inhibition by saxagliptin, NMR spectra of enzyme-saxagliptin complexes revealed the presence of three downfield resonances with low fractionation factors characteristic of short and strong hydrogen bonds (SSHB). Comparison of the NMR spectra of various wild-type and mutant DPP-IV:ligand complexes enabled assignment of a resonance at {approx}14 ppm to H740. Two additional DPP-IV mutants, Y547F and Y547Q, generated to probe potential stabilization of the enzyme-inhibitor complex by this residue, did not show any differences in inhibitor binding either by ITC or NMR. Together with the previously published enzymatic data, the structural and binding data presented here strongly support a histidine-assisted covalent bond formation between S630 hydroxyl oxygen and the nitrile group of saxagliptin.« less

Topographic and biomechanical evaluation of cornea in patients with ichthyosis vulgaris.

PubMed

Kara, Necip; Yildirim, Yusuf; Demircan, Ali; Cankaya, Ilker; Kutlubay, Zekayi; Engin, Burhan; Serdaroglu, Server

2012-10-01

To compare the topographic and biomechanical properties of corneas in eyes of patients with ichthyosis vulgaris (IV) and eyes of healthy individuals. Thirty healthy individuals (control group) and 30 patients with IV (study group) were enrolled in this prospective study. Topographic measurements, including keratometry values, irregularity, and surface asymmetry index in the right eye of each participant were obtained using Scheimpflug camera with a Placido disc topographer (Sirius). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc) and Goldman-related intraocular pressure (IOPg) were measured using the Reichert Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was also measured with ultrasonic pachymetry and the Sirius corneal topography system. Topographic parameters were not significantly different between both groups (p>0.05). Although mean CH was not significantly different between the groups, the CRF was significantly lower in patients with IV (p=0.249 and p=0.005, respectively). The CCT was significantly lower in patients with IV compared to healthy controls (p<0.001). The IOPg and IOPcc were significantly lower in the patients with ichthyosis than in healthy controls (p=0.001 and p=0.004, respectively). The study demonstrated that while the eyes of patients with IV had corneal topographic findings and corneal hysteresis similar to those of healthy controls, some of corneal biomechanical properties such CRF and CCT and IOP values such as IOPg and IOPcc were significantly lower in patients with IV. These results should be taken into account when planning a corneal refractive surgery and glaucoma screening for patients with IV. Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria.

PubMed

Adamis, Dimitrios; Rooney, Siobhan; Meagher, David; Mulligan, Owen; McCarthy, Geraldine

2015-06-01

The recently published DSM-5 criteria for delirium may lead to different case identification and rates of delirium than previous classifications. The aims of this study are to determine how the new DSM-5 criteria compare with DSM-IV in identification of delirium in elderly medical inpatients and to investigate the agreement between different methods, using CAM, DRS-R98, DSM-IV, and DSM-5 criteria. Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days of admission using the DSM-5, and DSM-IV criteria plus the DRS-R98, and CAM scales. We assessed 200 patients [mean age 81.1±6.5; 50% female; pre-existing cognitive impairment in 63%]. The prevalence rates of delirium for each diagnostic method were: 13.0% (n = 26) for DSM-5; 19.5% (n = 39) for DSM-IV; 13.5% (n = 27) for DRS-R98 and 17.0%, (n = 34) for CAM. Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (ρtetr = 0.64, SE = 0.1, p < 0.0001). Similar significant agreement was found between the four methods. DSM-IV is the most inclusive diagnostic method for delirium, while DSM-5 is the most restrictive. In addition, these classification systems identify different cases of delirium. This could have clinical, financial, and research implications. However, both classification systems have significant agreement in the identification of the same concept (delirium). Clarity of diagnosis is required for classification but also further research considering the relevance in predicting outcomes can allow for more detailed evaluation of the DSM-5 criteria.

Direct and indirect comparison meta-analysis of levetiracetam versus phenytoin or valproate for convulsive status epilepticus.

PubMed

Brigo, Francesco; Bragazzi, Nicola; Nardone, Raffaele; Trinka, Eugen

2016-11-01

The aim of this study was to conduct a meta-analysis of published studies to directly compare intravenous (IV) levetiracetam (LEV) with IV phenytoin (PHT) or IV valproate (VPA) as second-line treatment of status epilepticus (SE), to indirectly compare intravenous IV LEV with IV VPA using common reference-based indirect comparison meta-analysis, and to verify whether results of indirect comparisons are consistent with results of head-to-head randomized controlled trials (RCTs) directly comparing IV LEV with IV VPA. Random-effects Mantel-Haenszel meta-analyses to obtain odds ratios (ORs) for efficacy and safety of LEV versus VPA and LEV or VPA versus PHT were used. Adjusted indirect comparisons between LEV and VPA were used. Two RCTs comparing LEV with PHT (144 episodes of SE) and 3 RCTs comparing VPA with PHT (227 episodes of SE) were included. Direct comparisons showed no difference in clinical seizure cessation, neither between VPA and PHT (OR: 1.07; 95% CI: 0.57 to 2.03) nor between LEV and PHT (OR: 1.18; 95% CI: 0.50 to 2.79). Indirect comparisons showed no difference between LEV and VPA for clinical seizure cessation (OR: 1.16; 95% CI: 0.45 to 2.97). Results of indirect comparisons are consistent with results of a recent RCT directly comparing LEV with VPA. The absence of a statistically significant difference in direct and indirect comparisons is due to the lack of sufficient statistical power to detect a difference. Conducting a RCT that has not enough people to detect a clinically important difference or to estimate an effect with sufficient precision can be regarded a waste of time and resources and may raise several ethical concerns, especially in RCT on SE. Copyright © 2016 Elsevier Inc. All rights reserved.

Ethnographic Observational Study of the Biologic Initiation Conversation Between Rheumatologists and Biologic-Naive Rheumatoid Arthritis Patients.

PubMed

Kottak, Nicholas; Tesser, John; Leibowitz, Evan; Rosenberg, Melissa; Parenti, Dennis; DeHoratius, Raphael

2018-01-30

This ethnographic market research study investigated the biologic initiation conversation between rheumatologists and biologic-naive patients with rheumatoid arthritis to assess how therapy options, particularly mode of administration, were discussed. Consenting rheumatologists (n = 16) and patients (n = 48) were videotaped during medical visits and interviewed by a trained ethnographer. The content, structure, and timing of conversations regarding biologic initiation were analyzed. The mean duration of physician-patient visits was approximately 15 minutes; biologic therapies were discussed for a mean of 5.6 minutes. Subcutaneous (SC) and intravenous (IV) therapy options were mentioned in 45 and 35 visits, respectively, out of a total of 48 visits. All patients had some familiarity with SC administration, but nearly half of patients (22 of 48) were unfamiliar with IV therapy going into the visit. IV administration was not defined or described by rheumatologists in 77% of visits (27 of 35) mentioning IV therapy. Thus, 19 of 22 patients who were initially unfamiliar with IV therapy remained unfamiliar after the visit. Disparities in physician-patient perceptions were revealed, as all rheumatologists (16 of 16) believed IV therapy would be less convenient than SC therapy for patients, while 46% of patients (22 of 48) felt this way. In post-visit interviews, some patients seemed confused and overwhelmed, particularly when presented with many treatment choices in a visit. Some patients stated they would benefit from visual aids or summary sheets of key points. This study revealed significant educational opportunities to improve the biologic initiation conversation and indicated a disparity between patients' and rheumatologists' perception of IV therapy. © 2018 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis.

PubMed

Tao, Xin; Chen, Lei; Ge, Shuqi; Cai, Lisi

2017-01-01

To explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas. A literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis. Twenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001). ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.

French national consensus clinical guidelines for the management of ulcerative colitis.

PubMed

Peyrin-Biroulet, Laurent; Bouhnik, Yoram; Roblin, Xavier; Bonnaud, Guillaume; Hagège, Hervé; Hébuterne, Xavier

2016-07-01

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of multifactorial etiology that primarily affects the colonic mucosa. The disease progresses over time, and clinical management guidelines should reflect its dynamic nature. There is limited evidence supporting UC management in specific clinical situations, thus precluding an evidence-based approach. To use a formal consensus method - the nominal group technique (NGT) - to develop a clinical practice expert opinion to outline simple algorithms and practices, optimize UC management, and assist clinicians in making treatment decisions. The consensus was developed by an expert panel of 37 gastroenterologists from various professional organizations with experience in UC management using the qualitative and iterative NGT, incorporating deliberations based on the European Crohn's and Colitis Organisation recommendations, recent reviews of scientific literature, and pertinent discussion topics developed by a steering committee. Examples of clinical cases for which there are limited evidence-based data from clinical trials were used. Two working groups proposed and voted on treatment algorithms that were then discussed and voted for by the nominal group as a whole, in order to reach a consensus. A clinical practice guideline covering management of the following clinical situations was developed: (i) moderate and severe UC; (ii) acute severe UC; (iii) pouchitis; (iv) refractory proctitis, in the form of treatment algorithms. Given the limited available evidence-based data, a formal consensus methodology was used to develop simple treatment guidelines for UC management in different clinical situations that is now accessible via an online application. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

VizieR Online Data Catalog: SN 2007on and SN 2011iv light curves (Gall+, 2018)

NASA Astrophysics Data System (ADS)

Gall, C.; Stritzinger, M. D.; Ashall, C.; Baron, E.; Burns, C. R.; Hoeflich, P.; Hsiao, E. Y.; Mazzali, P. A.; Phillips, M. M.; Filippenko, A. V.; Anderson, J. P.; Benetti, S.; Brown, P. J.; Campillay, A.; Challis, P.; Contreras, C.; Elias de La Rosa, N.; Folatelli, G.; Foley, R. J.; Fraser, M.; Holmbo, S.; Marion, G. H.; Morrell, N.; Pan, Y.-C.; Pignata, G.; Suntzeff, N. B.; Taddia, F.; Torres Robledo, S.; Valenti, S.

2017-11-01

Detailed optical and NIR light curves of SN 2007on obtained by the first phase of the Carnegie Supernova Project (CSP-I, 2004-2009; Hamuy et al., 2006PASP..118....2H) were published by Stritzinger et al. (2011, Cat. J/AJ/142/156).UV uvw2-, uvm2-, and uvw1-band imaging of both SN 2007on and SN 2011iv were obtained with Swift (+ UVOT). Photome- try of SN 2007on and SN 2011iv was computed following the method described in detail by Brown et al. (2014Ap&SS.354...89B), who use the calibration published by Breeveld et al. (2011, AIPCS, 1358, 373). The Swift UVOT images and photometry are also available as part of the Swift Optical Ultraviolet Supernova Archive (SOUSA; Brown et al. 2014Ap&SS.354...89B). Optical ugriBV-band imaging of SN 2007on and SN 2011iv was obtained with the Henrietta Swope 1.0m telescope (+ SITe3 direct CCD camera) located at the Las Campanas Observatory (LCO). The NIR YJH-band imaging of SN 2007on was obtained with the Swope (+ RetroCam) and the Irenee du Pont 2.5m (+ WIRC: Wide Field Infrared Camera) telescopes (Stritzinger et al., Cat. J/AJ/142/156), while in the case of SN 2011iv all NIR YJH-band imaging was taken with RetroCam attached to the Irenee du Pont telescope. The optical local sequence is calibrated relative to Landolt (1992AJ....104..372L) (BV) and Smith et al. (2002AJ....123.2121S) (ugri) standard-star fields observed over multiple photometric nights. The NIR J-band and H-band local sequences were calibrated relative to the Persson et al. (1998AJ....116.2475P) standard stars, while the Y- band local sequence was calibrated relative to standard Y-band magnitudes computed using a combination of stellar atmosphere models (Castelli & Kurucz, 2003, IAUSymp, 210, A20) with the J-Ks colours of the Persson et al. standard-star catalogue (Hamuy et al., 2006PASP..118....2H). (5 data files).

Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncology center.

PubMed

Araujo, K G; Jales, R M; Pereira, P N; Yoshida, A; de Angelo Andrade, L; Sarian, L O; Derchain, S

2017-06-01

To evaluate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX model in the preoperative discrimination between benign ovarian (including tubal and para-ovarian) tumors, borderline ovarian tumors (BOT), Stage I ovarian cancer (OC), Stage II-IV OC and ovarian metastasis in a gynecological oncology center in Brazil. This was a diagnostic accuracy study including 131 women with an adnexal mass invited to participate between February 2014 and November 2015. Before surgery, pelvic ultrasound examination was performed and serum levels of tumor marker CA 125 were measured in all women. Adnexal masses were classified according to the IOTA ADNEX model. Histopathological diagnosis was the gold standard. Receiver-operating characteristics (ROC) curve analysis was used to determine the diagnostic accuracy of the model to classify tumors into different histological types. Of 131 women, 63 (48.1%) had a benign ovarian tumor, 16 (12.2%) had a BOT, 17 (13.0%) had Stage I OC, 24 (18.3%) had Stage II-IV OC and 11 (8.4%) had ovarian metastasis. The area under the ROC curve (AUC) was 0.92 (95% CI, 0.88-0.97) for the basic discrimination between benign vs malignant tumors using the IOTA ADNEX model. Performance was high for the discrimination between benign vs Stage II-IV OC, BOT vs Stage II-IV OC and Stage I OC vs Stage II-IV OC, with AUCs of 0.99, 0.97 and 0.94, respectively. Performance was poor for the differentiation between BOT vs Stage I OC and between Stage I OC vs ovarian metastasis with AUCs of 0.64. The majority of adnexal masses in our study were classified correctly using the IOTA ADNEX model. On the basis of our findings, we would expect the model to aid in the management of women with an adnexal mass presenting to a gynecological oncology center. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

The Indian consensus guidance on stroke prevention in atrial fibrillation: An emphasis on practical use of nonvitamin K oral anticoagulants.

PubMed

Dalal, Jamshed; Bhave, Abhay; Oomman, Abraham; Vora, Amit; Saxena, Anil; Kahali, Dhiman; Poncha, Fali; Gambhir, D S; Chaudhuri, Jaydip Ray; Sinha, Nakul; Ray, Saumitra; Iyengar, S S; Banerjee, Suvro; Kaul, Upendra

2015-12-01

The last ten years have seen rapid strides in the evolution of nonvitamin K oral anticoagulants (NOACs) for stroke prevention in patients with atrial fibrillation (AF). For the preparation of this consensus, a comprehensive literature search was performed and data on available trials, subpopulation analyses, and case reports were analyzed. This Indian consensus document intends to provide guidance on selecting the right NOAC for the right patients by formulating expert opinions based on the available trials and Asian/Indian subpopulation analyses of these trials. A section has been dedicated to the current evidence of NOACs in the Asian population. Practical suggestions have been formulated in the following clinical situations: (i) Dose recommendations of the NOACs in different clinical scenarios; (ii) NOACs in patients with rheumatic heart disease (RHD); (iii) Monitoring anticoagulant effect of the NOACs; (iv) Overdose of NOACs; (v) Antidotes to NOACs; (vi) Treatment of hypertrophic cardiomyopathy (HCM) with AF using NOACs; (vii) NOACs dose in elderly, (viii) Switching between NOACs and vitamin K antagonists (VKA); (ix) Cardioversion or ablation in NOAC-treated patients; (x) Planned/emergency surgical interventions in patients currently on NOACs; (xi) Management of bleeding complications of NOACs; (xii) Management of acute coronary syndrome (ACS) in AF with NOACs; (xiii) Management of acute ischemic stroke while on NOACs. Copyright © 2015. Published by Elsevier B.V.

Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

PubMed

Ho, Vanessa Phillis; Patel, Nimitt J; Bokhari, Faran; Madbak, Firas G; Hambley, Jana E; Yon, James R; Robinson, Bryce R H; Nagy, Kimberly; Armen, Scott B; Kingsley, Samuel; Gupta, Sameer; Starr, Frederic L; Moore, Henry R; Oliphant, Uretz J; Haut, Elliott R; Como, John J

2017-01-01

Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. Systematic review, level III.

Osteomyelitis

MedlinePlus

... to need IV or oral (taken by mouth) antibiotics at home for several more weeks. Most teens recover completely from osteomyelitis. Can I Prevent Osteomyelitis? The easiest way to prevent yourself from getting osteomyelitis is to practice good hygiene. If you get a cut or a ...

The Role of the Urologist in Treating Patients with Hormone-Refractory Prostate Cancer

PubMed Central

Crawford, E. David

2003-01-01

Objectives: To ascertain what percentage of urologists’ oncology practice is dedicated to the care of prostate cancer patients and to determine urologists’ attitudes towards the treatment of patients with metastatic and hormone-refractory prostate cancer (HRPC). An additional objective is to determine urologists’ interest in administering various types of chemotherapy in HRPC patients. Materials and Methods: The American Urological Association (AUA) directory of practicing urologists was obtained, and 3000 randomly selected members of the AUA, as well as the complete list of 168 Society of Urologic Oncology (SUO) members, were chosen for the mailing of a 16-item questionnaire. The urologists were asked about how many of their patients have prostate cancer, how many have metastatic disease, and how many have HRPC and are currently receiving intravenous (IV) chemotherapy. In addition, the urologists were queried regarding their level of interest in learning about chemotherapy options as well as learning how to administer chemotherapy. Results: A total of 654 survey questionnaires were completed and returned for tabulation, resulting in a 21% effective response rate. Sixty-four percent of the responding urologists’ cancer patients had prostate cancer, 21% had metastatic disease, and 19% had HRPC; only 4% of the urologists currently administer IV chemotherapy themselves. When asked to describe their interest in learning how to deliver and be reimbursed for IV chemotherapy, 26% expressed an extremely low level of interest, 23% a low level of interest, 31% a high level of interest, and 17% an extremely high level of interest. The results of other questions are presented and correlated with the number of years the urologists have been in practice and other demographic data. Conclusions: The management of prostate cancer comprises a major portion of urologists’ practices. Almost one half (48%) of the urologists in this survey were interested in administering and being reimbursed for IV chemotherapy. Several chemotherapy regimens have been shown to improve quality of life in patients with HRPC, yet only about 30% of these patients were referred for chemotherapy. If more urologists were able to deliver these drugs, then the number of patients referred for chemotherapy would likely increase, as would accrual to important clinical trials in HRPC. The results of this survey suggest that methods to implement the training and reimbursement of urologists in the use of chemotherapy regimens should be investigated. PMID:16986047

Promising ferroelectricity in 2D group IV tellurides: a first-principles study

NASA Astrophysics Data System (ADS)

Wan, Wenhui; Liu, Chang; Xiao, Wende; Yao, Yugui

2017-09-01

Based on the first-principles calculations, we investigated the ferroelectric properties of two-dimensional (2D) Group-IV tellurides XTe (X = Si, Ge, and Sn), with a focus on GeTe. 2D Group-IV tellurides energetically prefer an orthorhombic phase with a hinge-like structure and an in-plane spontaneous polarization. The intrinsic Curie temperature Tc of monolayer GeTe is as high as 570 K and can be raised quickly by applying a tensile strain. An out-of-plane electric field can effectively decrease the coercive field for the reversal of polarization, extending its potential for regulating the polarization switching kinetics. Moreover, for bilayer GeTe, the ferroelectric phase is still the ground state. Combined with these advantages, 2D GeTe is a promising candidate material for practical integrated ferroelectric applications.

[Intravenous chemotherapy at home: A pediatric monocentric experience].

PubMed

Bertrand, Amandine; Favier, Bertrand; Devaux, Yves; Goy, Florence; Marcault-Derouard, Anna; Veyet, Véronique; Cervos, Marie; Schell, Matthias

2018-02-01

Our home care unit (HCU) developed the administration of IV chemotherapy at home for some pediatric oncologic patients. We conducted a retrospective monocentric analysis, leading to identify patients with at least one sequence of chemotherapy at home in 2015. Two hundred and forty four sequences of home chemotherapy have been administered in 2015. We identified two situations for home IV chemotherapy. Pediatric oncologist of day hospital prescribes the sequence. The chemotherapy is delivered at hospital for the first day. HCU takes over for the next days at home. For a sequence replacing a conventional hospitalization, the attending physician examines the patient, and confirm the clinical validation. The pediatric oncologist of HCU checks lab exams, and prescribes the chemotherapy. For both situations, IV chemotherapy is prepared by our hospital pharmacy, delivers at home or at day hospital, and HCU team manages home material and organizes hospitalization. This kind of organization allows setting up home IV CT for more and more patients. It allows to limit daily hospitalization for some patients living far from the hospital, and whose therapies lead to several hospitalizations. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

βIV Spectrinopathies Cause Profound Intellectual Disability, Congenital Hypotonia, and Motor Axonal Neuropathy.

PubMed

Wang, Chih-Chuan; Ortiz-González, Xilma R; Yum, Sabrina W; Gill, Sara M; White, Amy; Kelter, Erin; Seaver, Laurie H; Lee, Sansan; Wiley, Graham; Gaffney, Patrick M; Wierenga, Klaas J; Rasband, Matthew N

2018-06-07

βIV spectrin links ankyrinG (AnkG) and clustered ion channels at axon initial segments (AISs) and nodes of Ranvier to the axonal cytoskeleton. Here, we report bi-allelic pathogenic SPTBN4 variants (three homozygous and two compound heterozygous) that cause a severe neurological syndrome that includes congenital hypotonia, intellectual disability, and motor axonal and auditory neuropathy. We introduced these variants into βIV spectrin, expressed these in neurons, and found that 5/7 were loss-of-function variants disrupting AIS localization or abolishing phosphoinositide binding. Nerve biopsies from an individual with a loss-of-function variant had reduced nodal Na + channels and no nodal KCNQ2 K + channels. Modeling the disease in mice revealed that although ankyrinR (AnkR) and βI spectrin can cluster Na + channels and partially compensate for the loss of AnkG and βIV spectrin at nodes of Ranvier, AnkR and βI spectrin cannot cluster KCNQ2- and KCNQ3-subunit-containing K + channels. Our findings define a class of spectrinopathies and reveal the molecular pathologies causing nervous-system dysfunction. Copyright © 2018 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices.

PubMed

Bajema, Ingeborg M; Wilhelmus, Suzanne; Alpers, Charles E; Bruijn, Jan A; Colvin, Robert B; Cook, H Terence; D'Agati, Vivette D; Ferrario, Franco; Haas, Mark; Jennette, J Charles; Joh, Kensuke; Nast, Cynthia C; Noël, Laure-Hélène; Rijnink, Emilie C; Roberts, Ian S D; Seshan, Surya V; Sethi, Sanjeev; Fogo, Agnes B

2018-04-01

We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term "endocapillary proliferation" is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific descriptor. We also make recommendations on issues for which there are limited data at present and that can best be addressed in future studies (phase 2). We propose to proceed to these investigations, with clinicopathologic studies and tests of interobserver reproducibility to evaluate the applications of the proposed definitions and to classify lupus nephritis lesions. Copyright © 2018 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.

PubMed

Blom, Jeanet; den Elzen, Wendy; van Houwelingen, Anne H; Heijmans, Margot; Stijnen, Theo; Van den Hout, Wilbert; Gussekloo, Jacobijn

2016-01-01

older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

Interaction of selenite with reduced Fe and/or S species: An XRD and XAS study.

PubMed

Finck, Nicolas; Dardenne, Kathy

2016-05-01

In this study, we investigated the interaction between selenite and either Fe((II))aq or S((-II))aq in solution, and the results were used to investigate the interaction between Se((IV))aq and FeS in suspension. The reaction products were characterized by a combination of methods (SEM, XRD and XAS) and the reaction mechanisms were identified. In a first experiment, Se((IV))aq was reduced to Se((0)) by interaction with Fe((II))aq which was oxidized to Fe((III)), but the reaction was only partial. Subsequently, some Fe((III)) produced akaganeite (β-FeOOH) and the release of proton during that reaction decreased the pH. The pH decrease changed the Se speciation in solution which hindered further Se((IV)) reduction by Fe((II))aq. In a second experiment, Se((IV))aq was quantitatively reduced to Se((0)) by S((-II))aq and the reaction was fast. Two sulfide species were needed to reduce one Se((IV)), and the observed pH increase was due to a proton consumption. For both experiments, experimental results are consistent with expectations based on the oxidation reduction potential of the various species. Upon interaction with FeS, Se((IV))aq was reduced to Se((0)) and minute amounts of pyrite were detected, a consequence of partial mackinawite oxidation at surface sulfur sites. These results are of prime importance with respect to safe deep disposal of nuclear waste which contains the long-lived radionuclide (79)Se. This study shows that after release of (79)Se((IV)) upon nuclear waste matrix corrosion, selenite can be reduced in the near field to low soluble Se((0)) by interaction with Fe((II))aq and/or S((-II))aq species. Because the solubility of Se((0)) species is significantly lower than that of Se((IV)), selenium will become much less (bio)available and its migration out of deep HLW repositories may be drastically hindered. Copyright © 2016. Published by Elsevier B.V.

Single- and multiple-dose pharmacokinetics and absolute bioavailability of tedizolid.

PubMed

Flanagan, Shawn; Fang, Edward; Muñoz, Kelly A; Minassian, Sonia L; Prokocimer, Philippe G

2014-09-01

Tedizolid phosphate is a novel antibacterial under investigation for the treatment of gram-positive infections. This study was conducted to assess the pharmacokinetics, safety, and tolerability of intravenous tedizolid phosphate as well as the oral bioavailability of tedizolid phosphate. Double-blind, single-ascending dose, multiple-dose pharmacokinetics study, as well as tolerability and open-label crossover studies. Single center in the United States (Covance Clinical Research Unit, Madison, WI) between September 2009 and January 2010. Ninety healthy volunteers. Single intravenous (IV) doses of tedizolid phosphate 50 mg (lead-in) and 100-400 mg. Single oral and IV dose of tedizolid phosphate 200 mg in crossover fashion. Multiple IV doses of tedizolid phosphate 200 and 300 mg for up to 7 days. A dose-dependent increase was observed in the maximum plasma concentration (1.2-5.1 μg/ml) and the area under the concentration-time curve (17.4-58.7 μg × hr/ml) of tedizolid (the microbiologically active moiety of tedizolid phosphate) after single IV doses of tedizolid phosphate 100-400 mg. Administration of IV tedizolid phosphate 200 mg once/day for 7 days resulted in minimal (28%) tedizolid accumulation. The absolute oral bioavailability of tedizolid after a single 200-mg dose of tedizolid phosphate was 91%; pharmacokinetic parameters of tedizolid were similar with oral and IV administration. Treatment-related adverse events occurred in 41% of subjects. Most adverse events were related to infusion site and became more frequent with multiple dosing. In an additional 3-day tolerability study, IV tedizolid phosphate 200 mg and placebo were similarly tolerated, based on visual infusion phlebitis scores. These results from a population of healthy volunteers support once/day dosing of tedizolid phosphate 200 mg with both the oral and IV formulations, without the need for dose adjustment when switching administration routes. © 2014 Cubist Pharmaceuticals. Pharmacotherapy published by Wiley Periodicals, Inc. on behalf of Pharmacotherapy Publications, Inc.

Chemical modification of group IV graphene analogs

PubMed Central

Nakano, Hideyuki; Tetsuka, Hiroyuki; Spencer, Michelle J. S.; Morishita, Tetsuya

2018-01-01

Abstract Mono-elemental two-dimensional (2D) crystals (graphene, silicene, germanene, stanene, and so on), termed 2D-Xenes, have been brought to the forefront of scientific research. The stability and electronic properties of 2D-Xenes are main challenges in developing practical devices. Therefore, in this review, we focus on 2D free-standing group-IV graphene analogs (graphene quantum dots, silicane, and germanane) and the functionalization of these sheets with organic moieties, which could be handled under ambient conditions. We highlight the present results and future opportunities, functions and applications, and novel device concepts. PMID:29410713

Does Expert Advice Improve Educational Choice?

PubMed Central

2015-01-01

This paper reports evidence that an individual meeting with a study counselor at high school significantly improves the quality of choice of tertiary educational field, as self-assessed 18 months after graduation from college. To address endogeneity, we explore the variation in study counseling practices between schools as an instrumental variable (IV). Following careful scrutiny of the validity of the IV, our results indicate a significant and positive influence of study counseling on the quality of educational choice, foremost among males and those with low educated parents. The overall result is stable across a number of robustness checks. PMID:26692388

12 CFR 34.21 - General rule.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and sound banking practices as described in published OCC guidance, including appropriate diligence... sound banking practices as described in published OCC guidance, including appropriate diligence...

Developing Collections of Web-Published Materials

ERIC Educational Resources Information Center

Hsieh, Inga K.; Murray, Kathleen R.; Hartman, Cathy Nelson

2007-01-01

Librarians and archivists face challenges when adapting traditional collection development practices to meet the unique characteristics of Web-published materials. Likewise, preservation activities for Web-published materials must be undertaken at the outset of collection development lest they be lost forever. Standards and best practices for…

Effect of closed-loop order processing on the time to initial antimicrobial therapy.

PubMed

Panosh, Nicole; Rew, Richardd; Sharpe, Michelle

2012-08-15

The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported. A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration. The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis). Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.

Plasma and cerebrospinal fluid pharmacokinetic parameters after single-dose administration of intravenous, oral, or rectal acetaminophen.

PubMed

Singla, Neil K; Parulan, Cherri; Samson, Roselle; Hutchinson, Joel; Bushnell, Rick; Beja, Evelyn G; Ang, Robert; Royal, Mike A

2012-09-01

This is the first study to compare plasma and cerebrospinal fluid (CSF) pharmacokinetics of intravenous (IV), oral (PO), or rectal (PR) formulations of acetaminophen. Healthy male subjects (N = 6) were randomized to receive a single dose of IV (OFIRMEV(®) ; Cadence) 1,000 mg (15 minute infusion), PO (2 Tylenol(®) 500 mg caplets; McNeil Consumer Healthcare), or PR acetaminophen (2 Feverall(®) 650 mg suppositories; Actavis) with a 1-day washout period between doses. The 1,300 mg PR concentrations were standardized to 1,000 mg. Acetaminophen plasma and CSF levels were obtained at T0, 0.25, 0.5, 0.75, 1, 2, 3, 4, and 6 hours. IV acetaminophen showed earlier and higher plasma and CSF levels compared with PO or PR administration. CSF bioavailability over 6 hours (AUC(0-6)) for IV, PO, and PR 1 g was 24.9, 14.2, and 10.3 μg·h/mL, respectively. No treatment-related adverse events were reported. One subject was replaced because of premature failure of his lumbar spinal catheter. The mean CSF level in the IV group was similar to plasma from 3 to 4 hours and higher from 4 hours on. Absorption phase, variability in plasma, and CSF were greater in PO and PR groups than variability with IV administration. These results demonstrate that earlier and greater CSF penetration occurs as a result of the earlier and higher plasma peak with IV administration compared with PO or PR. © 2012 Lotus Clinical Research, LLC. Pain Practice © 2012 World Institute of Pain.

Intravenous Infiltration Risk by Catheter Dwell Time Among Hospitalized Children.

PubMed

Jeong, Ihn Sook; Jeon, Gey Rok; Lee, Man Seop; Shin, Bum Joo; Kim, Yong-Jin; Park, Soon Mi; Hyun, Sookyung

This study was aimed to examine the cumulative risk for infiltration over IV catheter dwell time by general or catheterization-specific characteristics of pediatric patients with IV therapy. This secondary data analysis was done with the data of 1596 children who received peripheral IV therapy at least once during their hospital stay between August 1st and October 30th, 2011 and in June, 2013 in an academic medical center, Yangsan, Republic of Korea. The survival functions of infiltration were determined by using the Kaplan-Meier analysis. The cumulative risk for infiltration had rapidly increased from 1.5% after 24 hours of catheter dwell time to 17.3% after 96 hours. The survival functions were significantly different in the medical than in the surgical department (p=.005), lower extremities than upper ones (p=.001), and use of 10% dextrose (p=.001), ampicillin/sulbactam (p<.001), vancomycin (p=.024), high-concentration electrolytes (p=.001), and phenytoin (p<.001). When catheter dwell times are similar, the cumulative risk for infiltration was higher in cases wherein the patient had a risk factor. The cumulative risk for infiltration has rapidly increased after 24 hours in patients who have 10% dextrose, high-concentration electrolytes, and phenytoin. The results suggest that nurses are required to assess the IV site every hour after 24 hours of catheter dwell time for the infusion of irritants for a safer practice of IV therapy. However, this monitoring time may be modified by the age of child, previous IV complications, and/or hemodynamic issues which may impact IV integrity. Copyright © 2016 Elsevier Inc. All rights reserved.

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis.

PubMed

Leber, Werner; Beresford, Lee; Nightingale, Claire; Barbosa, Estela Capelas; Morris, Stephen; El-Shogri, Farah; McMullen, Heather; Boomla, Kambiz; Delpech, Valerie; Brown, Alison; Hutchinson, Jane; Apea, Vanessa; Symonds, Merle; Gilliham, Samantha; Creighton, Sarah; Shahmanesh, Maryam; Fulop, Naomi; Estcourt, Claudia; Anderson, Jane; Figueroa, Jose; Griffiths, Chris

2017-12-14

HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets). Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses. The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Efficacy and safety of intravenous secukinumab in noninfectious uveitis requiring steroid-sparing immunosuppressive therapy.

PubMed

Letko, Erik; Yeh, Steven; Foster, C Stephen; Pleyer, Uwe; Brigell, Mitchell; Grosskreutz, Cynthia L

2015-05-01

Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, exhibited promising activity in a proof-of-concept study when administered in intravenous (IV) doses to patients with active, chronic, noninfectious uveitis. This study compared the efficacy and safety of different IV and subcutaneous (SC) doses of secukinumab in patients with noninfectious uveitis. Multicenter, randomized, double-masked, dose-ranging, phase 2 clinical trial. Thirty-seven patients with active noninfectious intermediate uveitis, posterior uveitis, or panuveitis who required corticosteroid-sparing immunosuppressive therapy. Patients were randomized to secukinumab 300 mg SC every 2 weeks for 4 doses, secukinumab 10 mg/kg IV every 2 weeks for 4 doses, or secukinumab 30 mg/kg IV every 4 weeks for 2 doses. Intravenous or SC saline was administered to maintain masking. Efficacy was assessed on day 57 (2-4 weeks after last dose). Percentage of patients with treatment response, defined as (1) at least a 2-grade reduction in vitreous haze score or trace or absent vitreous haze in the study eye without an increase in corticosteroid dose and without uveitis worsening or (2) reduction in corticosteroid dosages to prespecified levels without uveitis worsening. Percentage of patients with remission, defined as anterior chamber cell and vitreous haze scores of 0 or 0.5+ in both eyes without corticosteroid therapy or uveitis worsening. Secukinumab 30 mg/kg IV and 10 mg/kg IV, compared with the 300 mg SC dose, produced higher responder rates (72.7% and 61.5% vs. 33.3%, respectively) and remission rates (27.3% and 38.5% vs. 16.7%, respectively). Statistical and clinical superiority for the 30 mg/kg IV dose compared with the 300 mg SC dose was established in a Bayesian probability model. Other measures, including time to response onset, change in visual acuity, and change in vitreous haze score, showed numeric trends favoring IV dosing. Secukinumab, administered in IV or SC formulations, appeared safe and was well tolerated. Intravenous secukinumab was effective and well tolerated in noninfectious uveitis requiring systemic corticosteroid-sparing immunosuppressive therapy. Greater activity with IV dosing suggests that patients may not receive sufficient drug with SC administration. High-dose IV secukinumab may be necessary to deliver secukinumab in therapeutic concentrations. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.

PubMed

Canbulat, Nejla; Ayhan, Fatma; Inal, Sevil

2015-02-01

The aim of this study was to investigate the effect of external cold and vibration stimulation via Buzzy on the pain and anxiety level of children during peripheral intravenous (IV) cannulation. This study was a prospective, randomized controlled trial. The sample consisted of 176 children ages 7 to 12 years who were randomly assigned to two groups: a control group that received no peripheral IV cannulation intervention and an experimental group that received external cold and vibration via Buzzy. The same nurse conducted the peripheral IV cannulation in all the children, and the same researcher applied the external cold and vibration to all the children. The external cold and the vibration were applied 1 minute before the peripheral IV cannulation procedure and continued until the end of the procedure. Preprocedural anxiety was assessed using the Children's Fear Scale, along with reports by the children, their parents, and an observer. Procedural anxiety was assessed with the Children's Fear Scale and the parents' and the observer's reports. Procedural pain was assessed using the Wong Baker Faces Scale and the visual analog scale self-reports of the children. Preprocedural anxiety did not differ significantly. Comparison of the two groups showed significantly lower pain and anxiety levels in the experimental group than in the control group during the peripheral IV cannulation. Buzzy can be considered to provide an effective combination of coldness and vibration. This method can be used during pediatric peripheral IV cannulation by pediatric nurses. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Population pharmacokinetics of intravenous acetaminophen in Japanese patients undergoing elective surgery.

PubMed

Imaizumi, Tsuyoshi; Obara, Shinju; Mogami, Midori; Iseki, Yuzo; Hasegawa, Makiko; Murakawa, Masahiro

2017-06-01

Intravenous (i.v.) acetaminophen is administered during surgery for postoperative analgesia. However, little information is available on the pharmacokinetics of i.v. acetaminophen in Japanese patients undergoing surgery under general anesthesia. The study was approved by the Institutional Review Board and registered at UMIN-CTR (UMIN000013418). Patients scheduled to undergo elective surgery under general anesthesia were enrolled after obtaining written informed consent. During surgery, 1 g of i.v. acetaminophen was administered over 15, 60, or 120 min. Acetaminophen concentrations (15 or 16 samples per case) were measured at time points from 0-480 min after the start of administration (liquid chromatography-mass spectrometry/tandem mass spectrometry; limit of quantitation 0.1 μg/mL). The predictive performance of three published pharmacokinetic models was evaluated. Population pharmacokinetics were also analyzed using a nonlinear mixed-effect model based on the NONMEM program. Data from 12 patients who underwent endoscopic or lower limb procedures were analyzed (male/female = 7/5, median age 55 years, weight 63 kg). Anesthesia was maintained with remifentanil and propofol or sevoflurane. The pharmacokinetic model of i.v. acetaminophen reported by Würthwein et al. worked well. Using 185 datapoints, the pharmacokinetics of i.v. acetaminophen were described by a two-compartment model with weight as a covariate but not age, sex, or creatinine clearance. The median prediction error and median absolute prediction error of the final model were -1 and 10%, respectively. A population pharmacokinetic model of i.v. acetaminophen in Japanese patients was constructed, with performance within acceptable ranges.

Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units.

PubMed

Maiguy-Foinard, Aurélie; Genay, Stéphanie; Lannoy, Damien; Barthélémy, Christine; Lebuffe, Gilles; Debaene, Bertrand; Odou, Pascal; Décaudin, Bertrand

2017-02-01

The aims are to identify critical parameters influencing the drug mass flow rate of infusion delivery to patients during multidrug infusion and to discuss their clinical relevance. A review of literature was conducted in January 2016 using Medline, Google Scholar, ScienceDirect, Web of Science and Scopus online databases. References relating to the accuracy of fluid delivery via gravity-flow intravenous (IV) infusion systems and positive displacement pumps, components of IV administration sets, causes of flow rate variability, potential complications due to flow rate variability, IV therapies especially at low flow rates and drug compatibilities were considered relevant. Several parameters impact the delivery of drugs and fluids by IV infusion. Among them are the components of infusion systems that particularly influence the flow rate of medications and fluids being delivered. By their conception, they may generate significant start-up delays and flow rate variability. Performing multidrug infusion requires taking into account two main points: the common dead volume of drugs delivered simultaneously with potential consequences on the accuracy and amount of drug delivery and the prevention of drug incompatibilities and their clinical effects. To prevent the potentially serious effects of flow rate variability on patients, clinicians should receive instruction on the fluid dynamics of an IV administration set and so be able to take steps to minimise flow rate changes during IV therapy. Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Photospheric, circumstellar, and interstellar features of HE, C, N. O, and Si in the HST spectra of four hot white dwarf stars

NASA Technical Reports Server (NTRS)

Shipman, Harry L.; Provencal, Judi; Roby, Scott W.; Barstow, Martin; Bond, Howard; Bruhweiler, Fred; Finley, David; Fontaine, Gilles; Holberg, Jay; Nousek, John

1995-01-01

This paper reports on the observations of four hot white dwarf stars with the spectrographs on the Hubble Space Telescope (HST). The higher resolving power and higher signal/noise, in comparison with IUE, reveals a very rich phenomomenology, including photospheric features from heavy elements, circumstellar features, and the first direct detection of accretion onto the white dwarf component of a binary system. Specific results include the following: Our observations of the ultrahot degenerate H1504+65 confirm that it has a photosphere which is depleted in both H and He, and reveals features of C IV and O VI. The spectrum fits previously published models extremely well. The intermediate-temperature DO star PG 1034+001 has an ultraviolet spectrum showing complex profiles of the well-known resonance doublets of C IV, N v, and Si IV. The O V 1371 line shows a clear separation into a photospheric and a circumstellar component, and it is likely that the same two components can explain the other lines as well. The cooler DA star GD 394 has an extensive system of heavy-element features, but their radial velocity is such that it is highly unlikely that they are formed in the stellar photosphere. Time-resolved spectra of the accreting white dwarf in the V 471 Tau binary system are briefly presented here; they do show the presence of C IV, Si IV, and He II. However, the C IV and He II lines are in emission, rather than in aborption as had been expected.

Policies on pets for healthy cities: a conceptual framework.

PubMed

Rock, Melanie J; Adams, Cindy L; Degeling, Chris; Massolo, Alessandro; McCormack, Gavin R

2015-12-01

Drawing on the One Health concept, and integrating a dual focus on public policy and practices of caring from the Ottawa Charter for Health Promotion, we outline a conceptual framework to help guide the development and assessment of local governments' policies on pets. This framework emphasizes well-being in human populations, while recognizing that these outcomes relate to the well-being of non-human animals. Five intersecting spheres of activity, each associated with local governments' jurisdiction over pets, are presented: (i) preventing threats and nuisances from pets, (ii) meeting pets' emotional and physical needs, (iii) procuring pets ethically, (iv) providing pets with veterinary services and (v) licensing and identifying pets. This conceptual framework acknowledges the tenets of previous health promotion frameworks, including overlapping and intersecting influences. At the same time, this framework proposes to advance our understanding of health promotion and, more broadly, population health by underscoring interdependence between people and pets as well as the dynamism of urbanized ecologies. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Requirements for self-magnetically insulated transmission lines

DOE PAGES

VanDevender, J. Pace; Pointon, Timothy D.; Seidel, David B.; ...

2015-03-01

Self-magnetically insulated transmission lines (MITLs) connect pulsed-power drivers with a load. Although the technology was originally developed in the 1970s and is widely used today in super power generators, failure of the technology is the principal limitation on the power that can be delivered to an experiment. We address issues that are often overlooked, rejected after inadequate simulations, or covered by overly conservative assumptions: (i) electron retrapping in coupling MITLs to loads, (ii) the applicability of collisionless versus collisional electron flow, (iii) power transport efficiency as a function of the geometry at the beginning of the MITL, (iv) gap closuremore » and when gap closure can be neglected, and (v) the role of negative ions in causing anode plasmas and enhancing current losses. We suggest a practical set of conservative design requirements for self-magnetically insulated electron flow based on the results discussed in this paper and on previously published results. The requirements are not necessarily severe constraints in all MITL applications; however, each of the 18 suggested requirements should be examined in the design of a MITL and in the investigation of excessive losses.« less

7 CFR 1466.21 - Contract requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... environmental significance that include methane digesters, other innovative technologies, and projects that will... practices, consistent with the provisions of § 1466.25; (iv) Implement a comprehensive nutrient management plan when the EQIP contract includes an animal waste management facility; (v) Implement a forest...

Reviews.

ERIC Educational Resources Information Center

Science Teacher, 1989

1989-01-01

Describes two software programs for the Apple II series and TRS-80 Models III and IV: (1) "Personal Energy Inventory" (grades 9-12, records and manages data, not considered user friendly); (2) "Energy Conservation" (grades 7-12, aids in converting and problem solving, uses drill and practice). (MVL)

5 CFR 900.706 - Employment practices.

Code of Federal Regulations, 2012 CFR

2012-01-01

... changes in compensation; (iv) Job assignments, job classifications, organizational structures, position descriptions, lines of progression, and seniority lists; (v) Leaves of absence, sick leave, or any other leave..., conferences, and other related activities, and selection for leaves of absence to pursue training; (viii...

5 CFR 900.706 - Employment practices.

Code of Federal Regulations, 2014 CFR

2014-01-01

... changes in compensation; (iv) Job assignments, job classifications, organizational structures, position descriptions, lines of progression, and seniority lists; (v) Leaves of absence, sick leave, or any other leave..., conferences, and other related activities, and selection for leaves of absence to pursue training; (viii...

5 CFR 900.706 - Employment practices.

Code of Federal Regulations, 2013 CFR

2013-01-01

... changes in compensation; (iv) Job assignments, job classifications, organizational structures, position descriptions, lines of progression, and seniority lists; (v) Leaves of absence, sick leave, or any other leave..., conferences, and other related activities, and selection for leaves of absence to pursue training; (viii...

42 CFR 483.470 - Condition of participation: Physical environment.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., comfortable, mattress; (iii) Bedding appropriate to the weather and climate; and (iv) Functional furniture... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted LSC does not...

42 CFR 483.70 - Physical environment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted edition of the... resident; (ii) A clean, comfortable mattress; (iii) Bedding appropriate to the weather and climate; and (iv...

42 CFR 483.70 - Physical environment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted edition of the... resident; (ii) A clean, comfortable mattress; (iii) Bedding appropriate to the weather and climate; and (iv...

42 CFR 483.70 - Physical environment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted edition of the... resident; (ii) A clean, comfortable mattress; (iii) Bedding appropriate to the weather and climate; and (iv...

77 FR 26129 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; 2012 Sector...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... rule soliciting public comment on the 19 sector operations plans and contracts was published in the.... After review of the public comments, NMFS has partially approved the 19 sector operations plans and... Bank Sector, Northeast Fishery Sector IV and Sustainable Harvest Sector 3 would operate as private...

42 CFR 483.70 - Physical environment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted edition of the... resident; (ii) A clean, comfortable mattress; (iii) Bedding appropriate to the weather and climate; and (iv...

42 CFR 483.470 - Condition of participation: Physical environment.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., comfortable, mattress; (iii) Bedding appropriate to the weather and climate; and (iv) Functional furniture... changes in this edition of the Code are incorporated by reference, CMS will publish notice in the Federal Register to announce the changes. (ii) Chapter 19.3.6.3.2, exception number 2 of the adopted LSC does not...

Childhood Abuse and Neglect in Body Dysmorphic Disorder

ERIC Educational Resources Information Center

Didie, Elizabeth R.; Tortolani, Christina C.; Pope, Courtney G.; Menard, William; Fay, Christina; Phillips, Katharine A.

2006-01-01

Objective: No published studies have examined childhood abuse and neglect in body dysmorphic disorder (BDD). This study examined the prevalence and clinical correlates of abuse and neglect in individuals with this disorder. Methods: Seventy-five subjects (69.3% female, mean age = 35.4 +/- 12.0) with DSM-IV BDD completed the Childhood Trauma…

78 FR 64929 - National Advisory Committee on Institutional Quality and Integrity (NACIQI)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... process for institutions of higher education under Title IV, of the HEA, together with recommendations for... Federal Register and the Code of Federal Regulations is available via the Federal Digital System at: www... of the Department published in the Federal Register by using the article search feature at: www...

75 FR 66195 - Schedules of Controlled Substances: Placement of Propofol Into Schedule IV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-27

... published abuse liability studies of propofol in humans in which the reinforcement and reward effects have... reporting by the subject feeling ``high,'' relative to the placebo. The motivation for abuse of propofol is... Reporting System (AERS) DataMart database). In the AERS database, there are reports of propofol diversion...

Critical medical humanities: embracing entanglement, taking risks.

PubMed

Viney, William; Callard, Felicity; Woods, Angela

2015-06-01

What can the medical humanities achieve? This paper does not seek to define what is meant by the medical humanities, nor to adjudicate the exact disciplinary or interdisciplinary knowledges it should offer, but rather to consider what it might be capable of doing. Exploring the many valences of the word 'critical', we argue here for a critical medical humanities characterised by: (i) a widening of the sites and scales of 'the medical' beyond the primal scene of the clinical encounter; (ii) greater attention not simply to the context and experience of health and illness, but to their constitution at multiple levels; (iii) closer engagement with critical theory, queer and disability studies, activist politics and other allied fields; (iv) recognition that the arts, humanities and social sciences are best viewed not as in service or in opposition to the clinical and life sciences, but as productively entangled with a 'biomedical culture'; and, following on from this, (v) robust commitment to new forms of interdisciplinary and cross-sector collaboration. We go on to introduce the five other articles published in this special issue of the journal, reflecting on the ways in which collaboration and critique are articulated in their analyses of immunology, critical neuroscience, toxicity, global clinical labour, and psychological coercion and workfare. As these articles demonstrate, embracing the complex role of critical collaborator--one based on notions of entanglement, rather than servility or antagonism--will, we suggest, develop the imaginative and creative heterodox qualities and practices which have long been recognised as core strengths of the medical humanities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women.

PubMed

Grauvogl, Andrea; Pelzer, Britt; Radder, Veerle; van Lankveld, Jacques

2018-02-01

Recently, the etiology of sexual dysfunctions in women has been approached from different angles. In clinical practice and in previous studies, it has been observed that women with sexual problems experience anxiety problems and express more rigid and perfectionistic personality traits than women without these problems. To investigate whether personality disorder characteristics according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) and psychological symptoms are associated with sexual problems in women. 188 women 18 to 25 years old participated in this cross-sectional study. Questionnaires measuring sexual functioning (Female Sexual Function Index), personality disorder characteristics (Assessment of DSM-IV-TR Personality Disorders Questionnaire), and psychological symptoms (Brief Symptom Inventory and Center for Epidemiological Studies Depression Scale) were used. The main outcome measure used was sexual functioning assessed by self-report. Results, using analysis of variance, indicated that women with sexual problems report significantly more cluster A (specifically schizoid) and C (specifically avoidant and obsessive-compulsive) personality disorder characteristics than women without sexual problems. Furthermore, using multiple regression analyses, higher cluster A (specifically schizoid) and lower cluster B (specifically borderline and antisocial) personality disorder characteristics indicated lower levels of sexual functioning. Psychological symptoms partly mediated the effect of cluster A personality disorder characteristics on sexual functioning. The results of this study indicate that clinical practice should extend its scope by focusing more on improving adaptive personality characteristics, such as extraversion and individualism seen in cluster B personality characteristics, and decreasing the perfectionistic, introvert, and self-doubting characteristics seen in cluster C personality characteristics. Because of the correlational design and use of self-report measures, causal relations cannot be established between personality disorder characteristics and sexual functioning. Overall, the results indicate that personality disorder characteristics can play an important associative role in the development and maintenance of sexual functioning problems in women. Grauvogl A, Pelzer B, Radder V, van Lankveld J. Associations Between Personality Disorder Characteristics, Psychological Symptoms, and Sexual Functioning in Young Women. J Sex Med 2018;15:192-200. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

An overview of herb and dietary supplement efficacy, safety and government regulations in the United States with suggested improvements. Part 1 of 5 series.

PubMed

Brown, Amy Christine

2017-09-01

This is the first of five review articles investigating dietary supplements (DS; includes herbs) that now exceed over 50,000 in the Office of Dietary Supplement's "Dietary Supplement Label Database." Four review articles follow summarizing published medical case reports of DS related to liver toxicity, kidney toxicity, heart toxicity, and cancer. The most popular DS were vitamin or mineral supplements (43%) followed by specialty supplements (20%), botanicals (20%; herbs), and sports supplements (16%). The 2013 Annual Report of the American Association of Poison Control Centers revealed 1692 fatalities due to drugs, and zero deaths due to DS. Less than 1 percent of Americans experience adverse events related to DS, and the majority was classified as minor, with many of these related to caffeine, yohimbe, or other stimulant ingredients. The number one adulterant in DS is drugs, followed by New Dietary Ingredients (NDI) not submitted to the FDA - both are illegal and not DS, but rather "tainted products marketed as dietary supplements." The three main categories of DS prone to medical problems are those for sexual enhancement, weight loss, and sports performance/body building. DS are regulated in the U.S. by several federal agencies with overlapping jurisdiction - the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC); enforced by the State Attorneys General Offices (AGO) and Department of Justice (DOJ); and monitored (not regulated) by the Centers for Disease Control and Prevention (CDC). The FDA can remove a DS from the market for phase IV post-marketing surveillance adverse event reports, adulteration (drugs, NDI, synthetic substances), contamination, misidentification, mislabeling or false claims, and not meeting good manufacturing practices (GMP). The FTC and state AGO can also enforce laws against deceptive marketing practices. Suggested improvements to current regulatory requirements are included along with online DS Toxic Tables in the series to forewarn consumers, clinicians, corporations, and governments of possible serious adverse events. They may also quicken the response rate during Phase IV post-marketing surveillance, in which governments could then exercise their regulatory powers. Copyright © 2017 Elsevier Ltd. All rights reserved.

26 CFR 601.601 - Rules and regulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... appear in internal management documents, are published in the Bulletin. No unpublished ruling or decision... internal management documents, but, where appropriate, they are also published to announce practices and procedures for guidance of the public. It is Service practice to publish as much of the internal management...

The System Engineering Approach: Taiwan Navy Incorporation of Mobile Devices (Smartphone) into Its Force Structure

DTIC Science & Technology

2015-06-01

words) Attempting different approaches to explore the best practice of optimizing mobile security and productivity is necessary to improve the...INTENTIONALLY LEFT BLANK iv ABSTRACT Attempting different approaches to explore the best practice of optimizing mobile security and productivity is...incredible kindness and unfathomable generosity. I am grateful to have watched Super Bowl XLIX in your living room, washed dirty clothes in your laundry room

The Consequences of Glasnost.

ERIC Educational Resources Information Center

Zilper, Nadia

1991-01-01

Offers an overview of Soviet and Eastern European publishing practices. The history of communist publishing practices and the dramatic effect which Glasnost has had upon these practices are summarized. It is observed that highly unstable conditions in the USSR have severely jeopardized bibliographic control and hindered collection development in…

Alport syndrome and thin glomerular basement membrane nephropathy: a practical approach to diagnosis.

PubMed

Haas, Mark

2009-02-01

Alport syndrome and thin glomerular basement membrane nephropathy (TBMN) are genetically heterogeneous conditions characterized by structural abnormalities in the glomerular basement membrane and an initial presentation that usually involves hematuria. Approximately 40% of patients with TBMN are heterozygous carriers for autosomal recessive Alport syndrome, with mutations at the genetic locus encoding type IV collagen alpha(3) [alpha(3)(IV)] and alpha(4) chains. However, although the clinical course of TBMN is usually benign, Alport syndrome, particularly the X-linked form with mutations in the locus encoding the alpha(5) chain of type IV collagen [alpha(5)(IV)], typically results in end-stage renal disease. Electron microscopy is essential to diagnosis of TBMN and Alport syndrome on renal biopsy, although electron microscopy alone is of limited value in distinguishing between TBMN, the heterozygous carrier state of X-linked Alport syndrome, autosomal recessive Alport syndrome, and even early stages of X-linked Alport syndrome. To review diagnostic pathologic features of each of the above conditions, emphasizing the need for immunohistology for alpha(3)(IV) and alpha(5)(IV) in addition to electron microscopy to resolve this differential diagnosis on a renal biopsy. The diagnostic value of immunofluorescence studies for alpha(5)(IV) on a skin biopsy in family members of patients with Alport syndrome also is reviewed. Original and comprehensive review articles on the diagnosis of Alport syndrome and TBMN from the past 35 years, primarily the past 2 decades, and experience in our own renal pathology laboratory. Although Alport syndrome variants and TBMN do not show characteristic light microscopic findings and can be difficult to differentiate from each other even by electron microscopy, using a combination of electron microscopy and immunohistology for alpha(3)(IV) and alpha(5)(IV) enables pathologists to definitively diagnose these disorders on renal biopsy in most cases.

A real-world, multi-site, observational study of infusion time and treatment satisfaction with rheumatoid arthritis patients treated with intravenous golimumab or infliximab.

PubMed

Daniel, Shoshana R; McDermott, John D; Le, Cathy; Pierce, Christine A; Ziskind, Michael A; Ellis, Lorie A

2018-05-25

To assess real-world infusion times for golimumab (GLM-IV) and infliximab (IFX) for rheumatoid arthritis (RA) patients and factors associated with treatment satisfaction. An observational study assessed infusion time including: clinic visit duration, RA medication preparation and infusion time, and infusion process time. Satisfaction was assessed by a modified Treatment Satisfaction Questionnaire for Medication (patient) and study-specific questionnaires (patient and clinic personnel). Comparative statistical testing for patient data utilized analysis of variance for continuous measures, and Fisher's exact or Chi-square test for categorical measures. Multivariate analysis was performed for the primary time endpoints and patient satisfaction. One hundred and fifty patients were enrolled from six US sites (72 GLM-IV, 78 IFX). The majority of patients were female (80.0%) and Caucasian (88.7%). GLM-IV required fewer vials per infusion (3.7) compared to IFX (4.9; p = .0001). Clinic visit duration (minutes) was shorter for GLM-IV (65.1) compared to IFX (153.1; p < .0001), as was total infusion time for RA medication (32.8 GLM-IV, 119.5 IFX; p < .0001) and infusion process times (45.8 GLM-IV, 134.1 IFX; p < .0001). Patients treated with GLM-IV reported higher satisfaction ratings with infusion time (p < .0001) and total visit time (p = .0003). Clinic personnel reported higher satisfaction with GLM-IV than IFX specific to medication preparation time, ease of mixing RA medication, frequency of patients requiring pre-medication, and infusion time. Findings may not be representative of care delivery for all RA infusion practices or RA patients. Shorter overall clinic visit duration, infusion process, and RA medication infusion times were observed for GLM-IV compared to IFX. A shorter duration in infusion time was associated with higher patient and clinic personnel satisfaction ratings.

Direct spectrophotometric measurement of supra-physiological levels of ascorbate in plasma.

PubMed

Witmer, Jordan R; Wetherell, Bailey J; Wagner, Brett A; Du, Juan; Cullen, Joseph J; Buettner, Garry R

2016-08-01

Supra-physiological concentrations of ascorbate, vitamin C, in blood, greater than 1mM, achieved through intravenous administration (IV), are being tested in clinical trials to treat human disease, e.g. cancer. These trials need information on the high levels of ascorbate achieved in blood upon IV administration of pharmacological ascorbate so appropriate clinical decisions can be made. Here we demonstrate that in the complex matrix of human blood plasma supra-physiological levels of ascorbate can be quantified by direct UV spectroscopy with use of a microvolume UV-vis spectrophotometer. Direct quantitation of ascorbate in plasma in the range of 2.9mM, lower limit of detection, up to at least 35mM can be achieved without any sample processing, other than centrifugation. This approach is rapid, economical, and can be used to quantify supraphysiological blood levels of ascorbate associated with the use of IV administration of pharmacological ascorbate to treat disease. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Pharmacokinetics of tramadol and its major metabolites in alpacas following intravenous and oral administration.

PubMed

Edmondson, M A; Duran, S H; Boothe, D M; Stewart, A J; Ravis, W R

2012-08-01

Tramadol, a centrally acting opioid analgesic with monamine reuptake inhibition, was administered to six alpacas (43-71 kg) randomly assigned to two treatment groups, using an open, single-dose, two-period, randomized cross-over design at a dose of 3.4-4.4 mg/kg intravenously (i.v.) and, after a washout period, 11 mg/kg orally. Serum samples were collected and stored at -80°C until assayed by HPLC. Pharmacokinetic parameters were calculated. The mean half-lives (t(1/2)) i.v. were 0.85±0.463 and 0.520±0.256 h orally. The Cp(0) i.v. was 2467±540 ng/mL, and the C(max) was 1202±1319 ng/mL orally. T(max) occurred at 0.111±0.068 h orally. The area under the curve (AUC(0-∞)) i.v. was 895±189 and 373±217 ng*h/mL orally. The volume of distribution (V(d[area])) i.v. was 5.50±2.66 L/kg. Total body clearance (Cl) i.v. was 4.62±1.09 h; Cl/F for oral administration was 39.5±23 L/h/kg. The i.v. mean residence time (MRT) was 0.720±0.264. Oral adsorption (F) was low (5.9-19.1%) at almost three times the i.v. dosage with a large inter-subject variation. This may be due to binding with the rumen contents or enzymatic destruction. Assuming linear nonsaturable pharmacokinetics and absorption processes, a dosage of 6.7 times orally would be needed to achieve the same i.v. serum concentration of tramadol. The t(1/2) of all three metabolites was longer than the parent drug; however, O-DMT, N-DMT, and Di-DMT metabolites were not detectable in all of the alpacas. Because of the poor bioavailability and adverse effects noted in this study, the oral administration of tramadol in alpacas cannot be recommended without further research. © 2011 Blackwell Publishing Ltd.

Research Supporting Middle Grades Practice

ERIC Educational Resources Information Center

Hough, David L., Ed.

2010-01-01

Exemplary Middle Grades Research: Evidence-Based Studies Linking Theory to Practice features research published throughout 2009 in MGRJ that has been identified by the Information Age Publishing's review board as the most useful in terms of assisting educators with making practical applications from evidence-based studies to classroom and school…

Criteria for extending the operation periods of thermoelectric converters based on IV-VI compounds

NASA Astrophysics Data System (ADS)

Sadia, Yatir; Ohaion-Raz, Tsion; Ben-Yehuda, Ohad; Korngold, Meidad; Gelbstein, Yaniv

2016-09-01

The recent energy demands affected by the dilution of conventional energy resources and the growing awareness of environmental considerations, had positioned the research of renewable energy conversion methods in general and of thermoelectric direct conversion of thermal into electrical energies in particular, in the forefront of the currently active applicative sciences. IV-VI thermoelectric compounds (e.g. GeTe, PbTe and SnTe) and their alloys comprise some of the most efficient thermoelectric compositions ever reported. Yet a proper utilization of such materials in practical thermoelectric devices, still requires an overcoming the so-called technological "valley of death", including among others, transport properties' degradation, due to sublimation of volatile Te rich species, while being subjected to elevated temperatures for long periods of time. In an attempt to establish practical operation criteria for extending the operation periods of such thermoelectric converters, it is currently shown based on thermal gravimetric and metallurgical considerations that such harmful sublimation can be practically bridged over by limiting the maximal operating temperatures to the 410-430 °C range for GeTe rich alloys and to 510-530 °C for PbTe and SnTe rich alloys, depending of the thermoelectric leg's diameter.

Cancer Risk Associated with Nuclear Atypia in Cytologically Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis.

PubMed

Valderrabano, Pablo; Khazai, Laila; Thompson, Zachary J; Sharpe, Susan C; Tarasova, Valentina D; Otto, Kristen J; Hallanger-Johnson, Julie E; Wadsworth, J Trad; Wenig, Bruce M; Chung, Christine H; Centeno, Barbara A; McIver, Bryan

2018-02-01

Indeterminate categories of thyroid cytopathology (categories B-III and B-IV of the Bethesda system) are integrated by a heterogeneous spectrum of cytological scenarios that are generally clustered for analysis and management recommendations. It has been suggested that aspirates exhibiting nuclear atypia have a higher risk of malignancy. This study aimed to assess whether cytologically indeterminate thyroid nodules with nuclear atypia have a significantly higher cancer risk than those without nuclear atypia. On June 30, 2016, PubMed and EMBASE were searched for articles in English or Spanish using a search strategy developed by an endocrinologist and a librarian. Case reports were excluded, and no date limits were used. The references of all included studies were also screened for relevant missing studies. Studies were included if the prevalences of malignancy of cytologically indeterminate thyroid nodules with histological confirmation with and without nuclear atypia were reported. Studies were excluded if they had: (i) nodules suspicious for malignancy; (ii) nodules with non-indeterminate (B-III or B-IV) cytology on repeated biopsy, if performed; (iii) nodules not consecutively evaluated; or (iv) cohorts overlapping with another larger series. Two investigators independently assessed the eligibility and risk of bias of the studies. PRISMA and MOOSE guidelines were followed. Summary data were extracted from published reports by one investigator and independently reviewed by another. Data were pooled using a random-effects model. Heterogeneity was explored using subgroup analysis and mixed-effect model meta-regression. The odds ratio for malignancy of cytologically indeterminate thyroid nodules with nuclear atypia over cytologically indeterminate thyroid nodules without nuclear atypia was calculated. Of 2571 retrieved studies, 20 were eligible. The meta-analysis was conducted on summary data of 3532 cytologically indeterminate thyroid nodules: 1162 with and 2370 without nuclear atypia. The odds ratio for malignancy in cytologically indeterminate thyroid nodules with nuclear atypia was 3.63 [confidence interval 3.06-4.35]. There was no evidence of publication bias, and heterogeneity was insignificant (I 2 < 0.01%, p = 0.40). Nuclear atypia is a significant indicator of malignancy in cytologically indeterminate thyroid nodules and needs to be standardized and implemented into clinical practice.

Developing Worksheet (LKS) Base on Process Skills in Curriculum 2013 at Elementary School Grade IV,V,VI

NASA Astrophysics Data System (ADS)

Subhan, M.; Oktolita, N.; Kn, M.

2018-04-01

The Lacks of students' skills in the learning process is due to lacks of exercises in the form of LKS. In the curriculum of 2013, there is no LKS as a companion to improve the students' skills. In order to solve those problem, it is necessary to develop LKS based on process skills as a teaching material to improve students' process skills. The purpose of this study is to develop LKS Process Skills based elementary school grade IV, V, VI which is integrated by process skill. The development of LKS can be used to develop the thematic process skills of elementary school students grade IV, V, VI based on curriculum 2013. The expected long-term goal is to produce teaching materials LKS Process Skill based of Thematic learning that is able to develop the process skill of elementary school students grade IV, V, VI. This development research refers to the steps developed by Borg & Gall (1983). The development process is carried out through 10 stages: preliminary research and gathering information, planning, draft development, initial test (limited trial), first product revision, final trial (field trial), product operational revision, Desemination and implementation. The limited subject of the this research is the students of SDN in Dharmasraya grade IV, V, VI. The field trial subjects in the experimental class are the students of SDN Dharmasraya grade IV, V, VI who have implemented the curriculum 2013. The data are collected by using LKS validation sheets, process skill observation sheets, and Thematic learning test (pre-test And post-test). The result of LKS development on the validity score is 81.70 (very valid), on practical score is 83.94 (very practical), and on effectiveness score is 86.67 (very effective). In the trial step the use of LKS using One Group Pretest-Posttest Design research design. The purpose of this trial is to know the effectiveness level of LKS result of development for improving the process skill of students in grade IV, V, and VI of elementary school. The data collection in this research uses the test result sheet of the process skill through pre-test and post-test. Observation results were analyzed with SPSS 16.0 software. The Result of analysis learning process of student skill of Sig value. (2-tailed) (0,000) <α (0.005) then H0 is rejected. There is a significant difference to the development of process skills between students using LKS with students who do not use LKS. It can be concluded that LKS have accuracy, ease and can improve result learn on aspect of skill process of student of grade IV, V and VI elementary school.

29 CFR 1926.1427 - Operator qualification and certification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... determination that industry recognized criteria for written testing materials, practical examinations, test... tests that: (A) Assess the operator applicant regarding, at a minimum, the knowledge and skills listed... an operator applicant fails a test or is decertified. (iv) Have testing procedures for re...

29 CFR 1926.1427 - Operator qualification and certification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... determination that industry recognized criteria for written testing materials, practical examinations, test... tests that: (A) Assess the operator applicant regarding, at a minimum, the knowledge and skills listed... an operator applicant fails a test or is decertified. (iv) Have testing procedures for re...

29 CFR 1926.1427 - Operator qualification and certification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... determination that industry recognized criteria for written testing materials, practical examinations, test... tests that: (A) Assess the operator applicant regarding, at a minimum, the knowledge and skills listed... an operator applicant fails a test or is decertified. (iv) Have testing procedures for re...

29 CFR 1926.1427 - Operator qualification and certification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... determination that industry recognized criteria for written testing materials, practical examinations, test... tests that: (A) Assess the operator applicant regarding, at a minimum, the knowledge and skills listed... an operator applicant fails a test or is decertified. (iv) Have testing procedures for re...

Iron deficiency intravenous substitution in a Swiss academic primary care division: analysis of practices

PubMed Central

Varcher, Monica; Zisimopoulou, Sofia; Braillard, Olivia; Favrat, Bernard; Junod Perron, Noëlle

2016-01-01

Background Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution. Objective The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland. Methods All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review. Results Out of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases. Conclusion There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning. PMID:27445502

Current variability of clinical practice management of pediatric diabetic ketoacidosis in Illinois pediatric emergency departments.

PubMed

Barrios, Ellen K; Hageman, Joseph; Lyons, Evelyn; Janies, Kathryn; Leonard, Daniel; Duck, Stephen; Fuchs, Susan

2012-12-01

This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program. In 2010, Illinois EMSC conducted a survey (including case scenarios) and medical record review regarding management of pediatric patients with DKA. Data were submitted by 116 EDs. Survey response rate was 94%. Only 34% of EDs had a documented DKA guideline/policy; 37% reported that they did not have hospital adult or pediatric endocrinology services. Case scenarios identified a high percentage of respondents given an intravenous (IV) isotonic sodium chloride solution of 10 to 20 mL/kg during the first hour. However 17% to 21% would use an alternative choice such as administering initial IV solution of 0.45 sodium chloride, initiating an insulin drip before fluids, or waiting for more laboratory results before giving fluids or insulin. A total of 532 medical record reviews were submitted. In 87% of records, patients received an initial IV isotonic sodium chloride solution within the first hour. In 74%, patients received IV insulin infusion/drip (0.1 U/kg/h) after the initial fluid bolus. Of the patients, 51% were transferred to another facility; 22% were admitted to an intensive care unit. Best ED practice management of pediatric DKA includes establishing a specific guideline/protocol and ensuring access to a pediatric endocrinologist. Both were identified as improvement areas in this project. Illinois EMSC has developed an educational module and provided direct feedback to all participating EDs, to improve their management of pediatric patients with DKA.

Endovascular revascularization results in IMS III: intracranial ICA and M1 occlusions.

PubMed

Tomsick, Thomas A; Yeatts, Sharon D; Liebeskind, David S; Carrozzella, Janice; Foster, Lydia; Goyal, Mayank; von Kummer, Ruediger; Hill, Michael D; Demchuk, Andrew M; Jovin, Tudor; Yan, Bernard; Zaidat, Osama O; Schonewille, Wouter; Engelter, Stefan; Martin, Renee; Khatri, Pooja; Spilker, Judith; Palesch, Yuko Y; Broderick, Joseph P

2015-11-01

Interventional Management of Stroke III did not show that combining IV recombinant tissue plasminogen activator (rt-PA) with endovascular therapies (EVTs) is better than IV rt-PA alone. To report efficacy and safety results for EVT of intracranial internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion. Five revascularization methods for persistent occlusions after IV rt-PA treatment were evaluated for prespecified primary and secondary endpoints, after accounting for differences in key baselines variables using propensity scores. Revascularization was scored using the arterial occlusive lesion (AOL) and the modified Thrombolysis in Cerebral Ischemia (mTICI) scores. EVT of 200 subjects with intracranial ICA or M1 occlusion resulted in 81.5% AOL 2-3 recanalization, in addition to 76% mTICI 2-3 and 42.5% mTICI 2b-3 reperfusion. Adverse events included symptomatic intracranial hemorrhage (SICH) (8.0%), vessel perforations (1.5%), and new emboli (14.9%). EVT techniques used were standard microcatheter n=51; EKOS n=14; Merci n=77; Penumbra n=39; Solitaire n=4; multiple n=15. Good clinical outcome was associated with both TICI 2-3 and TICI 2b-3 reperfusion. Neither modified Rankin scale (mRS) 0-2 (28.5%), nor 90-day mortality (28.5%), nor asymptomatic ICH (36.0%) differed among revascularization methods after propensity score adjustment for subjects with intracranial ICA or M1 occlusion. Good clinical outcome was associated with good reperfusion for ICA and M1 occlusion. No significant differences in efficacy or safety among revascularization methods were demonstrated after adjustment. Lack of high-quality reperfusion, adverse events, and prolonged time to treatment contributed to lower-than-expected mRS 0-2 outcomes and study futility compared with IV rt-PA. NCT00359424. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: A systematic review and meta-analysis.

PubMed

Zhang, Lu-Kai; Ma, Jian-Xiong; Kuang, Ming-Jie; Zhao, Jie; Wang, Ying; Lu, Bin; Sun, Lei; Ma, Xin-Long

2017-09-01

Tranexamic acid (TXA) is regarded as one of the most important drugs in reducing blood loss and hemoglobin (Hb) drop after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Treatment with tranexamic acid (TXA) by intravenous application has been discussed extensively. Recently, several studies have reported that oral administration has an effect on blood sparing. Therefore, we performed a meta-analysis to investigate the efficacy and safety between oral TXA and intravenous TXA (IV-TXA) for blood sparing in total knee and hip arthroplasty. Randomized controlled trials (RCTs) or retrospective cohort studies (RCSs) about relevant research were searched for by using PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Five studies that compared oral with IV administration of TXA were included in our meta-analysis. Meta-analysis results were collected and analyzed by the software Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center, The Collaboration, 2014). Five studies containing 3474 patients met the inclusion criteria. Our pooled data analysis indicated that oral TXA was as effective as the IV-TXA in terms of the average Hb drop (P = 0.88), total Hb loss (P = 0.57), total blood loss (P = 0.42), transfusion rate (P = 0.16), complications (P = 0.61), and length of hospital stay (P = 1.00). Compared with the IV-TXA method, oral TXA shows similar blood-sparing efficacy for preventing hemoglobin drop, total hemoglobin loss, and total blood loss following TKA or THA. In addition, no significant differences of transfusion rate, complications, or length of hospital stay were found between the 2 groups. However, because of the limited number of included studies, more studies of high quality are needed to further identify the optimal administration time for oral TXA. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

PubMed

Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

2016-01-20

Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Plasma ET-1 Concentrations Are Elevated in Pregnant Women with Hypertension -Meta-Analysis of Clinical Studies.

PubMed

Lu, Yong-Ping; Hasan, Ahmed Abdallah; Zeng, Shufei; Hocher, Berthold

2017-01-01

The ET system might be involved in the pathogenesis of hypertensive disorders during pregnancy. The objective is to analyse the impact of ET-1 in hypertensive pregnant women by a strict meta-analysis of published human clinical studies. Based on the principle of Cochrane systematic reviews, Cohort studies in PubMed (Medline), Google Scholar and China Biological Medicine Database (CBM-disc) designed to identify the role of endothelin-1 (ET-1) in the pathophysiology of gestational hypertension and preeclampsia were screened. Review Manager Version 5.0 (Rev-Man 5.0) was applied for statistical analysis. Mean difference and 95% confidence interval (CI) were shown in inverse variance (IV) fixed-effects model or IV random-effects model. Sixteen published cohort studies including 1739 hypertensive cases and 409 controls were used in the meta-analysis. ET-1 plasma concentrations were higher in hypertensive pregnant women as compared to the controls (mean difference between groups: 19.02 [15.60～22.44], P < 0.00001,). These finding were driven by severity of hypertension and/or degree of proteinuria. Plasma ET-1 concentrations are elevated in hypertensive disorders during human pregnancy. In particular women with preeclampsia (hypertensive pregnant women with proteinuria) have substantially elevated plasma ET-1 concentration as compared to pregnant women with normal blood pressure. © 2017 The Author(s). Published by S. Karger AG, Basel.

Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry.

PubMed

Chiang, Harmeet K; Best, Al M; Sarrett, David C

2017-09-01

To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice. Copyright © 2017 Elsevier Inc. All rights reserved.

Reporting Practices in Confirmatory Factor Analysis: An Overview and Some Recommendations

ERIC Educational Resources Information Center

Jackson, Dennis L.; Gillaspy, J. Arthur, Jr.; Purc-Stephenson, Rebecca

2009-01-01

Reporting practices in 194 confirmatory factor analysis studies (1,409 factor models) published in American Psychological Association journals from 1998 to 2006 were reviewed and compared with established reporting guidelines. Three research questions were addressed: (a) how do actual reporting practices compare with published guidelines? (b) how…

The influence of rehydration mode after exercise dehydration on cardiovascular function.

PubMed

McDermott, Brendon P; Casa, Douglas J; Lee, Elaine C; Yamamoto, Linda M; Beasley, Kathleen N; Emmanuel, Holly; Pescatello, Linda S; Kraemer, William J; Anderson, Jeffrey M; Armstrong, Lawrence E; Maresh, Carl M

2013-08-01

Our purpose was to compare the common modes of rehydration (REHY) on cardiovascular and fluid regulation recovery after exercise dehydration (EXDE). Twelve nonheat-acclimatized trained subjects (age: 23 ± 4 years, weight: 81.3 ± 3.7 kg, height: 180 ± 6 cm, V[Combining Dot Above]O2max: 56.9 ± 4.4 ml·min·kg , and body fat: 7.8 ± 3.0%) completed 20-hour fluid restriction and 2-hour EXDE to -4% body mass, and then were rehydrated to -2% body mass in a randomized, crossover design. The REHY methods included no fluid (NF), ad libitum, oral (OR), intravenous (IV), and a combination of IV and OR (IV + OR) of 1/2-normal saline (0.45% NaCl). The REHY occurred for 30 minutes, and the subjects were observed during rest for 30 minutes. Seated, standing, and mean arterial pressure (MAP) and blood pressure (BP) were measured every 15 minutes throughout REHY. Heart rate (HR), plasma arginine vasopressin concentration [AVP], and thirst perception were measured throughout REHY. The EXDE resulted in a body mass loss of 4.32 ± 0.22%. The REHY returned the subjects to -2.13 ± 0.47% body mass for controlled trials. Seated systolic BP was greater for IV + OR compared with that for OR (p = 0.015). Seated systolic BP and MAP during REHY showed that IV + OR was greater than OR, independent of time (p ≤ 0.011). Upon standing, IV + OR demonstrated a greater BP than both NF (p = 0.012) and OR (p = 0.031) did. The HR was reduced by IV and IV + OR to a greater extent than NF at REHY30 and REHY60 (p < 0.05). The IV + OR [AVP] demonstrated a strong trend for decreasing over time (p = 0.054) and was significantly less than NF at REHY60 (p = 0.003). Practical application seeking to restore cardiovascular function after EXDE, the combined use of IV + OR rather than a single REHY method seems to be most expedient.

Meta-Analysis of Human Factors Engineering Studies Comparing Individual Differences, Practice Effects and Equipment Design Variations.

DTIC Science & Technology

1985-02-21

Approvoid foT public 90Ieleol, 2* . tJni7nited " - . - o . - ’--. * . -... . 1 UNCLASSIFIED S, E CURITY CLASSIFICATION OF THIS PAGE-" REPORT DOCUMENTATION...ACCESSION NO. 11. TITLE (Include Security Classification) . Veta -Analysis of Human Factors Engineering Studies Comparing Individual Differences, Practice...Background C Opportunity D Significance E History III. PHASE I FINAL REPORT A Literature Review B Formal Analysis C Results D Implications for Phase II IV

American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

PubMed Central

Azzoli, Christopher G.; Baker, Sherman; Temin, Sarah; Pao, William; Aliff, Timothy; Brahmer, Julie; Johnson, David H.; Laskin, Janessa L.; Masters, Gregory; Milton, Daniel; Nordquist, Luke; Pfister, David G.; Piantadosi, Steven; Schiller, Joan H.; Smith, Reily; Smith, Thomas J.; Strawn, John R.; Trent, David; Giaccone, Giuseppe

2009-01-01

The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non–small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy. PMID:19917871

Health professionals' and patients' perspectives on pelvic floor muscle training adherence-2011 ICS State-of-the-Science Seminar research paper IV of IV.

PubMed

Frawley, Helena C; McClurg, Doreen; Mahfooza, Aishath; Hay-Smith, Jean; Dumoulin, Chantale

2015-09-01

There is scant information on pelvic floor muscle training (PFMT) adherence barriers and facilitators. A web-based survey was conducted (1) to investigate whether responses from health professionals and the public broadly reflected findings in the literature, (2) if responses differed between the two groups, and (3) to identify new research directions. Health professional and public surveys were posted on the ICS website. PFMT adherence barriers and facilitators were divided into four categories: physical/condition, patient, therapy, and social-economic. Responses were analyzed using descriptive statistics from quantitative data and thematic data analysis for qualitative data. Five hundred and fifteen health professionals and 51 public respondents participated. Both cohorts felt "patient-related factors" constituted the most important adherence barrier, but differed in their rankings of short- and long-term barriers. Health professionals rated "patient-related" and the public "therapy-related" factors as the most important adherence facilitator. Both ranked "perception of PFMT benefit" as the most important long-term facilitator. Contrary to published findings, symptom severity was not ranked highly. Neither cohort felt the barriers nor facilitators differed according to PFM condition (urinary/faecal incontinence, pelvic organ prolapse, pelvic pain); however, a large number of health professionals felt differences existed across age, gender, and ethnicity. Half of respondents in both cohorts felt research barriers and facilitators differed from those in clinical practice. An emphasis on "patient-related" factors, ahead of "condition-specific" and "therapy-related," affecting PFMT adherence barriers was evident. Health professionals need to be aware of the importance of long-term patient perception of PFMT benefits and consider enabling strategies. © 2015 Wiley Periodicals, Inc.

Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification.

PubMed

Mastrorilli, C; Tripodi, S; Caffarelli, C; Perna, S; Di Rienzo-Businco, A; Sfika, I; Asero, R; Dondi, A; Bianchi, A; Povesi Dascola, C; Ricci, G; Cipriani, F; Maiello, N; Miraglia Del Giudice, M; Frediani, T; Frediani, S; Macrì, F; Pistoletti, C; Dello Iacono, I; Patria, M F; Varin, E; Peroni, D; Comberiati, P; Chini, L; Moschese, V; Lucarelli, S; Bernardini, R; Pingitore, G; Pelosi, U; Olcese, R; Moretti, M; Cirisano, A; Faggian, D; Travaglini, A; Plebani, M; Verga, M C; Calvani, M; Giordani, P; Matricardi, P M

2016-08-01

Pollen-food syndrome (PFS) is heterogeneous with regard to triggers, severity, natural history, comorbidities, and response to treatment. Our study aimed to classify different endotypes of PFS based on IgE sensitization to panallergens. We examined 1271 Italian children (age 4-18 years) with seasonal allergic rhinoconjunctivitis (SAR). Foods triggering PFS were acquired by questionnaire. Skin prick tests were performed with commercial pollen extracts. IgE to panallergens Phl p 12 (profilin), Bet v 1 (PR-10), and Pru p 3 (nsLTP) were tested by ImmunoCAP FEIA. An unsupervised hierarchical agglomerative clustering method was applied within PFS population. PFS was observed in 300/1271 children (24%). Cluster analysis identified five PFS endotypes linked to panallergen IgE sensitization: (i) cosensitization to ≥2 panallergens ('multi-panallergen PFS'); (ii-iv) sensitization to either profilin, or nsLTP, or PR-10 ('mono-panallergen PFS'); (v) no sensitization to panallergens ('no-panallergen PFS'). These endotypes showed peculiar characteristics: (i) 'multi-panallergen PFS': severe disease with frequent allergic comorbidities and multiple offending foods; (ii) 'profilin PFS': oral allergy syndrome (OAS) triggered by Cucurbitaceae; (iii) 'LTP PFS': living in Southern Italy, OAS triggered by hazelnut and peanut; (iv) 'PR-10 PFS': OAS triggered by Rosaceae; and (v) 'no-panallergen PFS': mild disease and OAS triggered by kiwifruit. In a Mediterranean country characterized by multiple pollen exposures, PFS is a complex and frequent complication of childhood SAR, with five distinct endotypes marked by peculiar profiles of IgE sensitization to panallergens. Prospective studies in cohorts of patients with PFS are now required to test whether this novel classification may be useful for diagnostic and therapeutic purposes in the clinical practice. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Perforator chimerism for the reconstruction of complex defects: A new chimeric free flap classification system.

PubMed

Kim, Jeong Tae; Kim, Youn Hwan; Ghanem, Ali M

2015-11-01

Complex defects present structural and functional challenges to reconstructive surgeons. When compared to multiple free flaps or staged reconstruction, the use of chimeric flaps to reconstruct such defects have many advantages such as reduced number of operative procedures and donor site morbidity as well as preservation of recipient vessels. With increased popularity of perforator flaps, chimeric flaps' harvest and design has benefited from 'perforator concept' towards more versatile and better reconstruction solutions. This article discusses perforator based chimeric flaps and presents a practice based classification system that incorporates the perforator flap concept into "Perforator Chimerism". The authors analyzed a variety of chimeric patterns used in 31 consecutive cases to present illustrative case series and their new classification system. Accordingly, chimeric flaps are classified into four types. Type I: Classical Chimerism, Type II: Anastomotic Chimerism, Type III: Perforator Chimerism and Type IV Mixed Chimerism. Types I on specific source vessel anatomy whilst Type II requires microvascular anastomosis to create the chimeric reconstructive solution. Type III chimeric flaps utilizes the perforator concept to raise two components of tissues without microvascular anastomosis between them. Type IV chimeric flaps are mixed type flaps comprising any combination of Types I to III. Incorporation of the perforator concept in planning and designing chimeric flaps has allowed safe, effective and aesthetically superior reconstruction of complex defects. The new classification system aids reconstructive surgeons and trainees to understand chimeric flaps design, facilitating effective incorporation of this important reconstructive technique into the armamentarium of the reconstruction toolbox. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[Compliance with the requirements of paediatric emergency departments in Spain: a self-assessment survey].

PubMed

Sánchez Etxaniz, J; Luaces I Cubells, C; Benito Fernández, J

2011-08-01

Paediatric emergency medicine in Spain is practiced in differently configured departments, staffing and organisation. Our goal was to determine the situation in Paediatric Emergency Departments (PED) and their adaptation to the quality standards proposed by the Spanish Society of Paediatric Emergencies. A self-assessment questionnaire on standards performance was sent to 47 PED directors by e-mail. It consisted of 101 items, 69 considered mandatory. According to the fulfilment of these 69 items 4 PED groups were selected: group I: in the best position (met 69), group II: requiring minimal changes (meeting 62-68), group III: requiring major changes (meeting 41-61); group IV: requiring a lot of major changes (meeting less than 41). Thirty nine questionnaires were completed in full. The PED included in the study tended to an average of 35310 annual emergencies (5000-115000). No PED was included in group I, 6 in II 27 in III and 6 in IV. There was a tendency towards higher compliance with standards in larger PED, but there was no significant relationship between the number of emergencies and the number of items fulfilled. 1. Staffing and architectural and organizational aspects may not be adequate to achieve optimal patient outcome in many PED in Spain. This fact does not appear to be related to the annual patient census. 2. The areas for improvement mainly affect functional issues that must be undertaken by those responsible. 3. A significant number of PED have serious architectural and staffing deficiencies, which would require economic measures by their managers. 4. Our self-assessment questionnaire identifies improvement actions. Copyright © 2010 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Definitive radiotherapy for primary vaginal cancer: correlation between treatment patterns and recurrence rate.

PubMed

Kanayama, Naoyuki; Isohashi, Fumiaki; Yoshioka, Yasuo; Baek, Sungjae; Chatani, Masashi; Kotsuma, Tadayuki; Tanaka, Eiichi; Yoshida, Ken; Seo, Yuji; Suzuki, Osamu; Mabuchi, Seiji; Shiki, Yasuhiko; Tatsumi, Keiji; Kimura, Tadashi; Teshima, Teruki; Ogawa, Kazuhiko

2015-03-01

The purpose of this study was to determine the outcomes and optimal practice patterns of definitive radiotherapy for primary vaginal cancer. Between 1993 and 2012, 49 patients were treated with definitive radiotherapy for primary vaginal cancer in three hospitals. Of these, 15 patients (31%) had clinically positive regional lymph node metastasis. A total of 34 patients (70%) received external beam radiotherapy with high-dose-rate brachytherapy (interstitial or intracavitary), and 8 (16%) (with small superficial Stage I tumors) were treated with local radiotherapy. The median follow-up was 33 months (range: 1-169 months). The 3-year overall survival (OS), disease-free survival (DFS), and loco-regional control (LRC) rates were 83%, 59% and 71%, respectively. In multivariate analysis, the histological type (P = 0.044) was significant risk factors for LRC. In Federation of Gynecology and Obstetrics (FIGO) Stage I cases, 3 of 8 patients (38%) who did not undergo prophylactic lymph node irradiation had lymph node recurrence, compared with 2 of 12 patients (17%) who underwent prophylactic pelvic irradiation. For Stage III-IV tumors, the local recurrence rate was 50% and the lymph node recurrence rate was 40%. Patients with FIGO Stage I/II or clinical Stage N1 had a higher recurrence rate with treatment using a single modality compared with the recurrence rate using combined modalities. In conclusion, our treatment outcomes for vaginal cancer were acceptable, but external beam radiotherapy with brachytherapy (interstitial or intracavitary) was needed regardless of FIGO stage. Improvement of treatment outcomes in cases of FIGO Stage III or IV remains a significant challenge. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Relationships between dry matter content, ensiling, ammonia-nitrogen, and ruminal in vitro starch digestibility in high-moisture corn samples.

PubMed

Ferraretto, L F; Taysom, K; Taysom, D M; Shaver, R D; Hoffman, P C

2014-05-01

The objectives of the study were (1) to determine relationships between high-moisture corn (HMC) dry matter (DM), ammonia-N [% of crude protein (CP)], and soluble CP concentrations, and pH, with 7-h ruminal in vitro starch digestibility (ivStarchD), and (2) to evaluate the effect of ensiling on pH, ammonia-N, soluble CP, and ivStarchD measurements in HMC. A data set comprising 6,131 HMC samples (55 to 80% DM) obtained from a commercial feed analysis laboratory was used for this study. Month of sample submittal was assumed to be associated with length of the ensiling period. Data for month of sample submittal were analyzed using Proc Mixed in SAS (SAS Institute Inc., Cary, NC) with month as a fixed effect. Regressions to determine linear and quadratic relationships between ivStarchD and ammonia-N, soluble CP, pH, and DM content were performed using Proc Mixed. The ivStarchD increased by 9 percentage units from October to August of the following year. Similar results were observed for ammonia-N and soluble CP with increases from 1.8 to 4.6% of CP and 31.3 to 46.4% of CP, respectively, from October to August of the following year. Ammonia-N was positively related to ivStarchD (R(2)=0.61). The DM content of HMC at silo removal was negatively related (R(2)=0.47) to ivStarchD with a decrease of 1.6 percentage units in ivStarchD per 1-percentage-unit increase in DM content. The pH of HMC was negatively related to ammonia-N (R(2)=0.53), soluble CP (R(2)=0.57), and ivStarchD (R(2)=0.51). Combined, ammonia-N, DM, soluble CP, and pH provided a good prediction of ivStarchD (adjusted R(2)=0.70). Increasing pH, ammonia-N, soluble CP, and ivStarchD values indicate that HMC may need up to 10 mo of ensiling to reach maximum starch digestibility. Ammonia-N, DM content, soluble CP concentration, and pH are good indicators of ruminal in vitro starch digestibility for high-moisture corn. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Circulatory kinetics of intravenously injected {sup 238}Pu(IV) citrate and {sup 14}C-CaNa{sub 3}-DTPA in mice: Comparison with rat, dog, and Reference Man

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

Durbin, P.W.; Kullgren, B.; Schmidt, C.T.

1997-02-01

New ligands for in vivo chelation of Pu(IV) are being synthesized and evaluated in mice for efficacy and toxicity. Biokinetic studies of the new ligands, CaNa{sub 3}-DTPA, and Pu(IV) are major components of those investigations. Young adult female mice were injected intravenously (iv) with {sup 3}H-inulin, {sup 14}C-CaNa{sub 3}-DTPA, or {sup 238}Pu(IV) citrate to provide base- line data for plasma clearance, tissue uptake, and excretion rates and to determine the dilution volume (VOD) and renal clearance rate (RC) of filterable substances. Published plasma clearance data in Reference Man, dog, and rat were collected. Based on combined data for {sup 3}H-inulinmore » and {sup 14}C-CaNa{sub 3}-DTPA, VOD = 17% of body weight and RC = 18 mL kg{sup -1} min{sup -1} for mice. Retention of {sup 14}C-CaNa{sub 3}-DTPA in the four species is proportional to body weight and inversely proportional to RC: Integrals of the retention of {sup 14}C-CaNa{sub 3}-DTPA from R(t) = 1.0 to R(t) = 0.05 are 108, 43, 28, and 10 DF min, respectively, for Reference Man, dog, rat, and mouse. Clearances of iv-injected Pu(IV) citrate from plasma are in the same order: The plasma curve integrals from injection to 1440 min are 840, 640, 280, and 67 DF min, respectively, for Reference Man, dog, rat, and mouse. In mice, a large fraction of newly injected Pu(IV) is rapidly transferred to the interstitial water of bulk soft tissue (excluding liver and kidneys), from which it is cleared at the same rate as from the plasma. Rapid plasma clearance, escape into interstitial water (22%ID at 20 min), significant early urinary excretion (8%ID in 12 h), and prompt deposition in liver and skeleton (complete in 12 h) are evidence of inefficient binding to plasma protein of newly injected Pu(IV) in mice. Slow plasma clearance, little early urinary excretion, and delayed deposition in liver and skeleton reflect more efficient binding of newly injected Pu(IV) in Reference Man and dog. 39 refs., 6 figs., 3 tabs.« less

The shortened infusion time of intravenous ibuprofen, part 2: a multicenter, open-label, surgical surveillance trial to evaluate safety.

PubMed

Gan, Tong J; Candiotti, Keith; Turan, Alparslan; Buvanendran, Asokumar; Philip, Beverly K; Viscusi, Eugene R; Soghomonyan, Suren; Bergese, Sergio D

2015-02-01

The literature and clinical data support the use of intravenous (IV) infusions of ibuprofen to control pain and reduce the opioid requirements associated with surgical pain. According to current guidelines, IV ibuprofen can be administered via a slow IV infusion performed during a 30-minute period. Although recent studies indicate that more rapid infusions may yield additional benefits for patients, the safety of such an approach needs further evaluation. The main purpose of this study was to determine the safety of single and multiple doses of IV ibuprofen (800 mg) administered over 5 to 10 minutes at the induction of anesthesia and after the surgical procedure for the treatment of postoperative pain. This was a Phase IV, multicenter, open-label, clinical surveillance study. It was conducted at 21 hospitals in the United States, and 300 adult hospitalized patients undergoing surgery were enrolled. The exclusion criteria for the study were: inadequate IV access; hypersensitivity to any component of IV ibuprofen, aspirin, or related products; and any active, clinically significant bleeding. Also excluded were patients who had taken NSAIDs <6 hours before administration of IV ibuprofen; pregnant or breastfeeding female patients; and patients in the perioperative period of coronary artery bypass graft surgery. Patients received 800 mg of IV ibuprofen administered over 5 to 10 minutes preoperatively. Vital signs, adverse events, and pain scores were assessed. Approximately 22% (65 of 300) of patients reported adverse events (serious and nonserious). The most common adverse event was infusion site pain (34 of 300 [11%]). No deaths were reported. Nine subjects reported serious adverse events, 8 of which occurred during the first 6 hours. All serious events reported were judged unrelated to ibuprofen. Of the 300 total patients, 2 (0.67%) discontinued the study drug due to an adverse event (1 patient discontinued the study because of infusion site pain, and 1 patient withdrew due to a hypersensitivity reaction after drug administration). Our study found that IV ibuprofen infused over 5 to 10 minutes at induction of anesthesia is a safe administration option for surgical patients. ClinicalTrials.gov identifier: NCT01334957. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

The 50 Most Cited Articles in Orthopedic Cartilage Surgery.

PubMed

Arshi, Armin; Siesener, Nathan J; McAllister, David R; Williams, Riley J; Sherman, Seth L; Jones, Kristofer J

2016-07-01

To determine the 50 most cited articles in orthopedic cartilage surgery and their characteristics. A systematic review of the Science Citation Index Expanded was performed for articles related to cartilage surgery published in the 66 journals under the category "Orthopedics." The 50 most cited articles were determined, and the following characteristics were analyzed for each article: authors, journal and year of publication, number of citations, geographic origin, article type (basic science or clinical), article subtype by study design, and level of evidence. Citation density (total number of citations/years since publication) was also computed. The 50 most cited articles ranged from 989 to 172 citations, with citation density ranging from 71.5 to 4.1. The publication years spanned from 1968 to 2008, with the 2000s accounting for half (25) of the articles and the highest mean citation density (14.6). The 50 most cited articles were published in 11 journals. The majority of the articles (29) were clinical, with level IV representing the most common level of evidence (10). The remaining basic science articles were most commonly animal in vivo studies (14). Stronger level of evidence was correlated with overall number of citations (P = 0.044), citation density (P < 0.001), and year of publication (P = 0.003). Articles with stronger levels of evidence are more highly cited, with an increasing trend as evidence-based practice has been emphasized. This article list provides clinicians, researchers, and trainees with a group of "citation classics" in orthopedic cartilage surgery.

Microneedles for drug and vaccine delivery

PubMed Central

Kim, Yeu-Chun; Park, Jung-Hwan; Prausnitz, Mark R.

2012-01-01

Microneedles were first conceptualized for drug delivery many decades ago, but only became the subject of significant research starting in the mid-1990’s when microfabrication technology enabled their manufacture as (i) solid microneedles for skin pretreatment to increase skin permeability, (ii) microneedles coated with drug that dissolves off in the skin, (iii) polymer microneedles that encapsulate drug and fully dissolve in the skin and (iv) hollow microneedles for drug infusion into the skin. As shown in more than 350 papers now published in the field, microneedles have been used to deliver a broad range of different low molecular weight drugs, biotherapeutics and vaccines, including published human studies with a number of small-molecule and protein drugs and vaccines. Influenza vaccination using a hollow microneedle is in widespread clinical use and a number of solid microneedle products are sold for cosmetic purposes. In addition to applications in the skin, microneedles have also been adapted for delivery of bioactives into the eye and into cells. Successful application of microneedles depends on device function that facilitates microneedle insertion and possible infusion into skin, skin recovery after microneedle removal, and drug stability during manufacturing, storage and delivery, and on patient outcomes, including lack of pain, skin irritation and skin infection, in addition to drug efficacy and safety. Building off a strong technology base and multiple demonstrations of successful drug delivery, microneedles are poised to advance further into clinical practice to enable better pharmaceutical therapies, vaccination and other applications. PMID:22575858

Sir Charles Bell (1774-1842): contributions to neuro-ophthalmology.

PubMed

Grzybowski, Andrzej; Kaufman, Matthew H

2007-12-01

Sir Charles Bell (1774-1842) was a Scottish anatomist, physiologist, neurologist, artist and surgeon, who enjoyed a distinguished career in teaching and clinical practice in London between 1804 and 1836. In 1814, he was appointed to the surgical staff of the Middlesex Hospital. In 1824, he was elected Professor of Anatomy and Surgery at the Royal College of Surgeons of England, and shortly afterwards was elected Professor of Physiology at the University of London. In 1831, he was knighted on the accession of William IV. In 1836, he was elected to the Chair of Surgery in the University of Edinburgh, and remained there until his death in 1842, at 68 years of age. During his career, Bell was a prolific medical author, a brilliant medical researcher and a skilled artist. In 1811, he discovered the distinct functions of the motor and sensory nerves, findings that were initially published in a pamphlet entitled 'Ideas of a New Anatomy of the Brain'. In 1821, Bell described the long thoracic nerve, which supplies the serratus anterior muscle, and which now bears his name. In the same paper he showed that lesions of the seventh cranial nerve produce facial paralysis (now termed Bell's palsy). He also demonstrated that the fifth cranial nerve is of sensory importance to the face and controls the muscles of mastication, whereas the seventh cranial nerve principally controls the muscles of facial expression. Bell published research on a number of ophthalmological subjects. This paper reviews some of these latter achievements.

International guidelines for the in vivo assessment of skin properties in non-clinical settings: Part 2. transepidermal water loss and skin hydration.

PubMed

du Plessis, Johan; Stefaniak, Aleksandr; Eloff, Fritz; John, Swen; Agner, Tove; Chou, Tzu-Chieh; Nixon, Rosemary; Steiner, Markus; Franken, Anja; Kudla, Irena; Holness, Linn

2013-08-01

There is an emerging perspective that it is not sufficient to just assess skin exposure to physical and chemical stressors in workplaces, but that it is also important to assess the condition, i.e. skin barrier function of the exposed skin at the time of exposure. The workplace environment, representing a non-clinical environment, can be highly variable and difficult to control, thereby presenting unique measurement challenges not typically encountered in clinical settings. An expert working group convened a workshop as part of the 5th International Conference on Occupational and Environmental Exposure of Skin to Chemicals (OEESC) to develop basic guidelines and best practices (based on existing clinical guidelines, published data, and own experiences) for the in vivo measurement of transepidermal water loss (TEWL) and skin hydration in non-clinical settings with specific reference to the workplace as a worst-case scenario. Key elements of these guidelines are: (i) to minimize or recognize, to the extent feasible, the influences of relevant endogenous-, exogenous-, environmental- and measurement/instrumentation-related factors; (ii) to measure TEWL with a closed-chamber type instrument; (iii) report results as a difference or percent change (rather than absolute values); and (iv) accurately report any notable deviations from this guidelines. It is anticipated that these guidelines will promote consistent data reporting, which will facilitate inter-comparison of study results. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Planning for an Evaluation of Teaching Performance. Volume IV. Summaries of Instruments for Use in Evaluating Teacher Performance.

ERIC Educational Resources Information Center

Yuzdepski, I., Comp.; Elliott, L., Comp.

This document presents information, in the form of summary sheets, on 54 teacher evaluation instruments. Each summary contains pertinent information about the instrument regarding publishing company, author, criteria evaluated, subject of observation, category dimension, and coding units. The 19 criteria used in the evaluation tests, which were…

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

Myers, G.; Korber, B.; Wain-Hobson, S.

This compendium, including accompanying floppy diskettes, is the result of an effort to compile and rapidly publish all relevant molecular data concerning the human immunodeficiency viruses (HIV) and related retroviruses. The scope of the compendium and database is best summarized by the five parts it comprises: (I) Nucleic Acid Alignments and Sequences; (II) Amino Acid Alignments; (III) Analysis; (IV) Related Sequences; (V) Database communications.

78 FR 68832 - National Advisory Committee on Institutional Quality and Integrity (NACIQI)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... process for institutions of higher education under Title IV, of the HEA, together with recommendations for... System at: www.gpo.gov/fdsys . At this site you can view this document, as well as all other documents of... documents of the Department published in the Federal Register by using the article search feature at: www...

78 FR 27888 - Approval and Promulgation of State Implementation Plans; State of North Dakota; Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... CSAPR mean or refer to the Cross-State Air Pollution Rule. (iv) The words EPA, we, us or our mean or... Evaluation A. EPA's Approach for Evaluating Interstate Transport of Air Pollution B. EPA's Evaluation of...\\ Most recently, EPA published the final Cross State Air Pollution Rule (``CSAPR'' or ``Transport Rule...

34 CFR 462.12 - What procedures does the Secretary use to review the suitability of tests?

Code of Federal Regulations, 2010 CFR

2010-07-01

... item selection must ensure negligible overlap in items across pre- and post-testing; (iv) Includes a... regarding the suitability of a test, the Secretary publishes in the Federal Register and posts on the... suitability of tests? 462.12 Section 462.12 Education Regulations of the Offices of the Department of...

Autism Spectrum Disorders in the DSM-V: Better or Worse than the DSM-IV?

ERIC Educational Resources Information Center

Wing, Lorna; Gould, Judith; Gillberg, Christopher

2011-01-01

The DSM-V-committee has recently published proposed diagnostic criteria for autism spectrum disorders. We examine these criteria in some detail. We believe that the DSM-committee has overlooked a number of important issues, including social imagination, diagnosis in infancy and adulthood, and the possibility that girls and women with autism may…

Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.

PubMed

Wetterneck, Tosha B; Skibinski, Kathleen A; Roberts, Tanita L; Kleppin, Susan M; Schroeder, Mark E; Enloe, Myra; Rough, Steven S; Hundt, Ann Schoofs; Carayon, Pascale

2006-08-15

Failure mode and effects analysis (FMEA) was used to evaluate a smart i.v. pump as it was implemented into a redesigned medication-use process. A multidisciplinary team conducted a FMEA to guide the implementation of a smart i.v. pump that was designed to prevent pump programming errors. The smart i.v. pump was equipped with a dose-error reduction system that included a pre-defined drug library in which dosage limits were set for each medication. Monitoring for potential failures and errors occurred for three months postimplementation of FMEA. Specific measures were used to determine the success of the actions that were implemented as a result of the FMEA. The FMEA process at the hospital identified key failure modes in the medication process with the use of the old and new pumps, and actions were taken to avoid errors and adverse events. I.V. pump software and hardware design changes were also recommended. Thirteen of the 18 failure modes reported in practice after pump implementation had been identified by the team. A beneficial outcome of FMEA was the development of a multidisciplinary team that provided the infrastructure for safe technology implementation and effective event investigation after implementation. With the continual updating of i.v. pump software and hardware after implementation, FMEA can be an important starting place for safe technology choice and implementation and can produce site experts to follow technology and process changes over time. FMEA was useful in identifying potential problems in the medication-use process with the implementation of new smart i.v. pumps. Monitoring for system failures and errors after implementation remains necessary.

Further development of an electroosmotic medium pump system for preparative disk gel electrophoresis.

PubMed

Hayakawa, Mitsuo; Hosogi, Yumiko; Takiguchi, Hisashi; Shiroza, Teruaki; Shibata, Yasuko; Hiratsuka, Koichi; Kiyama-Kishikawa, Michiko; Hamajima, Susumu; Abiko, Yoshimitsu

2003-02-01

A simple and practical 6.8-cm-diameter (36.30-cm(2) cross-sectional-area) preparative disk gel electrophoresis device, based on the design of M. Hayakawa et al. (Anal. Biochem. 288 (2001) 168), in which the elution buffer is driven by an electroosmotic buffer flow through the membrane into the elution chamber from the anode chamber was constructed. We have found that the dialysis membranes employed provide suitable flow rates for the elution buffer, similar to those of an earlier 3.6-cm-diameter device, resulting in the prevention of excess eluate dilution. The efficiency of this device was demonstrated by the fractionation of a bovine serum albumin (BSA) Cohn V fraction into monomer, dimer, and oligomer components using nondenaturing polyacrylamide gel electrophoresis (native-PAGE). The maximum protein concentration of the eluate achieved was 133 mg/ml of BSA monomer, which required a dilution of the eluate for subsequent analytical PAGE performance. As a practical example, the two-dimensional fractionation of soluble dipeptidyl peptidase IV (sDPP IV) from 50 ml fetal bovine serum (3.20 g protein) per gel is presented. The sDPP IV enzyme protein was recovered in a relatively short time, utilizing a 6.5% T native-PAGE and subsequential sodium dodecyl sulfate-PAGE system. This device enhances the possibility of continuous electrophoretic fractionation of complex protein mixtures on a preparative scale. Copyright 2003 Elsevier Science (USA)

Enhanced transdermal delivery of ondansetron using nanovesicular systems: Fabrication, characterization, optimization and ex-vivo permeation study-Box-Cox transformation practical example.

PubMed

Habib, Basant A; Sayed, Sinar; Elsayed, Ghada M

2018-03-30

This study aimed to formulate suitable nanovesicles (NVs) for transdermal delivery of Ondansetron. It also illustrated a practical example for the importance of Box-Cox transformation. A 2 3 full factorial design was used to enable testing transfersomes, ethosomes, and transethosomes of Ondansetron simultaneously. The independent variables (IVs) studied were sodium taurocholate amount, ethanol volume in hydration medium and sonication time. The studied dependent variables (DVs) were: particle size (PS), zeta potential (ZP) and entrapment efficiency (EE). Polynomial equations were used to study the influence of IVs on each DV. Numerical multiple response optimization was applied to select an optimized formula (OF) with the goals of minimizing PS and maximizing ZP absolute value and EE. Box-Cox transformation was adopted to enable modeling PS raised to the power of 1.2 with an excellent prediction R 2 of 1.000. ZP and EE were adequately represented directly with prediction R 2 of 0.9549 and 0.9892 respectively. Response surface plots helped in explaining the influence of IVs on each DV. Two-sided 95% prediction interval test and percent deviation of actual values from predicted ones proved the validity of the elucidated models. The OF was a transfersomal formula with desirability of 0.866 and showed promising results in ex-vivo permeation study. Copyright © 2018 Elsevier B.V. All rights reserved.

Effectiveness of Systems Training for Emotional Predictability and Problem Solving (STEPPS) for borderline personality problems in a 'real-world' sample: moderation by diagnosis or severity?

PubMed

Bos, Elisabeth H; van Wel, E Bas; Appelo, Martin T; Verbraak, Marc J P M

2011-01-01

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group treatment for borderline personality disorder (BPD). Two prior randomized controlled trials (RCTs) have shown the efficacy of this training. In both RCTs, patients with borderline features who did not meet the DSM-IV criteria for BPD were excluded, which were many. We investigated the effectiveness of STEPPS in a sample representative of routine clinical practice and examined whether DSM-IV diagnosis and/or baseline severity were related to differential effectiveness. Patients whom their practicing clinician diagnosed with BPD were randomized to STEPPS plus adjunctive individual therapy (STEPPS, n = 84) or to treatment as usual (TAU, n = 84). STEPPS recipients showed more improvement on measures of general and BPD-specific psychopathology as well as quality of life than TAU recipients, both at the end of treatment and at a 6-month follow-up. Presence of DSM-IV-diagnosed BPD was not related to differential treatment effectiveness, but dimensional measures of symptom severity were; STEPPS was superior to TAU particularly in patients with higher baseline severity scores. The findings show the effectiveness of STEPPS in a 'real-world' sample, and underscore the importance of dimensional versus categorical measures of personality disturbance. Copyright © 2011 S. Karger AG, Basel.

7 CFR 46.45 - Procedure in administering section 2(5) of the Act.

Code of Federal Regulations, 2010 CFR

2010-01-01

....45 Section 46.45 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE MARKETING OF PERISHABLE... than four percent below the declared weight; (iv) Multiple sales or shipments of a misrepresented...

40 CFR 258.12 - Wetlands.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Wetlands. 258.12 Section 258.12... Act or applicable State wetlands laws, the presumption that practicable alternative to the proposed... Species Act of 1973, and (iv) Violate any requirement under the Marine Protection, Research, and...

40 CFR 258.12 - Wetlands.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Wetlands. 258.12 Section 258.12... Act or applicable State wetlands laws, the presumption that practicable alternative to the proposed... Species Act of 1973, and (iv) Violate any requirement under the Marine Protection, Research, and...

40 CFR 258.12 - Wetlands.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Wetlands. 258.12 Section 258.12... Act or applicable State wetlands laws, the presumption that practicable alternative to the proposed... Species Act of 1973, and (iv) Violate any requirement under the Marine Protection, Research, and...

40 CFR 125.63 - Establishment of a monitoring program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... to the extent practicable: (i) Periodic surveys of the biological communities and populations which... surveys; (ii) Periodic determinations of the accumulation of toxic pollutants and pesticides in organisms... surveys and to measure the accumulation of toxic pollutants and pesticides; and (iv) Where the discharge...

40 CFR 125.63 - Establishment of a monitoring program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to the extent practicable: (i) Periodic surveys of the biological communities and populations which... surveys; (ii) Periodic determinations of the accumulation of toxic pollutants and pesticides in organisms... surveys and to measure the accumulation of toxic pollutants and pesticides; and (iv) Where the discharge...

40 CFR 125.63 - Establishment of a monitoring program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... to the extent practicable: (i) Periodic surveys of the biological communities and populations which... surveys; (ii) Periodic determinations of the accumulation of toxic pollutants and pesticides in organisms... surveys and to measure the accumulation of toxic pollutants and pesticides; and (iv) Where the discharge...

40 CFR 125.63 - Establishment of a monitoring program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... to the extent practicable: (i) Periodic surveys of the biological communities and populations which... surveys; (ii) Periodic determinations of the accumulation of toxic pollutants and pesticides in organisms... surveys and to measure the accumulation of toxic pollutants and pesticides; and (iv) Where the discharge...

40 CFR 125.63 - Establishment of a monitoring program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... to the extent practicable: (i) Periodic surveys of the biological communities and populations which... surveys; (ii) Periodic determinations of the accumulation of toxic pollutants and pesticides in organisms... surveys and to measure the accumulation of toxic pollutants and pesticides; and (iv) Where the discharge...

21 CFR 10.115 - Good guidance practices.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., journal articles and editorials, media interviews, press materials, warning letters, memoranda of... document “Guidance Document Submission” and submit it to Division of Dockets Management (HFA-305), 5630... review. (iv) After providing an opportunity for public comment on a Level 1 guidance document, FDA will...

21 CFR 10.115 - Good guidance practices.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., journal articles and editorials, media interviews, press materials, warning letters, memoranda of... document “Guidance Document Submission” and submit it to Division of Dockets Management (HFA-305), 5630... review. (iv) After providing an opportunity for public comment on a Level 1 guidance document, FDA will...

21 CFR 10.115 - Good guidance practices.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., journal articles and editorials, media interviews, press materials, warning letters, memoranda of... document “Guidance Document Submission” and submit it to Division of Dockets Management (HFA-305), 5630... review. (iv) After providing an opportunity for public comment on a Level 1 guidance document, FDA will...

21 CFR 10.115 - Good guidance practices.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., journal articles and editorials, media interviews, press materials, warning letters, memoranda of... document “Guidance Document Submission” and submit it to Division of Dockets Management (HFA-305), 5630... review. (iv) After providing an opportunity for public comment on a Level 1 guidance document, FDA will...

32 CFR 56.8 - Guidelines for determining discriminatory practices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... changes in compensation. (iv) Job assignments, job classifications, organizational structures, position... means as the acquisition or redesign of equipment, such as telecommunication or other telephonic devices... decision to grant a modification or waiver shall be based on consideration of the following: (1) Scale of...

Prophylactic Antibiotics for Enucleation and Evisceration: A Retrospective Study and Systematic Literature Review.

PubMed

Pariseau, Brett; Fox, Barry; Dutton, Jonathan J

To report surgical site infection (SSI) rates of eviscerations and enucleations with implants performed without perioperative intravenous (IV) antibiotics or postoperative oral antibiotics, and to give SSI prevention recommendations. A single-center retrospective chart review was performed after obtaining institutional review board approval. Charts were found by Current Procedural Terminology codes. Demographics, surgical indication, procedure, implant, antibiotic use, and postoperative course were recorded. SSIs occurring within 30 days after surgery were reviewed and postoperative infection rates were determined. Four hundred eighty-one cases from January 1999 to December 2015 were analyzed. There were 102 eviscerations with implants, 314 enucleations with implants, 23 enucleations without implants, 23 implant exchanges, 15 implants placed secondarily after enucleation, and 4 implant removals. Seventy cases (14.6%) were given perioperative IV antibiotics, and in this group one periorbital infection occurred unrelated to orbital surgery (1.4%). Of the 411 cases (85.4%) not given perioperative IV antibiotics, 1 of 87 eviscerations with implants developed an SSI (1.1%), 2 of 273 enucleations with implants developed SSIs (0.7%), and none of the 13 enucleations without implants developed SSIs. To our knowledge, this is the first published case series reporting SSI rates of enucleations and eviscerations with implants performed without perioperative IV antibiotics or postoperative oral antibiotics. With infection rates comparing favorably to other case series where antibiotics were given, the routine use of perioperative IV antibiotics and postoperative oral antibiotics for enucleations and eviscerations may not be indicated.

Expression of recombinant human α-lactalbumin in milk of transgenic cloned pigs is sufficient to enhance intestinal growth and weight gain of suckling piglets.

PubMed

Ma, Jin; Li, Qiuyan; Li, Yan; Wen, Xiao; Li, Zhiyuan; Zhang, Zaihu; Zhang, Jiuming; Yu, Zhengquan; Li, Ning

2016-06-10

Human α-lactalbumin (HLA) has very high nutritional value and important physiological functions during the neonatal period. The peptides derived from HLA provide diverse health benefits including antimicrobial, antiviral, immune-modulating, and antihypertensive effects. Thus, it is worth investigating the effects on offspring development of increasing HLA in milk. In this study, we found that recombinant human α-lactalbumin (rHLA) exhibits efficient inhibition of dipeptidyl peptidase-IV (DPP-IV) activity in an in vitro simulated gastrointestinal digestion system. Using a BAC clone containing the complete HLA gene as a candidate vector, we generated two lines of transgenic cloned sows via somatic cell nuclear transfer that over-expressed rHLA. The average concentrations of rHLA in milk from the two lines of transgenic cloned sows were 2.24 ± 0.71 mg/ml and 2.67 ± 1.29 mg/ml. The feeding experiments revealed that rHLA represses dipeptidyl peptidase-IV (DPP-IV) activity in vivo. Furthermore, the piglets reared by rHLA transgenic cloned sows exhibit better performance in gain of body weight and intestine growth than the control piglets reared by non-transgenic sows. Therefore, these findings indicate that rHLA could serve as a natural precursor for a DPP-IV inhibitor, and the transgenic technology that produced the over-expression of rHLA could be a useful method for pig breeders to improve lactation performance. Copyright © 2016. Published by Elsevier B.V.

Is complete resection of high-risk stage IV neuroblastoma associated with better survival?

PubMed

Yeung, Fanny; Chung, Patrick Ho Yu; Tam, Paul Kwong Hang; Wong, Kenneth Kak Yuen

2015-12-01

The role of surgery in the management of stage IV neuroblastoma is controversial. In this study, we attempted to study if complete tumor resection had any impact on event-free survival (EFS) and overall survival (OS). A retrospective analysis of patients with stage IV neuroblastoma between November 2000 and July 2014 in a tertiary referral center was performed. Demographics data, extent of surgical resection, and outcomes were analyzed. A total of 34 patients with stage IV neuroblastoma according to International Neuroblastoma Staging System (INSS) were identified. The median age at diagnosis and operation was 3.5 (±1.9) years and 3.8 (±2.0) years, respectively. Complete gross tumor resection (CTR) was achieved in twenty-four patients (70.1%), in which one of the patients had nephrectomy and another had distal pancreatectomy. Gross total resection (GTR) with removal of >95% of tumor was performed in six patients (17.6%) and subtotal tumor resection (STR) with removal of >50%, but <95% of tumor was performed in four patients (11.8%). There was no statistical significance in terms of 5-year EFS and OS among the 3 groups. There was no surgery-related mortality or morbidity. From our center's experience, as there was no substantial survival benefit in stage IV neuroblastoma patients undergoing complete tumor resection, organ preservation and minimalization of morbidity should also be taken into consideration. Copyright © 2015. Published by Elsevier Inc.

Loss of the smallest subunit of cytochrome c oxidase, COX8A, causes Leigh-like syndrome and epilepsy.

PubMed

Hallmann, Kerstin; Kudin, Alexei P; Zsurka, Gábor; Kornblum, Cornelia; Reimann, Jens; Stüve, Burkhard; Waltz, Stephan; Hattingen, Elke; Thiele, Holger; Nürnberg, Peter; Rüb, Cornelia; Voos, Wolfgang; Kopatz, Jens; Neumann, Harald; Kunz, Wolfram S

2016-02-01

Isolated cytochrome c oxidase (complex IV) deficiency is one of the most frequent respiratory chain defects in humans and is usually caused by mutations in proteins required for assembly of the complex. Mutations in nuclear-encoded structural subunits are very rare. In a patient with Leigh-like syndrome presenting with leukodystrophy and severe epilepsy, we identified a homozygous splice site mutation in COX8A, which codes for the ubiquitously expressed isoform of subunit VIII, the smallest nuclear-encoded subunit of complex IV. The mutation, affecting the last nucleotide of intron 1, leads to aberrant splicing, a frame-shift in the highly conserved exon 2, and decreased amount of the COX8A transcript. The loss of the wild-type COX8A protein severely impairs the stability of the entire cytochrome c oxidase enzyme complex and manifests in isolated complex IV deficiency in skeletal muscle and fibroblasts, similar to the frequent c.845_846delCT mutation in the assembly factor SURF1 gene. Stability and activity of complex IV could be rescued in the patient's fibroblasts by lentiviral expression of wild-type COX8A. Our findings demonstrate that COX8A is indispensable for function of human complex IV and its mutation causes human disease. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Practical Guide To Solar Array Simulation And PCDU Test

NASA Astrophysics Data System (ADS)

Schmitz, Noah; Carroll, Greg; Clegg, Russell

2011-10-01

Solar arrays consisting of multiple photovoltaic segments provide power to satellites and charge internal batteries for use during eclipse. Solar arrays have unique I-V characteristics and output power which vary with environmental and operational conditions such as temperature, irradiance, spin, and eclipse. Therefore, specialty power solutions are needed to properly test the satellite on the ground, especially the Power Control and Distribution Unit (PCDU) and the Array Power Regulator (APR.) This paper explores some practical and theoretical considerations that should be taken into account when choosing a commercial, off-the-shelf solar array simulator (SAS) for verification of the satellite PCDU. An SAS is a unique power supply with I-V output characteristics that emulate the solar arrays used to power a satellite. It is important to think about the strengths and the limitations of this emulation capability, how closely the SAS approximates a real solar panel, and how best to design a system using SAS as components.

Practical strategies when using a stable isotope labeled microtracer for absolute bioavailability assessment: A case study of a high oral dose clinical candidate GDC-0810.

PubMed

Chen, Buyun; Lu, Pingping; Freeman, Dugan; Gao, Yang; Choo, Edna; DeMent, Kevin; Savage, Scott; Zhang, Kelly; Milanwoski, Dennis; Liu, Lichuan; Dean, Brian; Deng, Yuzhong

2018-05-30

The pH labile metabolite, hydrophobicity, high oral dose and systematic exposure of GDC-0810 posed tremendous challenges to develop a LC-MS method for a stable isotope labeled aBA study. In this study, we explored practical solutions to balance stability and sensitivity and to cope with the impact of high C p.o. to C i.v. ratio on the labeling selection and assay dynamic range. A [ 13 C 9 ] GDC-0810 was synthesized to minimize the isotopic interference between PO dose, internal standard and I.V. microtracer. A highly sensitive LC-MS assay was validated for quantitation of [ 13 C 9 ] GDC-0810 from 5 to 1250 pg/mL. The optimized method was applied to a proof of concept cynomolgus monkey aBA study and the bioavailability calculated using microtracer dosing and regular dosing were similar to each other. Copyright © 2018 Elsevier B.V. All rights reserved.

Should criteria be specified for depressive disorder not otherwise specified?

PubMed

Zimmerman, Mark; Martinez, Jennifer H; Dalrymple, Kristy; Chelminski, Iwona; Young, Diane

2013-05-01

Many patients have clinically significant symptoms of depression that do not meet the DSM-IV diagnostic thresholds for major depressive disorder (MDD) or dysthymic disorder. DSM-IV does not specify criteria for depressive disorder not otherwise specified (DDNOS). While it is not surprising that research on subthreshold depression has used diverse criteria, some consensus has emerged to define minor depression analogous to MDD, though requiring fewer than the 5 symptoms required to diagnose MDD. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined how many patients diagnosed with DDNOS met the DSM-IV proposed research criteria for minor depression, and we compared the demographic and clinical profiles of patients diagnosed with DDNOS who did and did not meet the criteria for minor depression Three thousand four hundred psychiatric patients presenting to the Rhode Island Hospital outpatient practice were evaluated with semi-structured diagnostic interviews for DSM-IV Axis I and Axis II disorders and measures of psychosocial morbidity. More than 6% of the 3400 patients were diagnosed with DDNOS (n=227). Only a minority of the patients with DDNOS met the criteria for minor depression (39.8%). There was no difference between patients with "subthreshold" depression who did and did not meet the DSM-IV research criteria for minor depression in demographic characteristics, the prevalence of comorbid Axis I or Axis II disorders, history of major depressive disorder, and family history of depression. The present study was conducted in a single outpatient practice in which the majority of patients were white, female, and had health insurance. Although the study was limited to a single site, a strength of the recruitment procedure was that the sample was not selected for participation in a treatment study, and exclusion and inclusion criteria did not reduce the representativeness of the patient groups. While we examined a number of validators, we did not systematically record the treatment the patients received and the outcome of treatment. Amongst psychiatric outpatients with clinically significant depression not meeting criteria for MDD or dysthymic disorder, there was little difference between patients who did and did not meet the DSM-IV research criteria for minor depressive disorder. Copyright © 2012 Elsevier B.V. All rights reserved.

Study of the relationship between mononuclear inflammatory infiltrate and Ki-67 and basement membrane and extracellular matrix protein expression in radicular cysts.

PubMed

Mourão, R V C; Júnior, E C Pinheiro; Barros Silva, P G; Turatti, E; Mota, M R L; Alves, A P N N

2016-05-01

To evaluate the relationship between mononuclear inflammatory infiltrate and the expression of a proliferative immunomarker (Ki-67) as well as to evaluate basement membrane and extracellular matrix proteins (laminin and collagen type IV) in radicular cysts and dentigerous cysts (DC). Immunohistochemical analyses were performed in heavily inflamed radicular cysts (HIRC), slightly inflamed radicular cysts (SIRC) and DC (n = 20) using Ki-67 (Dako(®) , 1 : 50), anticollagen type IV (DBS(®) , 1 : 40) and antilaminin (DBS(®) , 1 : 20). The data were analysed using anova/Tukey's test (Ki-67) and Kruskal-Wallis/Dunn's test (collagen type IV and laminin) (P < 0.05). The immunoexpression of Ki-67 was significantly greater in the SIRC group compared with the HIRC and DC (P = 0.0040). Likewise, the immunoexpression of collagen type IV in the basement membrane of the SIRC group was significantly more continuous (P = 0.0475) than in the HIRC group. DC had significantly less collagen type IV in extracellular matrix immunoexpression than HIRC and SIRC (P = 0.0246). Laminin was absent in the basement membrane in the SIRC and DC groups, and the extracellular matrix of the HIRC was weak and punctate. The presence of inflammatory factors in the radicular cyst wall modified the expression of proliferation factors in the epithelial lining and the expression of collagen type IV and laminin in the basement membrane, but did not modify extracellular matrix behaviour in radicular cysts. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV.

PubMed

Stinchfield, Randy; McCready, John; Turner, Nigel E; Jimenez-Murcia, Susana; Petry, Nancy M; Grant, Jon; Welte, John; Chapman, Heather; Winters, Ken C

2016-09-01

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5-DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.

[Evolution of non-invasive ventilation in acute bronchiolitis].

PubMed

Toledo del Castillo, B; Fernández Lafever, S N; López Sanguos, C; Díaz-Chirón Sánchez, L; Sánchez da Silva, M; López-Herce Cid, J

2015-08-01

The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis. A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study. A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased (P<.0001) in the second period, and the PICU length of stay was shorter (P=.011). The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Targeted pancreatic cancer therapy with the small molecule drug conjugate SW IV-134.

PubMed

Hashim, Yassar M; Spitzer, Dirk; Vangveravong, Suwanna; Hornick, Mary C; Garg, Gunjal; Hornick, John R; Goedegebuure, Peter; Mach, Robert H; Hawkins, William G

2014-07-01

Pancreatic adenocarcinoma is highly resistant to conventional therapeutics and has been shown to evade apoptosis by deregulation of the X-linked and cellular inhibitors of apoptosis proteins (XIAP and cIAP). Second mitochondria-derived activator of caspases (Smac) induces and amplifies cell death by reversing the anti-apoptotic activity of IAPs. Thus, Smac-derived peptide analogues (peptidomimetics) have been developed and shown to represent promising cancer therapeutics. Sigma-2 receptors are overexpressed in many proliferating tumor cells including pancreatic cancer. Selected ligands to this receptor are rapidly internalized by cancer cells. These characteristics have made the sigma-2 receptor an attractive target for drug delivery because selective delivery to cancer cells has the potential to increase therapeutic efficacy while minimizing toxicity to normal tissues. Here, we describe the initial characterization of SW IV-134, a chemically linked drug conjugate between the sigma-2 ligand SW43 and the Smac mimetic SW IV-52 as a novel treatment option for pancreatic adenocarcinoma. The tumor killing characteristics of our dual-domain therapeutic SW IV-134 was far greater than either component in isolation or in an equimolar mix and suggests enhanced cellular delivery when chemically linked to the sigma-2 ligand. One of the key findings was that SW IV-134 retained target selectivity of the Smac cargo with the involvement of the NF-κB/TNFα signaling pathway. Importantly, SW IV-134 slowed tumor growth and improved survival in murine models of pancreatic cancer. Our data support further study of this novel therapeutic and this drug delivery strategy because it may eventually benefit patients with pancreatic cancer. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

Intravenous iron administration strategies and anemia management in hemodialysis patients.

PubMed

Michels, Wieneke M; Jaar, Bernard G; Ephraim, Patti L; Liu, Yang; Miskulin, Dana C; Tangri, Navdeep; Crews, Deidra C; Scialla, Julia J; Shafi, Tariq; Sozio, Stephen M; Bandeen-Roche, Karen; Cook, Courtney J; Meyer, Klemens B; Boulware, L Ebony

2017-01-01

The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear. We performed an observational cohort study, in adult incident dialysis patients starting on hemodialysis. We defined IV administration strategies over a 12-week period following a patient's initiation of hemodialysis; all those receiving IV iron at regular intervals were considered maintenance, and all others were considered non-maintenance. We used multivariable models adjusting for demographics, clinical and treatment parameters, iron dose, measures of iron stores and pro-infectious and pro-inflammatory parameters to compare these strategies. The outcomes under study were patients' (i) achievement of hemoglobin (Hb) of 10-12 g/dL, (ii) more than 25% reduction in mean weekly erythropoietin stimulating agent (ESA) dose and (iii) mortality, ascertained over a period of 4 weeks following the iron administration period. Maintenance IV iron was administered to 4511 patients and non-maintenance iron to 8458 patients. Maintenance IV iron administration was not associated with a higher likelihood of achieving an Hb between 10 and 12 g/dL {adjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]} compared with non-maintenance, but was associated with a higher odds of achieving a reduced ESA dose of 25% or more [OR 1.33 (95% CI 1.18-1.49)] and lower mortality [hazard ratio (HR) 0.73 (95% CI 0.62-0.86)]. Maintenance IV iron strategies were associated with reduced ESA utilization and improved early survival but not with the achievement of Hb targets. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Managing acute acetaminophen poisoning with oral versus intravenous N-acetylcysteine: a provider-perspective cost analysis.

PubMed

Marchetti, Albert; Rossiter, Richard

2009-01-01

Acetaminophen (APAP) overdose, which can lead to hepatotoxicity, is the most commonly reported poisoning in the United States and has the highest rate of mortality, with more than 100,000 exposures and 300 deaths reported annually (1) . The treatment of choice, N-acetylcysteine (NAC), is effective in both oral (PO) and intravenous (IV) formulations. The main difference in therapies, other than administration route, is time to complete delivery--72 hours for PO NAC versus 21 hours for IV NAC, according to full prescribing information. This distinction is the primary basis for variation in management costs for hospitalized patients receiving these products. To quantify and compare full treatment costs from the provider perspective to manage acute APAP poisoning with either PO or IV NAC in a standard treatment regimen. A cost model was developed and populated with published data comprising probabilities of potential clinical outcomes and the costs of resources consumed during patient care. For patients who present <10 hours post-ingestion, the estimated total cost of care with PO NAC in the treatment regimen is $5,817 (ICU patients) or $3,850, (ward patients) compared with $3,765 and $2,768 for similar care with IV NAC. Potential cost savings equal - $2,052 (-35%) or -$1,083 (-28%), respectively, in favor of IV NAC. Similar potential savings were estimated for patients presenting 10-24 hours post-ingestion. IV NAC is the less costly therapeutic option for APAP poisonings, based on simulation modeling and retrospective data. The current economic evaluation is restricted by the absence of comparative data from head-to-head, matched-cohort studies and the limitations common to retrospective APAP toxicology datasets. Additional research could refine these results.

Molecular epidemiology of Methicillin-resistant Staphylococcus aureus in Africa: a systematic review

PubMed Central

Abdulgader, Shima M.; Shittu, Adebayo O.; Nicol, Mark P.; Kaba, Mamadou

2015-01-01

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a serious global problem, with considerable impact on patients and substantial health care costs. This systematic review provides an overview on the clonal diversity of MRSA, as well as the prevalence of Panton-Valentine leukocidin (PVL)-positive MRSA in Africa. A search on the molecular characterization of MRSA in Africa was conducted by two authors using predefined terms. We screened for articles published in English and French through to October 2014 from five electronic databases. A total of 57 eligible studies were identified. Thirty-four reports from 15 countries provided adequate genotyping data. CC5 is the predominant clonal complex in the healthcare setting in Africa. The hospital-associated MRSA ST239/ST241-III [3A] was identified in nine African countries. This clone was also described with SCCmec type IV [2B] in Algeria and Nigeria, and type V [5C] in Niger. In Africa, the European ST80-IV [2B] clone was limited to Algeria, Egypt and Tunisia. The clonal types ST22-IV [2B], ST36-II [2A], and ST612-IV [2B] were only reported in South Africa. No clear distinctions were observed between MRSA responsible for hospital and community infections. The community clones ST8-IV [2B] and ST88-IV [2B] were reported both in the hospital and community settings in Angola, Cameroon, Gabon, Ghana, Madagascar, Nigeria, and São Tomé and Príncipe. The proportion of PVL-positive MRSA carriage and/or infections ranged from 0.3 to 100% in humans. A number of pandemic clones were identified in Africa. Moreover, some MRSA clones are limited to specific countries or regions. We strongly advocate for more surveillance studies on MRSA in Africa. PMID:25983721

THE UNUSUAL VARIABLE HOT B SUBDWARF LS IV-14{sup 0}116

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

Green, E. M.; Guvenen, B.; O'Malley, C. J.

2011-06-10

We first present the results of follow-up photometric observations of the He-rich hot B subdwarf LS IV-14{sup 0}116, which confirm the presence of multiperiodic luminosity variations in the light curve of this star. Rather surprisingly, no other follow-up observations of this kind seem to have been published after the initial suggestion in 2005 that LS IV-14{sup 0}116 could be a pulsating star of a new kind. We were able to extract from our data at least six significant periodicities ranging from 1954 s to 5084 s, including the two oscillations uncovered previously. We also present the results of an analysismore » combining a high signal-to-noise optical spectrum of LS IV-14{sup 0}116 with recently developed non-local thermodynamic equilibrium model atmospheres and synthetic spectra. Our best estimates of the atmospheric parameters of this star are T{sub eff} = 34950 {+-} 250 K, log g = 5.93 {+-} 0.04, and log N(He)/N(H) = -0.62 {+-} 0.03 (formal fitting errors only). These place LS IV-14{sup 0}116 very near the region of maximum instability in the T{sub eff}-log g plane for short-period p-mode pulsators of the hot subdwarf type. If the luminosity variations are indeed due to pulsations, then LS IV-14{sup 0}116 poses a real challenge to current theory: how can such long observed periods (which would have to be associated with medium- to high-order g-modes) be excited at such a high effective temperature and surface gravity, while the short-period p-modes, more typically excited in this domain, are not observed in this particular star?« less

Interactions between superficial and deep dorsal horn spinal cord neurons in the processing of nociceptive information.

PubMed

Petitjean, Hugues; Rodeau, Jean-Luc; Schlichter, Rémy

2012-12-01

In acute rat spinal cord slices, the application of capsaicin (5 μm, 90 s), an agonist of transient receptor potential vanilloid 1 receptors expressed by a subset of nociceptors that project to laminae I-II of the spinal cord dorsal horn, induced an increase in the frequency of spontaneous excitatory and spontaneous inhibitory postsynaptic currents in about half of the neurons in laminae II, III-IV and V. In the presence of tetrodotoxin, which blocks action potential generation and polysynaptic transmission, capsaicin increased the frequency of miniature excitatory postsynaptic currents in only 30% of lamina II neurons and had no effect on the frequency of miniature excitatory postsynaptic currents in laminae III-V or on the frequency of miniature inhibitory postsynaptic currents in laminae II-V. When the communication between lamina V and more superficial laminae was interrupted by performing a mechanical section between laminae IV and V, capsaicin induced an increase in spontaneous excitatory postsynaptic current frequency in laminae II-IV and an increase in spontaneous inhibitory postsynaptic current frequency in lamina II that were similar to those observed in intact slices. However, in laminae III-IV of transected slices, the increase in spontaneous inhibitory postsynaptic current frequency was virtually abolished. Our results indicate that nociceptive information conveyed by transient receptor potential vanilloid 1-expressing nociceptors is transmitted from lamina II to deeper laminae essentially by an excitatory pathway and that deep laminae exert a 'feedback' control over neurons in laminae III-IV by increasing inhibitory synaptic transmission in these laminae. Moreover, we provide evidence that laminae III-IV might play an important role in the processing of nociceptive information in the dorsal horn. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures.

PubMed

Heinrich, Sebastian; Birkholz, Torsten; Ihmsen, Harald; Irouschek, Andrea; Ackermann, Andreas; Schmidt, Joachim

2012-08-01

Difficult laryngoscopy in pediatric patients undergoing anesthesia. This retrospective analysis was conducted to investigate incidence and predictors of difficult laryngoscopy in a large cohort of pediatric patients receiving general anesthesia with endotracheal intubation. Young age and craniofacial dysmorphy are predictors for the difficult pediatric airway and difficult laryngoscopy. For difficult laryngoscopy, other general predictors are not yet described. Retrospectively, from a 5-year period, data from 11.219 general anesthesia procedures in pediatric patients with endotracheal intubation using age-adapted Macintosh blades in a single center (university hospital) were analyzed statistically. The overall incidence of difficult laryngoscopy [Cormack and Lehane (CML) grade III and IV] was 1.35%. In patients younger than 1 year, the incidence of CML III or IV was significantly higher than in the older patients (4.7% vs 0.7%). ASA Physical Status III and IV, a higher Mallampati Score (III and IV) and a low BMI were all associated (P < 0.05) with difficult laryngoscopy. Patients undergoing oromaxillofacial surgery and cardiac surgery showed a significantly higher rate of CML III/IV findings. The general incidence of difficult laryngoscopy in pediatric anesthesia is lower than in adults. Our results show that the risk of difficult laryngoscopy is much higher in patients below 1 year of age, in underweight patients and in ASA III and IV patients. The underlying disease might also contribute to the risk. If the Mallampati score could be obtained, prediction of difficult laryngoscopy seems to be reliable. Our data support the existing recommendations for a specialized anesthesiological team to provide safe anesthesia for infants and neonates. © 2012 Blackwell Publishing Ltd.

Effect of Selective Prostaglandin E2 EP2 Receptor Agonist CP-533,536 on Voiding Efficiency in Rats with Midodrine-Induced Functional Urethral Obstruction.

PubMed

Kurihara, Ryoko; Imazumi, Katsunori; Takamatsu, Hajime; Ishizu, Kenichiro; Yoshino, Taiji; Masuda, Noriyuki

2016-05-01

We investigated the effect of the selective prostaglandin E2 EP2 receptor agonist CP-533,536 on voiding efficiency in rats with midodrine-induced functional urethral obstruction. The effect of CP-533,536 (0.03-0.3 mg/kg, intravenous [i.v.]) on urethral perfusion pressure (UPP) was investigated in anesthetized rats pre-treated with midodrine (1 mg/kg, i.v.), which forms an active metabolite that acts as an α1 -adrenoceptor agonist. The effect of CP-533,536 (0.03-0.3 mg/kg, i.v.) on cystometric parameters was also investigated in anesthetized rats. In addition, the effect of CP-533,536 (0.03-0.3 mg/kg, i.v.) on residual urine volume (RV) and voiding efficiency (VE) was investigated in conscious rats treated with midodrine (1 mg/kg, i.v.). CP-533,536 dose-dependently decreased UPP elevated by midodrine in anesthetized rats. In contrast, CP-533,536 did not affect maximum voiding pressure, intercontraction interval, or intravesical threshold pressure. In conscious rats, midodrine (1 mg/kg, i.v.) markedly increased RV and reduced VE. CP-533,536 dose-dependently ameliorated increases in RV and decreases in VE induced by midodrine. These results suggest that a selective EP2 receptor agonist could ameliorate the elevation of RV and improve the reduction of VE in rats with functional urethral obstruction caused by stimulation of α1 -adrenoceptors. The mechanism of action might be not potentiation of bladder contraction but rather preferential relief of urethral constriction. © 2014 Wiley Publishing Asia Pty Ltd.

Bosniak Classification for Complex Renal Cysts Reevaluated: A Systematic Review.

PubMed

Schoots, Ivo G; Zaccai, Keren; Hunink, Myriam G; Verhagen, Paul C M S

2017-07-01

We systematically evaluated the Bosniak classification system with malignancy rates of each Bosniak category, and assessed the effectiveness related to surgical treatment and oncologic outcome based on recurrence and/or metastasis. In a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria, we selected 39 publications for inclusion in this analysis and categorized them into 1) surgical cohorts-all cysts treated surgically and 2) radiological cohorts-cysts with surgical treatment or radiological followup. A total of 3,036 complex renal cysts were categorized into Bosniak II, IIF, III and IV. In surgical and radiological cohorts pooled estimates showed a malignancy prevalence of 0.51 (0.44, 0.58) in Bosniak III and 0.89 (0.83, 0.92) in Bosniak IV cysts, respectively. Stable Bosniak IIF cysts showed a malignancy rate of less than 1% during radiological followup (surveillance). Bosniak IIF cysts, which showed reclassification to the Bosniak III/IV category during radiological followup (12%), showed malignancy in 85%, comparable to Bosniak IV cysts. The estimated surgical number needed to treat to avoid metastatic disease of Bosniak III and IV cysts was 140 and 40, respectively. The effectiveness of the Bosniak classification system for complex renal cysts was high in categories II, IIF and IV, but low in category III, and 49% of Bosniak III cysts was overtreated because of a benign outcome. This surgical overtreatment combined with the excellent outcome for Bosniak III cysts may suggest that surveillance is a rational alternative to surgery. This will require further study to assess whether surveillance of Bosniak III cysts will prove safe. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Is combined use of intravenous and intraarticular tranexamic acid superior to intravenous or intraarticular tranexamic acid alone in total knee arthroplasty? A meta-analysis of randomized controlled trials.

PubMed

Mi, Bobin; Liu, Guohui; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

2017-04-18

Tranexamic acid (TXA) has been proven to be effective in reducing blood loss and transfusion rate after total knee arthroplasty (TKA) without increasing the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). Recently, an increasing number of studies have been interested in applying combined intravenous (IV) with intraarticular (IA) tranexamic acid in total knee arthroplasty. The purpose of this meta-analysis was to compare the blood loss and complications of combined TXA with IV TXA or IA TXA on TKA. Systematic search of literatures were conducted to identify related articles that were published in PubMed, MEDLINE, Embase, the Cochrane Library, SpringerLink, ClinicalTrials.gov, and Ovid from their inception to September 2016. All studies that compare blood loss and complications of combined TXA and IV TXA or IA TXA on TKA were included. Main outcomes were collected and analyzed by the Review Manager 5.3. Five studies were included in the present meta-analysis. There was significant difference in total blood loss and blood volume of drainage when compared combined TXA group with IV TXA group or IA TXA group (P < 0.05). There was no difference in transfusion rate and thromboembolic complications when comparing combined TXA with IV TXA or IA TXA alone (P > 0.05). Compared with administration of IA TXA or IV TXA alone on TKA, combined use of TXA has advantages in reducing total blood loss and blood volume of drainage without increasing the incidence of thromboembolic complications. We recommend combined TXA as the preferred option for patients undergoing TKA.

Comparison of treatment outcome using two definitions of rapid cycling in subjects with bipolar II disorder.

PubMed

Amsterdam, Jay D; Lorenzo-Luaces, Lorenzo; DeRubeis, Robert J

2017-02-01

We examined differences in treatment outcome between Diagnostic and Statistical Manual Fourth Edition (DSM-IV)-defined rapid cycling and average lifetime-defined rapid cycling in subjects with bipolar II disorder. We hypothesized that, compared with the DSM-IV definition, the average lifetime definition of rapid cycling may better identify subjects with a history of more mood lability and a greater likelihood of hypomanic symptom induction during long-term treatment. Subjects ≥18 years old with a bipolar II major depressive episode (n=129) were categorized into DSM-IV- and average lifetime-defined rapid cycling and prospectively treated with either venlafaxine or lithium monotherapy for 12 weeks. Responders (n=59) received continuation monotherapy for six additional months. These exploratory analyses found moderate agreement between the two rapid-cycling definitions (κ=0.56). The lifetime definition captured subjects with more chronic courses of bipolar II depression, whereas the DSM-IV definition captured subjects with more acute symptoms of hypomania. There was no difference between rapid-cycling definitions with respect to the response to acute venlafaxine or lithium monotherapy. However, the lifetime definition was slightly superior to the DSM-IV definition in identifying subjects who went on to experience hypomanic symptoms during continuation therapy. Although sample sizes were limited, the findings suggest that the lifetime definition of rapid cycling may identify individuals with a chronic rapid-cycling course and may also be slightly superior to the DSM-IV definition in identifying individuals with hypomania during relapse-prevention therapy. These findings are preliminary in nature and need replication in larger, prospective, bipolar II studies. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Finite element analysis of maxillary bone stress caused by Aramany Class IV obturator prostheses.

PubMed

Miyashita, Elcio Ricardo; Mattos, Beatriz Silva Câmara; Noritomi, Pedro Yoshito; Navarro, Hamilton

2012-05-01

The retention of an Aramany Class IV removable partial dental prosthesis can be compromised by a lack of support. The biomechanics of this obturator prosthesis result in an unusual stress distribution on the residual maxillary bone. This study evaluated the biomechanics of an Aramany Class IV obturator prosthesis with finite element analysis and a digital 3-dimensional (3-D) model developed from a computed tomography scan; bone stress was evaluated according to the load placed on the prosthesis. A 3-D model of an Aramany Class IV maxillary resection and prosthesis was constructed. This model was used to develop a finite element mesh. A 120 N load was applied to the occlusal and incisal platforms corresponding to the prosthetic teeth. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis were expressed in MPa. Under posterior load, tensile and compressive stresses were observed; the tensile stress was greater than the compressive stress, regardless of the bone region, and the greatest compressive stress was observed on the anterior palate near the midline. Under an anterior load, tensile stress was observed in all of the evaluated bone regions; the tensile stress was greater than the compressive stress, regardless of the bone region. The Aramany Class IV obturator prosthesis tended to rotate toward the surgical resection when subjected to posterior or anterior loads. The amount of tensile and compressive stress caused by the Aramany Class IV obturator prosthesis did not exceed the physiological limits of the maxillary bone tissue. (J Prosthet Dent 2012;107:336-342). Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Rethinking Research Ethics: The Case of Postmarketing Trials

PubMed Central

London, Alex John; Carlisle, Benjamin

2015-01-01

Phase IV studies are often criticized for poor scientific standards. Yet they provide an important resource for addressing evidence shortfalls in drug safety, comparative effectiveness, and real-world utility. Current research ethics policies, and contemplated revisions to them, do not provide an adequate framework for preventing social harms that result from poor post-marketing research practice. Rather than focus exclusively on the welfare and interests of human volunteers, research policies and ethics should also safeguard the integrity of the research enterprise as a system for producing reliable medical evidence. We close by briefly describing how an integrity framework might be implemented for phase IV studies. PMID:22556237

Improving Efficiency Using a Hybrid Approach: Revising an Intravenous/Blood Workshop in a Clinical Research Environment.

PubMed

Parchen, Debra A; Phelps, Sandra E; Johnson, Eunice M; Fisher, Cheryl A

2016-01-01

Orienting to a new job can be overwhelming, especially if the nurse is required to develop or refine new skills, such as intravenous (IV) therapy or blood administration. At the National Institutes of Health Clinical Center Nursing Department, a group of nurse educators redesigned their IV/Blood Workshop to prepare nurses with skills needed when caring for patients on protocol in a research intensive environment. Innovative teaching strategies and a hybrid instructional approach were used along with a preworkshop activity, skills lab practice, and follow-up skill validation at the unit level to provide a comprehensive curriculum while decreasing resource utilization.

Update in perioperative medicine: practice changing evidence published in 2016.

PubMed

Regan, Dennis W; Kashiwagi, Deanne; Dougan, Brian; Sundsted, Karna; Mauck, Karen

2017-10-01

This summary reviews 18 key articles published in 2016 which have significant practice implications for the perioperative medical care of surgical patients. Due to the multi-disciplinary nature of the practice of perioperative medicine, important new evidence is published in journals representing a variety of medical and surgical specialties. Keeping current with the evidence that drives best practice in perioperative medicine is therefore challenging. We set out to identify, critically review, and summarize key evidence which has the most potential for practice change. We integrated the new evidence into the existing body of medical knowledge and identified practical implications for real world patient care. The articles address issues related to anticoagulation, transfusion threshold, immunosuppressive medications, postoperative delirium, myocardial injury after noncardiac surgery, postoperative pain management, perioperative management of antihypertensives, perioperative fasting, and perioperative diabetic control.

Goodpasture's autoimmune disease - A collagen IV disorder.

PubMed

Pedchenko, Vadim; Richard Kitching, A; Hudson, Billy G

2018-05-12

Goodpasture's (GP) disease is an autoimmune disorder characterized by the deposition of pathogenic autoantibodies in basement membranes of kidney and lung eliciting rapidly progressive glomerulonephritis and pulmonary hemorrhage. The principal autoantigen is the α345 network of collagen IV, which expression is restricted to target tissues. Recent discoveries include a key role of chloride and bromide for network assembly, a novel posttranslational modification of the antigen, a sulfilimine bond that crosslinks the antigen, and the mechanistic role of HLA in genetic susceptibility and resistance to GP disease. These advances provide further insights into molecular mechanisms of initiation and progression of GP disease and serve as a basis for developing of novel diagnostic tools and therapies for treatment of Goodpasture's disease. Copyright © 2017. Published by Elsevier B.V.

The nociception genes painless and Piezo are required for the cellular immune response of Drosophila larvae to wasp parasitization.

PubMed

Tokusumi, Yumiko; Tokusumi, Tsuyoshi; Schulz, Robert A

2017-05-13

In vertebrates, interaction between the nervous system and immune system is important to protect a challenged host from stress inputs from external sources. In this study, we demonstrate that sensory neurons are involved in the cellular immune response elicited by wasp infestation of Drosophila larvae. Multidendritic class IV neurons sense contacts from external stimuli and induce avoidance behaviors for host defense. Our findings show that inactivation of these sensory neurons impairs the cellular response against wasp parasitization. We also demonstrate that the nociception genes encoding the mechanosensory receptors Painless and Piezo, both expressed in class IV neurons, are essential for the normal cellular immune response to parasite challenge. Copyright © 2017. Published by Elsevier Inc.

Object permanence in cats: Analysis in locomotor space.

PubMed

Thinus-Blanc, C; Poucet, B; Chapuis, N

1982-04-01

Stages IV and V object permanence were studied with 38-40-week-old cats. A constraining apparatus preventing animals from pursuing the bowl containing meat before it was concealed was used. Either the bowl was seen moving and disappeared from view behind a screen (stage IV trials), or after this sequence, it reappeared from behind the first screen and disappeared behind a second screen (stage V trials). In both situations cats performed significantly above chance but the paths taken to reach the food were different according to the stage. In stage V trials, cats expressed a preference for the path leading to the end of the second screen where the food was last seen disappearing. Copyright © 1982. Published by Elsevier B.V.

The Clinical and Immunologic Features of Patients With Combined Anti-GBM Disease and Castleman Disease.

PubMed

Gu, Qiu-Hua; Jia, Xiao-Yu; Hu, Shui-Yi; Wang, Su-Xia; Zou, Wan-Zhong; Cui, Zhao; Zhao, Ming-Hui

2018-06-01

Patients with both anti-glomerular basement membrane (anti-GBM) disease and Castleman disease have been rarely reported. In this study, we report 3 patients with this combination. They had immunologic features similar to patients with classic anti-GBM disease. Sera from the 3 patients recognized the noncollagenous (NC) domain of the α3 chain of type IV collagen (α3(IV)NC1) and its 2 major epitopes, EA and EB. All 4 immunogloblin G (IgG) subclasses against α3(IV)NC1 were detectable, with predominance of IgG1. In one patient with lymph node biopsy specimens available, sporadic plasma cells producing α3(IV)NC1-IgG were found, suggesting a causal relationship between the 2 diseases. One patient, who achieved remission with antibody clearance and normalization of serum creatinine and interleukin 6 concentrations after plasma exchange and 3 cycles of chemotherapy, experienced recurrence of anti-GBM antibodies and an increase in interleukin 6 concentration after chemotherapy discontinuation because of adverse effects, but both returned to normal after another cycle of chemotherapy. This clinical course and the pathologic findings support the hypothesis that the Castleman disease-associated tumor cells are the source of the anti-GBM autoantibodies. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Effectiveness of Cognitive-behavioral Program on Pain and Fear in School-aged Children Undergoing Intravenous Placement.

PubMed

Hsieh, Yi-Chuan; Cheng, Su-Fen; Tsay, Pei-Kwei; Su, Wen-Jen; Cho, Yen-Hua; Chen, Chi-Wen

2017-12-01

This study aimed to evaluate the effects of cognitive-behavioral program on pain and medical fear in hospitalized school-aged children receiving intravenous (IV) placement. This study used an quasi-experimental design. Thirty-five participants were assigned to the experimental group and 33 to the control group in the acute internal medicine ward of a children's hospital. The cognitive-behavioral program entailed having the patients read an educational photo book about IV placement before the procedure and having them watch their favorite music video during the procedure. The outcome measures were numeric rating scales for pain intensity and fear during the procedure. After applying the cognitive-behavioral program, the mean scores on pain and fear decreased in the experimental group. However, the difference in pain intensity between these two groups was nonsignificant. The intensity of fear in the experimental group was significantly lower than that in the control group. In this study, the cognitive-behavioral program used with school-aged hospitalized children promoted less fear during IV placement. The results of this study can serve as a reference for empirical nursing care and as care guidance for clinical IV injections involving children. Copyright © 2017. Published by Elsevier B.V.

Two case reports-Use of relative motion orthoses to manage extensor tendon zones III and IV and sagittal band injuries in adjacent fingers.

PubMed

Hirth, Melissa J; Howell, Julianne W; O'Brien, Lisa

Case report. Injuries to adjacent fingers with differing extensor tendon (ET) zones and/or sagittal band pose a challenge to therapists as no treatment guidelines exist. This report highlights how the relative motion flexion/extension (RMF/RME) concepts were combined into one orthosis to manage a zone IV ET repair (RME) and a zone III central slip repair (RMF) in adjacent fingers (Case 1); and how a single RME orthosis was adapted to limit proximal interphalangeal joint motion to manage multi-level ET zone III-IV injuries and a sagittal band repair in adjacent fingers (case 2). Adapted relative motion orthoses allowed early active motion and graded exercises based on clinical reasoning and evidence. Outcomes were standard TAM% and Miller's criteria. 'Excellent' and 'good' outcomes were achieved by twelve weeks post surgery. Both cases returned to unrestricted work at 6 and 7 weeks. Neither reported functional deficits at discharge. Outcomes in 2 cases involving multiple digit injuries exceeded those previously reported for ET zone III-IV repairs. Relative motion orthoses can be adapted and applied to multi-finger injuries, eliminating the need for multiple, bulky or functionally-limiting orthoses. 4. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry.

PubMed

Holmes, David R; Nishimura, Rick A; Grover, Frederick L; Brindis, Ralph G; Carroll, John D; Edwards, Fred H; Peterson, Eric D; Rumsfeld, John S; Shahian, David M; Thourani, Vinod H; Tuzcu, E Murat; Vemulapalli, Sreekanth; Hewitt, Kathleen; Michaels, Joan; Fitzgerald, Susan; Mack, Michael J

2015-12-29

The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. This report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers. The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared. Comparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%. The TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement. Copyright © 2015 American College of Cardiology Foundation and The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations.

PubMed

Knowles, C H; Grossi, U; Horrocks, E J; Pares, D; Vollebregt, P F; Chapman, M; Brown, S; Mercer-Jones, M; Williams, A B; Yiannakou, Y; Hooper, R J; Stevens, N; Mason, J

2017-09-01

This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR). Summary of review data, development of GPR and future research recommendations as outlined in detail in the 'introduction and methods' paper. The overall quality of data in the five reviews was poor with 113/156(72.4%) of included studies providing only level IV evidence and only four included level I RCTs. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred 'prototype' GPRs developed by the clinical guideline group, 85/100 were deemed 'appropriate' based on the independent scoring of a panel of 18 European experts and use of RAND-UCLA consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential RCTs but also a strong emphasis on delivery of large multinational high-quality prospective cohort studies. While the evidence base for surgery in CC is poor, the widespread European consensus for GPRs is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines. © 2017 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.

Current status of intravenous thrombolysis for acute ischemic stroke in Asia.

PubMed

Sharma, Vijay K; Ng, Kay W P; Venketasubramanian, Narayanaswamy; Saqqur, Maher; Teoh, Hock L; Kaul, Subash; Srivastava, Padma M V; Sergentanis, Theodoris; Suwanwela, Nijasri; Nguyen, Thang H; Lawrence Wong, K S; Chan, Bernard P L

2011-12-01

Data regarding thrombolysis for acute ischemic stroke in Asia are scarce and only a small percentage of patients are thrombolysed. The dose of intravenous tissue plasminogen activator (IV-tPA) in Asia remains controversial. Case-controlled observation studies in Asia included only Japanese patients and suggested the clinical efficacy and safety of low-dose IV-tPA (0.6 mg/kg body weight; max 60 mg) comparable to standard dose (0.9 mg/kg body weight; max. 90 mg). Reduced treatment cost, lower symptomatic intracerebral hemorrhage risk and comparable efficacy encouraged many Asian centers to adopt low-dose or even variable-dose IV-tPA regimens. We evaluated various Asian thrombolysis studies and compared with SITS-MOST registry and NINDS trial. We included the published studies on acute ischemic stroke thrombolysis in Asia. Unadjusted relative risks and 95% Confidence intervals were calculated for each study. Pooled estimates from random effects models were used because the tests for heterogeneity were significant. We found only 18 publications regarding acute ischemic stroke thrombolysis in Asia that included total of 9300 patients. Owing to ethnic differences, stroke severity, small number of cases in individual reports, outcome measures and tPA dose regimes, it is difficult to compare these studies. Functional outcomes were almost similar (to Japanese studies) when lower-dose IV-tPA was used in non-Japanese populations across Asia. Interestingly, with standard dose IV-tPA, considerably better functional outcomes were observed, without increasing symptomatic intracerebral hemorrhage rates. Variable dose regimens of IV-tPA are used across Asia without any reliable or established evidence. Establishing a uniform IV-tPA regimen is essential since the rapid improvements in health-care facilities and public awareness are expected to increase the rates of thrombolysis in Asia. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Choice of intravenous antibiotic prophylaxis for colorectal surgery does matter.

PubMed

Deierhoi, Rhiannon J; Dawes, Lillian G; Vick, Catherine; Itani, Kamal M F; Hawn, Mary T

2013-11-01

The Surgical Care Improvement Program endorses mandatory compliance with approved intravenous prophylactic antibiotics; however, oral antibiotics are optional. We hypothesized that surgical site infection (SSI) rates may vary depending on the choice of antibiotic prophylaxis. A retrospective cohort study of elective colorectal procedures using Veterans Affairs Surgical Quality Improvement Program (VASQIP) and SSI outcomes data was linked to the Office of Informatics and Analytics (OIA) and Pharmacy Benefits Management (PBM) antibiotic data from 2005 to 2009. Surgical site infection rates by type of IV antibiotic agent alone (IV) or in combination with oral antibiotic (IV + OA) were determined. Generalized estimating equations were used to examine the association between type of antibiotic prophylaxis and SSI for the entire cohort and stratified by use of oral antibiotics. After 5,750 elective colorectal procedures, 709 SSIs (12.3%) developed within 30 days. Oral antibiotic + IV (n = 2,426) had a lower SSI rate than IV alone (n = 3,324) (6.3% vs 16.7%, p < 0.0001). There was a significant difference in the SSI rate based on type of preoperative IV antibiotic given (p ≤ 0.0001). Generalized estimating equations adjusting for significant covariates of age, body mass index, procedure work relative value units, and operation duration demonstrated an independent protective effect of oral antibiotics (odds ratio [OR] 0.37, 95% CI 0.29 to 0.46), as well as increased rates of SSI associated with ampicillin/sulbactam (OR 2.21, 95% CI 1.37 to 3.56) and second generation cephalosporins (cefoxitin, OR 2.50, 95% CI 1.83 to 3.42; cefotetan, OR 2.70, 95% CI 1.72 to 4.22) when compared with first generation cephalosporin/metronidazole. The choice of IV antibiotic was related to the SSI rate; however, oral antibiotics were associated with reduced SSI rate for every antibiotic class. Published by Elsevier Inc.

Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study.

PubMed

Mattila, Marja-Leena; Kielinen, Marko; Linna, Sirkka-Liisa; Jussila, Katja; Ebeling, Hanna; Bloigu, Risto; Joseph, Robert M; Moilanen, Irma

2011-06-01

The latest definitions of autism spectrum disorders (ASDs) were specified in DSM-IV-TR in 2000. DSM-5 criteria are planned for 2013. Here, we estimated the prevalence of ASDs and autism according to DSM-IV-TR, clarified confusion concerning diagnostic criteria, and evaluated DSM-5 draft criteria for ASD posted by the American Psychiatry Association (APA) in February 2010. This was an epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (81%) of them rated via the Autism Spectrum Screening Questionnaire by parents and/or teachers, and 110 examined by using a structured interview, semi-structured observation, IQ measurement, school-day observation, and patient records. Diagnoses were assigned according to DSM-IV-TR criteria and DSM-5 draft criteria in children with a full-scale IQ (FSIQ) ≥50. Patient records were evaluated in children with an FSIQ <50 to discover diagnoses of ASDs. The prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 in 1,000 according to DSM-IV-TR. Of the subjects with ASDs and autism, 65% and 61% were high-functioning (FSIQ ≥70), respectively. The prevalence of pervasive developmental disorder not otherwise specified was not estimated because of inconsistency in DSM-IV-TR criteria. DSM-5 draft criteria were shown to be less sensitive in regard to identification of subjects with ASDs, particularly those with Asperger's syndrome and some high-functioning subjects with autism. DSM-IV-TR helps with the definition of ASDs only up to a point. We suggest modifications to five details of DSM-5 draft criteria posted by the APA in February 2010. Completing revision of DSM criteria for ASDs is a challenging task. Copyright © 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Reference Accuracy among Research Articles Published in "Research on Social Work Practice"

ERIC Educational Resources Information Center

Wilks, Scott E.; Geiger, Jennifer R.; Bates, Samantha M.; Wright, Amy L.

2017-01-01

Objective: The objective was to examine reference errors in research articles published in Research on Social Work Practice. High rates of reference errors in other top social work journals have been noted in previous studies. Methods: Via a sampling frame of 22,177 total references among 464 research articles published in the previous decade, a…

DIFFERENCES IN THE PROFILES OF DSM-IV AND DSM-5 ALCOHOL USE DISORDERS: IMPLICATIONS FOR CLINICIANS

PubMed Central

Dawson, Deborah A.; Goldstein, Risë B.; Grant, Bridget F.

2013-01-01

Background Existing information on consequences of the DSM-5 revision for diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice. Methods Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared three mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder and those positive for both. Results Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p<.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (≥4 vs. ≥3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White and male, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter. Conclusions Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector. PMID:22974144

49 CFR 538.7 - Petitions for reduction of minimum driving range.

Code of Federal Regulations, 2010 CFR

2010-10-01

... type treated as an electric dual fueled automobile. (3) Be written in the English language. (4) State... displacement and type, electric storage capacity, transmission type, and average fuel economy when operating on...) Economic practicability; (iv) Technology; (v) Environmental impact; (vi) Safety; (vii) Driveability; and...

5 CFR 4.3 - Prohibition against securing withdrawal from competition.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Prohibition against securing withdrawal from competition. 4.3 Section 4.3 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES PROHIBITED PRACTICES (RULE IV) § 4.3 Prohibition against securing withdrawal from competition. No...

5 CFR 4.1 - Prohibition against political activity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Prohibition against political activity. 4.1 Section 4.1 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE RULES PROHIBITED PRACTICES (RULE IV) § 4.1 Prohibition against political activity. No person employed in the executive branch...

Effect of piracetam and nimodipine on full-thickness skin burns in rabbits.

PubMed

Sari, Elif; Dincel, Gungor C

2016-08-01

The potential of several drugs for full-thickness skin burns has been investigated, but the treatment of such burns remains a challenge in plastic surgery. The present study was designed to determine the effect of systemic and topical administration of piracetam and nimodipine on full-thickness skin burn wound healing. A total of 36 New Zealand male rabbits were divided into six groups. Full-thickness skin burns were produced in all the groups, except the control group. Piracetam was administered systemically (piracetam-IV) and topically (piracetam-C) for 14 days, and nimodipine was administered systemically (nimodipine-IV) and topically (nimodipine-C) over the burn wounds for 14 days. The sham group underwent burn injury but was not administered any drug. After 21 days, gross examination and histopathological analysis were performed and the results were compared statistically. Nimodipine-C and nimodipine-IV had no effect on burn wound healing. However, both piracetam-IV and piracetam-C significantly enhanced the healing of the full-thickness skin burn wounds, although the latter was more effective, useful and practical in burn wound healing. The histopathological features of the wounds in the piracetam-C group were closer to those of the control group than those of the other groups. Piracetam-C rather than piracetam-IV may promote full-thickness burn wound healing in rabbits. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Report on Predatory Lending Practices Directed at Members of the Armed Forces and Their Dependents

DTIC Science & Technology

2006-08-09

implemented by the Military Services that may have particular impact on predatory lending is “Military Saves,” which is a social marketing campaign to...Around Military Communities 10 4 Education Programs 23 5 Strategies and Practices to Reduce the Prevalence and Impact of Predatory Lending 28 6...57 3 Survey on Internet Payday Loan and Installment Lenders 63 4 DoD Strategy for Personal Finance 68 5 Leadership Messages 82 iii iv 1

Special Operations Forces Language Transformation Strategy Needs Assessment Project: Air Force Operator Survey Report

DTIC Science & Technology

2004-10-15

CAT III/IV Language More difficult languages to acquire for native English speakers. Examples: Cantonese , Japanese, Arabic, Dari, Pashto, Turkish...conversations on practical, social , and professional topics in my required AOR language. 64.1 62.0 68.8 SOF Language Transformation Strategy Needs...practical, social , and professional topics in the language required by my AOR assignment. 39 3.6 1.29 64.1 7.7 17.9 12.8 33.3 28.2 SOF

Special Operations Forces Language Transformation Strategy Needs Assessment Project: Final Project Report

DTIC Science & Technology

2005-03-15

German (includes romance languages, etc.) CAT III/IV Language More difficult languages to acquire for native English speakers. Examples: Cantonese ...conversations on practical, social , and professional topics in my required AOR language. 52.9 62.1 51.9 51.9 52.0 SOF Language Transformation...67.6 85.7 77.2 67.5 71.9 73.1 63.6 67.6 63.0 I feel confident in my ability to participate in informal conversations on practical, social , and

The Psychiatric Cultural Formulation: Applying Medical Anthropology in Clinical Practice

PubMed Central

Aggarwal, Neil Krishan

2014-01-01

This paper considers revisions to the DSM-IV Outline for Cultural Formulation from the perspective of clinical practice. First, the paper explores the theoretical development of the Cultural Formulation. Next, a case presentation demonstrates challenges in its actual implementation. Finally, the paper recommends a set of questions for the clinician on barriers to care and countertransference. The development of a standardized, user-friendly format can increase the Cultural Formulation’s utilization among all psychiatrists beyond those specializing in cultural psychiatry. PMID:22418398

Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

ERIC Educational Resources Information Center

Beckley, Firle; Best, Wendy; Beeke, Suzanne

2017-01-01

Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

[Alcohol-related cognitive impairment and the DSM-5].

PubMed

Walvoort, S J W; Wester, A J; Doorakkers, M C; Kessels, R P C; Egger, J I M

2016-01-01

It is evident from the dsm-iv-tr that alcohol-related impairment is extremely difficult to classify accurately. As a result, cognitive deficits can easily be overlooked. The dsm-5, however, incorporates a new category, namely 'neurocognitive disorders', which may lead to significant improvements in clinical practice. To compare the classification of alcohol-related cognitive dysfunction in dsm-iv-tr and dsm-5 and to discuss the clinical relevance of the revised classification in the dsm-5. We compare the chapters of the dsm-iv-tr and the dsm-5 concerning alcohol-related cognitive impairment and describe the changes that have been made. The dsm-5 puts greater emphasis on alcohol-related neurocognitive impairment. Not only does dsm-5 distinguish between the degree of severity (major or minor neurocognitive disorder), it also distinguishes between the type of impairment (non-amnestic-type versus confabulating-amnestic type). It also makes a distinction between the durations of impairment (behavioural and/or persistent disorders). The dsm-5 gives a clearer description of alcohol-related neurocognitive dysfunction than does dsm-iv-tr and it stresses the essential role of neuropsychological assessment in the classification, diagnosis, and treatment of neurocognitive disorders.

Fundamental Understanding of Crack Growth in Structural Components of Generation IV Supercritical Light Water Reactors

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

Iouri I. Balachov; Takao Kobayashi; Francis Tanzella

2004-11-17

This work contributes to the design of safe and economical Generation-IV Super-Critical Water Reactors (SCWRs) by providing a basis for selecting structural materials to ensure the functionality of in-vessel components during the entire service life. During the second year of the project, we completed electrochemical characterization of the oxide film properties and investigation of crack initiation and propagation for candidate structural materials steels under supercritical conditions. We ranked candidate alloys against their susceptibility to environmentally assisted degradation based on the in situ data measure with an SRI-designed controlled distance electrochemistry (CDE) arrangement. A correlation between measurable oxide film properties andmore » susceptibility of austenitic steels to environmentally assisted degradation was observed experimentally. One of the major practical results of the present work is the experimentally proven ability of the economical CDE technique to supply in situ data for ranking candidate structural materials for Generation-IV SCRs. A potential use of the CDE arrangement developed ar SRI for building in situ sensors monitoring water chemistry in the heat transport circuit of Generation-IV SCWRs was evaluated and proved to be feasible.« less

Intravenous fluid temperature management by infrared thermometer.

PubMed

Lapostolle, Frédéric; Catineau, Jean; Le Toumelin, Philippe; Proust, Clément; Garrigue, Bruno; Galinski, Michel; Adnet, Frédéric

2006-03-01

The management of intravenous (IV) fluid temperature is a daily challenge in critical care, anesthesiology, and emergency medicine. Infusion of IV fluids at the right temperature partly influences clinical outcomes of critically ill patients. Nowadays, intravenous fluid temperature is poorly managed, as no suitable device is routinely available. Infrared (IR) thermometers have been recently developed for industrial, personal, or medical purposes. The aim of this study was to evaluate the accuracy of an IR thermometer in measuring temperature of warmed and cooled infusion fluids in fluid bags. This study compared temperatures simultaneously recorded by an infrared thermometer and a temperature sensor. Temperatures of warmed (41 degrees C) and cooled (4 degrees C) infusion fluids in fluid bags were recorded by 2 independent operators every minute until IV bags' temperature reached ambient temperature. The relation curve was established with 576 measures. Temperature measures performed with an IR thermometer were perfectly linear and perfectly correlated with the reference method (R(2) = 0.995, P < 10(-5)). Infrared thermometers are efficient to measure IV fluid bag temperature in the range of temperatures used in clinical practice. As these devices are easy to use and inexpensive, they could be largely used in critical care, anesthesiology, or emergency medicine.

Treatment of mild to moderate dehydration in children with oral rehydration therapy.

PubMed

Diggins, Kristene C

2008-08-01

To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children. Recommendations from American Academy of Pediatrics (AAP), World Health Organization (WHO), selected research articles (2000-2006), and Internet sources. Dehydration is a common diagnosis in pediatric primary care. The literature indicates that dehydration is more often treated with intravenous (IV) therapy when ORT would be equally effective. ORT is an effective treatment for children with mild to moderate dehydration. ORT could be used more frequently rather than IV rehydration therapy. The use of ORT versus traditional methods of IV hydration matches the nursing philosophy of holistic care by enhancing client comfort and autonomy. Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.

Challenges and Opportunities for Harmonizing Research Methodology: Raw Accelerometry.

PubMed

van Hees, Vincent T; Thaler-Kall, Kathrin; Wolf, Klaus-Hendrik; Brønd, Jan C; Bonomi, Alberto; Schulze, Mareike; Vigl, Matthäus; Morseth, Bente; Hopstock, Laila Arnesdatter; Gorzelniak, Lukas; Schulz, Holger; Brage, Søren; Horsch, Alexander

2016-12-07

Raw accelerometry is increasingly being used in physical activity research, but diversity in sensor design, attachment and signal processing challenges the comparability of research results. Therefore, efforts are needed to harmonize the methodology. In this article we reflect on how increased methodological harmonization may be achieved. The authors of this work convened for a two-day workshop (March 2014) themed on methodological harmonization of raw accelerometry. The discussions at the workshop were used as a basis for this review. Key stakeholders were identified as manufacturers, method developers, method users (application), publishers, and funders. To facilitate methodological harmonization in raw accelerometry the following action points were proposed: i) Manufacturers are encouraged to provide a detailed specification of their sensors, ii) Each fundamental step of algorithms for processing raw accelerometer data should be documented, and ideally also motivated, to facilitate interpretation and discussion, iii) Algorithm developers and method users should be open about uncertainties in the description of data and the uncertainty of the inference itself, iv) All new algorithms which are pitched as "ready for implementation" should be shared with the community to facilitate replication and ongoing evaluation by independent groups, and v) A dynamic interaction between method stakeholders should be encouraged to facilitate a well-informed harmonization process. The workshop led to the identification of a number of opportunities for harmonizing methodological practice. The discussion as well as the practical checklists proposed in this review should provide guidance for stakeholders on how to contribute to increased harmonization.

What is the current status of training and practice of early intervention in psychiatry? Results from a survey in 35 countries.

PubMed

Fiorillo, Andrea; Sampogna, Gaia; Del Vecchio, Valeria; Luciano, Mario; Del Gaudio, Lucia; De Rosa, Corrado; Catapano, Francesco; Maj, Mario

2015-02-01

To assess: (i) trainees' educational needs on early intervention in psychiatry; (ii) their satisfaction and competence in early detection and management of patients with severe mental disorders; (iii) characteristics of training on prevention and on early intervention in psychiatry; and (iv) organizational and clinical differences of early intervention programmes and services in different countries. Sixty early career psychiatrists, recruited from the early career psychiatrists' network of the World Psychiatric Association, were invited to participate in the survey. Respondents were asked to provide the collective input of their trainees' association rather than that of any individual officer or member. An online survey was conducted using an ad hoc questionnaire consisting of 18 items. Thirty-five countries sent back the questionnaire (58.3%). University training in early intervention for mental disorders was provided in 13 countries (38%); 54% of respondents were not satisfied with received training and about half of them did not feel enough confident to provide specialistic interventions to patients at the onset of the disorder. Services for early intervention existed in 22 countries (63%). The most frequently available were those for schizophrenia (75%). Informative campaigns on mental disorders were usually carried out in almost all surveyed countries (85%). Although prevention and early intervention represent one of the current paradigms of psychiatric practice and research, efforts are still needed in order to improve training programmes at university sites. © 2013 Wiley Publishing Asia Pty Ltd.

PUBLIC AND PATIENT INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT: A FRAMEWORK FOR ACTION.

PubMed

Abelson, Julia; Wagner, Frank; DeJean, Deirdre; Boesveld, Sarah; Gauvin, Franςois-Pierre; Bean, Sally; Axler, Renata; Petersen, Stephen; Baidoobonso, Shamara; Pron, Gaylene; Giacomini, Mita; Lavis, John

2016-01-01

As health technology assessment (HTA) organizations in Canada and around the world seek to involve the public and patients in their activities, frameworks to guide decisions about whom to involve, through which mechanisms, and at what stages of the HTA process have been lacking. The aim of this study was to describe the development and outputs of a comprehensive framework for involving the public and patients in a government agency's HTA process. The framework was informed by a synthesis of international practice and published literature, a dialogue with local, national and international stakeholders, and the deliberations of a government agency's public engagement subcommittee in Ontario, Canada. The practice and literature synthesis failed to identify a single, optimal approach to involving the public and patients in HTA. Choice of methods should be considered in the context of each HTA stage, goals for incorporating societal and/or patient perspectives into the process, and relevant societal and/or patient values at stake. The resulting framework is structured around four actionable elements: (i) guiding principles and goals for public and patient involvement (PPI) in HTA, (ii) the establishment of a common language to support PPI efforts, (iii) a flexible array of PPI approaches, and (iv) on-going evaluation of PPI to inform adjustments over time. A public and patient involvement framework has been developed for implementation in a government agency's HTA process. Core elements of this framework may apply to other organizations responsible for HTA and health system quality improvement.

Identification of novel mammalian hosts and Brazilian biome geographic distribution of Trypanosoma cruzi TcIII and TcIV.

PubMed

Barros, Juliana Helena S; Xavier, Samanta Cristina C; Bilac, Daniele; Lima, Valdirene Santos; Dario, Maria Augusta; Jansen, Ana Maria

2017-08-01

Trypanosoma cruzi is a parasitic protozoan responsible for Chagas disease. Seven different Discrete Typing Units (DTUs) of T. cruzi are currently identified in nature: TcI-TcVI, and TcBat whose distribution patterns in nature, hosts/reservoirs and eco-epidemiological importance are still little known. Here, we present novel data on the geographic distribution and diversity of mammalian hosts and vectors of T. cruzi DTUs TcIII and TcIV. In this study, we analyzed 61 T. cruzi isolates obtained from 18 species of mammals (five orders) and two Hemiptera genera. Samples were collected from five Brazilian biomes (Pantanal, Caatinga, Cerrado, Atlantic Rainforest, and Amazon) previously characterized as Z3 or mixed infection (TcI-Z3) by mini-exon gene PCR. To identify TcIII and TcIV genotypes, we applied restriction fragment length polymorphism analysis to the PCR-amplified histone 3 gene. DTUs TcIII and TcIV were identified in single and mixed infections from wide dispersion throughout five Brazilian biomes studied, with TcIV being the most common. Pantanal was the biome that displayed the largest number of samples characterized as TcIII and TcIV in single and mixed infections, followed by Atlantic Rainforest and Amazon. Species from the Didelphimorphia order displayed the highest frequency of infection and were found in all five biomes. We report, for the first time, the infection of a species of the Artiodactyla order by DTU TcIII. In addition, we describe new host species: five mammals (marsupials and rodents) and two genera of Hemiptera. Our data indicate that DTUs TcIII and TcIV are more widespread and infect a larger number of mammalian species than previously thought. In addition, they are transmitted in restricted foci and cycles, but in different microhabitats and areas with distinct ecological profiles. Finally, we show that DTUs TcIII and TcIV do not present any specific association with biomes or host species. Copyright © 2017. Published by Elsevier B.V.

An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit.

PubMed

Wong, Rowena S Y; Ismail, Noor Azina; Tan, Cheng Cheng

2015-04-01

Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU. A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration. APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P <0.001). Predicted in-ICU mortality rate (28.1%) was significantly higher than the actual in-ICU mortality rate (18.8%). Model calibration was improved after applying first-level customisation (Ĉ = 6.39, P = 0.78) although discrimination was not affected. APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

The inhibition of Pb(IV) oxide formation in chlorinated water by orthophosphate.

PubMed

Lytle, Darren A; Schock, Michael R; Scheckel, Kirk

2009-09-01

Historically, understanding lead solubility and its control in drinking water has been based on Pb(II) chemistry. Unfortunately, there is very little information available regarding the nature of Pb(IV) oxides in finished drinking water and water distribution systems, and the conditions under which they persist. The objective of this research was to explore the impact of orthophosphate on the realistic pathways that lead to the formation of Pb(IV) oxides in chlorinated water. The results of XRD and XANES analysis showed that, in the absence of orthophosphate (DIC = 10 mg C/L, 24 degrees C, pH 7.75-8.1, 3 mg Cl2/L goal), Pb(IV) oxides formed with time following a transformation from the Pb(II) mineral hydrocerussite. Under the same experimental conditions, orthophosphate dosing inhibited the formation of Pb(IV) oxides. The Pb(II) mineral hydroxypyromorphite, Pb5(PO4)3OH, was the only mineral phase identified during the entire study of over 600 days, although the presence of some chloropyromorphite, Pb5(PO4)3Cl, could not be ruled out The conclusions were further supported by SEM, TEM, and XANES analysis of lead colloids, and lead precipitation experiments conducted in the absence of free chlorine. The findings provide an important explanation for the absence of Pb(IV) oxides in some water systems that have used, or currently use, orthophosphate for corrosion control when otherwise, based on disinfection practices and water quality, its presence would be anticipated, as well as why the conversion from free chlorine to chloramines was not observed to increase lead release.

Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®).

PubMed

Strudwick, Gillian; Hardiker, Nicholas R

2016-10-01

In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice(®), Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions' impact on quality, safety and patient outcomes in published research is relatively unknown. This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice(®) as a case study. A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice(®) were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Since 2006, 38 studies have been published on the International Classification for Nursing Practice(®). The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.