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Sample records for serving vulnerable patients

  1. Accuracy of Diagnostic Mammography at Facilities Serving Vulnerable Women

    PubMed Central

    Goldman, L. Elizabeth; Walker, Rod; Miglioretti, Diana L.; Smith-Bindman, Rebecca; Kerlikowske, Karla

    2011-01-01

    Background Breast cancer missed on diagnostic mammography may contribute to delayed diagnoses, while false-positive results may lead to unnecessary invasive procedures. Whether accuracy of diagnostic mammography at facilities serving vulnerable women differs from other facilities is unknown. Objective To compare the interpretive performance of diagnostic mammography at facilities serving vulnerable women to those serving non-vulnerable women. Design We examined 168,251 diagnostic mammograms performed at BCSC facilities from 1999–2005. We used hierarchical logistic regression to compare sensitivity, false positive rates, and cancer detection rates. Subjects Women ages 40–80 years undergoing diagnostic mammography to evaluate an abnormal screening mammogram or breast problem. Measures Facilities were assigned vulnerability indices according to the populations served based on the proportion of mammograms performed on women with lower educational attainment, racial/ethnic minority status, limited household income, or rural residences. Results Sensitivity of diagnostic mammography did not vary significantly across vulnerability indices adjusted for patient-level characteristics, but false-positive rates for diagnostic mammography examinations to evaluate a breast problem were higher at facilities serving vulnerable women defined as those with: lower educational attainment (odds ratio (OR) 1.39; 95% confidence interval (CI) 1.08, 1.79); racial/ethnic minorities (OR 1.32; 95% CI 0.98, 1.76); limited income (OR 1.34; 95% CI 1.08, 1.66), and rural residence (OR 1.55; 95% CI 1.27, 1.88). Conclusions Diagnostic mammography to evaluate a breast problem at facilities serving vulnerable women has higher false positive rates than at facilities serving non-vulnerable women. This may reflect concerns that vulnerable populations may be less likely to follow-up after abnormal diagnostic mammography or concerns that such populations have higher cancer prevalence. PMID:20966780

  2. Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations.

    PubMed

    Lee, Christoph I; Bogart, Andy; Germino, Jessica C; Goldman, L Elizabeth; Hubbard, Rebecca A; Haas, Jennifer S; Hill, Deirdre A; Tosteson, Anna Na; Alford-Teaster, Jennifer A; DeMartini, Wendy B; Lehman, Constance D; Onega, Tracy L

    2016-03-01

    Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. 73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012. We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use. © The Author(s) 2015.

  3. Motivation to serve in the military influences vulnerability to future posttraumatic stress disorder.

    PubMed

    Kaplan, Zeev; Weiser, Mark; Reichenberg, Abraham; Rabinowitz, Jonathan; Caspi, Asaf; Bodner, Ehud; Zohar, Joseph

    2002-01-31

    High motivation and belief in a cause have been reported to be protective against posttraumatic stress disorder (PTSD), while below-average intellectual functioning and poor educational achievements have been reported to increase vulnerability to PTSD. The main goal of this study was to assess the effect of education, and intellectual and behavioral functioning on the risk for future PTSD. Data collected before exposure to trauma, on intellectual and behavioral functioning, and educational achievements of 901 male Israeli adolescents who had performed pre-induction screening tests by the Israeli Draft Board, and were later diagnosed with PTSD, were compared with a control group of adolescents who were not later diagnosed with PTSD. Future PTSD patients had significantly lower intelligence, fewer years of formal education and lower scores on a scale assessing motivation to serve in the military, in comparison with the control group, with effect sizes (ES) ranging from 0.14-0.34. In contrast, future PTSD patients scored significantly higher on a scale assessing social functioning, ES=0.13. However, when controlling for the differences in motivation to serve, all of these differences disappeared. In this cohort, although slightly below average intellectual functioning and formal education, and better social functioning, independently increased vulnerability to suffer from PTSD, these associations disappeared when the future PTSD patients' lower motivation to serve in the military was included in the analysis. This suggests that low motivation to serve in the military might increase vulnerability for PTSD.

  4. Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women

    PubMed Central

    Goldman, L. Elizabeth; Walker, Rod; Hubbard, Rebecca; Kerlikowske, Karla

    2013-01-01

    Background Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. Methods We examined receipt of diagnostic evaluation following abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. Results We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4-5% difference, p<0.05), and women at facilities serving more rural and low income populations had lower rates of biopsy (4-5% difference, p<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving non-vulnerable populations (21.6 days vs. 15.6 days; 95% CI for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). Conclusions Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities

  5. The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

    PubMed Central

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-01-01

    Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

  6. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

    PubMed

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-06-01

    To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

  7. Vulnerability of older patients in critical care.

    PubMed

    Hardin, Sonya R

    2015-06-01

    One of the patient characteristics in the AACN Synergy Model is vulnerability. Vulnerability is defined in the model as the susceptibility to actual or potential stressors that may adversely affect patients' outcomes. The risk of vulnerability increases in older patients in critical care units.

  8. Pharmacists' considerations when serving Amish patients.

    PubMed

    Crawford, Stephanie Y; Manuel, Aimée M; Wood, Bruce D

    2009-01-01

    To introduce historical and sociocultural influences on health and health care decisions that should be considered by pharmacists and other health professionals when serving Amish patients and to describe the roles of pharmacists in working with Amish populations, as an example of culturally and linguistically appropriate care. Community independent pharmacy in Arthur, IL, from 1991 to 2008. Reflections of a pharmacist-owner whose community practice serves a sizeable Amish population. The Old Order Amish are a religious group that values health and actively participates in its health care decisions. The Amish possess a strong sense of community responsibility and often seek advice of friends, family, and community in health care decisions. Their explanatory models of health and illness differ, in some respects, from the larger American society. The Amish are open to the use of folk medicine, complementary and alternative medicine, and conventional care when deemed necessary. They are receptive to health care information and explanations of options from trusted sources and use increased self-care modalities, including herbal remedies. Knowledge of salient cultural differences is important, but care should be given to avoid stereotyping patients because Amish rules and customs differ across districts. Culturally competent pharmacist care should be individualized based on patient needs and in consideration of aspects of differences in Amish cultures and districts. When serving Amish patients, special consideration should be given to addressing potential barriers to health care use, such as unique dialects, affordability issues for largely cash-paying customers, lower prenatal care use, and lower vaccination rates. Enhanced awareness and sensitivity to Amish lifestyles and beliefs can lessen misconceptions and minimize barriers that interfere with optimal provision of patient-centered pharmacy care and services. By working through established community norms, building

  9. Vulnerability in patients and nurses and the mutual vulnerability in the patient-nurse relationship.

    PubMed

    Angel, Sanne; Vatne, Solfrid

    2017-05-01

    To examine the mutual vulnerability of patients and nurses, anticipating that an enhanced understanding of the phenomenon may help reduce vulnerability. Patient vulnerability is a key issue in nursing, aimed at protecting the patient from harm. In the literature, vulnerability is described both from a risk perspective and a subjective perspective. This implies that the objective dimension of patient vulnerability does not necessarily reflect the patient's own perception of being vulnerable. However, external judgment may influence internal perception. Adding to this complexity, attention has also been drawn to the vulnerability of the nurse. A definition deduced from central literature on vulnerability captures the complexity of objective versus subjective vulnerability. Based on the perspective of vulnerability in general, vulnerability in healthcare services shows how dependency may increase patient vulnerability. Further, despite education, training and supportive settings, patients may increase nurse vulnerability. The core of this mutuality is explored in the light of Martin Heidegger's philosophy of being. The patient's need for help from the nurse opens the patient to engage in supportive and/or harmful encounters. Thus, dependency adds to the vulnerability related to health issues. The nurse's vulnerability lies in her engagement in caring for the patient. If failing to provide proper care, the nurse's existence as 'a good nurse' is threatened. This is exacerbated if the patient turns against the nurse. Therefore, the core of vulnerability seems to lie in the fact that the patient and the nurse are both striving to be the persons they want to be, and the persons they have not yet become. Recognition of the mutual vulnerability in the patient-nurse relationship calls for collective acknowledgement of the demanding nature of caring relationships, for support and for a strengthening of professional skills. © 2016 John Wiley & Sons Ltd.

  10. Medical paternalism serves the patient best.

    PubMed

    Lim, L S

    2002-03-01

    It seems obvious that in a post-modern, constructivist world where meaning and value systems are often subjective and relative, any absolutist view is likely to be questionable. This is more so if it relates to ethics, the foundations, interpretation and application of which have been and continue to be much debated. So, in addressing the proposition, my efforts were directed at identifying a position that would mediate polarity. I examined the contention that the doctor, because he is better informed, may claim greater acuity and powers of judgment, and its defences against the charge of interfering with individual liberty and autonomy through various arguments such as the harm principle, the welfare, the principle of legal moralism and the appeal to uncertainty. While there is some validity to the arguments proposed, absolute paternalism would seem incompatible with respect for individual rights. How satisfactory, then, is the paradigm shift from paternalism to the independent choice model where the doctor presents neutral statistics as little biased as possible by his own views and judgments and leaves the decision making entirely to the patient or his/her relatives. This clearly had its limitations too. As with much of human experience, the answer would seem to rest in mediating the happy mean. Recognising a distinction between autonomy (self-determination) and independence (total freedom of choice without any interference) allows for a model of qualified independence or "enhanced autonomy" (Quill & Brody, 1996). This is predicated on doctor-patient dialogue, exchange of ideas/views, negotiation of differences, and sharing power and influence for the common purpose of serving the patient's best interest. This model would seem to be a responsible and effective approach to management of clinical dilemmas, as well as one that in its pluralistic approach is consistent with fundamental moral and philosophic propositions. It is by no means flawless, but in an

  11. Leaf size serves as a proxy for xylem vulnerability to cavitation in plantation trees.

    PubMed

    Schreiber, Stefan G; Hacke, Uwe G; Chamberland, Sabrina; Lowe, Christopher W; Kamelchuk, David; Bräutigam, Katharina; Campbell, Malcolm M; Thomas, Barb R

    2016-02-01

    Hybrid poplars are an important renewable forest resource known for their high productivity. At the same time, they are highly vulnerable to water stress. Identifying traits that can serve as indicators for growth performance remains an important task, particularly under field conditions. Understanding which trait combinations translate to improved productivity is key in order to satisfy the demand for poplar wood in an uncertain future climate. In this study, we compared hydraulic and leaf traits among five hybrid poplar clones at 10 plantations in central Alberta. We also assessed the variation of these traits between 2- to 3-year-old branches from the lower to mid-crown and current-year long shoots from the mid to upper crown. Our results showed that (1) hybrid poplars differed in key hydraulic parameters between branch type, (2) variation of hydraulic traits among clones was relatively large for some clones and less for others, and (3) strong relationships between measured hydraulic traits, such as vessel diameter, cavitation resistance, xylem-specific and leaf-specific conductivity and leaf area, were observed. Our results suggest that leaf size could serve as an additional screening tool when selecting for drought-tolerant genotypes in forest management and tree improvement programmes. © 2015 John Wiley & Sons Ltd.

  12. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned

    NASA Astrophysics Data System (ADS)

    Tuberville, Tracey D.; Andrews, Kimberly M.; Sperry, Jinelle H.; Grosse, Andrew M.

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself.

  13. Use of the NatureServe Climate Change Vulnerability Index as an Assessment Tool for Reptiles and Amphibians: Lessons Learned.

    PubMed

    Tuberville, Tracey D; Andrews, Kimberly M; Sperry, Jinelle H; Grosse, Andrew M

    2015-10-01

    Climate change threatens biodiversity globally, yet it can be challenging to predict which species may be most vulnerable. Given the scope of the problem, it is imperative to rapidly assess vulnerability and identify actions to decrease risk. Although a variety of tools have been developed to assess climate change vulnerability, few have been evaluated with regard to their suitability for certain taxonomic groups. Due to their ectothermic physiology, low vagility, and strong association with temporary wetlands, reptiles and amphibians may be particularly vulnerable relative to other groups. Here, we evaluate use of the NatureServe Climate Change Vulnerability Index (CCVI) to assess a large suite of herpetofauna from the Sand Hills Ecoregion of the southeastern United States. Although data were frequently lacking for certain variables (e.g., phenological response to climate change, genetic variation), sufficient data were available to evaluate all 117 species. Sensitivity analyses indicated that results were highly dependent on size of assessment area and climate scenario selection. In addition, several ecological traits common in, but relatively unique to, herpetofauna are likely to contribute to their vulnerability and need special consideration during the scoring process. Despite some limitations, the NatureServe CCVI was a useful tool for screening large numbers of reptile and amphibian species. We provide general recommendations as to how the CCVI tool's application to herpetofauna can be improved through more specific guidance to the user regarding how to incorporate unique physiological and behavioral traits into scoring existing sensitivity factors and through modification to the assessment tool itself.

  14. Accelerated RN-to-BSN Service-Learning Program Serves the Vulnerable.

    PubMed

    Barnes, Margaret

    The definition, implementation, and benefits support the value of service-learning for nursing education. However, accelerated RN-to-BSN programs may have difficulty requiring service-learning experiences. This article offers a biblical rationale for service with vulnerable populations and an example of how service-learning is implemented into the curriculum of an accelerated, nontraditional, online/onsite RN-BSN completion program at a Christian university.

  15. Vulnerability

    NASA Technical Reports Server (NTRS)

    Taback, I.

    1979-01-01

    The discussion of vulnerability begins with a description of some of the electrical characteristics of fibers before definiting how vulnerability calculations are done. The vulnerability results secured to date are presented. The discussion touches on post exposure vulnerability. After a description of some shock hazard work now underway, the discussion leads into a description of the planned effort and some preliminary conclusions are presented.

  16. The collaborative edge: patient empowerment for vulnerable populations.

    PubMed

    Safran, Charles

    2003-03-01

    The problems with access to care and the special needs for educational outreach for disadvantage or vulnerable populations of patients require innovation. This paper describes Baby CareLink use of information technology to support communication, consultation, and collaboration among colleagues as well as with patients, their families, and community resources. In response to the educational, emotional and communication needs of parents of premature infants and the clinicians who care for the infants and support the families, we developed Baby CareLink, a secure collaborative environment. Baby CareLink provides a nurturing environment where parents, even though remote from the Neonatal Intensive Care Unit, can actively participate in decisions surrounding their baby's care. In a southeastern hospital serving a mostly Medicaid population in a rural setting, more than 300 parents have used Baby CareLink more than 11000 times during the past year. Despite the common wisdom that Medicaid families do not have access to the Internet, approximately 85% of the parents access Baby CareLink from home, at work, from the library or other public access point. The median use of Baby CareLinks from outside the hospital by parents is 17 separate sessions. In a city hospital in the midwestern US which exclusively serves a Medicaid population, experience has been equally encouraging. More than 70 parents have initiated more than 600 secure sessions with Baby CareLink. In contrast to the rural hospital, only 35% of sessions have been initiated outside the hospital. Experience with Baby CareLink suggests that families from all walks of life will use and benefit from collaborative tools that keep them informed and involved in the care of their children. The most significant barrier to wider deployment is bandwidth limitations into the homes of most families. The care of premature infants is a great example of an area where medical knowledge and ability has grown dramatically, and where

  17. Psychosocial Vulnerability Among Patients Contacting a Norwegian Sexual Assault Center.

    PubMed

    Vik, Bjarte Frode; Nöttestad, Jim Aage; Schei, Berit; Rasmussen, Kirsten; Hagemann, Cecilie Therese

    2016-07-22

    In this study, the objective was to assess the occurrence of specific vulnerability factors among adult and adolescent females attending a Norwegian sexual assault center (SAC). We also explored assault characteristics and investigated whether these characteristics differed between the group of patients with vulnerability factors compared with the group without such factors. We conducted a retrospective descriptive study of 573 women ≥ 12 years of age attending the SAC at St. Olavs Hospital, Trondheim, Norway, between July 1, 2003 and December 31, 2010. A patient was considered vulnerable if at least one of the following features was present: intellectual or physical disability; history of present/former mental health problems; history of present/former alcohol/substance abuse; or former sexual assault. At least one vulnerability factor was present in 59% of the cases. More than one vulnerability factor was present in 29%. Reporting at least one vulnerability factor was associated with a higher patient age, unemployment, a higher frequency of reported light/moderate physical violence, and the documentation of minor body injury. In contrast, those without vulnerability more often were students assaulted during night time, by a casual or stranger assailant and reporting a higher intake of alcohol prior to the assault. There are obvious patterns of differences in the nature of sexual assaults reported among victims with specific vulnerability factors compared with victims without these factors. Future research should address these differences and possible solutions for better protection of especially vulnerable individuals against sexual offenses, such as those with mental health and substance abuse difficulties. © The Author(s) 2016.

  18. [Psychiatric patient: the most vulnerable traveller].

    PubMed

    Felkai, Péter; Kurimay, Tamás; Fülöp, Emoke

    2011-01-23

    Authors analyse questions of medical evacuation of the psychotic patient from abroad to homeland. This task can be considered the most difficult problem for the attending physician and the escorting medical team as well. The main challenge is to recognise the psychotic patient in a foreign country with a different health-care system and to overcome the language barrier and the different cultural background. The second issue is to prepare the patients - who are usually in a poor condition - for the medical evacuation by commercial aircraft. Another important issue is to take the patient through the strict security control. All of these (partially unsolved) problems make the mentally ill patient defenceless. Although the repatriation of a mentally ill patient is vital and urgent, travel insurance policy mostly excludes to cover the cost of treatment and repatriation. The high cost of treatment and repatriation of the patient should be paid by the patient or the family, who are often in the position of insolvency. In this paper authors present the history of a patient and give a brief review on travel-related mental disorders, the epidemiology of mental alterations during travel as well as the problems of appropriate evacuation. Authors conclude that there is a need for a better approach of the airport authorities and insurance decision makers to the mentally ill patient travelling abroad.

  19. Competing values in serving older and vulnerable adults: adult protective services, mandated reporting, and domestic violence programs.

    PubMed

    Cramer, Elizabeth P; Brady, Shane R

    2013-01-01

    State mandatory reporting statutes may directly or indirectly list domestic violence programs as among those that are mandated reporters of cases of suspected abuse, neglect, or exploitation of older individuals and those with disabilities. Domestic violence programs, however, may not consider themselves to be mandated reporters, because the responsibility of reporting abuse may be contrary to their programmatic philosophy. In the Commonwealth of Virginia, the potential conflict between domestic violence programs and Adult Protective Services about the issue of mandated reporting has created tension between these organizations as each entity continues interpreting the issues and policies of mandated reporting through its own lens. The authors draw out some of the reasons for the conflict as well as make recommendations for improving relationships between the two organizations, which will ultimately benefit vulnerable adults who are experiencing abuse.

  20. Profile of minority and under-served patients using acupuncture.

    PubMed

    Highfield, Ellen Silver; Spellman, Lisa; Barnes, Linda L; Kaptchuk, Ted J; Paradis, Gabrielle; Conboy, Lisa Ann; Saper, Robert

    2012-01-01

    Acupuncture use remains common in the United States, yet little is known of its utilization by minority and underserved populations. Herein we report first visit data capturing patient profiles, types of conditions presented, and self-reports of their experience and satisfaction with acupuncture accessed at a free care clinic with in a large urban safety net hospital. Sixty-one adult, English-speaking acupuncture patients were given a 20 min survey after their first visit to a free care acupuncture clinic. Patients were from 12 different countries. Fifty-six percent of the participants were minorities. Sixty-five percent of respondents were female. Average age was 42.1. Eighty percent were acupuncture naïve. Patients' health complaints were similar to those of other surveyed mainstream patients with 57% reporting musculoskeletal conditions. Ninety-three percent would recommend a friend or family for acupuncture, 97% rating their overall experience with the acupuncture clinic as either very good or good. When made available to a diverse population of patients, acupuncture is utilized and perceived to be helpful. In this survey, patients sought treatment for musculoskeletal conditions and were satisfied with their first visit. Future research is warranted. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Glycemic control in diabetic patients served by community health centers.

    PubMed

    Maizlish, Neil A; Shaw, Beryl; Hendry, Khati

    2004-01-01

    The Community Health Center Network measured the prevalence of glycemic control in diabetic patients at 7 community health centers as part of its clinical quality improvement program. A cross-sectional survey was carried out in a random sample of 1817 diabetic patients having 1 or more encounters from October 1, 2000 to September 30, 2001. Computerized laboratory results for hemoglobin A1c (HbA1c) tests were available for half the sample. Manual review of medical charts was carried out for the rest. The proportion of diabetic patients with 1 or more HbA1c tests in the measurement year was 91% (CI95%: 90-93%) and poor glycemic control (HbA1c > 9%) occurred in 27% (CIM%: 25-30%). The mean of the most recent test was 7.8%. The frequency of testing varied significantly by clinic from 79% to 94% and increased with the number of encounters. Poor glycemic control also varied significantly by clinic (17-48%) and was significantly better in females and older patients. Measures of glycemic control were not associated with ethnicity or insurance status in multivariate analyses. A high proportion of diabetic patients received appropriate care, and this care was not associated with ethnicity or insurance status. The data warehouse was an essential tool for the clinical quality improvement program.

  2. Clinical research centre serves 70,000 patients annually.

    PubMed

    1992-01-01

    The Bangladesh, ICDDR,B's Clinical Research Center (CPR) is described since its inception in 1960 as the former Dhaka Hospital. As 1 of 4 divisions, the CRC has increased admissions for diarrheal diseases, which is associated with the respect earned within the population, and averages 70,000/year. Included in the discussion is consideration of the objectives of the CRC and its predecessor, patient care, research, training, physical facilities, and new and other activities. Early research objectives were to find a better protocol for treatment of diarrheal diseases. Cholera and other diarrheal disease findings contributed to the formulation of an iv fluid for the treatment of severely dehydrated patients. Oral rehydration therapy (ORT) research was also conducted at the center. The cholera death rate with treatment has been reduced to 1%. 70% of patients are children under 15 years old and 65% have some malnutrition. Patients in general come from Dhaka city and suburbs, but they also come from outside the district. Current research focuses on clinical management and basic pathophysiological and nutritional issues; efforts are underway to develop a super oral rehydration solution to improve special diets, and to determine successful implementation strategies. Medical, paramedical, and health workers are trained in establishing diarrheal treatment and training programs in other locations and in research methodologies. The Public Health Institutes has increased capacity to include a 60-bed inpatient ward, an intensive care unit of 12 beds, a 120-bed observation unit, a 30-bed research ward, and a traveler's clinic. The research ward also has an office and laboratory facility and endoscopic facilities with computers, icemakers, centrifuge, deep freezers, and a biological safety hood for sample processing and storage. During epidemics the facilities are still inadequate. Water supply and air cooling and electronic precision weighing scales are available. The Child Health

  3. The impact of a clinic move on vulnerable patients with chronic disease: a Geographic Information Systems (GIS) analysis.

    PubMed

    Bazemore, Andrew; Diller, Philip; Carrozza, Mark

    2010-01-01

    Changing locations disrupts the populations served by primary health care clinics, and such changes may differentially affect access to care for vulnerable populations. Online geographic information systems mapping tools were used to define how the relocation of a family medicine center impacted access to care for black and Hispanic patients with chronic disease. Maps created from practice management data revealed a distinct shift in black and Hispanic patients with chronic disease being served in the new location. Geographic information systems tools are valuable aids in defining changing service areas of primary health care clinics.

  4. Aspects of vulnerable patients and informed consent in clinical trials

    PubMed Central

    Kuthning, Maria; Hundt, Ferdinand

    2013-01-01

    Scope: To discuss the rationale behind informed consent in clinical trials focusing on vulnerable patients from a European and German viewpoint. Methods: Scientific literature search via PubMed, Medline, Google. Results: Voluntary informed consent is the cornerstone of policies regulating clinical trials. To enroll a patient into a clinical trial without having obtained written and signed consent is to be considered as a serious issue in the conduct of a clinical trial. Development of ethical guidance for physicians started before Christ Era with the Hippocratic Oath. Main function of consent, as articulated in all guidelines developed for clinical research, is to facilitate an individual’s freedom of choice, respect autonomy, and thus to ensure welfare of the participants in clinical trials. Minors are unable to provide legally binding informed consent, this issue is addressed through a combination of parental permission and minor’s assent. Illiteracy is a critical problem that affects all corners of our earth; it has no boundaries and exists among every race and ethnicity, age group, and economic class. New strategies to improve communication with patients including the use of videotapes or animated cartoon illustrations could be taught. Finally the time with the potential participant seems to be the best way to improve understanding. Conclusion: Discovery of life saving and life enhancing new treatments requires partnership that is based on good communication and trust between patients and researchers, sponsors, ethics committees, authorities, lawyers and politicians so that vulnerable patients can benefit from the results of well controlled clinical trials. PMID:23346043

  5. Developing Dental Students' Awareness of Health Care Disparities and Desire to Serve Vulnerable Populations Through Service-Learning.

    PubMed

    Behar-Horenstein, Linda S; Feng, Xiaoying; Roberts, Kellie W; Gibbs, Micaela; Catalanotto, Frank A; Hudson-Vassell, Charisse M

    2015-10-01

    Service-learning in dental education helps students integrate knowledge with practice in an underserved community setting. The aim of this study was to explore how a service-learning experience affected a small group of dental students' beliefs about cultural competence, professionalism, career development, desire to practice in a community service setting, and perceptions about access and disparities issues. Prior to beginning their first year of dental school, five first-year dental students at one U.S. dental school participated in a six-week service-learning program in which they interned at one of three at-risk settings in order to experience health care delivery there. After the program, 60 reflective writing assignments completed by the participants were analyzed using grounded theory methods; interviews with the students were used to corroborate the findings from that analysis. Seven themes identified in the journal reflections and interview findings showed enhanced awareness of social health care issues and patient differences, as well as a social justice orientation and desire to address disparities. Building on this study, future research should explore the curricular components of service-learning programs to ensure students receive ample opportunity to reflect upon their experiences in order to integrate previously held assumptions with their newfound knowledge.

  6. The association between dental, general, and mental health status among underserved and vulnerable populations served at health centers in the US.

    PubMed

    Nguyen, Vy H; Lin, Sue C; Cappelli, David P; Nair, Suma

    2017-07-18

    Vulnerable populations in underserved communities are disproportionately at high risk for multiple medical, dental, and behavioral health conditions. This study aims to: a) examine the occurrence of acute dental needs and b) investigate the association of acute dental needs and self-rated general and mental health status among the adult dentate health center population. This cross-sectional study analyzed data on adult patients (n = 5,035) from the 2014 Health Center Patient Survey, a nationally representative survey of health center patients. Multivariate logistic regression was used to assess the association of acute dental needs and a) self-rated general health status and b) mental health status. Approximately, two thirds of adult dentate heath center patients reported having an acute dental need. After adjusting for confounding factors, not having or having had health insurance that pays for dental care, general health status of fair or poor, and ever having a mental illness were associated with higher odds of having an acute dental need. The results highlight the role of health centers in addressing oral health disparities among vulnerable populations and the importance of a team-based multidisciplinary approach to ensuring the integration and coordination of oral health services within a comprehensive primary care delivery system. © 2017 American Association of Public Health Dentistry.

  7. Social vulnerability and hypoglycemia among patients with diabetes.

    PubMed

    Waitman, Jorge; Caeiro, Gabriela; Romero Gonzalez, Silvana A; Ré, Danila P; Daghero, Andrea; Gonzalez, Claudio D; Umpierrez, Guillermo E

    2017-02-01

    Lower-income populations are hit harder by the diabetes epidemic as regards both prevalence and the risk of complications. Food Insecurity is one of the mechanisms through which poverty may predispose people with low socio-economic status to poorer control and higher complication rates. The United Nations Food and Agriculture Organization defined food security as "the right to have access to sufficient nutritional and culturally acceptable food choices." Adults suffering from diabetes with limited income have a 40% greater chance of having food insecurity and an inadequate blood glucose control. Such patients have a two-fold greater risk of developing severe hypoglycemia. In addition, several studies have shown that social vulnerability resulting from food insecurity, low socioeconomic status, low educational levels, and poor health education is an independent risk factor for hypoglycemia, even after conventional predictors are controlled. This review analyzes the literature available on social vulnerability as a non-conventional risk factor for development of hypoglycemia in diabetic subjects. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Vulnerable Hospitals and Cancer Surgery Readmissions: Insights into the Unintended Consequences of the Patient Protection and Affordable Care Act.

    PubMed

    Hong, Young; Zheng, Chaoyi; Hechenbleikner, Elizabeth; Johnson, Lynt B; Shara, Nawar; Al-Refaie, Waddah B

    2016-07-01

    Penalties from the Hospital Readmission Reduction Program can push financially strained, vulnerable patient-serving hospitals into additional hardship. In this study, we quantified the association between vulnerable hospitals and readmissions and examined the respective contributions of patient- and hospital-related factors. A total of 110,857 patients who underwent major cancer operations were identified from the 2004-2011 State Inpatient Database of California. Vulnerable hospitals were defined as either self-identified safety net hospitals (SNHs) or hospitals with a high percentage of Medicaid patients (high Medicaid hospitals [HMHs]). We used multivariable logistic regression to determine the association between vulnerable hospitals and readmission. Patient and hospital contributions to the elevation in odds of readmission were assessed by comparing estimates from models with different subsets of predictors. Of the 355 hospitals, 13 were SNHs and 31 were HMHs. After adjusting for Hospital Readmission Reduction Program variables, SNHs had higher 30-day (odds ratio [OR] = 1.32; 95% CI, 1.18-1.47), 90-day (OR = 1.28; 95% CI, 1.18-1.38), and repeated readmissions (OR = 1.33; 95% CI, 1.18-1.49); HMHs also had higher 30-day (OR = 1.18; 95% CI, 1.05-1.32), 90-day (OR = 1.28; 95% CI, 1.16-1.42), and repeated readmissions (OR = 1.24; 95% CI, 1.01-1.54). Compared with patient characteristics, hospital factors accounted for a larger proportion of the increase in odds of readmission among SNHs (60% to 93% vs 24% to 39%), but a smaller proportion among HMHs (9% to 15% vs 60% to 115%). Vulnerable status of hospitals is associated with higher readmission rates after major cancer surgery. These findings reinforce the call to account for socioeconomic variables in risk adjustments for hospitals who serve a disproportionate share of disadvantaged patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Neurocognitive Vulnerability: Suicidal and Homicidal Behaviours in Patients With Schizophrenia

    PubMed Central

    Richard-Devantoy, Stéphane; Orsat, Manuel; Dumais, Alexandre; Turecki, Gustavo; Jollant, Fabrice

    2014-01-01

    Objective Schizophrenia is associated with an increase in the risk of both homicide and suicide. The objectives of this study were to systematically review all published articles that examined the relation between neurocognitive deficits and suicidal or homicidal behaviours in schizophrenia, and to identify vulnerabilities in suicidal and homicidal behaviour that may share a common pathway in schizophrenia. Methods: A systematic review of the literature was performed using MEDLINE to include all studies published up to August 31, 2012. Results: Among the 1760 studies, 7 neuropsychological and 12 brain imaging studies met the selection criteria and were included in the final analysis. The neuropsychological and functional neuroimaging studies were inconclusive. The structural imaging studies reported various alterations in patients with schizophrenia and a history of homicidal behaviour, including: reduced inferior frontal and temporal cortices, increased mediodorsal white matter, and increased amygdala volumes. Patients with a history of suicidal acts showed volumetric reductions in left orbitofrontal and superior temporal cortices, while right amygdala volume was increased, though, these findings have rarely been replicated. Finally, no study has directly compared neurocognitive markers of suicidal and homicidal risk. Conclusion: These results suggest that brain alterations, in addition to those associated with schizophrenia, may predispose some patients to a higher risk of homicide or suicide in particular circumstances. Moreover, some of these alterations may be shared between homicidal and suicidal patients. However, owing to several limitations, including the small number of available studies, no firm conclusions can be drawn and further investigations are necessary. PMID:24444320

  10. The Importance of Recognizing Social Vulnerability in Patients during Clinical Practice.

    PubMed

    Loh, Lik Wei

    2017-01-01

    Abstract Enrolled patients at the free clinic in Dunedin, New Zealand were not just financially poor, but also vulnerable. Large social inequalities are present in the United States and New Zealand. The literature on vulnerability originates predominantly from sociology and public health. This commentary discusses the concept of vulnerability within clinical practice, and makes a case for the improved recognition of patient vulnerability. Vulnerability arises from an individual's susceptibility to harm and their exposure to risks and negative events. Biographical factors commonly regarded as social vulnerability characteristics such as homelessness, teenage parenthood, and childhood abuse do not necessarily lead to negative health and other outcomes because of a direct, causal effect, but because they are indicative of more upstream adversities. Health professionals should address vulnerability not just during clinical encounters, but also at an institutional and policy level.

  11. Psychological vulnerabilities in patients with major depression vs panic disorder.

    PubMed

    Cox, B J; Enns, M W; Walker, J R; Kjernisted, K; Pidlubny, S R

    2001-05-01

    The tripartite model (Clark & Watson, 1991: Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336) posits that anxiety and depression share nonspecific features of neuroticism but that somatic arousal appears unique to anxiety, and low positive affect appears unique to depression. The present study controlled for these higher-order effects and evaluated the relative contributions of four, specific lower-order vulnerabilities (anxiety sensitivity, rumination, self-criticism, self-oriented perfectionism). Participants were 38 depressed patients and 38 patients with panic disorder matched as closely as possible for age and gender, and all were diagnosed using the same structured interview by an experienced clinician. Results from hierarchical logistic regression analysis were consistent with predictions from the tripartite model in that only the unique features of arousal and positive affectivity differentiated the two diagnostic groups. At a lower-order level, only anxiety sensitivity (and its facet of fear of physical symptoms) and a ruminative response style demonstrated incremental predictive ability. The discussion focuses on the relationships among these higher-order and lower-order variables, and their potential importance for understanding specific manifestations of psychopathology.

  12. [Patients with vulnerable coronary plaques have higher serum metalloproteinase-1 levels].

    PubMed

    Sánchez Elvira, G; Coma-Canella, I; Artaiz, M; Páramo, J A; Barba, J; Calabuig, J

    2017-04-30

    Most acute coronary syndromes are caused by the fracture of a vulnerable atherosclerotic plaque. These plaques are thin cap fibroatheromas, which can only be detected with invasive coronary imaging techniques. It is necessary to find a non-invasive biomarker of these vulnerable plaques in order to identify patients at risk without a coronary angiography. Metalloproteinase-1 is an enzyme involved in extracellular matrix metabolism which has been correlated with the rupture of atherosclerotic plaques. Its serum levels in patients with vulnerable plaques remain unknown. Patients with suspected stable coronary artery disease undergoing coronary angiography in our hospital were in-cluded. The coronary arteries were studied with optical coherence tomography to detect vulnerable plaques. Blood samples were taken from a peripheral vein and from the coronary sinus, to assess metalloproteinase-1 levels. Fifty-one patients were included, 13 of whom had at least one vulnerable plaque. There were not significant dif-ferences in clinical characteristics, lipid profile or C reactive protein levels, between patients with or without vulnerable plaques. Patients with vulnerable plaques had significant higher metalloproteinase-1 levels both in peripheral (7330±5541 vs 2894±1783 pg/ml, p=0.025) and coronary sinus serum (6012±3854 vs 2707±1252 pg/ml, p=0.047). Patients with vulnerable plaques had significantly higher metalloproteinase-1 serum levels. Further studies with clinical follow up are needed to assess the prognostic value of serum metalloproteinase-1.

  13. Satisfied patients are also vulnerable patients--narratives from an acute care ward.

    PubMed

    Sørlie, Venke; Torjuul, Kirsti; Ross, Anita; Kihlgren, Mona

    2006-10-01

    To illuminate the experience of being a patient and cared for in an acute care ward. Patients may be the best source of information for assessing the quality of care in acute care wards. Studies often show that patients' satisfaction with their hospital stay is interpreted by managers and care providers as a measure for quality of care. Ten patients were interviewed as part of a comprehensive investigation by four researchers into the narratives of five enrolled nurses (study No. 1--published in Nursing Ethics 2004), five Registered Nurses (study No. 2 published in Nursing Ethics 2005) and 10 patients (study No. 3) about their experiences from an acute care ward at one university hospital in Sweden. A phenomenological hermeneutical method (inspired by the French philosopher Paul Ricoeur) was conducted in all three studies. The patients are very satisfied with their treatment and care. They also tell about factors that they do not consider as optimal, but which they explain as compromises, which must be accepted as a necessary part of their stay in the ward. This study demonstrates a close connection between patient satisfaction and vulnerability. It is important for all health care providers not to be complacent and satisfied when patients express their satisfaction with their treatment and care. This can result in losing the focus on the patients' vulnerability and existential thoughts and reflections which are difficult for them, and which need to be addressed. The findings can be seen as a challenge for the health care providers as well as the organization to provide quality of care to patients in acute care ward. When listening to the patients' voice it makes it easier to be aware of the content of their vulnerability.

  14. Vulnerable, but strong: The spinal cord-injured patient during rehabilitation

    PubMed Central

    Angel, Sanne

    2010-01-01

    A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge. A phenomenological–hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient's perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person's experience of the situation rather than the person, as it may hinder the professionals' open, explorative approach towards the person. PMID:20927203

  15. Vulnerable, but strong: The spinal cord-injured patient during rehabilitation.

    PubMed

    Angel, Sanne

    2010-10-04

    A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation.The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge.A phenomenological-hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury.The patient's strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient's perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person's experience of the situation rather than the person, as it may hinder the professionals' open, explorative approach towards the person.

  16. Feeling "overloaded" and "shortcomings": milieu therapists' experiences of vulnerability in caring for severely mentally ill patients.

    PubMed

    Bachmann, Liv; Michaelsen, Ragnhild A; Vatne, Solfrid

    2016-01-01

    Milieu therapists' relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists' vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists' experiences of their own vulnerability in their interactions with patients in mental health services. The data collection method was focus-group interviews. Thirteen part-time master's in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2-8 years). The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) "overloaded", by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) "shortcomings", connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists' vulnerability might strengthen their personal and professional integrity in professional

  17. Changes to criminal records checks used to safeguard vulnerable patients.

    PubMed

    Griffith, Richard; Tengnah, Cassam

    2012-07-01

    The Protection of Freedoms Act 2012 is introducing changes to the Criminal Records Bureau (CRB) checks carried out on those people who work with vulnerable groups. The new law is the coalition Government's response to the criticism of the Safeguarding Vulnerable Group Act 2006. It will merge the CRB and Independent Safeguarding Authority into a new Disclosure and Barring Service and will enhance the rights of applicants to challenge the CRB's right to disclose non-conviction information as part of an enhanced criminal records check. In the first of two articles on the Protection of Freedoms Act 2012, Richard Griffith and Cassam Tengnah discuss the current framework for disclosing criminal records and the impact of the changes on district nurses applying for new posts.

  18. Patient safety through RFID: vulnerabilities in recently proposed grouping protocols.

    PubMed

    Wickboldt, Anne-Katrin; Piramuthu, Selwyn

    2012-04-01

    As RFID-tagged systems become ubiquitous, acceptance of this technology by the general public necessitates addressing related security/privacy issues. The past eight years have seen an increasing number of publications in this direction, specifically using cryptographic approaches. Recently, the Journal of Medical Systems published two papers addressing security/privacy issues through cryptographic protocols. We consider the proposed protocols and identify some existing vulnerabilities.

  19. Vulnerable caregivers of patients with Alzheimer's disease have a deficit in circulating CD62L- T lymphocytes.

    PubMed

    Mills, P J; Yu, H; Ziegler, M G; Patterson, T; Grant, I

    1999-01-01

    The cell adhesion molecule, L-selectin (CD62L), serves a crucial role in the migration of naive T lymphocytes and is typically shed on cell activation. The objective of this study was to determine the effects of chronic stress on L-selectin expression on peripheral lymphocytes in elderly spousal caregivers of patients with Alzheimer's disease. Twenty caregivers (mean age, 73.5 years) had their lymphocytes and catecholamine levels sampled at rest and in response to an acute psychological stressor. Ten of the caregivers were classified as susceptible or "vulnerable" based on the large amount of care required by the patient relative to the amount of respite the caregiver received during the previous 6 months. At rest, vulnerable caregivers had 60% fewer L-selectin negative CD8+ T cells (CD8+CD62L-) (p=.01) but no difference in CD8+CD62L+ cells. Vulnerable caregivers also showed significantly fewer CD4+CD62L- T lymphocytes (p=.04) but no difference in CD4+CD62L+ lymphocytes. Resting plasma epinephrine levels were 44% higher in vulnerable caregivers as compared with nonvulnerable caregivers (p=.01). The acute stressor increased circulating levels of CD8+CD62L- and CD8+CD62L+ lymphocytes and catecholamines similarly in both groups. The findings suggest that caregivers who are more vulnerable to the chronic stress of caregiving show a decrement in circulating CD62L- T lymphocytes, possibly by adrenomedullary activation. The data also suggest the identity of lymphocyte subsets that may underlie prior observations of immunologic decrements associated with the chronic stress of caregiving.

  20. Serving Those That Serve.

    PubMed

    Torrens Armstrong, Anna

    2017-03-01

    Since 1986, health promotion has had a place within the U.S. Department of Defense. Emphasizing the leading health indicators of Healthy People, the role of health promotion has continued to support the U.S. Armed Forces in perhaps one of the most challenging decades of wartime operations. Serving a sizable population with both typical and mission-related health issues, health promotion plays a critical role in maintaining and improving health. The purpose of this article is to highlight military health promotion by offering insight into the day-to-day life of a "boots on the ground" military health educator, reviewing the challenges and opportunities of working with a unique population. A summary of a variety of military specific initiatives is provided. Additionally, the article highlights the barriers and benefits to military health promotion. Last, the article concludes with a call to action to consider the role of all health educators in serving those that serve.

  1. Knowledge to serve the city: insights from an emerging knowledge-action network to address vulnerability and sustainability in San Juan, Puerto Rico

    Treesearch

    T.A. Munoz-Erickson; A.E. Lugo; E. Melendez-Ackerman; L.E. Santiago-Acevedo; J. Seguinot-Barbosa; P. Mendez-Lazaro

    2014-01-01

    This paper presents initial efforts to establish the San Juan Urban Long-Term Research Area Exploratory (ULTRA-Ex), a long-term program aimed at developing transdisciplinary social-ecological system (SES) research to address vulnerability and sustainability for the municipality of San Juan. Transdisciplinary approaches involve the collaborations between researchers,...

  2. Can Erectile Dysfunction in Young Patients Serve as a Surrogate Marker for Coronary Artery Disease?

    PubMed Central

    Dattatrya, Kaje Yogesh; Gorakhnath, Wagaska Vinayak; kiran, Patwardhan Sujata

    2015-01-01

    Introduction Early diagnosis and expeditious management of coronary artery disease (CAD) has a rewarding survival benefit. Aim To study whether erectile dysfunction (ED) serves as a surrogate marker for CAD in a young patient. Settings and Design Males (n=207) between ages 20-60 years with ED were evaluated prospectively for risk factors for CAD. Materials and Methods Blood Glucose Levels (BGL) fasting and post meal), lipid profile (LP) and 12 lead electrocardiogram (ECG) was done in all of them. International Index of Erectile Function-5 (IEF-5) was used for the evaluation of ED. Those with abnormal parameters were assessed by cardiologists by echocardiography, stress test and if necessary coronary angiography (Non-Invasive or Invasive). Statistical Analysis All the data were analysed using SPSS. 16 statistical software (SPSS Inc., Chicago, IL, USA). All data are expressed as mean and standard deviation. The Student’s t-test was used to compare means between groups, and the chi-square test was used to compare proportions between the groups. P-value <0.05 was considered statistically significant. All confidence intervals (CIs) are two tailed and calculated at the 0.05 level. Results Out of 207, 149 patients had at least one abnormal screening parameter. All underwent cardiology consultation and 2D ECHO and Stress test. Thirty six patients underwent coronary angiography. CAD was found in 22 patients. Of these, 19 patients had severe ED. Nine patients were between 20-40 years of age (13.23%). All 9 young patients had deranged LP; severe ED. Six patients were smokers while nobody was hypertensive. Conclusion ED serves as a surrogate marker for CAD in young patients (p=0.001). Presence of risk factors and lab abnormalities in young patients with ED warrants a cardiology referral to detect CAD. PMID:26674799

  3. Physician Willingness and Resources to Serve More Medicaid Patients: Perspectives from Primary Care Physicians

    PubMed Central

    Sommers, Anna S.; Paradise, Julia; Miller, Carolyn

    2011-01-01

    Objective Sixteen million people will gain Medicaid under health reform. This study compares primary care physicians (PCPs) on reported acceptance of new Medicaid patients and practice characteristics. Data and Methods Sample of 1,460 PCPs in outpatient settings was drawn from a 2008 nationally representative survey of physicians. PCPs were classified into four categories based on distribution of practice revenue from Medicaid and Medicare and acceptance of new Medicaid patients. Fifteen in-depth telephone interviews supplemented analysis. Findings Most high- and moderate-share Medicaid PCPs report accepting “all” or “most” new Medicaid patients. High-share Medicaid PCPs were more likely than others to work in hospital-based practices (20%) and health centers (18%). About 30% of high- and moderate-share Medicaid PCPs worked in practices with a hospital ownership interest. Health IT use was similar between these two groups and high-share Medicare PCPs, but more high- and moderate-share Medicaid PCPs provided interpreters and non-physician staff for patient education. Over 40% of high- and moderate-share Medicaid PCPs reported inadequate patient time as a major problem. Low- and no-share Medicaid PCPs practiced in higher-income areas than high-share Medicaid PCPs. In interviews, difficulty arranging specialist care, reimbursement, and administrative hassles emerged as reasons for limiting Medicaid patients. Policy Implications PCPs already serving Medicaid are positioned to expand capacity but also face constraints. Targeted efforts to increase their capacity could help. Acceptance of new Medicaid patients under health reform will hinge on multiple factors, not payment alone. Trends toward hospital ownership could increase practices' capacity and willingness to serve Medicaid. PMID:22340772

  4. Differences in risk factors for suicidality between African American and White patients vulnerable to suicide.

    PubMed

    Vanderwerker, Lauren C; Chen, Joyce H; Charpentier, Peter; Paulk, Mary Elizabeth; Michalski, Marion; Prigerson, Holly G

    2007-02-01

    Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty. In adjusted analyses, social support was significantly associated with suicidality in African American patients, while younger age and the presence of an anxiety disorder were significantly associated with suicidality in White patients. The results suggest that race/ethnicity-specific risk profiles may improve the detection of suicidality in vulnerable populations.

  5. Ethical vulnerabilities in nursing history: conflicting loyalties and the patient as 'other'.

    PubMed

    Lagerwey, Mary Deane

    2010-09-01

    The purpose of this article is to explore enduring ethical vulnerabilities of the nursing profession as illustrated in historical chapters of nursing's past. It describes these events, then explores two ethical vulnerabilities in depth: conflicting loyalties and duties, and relationships with patients as 'other'. The article concludes with suggestions for more ethical approaches to the other in current nursing practice. The past may be one of the most fruitful sites for examining enduring ethical vulnerabilities of the nursing profession. First of all, professional identity, which includes moral identity, comes in part from knowledge of the nursing profession's past. Second, looking to the past to understand better how events and ideologies have brought vulnerabilities to the fore raises questions about ethical nursing practice today.

  6. "It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.

    PubMed

    Groene, Raluca Oana; Orrego, Carola; Suñol, Rosa; Barach, Paul; Groene, Oliver

    2012-12-01

    Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. To explore handover practices at discharge and to focus on the patients' role in handovers and on the potential additional risks for vulnerable patients. We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment.

  7. Spine and Pain Clinics Serving North Carolina Patients With Back and Neck Pain

    PubMed Central

    Castel, Liana D.; Freburger, Janet K.; Holmes, George M.; Scheinman, Rachael P.; Jackman, Anne M.; Carey, Timothy S.

    2009-01-01

    Study Design Cross-sectional survey. Objective Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Summary of Background Data Pain clinics have become common in the United States, and patients with chronic back pain have increasingly been seeking services at these clinics. Little is known about the organizational characteristics of spine and pain clinics. Methods We identified and surveyed spine and pain clinics serving North Carolina residents with chronic back and neck pain. Practice managers at 46 clinics completed a 20-minute questionnaire about the characteristics of their clinic, including providers on staff and services offered. Descriptive and exploratory analyses were conducted to summarize the data. Several variables were constructed to assess the multidisciplinary nature of the clinics. Results The response rate was 75%. There was marked heterogeneity among the clinics surveyed. Fifty-nine percent of practices were free-standing (n = 27) and 61% were physician-owned (n = 28). Twenty-five clinics (54%) had an anesthesiologist. Other common physician providers were physiatrists and surgeons. Less than one third of sites had mental health providers (n = 12; 26%); only 26% employed physical therapists. Seventy-six percent of sites offered epidural injections, 74% long-term narcotic prescriptions, and 67% antidepressants. The majority of clinics (30 of 33) prescribing narcotics provided monitoring of therapy using periodic urine toxicology testing. Forty-eight percent of sites (n = 22) offered exercise instruction. Few clinics were multidisciplinary in nature. Only 3 (7%) met the criteria of having a medical physician, registered nurse, physical therapist, and mental health specialist. Conclusion Clinics varied widely in their organizational characteristics, including providers

  8. Scheduled out-patient endoscopy and lack of compliance in a minority serving tertiary institution

    PubMed Central

    Jackson, Danielle S.; Egbuonnu, Nneka; Umunakwe, Chukwuma; Fullum, Terrence M.; Ford, Debra H.; Anders, Kyle B.; McDonald-Pinkett, Shelly; Smoot, Duane T.; Laiyemo, Adeyinka O.

    2011-01-01

    Background Lack of adherence to appointments wastes resources and portends a poorer outcome for patients. We sought to determine if the type of scheduled endoscopic procedures affect compliance. Methods We reviewed the final endoscopy schedule from January 2010 to August 2010 in an inner city teaching hospital that serves a predominantly African American population. The final schedule only includes patients who did not cancel, reschedule or notify the facility of their inability to adhere to their care plan up to 24 hours prior to their procedures. All patients had face to face consultation with gastroenterologists or surgeons prior to scheduling. We identified patients who did not show up for their procedures. We used Poisson regression models to calculate Relative Risks (RR) and 95% Confidence Intervals (CI). Results Of 2,183 patients who were scheduled for outpatient endoscopy, 400 (18.3%) patients were scheduled for Esophago-gastro-duodenoscopy (EGD), 1,335 (61.2%) for colonoscopy and 448 (20.5%) for both EGD and colonoscopy. The rate of non compliance was 17.5%, 22.8% and 22.1%, respectively. When compared to those scheduled for only EGD, patients scheduled for colonoscopy alone (RR = 1.47; 95%CI: 1.13-1.92) and patients scheduled for both EGD and colonoscopy (RR = 1.36; 95%CI: 1.01-1.84) were less likely to show up for their procedures. Conclusions Our study suggests a high rate of non-compliance with scheduled out-patient endoscopy, particularly for colonoscopy. Since this may be a contributing factor to colorectal cancer disparities, increased community outreach on colorectal cancer education is needed and may help to reduce non compliance. PMID:22197978

  9. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making.

    PubMed

    Mijderwijk, Herjan; Stolker, Robert Jan; Duivenvoorden, Hugo J; Klimek, Markus; Steyerberg, Ewout W

    2016-09-01

    Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R (2) ). In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R (2)  = 30% and ORC = 0.76 after correction for optimism. This study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare

  10. The hub-and-spoke organization design: an avenue for serving patients well.

    PubMed

    Elrod, James K; Fortenberry, John L

    2017-07-11

    The healthcare industry is characterized by intensive, never-ending change occurring on a multitude of fronts. Success in such tumultuous environments requires healthcare providers to be proficient in myriad areas, including the manner in which they organize and deliver services. Less efficient designs drain precious resources and hamper efforts to deliver the best care possible to patients, making it imperative that optimal pathways are identified and pursued. One particular avenue that offers great potential for serving patients efficiently and effectively is known as the hub-and-spoke organization design. The hub-and-spoke organization design is a model which arranges service delivery assets into a network consisting of an anchor establishment (hub) which offers a full array of services, complemented by secondary establishments (spokes) which offer more limited service arrays, routing patients needing more intensive services to the hub for treatment. Hub-and-spoke networks afford many benefits for healthcare providers, but in order to capitalize fully, proper assembly is required. To advance awareness, knowledge, and use of the hub-and-spoke organization design, this article profiles Willis-Knighton Health System's service delivery network which has utilized the model for over three decades. Among other things, the hub-and-spoke organization design is defined, benefits are stipulated, and applications are discussed, permitting healthcare providers essential insights for the establishment and operation of these networks. The change-rich nature of the healthcare industry places a premium on incorporating advancements that permit health and medical providers to operate as optimally as possible. The hub-and-spoke organization design represents an option that, when deployed correctly, can greatly assist healthcare establishments in their quests to serve patients well.

  11. Serum liver enzymes serve as prognostic factors in patients with intrahepatic cholangiocarcinoma

    PubMed Central

    Zhang, Chenyue; Wang, Haiyong; Ning, Zhouyu; Xu, Litao; Zhuang, Liping; Wang, Peng; Meng, Zhiqiang

    2017-01-01

    Objective Liver functions, reflective of the overall status of the host, have been reported to be important factors affecting the prognosis in many types of cancers. In this study, we explored the influences of liver enzymes albumin (ALB), globulin (GELO), total protein (TP), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), gamma glutamyltranspeptidase (GGT), and lactate dehydrogenase (LDH) on the overall survival (OS) in a number of 173 patients with intrahepatic cholangiocarcinoma (ICC). Patients and methods Between 2011 and 2015, we enrolled patients with pathologically proven locally advanced or metastatic ICC. The impact of ALB, GELO, TP, ALP, ALT, AST, TBIL, DBIL, GGT, and LDH on OS were analyzed using Kaplan–Meier analysis. Next, the associations between these liver enzymes and OS were evaluated by univariate and multivariate analyses. Finally, the role of these enzymes in OS was evaluated in the subgroups. Results Elevated liver enzymes were linked with OS. We revealed that independent prognostic factors of poor outcome were ALP, TBIL, DBIL, and GGT, whereas ALB is a protective factor in ICC patients. Conclusion Our results demonstrate that these liver enzymes may serve as valuable predictive markers in ICC patients. PMID:28331337

  12. Ward mortality in patients discharged from the ICU with tracheostomy may depend on patient's vulnerability.

    PubMed

    Fernandez, Rafael; Bacelar, Nestor; Hernandez, Gonzalo; Tubau, Isabel; Baigorri, Francisco; Gili, Gisela; Artigas, Antonio

    2008-10-01

    To determine the effect of discharge from the ICU with a tracheostomy tube on ward mortality and its relation to patient vulnerability. Retrospective single-center cohort study. Database (2003-2006) review of patients undergoing mechanical ventilation (MV) > 24 h and discharged from the ICU with or without tracheostomy tube in place and followed up to hospital discharge or death. We recorded clinical characteristics, complications, major ICU procedures, subjective prognosis at ICU discharge (Sabadell score), and hospital outcome. Factors associated with ward mortality were analyzed by multiple logistic regression. From 3,065 patients admitted to the ICU, 1,502 needed MV > 24 h. Only 936 patients (62%) survived the ICU and were transferred to the ward; of these, 130 (13.9%) had a tracheostomy tube in place. Ward mortality was higher in patients with a tracheostomy tube in place than in those without (26 vs. 7%, P < 0.001). Increased ward mortality among cannulated patients was seen only in those with intermediate Sabadell score (24 vs. 9% in score 1, P = 0.02, and 38 vs. 24% in score 2, P = 0.06), but not in the "good prognosis" (2 vs. 2%, score 0) and "expected to die in hospital" (80 vs. 75%, score 3) groups. Multivariate analysis found three factors associated with ward mortality: age, tracheostomy tube in place, and Sabadell score. Lack of tracheostomy decannulation in the ICU appears to be associated with ward mortality, but only in the group with a Sabadell score of 1.

  13. Serum liver enzymes serve as prognostic factors in patients with intrahepatic cholangiocarcinoma.

    PubMed

    Zhang, Chenyue; Wang, Haiyong; Ning, Zhouyu; Xu, Litao; Zhuang, Liping; Wang, Peng; Meng, Zhiqiang

    2017-01-01

    Liver functions, reflective of the overall status of the host, have been reported to be important factors affecting the prognosis in many types of cancers. In this study, we explored the influences of liver enzymes albumin (ALB), globulin (GELO), total protein (TP), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), gamma glutamyltranspeptidase (GGT), and lactate dehydrogenase (LDH) on the overall survival (OS) in a number of 173 patients with intrahepatic cholangiocarcinoma (ICC). Between 2011 and 2015, we enrolled patients with pathologically proven locally advanced or metastatic ICC. The impact of ALB, GELO, TP, ALP, ALT, AST, TBIL, DBIL, GGT, and LDH on OS were analyzed using Kaplan-Meier analysis. Next, the associations between these liver enzymes and OS were evaluated by univariate and multivariate analyses. Finally, the role of these enzymes in OS was evaluated in the subgroups. Elevated liver enzymes were linked with OS. We revealed that independent prognostic factors of poor outcome were ALP, TBIL, DBIL, and GGT, whereas ALB is a protective factor in ICC patients. Our results demonstrate that these liver enzymes may serve as valuable predictive markers in ICC patients.

  14. Agricultural exposures in patients with COPD in health systems serving rural areas.

    PubMed

    Bailey, Kristina L; Meza, Jane L; Smith, Lynette M; Von Essen, Susanna G; Romberger, Debra J

    2007-01-01

    Agricultural exposure is a risk factor for the development of chronic obstructive pulmonary disease (COPD). However, there are no good estimates of the number of COPD patients with a history of agricultural exposure. We conducted a telephone interview of subjects with COPD identified by reviewing all pulmonary function tests at the Omaha Veterans Administration Hospital between November 2004 and March 2005. Obstructive lung disease was defined as a FEV(1)/FVC ratio of less than 70%. The survey detailed demographic data, smoking history, pulmonary symptoms, and history of agricultural exposures. Participants included 150 veterans (mean age 68.2 years +/-10.8). A history of agricultural exposure was elicited in 68% of subjects. Of those who had worked in agriculture, the types of exposures varied, with 14% in hog confinement barns, 20% on dairy farms, 8% on poultry farms, and 87% exposed to grain dust. There was a trend of diminishing FEV(1) with increasing years of agricultural exposure. In health systems that serve rural areas, patients with COPD commonly have a history of agricultural exposures that may contribute to the development of COPD. Health care workers in these areas should include agricultural exposures as an important part of the social/occupational history in these patients.

  15. Differences in Risk Factors for Suicidality between African American and White Patients Vulnerable to Suicide

    ERIC Educational Resources Information Center

    Vanderwerker, Lauren C.; Chen, Joyce H; Charpentier, Peter; Paulk, Mary Elizabeth; Michalski, Marion; Prigerson, Holly G.

    2007-01-01

    Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a population of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty.…

  16. Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link?

    PubMed

    Pedersen, Susanne S; Brouwers, Corline; Versteeg, Henneke

    2012-07-01

    Implantable cardioverter defibrillator (ICD) therapy is the first-line treatment for the prevention of sudden cardiac death. Despite the demonstrated survival benefits of the ICD, predicting which patients will die from a ventricular tachyarrhythmia remains a major challenge. So far, psychological factors have not been considered as potential risk markers that might enhance the prediction of sudden cardiac death. This article evaluates the evidence for a link between psychological vulnerability, ventricular tachyarrhythmias and mortality and the pathways that might explain such a link. This review demonstrates that there is cumulative evidence supporting a link between psychological vulnerability and risk of ventricular tachyarrhythmias and mortality in ICD patients independent of disease severity and other biomedical risk factors. It may be premature to include psychological factors in risk algorithms, but information on the psychological profile of the patient may help to optimize the management and care of these patients in clinical practice.

  17. Report of the ASHP Task Force on Caring for Patients Served by Specialty Suppliers.

    PubMed

    Caselnova, Dominick; Donley, Kathy; Ehlers, Diane; Hyduk, Amy E; Koontz, Susannah E; Nowobilski-Vasilios, Anna; Pawlicki, Kathleen S; Poikonen, John C; Poremba, Art C; Sasser, Cathy L; Schell, Kenneth H; Schwab, Jay L; Swinarski, Dave; Chen, David; Kirschenbaum, Bonnie; Armitstead, John

    2010-10-01

    Task Force recommendations are discussed in more detail in eAppendix A (available at www.ajhp.org). What follows is a brief summary of those recommendations. In very abbreviated terms, the Task Force suggested that ASHP: 1. Consider creating and maintaining a Web resource center on ASHP's website to provide information about restricted drug distributions systems (RDDSs), risk evaluation and mitigation strategies (REMSs), risk assessment and minimization plans (RiskMAPs), and specialty suppliers and products. 2. Provide comprehensive education to members, other health professionals, regulators, third-party payers, patients, and other stakeholders about RDDSs, REMSs, RiskMAPs, and specialty suppliers and products. 3. Develop policies to advocate that a. Pharmacists serve as the institutional leaders in compliance and utilization challenges of safely managing externally supplied medications and related drug administration devices, b. Agencies, organizations, and associations that influence the distribution, sale, and dispensing of medications under these alternative distribution models address issues these models create in continuity of care, reimbursement, and patient safety, c. The Centers for Medicare and Medicaid Services and the Joint Commission develop standards and interpretations that accommodate hospital use of these products and devices when currently available technology (e.g., cold-chain storage, e-pedigree) is used to ensure patient safety, d. Group purchasing organizations negotiate contractual arrangements for specialty pharmaceuticals for both acquisition costs and distribution arrangements, and e. Information technology (IT) be used to resolve issues created by alternative distribution models and that ASHP work with IT vendors to ensure that programs are designed to meet the needs of these evolving models. 4. Quantify through research, perhaps in cooperation with entities such as the Agency for Healthcare Research and Quality, the Institute of

  18. Advocacy at the end of life: meeting the needs of vulnerable Latino patients.

    PubMed

    Nedjat-Haiem, Frances R; Carrion, Iraida V; Cribbs, Kristen; Lorenz, Karl

    2013-01-01

    This research explores health care professionals' understanding of the problems that arise in managing a terminal condition impacting the Latino population and conceptualizes the components of patient advocacy that address gaps in end-of-life care for patients and their family members. Limited research exists regarding patient advocacy from the perspectives of health care providers working with vulnerable Latino populations utilizing a public sector health care system. Forty-six semi-structured interviews were conducted with providers from different disciplines including medicine, nursing, social work, and chaplaincy. Although roles and responsibilities vary among health providers, it is imperative that all providers become aware of the need for patient advocacy. Doing so is not only in the best interest of vulnerable Latino populations but also has overarching financial benefits and positive outcomes for patients, administrators, and public health care systems. Social workers are the ideal professionals to assume leadership roles and share their knowledge of how to advocate effectively for the most vulnerable populations.

  19. Return home at the end of life: Patients' vulnerability and risk factors.

    PubMed

    Vassal, P; Le Coz, P; Hervé, C; Matillon, Y; Chapuis, F

    2011-03-01

    Although most of the people in good health questioned about the subject said they would like to die at home, in the western world between 60 and 80% of deaths occur in hospital. Most authors consider that the indispensable conditions for a return home are the patient's desire and presence of the family and caregivers with the appropriate skills. The assessment of other factors predictive of a return home is inadequate. The aim of this study is to clarify how the return home is influenced by the vulnerability of the patient at the end of life, and by that of the family and caregivers. We carried out a multicentric, observational, prospective, exhaustive and longitudinal epidemiological study (three months follow-up), including 146 patients hospitalized at the end of their life and desiring to return home. For these patients the caregivers respected their freedom to choose to die at home in over half the cases (56%). Their overall vulnerability (personal, family context and caregivers) had a significant influence on the return home. This overall vulnerability was in fact identified as applying in 40% of the clinical situations, and made the possibility of a return home 50% less likely.

  20. Hemodialysis patients have plasmatic hypercoagulability and decreased fibrinolytic vulnerability: role of carbon monoxide.

    PubMed

    Matika, Ryan W; Nielsen, Vance G; Steinbrenner, Evangelina B; Sussman, Amy N; Madhrira, Machaiah

    2014-01-01

    Chronic hemodialysis is associated with significant thrombophilia. Of interest, hemodialysis patients have increased carboxyhemoglobin (COHb) and exhaled carbon monoxide (CO), signs of upregulated heme oxygenase (Hmox) activity. Given that CO enhances plasmatic coagulation, we determined whether patients requiring chronic hemodialysis had an increase in endogenous CO, plasmatic hypercoagulability and decreased fibrinolytic vulnerability. Carbon monoxide was determined by noninvasive pulse oximetry measurement of COHb. Blood samples were obtained just before hemodialysis. Thrombelastographic methods to assess plasma coagulation kinetics, fibrinolytic kinetics, and formation of carboxyhemefibrinogen (COHF) were used. Hemodialysis patients (n = 45) had abnormally increased COHb concentrations of 2.2 ± 1.9%, indicative of Hmox upregulation. Coagulation and fibrinolytic parameter normal values were determined with normal individual (n = 30) plasma. Thirty-seven patients of the hemodialysis cohort had COHF formation (82.2%, [67.9%-92.0%]; mean, [95% confidence interval]), and many of this group of patients had abnormally great velocity of clot growth (73.3%, [58.1%-85.4%]) and strength (75.6%, [60.5%-87.1%]). Furthermore, over half of COHF positive patients had a hypofibrinolytic state, evidenced by an abnormally prolonged time to maximum rate of lysis (53.3%, [37.9%-68.6%]) and clot lysis time (64.4%, [48.8%-78.1%]). Carbon monoxide enhanced coagulation and diminished fibrinolytic vulnerability in hemodialysis patients. Future investigation of hemodialysis, CO-related thrombophilia is warranted.

  1. Psychiatric patients' vulnerability in the wake of the September 11th terrorist attacks.

    PubMed

    Franklin, C Laurel; Young, Diane; Zimmerman, Mark

    2002-12-01

    The September 11, 2001 (9/11) terrorist attacks led to speculation about the vulnerability of psychiatric patients to psychological distress following such events. This study examined the impact of national terrorist attacks on psychiatric and medical outpatients living approximately 150 to 200 miles from the attack sites (N = 308). Two to 3 weeks following 9/11, patients were given questionnaires assessing background information, healthcare service utilization, and posttraumatic stress disorder (PTSD) symptoms. Psychiatric patients (33%) were significantly more likely than medical patients (13%) to report distressing symptoms meeting criteria for PTSD (except for the duration criterion) despite no differences in learning about the attacks or personal involvement with the victims. Patients meeting PTSD criteria were more likely to schedule an appointment to speak with their physician about their reactions. Psychiatric patients not directly impacted by the 9/11 terrorist attacks are at increased risk for experiencing distressing symptoms following national terrorist attacks.

  2. Feeling “overloaded” and “shortcomings”: milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients

    PubMed Central

    Bachmann, Liv; Michaelsen, Ragnhild A; Vatne, Solfrid

    2016-01-01

    Background Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might

  3. Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

    PubMed Central

    Taylor, Natalie; Hogden, Emily; Clay-Williams, Robyn; Li, Zhicheng; Lawton, Rebecca; Braithwaite, Jeffrey

    2016-01-01

    Objectives The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study ‘Deepening our Understanding of Quality in Australia’ (DUQuA). Participants Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital. Methods 2 phases were conducted. First, a ‘think aloud’ study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA. Results Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge. Conclusions Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study. PMID:27279478

  4. Medicare home health payment reform may jeopardize access for clinically complex and socially vulnerable patients.

    PubMed

    Rosati, Robert J; Russell, David; Peng, Timothy; Brickner, Carlin; Kurowski, Daniel; Christopher, Mary Ann; Sheehan, Kathleen M

    2014-06-01

    The Affordable Care Act directed Medicare to update its home health prospective payment system to reflect more recent data on costs and use of services-an exercise known as rebasing. As a result, the Centers for Medicare and Medicaid Services will reduce home health payments 3.5 percent per year in the period 2014-17. To determine the impact that these reductions could have on beneficiaries using home health care, we examined the Medicare reimbursement margins and the use of services in a national sample of 96,621 episodes of care provided by twenty-six not-for-profit home health agencies in 2011. We found that patients with clinically complex conditions and social vulnerability factors, such as living alone, had substantially higher service delivery costs than other home health patients. Thus, the socially vulnerable patients with complex conditions represent less profit-lower-to-negative Medicare margins-for home health agencies. This financial disincentive could reduce such patients' access to care as Medicare payments decline. Policy makers should consider the unique characteristics of these patients and ensure their continued access to Medicare's home health services when planning rebasing and future adjustments to the prospective payment system.

  5. Narcissistic vulnerability is a common cause for depression in patients with Gilles de la Tourette syndrome.

    PubMed

    Trillini, Morounke O; Müller-Vahl, Kirsten R

    2015-12-15

    The aim of this study was to assess for the first time different dimensions of narcissistic self-regulation in a large cohort of adult patients with Gilles de la Tourette syndrome (GTS) (n=50). From preliminary studies it is suggested that narcissistic personality trait and disorder, respectively, are relatively uncommon and occur in only 6-10% of GTS patients. In this study we used the Narcissism Inventory (NI), a 163-items questionnaire that measures four different dimensions of narcissism. The main result was that the prevalence of narcissism strongly depends on the subtype of narcissism: while the vulnerable narcissism ("threatened self" and "hypochondriac self") was common, the "classic narcissistic self" (grandiose narcissism) was rare. From our data an association between comorbid depression and increased values of the "threatened self" and comorbid OCD with increased values of the "hypochondriac self" is suggested. Narcissism correlated positively with the personality domain neuroticism and had a significantly negative impact on patients' quality of life. Therefore it can be speculated that vulnerable narcissism is - among several others - one cause for depression in patients with GTS. These findings may open new psychotherapeutic perspectives in the treatment of depression in patients with GTS.

  6. Hypertension--a possible vulnerability marker for depression in patients with end-stage renal disease.

    PubMed

    Fan, Pao-Luo; Shu, Chin-Hsing; Shiang, Jeng-Chuan; Kuo, Tai-Song; Lung, For-Wey

    2006-01-01

    This study explored the association of hypertension and psychiatric morbidity in patients with end-stage renal disease (ESRD) under adjusted personality characteristics and parental attachment. The mental health of 121 patients with ESRD in a general teaching hospital was evaluated using the 12-item version of the Chinese Health Questionnaire (CHQ). Only 40 males and 49 females completed all the questionnaires. Ten of the 40 males and 21 of the 49 females had high scores (> or = 4) and were allotted to the case group (n = 31). The remaining 58 patients constituted the control group (CHQ < 4). The logistic regression model showed that hypertension, gender, and neuroticism are statistically significant covariates. Hypertension, especially, was strongly associated with depressive vulnerability (odds ratio of hypertension versus without hypertension = 9.07:1). Structural equation modeling revealed that gender difference and hypertension directly influenced the individuals' mental health status and that the influence of hypertension on mental health was highly variable. A parsimonious structural equation model provided considerable evidence that hypertension could have an important effect on depression in ESRD patients, when predisposing factors, such as personality characteristics and parental attachment, gender, duration of hemodialysis and other medical diseases were adjusted. Hence, hypertension might be a mediating factor of depressive vulnerability in ESRD patients underling genetic and environmental problems. 2006 S. Karger AG, Basel.

  7. The relationship between vulnerable attachment style, psychopathology, drug abuse, and retention in treatment among methadone maintenance treatment patients.

    PubMed

    Potik, David; Peles, Einat; Abramsohn, Yahli; Adelson, Miriam; Schreiber, Shaul

    2014-01-01

    The relationship between vulnerable attachment style, psychopathology, drug abuse, and retention in treatment among patients in methadone maintenance treatment (MMT) was examined by the Vulnerable Attachment Style Questionnaire (VASQ), the Symptom Checklist-90 (SCL-90), and drug abuse urine tests. After six years, retention in treatment and repeated urine test results were studied. Patients with vulnerable attachment style (a high VASQ score) had higher rates of drug abuse and higher psychopathology levels compared to patients with secure attachment style, especially on the interpersonal sensitivity, anxiety, hostility, phobic anxiety, and paranoid ideation scales. Drug abstinence at baseline was related to retention in treatment and to higher rates of drug abstinence after six years in MMT, whereas a vulnerable attachment style could not predict drug abstinence and retention in treatment. Clinical Implications concerning treatment of drug abusing populations and methodological issues concerning the VASQ's subscales are also discussed.

  8. The Spatial Distribution of Plaque Vulnerabilities in Patients with Acute Myocardial Infarction

    PubMed Central

    Zheng, Guian; Li, Yuxin; Takayama, Tadateru; Nishida, Toshihiko; Sudo, Mitsumasa; Haruta, Hironori; Fukamachi, Daisuke; Okubo, Kimie; Higuchi, Yoshiharu; Hiro, Takafumi; Saito, Satoshi; Hirayama, Atsushi

    2016-01-01

    Objective Although the plaque characteristics have been recognized in patients with acute myocardial infarction (AMI), the plaque spatial distribution is not well clarified. Using color-mapping intravascular ultrasound (iMAP-IVUS), we examined culprit lesions to clarify plaque morphology, composition and spatial distribution of the sites of potential vulnerability. Methods Sixty-eight culprit lesions in 64 consecutive AMI patients who underwent angiography and IVUS examinations before intervention were analyzed. Plaque morphology and composition were quantified with iMAP-IVUS. The spatial distribution of the sites of potential vulnerability was assessed with longitudinal reconstruction of the consecutive IVUS images. The plaque characteristics were also compared between ruptured and non-ruptured lesions, and between totally occlusive (TO) and non-TO lesions. Results The sites with maximum necrotic area (maxNA), maximum plaque burden (maxPB) and most severely narrowed (minimal luminal area, MLA) were recognized vulnerability. In the majority of cases, maxNA sites were proximal to the maxPB sites, and MLA sites were distal to the maxNA and maxPB sites. Ruptures usually occurred close to maxNA sites and proximal to maxPB and MLA sites. The average distance from the site of rupture to the maxNA site was 0.33 ± 4.04 mm. Ruptured lesions showed significant vessel remodeling, greater plaque volume, and greater lipidic volume compared to those of non-ruptured lesions. Both the length and plaque burden (PB) of TO lesions were greater than those of non-TO lesions. Conclusions Instead of overlapping on maxPB sites, most maxNA sites are proximal to the maxPB sites and are the sites most likely to rupture. Plaque morphology and composition play critical roles in plaque rupture and coronary occlusion. PMID:27031514

  9. Plaque Vulnerability as Assessed by Radiofrequency Intravascular Ultrasound in Patients with Valvular Calcification

    PubMed Central

    Senguttuvan, Nagendra Boopathy; Kumar, Sharath; Mishra, Sundeep; Cho, Jun Hwan; Kwon, Jee Eun; Hyeon, Seong Hyeop; Jeong, Yun Sang; Won, Hoyoun; Shin, Seung Yong; Lee, Kwang Je; Kim, Tae Ho; Kim, Chee Jeong; Kim, Sang-Wook

    2016-01-01

    Background Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability. Methods Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score–matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive. Results Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification. Conclusions There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA). PMID

  10. Drug prescribing for TPN patients at a teaching hospital serving a developing community.

    PubMed

    Bertram, T; Summers, R S

    1987-02-01

    Drug prescribing for TPN patients at Ga-Rankuwa Hospital was investigated as part of a larger retrospective survey of TPN products and practices. The medical records of 45 patients who received parenteral nutrition over the period April-August 1985 were examined. Relevant information was transcribed onto survey forms, classified and analysed. The major defined complaints were gastrointestinal (50%) and perinatal (34.5%). Twelve patients had more than one major complaint. Seventy-three per cent of the patients were admitted to paediatric wards and over 24% to (adult) surgical wards. There was one medical patient in the group. The only drug categories that were prescribed in more than 10% of cases were antimicrobial agents (64.9%) and analgesics (10.4%). The most frequently used individual drugs were gentamicin (17.5%), penicillin G (14.3%), piperacillin (17%) and aminophylline (11%). The implications of this pattern of drug use for TPN patient monitoring are discussed.

  11. Baseline traits of low vision patients served by private outpatient clinical centers in the United States.

    PubMed

    Goldstein, Judith E; Massof, Robert W; Deremeik, James T; Braudway, Sonya; Jackson, Mary Lou; Kehler, K Bradley; Primo, Susan A; Sunness, Janet S

    2012-08-01

    To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States. In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded. Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove. Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.

  12. The challenges of health professionals in meeting the needs of vulnerable patients undergoing chemotherapy: a focus group study.

    PubMed

    Witham, Gary; Haigh, Carol; Foy, Sharon

    2014-10-01

    To explore health professionals' perceptions of the needs of patients undergoing chemotherapy treatment for cancer. Patients with vulnerabilities face additional challenges. People with learning difficulties are often protected from even basic cancer information; patients with severe mental illness are open to structural discrimination with limited access to diagnostic and treatment services. There is also a much poorer survival rate after a cancer diagnosis for patients living with dementia. A qualitative design was used. A focus group design was undertaken for this project using a narrative analytical approach revealing how narrative tales are presented and performed. Eighteen healthcare workers were recruited from a regional oncology centre in North West England. Two focus groups were conducted with nine participants in each. The data were collected from late 2011-2012. Participants were primarily focused on getting patients through treatment. The identification of vulnerability was an 'extra' complication and one that in practice was difficult to define/categorise. The participants appreciated the wider inclusion of family and friends to support vulnerable patients although they felt formalised health care was not particularly facilitative of this process. There were difficulties in achieving support for complex patient needs in the presence of a target driven culture. Healthcare professionals need wider managerial and cultural support in meeting the needs of vulnerable patients. There appeared to be a tendency by healthcare professionals to minimise the inherent coping abilities of vulnerable patients. There is a clear need to support health professionals in providing appropriate resources in order to address the complex needs of vulnerable patients. This requires a cultural shift away from targets and an investment into greater resources for effective multidisciplinary working. © 2014 John Wiley & Sons Ltd.

  13. Specific vulnerability of face perception to noise: A similar effect in schizophrenia patients and healthy individuals

    PubMed Central

    Chen, Yue; McBain, Ryan; Norton, Daniel

    2014-01-01

    Face perception plays a foundational role in the social world. This perceptual ability is deficient in schizophrenia. A noise-filtering mechanism is essential for perceptual processing. It remains unclear as to whether a specific noise-filtering mechanism is implicated in the face perception problem or a general noise-filtering mechanism is involved which also mediates non-face visual perception problems associated with this psychiatric disorder. This study examined and compared the effects of external noise on the performance of face discrimination and car discrimination in schizophrenia patients (n=25) and healthy controls (n=27). Superimposing the external visual noise on face or car stimuli elevated perceptual thresholds (i.e. degraded performance levels) for both face and car discrimination. However, the effect of noise was significantly larger on face than on car discrimination, both in patients and controls. This pattern of results suggests specific vulnerability of face processing to noise in healthy individuals and those with schizophrenia. PMID:25500350

  14. Clinically Meaningful Rehabilitation Outcomes of Low Vision Patients Served by Outpatient Clinical Centers.

    PubMed

    Goldstein, Judith E; Jackson, Mary Lou; Fox, Sandra M; Deremeik, James T; Massof, Robert W

    2015-07-01

    To facilitate comparative clinical outcome research in low vision rehabilitation, we must use patient-centered measurements that reflect clinically meaningful changes in visual ability. To quantify the effects of currently provided low vision rehabilitation (LVR) on patients who present for outpatient LVR services in the United States. Prospective, observational study of new patients seeking outpatient LVR services. From April 2008 through May 2011, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study. The Activity Inventory, a visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline and 6 to 9 months after usual LVR care. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively, and clinical findings of patients were provided by study centers. Mean changes in the study population and minimum clinically important differences in the individual in overall visual ability and in visual ability in 4 functional domains as measured by the Activity Inventory. Baseline and post-rehabilitation measures were obtained for 468 patients. Minimum clinically important differences (95% CIs) were observed in nearly half (47% [95% CI, 44%-50%]) of patients in overall visual ability. The prevalence rates of patients with minimum clinically important differences in visual ability in functional domains were reading (44% [95% CI, 42%-48%]), visual motor function (38% [95% CI, 36%-42%]), visual information processing (33% [95% CI, 31%-37%]), and mobility (27% [95% CI, 25%-31%]). The largest average effect size (Cohen d = 0.87) for the

  15. Implementing the Ten Steps for Successful Breastfeeding in Hospitals Serving Low-Wealth Patients

    PubMed Central

    Taylor, Emily C.; Nickel, Nathan C.

    2012-01-01

    Objectives. The Ten Steps to Successful Breastfeeding is a proven approach to support breastfeeding in maternity settings; however, scant literature exists on the relative impact and interpretation of each step on breastfeeding. We assessed the Ten Steps and their relationship with in-hospital breastfeeding rates at facilities serving low-wealth populations and explored the outcomes to identify step-specific actions. Methods. We present descriptive and nonparametric comparisons and qualitative findings to examine the relationship between the Ten Steps and breastfeeding rates from each hospital using baseline data collection. Results. Some steps (1-policy, 2-training, 4-skin-to-skin, 6-no supplements, and 9-no artificial nipples, followed by 3-prenatal counseling, 7-rooming-in) reflected differences in relative baseline breastfeeding rates between settings. Key informant interviews revealed misunderstanding of some steps. Conclusions. Self-appraisal may be less valid when not all elements of the criteria for evaluating Step implementation may be fully understood. Limited exposure and understanding may lead to self-appraisal errors, resulting in scores that are not reflective of actual practices. Nonetheless, the indication that breastfeeding rates may be better mirrored by a defined subset of steps may provide some constructive insight toward prioritizing implementation activities and simplifying assessment. These issues will be further explored in the next phase of this study. PMID:23078473

  16. The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families.

    PubMed

    Ely, E Wesley

    2017-02-01

    Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called "the postintensive care syndrome." Patients with postintensive care syndrome are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU liberation is an extensive program designed to facilitate the implementation of the pain, agitation, and delirium guidelines using the evidence-based ABCDEF bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In doing so, patients are "liberated" from iatrogenic aspects of care that threaten his or her sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th Society of Critical Care Medicine Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU liberation philosophy and to explain how this patient- and family-centered, quality improvement program is novel, generalizable, and practice changing.

  17. Serving Families.

    ERIC Educational Resources Information Center

    Link, Geoffrey; Beggs, Marjorie; Seiderman, Ethel

    Parent Services Project (PSP), the first comprehensive program of resources and mental health activities for parents offered at child care centers in the San Francisco Bay Area (California), has expanded to centers in six states, serving over 19,000 families. This report describes the program's history, aims, and achievements, along with specific…

  18. Serving Families.

    ERIC Educational Resources Information Center

    Link, Geoffrey; Beggs, Marjorie; Seiderman, Ethel

    Parent Services Project (PSP), the first comprehensive program of resources and mental health activities for parents offered at child care centers in the San Francisco Bay Area (California), has expanded to centers in six states, serving over 19,000 families. This report describes the program's history, aims, and achievements, along with specific…

  19. HLA alleles may serve as a tool to discriminate atypical type 2 diabetic patients

    PubMed Central

    Fernández, Mariana; Fabregat, Matías; Javiel, Gerardo; Mimbacas, Adriana

    2014-01-01

    AIM: To investigate whether the presence of human leukocyte antigen (HLA) marker could add new information to discriminated atypical diabetic type 2 patients. METHODS: We analyzed 199 patients initially diagnosed as type 2 diabetes who are treated in special care diabetes clinics (3rd level). This population was classified in “atypical” (sample A) and “classic” (sample B) according to HLA typing. We consider “classic patient” when has absence of type 1 diabetes associated HLA alleles and no difficulties in their diagnosis and treatments. By the other hand, we considered “atypical patient” when show type 1 diabetes associated HLA alleles and difficulties in their diagnosis and treatments. The standard protocol Asociacion Latinoamericana de Diabetes 2006 was used for patients follow up. To analyze differences between both populations in paraclinical parameters we used unpaired t tests and contingence tables. Bivariate and multivariate analyses were carried out using the SPSS software program. In all studies we assume differences statistically significant, with a P-value < 0.05 corrected and 95%CI. RESULTS: The typing HLA in the “atypical” populations show that 92.47% patients presented at list one type 1 diabetes associated HLA alleles (DQB1*0201-0302 and DR 3-4) and 7.53% had two of its. The results showed for categorical variables (family history, presence or absence of hypertension and/or dyslipidemia, reason for initial consultation) the only difference found was at dyslipidemia (OR = 0.45, 0.243 < OD < 0.822 (P < 0.001). In relation to continuous variables we found significant differences between atypical vs classic only in cholesterol (5.07 ± 1.1 vs 5.56 ± 1.5, P < 0.05), high density lipoproteins (1.23 ± 0.3 vs 1.33 ± 0.3, P < 0.05) and low density lipoproteins (2.86 ± 0.9 vs 3.38 ± 1.7, P < 0.01). None of the variables had discriminating power when logistic regression was done. CONCLUSION: We propose an algorithm including HLA

  20. Substance Use in Vulnerable Patients with Orofacial Injury: Prevalence, Correlates, and Unmet Service Needs

    PubMed Central

    Murphy, Debra A.; Shetty, Vivek; Resell, Judith; Zigler, Cory; Yamashita, Dennis Duke

    2009-01-01

    Background A large portion of the injuries treated at urban trauma centers are preventable with alcohol and substance use presenting as common antecedent risk factors. Methods Alcohol and drug use characteristics of vulnerable adults treated for intentional orofacial injury at a regional trauma center were investigated. Patients (N = 154) presenting with intentional facial injury were recruited. Patients were considered eligible for recruitment if they were adults, recently used alcohol or drugs, and had a fracture within the 30 days preceding recruitment that involved the jaw, orbit, nose, or cheekbone as determined by clinical history, examination and radiographic findings and that injury was due to interpersonal violence. Results This patient cohort evidenced significant levels of alcohol use, with 58% of our patient cohort meeting the criteria for problem drinking. Although lower than alcohol use rates, the reported use of illicit drugs was substantial. Almost half of the sample reported other substance use in the previous month, with 24% meeting the criteria for problem drug use. Conclusions Despite the very high percentage of individuals needing alcohol or drug treatment, only a small proportion of the patient sample reported having seen a professional for alcohol or drug treatment. Integrating substance use services into trauma care is discussed. PMID:19204524

  1. “It's like two worlds apart”: an analysis of vulnerable patient handover practices at discharge from hospital

    PubMed Central

    Groene, Raluca Oana; Orrego, Carola; Suñol, Rosa; Barach, Paul; Groene, Oliver

    2012-01-01

    Background Handover practices at hospital discharge are relatively under-researched, particularly as regards the specific risks and additional requirements for handovers involving vulnerable patients with limited language, cognitive and social resources. Objective To explore handover practices at discharge and to focus on the patients’ role in handovers and on the potential additional risks for vulnerable patients. Methods We conducted qualitative interviews with patients, hospital professionals and primary care professionals in two hospitals and their associated primary care centres in Catalonia, Spain. Results We identified handover practices at discharge that potentially put patients at risk. Patients did not feel empowered in the handover but were expected to transfer information between care providers. Professionals identified lack of medication reconciliation at discharge, loss of discharge information, and absence of plans for follow-up care in the community as quality and safety problems for discharge handovers. These occurred for all patients, but appeared to be more frequent and have a greater negative effect in patients with limited language comprehension and/or lack of family and social support systems. Conclusions Discharge handovers are often haphazard. Healthcare professionals do not consider current handover practices safe, with patients expected to transfer information without being empowered to understand and act on it. This can lead to misinformation, omission or duplication of tests or interventions and, potentially, patient harm. Vulnerable patients may be at greater risk given their limited language, cognitive and social resources. Patient safety at discharge could benefit from strategies to enhance patient education and promote empowerment. PMID:23112285

  2. Communication vulnerable patients in the pediatric ICU: Enhancing care through augmentative and alternative communication.

    PubMed

    Costello, John M; Patak, Lance; Pritchard, Jennifer

    2010-01-01

    Children in pediatric intensive care units (PICUs) may experience a broad range of motor, sensory, cognitive, and linguistic difficulties that make it difficult for them to communicate effectively. Being unable to communicate is emotionally frightening for children and can lead to an increase in sentinel events, medical errors and extended lengths of stay. Implementation of augmentative and alternative communication (AAC) tools and strategies can address the communication needs of children in the PICU by enabling them to communicate their wants, needs and feelings to healthcare providers and family members and participate in their own care more productively. Hospitals around the world are increasingly recognizing and addressing patients' needs for communication access and have begun to implement communication screenings and assessments and interventions at admission and throughout the hospital stay. New standards for all American hospitals, in fact, mandate efforts to improve patient communication. When patient-provider communication improves, treatment success goes up, hospital-caused errors decrease and patient and family satisfaction improve. This article describes three phases of intervention for communication vulnerable children in the PICU and provides examples of treatment approaches that ensure communication access as their medical condition changes.

  3. The ethics of imperfect cures: models of service delivery and patient vulnerability.

    PubMed

    Lanoix, Monique

    2013-11-01

    A rising number of patients require continuing or palliative services and this means that they will need to transition from one model of healthcare delivery to another. If it is generally recognised that patient vulnerability to inadequate services increases when the setting in which patient receives care changes, it is usually taken to be the result of poor coordination of services or personnel. Recognising that an integrated system is essential to adequate access, the point that I put forward in this paper is that the centrality of acute care services affects the way in which chronic and palliative services are structured and, consequently, their availability. I argue that the problem originates in the manner in which some of the foundational concepts of the acute care model are imported into the other models of care delivery. In order to make this case, I review the three main models of healthcare service delivery by focusing my analysis along three axes: the goal of the care model; the predominant understanding of autonomy implicit in the model; and, the main actors in the care relationship. By examining how the various concepts translate from one model to the next, I discuss what I identify to be one of the main conceptual obstacles to less problematic transitioning, the notion of autonomy and the corresponding view of the patient as an isolated agent.

  4. Cognitive and metabolic correlates of emotional vulnerability in patients with temporal lobe epilepsy.

    PubMed

    Lanteaume, Laura; Guedj, Eric; Bastien-Toniazzo, Mireille; Magalahaes, Audrey; Mundler, Olivier; Bartolomei, Fabrice

    2012-05-01

    Recent investigations have suggested that the occurrence of epileptic seizures is not completely random. In particular, various types of psychological changes or life events may act as triggering factors. To identify a possible link between self-perception of the impact of affective precipitants, cognitive responses modulated by aversive information and brain metabolic modifications in patients with temporal lobe epilepsy (TLE). The extent to which seizures were elicited or not by emotional precipitants was estimated using a self-reported scale, allowing distinction of two groups: 'Emo-TLE' group (patients reporting to have seizures triggered by emotional events) and 'Other-TLE' group, which were compared with healthy individuals ('control' group). Attentional biases were investigated using the probe detection paradigm, using negative and neutral stimuli. Interictal brain metabolism was studied using FDG-PET, and comparison was made between controls, Emo-TLE and Other-TLE groups. Patients with emotional vulnerability (Emo-TLE) disclosed specific attentional biases towards negative stimuli compared with the Other-TLE and control groups. Patients with Emo-TLE also exhibited specific hypometabolism in the anterior temporal lobe, including amygdala and hippocampus. The degree of attentional biases correlated with decreased metabolism in these regions. This investigation shows that the impact of affective events is the result of self-perception and also that it might be determined by specific cognitive and brain metabolic modifications in TLE.

  5. Reflective Practice and Competencies in Global Health Training: Lesson for Serving Diverse Patient Populations

    PubMed Central

    Castillo, Jonathan; Goldenhar, Linda M.; Baker, Raymond C.; Kahn, Robert S.; DeWitt, Thomas G.

    2010-01-01

    Background Resident interest in global health care training is growing and has been shown to have a positive effect on participants' clinical skills and cultural competency. In addition, it is associated with career choices in primary care, public health, and in the service of underserved populations. The purpose of this study was to explore, through reflective practice, how participation in a formal global health training program influences pediatric residents' perspectives when caring for diverse patient populations. Methods Thirteen pediatric and combined-program residents enrolled in a year-long Global Health Scholars Program at Cincinnati Children's Hospital Medical Center during the 2007–2008 academic year. Educational interventions included a written curriculum, a lecture series, one-on-one mentoring sessions, an experience abroad, and reflective journaling assignments. The American Society for Tropical Medicine and Hygiene global health competencies were used as an a priori coding framework to qualitatively analyze the reflective journal entries of the residents. Results Four themes emerged from the coded journal passages from all 13 residents: (1) the burden of global disease, as a heightened awareness of the diseases that affect humans worldwide; (2) immigrant/underserved health, reflected in a desire to apply lessons learned abroad at home to provide more culturally effective care to immigrant patients in the United States; (3) parenting, or observed parental, longing to assure that their children receive health care; and (4) humanitarianism, expressed as the desire to volunteer in future humanitarian health efforts in the United States and abroad. Conclusions Our findings suggest that participating in a global health training program helped residents begin to acquire competence in the American Society for Tropical Medicine and Hygiene competency domains. Such training also may strengthen residents' acquisition of professional skills, including the

  6. Pairing virtual reality with dynamic posturography serves to differentiate between patients experiencing visual vertigo.

    PubMed

    Keshner, Emily A; Streepey, Jefferson; Dhaher, Yasin; Hain, Timothy

    2007-07-09

    To determine if increased visual dependence can be quantified through its impact on automatic postural responses, we have measured the combined effect on the latencies and magnitudes of postural response kinematics of transient optic flow in the pitch plane with platform rotations and translations. Six healthy (29-31 yrs) and 4 visually sensitive (27-57 yrs) subjects stood on a platform rotated (6 deg of dorsiflexion at 30 deg/sec) or translated (5 cm at 5 deg/sec) for 200 msec. Subjects either had eyes closed or viewed an immersive, stereo, wide field of view virtual environment (scene) moved in upward pitch for a 200 msec period for three 30 sec trials at 5 velocities. RMS values and peak velocities of head, trunk, and head with respect to trunk were calculated. EMG responses of 6 trunk and lower limb muscles were collected and latencies and magnitudes of responses determined. No effect of visual velocity was observed in EMG response latencies and magnitudes. Healthy subjects exhibited significant effects (p < 0.05) of visual field velocity on peak angular velocities of the head. Head and trunk velocities and RMS values of visually sensitive subjects were significantly larger than healthy subjects (p < 0.05), but their responses were not modulated by visual field velocity. When examined individually, patients with no history of vestibular disorder demonstrated exceedingly large head velocities; patients with a history of vestibular disorder exhibited head velocities that fell within the bandwidth of healthy subjects. Differentiation of postural kinematics in visually sensitive subjects when exposed to the combined perturbations suggests that virtual reality technology could be useful for differential diagnosis and specifically designed interventions for individuals whose chief complaint is sensitivity to visual motion.

  7. Pairing virtual reality with dynamic posturography serves to differentiate between patients experiencing visual vertigo

    PubMed Central

    Keshner, Emily A; Streepey, Jefferson; Dhaher, Yasin; Hain, Timothy

    2007-01-01

    Background To determine if increased visual dependence can be quantified through its impact on automatic postural responses, we have measured the combined effect on the latencies and magnitudes of postural response kinematics of transient optic flow in the pitch plane with platform rotations and translations. Methods Six healthy (29–31 yrs) and 4 visually sensitive (27–57 yrs) subjects stood on a platform rotated (6 deg of dorsiflexion at 30 deg/sec) or translated (5 cm at 5 deg/sec) for 200 msec. Subjects either had eyes closed or viewed an immersive, stereo, wide field of view virtual environment (scene) moved in upward pitch for a 200 msec period for three 30 sec trials at 5 velocities. RMS values and peak velocities of head, trunk, and head with respect to trunk were calculated. EMG responses of 6 trunk and lower limb muscles were collected and latencies and magnitudes of responses determined. Results No effect of visual velocity was observed in EMG response latencies and magnitudes. Healthy subjects exhibited significant effects (p < 0.05) of visual field velocity on peak angular velocities of the head. Head and trunk velocities and RMS values of visually sensitive subjects were significantly larger than healthy subjects (p < 0.05), but their responses were not modulated by visual field velocity. When examined individually, patients with no history of vestibular disorder demonstrated exceedingly large head velocities; patients with a history of vestibular disorder exhibited head velocities that fell within the bandwidth of healthy subjects. Conclusion Differentiation of postural kinematics in visually sensitive subjects when exposed to the combined perturbations suggests that virtual reality technology could be useful for differential diagnosis and specifically designed interventions for individuals whose chief complaint is sensitivity to visual motion. PMID:17620142

  8. From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.

    PubMed

    Naghavi, Morteza; Falk, Erling; Hecht, Harvey S; Jamieson, Michael J; Kaul, Sanjay; Berman, Daniel; Fayad, Zahi; Budoff, Matthew J; Rumberger, John; Naqvi, Tasneem Z; Shaw, Leslee J; Faergeman, Ole; Cohn, Jay; Bahr, Raymond; Koenig, Wolfgang; Demirovic, Jasenka; Arking, Dan; Herrera, Victoria L M; Badimon, Juan; Goldstein, James A; Rudy, Yoram; Airaksinen, Juhani; Schwartz, Robert S; Riley, Ward A; Mendes, Robert A; Douglas, Pamela; Shah, Prediman K

    2006-07-17

    Screening for early-stage asymptomatic cancers (eg, cancers of breast and colon) to prevent late-stage malignancies has been widely accepted. However, although atherosclerotic cardiovascular disease (eg, heart attack and stroke) accounts for more death and disability than all cancers combined, there are no national screening guidelines for asymptomatic (subclinical) atherosclerosis, and there is no government- or healthcare-sponsored reimbursement for atherosclerosis screening. Part I and Part II of this consensus statement elaborated on new discoveries in the field of atherosclerosis that led to the concept of the "vulnerable patient." These landmark discoveries, along with new diagnostic and therapeutic options, have set the stage for the next step: translation of this knowledge into a new practice of preventive cardiology. The identification and treatment of the vulnerable patient are the focuses of this consensus statement. In this report, the Screening for Heart Attack Prevention and Education (SHAPE) Task Force presents a new practice guideline for cardiovascular screening in the asymptomatic at-risk population. In summary, the SHAPE Guideline calls for noninvasive screening of all asymptomatic men 45-75 years of age and asymptomatic women 55-75 years of age (except those defined as very low risk) to detect and treat those with subclinical atherosclerosis. A variety of screening tests are available, and the cost-effectiveness of their use in a comprehensive strategy must be validated. Some of these screening tests, such as measurement of coronary artery calcification by computed tomography scanning and carotid artery intima-media thickness and plaque by ultrasonography, have been available longer than others and are capable of providing direct evidence for the presence and extent of atherosclerosis. Both of these imaging methods provide prognostic information of proven value regarding the future risk of heart attack and stroke. Careful and responsible

  9. Impact of social vulnerability on the outcomes of predialysis chronic kidney disease patients in an interdisciplinary center.

    PubMed

    Tirapani, Luciana dos Santos; Pinheiro, Hélady Sanders; Mansur, Henrique Novais; Oliveira, Dilmerson de; Huaira, Rosália Maria Nunes Henriques; Huaira, Carlos Contreras; Grincenkov, Fabiane Rossi dos Santos; Bastos, Marcus Gomes; Fernandes, Natália Maria da Silva

    2015-01-01

    Numerous studies examined the associations between socio-demographic, economic and individual factors and chronic kidney disease (CKD) outcomes and observed that the associations were complex and multifactorial. Socioeconomic factors can be evaluated by a model of social vulnerability (SV). To analyze the impact of SV on the outcomes of predialysis patients. Demographic, clinical and laboratory data were collected from a cohort of patients with predialysis stage 3 to 5 who were treated by an interdisciplinary team (January 2002 and December 2009) in Minas Gerais, Brazil. Factor, cluster and discriminant analysis were performed in sequence to identify the most important variables and develop a model of SV that allowed for classification of the patients as vulnerable or non-vulnerable. Cox regression was performed to examine the impact of SV on the outcomes of mortality and need for renal replacement therapy (RRT). Of the 209 patients examined, 29.4% were classified as vulnerable. No significance difference was found between the vulnerable and non-vulnerable groups regarding either mortality (log rank: 0.23) or need for RRT (log rank: 0.17). In the Cox regression model, the hazard ratios (HRs) for the unadjusted and adjusted impact of SV on mortality were found to be 1.87 (confidence interval [CI]: 0.64-5.41) and 1.47 (CI: 0.35-6.0), respectively, and the unadjusted and adjusted impact of need for RRT to be 1.85 (CI: 0.71-4.8) and 2.19 (CI: 0.50-9.6), respectively. These findings indicate that SV did not influence the outcomes of patients with predialysis CKD treated in an interdisciplinary center.

  10. GPR155 Serves as a Predictive Biomarker for Hematogenous Metastasis in Patients with Gastric Cancer

    PubMed Central

    Shimizu, Dai; Kanda, Mitsuro; Tanaka, Haruyoshi; Kobayashi, Daisuke; Tanaka, Chie; Hayashi, Masamichi; Iwata, Naoki; Niwa, Yukiko; Takami, Hideki; Yamada, Suguru; Fujii, Tsutomu; Nakayama, Goro; Fujiwara, Michitaka; Kodera, Yasuhiro

    2017-01-01

    The prognosis of patients with gastric cancer (GC) with hematogenous metastasis is dismal. Identification of biomarkers specific for hematogenous metastasis is required to develop personalized treatments that improve patients’ outcomes. Global expression profiling of GC tissues with synchronous hepatic metastasis without metastasis to the peritoneal cavity or distant lymph nodes was conducted using next-generation sequencing and identified the G protein-coupled receptor 155 (GPR155) as a candidate biomarker. GPR155 transcription was suppressed in GC cell lines compared with a nontumorigenic cell line. DNA methylation of the GPR155 promoter region was not detected, albeit 20% of GC cell lines harbored copy number loss at GPR155 locus. The expression levels of GPR155 mRNA correlated inversely with those of TWIST1 and WNT5B. Inhibition of GPR155 expression increased the levels of p-ERK1/2 and p-STAT1, significantly increased cell proliferation, and increased the invasiveness of a GC cell lines. GPR155 mRNA levels in GC clinical samples correlated with hematogenous metastasis and recurrence. Multivariate analysis revealed that reduced expression of GPR155 mRNA was an independent predictive marker of hematogenous metastasis. GPR155 may represent a biomarker for diagnosing and predicting hematogenous metastasis of GC. PMID:28165032

  11. Integrating Soluble Biomarkers and Imaging Technologies in the Identification of Vulnerable Atherosclerotic Patients

    PubMed Central

    Páramo, José A.; Rodríguez JA, José A.; Orbe, Josune

    2006-01-01

    The clinical utility of a biomarker depends on its ability to identify high-risk individuals to optimally manage the patient. A new biomarker would be of clinical value if it is accurate and reliable, provides good sensitivity and specificity, and is available for widespread application. Data are accumulating on the potential clinical utility of integrating imaging technologies and circulating biomarkers for the identification of vulnerable (high-risk) cardiovascular patients. A multi-biomarker strategy consisting of markers of inflammation, hemostasis and thrombosis, proteolysis and oxidative stress, combined with new imaging modalities (optical coherence tomography, virtual histology plus IVUS, PET) can increase our ability to identify such thombosis-prone patients. In an ideal scenario, cardiovascular biomarkers and imaging combined will provide a better diagnostic tool to identify high-risk individuals and also more efficient methods for effective therapies to reduce such cardiovascular risk. However, additional studies are required in order to show that this approach can contribute to improved diagnostic and therapeutic of atherosclerotic disease. PMID:19690647

  12. Provider Perspectives Regarding Resuscitation Decisions for Neonates and Other Vulnerable Patients.

    PubMed

    Dupont-Thibodeau, Amélie; Hindié, Jade; Bourque, Claude Julie; Janvier, Annie

    2017-09-01

    To use structured surveys to assess the perspectives of pediatric residents and neonatal nurses on resuscitation decisions for vulnerable patients, including neonates. Pediatric providers were surveyed using scenarios for 6 critically ill patients of different ages with outcomes explicitly described. Providers were asked (1) whether resuscitation was in each patient's best interest; (2) whether they would accept families' wishes for comfort care (no resuscitation); and (3) to rank patients in order of priority for resuscitation. In a structured interview, each participant explained how they evaluated patient interests and when applicable, why their answers differed for neonates. Interviews were audiotaped; transcripts were analyzed using thematic analysis and mixed methods. Eighty pediatric residents and neonatal nurses participated (response rate 74%). When making life and death decisions, participants considered (1) patient characteristics (96%), (2) personal experience/biases (85%), (3) family's wishes and desires (81%), (4) disease characteristics (74%), and (5) societal perspectives (36%). These factors were not in favor of sick neonates: of the participants, 85% reported having negative biases toward neonates and 60% did not read, misinterpreted, and/or distrusted neonatal outcome statistics. Additional factors used to justify comfort care for neonates included limited personhood and lack of relationships/attachment (73%); prioritization of family's best interest, and social acceptability of death (36%). When these preconceptions were discussed, 70% of respondents reported they would change their answers in favor of neonates. Resuscitation decisions for neonates are based on many factors, such as considerations of personhood and family's interests (that are not traditional indicators of benefit), which may explain why decision making is different for the neonatal population. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Specific vulnerability of face perception to noise: a similar effect in schizophrenia patients and healthy individuals.

    PubMed

    Chen, Yue; McBain, Ryan; Norton, Daniel

    2015-02-28

    Face perception plays a foundational role in the social world. This perceptual ability is deficient in schizophrenia. A noise-filtering mechanism is essential for perceptual processing. It remains unclear as to whether a specific noise-filtering mechanism is implicated in the face perception problem or a general noise-filtering mechanism is involved which also mediates non-face visual perception problems associated with this psychiatric disorder. This study examined and compared the effects of external noise on the performance of face discrimination and car discrimination in schizophrenia patients (n=25) and healthy controls (n=27). Superimposing the external visual noise on face or car stimuli elevated perceptual thresholds (i.e. degraded performance levels) for both face and car discrimination. However, the effect of noise was significantly larger on face than on car discrimination, both in patients and controls. This pattern of results suggests specific vulnerability of face processing to noise in healthy individuals and those with schizophrenia. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Vulnerable Blood in High Risk Vascular Patients: Study Design and Methods

    PubMed Central

    McDermott, Mary M.; Greenland, Philip; Liu, Kiang; Tian, Lu; Green, David; Shah, Sanjiv J.; Huffman, Mark; Wilkins, John; Kibbe, Melina; Liao, Yihua; Huang, Chiang-Ching; Skelly, Christopher; Jacobs, Chad; McCarthy, Walter; Auerbach, Amanda; Lloyd-Jones, Donald

    2014-01-01

    BACKGROUND Basic research suggests that rapid increases in circulating inflammatory and hemostatic blood markers may trigger or indicate impending plaque rupture and coronary thrombosis, resulting in acute ischemic heart disease (IHD) events. However, these associations are not established in humans. METHODS AND RESULTS The Biomarker Risk Assessment in Vulnerable Outpatients (BRAVO) Study will determine whether levels of inflammatory and hemostatic biomarkers rapidly increase during the weeks prior to an acute IHD event in people with lower extremity peripheral artery disease (PAD). The BRAVO Study will determine whether biomarker levels measured immediately prior to an IHD event are higher than levels not preceding an IHD event; whether participants who experience an IHD event (cases) have higher biomarker levels immediately prior to the event and higher biomarker levels at each time point leading up to the IHD event than participants without an IHD event (controls); and whether case participants have greater increases in biomarkers during the months leading up to the event than controls. BRAVO enrolled 595 patients with PAD, a population at high risk for acute IHD events. After a baseline visit, participants returned every two months for blood collection, underwent an electrocardiogram to identify new silent myocardial infarctions, and were queried about new hospitalizations since their prior study visit. Mortality data were also collected. Participants were followed prospectively for up to three years. CONCLUSIONS BRAVO results will provide important information about the pathophysiology of IHD events and may lead to improved therapies for preventing IHD events in high-risk patients. PMID:24721480

  15. Perceptions of Provider Communication Among Vulnerable Patients With Diabetes: Influences of Medical Mistrust and Health Literacy.

    PubMed

    White, Richard O; Chakkalakal, Rosette J; Presley, Caroline A; Bian, Aihua; Schildcrout, Jonathan S; Wallston, Kenneth A; Barto, Shari; Kripalani, Sunil; Rothman, Russell

    2016-01-01

    Patient-provider communication is modifiable and is linked to diabetes outcomes. The association of communication quality with medical mistrust is unknown. We examined these factors within the context of a low-literacy/numeracy-focused intervention to improve diabetes care, using baseline data from diverse patients enrolled in a randomized trial of a health communication intervention. Demographics, measures of health communication (Communication Assessment Tool [CAT], Interpersonal Processes of Care survey [IPC-18]), health literacy (Short Test of Functional Health Literacy in Adults), depression, medical mistrust, and glycemic control were ascertained. Adjusted proportional odds models were used to test the association of mistrust with patient-reported communication quality. The interaction effect of health literacy on mistrust and communication quality was also assessed. A total of 410 patients were analyzed. High levels of mistrust were observed. In multivariable modeling, patients with higher mistrust had lower adjusted odds of reporting a higher CAT score (adjusted odds ratio [AOR] = 0.67, 95% confidence interval [CI] [0.52, 0.86], p = .003) and higher scores on the Communication (AOR = 0.69, 95% CI [0.55, 0.88], p = .008), Decided Together (AOR = 0.74, 95% CI [0.59, 0.93], p = .02), and Interpersonal Style (AOR = 0.69, 95% CI [0.53, 0.90], p = .015) subscales of the IPC-18. We observed evidence of an interaction effect of health literacy for the association between mistrust and the Decided Together subscale of the IPC-18 such that patients with higher mistrust and lower literacy perceived worse communication relative to mistrustful patients with higher literacy. In conclusion, medical mistrust was associated with poorer communication with providers in this public health setting. Patients' health literacy level may vary the effect of mistrust on interactional aspects of communication. Providers should consider the impact of mistrust on communication

  16. Study of stress and vulnerability in patients with somatoform and dissociative disorders in a psychiatric clinic in North India.

    PubMed

    Irpati, Anand S; Avasthi, Ajit; Sharan, Pratap

    2006-10-01

    The authors compared perceived stress in subgroups of patients defined by vulnerability (high and low) and disorder (somatoform and dissociative). A total of 30 patients each of somatoform and dissociative disorders diagnosed according to the classification of mental and behavioral disorders criteria were assessed with Presumptive Stressful Life Event Scale, The Hassles Scale, Psychoticism Extraversion Neuroticism Inventory, Dissociative Experience Scale, Twenty-Item Toronto Alexithyma Scale, and Illness Behavior Questionnaire. Somatoform and dissociative disorder groups had comparable scores on measures of perceived stress and vulnerability. Two-way anova showed significant main effect of neuroticism (F = 13.65, d.f. = 1.56, P < 0.01), psychoticism (F = 7.92, d.f. = 1.56, P < 0.01), illness behavior (F = 5.82, d.f. = 1.56, P < 0.05), and dissociative experience (F = 8.45, d.f. = 1.56, P < 0.01) on total hassles score, but no significant main effect of disorder groups or interaction effect for disorder and vulnerability was seen on total hassles score. No significant main or interaction effect was seen on life events score. Similarities were seen in stress and vulnerability factors in the two disorders. Neuroticism, psychoticism, dissociative experience, and abnormal illness behavior were significantly related to stress (daily hassles) perceived by the patient, irrespective of the disorder.

  17. Epstein-Barr virus infection serves as an independent predictor of survival in patients with lymphoepithelioma-like gastric carcinoma.

    PubMed

    Min, Byung-Hoon; Tae, Chung Hyun; Ahn, Soo Min; Kang, So Young; Woo, Sook-Young; Kim, Seonwoo; Kim, Kyoung-Mee

    2016-07-01

    The pathogenesis and clinicopathologic characteristics of Epstein-Barr virus (EBV)-negative lymphoepithelioma-like gastric carcinoma (LELC) are still unclear. In addition, it remains controversial whether EBV infection itself affects the prognosis of LELC. Between 1995 and 2011, 145 LELC patients (124 patients with EBV infection and 21 patients without EBV infection) underwent radical gastrectomy with D2 lymph node dissection. The clinicopathologic features and prognosis of EBV-negative LELC cases were compared with those of EBV-positive LELC cases. The median duration of follow-up after surgery was 55 months. Microsatellite instability (MSI) analysis was performed on 20 EBV-negative LELC cases. EBV-negative LELC accounted for 14.5 % of the total LELC cases. EBV-negative LELC was significantly associated with older age, female sex, advanced T stage, and advanced American Joint Committee on Cancer (AJCC) tumor stage compared with EBV-positive LELC. In univariate analysis, patients with EBV-negative LELC had significantly shorter overall, disease-specific, and recurrence-free survival than those with EBV-positive LELC. The 5-year overall survival rates were 81.0 % for patients with EBV-negative LELC and 96.2 % for patients with EBV-positive LELC. In a Cox proportional hazards model, EBV infection, age, and AJCC tumor stage were identified as independent predictors of overall survival. MSI-high, MSI-low, and microsatellite-stable tumors accounted for 25, 10, and 65 % of EBV-negative LELC cases, respectively. MSI status did not affect the prognosis of EBV-negative LELC cases. EBV infection serves as an independent predictor of survival in patients with LELC. EBV-negative LELC exhibited clinicopathologic features and prognosis distinct from those of EBV-positive LELC.

  18. Abstinence and Teenagers: Prevention Counseling Practices of Health Care Providers Serving High-Risk Patients in the United States

    PubMed Central

    Harper, Cynthia C.; Henderson, Jillian T.; Schalet, Amy; Becker, Davida; Stratton, Laura; Raine, Tina R.

    2010-01-01

    CONTEXT Abstinence-only education has had little demonstrable impact on teenagers’ sexual behaviors, despite significant policy and funding efforts. Given the struggle over resources to improve teenagers’ reproductive health outcomes, the views of clinicians serving teenagers at high risk for unintended pregnancy and STDs merit particular attention. METHODS In 2005, a qualitative study with 31 clinicians serving low-income, at-risk patients was conducted. A semistructured interview guide was used to ask clinicians about adolescent pregnancy, HIV and STD prevention counseling, and when they include abstinence. Thematic content analysis was used to examine the content of the counseling and the techniques used in different situations. RESULTS Providers reported offering comprehensive counseling, presenting abstinence as a choice for teenagers, along with information about contraceptives and condoms. Several providers mentioned that with young, sexually inexperienced teenagers, they discuss delaying sexual activity and suggest other ways to be affectionate, while giving information on condoms. Providers explained how they assess whether teenagers feel ready to be sexually active and try to impart skills for healthy relationships. Some described abstinence as giving teenagers a way to opt out of unwanted sexual activity. Many support abstinence if that is the patient’s desire, but routinely dispense condoms and contraceptives. CONCLUSIONS Overall, providers did not give abstinence counseling as a rigid categorical concept in their preventive practices, but as a health tool to give agency to teenagers within a harm reduction framework. Their approach may be informative for adolescent policies and programs in the future. PMID:20618752

  19. Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

    PubMed

    Gainer, Ryan A; Curran, Janet; Buth, Karen J; David, Jennie G; Légaré, Jean-Francois; Hirsch, Gregory M

    2017-07-01

    Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention

  20. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study.

    PubMed

    Soubeyran, Pierre; Bellera, Carine; Goyard, Jean; Heitz, Damien; Curé, Hervé; Rousselot, Hubert; Albrand, Gilles; Servent, Véronique; Jean, Olivier Saint; van Praagh, Isabelle; Kurtz, Jean-Emmanuel; Périn, Stéphane; Verhaeghe, Jean-Luc; Terret, Catherine; Desauw, Christophe; Girre, Véronique; Mertens, Cécile; Mathoulin-Pélissier, Simone; Rainfray, Muriel

    2014-01-01

    Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13). The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate. Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P =  0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival. With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.

  1. Polarized stakeholders and institutional vulnerabilities: the enduring politics of the Patient Protection and Affordable Care Act.

    PubMed

    Béland, Daniel; Rocco, Philip; Waddan, Alex

    2015-04-01

    We conducted a comparative study of how state-level political stakeholders affected the implementation of 3 major reforms within the Patient Protection and Affordable Care Act (ACA). Our goal was to analyze the effects of policy legacy, institutional fragmentation, and public sentiments on state obstruction of the reform. We gathered quantitative and qualitative evidence to generate cross-case comparisons of state implementation of 3 reform streams within the ACA: health insurance exchanges, Medicaid expansion, and regulatory reform. Our sources included secondary literature, analysis of official decisions, and background interviews with experts and public officials. We found that state-level opponents of the ACA were most likely to be successful in challenging reforms with few preexisting policy legacies, high institutional fragmentation, and negative public sentiments. Reforms that built on existing state legislation, avoided state veto points or offered lucrative fiscal incentives, and elicited less negative public reaction were less likely to be contested. Our findings point to the importance of institutional design for the role of political stakeholders in implementing reforms to improve the cost, quality, and availability of medical treatments. Although other research has found that political polarization has shaped early ACA outcomes, comparative analysis suggests political stakeholders have had the highest effect on reforms that were particularly vulnerable. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

  2. Restoration of root surface caries in vulnerable elderly patients: a review of the literature.

    PubMed

    Amer, R S; Kolker, J L

    2013-01-01

    The authors conducted a review to evaluate the current literature addressing root surface caries treatment in the vulnerable elderly, to identify any gaps in the literature that will need to be addressed in the future. The authors conducted a literature search of the electronic databases using MEDLINE, PubMed, to identify original clinical research articles regarding treatment of root caries lesions, with emphasis on research focused on the vulnerable elderly. Five articles were clinical studies of root caries restorations. Only one was conducted on a vulnerable elderly population. The results of the literature review show that there is a need for further studies addressing the restorative needs of the vulnerable elderly. With the aging of the American population, more research is needed to provide adequate care to this population. At this time, glass ionomers are a good treatment option. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

  3. Serum Osteopontin Predicts Degree of Hepatic Fibrosis and Serves as a Biomarker in Patients with Hepatitis C Virus Infection

    PubMed Central

    Matsue, Yasuhiro; Tsutsumi, Mikihiro; Hayashi, Nobuhiko; Saito, Takashi; Tsuchishima, Mutsumi; Toshikuni, Nobuyuki; Arisawa, Tomiyasu; George, Joseph

    2015-01-01

    Background & Aims Osteopontin (OPN) is a matricellular protein that upregulates during pathogenesis of hepatic fibrosis. The present study was aimed to evaluate whether serum OPN could be used as a biomarker to assess the degree of hepatic fibrosis in patients with hepatitis C virus (HCV) infection. Methods Needle biopsy was performed on HCV patients and scored as zero fibrosis (F0), mild fibrosis (F1), moderate fibrosis (F2), severe fibrosis (F3) and liver cirrhosis (F4) based on Masson’s trichrome and α-smooth muscle actin (α-SMA) staining. Serum OPN levels were measured using ELISA and correlated with the degree of fibrosis. Furthermore, the OPN values were correlated and evaluated with platelets count, serum hyaluronic acid (HA), and collagen type IV and subjected to receiver operating characteristic (ROC) curve analysis. Results Serum OPN levels were remarkably increased from F0 through F4 in a progressive manner and the differences were significant (P < 0.001) between each group. The data were highly correlated with the degree of hepatic fibrosis. The ROC curve analysis depicted that serum OPN is an independent risk factor and an excellent biomarker and a prognostic index in HCV patients. Conclusions The results of the present study indicate that serum OPN levels reflect the degree of hepatic fibrosis and could be used as a biomarker to assess the stage of fibrosis in HCV patients which would help to reduce the number of liver biopsies. Furthermore, serum OPN serves as a prognostic index towards the progression of hepatic fibrosis to cirrhosis and hepatocellular carcinoma. PMID:25760884

  4. A qualitative analysis of identity and goals in patients with deformities: preparation for an evidence-based advocacy for a vulnerable population.

    PubMed

    Tapia, Viridiana J; Chang, David C; Ramirez, Michelle; Gosman, Amanda

    2013-04-01

    Economically and socially vulnerable patients with deformities are likely to live a marginalized life, reducing their quality of life and societal participation. An evidence-based approach is needed for these patients who may not be able to advocate for themselves. The objective of this study is to identify important aspects of the perceived identity of adult patients with deformities. This retrospective qualitative analysis is of applicant responses to an intake questionnaire for Fresh Start Surgical Gifts, a charitable reconstructive surgery organization serving children and adults with deformities. Five open-ended questions were analyzed and grouped into 2 broad categories: Identity and Goals. Keywords were identified by an online survey website and subjective judgment of the investigators. Keywords were then combined into broader themes. Seventy respondents with a mean age of 24.79 (median 23) between 1992 and 2011 were analyzed. Social and professional issues were the most frequently occurring themes among Identity and Goals questions. The current identity of patients with deformities centers on social aspects of their lives, rather than a career or profession, yet they do hold both professional and social aspirations. This research will guide the development of an objective tool to measure patient-reported impact and outcomes of reconstructive plastic surgery.

  5. Academic health centers and community health centers partnering to build a system of care for vulnerable patients: lessons from Carolina Health Net.

    PubMed

    Denham, Amy C; Hay, Sherry S; Steiner, Beat D; Newton, Warren P

    2013-05-01

    Academic health centers (AHCs) are challenged to meet their core missions in a time of strain on the health care system from rising costs, an aging population, increased rates of chronic disease, and growing numbers of uninsured patients. AHCs should be leaders in developing creative solutions to these challenges and training future leaders in new models of care. The authors present a case study describing the development, implementation, and early results of Carolina Health Net, a partnership between an AHC and a community health center to manage the most vulnerable uninsured by providing access to primary care medical homes and care management systems. This partnership was formed in 2008 to help transform the delivery of health care for the uninsured. As a result, 4,400 uninsured patients have been connected to primary care services. Emergency department use by enrolled patients has decreased. Patients have begun accessing subspecialty care within the medical home. More than 2,200 uninsured patients have been assisted to enroll in Medicaid. The experience of Carolina Health Net demonstrates that developing a system of care with primary care and wrap-around services such as pharmacy and case management can improve the cost-effectiveness and quality of care, thereby helping AHCs meet their broader missions. This project can serve as a model for other AHCs looking to partner with community-based providers to improve care and control costs for underserved populations.

  6. Hippocampal substructural vulnerability to sleep disturbance and cognitive impairment in patients with chronic primary insomnia: magnetic resonance imaging morphometry.

    PubMed

    Joo, Eun Yeon; Kim, Hosung; Suh, Sooyeon; Hong, Seung Bong

    2014-07-01

    Despite compelling evidence from animal studies indicating hippocampal subfield-specific vulnerability to poor sleep quality and related cognitive impairment, there have been no human magnetic resonance imaging (MRI) studies investigating the relationship between hippocampal subfield volume and sleep disturbance. Our aim was to investigate the pattern of volume changes across hippocampal subfields in patients with primary insomnia relative to controls. Pointwise morphometry allowed for volume measurements of hippocampal regions on T1-weighted MRI. University hospital. Twenty-seven unmedicated patients (age: 51.2 ± 9.6 y) and 30 good sleepers as controls (50.4 ± 7.1 y). N/A. We compared hippocampal subfield volumes between patients and controls and correlated volume with clinical and neuropsychological features in patients. Patients exhibited bilateral atrophy across all hippocampal subfields (P < 0.05 corrected). Cornu ammonis (CA) 1 subfield atrophy was associated with worse sleep quality (higher Pittsburgh Sleep Quality Index and higher arousal index of polysomnography) (r < -0.45, P < 0.005). The volume of the combined region, including the dentate gyrus (DG) and CA3-4, negatively correlated with verbal memory, verbal information processing, and verbal fluency in patients (|r| > 0.45, P < 0.05). Hemispheric volume asymmetry of this region (left smaller than right) was associated with impaired verbal domain functions (r = 0.50, P < 0.005). Hippocampal subfield atrophy in chronic insomnia suggests reduced neurogenesis in the dentate gyrus (DG) and neuronal loss in the cornu ammonis (CA) subfields in conditions of sleep fragmentation and related chronic stress condition. Atrophy in the CA3-4-DG region was associated with impaired cognitive functions in patients. These observations may provide insight into pathophysiological mechanisms that make patients with chronic sleep disturbance vulnerable to cognitive impairment. Joo EY, Kim H, Suh S, Hong SB. Hippocampal

  7. When hope makes us vulnerable: a discussion of patient-healthcare provider interactions in the context of hope.

    PubMed

    Simpson, Christy

    2004-09-01

    When hope is discussed in bioethics' literature, it is most often in the context of 'false hopes' and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified.

  8. [Panaceas disseminated over the Internet and vulnerable patients: how to check a market of illusions?].

    PubMed

    Vasconcellos-Silva, Paulo R; Castiel, Luis David; Bagrichevsky, Marcos; Griep, Rosane Harter

    2011-06-01

    This article discusses the proliferation of medical quackery and fraud appearing and disappearing daily on the Internet. The customers of these scams, made vulnerable by disease or the prospect of death, use the Internet to buy products that would probably be ignored in other contexts. This vulnerability is linked to strenuous physical demands that compromise the ability to make decisions. The attempt to control the phenomenon of fraud as strictly rational, without taking into account the vulnerability of consumers who have little to lose and not considering their demands for comprehensive care, can lead to disappointing results, since these nostrums seem to be filling the gaps left by health care structures that have been insensitive to the immaterial nature of human fears.

  9. Current and Projected Characteristics and Unique Health Care Needs of the Patient Population Served by the Department of Veterans Affairs

    PubMed Central

    Eibner, Christine; Krull, Heather; Brown, Kristine M.; Cefalu, Matthew; Mulcahy, Andrew W.; Pollard, Michael; Shetty, Kanaka; Adamson, David M.; Amaral, Ernesto F. L.; Armour, Philip; Beleche, Trinidad; Bogdan, Olena; Hastings, Jaime; Kapinos, Kandice; Kress, Amii; Mendelsohn, Joshua; Ross, Rachel; Rutter, Carolyn M.; Weinick, Robin M.; Woods, Dulani; Hosek, Susan D.; Farmer, Carrie M.

    2016-01-01

    Abstract The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade. PMID:28083423

  10. Vulnerable patients going to court: a psychiatrist's guide to special measures

    PubMed Central

    Cooper, Penny; Grace, Janet

    2016-01-01

    There have been significant changes to how vulnerable people are treated in the court system, including the introduction of special measures to support people both as witness and as accused. This paper summarises the use of special measures and their application to people with mental health diagnoses or cognitive impairment. PMID:27512594

  11. Relation of microchannel structure identified by optical coherence tomography to plaque vulnerability in patients with coronary artery disease.

    PubMed

    Kitabata, Hironori; Tanaka, Atsushi; Kubo, Takashi; Takarada, Shigeho; Kashiwagi, Manabu; Tsujioka, Hiroto; Ikejima, Hideyuki; Kuroi, Akio; Kataiwa, Hideaki; Ishibashi, Kohei; Komukai, Kenichi; Tanimoto, Takashi; Ino, Yasushi; Hirata, Kumiko; Nakamura, Nobuo; Mizukoshi, Masato; Imanishi, Toshio; Akasaka, Takashi

    2010-06-15

    Increased neovascularization in atherosclerotic plaques is associated with plaque vulnerability. The high resolution of optical coherence tomography (OCT) might provide a chance to directly visualize plaque neovascularization in vivo. The aim of the present study was to investigate the relation between microchannels in culprit plaques identified by OCT and plaque vulnerability in patients with coronary artery disease. A total of 63 consecutive patients with coronary artery disease who had undergone both OCT and intravascular ultrasound before any interventions to examine culprit lesion morphologies were enrolled. Microchannel was defined as a no-signal tubuloluminal structure on the cross-sectional optical coherence tomographic image. Microchannels were found in 24 (38%) of the 63 patients. The patients were divided into 2 groups according to the presence or absence of microchannels. The frequency of plaque rupture tended to be greater in the microchannel group (50% vs 28%, p = 0.11). The thickness of the fibrous cap (median 60 vs 100 microm, p = 0.001) was significantly less in the patients with microchannels, and significant differences were found in the frequency of thin-cap fibroatheroma (54% vs 21%, p = 0.012) and positive remodeling (67% vs 36%, p = 0.02) between the 2 groups. The high-sensitivity C-reactive protein levels in the microchannel group was significantly greater than those in the no-microchannel group (median 0.27 vs 0.13 mg/dl, p = 0.015). Moreover, increased microchannel counts were associated with greater high-sensitivity C-reactive protein levels (p = 0.01). In conclusion, a significant relation was found between the presence of microchannels in plaques identified by OCT and plaque vulnerability in patients with coronary artery disease.

  12. Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups.

    PubMed

    Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D

    2007-10-01

    Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.

  13. Vulnerabilities in Older Patients when Cancer Treatment is Initiated: Does a Cognitive Impairment Impact the Two-Year Survival?

    PubMed Central

    Borghgraef, Cindy; Etienne, Anne-Marie; Merckaert, Isabelle; Paesmans, Marianne; Reynaert, Christine; Roos, Myriam; Slachmuylder, Jean-Louis; Vandenbossche, Sandrine; Bron, Dominique; Razavi, Darius

    2016-01-01

    Introduction Dementia is a known predictor of shorter survival times in older cancer patients. However, no empirical evidence is available to determine how much a cognitive impairment shortens survival in older patients when cancer treatment is initiated. Purpose To longitudinally investigate how much a cognitive impairment detected at the initiation of cancer treatment influences survival of older patients during a two-year follow-up duration and to compare the predictive value of a cognitive impairment on patients survival with the predictive value of other vulnerabilities associated with older age. Methods Three hundred and fifty-seven consecutive patients (≥65 years old) admitted for breast, prostate, or colorectal cancer surgeries were prospectively recruited. A cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA<26). Socio-demographic, disease-related, and geriatric vulnerabilities were assessed using validated tools. Univariate and subsequent multivariate Cox proportional hazards models stratified for diagnosis (breast/prostate cancer versus colorectal cancer) and disease status (metastatic versus non-metastatic) were used. Results A cognitive impairment was detected in 46% (n = 163) of patients. Survival was significantly influenced by a cognitive impairment (HR = 6.13; 95% confidence interval [CI] = 2.07–18.09; p = 0.001), a loss in instrumental autonomy (IADL ≤7) (HR = 3.06; 95% CI = 1.31–7.11; p = 0.009) and fatigue (Mob-T<5) (HR = 5.98; 95% CI = 2.47–14.44; p <0.001). Conclusions During the two years following cancer treatment initiation, older patients with a cognitive impairment were up to six times more likely to die than patients without. Older patients should be screened for cognitive impairments at cancer treatment initiation to enable interventions to reduce morbidity and mortality. Further studies should address processes underlying the relationship between cognitive impairments and an increased risk of dying

  14. Hippocampal Substructural Vulnerability to Sleep Disturbance and Cognitive Impairment in Patients with Chronic Primary Insomnia: Magnetic Resonance Imaging Morphometry

    PubMed Central

    Joo, Eun Yeon; Kim, Hosung; Suh, Sooyeon; Hong, Seung Bong

    2014-01-01

    Study Objectives: Despite compelling evidence from animal studies indicating hippocampal subfield-specific vulnerability to poor sleep quality and related cognitive impairment, there have been no human magnetic resonance imaging (MRI) studies investigating the relationship between hippocampal subfield volume and sleep disturbance. Our aim was to investigate the pattern of volume changes across hippocampal subfields in patients with primary insomnia relative to controls. Design: Pointwise morphometry allowed for volume measurements of hippocampal regions on T1-weighted MRI. Setting: University hospital. Patients: Twenty-seven unmedicated patients (age: 51.2 ± 9.6 y) and 30 good sleepers as controls (50.4 ± 7.1 y). Interventions: N/A. Measurements: We compared hippocampal subfield volumes between patients and controls and correlated volume with clinical and neuropsychological features in patients. Results: Patients exhibited bilateral atrophy across all hippocampal subfields (P < 0.05 corrected). Cornu ammonis (CA) 1 subfield atrophy was associated with worse sleep quality (higher Pittsburgh Sleep Quality Index and higher arousal index of polysomnography) (r < -0.45, P < 0.005). The volume of the combined region, including the dentate gyrus (DG) and CA3-4, negatively correlated with verbal memory, verbal information processing, and verbal fluency in patients (|r| > 0.45, P < 0.05). Hemispheric volume asymmetry of this region (left smaller than right) was associated with impaired verbal domain functions (r = 0.50, P < 0.005). Conclusion: Hippocampal subfield atrophy in chronic insomnia suggests reduced neurogenesis in the dentate gyrus (DG) and neuronal loss in the cornu ammonis (CA) subfields in conditions of sleep fragmentation and related chronic stress condition. Atrophy in the CA3-4-DG region was associated with impaired cognitive functions in patients. These observations may provide insight into pathophysiological mechanisms that make patients with chronic

  15. When grandiosity and vulnerability collide: Implicit and explicit self-esteem in patients with narcissistic personality disorder.

    PubMed

    Vater, Aline; Ritter, Kathrin; Schröder-Abé, Michela; Schütz, Astrid; Lammers, Claas-Hinrich; Bosson, Jennifer K; Roepke, Stefan

    2013-03-01

    Narcissistic personality disorder (NPD) is characterized by reports of grandiosity including exaggerated illusions of superiority and entitlement (DSM-IV-TR, APA, 2000). Based on clinical theories (e.g., Kernberg, 1975), many researchers argue that high explicit self-esteem in narcissists masks underlying implicit vulnerability (low implicit self-esteem). Conversely, based on social learning theories (i.e., Millon, 1981), people with NPD are characterized by implicit grandiosity (high implicit self-esteem). We test these competing hypotheses in patients diagnosed with NPD. The present study examined implicit self-esteem (using an Implicit Association Test) and explicit self-esteem (using a self-report questionnaire) in patients with NPD in comparison to non-clinical and clinical, non-NPD (Borderline Personality Disorder, BPD) control groups. Patients with NPD scored lower on explicit self-esteem than non-clinical controls. In comparison to patients with BPD, NPD patients scored higher on explicit and implicit self-esteem. Moreover, within the group of NPD patients, damaged self-esteem (i.e., low explicit, high implicit) was associated with higher narcissistic psychopathology. In both clinical groups we included participants seeking psychiatric treatment, which might influence explicit self-esteem. Longitudinal studies are needed to further assess self-esteem stability in NPD patients in comparison to the control groups. Our findings are indicative of vulnerable facets in patients with NPD (i.e., low explicit self-esteem). Furthermore, damaged self-esteem is connected to specific psychopathology within the NPD group. Implications for research on NPD are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Circulating CD36 and fractalkine levels are associated with vulnerable plaque progression in patients with unstable angina pectoris.

    PubMed

    Li, Rui Jian; Yang, Ming; Li, Ji Fu; Xue, Li; Chen, Yu Guo; Chen, Wen Qiang

    2014-11-01

    The chemokine, fractalkine, independently enhances the vulnerability of coronary atherosclerotic plaques. The present study investigated the combined effects of CD36 and fractalkine on coronary plaque progression in patients with unstable angina pectoris. In the present study, 120 unstable angina pectoris patients undergoing coronary angiography and intravascular ultrasound were divided into two groups: an intermediate lesion group (lumen diameter stenosis 50-70%, 80 patients) and a severe lesion group (at least one lesion with lumen diameter stenosis > 70%, 40 patients). The control group consisted of 40 healthy age- and sex-matched subjects. Concentrations of CD36 and fractalkine were measured by enzyme-linked immunosorbent assay. Major adverse cardiovascular events were monitored over a 2-year follow up. Intravascular ultrasound showed that patients with severe lesions had more calcified and mixed plaques, and a larger plaque area and plaque burden than patients with intermediate lesions (P < 0.05-0.01). More patients with severe lesions underwent stent deployment (P < 0.05) than those with intermediate lesions. CD36 and fractalkine concentrations were significantly higher in the severe lesion patients (P < 0.05), and both had significant positive correlations (P < 0.05) with the plaque burden of atherosclerotic lesions. Using the matched nested case-control study, we found that CD36 and fractalkine levels were higher in patients with recurrent major adverse cardiovascular events than controls (P < 0.05). In conclusion, CD36 and fractalkine both promote, and might synergistically enhance, the progression of coronary atherosclerotic plaques.

  17. A profile of four patterns of vulnerability to functional decline in older general medicine patients in Victoria, Australia: a cross sectional survey.

    PubMed

    Beddoes-Ley, Lenore; Khaw, Damien; Duke, Maxine; Botti, Mari

    2016-08-05

    There are limited published data reporting Australian hospitalized elders' vulnerability to functional decline to guide best practice interventions. The objectives of this study were to describe the prevalence of vulnerability to functional decline and explore profiles of vulnerability related to the performance of physical activity in a representative group of elders in a single centre in Victoria, Australia. A cross-sectional survey of patients aged ≥ 70 years (Mean age 82.4, SD 7 years) admitted to a general medical ward of an Australian tertiary-referral metropolitan public hospital from March 2010 to March 2011 (n = 526). Patients were screened using the Vulnerable Elders Survey (VES-13). Distinct typologies of physical difficulties were identified using latent class analysis. Most elders scored ≥3/10 on the VES-13 and were rated vulnerable to functional decline (n = 480, 89.5 %). Four distinct classes of physical difficulty were identified: 1) Elders with higher physical functioning (n = 114, 21.7 %); 2) Ambulant elders with diminished strength (n = 24, 4.6 %); 3) Elders with impaired mobility, strength and ability to stoop (n = 267, 50.8 %) and 4) Elders with extensive physical impairment (n = 121, 23 %) Vulnerable elders were distributed through all classes. Older general medicine patients in Victoria, Australia, are highly vulnerable to functional decline. We identified four distinct patterns of physical difficulties associated with vulnerability to functional decline that can inform health service planning, delivery and education.

  18. Vulnerable Plaque

    MedlinePlus

    ... all vulnerable plaque ruptures, and researchers at the Texas Heart Institute are looking at ways to determine ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  19. Perfectionism dimensions and dependency in relation to personality vulnerability and psychosocial adjustment in patients with coronary artery disease.

    PubMed

    Dunkley, David M; Schwartzman, Deborah; Looper, Karl J; Sigal, John J; Pierre, Andrena; Kotowycz, Mark A

    2012-06-01

    The present study sought to illuminate self-criticism and personal standards dimensions of perfectionism and dependency as specific cognitive-personality vulnerability factors that might contribute to a better understanding of numerous psychosocial problem areas that are relevant to coronary artery disease (CAD). One hundred and twenty-three patients diagnosed with clinically significant CAD completed self-report questionnaires. Zero-order correlations and factor analysis results revealed that self-criticism was primarily related to personality vulnerability (aggression/anger/hostility, Type D negative affectivity) and psychosocial maladjustment (depressive symptoms, worry, avoidant coping, support dissatisfaction), whereas personal standards was primarily related to adaptive coping (problem-focused coping, positive reinterpretation) and dependency was primarily related to worry. Hierarchical regression results demonstrated the incremental utility of self-criticism, personal standards, and dependency in relation to (mal)adjustment over and above aggression/anger/hostility, negative affectivity, and social inhibition. Continued efforts to understand the role of perfectionism dimensions and dependency in CAD appear warranted.

  20. Vulnerability to traumatic stress in fibromyalgia patients: 19 month follow-up after the great East Japan disaster.

    PubMed

    Usui, Chie; Hatta, Kotaro; Aratani, Satoko; Yagishita, Naoko; Nishioka, Kenya; Okamura, Satoko; Itoh, Kenji; Yamano, Yoshihisa; Nakamura, Hiroyuki; Asukai, Nozomu; Nakajima, Toshihiro; Nishioka, Kusuki

    2013-09-23

    The aim of this study was to investigate vulnerability and long-term influence of traumatic stress caused by the Great East Japan Disaster which occurred on March 11, 2011, in patients with fibromyalgia, which is a chronic pain syndrome probably involving central sensitization. A total of 60 female patients with fibromyalgia were compared with female patients with rheumatoid arthritis (RA, n = 23) as another chronic pain disease, and with female healthy controls (HC, n = 26) in the observational study. To evaluate responses to traumatic stress, the scores of Impact of Event Scale-Revised (IES-R) were assessed one month after the disaster and every six months until 19 months after the disaster. We also evaluated levels of depression during the study period. To know the score of IES-R of patients with fibromyalgia during usual living, we assessed IES-R in another population of fibromyalgia patients without exposure to a great disaster. The mean score of IES-R one month after the disaster in the fibromyalgia group (24.6 [SD 18.9]) was significantly higher than that of RA group (13.4 [SD 14.5]) or HC group (9.1 [9.2]) (F = 9.96, p < 0.0001). However, the mean score of IES-R in fibromyalgia patients without exposure to a great disaster was (20.3 [SD 18.7]), which was almost the same value as the fibromyalgia group seven months after the disaster (20.2 [SD 19.5]). Repeated measures analysis of variance showed significant effect of time course in the depression-related symptoms (F = 6.68, P = 0.001), and a post-hoc test revealed that the number of depression-related symptoms one month before the disaster was significantly different from other time points until 19 months after the disaster, respectively. Although response to acute stress induced by the great earthquake was likely to be settled within seven months after the disaster, depression-related symptoms have been increasing for more than one year after the disaster, despite exclusion of patients with major

  1. Vulnerability to traumatic stress in fibromyalgia patients: 19 month follow-up after the great East Japan disaster

    PubMed Central

    2013-01-01

    Introduction The aim of this study was to investigate vulnerability and long-term influence of traumatic stress caused by the Great East Japan Disaster which occurred on March 11, 2011, in patients with fibromyalgia, which is a chronic pain syndrome probably involving central sensitization. Methods A total of 60 female patients with fibromyalgia were compared with female patients with rheumatoid arthritis (RA, n = 23) as another chronic pain disease, and with female healthy controls (HC, n = 26) in the observational study. To evaluate responses to traumatic stress, the scores of Impact of Event Scale-Revised (IES-R) were assessed one month after the disaster and every six months until 19 months after the disaster. We also evaluated levels of depression during the study period. To know the score of IES-R of patients with fibromyalgia during usual living, we assessed IES-R in another population of fibromyalgia patients without exposure to a great disaster. Results The mean score of IES-R one month after the disaster in the fibromyalgia group (24.6 [SD 18.9]) was significantly higher than that of RA group (13.4 [SD 14.5]) or HC group (9.1 [9.2]) (F = 9.96, p < 0.0001). However, the mean score of IES-R in fibromyalgia patients without exposure to a great disaster was (20.3 [SD 18.7]), which was almost the same value as the fibromyalgia group seven months after the disaster (20.2 [SD 19.5]). Repeated measures analysis of variance showed significant effect of time course in the depression-related symptoms (F = 6.68, P = 0.001), and a post-hoc test revealed that the number of depression-related symptoms one month before the disaster was significantly different from other time points until 19 months after the disaster, respectively. Conclusions Although response to acute stress induced by the great earthquake was likely to be settled within seven months after the disaster, depression-related symptoms have been increasing for more than one year after the disaster, despite

  2. Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

    PubMed

    Galvez-Ruiz, Alberto

    2015-01-01

    The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET). The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis. Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze. Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET.

  3. Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

    PubMed Central

    Galvez-Ruiz, Alberto

    2015-01-01

    Purpose: The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET). Methods: The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis. Results: Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze. Discussion: Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET. PMID:26180479

  4. Vulnerability of Older Adults in Disasters: Emergency Department Utilization by Geriatric Patients After Hurricane Sandy.

    PubMed

    Malik, Sidrah; Lee, David C; Doran, Kelly M; Grudzen, Corita R; Worthing, Justin; Portelli, Ian; Goldfrank, Lewis R; Smith, Silas W

    2017-08-02

    Older adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, we performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy's landfall. We used an all-payer claims database to analyze demographics, insurance status, geographic distribution, and health conditions for post-disaster ED visits among older adults. We compared ED patterns of use in the weeks before and after Hurricane Sandy throughout NYC and the most afflicted evacuation zones. We found significant increases in ED utilization by older adults (and disproportionately higher in those aged ≥85 years) in the 3 weeks after Hurricane Sandy, especially in NYC evacuation zone one. Primary diagnoses with notable increases included dialysis, electrolyte disorders, and prescription refills. Secondary diagnoses highlighted homelessness and care access issues. Older adults display heightened risk for worse health outcomes with increased ED visits after a disaster. Our findings suggest the need for dedicated resources and planning for older adults following a natural disaster by ensuring access to medical facilities, prescriptions, dialysis, and safe housing and by optimizing health care delivery needs to reduce the burden of chronic disease. (Disaster Med Public Health Preparedness. 2017;page 1 of 10).

  5. Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas

    PubMed Central

    KAGEJI, Teruyoshi; OBATA, Fumiaki; OKA, Hirofumi; KANEMATSU, Yasuhisa; TABATA, Ryo; TANI, Kenji; BANDO, Hiroyasu; NAGAHIRO, Shinji

    2016-01-01

    There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists. In the course of 34 months, we used the TSS in 321 emergencies. A total of 9 of 188 (4.8%) with acute ischemic stroke, received iv rt-PA infusion therapy using a mobile TSS; in 5 among these (55.6%), we obtained partial or complete recanalization of occluded arteries. None suffered post-treatment hemorrhage and their average NIH stroke score fell from 14.6 at the time of admission to 6.8 at 24 h post-infusion. The drip-and-ship protocol contributed to the safe and effective treatment of the stroke patients living in medically under-served rural areas. PMID:27333939

  6. Fleshing out vulnerability.

    PubMed

    Tavaglione, Nicolas; Martin, Angela K; Mezger, Nathalie; Durieux-Paillard, Sophie; François, Anne; Jackson, Yves; Hurst, Samia A

    2015-02-01

    In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged - that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care - thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self-respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice. © 2013 John Wiley & Sons Ltd.

  7. Former Buruli Ulcer Patients' Experiences and Wishes May Serve as a Guide to Further Improve Buruli Ulcer Management.

    PubMed

    Velink, Anita; Woolley, Rebecca J; Phillips, Richard O; Abass, Kabiru M; van der Werf, Tjip S; Agumah, Emmanuel; de Zeeuw, Janine; Klis, Sandor; Stienstra, Ymkje

    2016-12-01

    Buruli ulcer (BU), caused by Mycobacterium ulcerans, is a neglected tropical disease frequently leading to permanent disabilities. The ulcers are treated with rifampicin and streptomycin, wound care and, if necessary surgical intervention. Professionals have exclusively shaped the research agenda concerning management and control, while patients' perspective on priorities and preferences have not explicitly been explored or addressed. To get insight into patient perception of the management and control of Buruli ulcer a mixed methods research design was applied with a questionnaire and focus group discussions among former BU patients. Data collection was obtained in collaboration with a local team of native speakers in Ghana. A questionnaire was completed by 60 former patients and four focus group discussions were conducted with eight participants per group. Former patients positively evaluated both the effectiveness of the treatment and the financial contribution received for the travel costs to the hospitals. Pain experienced during treatment procedures, in particular wound care and the streptomycin injections, and the side-effects of the treatment were negatively evaluated. Former patients considered the development of preventive measures and knowledge on the transmission as priorities. Additionally, former patients asked for improved accessibility of health services, counselling and economic support. These findings can be used to improve clinical management and to guide the international research agenda.

  8. Vulnerable populations: considerations for wound care.

    PubMed

    Pieper, Barbara

    2009-05-01

    Race/ethnicity, immigration, health insurance, and literacy--along with patient-provider communication and understanding of and adherence to treatment protocols--are societal factors that affect the provision of optimal healthcare. Wound care practitioners should be aware of the need to address these factors in vulnerable groups, including the effects of racial/ethnic care disparities, immigration, low income, uninsured or underinsured status, and literacy/health literacy on health and wound care. The literature shows that care is not always perceived to be or equitably provided across different ethnic and economically diverse populations. Hence, clinicians must strive to listen to and interact non-judgmentally with vulnerable patients. Each patient's physical and psychosocial concerns must be assessed without malice and clinicians must work with community, state, and federal agencies to enhance access to necessary services. Wound care patient teaching materials need to be developed that consider the literacy and language skills of the community served. Once the type of wound and its appropriate treatment are determined, wound care practitioners must consider patient teaching, vulnerability, cultural, and economic constraints of care, along with strategies for prevention of complications and hospitalizations.

  9. Are Concerns About Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying?

    PubMed

    Rooney, William; Schuklenk, Udo; van de Vathorst, Suzanne

    2017-06-17

    Some jurisdictions that have decriminalized assisted dying (like Canada) exclude psychiatric patients on the grounds that their condition cannot be determined to be irremediable, that they are vulnerable and in need of protection, or that they cannot be determined to be competent. We review each of these claims and find that none have been sufficiently well-supported to justify the differential treatment psychiatric patients experience with respect to assisted dying. We find bans on psychiatric patients' access to this service amount to arbitrary discrimination. Proponents of banning the practice ignore or overlook alternatives to their proposal, like an assisted dying regime with additional safeguards. Some authors have further criticized assisted dying for psychiatric patients by highlighting allegedly problematic practices in those countries which allow it. We address recent evidence from the Netherlands, showing that these problems are either misrepresented or have straightforward solutions. Even if one finds such evidence troubling despite our analysis, other jurisdictions need not adopt every feature of the Dutch system.

  10. The impact of cancer diagnosis on the lifestyle and habits of patients served at a Veterans Administration Hospital.

    PubMed

    Jazieh, Abdul-Rahman; Foraida, Monammad; Ghouse, Masood; Khalil, Maisaa M; Kopp, Monica; Savidge, Mildred

    2006-01-01

    Cancer diagnosis is associated with many changes in the life of the patients. However, the impact of cancer diagnosis on the lifestyle and habits of veterans has not been reported. We conducted a cross-sectional study of veterans with cancer to evaluate the impact of cancer diagnosis on their lifestyle including diet, habits, and exercise. We correlated habit changes with demographic and disease-related factors. We surveyed 200 patients. Most patients were males (98%), with median age of 68 years (range, 36-87) and with the following types of malignancy: genitourinary (39.5%); lung (19.5%); gastrointestinal (14.5%); hematologic (16%); skin, head, and neck (6.5%); and others (4%). Of the patients, 83.5% were current or former smokers with a median smoking history of 54.4 pack-year (range, 2-198). Less than a quarter of the patients changed behaviors positively (decreased smoking, drinking, and fat consumption; increased exercise and fruit/vegetable consumption). Up to two thirds of the patients did not change any of these habits. Although many veterans may adopt healthier habits after cancer diagnosis, a larger portion of them do not, which highlights the need for further evaluation and implementation of educational interventions.

  11. Self-monitoring as a familial vulnerability marker for psychosis: an analysis of patients, unaffected siblings and healthy controls.

    PubMed

    Hommes, J; Krabbendam, L; Versmissen, D; Kircher, T; van Os, J; van Winkel, R

    2012-02-01

    Alterations in self-monitoring have been reported in patients with psychotic disorders, but it remains unclear to what degree they represent true indicators of familial vulnerability for psychosis. An error-correction action-monitoring task was used to examine self-monitoring in 42 patients with schizophrenia, 32 of their unaffected siblings and 41 healthy controls. Significant between-group differences in self-monitoring accuracy were found (χ2=29.3, p<0.0001), patients performing worst and unaffected siblings performing at an intermediate level compared to controls (all between-group differences p<0.05). In the combined group of healthy controls and unaffected siblings, detection accuracy was associated with positive schizotypy as measured by the Structured Interview for Schizotypy - Revised (SIS-R) (β=-0.16, s.e.=0.07, p=0.026), but not with negative schizotypy (β=-0.05, s.e.=0.12, p=0.694). In patients, psychotic symptoms were not robustly associated with detection accuracy (β=-0.01, s.e.=0.01, p=0.094), although stratified analysis revealed suggestive evidence for association in patients not currently using antipsychotic medication (β=-0.03, s.e.=0.01, p=0.052), whereas no association was found in patients on antipsychotic medication (β=-0.01, s.e.=0.01, p=0.426). A similar pattern of associations was found for negative symptoms. Alterations in self-monitoring may be associated with familial risk and expression of psychosis. The association between psychotic symptoms and self-monitoring in patients may be affected by antipsychotic medication, which may explain previous inconsistencies in the literature.

  12. Consenting of the vulnerable: the informed consent procedure in advanced cancer patients in Mexico

    PubMed Central

    Verástegui, Emma L

    2006-01-01

    Background A topic of great concern in bioethics is the medical research conducted in poor countries sponsored by wealthy nations. Western drug companies increasingly view Latin America as a proper place for clinical research trials. The region combines a large population, modern medical facilities, and low per capita incomes. Participants from developing countries may have little or non alternative means of treatment other than that offered through clinical trials. Therefore, the provision of a valid informed consent is important. Methods To gain insight about some aspects of the informed consent procedure in a major cancer centre in Mexico, we conducted a three-step evaluation process: 1) a ten point multiple choice survey questionnaires, was used to explore some aspects of the patients' experiences during the informed consent process, 2) researchers' knowledge about specific aspects of the informed consent was evaluated in this study using survey questionnaires; and 3) the comprehensibility, readability and number of pages of the consent forms were analysed. The socioeconomic and educational level of the patients, were also considered. Results were reported using a numerical scale. Results Thirty five patients, 20 doctors, and 10 individuals working at the hospital agreed to participate in the study. Eighty three percent of the patients in the study were classified as living in poverty; education level was poor or non existent, and 31% of the patients were illiterate. The consent forms were difficult to understand according to 49% of the patients, most doctors agreed that the forms were not comprehensible to the patients. The average length of the IC documents analysed was 14 pages, and the readability average score was equivalent to 8TH Grade. Conclusion The results presented in this work describe some relevant characteristics of the population seen at public health care institutions in Mexico. Poverty, limited or no education, and the complexity of the

  13. How practice contributes to trolley food waste. A qualitative study among staff involved in serving meals to hospital patients.

    PubMed

    Ofei, K T; Holst, M; Rasmussen, H H; Mikkelsen, B E

    2014-12-01

    This study investigated the generation of trolley food waste at the ward level in a hospital in order to provide recommendations for how practice could be changed to reduce food waste. Three separate focus group discussions were held with four nurses, four dietitians and four service assistants engaged in food service. Furthermore, single qualitative interviews were conducted with a nurse, a dietitian and two service assistants. Observations of procedures around trolley food serving were carried out during lunch and supper for a total of 10 weekdays in two different wards. All unserved food items discarded as waste were weighed after each service. Analysis of interview and observation data revealed five key themes. The findings indicate that trolley food waste generation is a practice embedded within the limitations related to the procedures of meal ordering. This includes portion size choices and delivery, communication, tools for menu information, portioning and monitoring of food waste, as well as the use of unserved food. Considering positive changes to these can be a way forward to develop strategies to reduce trolley food waste at the ward level.

  14. Health status and satisfaction with health care: a longitudinal study among patients served by the Veterans Health Administration.

    PubMed

    Ren, X S; Kazis, L; Lee, A; Rogers, W; Pendergrass, S

    2001-01-01

    As the Veterans Health Administration (VHA) places high priority on becoming a performance-based organization, there is an increasing need to quantify and refine its outcome measurement system. Using panel data from VHA ambulatory care patients (1996-1998), we conducted cross-lagged correlations and ordinary least squares regression to examine the relationship between 2 VHA health care values: health status and satisfaction with care. The study results indicated that patients' health status was significantly associated with their satisfaction with care, indicating that patients with better health status were more likely to be satisfied with health care. Although satisfaction with care was both a consequence and a determinant of health status, the effects of health status on satisfaction seemed to be more important than the effects of satisfaction on health status. More research is needed for a better understanding of the dynamic relationship between health status and satisfaction with care.

  15. A systems-based intervention to promote smoking as a vital sign in patients served by community health centers.

    PubMed

    Maizlish, Neil A; Ruland, Jodie; Rosinski, Marishka E; Hendry, Khati

    2006-01-01

    The frequency of asking and advising adult patients about tobacco use was measured after an intervention to adopt smoking as a vital sign at 7 community health centers. The intervention consisted of training staff, revising forms and vital sign stamps, and disseminating educational materials. Documentation in medical charts was reviewed for 1,571 randomly sampled patients in 2002 and 2003. The point prevalence (last encounter) and period prevalence (any annual encounter) of asking patients about smoking increased significantly from 2002 to 2003 (59% to 85%, and 71% to 97%, respectively) overall and at each health center. On advising smokers to quit, 4 health centers improved, but the overall point prevalence, 26%, and period prevalence, 46%, were unchanged over time. An intervention using multiple strategies may have contributed to improving the rates of asking but did not have as large or consistent an impact on rates of advising smokers to quit.

  16. 42 CFR 412.106 - Special treatment: Hospitals that serve a disproportionate share of low-income patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...-income patients. (a) General considerations. (1) The factors considered in determining whether a hospital... within 24 hours for 30 consecutive days. (iii) The hospital's location, in an urban or rural area, is... an urban hospital reclassified as rural as set forth in § 412.103 is classified as rural. (2)...

  17. Caregiver Burden, Quality of Life and Vulnerability Towards Psychopathology in Caregivers of Patients with Dementia/Alzheimer's Disease.

    PubMed

    Dawood, Saima

    2016-11-01

    To identify caregivers' burden, evaluate quality of life in them; and predict anxiety and depression in caregivers of patients with Alzheimer's disease (AD). Cross-sectional study. Neurology and Psychiatry Department of Lahore General Hospital (LGH), from January to December, 2013. A purposive sample of 60 caregivers, who had been taking care of patients with AD for more than one year, were recruited from the study centre. The Zarit Burden Interview was used to assess caregiver burden. The brief version of World Health Organization Quality of Life Scale to assess quality of life and anxiety and depression subscales of symptom checklist-revised were administered to assess caregivers' vulnerability towards psychopathology. There were 6 males and 54 females caregivers with mean age of 37.60 ±14.87 years. The burden of caregiving had negative relationship (-0.57; -0.50; -0.48; and -0.50, respectively) with physical, psychological, social, and environmental domains of quality of life. Neither caregiver burden nor quality of life predicted for anxiety and depression in the caregivers. Caregiver burden may impair quality of life of caregivers but results imply the need to identify the interpersonal and intrapersonal characteristics of caregivers that buffered the adverse effects of caregiver burden and impaired the quality of life on psychological wellbeing of the patients with AD.

  18. Stroop and emotional Stroop interference in unaffected relatives of patients with schizophrenic and bipolar disorders: distinct markers of vulnerability?

    PubMed

    Besnier, Nathalie; Richard, Floriane; Zendjidjian, Xavier; Kaladjian, Arthur; Mazzola-Pomietto, Pascale; Adida, Marc; Azorin, Jean-Michel

    2009-01-01

    Reduced inhibition has been demonstrated in both schizophrenic and bipolar patients through the findings of increased interference on the Stroop Colour-Word Task (SCWT) and increased emotional interference on specific versions of the Emotional Stroop Task (EST). Despite previous findings of enhanced interference in unaffected relatives of schizophrenic and bipolar patients, it remains unclear whether interference might be a candidate endophenotype to both disorders. Moreover, data regarding emotional interference in unaffected relatives are critically lacking. In the present study, we aimed to compare unaffected relatives of patients with schizophrenia (SZ-rel, N = 30) and bipolar disorder (BD-rel, N= 30) with normal controls (N = 60) when performing the SCWT and an EST designed with neutral, depressive, paranoid and manic words. SZ-rel exhibited greater interference effect on both the SCWT and the EST as compared to either BD-rel or normal controls. BD-rel, and by contrast to SZ-rel and controls, showed increased emotional interference effect on the EST that was specifically associated to the disease-related words. The findings support the hypothesis of different markers of vulnerability to schizophrenic and bipolar disorders; impairment in cognitive inhibition could characterize high-risk individuals for schizophrenia whereas an emotional bias towards mood-related information could be a trait marker of bipolar disease.

  19. The Spoken Knowledge in Low Literacy in Diabetes scale: a diabetes knowledge scale for vulnerable patients.

    PubMed

    Rothman, Russell L; Malone, Robb; Bryant, Betsy; Wolfe, Catherine; Padgett, Penelope; DeWalt, Darren A; Weinberger, Morris; Pignone, Michael

    2005-01-01

    The purpose of this study was to develop and validate a new knowledge scale for patients with type 2 diabetes and poor literacy: the Spoken Knowledge in Low Literacy patients with Diabetes (SKILLD). The authors evaluated the 10-item SKILLD among 217 patients with type 2 diabetes and poor glycemic control at an academic general medicine clinic. Internal reliability was measured using the Kuder-Richardson coefficient. Performance on the SKILLD was compared to patient socioeconomic status, literacy level, duration of diabetes, and glycated hemoglobin (A1C). Respondents' mean age was 55 years, and they had diabetes for an average of 8.4 years; 38% had less than a sixth-grade literacy level. The average score on the SKILLD was 49%. Less than one third of patients knew the signs of hypoglycemia or the normal fasting blood glucose range. The internal reliability of the SKILLD was good (0.72). Higher performance on the SKILLD was significantly correlated with higher income (r = 0.22), education level (r = 0.36), literacy status (r = 0.33), duration of diabetes (r = 0.30), and lower A1C (r = -0.16). When dichotomized, patients with low SKILLD scores (< or = 50%) had significantly higher A1C (11.2% vs 10.3%, P < .01). This difference remained significant when adjusted for covariates. The SKILLD demonstrated good internal consistency and validity. It revealed significant knowledge deficits and was associated with glycemic control. The SKILLD represents a practical scale for patients with diabetes and low literacy.

  20. Key Elements of High-Quality Primary Care for Vulnerable Elders

    PubMed Central

    Fung, Constance H.; Sinsky, Christine A.; Wu, Shinyi; Reuben, David B.

    2008-01-01

    With the impending surge in the number of older adults, primary care clinicians will increasingly need to manage the care of vulnerable elders. Caring for vulnerable elders is complex because of their wide range of health goals and the interdependence of medical care and community supports needed to achieve those goals. In this article, we identify ways a primary care practice can reorganize to improve the care of vulnerable elders. We begin by identifying important outcomes for vulnerable elders and three key processes of care (communication, developing a personal care plan for each patient, and care coordination) needed to achieve these outcomes. We then describe two delivery models of primary care for vulnerable elders – co-management, and augmented primary care. Finally, we discuss how the physical plant, people, workflow management, and community linkages in a primary care practice can be restructured to better serve these patients. PMID:18839261

  1. Evidence of a disposition toward fearfulness and vulnerability to posttraumatic stress in dysfunctional pain patients.

    PubMed

    Asmundson, G J; Bonin, M F; Frombach, I K; Norton, G R

    2000-08-01

    Few investigations have addressed whether patient subgroups derived using the Multiaxial Assessment of Pain (MAP) [Turk, D. C., & Rudy, T. E. (1987). Towards a comprehensive assessment of chronic pain patients. Behaviour Research and Therapy, 25, 237-249; Turk, D. C., & Rudy, T. E. (1988). Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. Journal of Consulting and Clinical Psychology, 56, 233-238.] differ with regard to fear and avoidance. It has, however, been reported that dysfunctional patients exhibit more pain-specific fear and avoidance than patients classified as interpersonally distressed or minimizers/adaptive copers [Asmundson, G. J. G., Norton, G. R., & Allerdings, M. D. (1997). Fear and avoidance in dysfunctional chronic back pain patients. Pain, 69, 231-236.]. We attempted to extend these findings by examining two fear constructs that are receiving increased attention in the chronic pain literature-anxiety sensitivity and PTSD. The sample comprised 115 patients with chronic pain. Of these, 14 (12.2%) were classified as dysfunctional, 21 (18.3%) as interpersonally distressed and 47 (40.8%) as minimizers/adaptive copers. Between-group differences were observed on the fear of cognitive and emotional dyscontrol dimension of anxiety sensitivity, total and symptom cluster scores on the PTSD measure, and depression. No differences were observed for the fear of somatic sensations dimension of anxiety sensitivity or agoraphobia, social phobia, and blood/injury fears. Dysfunctional patients generally exhibited elevated scores relative to one or both of the other MAP subgroups on fear of cognitive and emotional dyscontrol, depressed affect, PTSD symptom total score and PTSD symptom cluster scores. As well, a substantial proportion of dysfunctional and interpersonally distressed patients were classified as having PTSD (71.4 and 42.9%, respectively) when compared to minimizers/adaptive copers (21

  2. Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.

    PubMed

    Morris, Timothy A; Gay, Peter C; MacIntyre, Neil R; Hess, Dean R; Hanneman, Sandra K; Lamberti, James P; Doherty, Dennis E; Chang, Lydia; Seckel, Maureen A

    2017-04-01

    Acute respiratory compromise describes a deterioration in respiratory function with a high likelihood of rapid progression to respiratory failure and death. Identifying patients at risk for respiratory compromise coupled with monitoring of patients who have developed respiratory compromise might allow earlier interventions to prevent or mitigate further decompensation. The National Association for the Medical Direction of Respiratory Care (NAMDRC) organized a workshop meeting with representation from many national societies to address the unmet needs of respiratory compromise from a clinical practice perspective. Respiratory compromise may arise de novo or may complicate preexisting lung disease. The group identified distinct subsets of respiratory compromise that present similar opportunities for early detection and useful intervention to prevent respiratory failure. The subtypes were characterized by the pathophysiological mechanisms they had in common: impaired control of breathing, impaired airway protection, parenchymal lung disease, increased airway resistance, hydrostatic pulmonary edema, and right-ventricular failure. Classification of acutely ill respiratory patients into one or more of these categories may help in selecting the screening and monitoring strategies that are most appropriate for the patient's particular pathophysiology. Standardized screening and monitoring practices for patients with similar mechanisms of deterioration may enhance the ability to predict respiratory failure early and prevent its occurrence.

  3. Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients.

    PubMed

    Foley, Perry; Steinberg, Dori; Levine, Erica; Askew, Sandy; Batch, Bryan C; Puleo, Elaine M; Svetkey, Laura P; Bosworth, Hayden B; DeVries, Abigail; Miranda, Heather; Bennett, Gary G

    2016-05-01

    Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients

    PubMed Central

    Foley, Perry; Steinberg, Dori; Levine, Erica; Askew, Sandy; Batch, Bryan C.; Puleo, Elaine M.; Svetkey, Laura P.; Bosworth, Hayden B.; DeVries, Abigail; Miranda, Heather; Bennett, Gary G.

    2016-01-01

    Introduction Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. Methods Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65 years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12 months, with study visits at baseline, 6, and 12 months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24 months. Results Participants are 68% female and on average 50.7 years old with a mean BMI of 35.9 kg/m2. Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. Conclusions Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment. PMID:26995281

  5. Urinary Macrophage Migration Inhibitory Factor Serves as a Potential Biomarker for Acute Kidney Injury in Patients with Acute Pyelonephritis

    PubMed Central

    Hong, Ming-Yuan; Tseng, Chin-Chung; Chuang, Chia-Chang; Chen, Chia-Ling; Lin, Sheng-Hsiang; Lin, Chiou-Feng

    2012-01-01

    Conventional markers of kidney function that are familiar to clinicians, including the serum creatinine and blood urea nitrogen levels, are unable to reveal genuine injury to the kidney, and their use may delay treatment. Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine, and the predictive role and pathogenic mechanism of MIF deregulation during kidney infections involving acute kidney injury (AKI) are not currently known. In this study, we showed that elevated urinary MIF levels accompanied the development of AKI during kidney infection in patients with acute pyelonephritis (APN). In addition to the MIF level, the urinary levels of interleukin (IL)-1β and kidney injury molecule (KIM)-1 were also upregulated and were positively correlated with the levels of urinary MIF. An elevated urinary MIF level, along with elevated IL-1β and KIM-1 levels, is speculated to be a potential biomarker for the presence of AKI in APN patients. PMID:23319831

  6. Patient and provider factors associated with colorectal cancer screening in safety net clinics serving low-income, urban immigrant Latinos.

    PubMed

    Lopez-Class, Maria; Luta, Gheorghe; Noone, Anne-Michelle; Canar, Janet; Selksy, Claire; Huerta, Elmer; Mandelblatt, Jeanne

    2012-08-01

    Latinos have lower colorectal cancer screening rates than Whites. We reviewed a random sample of charts between July 2009 and February 2010 of safety-net clinic of 840 immigrants (50 years and older) from Central and South America receiving care. Logistic regression evaluated associations of ever vs. never screening, patient and physician factors. Ever screening rates were 24.5%, and only 17% of charts noted a physician screening recommendation. However, the odds of screening were 9.89 times higher (95% CI: 6.25-15.64, p<.001) among patients with a physician recommendation vs. those without, considering covariates. The odds of screening were 0.61 times lower (95% CI: 0.40-0.92, p=.02) in patients with a body mass index ≥ 30 vs. <30. While rates were low, determinants of screening were similar in this Latino subgroup to those reported in other Latino and non-Latino populations. Low rates of documented physician screening recommendations may indicate a potential missed opportunity for cancer control in safety-net clinics.

  7. Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT).

    PubMed

    Aldridge, Arnie; Linford, Robyn; Bray, Jeremy

    2017-02-01

    To estimate changes in the substance use behaviors of patients who received services as part of the US Substance Abuse and Mental Health Services Administration's (SAMHSA) Screening, Brief Intervention and Referral to Treatment (SBIRT) grant program. We use a pre-post design and performance monitoring data collected by SBIRT organizations. For a sample of 17 575 patients, we compare pre-SBIRT substance use with substance use 6 months after receipt of SBIRT services. SBIRT's correlation with changes in substance use was estimated using generalized linear mixed models to account for the clustering of patients within health-care facility and US state. From pre- to post-SBIRT we found large and statistically significant decreases for almost every measure of substance use. Model-adjusted means indicate that the prevalence of alcohol use was lower 6 months later by 35.6%, heavy drinking by 43.4% and illicit drug use by 75.8%. Greater intervention intensity was associated with larger decreases in substance use. The study design does not support causal conclusions and estimated decreases in reported substance use are due, at least in part, to a well-known set of confounders and natural substance use patterns that may be unrelated to any particular SBIRT intervention. Compared with previously published findings on the Screening, Brief Intervention and Referral to Treatment grant program, our estimates of substance use reduction were smaller, but still consistently large in absolute magnitude and within ranges of estimates from past trials of Screening, Brief Intervention and Referral to Treatment. © 2017 Society for the Study of Addiction.

  8. Could gut microbiota serve as prognostic biomarker associated with colorectal cancer patients' survival? A pilot study on relevant mechanism

    PubMed Central

    Wei, Zhiliang; Cao, Shougen; Liu, Shanglong; Yao, Zengwu; Sun, Teng; Li, Yi; Li, Jiante; Zhang, Dongfeng; Zhou, Yanbing

    2016-01-01

    Evidences have shown that dysbiosis could promote the progression of colorectal cancer (CRC). However, the association of dysbiosis and prognosis of CRC is barely investigated. Therefore, we used 16S rRNA gene sequencing approach to determine differences in microbiota among tumor tissues of different prognosis and found that Fusobacterium nucleatum and Bacteroides fragilis were more abundant in worse prognosis groups, while Faecalibacterium prausnitzii displayed higher abundance in survival group. To further explore the prognostic value of the found bacteria, Kaplan–Meier and Cox proportional regression analyses were used and the results exhibited that high abundance of F. nucleatum and B. fragilis were independent indicators of poor patient's survival. Besides, the expression of major inflammatory mediator were analyzed using PCR and western blot methods, and it turned out that high abundance of F. nucleatum was associated with increased expression of TNF-α, β-catenin and NF-κB, while COX-2, MMP-9 and NF-κB were positively related with high B. fragilis level, and high level of F. prausnitzii showed lower expression of β-catenin, MMP-9 and NF-κB. Moreover, immunohistochemical analysis indicated that KRAS and BRAF expression were prominent in F. nucleatum and B. fragilis high abundance group, while MLH1 showed lower expression. In conclusion, F. nucleatum, B. fragilis and F. prausnitzii can be identified as useful prognostic biomarkers for CRC, and dysbiosis might worsen the patients' prognosis by up-regulating gut inflammation level. PMID:27323816

  9. Carbapenem-resistant Enterobacteriaceae: A menace to our most vulnerable patients

    PubMed Central

    PEREZ, FEDERICO; VAN DUIN, DAVID

    2014-01-01

    The emergence of carbapenem-resistant Enterobacteriaceae (CRE) highlights the importance of effective antibiotics to maintain the safety of our health care system. Clinicians will encounter CRE as a cause of difficult-to-treat and often fatal infections in hospitalized patients. We review the mechanisms of carbapenem resistance, the dissemination and clinical impact of these resistant organisms, and challenges to their detection, treatment, and control. PMID:23547093

  10. Patient-tailored implantable cardioverter defibrillator testing using the upper limit of vulnerability: the TULIP protocol.

    PubMed

    Lemke, Bernd; Lawo, Thomas; Zarse, Markus; Lubinski, Andrzej; Kreutzer, Ulrich; Mueller, Johannes; Schuchert, Andreas; Mitzenheim, Sabine; Danilovic, Dejan; Deneke, Thomas

    2008-08-01

    We evaluated the feasibility of the TULIP (Threshold test using Upper Limit during ImPlantation) protocol, which was designed to provide a confirmed, low defibrillation energy value during implantable cardioverter defibrillator (ICD) implantation with only two induced ventricular fibrillation (VF) episodes. Ninety-eight patients (62 +/- 12 years, 86 male) from 13 clinical centres underwent an active can ICD implantation. A single coupling interval derived from electrocardiogram lead II during ventricular pacing was used for VF induction shocks at 13, 11, 9, and 6 J in a step-down manner until the upper limit of VF induction (ULVI) was determined. If ULVI >or=9 J, a defibrillation energy of ULVI + 4 J was tested. For ULVI <9 J, the defibrillation test energy was 9 J. In 79/98 patients (80.6%), two induced VF episodes were sufficient to obtain confirmed defibrillation energy of 11.1 +/- 3.3 J. The mean strength of the successful VF induction shock was 6.8 +/- 4.3 J, the coupling interval was 303 +/- 35 ms, and the number of delivered induction shocks until the first VF induction was 3.9 +/- 1.6. TULIP is a safe and simple device testing procedure allowing the determination of confirmed, low defibrillation energy in most patients with two VF episodes induced at a single coupling interval.

  11. Can hydroxyurea serve as a free radical scavenger and reduce iron overload in β-thalassemia patients?

    PubMed

    Italia, Khushnooma; Chandrakala, S; Ghosh, Kanjaksha; Colah, Roshan

    2016-09-01

    In this study, we hypothesize that hydroxyurea could provide an additional benefit as a free radical scavenger and/or iron chelator in β-thalassemia patients with iron overload. Twenty-one β-thalassemia intermedia patients who presented between 3 and 17 years but later required regular blood transfusions were enrolled for hydroxyurea therapy for a year. Fourteen patients responded to the therapy with hemoglobin levels maintained above 7.5 g/dl without transfusions. Hydroxyurea was discontinued after 6 months in seven patients who did not respond to the therapy and had to be continued on regular blood transfusions. We observed a statistically significant decrease in serum ferritin levels from 4194 ± 4850 ng/ml to 2129 ± 2380 ng/ml among the responders and from 2955 ± 2909 ng/ml to 2040 ± 2432 ng/ml among the non-responders and statistically significant decrease in labile iron pool from 18678.7 ± 10067.4 mean fluorescence intensity (MFI) to 14888.5 ± 5284.0 MFI among responders and from 17986.3 ± 9079.8 MFI to 15634.8 ± 8976.9 MFI among the non-responders after therapy. Phosphatidylserine externalization also showed a statistically significant decrease from 44.2 ± 22.2 MFI to 16.6 ± 6.7 MFI among the responders and from 46.9 ± 33.1 MFI to 39.8 ± 7.4 MFI among the non-responders along with a statistically significant decrease in the levels of reactive oxygen species from 72.8 ± 35.5 MFI to 29.0 ± 8.3 MFI among the responders and from 80.9 ± 41.4 MFI to 40.5 ± 15.8 MFI among the non-responders after therapy. A statistically significant increase in reduced glutathione levels was also observed from 430.8 ± 201.1 MFI to 715.5 ± 292.4 MFI among the responders and from 359.6 ± 165.6 MFI to 450.3 ± 279.5 MFI among the non-responders after therapy. This suggests the possible additional role of hydroxyurea as a free radical scavenger and

  12. Vulnerability of white matter to insult during childhood: evidence from patients treated for medulloblastoma.

    PubMed

    Moxon-Emre, Iska; Bouffet, Eric; Taylor, Michael D; Laperriere, Normand; Sharpe, Michael B; Laughlin, Suzanne; Bartels, Ute; Scantlebury, Nadia; Law, Nicole; Malkin, David; Skocic, Jovanka; Richard, Logan; Mabbott, Donald J

    2016-07-01

    OBJECTIVE Craniospinal irradiation damages the white matter in children treated for medulloblastoma, but the treatment-intensity effects are unclear. In a cross-sectional retrospective study, the effects of treatment with the least intensive radiation protocol versus protocols that delivered more radiation to the brain, in addition to the effects of continuous radiation dose, on white matter architecture were evaluated. METHODS Diffusion tensor imaging was used to assess fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity. First, regional white matter analyses and tract-based spatial statistics were conducted in 34 medulloblastoma patients and 38 healthy controls. Patients were stratified according to those treated with 1) the least intensive radiation protocol, specifically reduced-dose craniospinal irradiation plus a boost to the tumor bed only (n = 17), or 2) any other dose and boost combination that delivered more radiation to the brain, which was also termed the "all-other-treatments" group (n = 17), and comprised patients treated with standard-dose craniospinal irradiation plus a posterior fossa boost, standard-dose craniospinal irradiation plus a tumor bed boost, or reduced-dose craniospinal irradiation plus a posterior fossa boost. Second, voxel-wise dose-distribution analyses were conducted on a separate cohort of medulloblastoma patients (n = 15). RESULTS The all-other-treatments group, but not the reduced-dose craniospinal irradiation plus tumor bed group, had lower fractional anisotropy and higher radial diffusivity than controls in all brain regions (all p < 0.05). The reduced-dose craniospinal irradiation plus tumor bed boost group had higher fractional anisotropy (p = 0.05) and lower radial diffusivity (p = 0.04) in the temporal region, and higher fractional anisotropy in the frontal region (p = 0.04), than the all-other-treatments group. Linear mixed-effects modeling revealed that the dose and age at diagnosis together

  13. Vulnerability of Purkinje Cells Generated from Spinocerebellar Ataxia Type 6 Patient-Derived iPSCs.

    PubMed

    Ishida, Yoshihito; Kawakami, Hideshi; Kitajima, Hiroyuki; Nishiyama, Ayaka; Sasai, Yoshiki; Inoue, Haruhisa; Muguruma, Keiko

    2016-11-01

    Spinocerebellar ataxia type 6 (SCA6) is a dominantly inherited neurodegenerative disease characterized by loss of Purkinje cells in the cerebellum. SCA6 is caused by CAG trinucleotide repeat expansion in CACNA1A, which encodes Cav2.1, α1A subunit of P/Q-type calcium channel. However, the pathogenic mechanism and effective therapeutic treatments are still unknown. Here, we have succeeded in generating differentiated Purkinje cells that carry patient genes by combining disease-specific iPSCs and self-organizing culture technologies. Patient-derived Purkinje cells exhibit increased levels of full-length Cav2.1 protein but decreased levels of its C-terminal fragment and downregulation of the transcriptional targets TAF1 and BTG1. We further demonstrate that SCA6 Purkinje cells exhibit thyroid hormone depletion-dependent degeneration, which can be suppressed by two compounds, thyroid releasing hormone and Riluzole. Thus, we have constructed an in vitro disease model recapitulating both ontogenesis and pathogenesis. This model may be useful for pathogenic investigation and drug screening.

  14. Shared networks of interpreter services, at relatively low cost, can help providers serve patients with limited english skills.

    PubMed

    Jacobs, Elizabeth A; Leos, Ginelle Sanchez; Rathouz, Paul J; Fu, Paul

    2011-10-01

    Language barriers in health care-a large and growing problem in the United States-contribute to disparities in health care quality and outcomes in populations with limited English proficiency. Providing access to adequate interpreter services has been shown to reduce health disparities in these populations. However, many health care organizations do not provide such services because of the perceived high cost. In this observational study we calculated the costs incurred by a group of California public hospitals that formed a network to make trained interpreters available via videoconference and telephone. We found that encounters in this network where interpreters helped patients and providers communicate lasted an average of 10.6 minutes and cost an average of $24.86 per encounter. Such costs should be weighed against the likely alternatives, such as the opportunity costs of having other hospital staff act as ad hoc interpreters; medical errors that could result from inadequate interpretation; and the fact that not providing such services may leave providers out of compliance with federal law. We also discuss ways in which providers could be compensated for providing interpreter services.

  15. Transparent collaboration between industry and academia can serve unmet patient need and contribute to reproductive public health.

    PubMed

    D'Hooghe, Thomas

    2017-08-01

    The pharmaceutical and device industry has greatly contributed to diagnostic and therapeutic approaches in reproductive medicine in a very highly regulated environment, ensuring that development and manufacturing follow the highest standards. In spite of these achievements, collaboration between industry and physicians/academia is often presented in a negative context. However, today more than ever, partnership between industry and academia is needed to shorten the timeline between innovation and application, and to achieve faster access to better diagnostics, drugs and devices for the benefit of patients and society, based on complementary knowledge, skills and expertise. Such partnerships can include joined preclinical/clinical and post-marketing research and development, joint intellectual property, and joint revenue. In Europe, the transparency of this collaboration between pharmaceutical industry and medical doctors has been made possible by the Compliance and Disclosure Policy published by the European Federation of Pharmaceutical Industries and Associations (EFPIA), which represents the major pharmaceutical companies operating in Europe, and includes as members some but not all companies active in infertility and women's health. Under the EFPIA Disclosure Code of conduct, companies need to disclose transfers of value including amounts, activity type and the names of the recipient Health Care Professionals and Organizations. EFPIA member companies have also implemented very strict internal quality control processes and procedures in the design, statistical analysis, reporting, publication and communication of clinical research, according to Good Clinical Practice and other regulations, and are regularly inspected by competent authorities such as the US Food and Drug Administration (FDA) or European Medicines Agency (EMA) for all trials used in marketing authorization applications. The risk of scientific bias exists not only in the pharmaceutical industry but

  16. Executive (Dys)Functioning and Impulsivity as Possible Vulnerability Factors for Aggression in Forensic Patients.

    PubMed

    Tonnaer, Franca; Cima, Maaike; Arntz, Arnoud

    2016-04-01

    This study investigated whether executive dysfunction and impulsivity are both predictors of reactive aggression and is the first to use behavioral assessment of aggression in response to provocation by means of a personalized boxing body opponent bag giving harassing feedback. Aggressive behavior, self-reported aggression, executive functioning (ie, working memory, flexibility, and divided attention), and impulsivity dimensions (i.e., Sensation Seeking, Impulsive Decision Making, and [inadequate] Response Inhibition) were measured in 44 incarcerated psychiatric patients. Results show that both executive functioning (working memory) and impulsivity (Impulsive Decision Making) predicted self-reported reactive aggression, whereas Response Inhibition was the only predictor for reactive aggressive behavioral responses. The study suggests that Response Inhibition is a stronger predictor of reactive aggressive behavior than executive capacities of working memory, flexibility, and divided attention. Therefore, future research should investigate whether (inadequate) Response Inhibition could also be a valuable predictor for violent recidivism.

  17. Over-expression of miR-98 in FFPE tissues might serve as a valuable source for biomarker discovery in breast cancer patients.

    PubMed

    Deng, Zhao-Qun; Yin, Jia-Yu; Tang, Qin; Liu, Feng-Qiong; Qian, Jun; Lin, Jiang; Shao, Rui; Zhang, Ming; He, Li

    2014-01-01

    The miR-98 is thought to be associated with various cancers. This study was to evaluate the potential predictive value of miR-98 expression in formalin-fixed paraffin-embedded tissue of breast cancer patients. The expression levels of miR-98 were examined in 98 breast cancer patients and 40 cancer-free controls using real-time quantitative PCR. The comparison of miR-98 expression levels between patient and control was performed using the Mann-Whitney test. The miR-98 showed higher expression levels in breast cancer patients compared with cancer free controls (p<0.01). The expression levels of miR-98 were highly correlated with miR24/93/378 in breast cancer patients. The miR-98 exhibited great capability of discriminating between cancer patients and controls by the Receiver-operator characteristic (ROC) curve analysis. The miR-98 was found highly correlated with breast cancer by Univariable logistic regression analysis. These results suggest that over-expression of miR-98 in formalin-fixed paraffin-embedded tissues might serve as a valuable source for biomarker discovery in breast cancer patients.

  18. Using participatory methods to enhance patient-centred mental health care in a federally qualified community health center serving a Mexican American farmworker community.

    PubMed

    Ingram, Maia; Schachter, Ken A; Guernsey de Zapien, Jill; Herman, Patricia M; Carvajal, Scott C

    2015-12-01

    Mexican American farmworkers experience high rates of mental health conditions; however, it is difficult for them to access care. Patient-centred care is a systems-wide approach to improving the delivery of services for diverse populations in the primary care setting. We describe the application of community-based participatory research methods to assess and address gaps in perceptions of mental health care between providers and migrant workers living in a US-Mexico Border community. A federally qualified health centre (FQHC) serving a community of approximately 60 000 agricultural workers who live in Yuma County and harvest vegetables during the winter season. We conducted patient focus groups (n = 64) and FQHC staff interviews (n = 16) to explore attributes and dimensions of patient-centred mental health care. Patients and staff both prioritized increased access to mental health care and patient-centred care, while patients were more concerned with interpersonal care and providers with coordination of care. All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the FQHC inform patients about mental health resources, provide community informational talks to address stigma, and offer support groups. The participatory approach of this qualitative study resulted in a wealth of data regarding patient preferences that will enable the FQHC to develop protocols and training to provide patient-centred mental health-care services for their community. © 2014 John Wiley & Sons Ltd.

  19. Serving Vulnerable Families: The Important Work of Head Start Programs

    ERIC Educational Resources Information Center

    Vinci, Yasmina

    2012-01-01

    The Obama Administration's most recent regulation on designation renewal of Early/Head Start grantees opens opportunities for early childhood programs in some communities to compete with existing grantees for the federal funding. Understanding some of the behind-the-scenes work that goes into Head Start may be helpful to centers deciding whether…

  20. Non-English speakers attend gastroenterology clinic appointments at higher rates than English speakers in a vulnerable patient population.

    PubMed

    Sewell, Justin L; Kushel, Margot B; Inadomi, John M; Yee, Hal F

    2009-08-01

    We sought to identify factors associated with gastroenterology clinic attendance in an urban safety net healthcare system. Missed clinic appointments reduce the efficiency and availability of healthcare, but subspecialty clinic attendance among patients with established healthcare access has not been studied. We performed an observational study using secondary data from administrative sources to study patients referred to, and scheduled for an appointment in, the adult gastroenterology clinic serving the safety net healthcare system of San Francisco, CA. Our dependent variable was whether subjects attended or missed a scheduled appointment. Analysis included multivariable logistic regression and classification tree analysis. A total of 1833 patients were referred and scheduled for an appointment between May 2005 and August 2006. Prisoners were excluded. All patients had a primary care provider. Six hundred eighty-three patients (37.3%) missed their appointment; 1150 patients (62.7%) attended. Language was highly associated with attendance in the logistic regression; non-English speakers were less likely than English speakers to miss an appointment [adjusted odds ratio 0.42 (0.28, 0.63) for Spanish, 0.56 (0.38, 0.82) for Asian language, P<0.001]. Other factors were also associated with attendance, but classification tree analysis identified language to be the most highly associated variable. In an urban safety net healthcare population, among patients with established healthcare access and a scheduled gastroenterology clinic appointment, not speaking English was most strongly associated with higher attendance rates. Patient-related factors associated with not speaking English likely influence subspecialty clinic attendance rates, and these factors may differ from those affecting general healthcare access.

  1. [Evaluation of professional practices: Implication of hospital pharmacist in improving care for vulnerable patients].

    PubMed

    Bataille, J; Bardo-Brouard, P; Cordonnier-Jourdin, C; Kini-Matondo, W; Simpelaere, S; Astier, A; Paul, M

    2017-03-01

    As drug delivery activity to outpatients in precarious situation is rising continuously, the goal of this work was to perform an assessment of the professional practices of the care pathway of these patients, called PASS in France (permanence d'accès aux soins de santé). At first, two pharmacists did an audit of this care pathway. Then, options for improvement were suggested and established after a multidisciplinary work with pharmacists, physicians and social workers of the relevant services. Finally, after six months, those actions and their impact were evaluated. Over a three-year period, the audit showed an increase by a factor of 1.77 of the average number of prescriptions provided per year. Over the same period, the number of dispensed lines was increased by 2.2 and the annual costs were multiplied per 1.82. The pharmacy department suggested several corrective actions: at first, initiating new schedules suited to the activity; then, making adjustments in the reception zone; but also, establishing two new specific prescriptions and 89 helps cards about the most frequently delivered medications. As a result, the time dedicated to drug delivery has been cut in half while the number of pharmaceutical actions remained constant. This assessment of the professional practices showed how hard it is to formalize a transversal circuit as the PASS in hospital. The actions established had improved the organization and the drug delivery activity in the pharmacy department.

  2. Non-English speakers attend gastroenterology clinic appointments at higher rates than English speakers in a vulnerable patient population

    PubMed Central

    Sewell, Justin L.; Kushel, Margot B.; Inadomi, John M.; Yee, Hal F.

    2009-01-01

    Goals We sought to identify factors associated with gastroenterology clinic attendance in an urban safety net healthcare system. Background Missed clinic appointments reduce the efficiency and availability of healthcare, but subspecialty clinic attendance among patients with established healthcare access has not been studied. Study We performed an observational study using secondary data from administrative sources to study patients referred to, and scheduled for an appointment in, the adult gastroenterology clinic serving the safety net healthcare system of San Francisco, California. Our dependent variable was whether subjects attended or missed a scheduled appointment. Analysis included multivariable logistic regression and classification tree analysis. 1,833 patients were referred and scheduled for an appointment between 05/2005 and 08/2006. Prisoners were excluded. All patients had a primary care provider. Results 683 patients (37.3%) missed their appointment; 1,150 (62.7%) attended. Language was highly associated with attendance in the logistic regression; non-English speakers were less likely than English speakers to miss an appointment (adjusted odds ratio 0.42 [0.28,0.63] for Spanish, 0.56 [0.38,0.82] for Asian language, p < 0.001). Other factors were also associated with attendance, but classification tree analysis identified language to be the most highly associated variable. Conclusions In an urban safety net healthcare population, among patients with established healthcare access and a scheduled gastroenterology clinic appointment, not speaking English was most strongly associated with higher attendance rates. Patient related factors associated with not speaking English likely influence subspecialty clinic attendance rates, and these factors may differ from those affecting general healthcare access. PMID:19169147

  3. MiR-486 and miR-92a Identified in Circulating HDL Discriminate between Stable and Vulnerable Coronary Artery Disease Patients

    PubMed Central

    Sanda, Gabriela M.; Carnuta, Mihaela G.; Stancu, Camelia S.; Popescu, Andreea C.; Popescu, Mihaela R.; Vlad, Adelina; Dimulescu, Doina R.; Simionescu, Maya; Sima, Anca V.

    2015-01-01

    Small non-coding microRNAs (miRNAs) are implicated in gene regulation, including those involved in coronary artery disease (CAD). Our aim was to identify whether specific serum miRNAs present in the circulating lipoproteins (Lp) are associated with stable or vulnerable CAD patients. A cardiovascular disease-focused screening array was used to assess miRNAs distribution in sera collected from 95 CAD patients: 30 with stable angina (SA), 39 with unstable angina (UA), 26 at one month after myocardial infarction (MI) and 16 healthy control subjects. We found that miR-486, miR-92a and miR-122 presented the highest expression in CAD sera. These miRNA together with miR-125a, miR-146a and miR-33a were further individually analyzed by TaqMan assays. The results were consistent with PCR-array screening data that all of these miRNAs were significantly increased in CAD patients compared to controls. Using a binary logistic regression model, we established that miR-486 and miR-92a in association with some high-density lipoprotein (HDL) components can designate vulnerable CAD patients. Further, all classes of Lp were isolated from sera by density gradient ultracentrifugation. Analysis of the selected miRNAs in each Lp class showed that they were associated mainly with HDL, miR-486 and miR-92a having the highest levels. In UA and MI patients, miR-486 prevailed in HDL2, while miR-92a prevailed in HDL3, and their levels discriminate between stable and vulnerable CAD patients. We identified two circulating miRNAs that in association with some lipid metabolism biomarkers can be used as an additional tool to designate vulnerable CAD patients. PMID:26485305

  4. MiR-486 and miR-92a Identified in Circulating HDL Discriminate between Stable and Vulnerable Coronary Artery Disease Patients.

    PubMed

    Niculescu, Loredan S; Simionescu, Natalia; Sanda, Gabriela M; Carnuta, Mihaela G; Stancu, Camelia S; Popescu, Andreea C; Popescu, Mihaela R; Vlad, Adelina; Dimulescu, Doina R; Simionescu, Maya; Sima, Anca V

    2015-01-01

    Small non-coding microRNAs (miRNAs) are implicated in gene regulation, including those involved in coronary artery disease (CAD). Our aim was to identify whether specific serum miRNAs present in the circulating lipoproteins (Lp) are associated with stable or vulnerable CAD patients. A cardiovascular disease-focused screening array was used to assess miRNAs distribution in sera collected from 95 CAD patients: 30 with stable angina (SA), 39 with unstable angina (UA), 26 at one month after myocardial infarction (MI) and 16 healthy control subjects. We found that miR-486, miR-92a and miR-122 presented the highest expression in CAD sera. These miRNA together with miR-125a, miR-146a and miR-33a were further individually analyzed by TaqMan assays. The results were consistent with PCR-array screening data that all of these miRNAs were significantly increased in CAD patients compared to controls. Using a binary logistic regression model, we established that miR-486 and miR-92a in association with some high-density lipoprotein (HDL) components can designate vulnerable CAD patients. Further, all classes of Lp were isolated from sera by density gradient ultracentrifugation. Analysis of the selected miRNAs in each Lp class showed that they were associated mainly with HDL, miR-486 and miR-92a having the highest levels. In UA and MI patients, miR-486 prevailed in HDL2, while miR-92a prevailed in HDL3, and their levels discriminate between stable and vulnerable CAD patients. We identified two circulating miRNAs that in association with some lipid metabolism biomarkers can be used as an additional tool to designate vulnerable CAD patients.

  5. Dex/CRH-test response and sleep in depressed patients and healthy controls with and without vulnerability for affective disorders.

    PubMed

    Friess, Elisabeth; Schmid, Dagmar; Modell, Sieglinde; Brunner, Hans; Lauer, Christoph J; Holsboer, Florian; Ising, Marcus

    2008-10-01

    Sleep electroencephalographic (EEG) abnormalities and increased hypothalamo-pituitary-adrenal (HPA) axis activity are the most prominent neurobiological findings in depression and were suggested as potential biomarker for depression. In particular, increased rapid eye movement sleep (REM) density, deficit in slow wave sleep and excessive stress hormone response are associated with an unfavorable long-term outcome of depression. Recent studies indicate that the sleep and endocrine parameters are related to each other. This study investigated the association of sleep structure including a quantitative EEG analysis with the results of the combined dexamethasone (Dex)/corticotropin-releasing hormone (CRH)-test in 14 patients with a severe major depression, 21 healthy probands with a positive family history of depression (HRPs) and 12 healthy control subjects without personal and family history for psychiatric disorders. As expected patients with depression showed an overactivity of the HPA axis, disturbed sleep continuity and prolonged latency until slow wave sleep in the first sleep cycle. Differences in microarchitecture of sleep were less prominent and restricted to a higher NonREM sigma power in the HRP group. Dexamethasone suppressed cortisol levels were positively associated with higher NonREM sigma power after merging the three groups. We also observed an inverse association between the ACTH response to the Dex/CRH-test and rapid eye movement sleep (REM) density in HRPs, with suggestive evidence also in patients, but not in controls. This contra-intuitive finding might be a result of the subject selection (unaffected HRPs, severely depressed patients) and the complementarity of the two markers. HRPs and patients with high disease vulnerability, indicated by an elevated REM density, seem to have a lower threshold until an actual disease process affecting the HPA axis translates into depression, and vice versa. To summarize, our findings provide further evidence

  6. Technologies to better serve the millions of diabetic patients: a holistic, interactive and persuasive ICT model to facilitate self care, in extremely poor rural zones of Central America.

    PubMed

    Vargas-Lombardo, Miguel; Jipsion, Armando; Vejarano, Rafael; Camargo, Ismael; Alvarez, Humberto; Mora, Elena Villalba; Ruíz, Ernestina Menasalva

    2012-04-01

    Health indicators express remarkable gaps between health systems at a world-wide level. Countries of the entire world are overflowed by the need of new strategies, methodologies and technologies to better serve the millions of patients, who demand better medical attention. The present archaic and ephemerally systematized systems widen the gap even more than the quality of medical services that should be provided for the millions of diabetic patients. It is therefore necessary to develop highly familiar environments with diabetic patients and their care needs. A Holistic, Interactive and Persuasive ICT model to facilitate self care of patients with diabetes (hIPAPD), is proposed as an innovative technological development in Panama to health optimized treatment for diabetic patients. Three health centers located in the District of Aguadulce, Province of Cocle, located on Panama's Pacific Coast, were selected to validate the model; the area presents extremely poor population, mostly with one daily meal, without any health insurance and with a high illiteracy rate. A series of experiences in the application and validation process are presented and analyzed in order to confirm the application, value and contribution of ICTs in health care in poor regions of Central America.

  7. A Helpful Serving

    ERIC Educational Resources Information Center

    Rockower, David

    2006-01-01

    This article briefly describes how a fifth-grade class collaborated with a downtown diner for several months and then actually ran the restaurant for four hours. Through the Chatters Cafe, a local high school cafe that serves as a culinary arts training ground for high school students, fifth graders had the opportunity to prepare and serve dinner…

  8. A Helpful Serving

    ERIC Educational Resources Information Center

    Rockower, David

    2006-01-01

    This article briefly describes how a fifth-grade class collaborated with a downtown diner for several months and then actually ran the restaurant for four hours. Through the Chatters Cafe, a local high school cafe that serves as a culinary arts training ground for high school students, fifth graders had the opportunity to prepare and serve dinner…

  9. Isolated tumor cells are frequently detectable in the peritoneal cavity of gastric and colorectal cancer patients and serve as a new prognostic marker.

    PubMed Central

    Schott, A; Vogel, I; Krueger, U; Kalthoff, H; Schreiber, H W; Schmiegel, W; Henne-Bruns, D; Kremer, B; Juhl, H

    1998-01-01

    OBJECTIVE: To evaluate the prognostic significance of isolated tumor cells detected by a panel of various monoclonal antibodies. SUMMARY BACKGROUND DATA: Previously, we showed by using immunocytology that cancer cells are frequently found in bone marrow and peritoneal cavity samples of gastrointestinal cancer patients. METHODS: Findings in bone marrow and peritoneal cavity samples were compared and correlated with the 4-year survival rate of 84 gastric and 109 colorectal patients with cancer. RESULTS: Although positive results in the bone marrow showed little prognostic significance, the peritoneal cavity results correlated with the 4-year survival rate (gastric cancer: p = 0.0038; colorectal cancer: p = 0.0079). Additionally, in subgroups of patients with early (gastric cancer: p = 0.02, colorectal cancer: p = 0.48) and advanced (gastric cancer: p = 0.02, colorectal cancer: p < 0.0001) tumor stages, a correlation of immunocytologic findings and the survival rate was seen. CONCLUSIONS: The detection of minimal residual disease in the peritoneal cavity serves as a new prognostic marker. Images Figure 5. PMID:9527060

  10. Association of circulating levels of neopterin with non-culprit plaque vulnerability in CAD patients an angiogram, optical coherent tomography and intravascular ultrasound study.

    PubMed

    Sun, Yong; He, Jieqiong; Tian, Jinwei; Xie, Zulong; Wang, Chao; Yu, Bo

    2015-07-01

    Neopterin is a pteridine derivative secreted by activated macrophages. Previous studies have shown that neopterin plays a pivotal role in coronary artery disease (CAD); however, the relationship between circulating neopterin and non-culprit plaque vulnerability in patients with CAD remains unclear. In this study, we investigated the correlation of neopterin and vulnerable plaque features in patients with CAD. One hundred and thirty non-culprit plaques from 81 patients with CAD were assessed by angiogram and optical coherence tomography (OCT) as well as intravascular ultrasound (IVUS) imaging. According to the median value of serum neopterin (10.61 nmol/L), patients were divided into a low neopterin group (n = 40, patients in the high neopterin group had thinner fibrous cap thickness (FCT) (90.02 ± 52.96 μm vs. 124.69 ± 65.23 μm, P = 0.004) and more thin-cap fibroatheroma (TCFA) (38.0% vs. 13.6%, P = 0.002). Microvessel and plaque rupture were more frequently observed in the high neopterin group (P = 0.004 and P = 0.005, respectively). IVUS findings showed that plaque burden was greater in the high neopterin group than that in the low neopterin group (P = 0.005). Neopterin was positively associated with vulnerable plaque features including TCFA, thinner fibrous cap, plaque rupture, greater plaque burden and frequent microvessel occurrence in CAD patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Local critical stress correlates better than global maximum stress with plaque morphological features linked to atherosclerotic plaque vulnerability: an in vivo multi-patient study

    PubMed Central

    Tang, Dalin; Teng, Zhongzhao; Canton, Gador; Hatsukami, Thomas S; Dong, Li; Huang, Xueying; Yuan, Chun

    2009-01-01

    Background It is believed that mechanical stresses play an important role in atherosclerotic plaque rupture process and may be used for better plaque vulnerability assessment and rupture risk predictions. Image-based plaque models have been introduced in recent years to perform mechanical stress analysis and identify critical stress indicators which may be linked to rupture risk. However, large-scale studies based on in vivo patient data combining mechanical stress analysis, plaque morphology and composition for carotid plaque vulnerability assessment are lacking in the current literature. Methods 206 slices of in vivo magnetic resonance image (MRI) of carotid atherosclerotic plaques from 20 patients (age: 49–71, mean: 67.4; all male) were acquired for model construction. Modified Mooney-Rivlin models were used for vessel wall and all plaque components with parameter values chosen to match available data. A morphological plaque severity index (MPSI) was introduced based on in vivo plaque morphological characteristics known to correlate with plaque vulnerability. Critical stress, defined as the maximum of maximum- principal-stress (Stress-P1) values from all possible vulnerable sites, was determined for each slice for analysis. A computational plaque stress index (CPSI, with 5 grades 0–4, 4 being most vulnerable) was defined for each slice using its critical stress value and stress interval for each CPSI grade was optimized to reach best agreement with MPSI. Correlations between CPSI and MPSI, plaque cap thickness, and lipid core size were analyzed. Results Critical stress values correlated positively with lipid core size (r = 0.3879) and negatively with cap thickness (r = -0.3953). CPSI classifications had 71.4% agreement with MPSI classifications. The Pearson correlation coefficient between CPSI and MPSI was 0.849 (p < 0.0001). Using global maximum Stress-P1 value for each slice to define a global maximum stress-based CPSI (G-CPSI), the agreement rate with

  12. Comparing the effect of a decision aid plus patient navigation with usual care on colorectal cancer screening completion in vulnerable populations: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Screening can reduce colorectal cancer (CRC) incidence and mortality. However, screening is underutilized in vulnerable patient populations, particularly among Latinos. Patient-directed decision aids can increase CRC screening knowledge, self-efficacy, and intent; however, their effect on actual screening test completion tends to be modest. This is probably because decision aids do not address some of the patient-specific barriers that prevent successful completion of CRC screening in these populations. These individual barriers might be addressed though patient navigation interventions. This study will test a combined decision aid and patient navigator intervention on screening completion in diverse populations of vulnerable primary care patients. Methods/Design We will conduct a multisite, randomized controlled trial with patient-level randomization. Planned enrollment is 300 patients aged 50 to 75 years at average CRC risk presenting for appointments at two primary clinics in North Carolina and New Mexico. Intervention participants will view a video decision aid immediately before the clinic visit. The 14 to 16 minute video presents information about fecal occult blood tests and colonoscopy and will be viewed on a portable computer tablet in English or Spanish. Clinic-based patient navigators are bilingual and bicultural and will provide both face-to-face and telephone-based navigation. Control participants will view an unrelated food safety video and receive usual care. The primary outcome is completion of a CRC screening test at six months. Planned subgroup analyses include examining intervention effectiveness in Latinos, who will be oversampled. Secondarily, the trial will evaluate the intervention effects on knowledge of CRC screening, self-efficacy, intent, and patient-provider communication. The study will also examine whether patient ethnicity, acculturation, language preference, or health insurance status moderate the intervention effect on

  13. Differences in vulnerability to traumatic stress among patients with psychiatric disorders: One-year follow-up study after the Great East Japan Earthquake.

    PubMed

    Inoue, Kana; Inoue, Koju; Suda, Shiro; Shioda, Katsutoshi; Kobayashi, Toshiyuki; Kishi, Koichiro; Kato, Satoshi

    2015-09-01

    The aim of this study was to evaluate differences in vulnerability to traumatic stress and the 1-year course of post-traumatic stress symptoms among patients with pre-existing psychiatric disorders after the Great East Japan Earthquake. The Impact of Event Scale-Revised (IES-R) was used to assess post-traumatic stress symptoms in 612 patients with schizophrenic (ICD-10 F2; n = 163), mood (F3; n = 299), or neurotic disorders (F4; n = 150) at 1-4 months and again at 13-16 months after the disaster (retention rate: 68%). The mean IES-R total score for all diagnostic groups was 18.6 at index and 13.4 at follow up. The mean IES-R total score for patients with neurotic disorders (22.5) was significantly higher than that of patients with mood disorders (18.1) and schizophrenic disorders (15.9). At follow up, these scores decreased for all groups and inter-group differences were not observed. Vulnerability to traumatic stress after a disaster was most severe in patients with neurotic disorders, followed by mood disorders, and, lastly, schizophrenic disorders. This difference among the three diagnostic groups was not found 1 year after the disaster. © 2015 The Authors. Psychiatry and Clinical Neurosciences © 2015 Japanese Society of Psychiatry and Neurology.

  14. Shared Decision Making With Vulnerable Populations in the Emergency Department.

    PubMed

    Castaneda-Guarderas, Ana; Glassberg, Jeffrey; Grudzen, Corita R; Ngai, Ka Ming; Samuels-Kalow, Margaret E; Shelton, Erica; Wall, Stephen P; Richardson, Lynne D

    2016-12-01

    The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations. © 2016 by the Society for Academic Emergency Medicine.

  15. Vulnerability Evaluation Framework

    EPA Pesticide Factsheets

    View the Vulnerability Evaluation Framework, which provides policy-makers, stakeholders, industry, and the public with a transparent framework to evaluate vulnerabilities associated with geologic sequestration sites.

  16. H19 serves as a diagnostic biomarker and up-regulation of H19 expression contributes to poor prognosis in patients with gastric cancer.

    PubMed

    Chen, J S; Wang, Y F; Zhang, X Q; Lv, J M; Li, Y; Liu, X X; Xu, T P

    2016-01-01

    Emerging evidences indicate that dysregulated long noncoding RNAs (lncRNAs) are implicated in cancer tumorigenesis and progression and might be used as diagnosis and prognosis biomarker, or potential therapeutic targets. LncRNA H19 has been reported to be upregulated in diverse human cancers; however, its clinical significance in gastric cancer (GC) remains elusive. Expression levels of H19 in 128 pairs of GC and adjacent normal tissues, GC cell lines and GC juices compared to their corresponding controls were detected by real-time quantitative polymerase chain reaction (qPCR) assay. A receiver operating characteristic (ROC) curve and Kaplan-Meier analysis were constructed to evaluate the diagnostic and prognostic values. Univariate and multivariate analysis were performed using the Cox proportional hazard analysis. H19 expression was remarkably increased in GC tissues and cell lines compared with that in the normal control, and its up-regulation was significantly correlated to invasion depth (P < 0.001), advanced TNM stage (P = 0.002) and regional lymph nodes metastasis (P < 0.001) in GC. H19 levels were robust in differentiating GC tissues from controls [area under the curve (AUC) = 0.697; 95% confidence interval (CI) = 0.636-0.752, p<0.01]. Kaplan-Meier analysis demonstrated that increased H19 expression contributed to poor overall survival (P = 0.017) and disease-free survival (P = 0.024) of patients. A multivariate survival analysis also indicated that H19 could be an independent prognostic marker. The levels of H19 in gastric juice from gastric patients were significantly higher than those from normal subjects (P = 0.034). Furthermore, knockdown of H19 expression by siRNA could inhibit cell migration and invasion in GC cells partly via regulating E-cadherin protein expression. H19 might serve as a promising biomarker for early detection and prognosis prediction of GC.

  17. Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients

    PubMed Central

    Sun, Beibei; Zhao, Huilin; Liu, Xiaosheng; Lu, Qing; Zhao, Xihai; Pu, Jun; Xu, Jianrong

    2016-01-01

    The association between hemoglobin A1c (HbA1c) level and carotid plaque vulnerability has been rarely studied by magnetic resonance imaging (MRI). The present study of MRI-identified carotid atherosclerotic lesions in hypertensive patients with acute stroke therefore sought to determine the associations between HbA1c level and plaque morphological and compositional characteristics and acute cerebral infarction (ACI) severity. Eighty hypertensive patients with acute stroke were enrolled; stratified into high (≥6.5%) and low (<6.5%) HbA1c groups; and underwent carotid and brain MRI to assess carotid plaque features and ACI volume in the region supplied by the internal carotid artery (ICA) in the symptomatic side. Plaque burden [percent wall volume (PWV), max wall thickness (max-WT)] and lipid-rich necrotic core (LRNC) were larger in the high as compared to the low HbA1c group. High HbA1c was an independent risk factor for the presence of plaque (odds ratio [OR] = 3.71) and LRNC plaque (OR = 7.08). HbA1c independently correlated with ACI severity among patients with ICA region cerebral infarction and carotid plaque. Our study suggested that an elevated HbA1c may have an adverse effect on carotid plaque vulnerability especially those with larger LRNC volumes in hypertensive stroke patients, which might exacerbate the severity of ACIs. PMID:27629481

  18. The importance of negative predictive value (NPV) of vulnerable elderly survey (VES 13) as a pre-screening test in older patients with cancer.

    PubMed

    Castagneto, B; Di Pietrantonj, C; Stevani, I; Anfossi, A; Arzese, M; Giorcelli, L; Giaretto, L

    2013-12-01

    The importance of prognostic value of the comprehensive geriatric assessment (CGA) is well known in geriatric oncology, but there is no consensus on the use of alternative abbreviated screening methods for the evaluation of older patient disabilities. The participants in this study underwent vulnerable elderly survey 13 (VES 13) at first entry in Oncology Department and were later assessed by a geriatrician according to CGA. A score >3 for VES 13 identified patients as vulnerable. Aim of this study was to evaluate the specificity, sensibility, positive predictive value (PPV), and negative predictive value (NPV) of VES 13 versus cumulative illness rating scale (CIRS), activities of daily living (ADL), instrumental activities of daily living (IADL), and short portable mental status questionnaire (SPMSQ). Hundred and seventeen patients (mean age 78.8 years) entered the study. The NPV of VES was 74.6% for CIRS, 90.1% for IADL, 93.0% for ADL, and 100% for SPMSQ. As for PPV, the VES 13 showed no accuracy. We can conclude that VES 13 demonstrated sufficient accuracy as a screening test in identifying elderly "fit" patients in order to spare the more time-consuming CGA.

  19. Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review

    PubMed Central

    Roland, Katherine B.; Milliken, Erin L.; Rohan, Elizabeth A.; DeGroff, Amy; White, Susan; Melillo, Stephanie; Rorie, William E.; Signes, Carmita-Anita C.; Young, Paul A.

    2017-01-01

    Abstract Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources. Clinical settings, such as federally qualified health centers (FQHCs) are mandated to provide care to medically underserved communities, and thus are also valuable in the effort to address health disparities. We conducted a systematic literature review to identify studies of cancer-related CHW/PN interventions in FQHCs, and to describe the components and characteristics of those interventions in order to guide future intervention development and evaluation. Method: We searched five databases for peer-reviewed CHW/PN intervention studies conducted in partnership with FQHCs with a focus on cancer, carried out in the United States, and published in English between January 1990 and December 2013. Results: We identified 24 articles, all reporting positive outcomes of CHW/PNs interventions in FQHCs. CHW/PN interventions most commonly promoted breast, cervical, or colorectal cancer screening and/or referral for diagnostic resolution. Studies were supported largely through federal funding. Partnerships with academic institutions and community-based organizations provided support and helped develop capacity among FQHC clinic leadership and community members. Discussion: Both the FQHC

  20. Electricity Serves Our Community.

    ERIC Educational Resources Information Center

    Rakow, Steven J., Ed.

    1992-01-01

    Features a color poster entitled "Electricity Serves Our Community" and describes how the poster can be used to help teach about energy, electricity concepts, and types of electrical generation. Explains how teachers can obtain other resources such as posters, lesson plans, and kits from the National Energy Foundation. (PR)

  1. Serving the Undocumented

    ERIC Educational Resources Information Center

    Pluviose, David

    2007-01-01

    Undocumented immigrant students in California are eligible to receive only private scholarships that "[aren't] enough to support a very expensive education," says CCLC CEO Scott Lay. Dr. Gerardo E. de los Santos, CEO of the League for Innovation in the Community College, calls "serving the undocumented" one of the major…

  2. Serving the Undocumented

    ERIC Educational Resources Information Center

    Pluviose, David

    2007-01-01

    Undocumented immigrant students in California are eligible to receive only private scholarships that "[aren't] enough to support a very expensive education," says CCLC CEO Scott Lay. Dr. Gerardo E. de los Santos, CEO of the League for Innovation in the Community College, calls "serving the undocumented" one of the major…

  3. Electricity Serves Our Community.

    ERIC Educational Resources Information Center

    Rakow, Steven J., Ed.

    1992-01-01

    Features a color poster entitled "Electricity Serves Our Community" and describes how the poster can be used to help teach about energy, electricity concepts, and types of electrical generation. Explains how teachers can obtain other resources such as posters, lesson plans, and kits from the National Energy Foundation. (PR)

  4. Circulating Immunoglobulins Are Not Associated with Intraplaque Mast Cell Number and Other Vulnerable Plaque Characteristics in Patients with Carotid Artery Stenosis

    PubMed Central

    Quax, Paul H. A.; de Borst, Gert Jan; de Vries, Jean-Paul P. M.; Moll, Frans L.; Kuiper, Johan; Toes, René E. M.; de Jager, Saskia C. A.; de Kleijn, Dominique P. V.; Hoefer, Imo E.; Pasterkamp, Gerard; Bot, Ilze

    2014-01-01

    Background Recently, we have shown that intraplaque mast cell numbers are associated with atherosclerotic plaque vulnerability and with future cardiovascular events, which renders inhibition of mast cell activation of interest for future therapeutic interventions. However, the endogenous triggers that activate mast cells during the progression and destabilization of atherosclerotic lesions remain unidentified. Mast cells can be activated by immunoglobulins and in the present study, we aimed to establish whether specific immunoglobulins in plasma of patients scheduled for carotid endarterectomy were related to (activated) intraplaque mast cell numbers and plasma tryptase levels. In addition, the levels were related to other vulnerable plaque characteristics and baseline clinical data. Methods and Results OxLDL-IgG, total IgG and total IgE levels were measured in 135 patients who underwent carotid endarterectomy. No associations were observed between the tested plasma immunoglobulin levels and total mast cell numbers in atherosclerotic plaques. Furthermore, no associations were found between IgG levels and the following plaque characteristics: lipid core size, degree of calcification, number of macrophages or smooth muscle cells, amount of collagen and number of microvessels. Interestingly, statin use was negatively associated with plasma IgE and oxLDL-IgG levels. Conclusions In patients suffering from carotid artery disease, total IgE, total IgG and oxLDL-IgG levels do not associate with plaque mast cell numbers or other vulnerable plaque histopathological characteristics. This study thus does not provide evidence that the immunoglobulins tested in our cohort play a role in intraplaque mast cell activation or grade of atherosclerosis. PMID:24586471

  5. Obsessive beliefs in first-degree relatives of patients with OCD: a test of the cognitive vulnerability model.

    PubMed

    Rector, Neil A; Cassin, Stephanie E; Richter, Margaret A; Burroughs, Eliza

    2009-01-01

    Cognitive models of obsessive-compulsive disorder (OCD) focus on the role of dysfunctional beliefs and appraisals in conferring risk to the onset and persistence of clinical obsessions. The origins of obsessive beliefs have been proposed to occur within a familial-based developmental context, although little research has examined this empirically. The aim of the present study was to examine the familial cognitive vulnerability for OCD by comparing scores on the Obsessive Beliefs Questionnaire (OBQ) [Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the obsessive beliefs questionnaire and interpretation of intrusions inventory-Part 2. Factor analyses and testing of a brief version. Behavior Research and Therapy, 43, 1527-1542] between DSM-IV diagnosed OCD probands, their nonaffected first-degree relatives, and nonaffected controls. First-degree relatives scored significantly higher than controls on the OBQ domain tapping inflated responsibility and overestimation of threat. Further, relatives of early onset OCD probands scored significantly higher than controls on both the inflated responsibility and overestimation of threat domain and the domain tapping perfectionism and intolerance of uncertainty. The results are discussed in relation to the developmental context of cognitive-based vulnerabilities for OCD.

  6. [Aging and becoming vulnerable].

    PubMed

    Monod, Stéfanie; Sautebin, Annelore

    2009-11-18

    "The vulnerable are those whose autonomy, dignity and integrity are capable of being threatened". Based on this ethical definition of vulnerability, four risk factors of vulnerability might be identified among elderly persons, and are described in this article: the functional limitation, the loss of autonomy, the social precariousness and the restriction of access to medical care. A clinical case of elderly abuse is presented to illustrate vulnerability. Finally, some recommendations to lower the risk of vulnerability in elderly persons are proposed.

  7. Sharing living and dying: A balancing act between vulnerability and a sense of security. Enrolled nurses' experiences of working in the sitting service for dying patients at home.

    PubMed

    Wallerstedt, Birgitta; Benzein, Eva; Andershed, Birgitta

    2011-09-01

    To describe enrolled nurses' (ENs') experiences of working in a sitting service for dying patients at home (SSH). The ENs who participated in this study had permanent jobs in community care/ primary care, but were also employed part time in a special home-sitting service organization in a municipality in the south of Sweden. Data were collected by four focus group interviews with 17 enrolled nurses. Qualitative content analysis was used to analyze the data. Care-giving in SSH was a balancing act between a sense of security and a feeling of vulnerability. Feeling secure and valued and that one is developing both professionally and personally, stemmed from working in partnership, whereas a feeling of vulnerability was associated with managing closeness and distance, being a mediator, having responsibility and feeling guilty, feeling hindered from doing good, facing loneliness, and affecting private lives. SSH makes it possible for people who are terminally ill to remain at home until they die. If the SSH organization were not an option for dying patients and their families, the pressure on the healthcare would be dramatically increased.

  8. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups--another perspective on Oregon's data.

    PubMed

    Finlay, I G; George, R

    2011-03-01

    Battin et al examined data on deaths from physician-assisted suicide (PAS) in Oregon and on PAS and voluntary euthanasia (VE) in The Netherlands. This paper reviews the methodology used in their examination and questions the conclusions drawn from it-namely, that there is for the most part 'no evidence of heightened risk' to vulnerable people from the legalisation of PAS or VE. This critique focuses on the evidence about PAS in Oregon. It suggests that vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. It also argues, on the basis of official reports from the Oregon Health Department on the working of the Oregon Death with Dignity Act since 2008, that, contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et al reported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.

  9. Software Vulnerability Taxonomy Consolidation

    SciTech Connect

    Polepeddi, Sriram S.

    2004-12-07

    In today's environment, computers and networks are increasing exposed to a number of software vulnerabilities. Information about these vulnerabilities is collected and disseminated via various large publicly available databases such as BugTraq, OSVDB and ICAT. Each of these databases, individually, do not cover all aspects of a vulnerability and lack a standard format among them, making it difficult for end-users to easily compare various vulnerabilities. A central database of vulnerabilities has not been available until today for a number of reasons, such as the non-uniform methods by which current vulnerability database providers receive information, disagreement over which features of a particular vulnerability are important and how best to present them, and the non-utility of the information presented in many databases. The goal of this software vulnerability taxonomy consolidation project is to address the need for a universally accepted vulnerability taxonomy that classifies vulnerabilities in an unambiguous manner. A consolidated vulnerability database (CVDB) was implemented that coalesces and organizes vulnerability data from disparate data sources. Based on the work done in this paper, there is strong evidence that a consolidated taxonomy encompassing and organizing all relevant data can be achieved. However, three primary obstacles remain: lack of referencing a common ''primary key'', un-structured and free-form descriptions of necessary vulnerability data, and lack of data on all aspects of a vulnerability. This work has only considered data that can be unambiguously extracted from various data sources by straightforward parsers. It is felt that even with the use of more advanced, information mining tools, which can wade through the sea of unstructured vulnerability data, this current integration methodology would still provide repeatable, unambiguous, and exhaustive results. Though the goal of coalescing all available data, which would be of use to

  10. Socio-economic and cultural vulnerabilities to cervical cancer and challenges faced by patients attending care at Tikur Anbessa Hospital: a cross sectional and qualitative study.

    PubMed

    Tadesse, Sara Kebede

    2015-09-16

    Cervical cancer is a leading cause of death among women in Ethiopia, affecting them at a time of their life when they are critical to social and economic stability. This study was mainly focused on assessing different socioeconomic and cultural related factors that make women vulnerable to cervical cancer and challenges women face in the process of diagnosis and treatment. To achieve the objective of the study both qualitative and quantitative methods were utilized.198 participants were enrolled in a cross- sectional survey and 10 in-depth interviews were conducted with patients in Tikur Anbessa Hospital. A consecutive sampling method was used to select participants in the survey while purposive sampling was employed to select participants in the qualitative design. For the population covered in the study, poverty along with other socio-cultural practices such as early marriage, high parity and to certain extent polygamy were identified as factors that increased the vulnerability of women to cervical cancer. In addition, the study has uncovered several challenges faced by cervical cancer patients in the diagnosis and treatment process. Three types of challenges that include, health care based, psychological and economic were identified. System and practitioner delay were found as the main hurdles within the variable of health care related challenges. What's more, the psychological challenges identified included, fear of recurrence, negative social attitude and distress associated with the side effects from treatments such as fecal & urinary leakage. Furthermore, inability of bearing costs related to treatment and accommodation were cited as the main economic challenges. The study showed various socio-economic and cultural vulnerabilities that expose women to cervical cancer and the challenges encountered by cervical cancer patients after their diagnosis. Addressing this issue largely lies in strengthening primary and secondary preventive mechanisms, providing

  11. Vulnerability and Trustworthiness.

    PubMed

    Barnard, David

    2016-04-01

    Although recent literature on professionalism in healthcare abounds in recommended character traits, attitudes, or behaviors, with a few exceptions, the recommendations are untethered to any serious consideration of the contours and ethical demands of the healing relationship. This article offers an approach based on the professional's commitment to trustworthiness in response to the vulnerability of those seeking professional help. Because our willingness and ability to trust health professionals or healthcare institutions are affected by our personality, culture, race, age, prior experiences with illness and healthcare, and socioeconomic and political circumstances-"the social determinants of trust"-the attitudes and behaviors that actually do gain trust are patient and context specific. Therefore, in addition to the commitment to cultivating attitudes and behaviors that embody trustworthiness, professionalism also includes the commitment to actually gaining a patient's or family's trust by learning, through individualized dialogue, which conditions would win their justified trust, given their particular history and social situation.

  12. Modeling Coastal Vulnerability through Space and Time

    PubMed Central

    2016-01-01

    Coastal ecosystems experience a wide range of stressors including wave forces, storm surge, sea-level rise, and anthropogenic modification and are thus vulnerable to erosion. Urban coastal ecosystems are especially important due to the large populations these limited ecosystems serve. However, few studies have addressed the issue of urban coastal vulnerability at the landscape scale with spatial data that are finely resolved. The purpose of this study was to model and map coastal vulnerability and the role of natural habitats in reducing vulnerability in Jamaica Bay, New York, in terms of nine coastal vulnerability metrics (relief, wave exposure, geomorphology, natural habitats, exposure, exposure with no habitat, habitat role, erodible shoreline, and surge) under past (1609), current (2015), and future (2080) scenarios using InVEST 3.2.0. We analyzed vulnerability results both spatially and across all time periods, by stakeholder (ownership) and by distance to damage from Hurricane Sandy. We found significant differences in vulnerability metrics between past, current and future scenarios for all nine metrics except relief and wave exposure. The marsh islands in the center of the bay are currently vulnerable. In the future, these islands will likely be inundated, placing additional areas of the shoreline increasingly at risk. Significant differences in vulnerability exist between stakeholders; the Breezy Point Cooperative and Gateway National Recreation Area had the largest erodible shoreline segments. Significant correlations exist for all vulnerability (exposure/surge) and storm damage combinations except for exposure and distance to artificial debris. Coastal protective features, ranging from storm surge barriers and levees to natural features (e.g. wetlands), have been promoted to decrease future flood risk to communities in coastal areas around the world. Our methods of combining coastal vulnerability results with additional data and across multiple time

  13. Modeling Coastal Vulnerability through Space and Time.

    PubMed

    Hopper, Thomas; Meixler, Marcia S

    2016-01-01

    Coastal ecosystems experience a wide range of stressors including wave forces, storm surge, sea-level rise, and anthropogenic modification and are thus vulnerable to erosion. Urban coastal ecosystems are especially important due to the large populations these limited ecosystems serve. However, few studies have addressed the issue of urban coastal vulnerability at the landscape scale with spatial data that are finely resolved. The purpose of this study was to model and map coastal vulnerability and the role of natural habitats in reducing vulnerability in Jamaica Bay, New York, in terms of nine coastal vulnerability metrics (relief, wave exposure, geomorphology, natural habitats, exposure, exposure with no habitat, habitat role, erodible shoreline, and surge) under past (1609), current (2015), and future (2080) scenarios using InVEST 3.2.0. We analyzed vulnerability results both spatially and across all time periods, by stakeholder (ownership) and by distance to damage from Hurricane Sandy. We found significant differences in vulnerability metrics between past, current and future scenarios for all nine metrics except relief and wave exposure. The marsh islands in the center of the bay are currently vulnerable. In the future, these islands will likely be inundated, placing additional areas of the shoreline increasingly at risk. Significant differences in vulnerability exist between stakeholders; the Breezy Point Cooperative and Gateway National Recreation Area had the largest erodible shoreline segments. Significant correlations exist for all vulnerability (exposure/surge) and storm damage combinations except for exposure and distance to artificial debris. Coastal protective features, ranging from storm surge barriers and levees to natural features (e.g. wetlands), have been promoted to decrease future flood risk to communities in coastal areas around the world. Our methods of combining coastal vulnerability results with additional data and across multiple time

  14. What Does Vulnerability Mean?

    ERIC Educational Resources Information Center

    Parley, Fiona F

    2011-01-01

    Protection of those deemed vulnerable has received increasing attention since 2000. This article reports on care staff views of vulnerability using original data from a research study (Parley. "Vulnerability and abuse: an exploration of views of care staff working with people who have learning disabilities," PhD Thesis, 2007) in which care staff…

  15. What Does Vulnerability Mean?

    ERIC Educational Resources Information Center

    Parley, Fiona F

    2011-01-01

    Protection of those deemed vulnerable has received increasing attention since 2000. This article reports on care staff views of vulnerability using original data from a research study (Parley. "Vulnerability and abuse: an exploration of views of care staff working with people who have learning disabilities," PhD Thesis, 2007) in which care staff…

  16. Sepsis in vulnerable populations.

    PubMed

    Bhagwanjee, Satish; Ugarte, Sebastian

    2014-09-01

    Despite the acquisition of a large body of evidence, there are many unanswered questions about sepsis. The definition of this disease is plagued by the lack of a simple pathophysiological description linking cause to effect and the activation of host immune responses that hinders disease progression at the same time producing multiorgan dysfunction. A plethora of inconsistent clinical features has served to obfuscate rather than illuminate. The Surviving Sepsis Guidelines (SSG) are a major advance because it comprehensively interrogates all aspects of care for the critically ill. For vulnerable populations living in low- and middle-income countries, this guideline is ineffectual because of the lack of region-specific data, differences in etiology of sepsis and burden of disease, limited human capacity and infrastructure, as well as socioeconomic realities. Appropriate care must be guided by common sense guidelines that are sensitive to local realities and adapted as relevant data are acquired. Copyright © 2014 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  17. Building Capacity for Trauma Intervention across Child-Serving Systems

    ERIC Educational Resources Information Center

    Chinitz, Susan; Stettler, Erin M.; Giammanco, Denise; Silverman, Marian; Briggs, Rahil D.; Loeb, Joanne

    2010-01-01

    Infants most vulnerable to trauma are often the least able to access interventions. Universal child-serving systems, such as primary pediatrics, early care and education, and the child welfare system, can offer a port of entry for millions of children annually for trauma-related supports and services. However, practitioners in these systems have…

  18. How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale.

    PubMed

    Voutilainen, Ari; Pitkäaho, Taina; Kvist, Tarja; Vehviläinen-Julkunen, Katri

    2016-04-01

    To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys. Although patient satisfaction is one of the most intensely studied issues in the health sciences, research information about the effects of possible instrument-related confounding factors on patient satisfaction surveys is scant. A quasi-experimental design was employed. A non-randomized sample of 150 surgical patients was gathered to minimize possible alterations in care quality. Data were collected in May-September 2014 from one tertiary hospital in Finland using the Revised Humane Caring Scale instrument. New versions of the instrument were created for the present purposes. In these versions, items were either in a visual analogue format or Likert-scaled, in systematic or random order. The data were analysed using an analysis of covariance and a paired samples t-test. The visual analogue scale items were less vulnerable to bias from confounding factors than were the Likert-scaled items. The visual analogue scale also avoided the ceiling effect better than Likert and the time needed to complete the visual analogue scale questionnaire was 28% shorter than that needed to complete the Likert-scaled questionnaire. The present results supported the use of visual analogue scale rather than Likert scaling in patient satisfaction surveys and stressed the need to account for as many potential confounding factors as possible. © 2015 John Wiley & Sons Ltd.

  19. Serving Bowl Selection Biases the Amount of Food Served

    ERIC Educational Resources Information Center

    van Kleef, Ellen; Shimizu, Mitsuru; Wansink, Brian

    2012-01-01

    Objective: To determine how common serving bowls containing food for multiple persons influence serving behavior and consumption and whether they do so independently of satiation and food evaluation. Methods: In this between-subjects experiment, 68 participants were randomly assigned to either a group serving pasta from a large-sized bowl (6.9-L…

  20. Serving Bowl Selection Biases the Amount of Food Served

    ERIC Educational Resources Information Center

    van Kleef, Ellen; Shimizu, Mitsuru; Wansink, Brian

    2012-01-01

    Objective: To determine how common serving bowls containing food for multiple persons influence serving behavior and consumption and whether they do so independently of satiation and food evaluation. Methods: In this between-subjects experiment, 68 participants were randomly assigned to either a group serving pasta from a large-sized bowl (6.9-L…

  1. HIV-AIDS Patients' Evaluation of Health Information on the Internet: The Digital Divide and Vulnerability to Fraudulent Claims

    ERIC Educational Resources Information Center

    Benotsch, Eric G.; Kalichman, Seth; Weinhardt, Lance S.

    2004-01-01

    Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health…

  2. Genetic Variations of PIP4K2A Confer Vulnerability to Poor Antipsychotic Response in Severely Ill Schizophrenia Patients

    PubMed Central

    Kaur, Harpreet; Jajodia, Ajay; Grover, Sandeep; Baghel, Ruchi; Gupta, Meenal; Jain, Sanjeev; Kukreti, Ritushree

    2014-01-01

    Literature suggests that disease severity and neurotransmitter signaling pathway genes can accurately identify antipsychotic response in schizophrenia patients. However, putative role of signaling molecules has not been tested in schizophrenia patients based on severity of illness, despite its biological plausibility. In the present study we investigated the possible association of polymorphisms from five candidate genes RGS4, SLC6A3, PIP4K2A, BDNF, PI4KA with response to antipsychotic in variably ill schizophrenia patients. Thus in present study, a total 53 SNPs on the basis of previous reports and functional grounds were examined for their association with antipsychotic response in 423 schizophrenia patients segregated into low and high severity groups. Additionally, haplotype, diplotype, multivariate logistic regression and multifactor-dimensionality reduction (MDR) analyses were performed. Furthermore, observed associations were investigated in atypical monotherapy (n = 355) and risperidone (n = 260) treated subgroups. All associations were estimated as odds ratio (OR) and 95% confidence interval (CI) and test for multiple corrections was applied. Single locus analysis showed significant association of nine variants from SLC6A3, PIP4K2A and BDNF genes with incomplete antipsychotic response in schizophrenia patients with high severity. We identified significant association of six marker diplotype ATTGCT/ATTGCT (rs746203-rs10828317-rs7094131-rs2296624-rs11013052-rs1409396) of PIP4K2A gene in incomplete responders (corrected p-value = 0.001; adjusted-OR = 3.19, 95%-CI = 1.46–6.98) with high severity. These associations were further observed in atypical monotherapy and risperidone sub-groups. MDR approach identified gene-gene interaction among BDNF_rs7103411-BDNF_rs1491851-SLC6A3_rs40184 in severely ill incomplete responders (OR = 7.91, 95%-CI = 4.08–15.36). While RGS4_rs2842026-SLC6A3_rs2975226 interacted synergistically in

  3. Selected Cytokines Serve as Potential Biomarkers for Predicting Liver Inflammation and Fibrosis in Chronic Hepatitis B Patients With Normal to Mildly Elevated Aminotransferases.

    PubMed

    Deng, Yong-Qiong; Zhao, Hong; Ma, An-Lin; Zhou, Ji-Yuan; Xie, Shi-Bin; Zhang, Xu-Qing; Zhang, Da-Zhi; Xie, Qing; Zhang, Guo; Shang, Jia; Cheng, Jun; Zhao, Wei-Feng; Zou, Zhi-Qiang; Zhang, Ming-Xiang; Wang, Gui-Qiang

    2015-11-01

    Previous studies of small cohorts have implicated several circulating cytokines with progression of chronic hepatitis B (CHB). However, to date there have been no reliable biomarkers for assessing histological liver damage in CHB patients with normal or mildly elevated alanine aminotransferase (ALT). The aim of the present study was to investigate the association between circulating cytokines and histological liver damage in a large cohort. Also, this study was designed to assess the utility of circulating cytokines in diagnosing liver inflammation and fibrosis in CHB patients with ALT less than 2 times the upper limit of normal range (ULN). A total of 227 CHB patients were prospectively enrolled. All patients underwent liver biopsy and staging by Ishak system. Patients with at least moderate inflammation showed significantly higher levels of CXCL-11, CXCL-10, and interleukin (IL)-2 receptor (R) than patients with less than moderate inflammation (P < 0.001). Patients with significant fibrosis had higher levels of IL-8 (P = 0.027), transforming growth factor alpha (TGF-α) (P = 0.011), IL-2R (P = 0.002), and CXCL-11 (P = 0.032) than the group without significant fibrosis. In addition, 31.8% and 29.1% of 151 patients with ALT < 2 × ULN had at least moderate inflammation and significant fibrosis, respectively. Multivariate analysis demonstrated that CXCL-11 was independently associated with at least moderate inflammation, and TGF-α and IL-2R independently correlated with significant fibrosis in patients with ALT < 2 × ULN. Based on certain cytokines and clinical parameters, an inflammation-index and fib-index were developed, which showed areas under the receiver operating characteristics curve (AUROC) of 0.75 (95% CI 0.66-0.84) for at least moderate inflammation and 0.82 (95% CI 0.75-0.90) for significant fibrosis, correspondingly. Compared to existing scores, fib-index was significantly superior to aspartate aminotransferase

  4. Selected Cytokines Serve as Potential Biomarkers for Predicting Liver Inflammation and Fibrosis in Chronic Hepatitis B Patients With Normal to Mildly Elevated Aminotransferases

    PubMed Central

    Deng, Yong-Qiong; Zhao, Hong; Ma, An-Lin; Zhou, Ji-Yuan; Xie, Shi-Bin; Zhang, Xu-Qing; Zhang, Da-Zhi; Xie, Qing; Zhang, Guo; Shang, Jia; Cheng, Jun; Zhao, Wei-Feng; Zou, Zhi-Qiang; Zhang, Ming-Xiang; Wang, Gui-Qiang

    2015-01-01

    Abstract Previous studies of small cohorts have implicated several circulating cytokines with progression of chronic hepatitis B (CHB). However, to date there have been no reliable biomarkers for assessing histological liver damage in CHB patients with normal or mildly elevated alanine aminotransferase (ALT). The aim of the present study was to investigate the association between circulating cytokines and histological liver damage in a large cohort. Also, this study was designed to assess the utility of circulating cytokines in diagnosing liver inflammation and fibrosis in CHB patients with ALT less than 2 times the upper limit of normal range (ULN). A total of 227 CHB patients were prospectively enrolled. All patients underwent liver biopsy and staging by Ishak system. Patients with at least moderate inflammation showed significantly higher levels of CXCL-11, CXCL-10, and interleukin (IL)-2 receptor (R) than patients with less than moderate inflammation (P < 0.001). Patients with significant fibrosis had higher levels of IL-8 (P = 0.027), transforming growth factor alpha (TGF-α) (P = 0.011), IL-2R (P = 0.002), and CXCL-11 (P = 0.032) than the group without significant fibrosis. In addition, 31.8% and 29.1% of 151 patients with ALT < 2 × ULN had at least moderate inflammation and significant fibrosis, respectively. Multivariate analysis demonstrated that CXCL-11 was independently associated with at least moderate inflammation, and TGF-α and IL-2R independently correlated with significant fibrosis in patients with ALT < 2 × ULN. Based on certain cytokines and clinical parameters, an inflammation-index and fib-index were developed, which showed areas under the receiver operating characteristics curve (AUROC) of 0.75 (95% CI 0.66–0.84) for at least moderate inflammation and 0.82 (95% CI 0.75–0.90) for significant fibrosis, correspondingly. Compared to existing scores, fib-index was significantly superior to aspartate

  5. Groundwater Pollution and Vulnerability Assessment.

    PubMed

    Kurwadkar, Sudarshan

    2017-10-01

    Groundwater is a critical resource that serve as a source of drinking water to large human population and, provide long-term water for irrigation purposes. In recent years; however, this precious resource being increasingly threatened, due to natural and anthropogenic activities. A variety of contaminants of emerging concern such as pharmaceuticals and personal care products, perfluorinated compounds, endocrine disruptors, and biological agents detected in the groundwater sources of both developing and developed nations. In this review paper, various studies have been included that documented instances of groundwater pollution and vulnerability to emerging contaminants of concern, pesticides, heavy metals, and leaching potential of various organic and inorganic contaminants from poorly managed residual waste products (biosolids, landfills, latrines, and septic tanks etc.). Understanding vulnerability of groundwater to pollution is critical to maintain the integrity of groundwater. A section on managed artificial recharge studies is included to highlight the sustainable approaches to groundwater conservation, replenishment and sustainability. This review paper is the synthesis of studies published in last one year that either documented the pollution problems or evaluated the vulnerability of groundwater pollution.

  6. MAGE-A family serves as poor prognostic markers and potential therapeutic targets for epithelial ovarian cancer patients: a retrospective clinical study.

    PubMed

    Sang, Meixiang; Wu, Xiaohua; Fan, Xiaojie; Lian, Yishui; Sang, Meijie

    2017-06-01

    The aim of our study is to investigate the expression pattern and prognostic significance of melanoma-associated antigens-A (MAGE-A) family in primary epithelial ovarian cancer (EOC) patients. The expression of MAGE-A family members, including MAGE-A1, -A2, -A3, -A4, -A6, -A10 and -A12 was immunohistochemically detected in 82 cases of primary EOC and 10 cases of pericarcinoma ovarian tissues. The association between MAGE-A family expression and the clinicopathological parameters as well as the prognosis of primary EOC patients was analyzed. MAGE-A family expressed in 48.8% of primary EOC tissues, but not expressed in pericarcinoma ovarian tissues. MAGE-A expression was associated with the pathological types, FIGO stage, and pre-operative serum CA125 level. Overall survival of EOC patients with positive MAGE-A family expression was significantly shorter than those patients with negative MAGE-A expression. Multivariate analysis showed that although MAGE-A family expression can affect the overall survival, it was not an independent prognostic marker for EOC patients. Molecular assessment of MAGE-A family members could be helpful to improve the prognostic evaluation and to provide a new potential therapeutic target for primary EOC patients.

  7. Automated Software Vulnerability Analysis

    NASA Astrophysics Data System (ADS)

    Sezer, Emre C.; Kil, Chongkyung; Ning, Peng

    Despite decades of research, software continues to have vulnerabilities. Successful exploitations of these vulnerabilities by attackers cost millions of dollars to businesses and individuals. Unfortunately, most effective defensive measures, such as patching and intrusion prevention systems, require an intimate knowledge of the vulnerabilities. Many systems for detecting attacks have been proposed. However, the analysis of the exploited vulnerabilities is left to security experts and programmers. Both the human effortinvolved and the slow analysis process are unfavorable for timely defensive measure to be deployed. The problem is exacerbated by zero-day attacks.

  8. Depression and anxiety in patients with and without same-sex attraction: differences in clinical expression, lifestyle factors, and vulnerability indicators

    PubMed Central

    Bos, Henny M W; Boschloo, Lynn; Schoevers, Robert A; Sandfort, Theo G M

    2015-01-01

    Background The aim of this study was to compare clinical expressions (severity and loneliness), lifestyle factors (substance use), and vulnerability indicators (stressful childhood experiences) in patients with any same-sex attraction versus heterosexual patients diagnosed with depression and/or anxiety disorder. Little is known about this, even though it is now well documented that depression and anxiety are more prevalent among persons with same-sex attraction. Method Data, derived from the Netherlands Study of Depression and Anxiety (NESDA), allowed us to compare patients with a same-sex (n = 122) and an exclusively opposite-sex (n = 1658) attraction. Persons with same-sex attraction included persons who were attracted to both sexes. Data were collected by means of the Composite International Diagnostic Interview and paper-and pencil questionnaires. Results Seven percent of the patients reported any same-sex orientation. Clinical expression of depression and anxiety did not differ in relation to sexual attraction. Regarding substance use, same-sex attracted women reported more drug use than heterosexual women (drug use: 16.2% vs. 6.6%, P = 0.003). Regarding stressful childhood experiences, men with any same-sex attraction reported more sexual abuse during childhood than men with a heterosexual orientation (20.4% vs. 8.5%, P = 0.005). Conclusions For women with same-sex attraction substance use (especially illicit drug use) might be a coping mechanism to deal with existing symptoms or with the minority stressors they have to deal with; for same-sex attracted men stressful childhood experiences might reflect an aspect of etiology. PMID:26445702

  9. Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implantable cardioverter defibrillators: Vulnerable patients to air pollution.

    PubMed

    Kim, In-Soo; Sohn, Jungwoo; Lee, Seung-Jun; Park, Jin-Kyu; Uhm, Jae-Sun; Pak, Hui-Nam; Lee, Moon-Hyoung; Kim, Changsoo; Joung, Boyoung

    2017-08-01

    This study investigated the acute effects of exposure to air pollution on ventricular tachyarrhythmias (VTAs) in an East Asian population. The association between air pollution and VTA has not yet been studied in an East Asian country affected by the Asian dust phenomenon, which worsens air quality. The study cohort consisted of 160patients with implantable cardioverter defibrillator (ICD) devices in the Seoul metropolitan area who were followed for 5.5±3.8years. We used ICD records of VTAs and matched these with hourly measurements of air pollutant concentrations and meteorological data. Fine particle mass and gaseous air pollution plus temperature and relative humidity were measured hourly during the study period. During the study period, 1064 VTA events including 204 instances of ventricular fibrillation (VF) were observed. We found a statistically significant association between overall VTA events and SO2 (lag 24h; OR 1.49, 95%CI 1.16-1.92, p=0.002), PM10 (lag 2h; OR 2.56, 95%CI 2.03-3.23, p<0.001), NO2 (lag 24h; OR 1.25, 95%CI 1.19-1.31, p<0.001) and CO (lag 24h; OR 1.05, 95%CI 1.02-1.08, p=0.003). Sustained ventricular tachycardia or VF was also independently associated with SO2, PM10, NO2 and CO (all p<0.01). Exposures to SO2, PM10, NO2, and CO (all p<0.01) were significantly related to overall VTAs, especially in patients with structural heart disease (SHD). Associations between air pollution and VTA were observed in a metropolitan area of an East Asian country. Exposures to SO2, PM10, NO2, and CO were significantly associated with VTAs in ICD patients with SHD. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. MyPreventiveCare: implementation and dissemination of an interactive preventive health record in three practice-based research networks serving disadvantaged patients--a randomized cluster trial.

    PubMed

    Krist, Alex H; Aycock, Rebecca A; Etz, Rebecca S; Devoe, Jennifer E; Sabo, Roy T; Williams, Robert; Stein, Karen L; Iwamoto, Gary; Puro, Jon; Deshazo, Jon; Kashiri, Paulette Lail; Arkind, Jill; Romney, Crystal; Kano, Miria; Nelson, Christine; Longo, Daniel R; Wolver, Susan; Woolf, Steven H

    2014-12-11

    Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement. We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on

  11. Forkhead box protein P3 (Foxp3) expression serves as an early chronic inflammation marker of squamous cell differentiation and aggressive pathology of urothelial carcinomas in neurological patients.

    PubMed

    Phé, Véronique; Rouprêt, Morgan; Cussenot, Olivier; Chartier-Kastler, Emmanuel; Gamé, Xavier; Compérat, Eva

    2015-04-01

    To establish whether the expression of forkhead box protein P3 (Foxp3) provides specific diagnostic information about neurological patients with urothelial carcinoma of the bladder (UCB). UCB tissue samples from neurological patients were retrieved and compared with control samples. The expression of Foxp3 was analysed via immunohistochemistry of microarray tissue sections. The correlation between Foxp3 expression, histological parameters and tumour stage was assessed. Overall, 20 UCB tissue samples and 20 others without UCB from neurological patients, and 46 UCB tissue samples from non-neurological patients were analysed. The distribution of pT of UCB in the neurological patients was as follows: one low-grade pTa (5%), three high-grade pTa (15%), three pT1(15%), one pT2(5%), seven pT3(35%) and five pT4(25%). Squamous cell differentiation was seen in nine UCB samples (45%). Foxp3 expression was detected in tumour tissues, including one pTa high grade, one pT1, one pT2, five pT3 and five pT4 tumours. Foxp3 was expressed in 11/13 muscle-invasive tumours. All tumours displaying squamous cell differentiation expressed Foxp3. Foxp3 was not expressed in the pT3 tumours that displayed sarcomatoid and micropapillary properties. Among the bladder samples without UCB from neurological patients, no expression of Foxp3 was observed. Among the UCB samples from the non-neurological patients, only seven displayed squamous cell differentiation. All tumours that displayed squamous cell differentiation expressed Foxp3, including one pTa high grade, four pT3 and two pT4 tumours. Other tumours displaying urothelial differentiation did not express Foxp3. The expression of Foxp3 correlated to squamous cell differentiation in neurological (P = 0.004) and non-neurological UCB tissue (P < 0.001). In neurological, but not non-neurological UCB tissue, the expression of Foxp3 correlated with the muscle-invasive stage (P = 0.022). Elevated expression of Foxp3 appears to be a characteristic of

  12. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services.

    PubMed

    Bliss, Julie; While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model - the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management.

  13. Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

    PubMed Central

    While, Alison E

    2014-01-01

    General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

  14. Should sulfonylureas remain an acceptable first-line add-on to metformin therapy in patients with type 2 diabetes? Yes, they continue to serve us well!

    PubMed

    Abrahamson, Martin J

    2015-01-01

    Since their introduction to clinical practice in the 1950s, sulfonylureas have been widely prescribed for use in patients with type 2 diabetes. Of all the other medications currently available for clinical use, only metformin has been used more frequently. However, several new drug classes have emerged that are reported to have equal glucose-lowering efficacy and greater safety when added to treatment of patients in whom metformin monotherapy is no longer sufficient. Moreover, current arguments also suggest that the alternative drugs may be superior to sulfonylureas with regard to the risk of cardiovascular complications. Thus, while there is universal agreement that metformin should remain the first-line pharmacologic therapy for those in whom lifestyle modification is insufficient to control hyperglycemia, there is no consensus as to which drug should be added to metformin. Therefore, given the current controversy, we provide a Point-Counterpoint on this issue. In the point narrative presented below, Dr. Abrahamson provides his argument suggesting that avoiding use of sulfonylureas as a class of medication as an add-on to metformin is not appropriate as there are many patients whose glycemic control would improve with use of these drugs with minimal risk of adverse events. In the following counterpoint narrative, Dr. Genuth suggests there is no longer a need for sulfonylureas to remain a first-line addition to metformin for those patients whose clinical characteristics are appropriate and whose health insurance and/or financial resources make an alternative drug affordable.

  15. Variation in resistance traits, phylogenetic backgrounds, and virulence genotypes among Escherichia coli clinical isolates from adjacent hospital campuses serving distinct patient populations.

    PubMed

    Drawz, Sarah M; Porter, Stephen; Kuskowski, Michael A; Johnston, Brian; Clabots, Connie; Kline, Susan; Ferrieri, Patricia; Johnson, James R

    2015-09-01

    Escherichia coli sequence type 13 (ST131), an emergent cause of multidrug-resistant extraintestinal infections, has important phylogenetic subsets, notably the H30 and H30Rx subclones, with distinctive resistance profiles and, possibly, clinical associations. To clarify the local prevalence of these ST131 subclones and their associations with antimicrobial resistance, ecological source, and virulence traits, we extensively characterized 233 consecutive E. coli clinical isolates (July and August 2013) from the University of Minnesota Medical Center-Fairview Infectious Diseases and Diagnostic Laboratory, Minneapolis, MN, which serves three adjacent facilities (a children's hospital and low- and high-acuity adult facilities). ST131 accounted for 26% of the study isolates (more than any other clonal group), was distributed similarly by facility, and was closely associated with ciprofloxacin resistance and extended-spectrum β-lactamase (ESBL) production. The H30 and H30Rx subclones accounted for most ST131 isolates and for the association of ST131 with fluoroquinolone resistance and ESBL production. Unlike ST131 per se, these subclones were distributed differentially by hospital, being most prevalent at the high-acuity adult facility and were absent from the children's hospital. The virulence gene profiles of ST131 and its subclones were distinctive and more extensive than those of other fluoroquinolone-resistant or ESBL-producing isolates. Within ST131, bla CTX-M-15 was confined to H30Rx isolates and other bla CTX-M variants to non-Rx H30 isolates. Pulsed-field gel electrophoresis documented a predominance of globally distributed pulsotypes and no local outbreak pattern. These findings help clarify the epidemiology, ecology, and bacterial correlates of the H30 and H30Rx ST131 subclones by documenting a high overall prevalence but significant segregation by facility, strong associations with fluoroquinolone resistance and specific ESBL variants, and distinctive

  16. Drug eluting stents for vulnerable plague.

    PubMed

    Toutouzas, Konstantinos; Synetos, Andreas; Stefanadis, Christodoulos

    2010-01-01

    A vulnerable plaque is an atheromatic plaque with specific morphological characteristics, mainly presented as an unstable collection of white blood cells and lipids in the wall of an artery. It is of great importance to adequately recognize and treat this entity before its rupture, before the initiation of an acute coronary syndrome. The search of the location of future plaque ruptures or plaque erosions is an important area of cardiovascular research. Systemic therapy, including use of statins, targets the vulnerable patient. However, adverse events cannot be completely eliminated with the appropriate application of systemic therapies and this has given rise to efforts for evolution of local or regional therapies of the vulnerable plaques to prevent future events. Recently drug eluting stents dedicated to vulnerable plaques have been developed, aiming in the local stabilization of the vulnerable plaque.

  17. Data-Driven Human Rights: Using Dual Loyalty Trainings to Promote the Care of Vulnerable Patients in Jail.

    PubMed

    Glowa-Kollisch, Sarah; Graves, Jasmine; Dickey, Nathaniel; MacDonald, Ross; Rosner, Zachary; Waters, Anthony; Venters, Homer

    2015-06-11

    Dual loyalty is an omnipresent feature of correctional health. As part of a human rights quality improvement committee, and utilizing the unique advantage of a fully integrated electronic health record system, we undertook an assessment of dual loyalty in the New York City jail system. The evaluation revealed significant concerns about the extent to which the mental health service is involved in assessments that are part of the punishment process of the security apparatus. As a result, dual loyalty training was developed and delivered to all types of health staff in the jail system via anonymous survey. Six clinical scenarios were presented in this training and staff members were asked to indicate whether they had encountered similar circumstances and how they would respond. Staff responses to the survey raised concerns about the frequency with which they are pressured or asked to put aside their primary goal of patient care for the interests of the security mission. The online training and follow-up small group sessions have revealed widespread support for more training on dual loyalty. Copyright 2015 Glowa-Kollisch et al. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  18. Mitochondrial Vulnerability and Increased Susceptibility to Nutrient-Induced Cytotoxicity in Fibroblasts from Leigh Syndrome French Canadian Patients

    PubMed Central

    Burelle, Yan; Thompson Legault, Julie; Boucher, Gabrielle; Morin, Charles; Coderre, Lise; Des Rosiers, Christine

    2015-01-01

    nature of the diets, particularly excess fat intake, as well as on the use of antioxidants in patients with LSFC and, possibly, other COX defects. PMID:25835550

  19. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students

    ERIC Educational Resources Information Center

    Santiago, Deborah A.; Andrade, Sally J.

    2010-01-01

    In this fifth brief in "Excelencia" in Education's series on Hispanic-Serving Institutions (HSIs) the focus is on the methods and strategies that are producing successful results in a growing sector of colleges and universities we call, "Emerging" Hispanic-Serving Institutions. These Emerging HSIs are institutions that…

  20. LuCaP Prostate Cancer Patient-Derived Xenografts Reflect the Molecular Heterogeneity of Advanced Disease an--d Serve as Models for Evaluating Cancer Therapeutics.

    PubMed

    Nguyen, Holly M; Vessella, Robert L; Morrissey, Colm; Brown, Lisha G; Coleman, Ilsa M; Higano, Celestia S; Mostaghel, Elahe A; Zhang, Xiaotun; True, Lawrence D; Lam, Hung-Ming; Roudier, Martine; Lange, Paul H; Nelson, Peter S; Corey, Eva

    2017-05-01

    Metastatic prostate cancer is a common and lethal disease for which there are no therapies that produce cures or long-term durable remissions. Clinically relevant preclinical models are needed to increase our understanding of biology of this malignancy and to evaluate new agents that might provide effective treatment. Our objective was to establish and characterize patient-derived xenografts (PDXs) from advanced prostate cancer (PC) for investigation of biology and evaluation of new treatment modalities. Samples of advanced PC obtained from primary prostate cancer obtained at surgery or from metastases collected at time of death were implanted into immunocompromised mice to establish PDXs. Established PDXs were propagated in vivo. Genomic, transcriptomic, and STR profiles were generated. Responses to androgen deprivation and docetaxel in vivo were characterized. We established multiple PDXs (LuCaP series), which represent the major genomic and phenotypic features of the disease in humans, including amplification of androgen receptor, PTEN deletion, TP53 deletion and mutation, RB1 loss, TMPRSS2-ERG rearrangements, SPOP mutation, hypermutation due to MSH2/MSH6 genomic aberrations, and BRCA2 loss. The PDX models also exhibit variation in intra-tumoral androgen levels. Our in vivo results show heterogeneity of response to androgen deprivation and docetaxel, standard therapies for advanced PC, similar to the responses of patients to these treatments. The LuCaP PDX series reflects the diverse molecular composition of human castration-resistant PC and allows for hypothesis-driven cause-and-effect studies of mechanisms underlying treatment response and resistance. Prostate 77: 654-671, 2017. © 2017 The Authors. The Prostate Published by Wiley Periodicals, Inc. © 2017 The Authors. The Prostate Published by Wiley Periodicals, Inc.

  1. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program.

    PubMed

    O'Toole, Thomas P; Johnson, Erin E; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-03-31

    Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.

  2. Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

    PubMed Central

    Johnson, Erin E.; Aiello, Riccardo; Kane, Vincent; Pape, Lisa

    2016-01-01

    Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services. Results More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies. Conclusion Integrating social determinants of health into clinical care can be effective for high

  3. Bioethics, vulnerability, and protection.

    PubMed

    Macklin, Ruth

    2003-10-01

    What makes individuals, groups, or even entire countries vulnerable? And why is vulnerability a concern in bioethics? A simple answer to both questions is that vulnerable individuals and groups are subject to exploitation, and exploitation is morally wrong. This analysis is limited to two areas. First is the context of multinational research, in which vulnerable people can be exploited even if they are not harmed, and harmed even if they are not exploited. The type of multinational research likely to raise the most ethical concerns is that in which the investigators or sponsors are from a powerful industrialised country or a giant pharmaceutical company and the research is conducted in a developing country. Second is the situation of women, who are made vulnerable in cultural settings or in entire countries in which they are oppressed and powerless. In the face of cultural values and practices, or governmental policies, these women suffer serious consequences for their health and even lives. Examples are provided, and it is suggested that in some cases vulnerable individuals can be harmed but not exploited. On the positive side, recent developments reveal a new awareness of exploitation and efforts to enhance the ability of developing countries to protect themselves and their citizens from exploitation at the hands of powerful sponsors of research. In addition, human rights principles are increasingly being used to monitor the actions (or inaction) of governments regarding women's reproductive rights and vulnerability with respect to HIV/AIDS, and to take remedial actions.

  4. Health Service Management Interns Serve as Practice Facilitators for Patient-Centered Medical Home Recognition: East Carolina University-Appalachian State University Initiative.

    PubMed

    Sasnett, Bonita; Watkins, R W; Ferlazzo, Marianne

    East Carolina University College of Allied Health Science's Department of Health Services Management program is partnering with Community Care of North Carolina and Access East to transform medical practices and educate students on the Patient-Centered Medical Home (PCMH) model of health care delivery. Why now? The Affordable Care Act (2010) and other health care reform changes brought to the forefront the need to focus on improving the quality of care while lowering the overall cost of care. This article describes the first year of implementation of a PCMH initiative where students in a health services management internship program act as facilitators to assist practices in the PCMH recognition process. Lessons learned were the importance of provider and staff endorsement of the PCMH model. In addition, educational needs, time constraints, electronic health record training, understanding practice workflow, and understanding of the National Committee on Quality Assurance PCMH standards were important aspects of the prerequisite knowledge necessary for success. This article compares the ECU Practicum in Primary Care and the Appalachian State University Practicum in Primary Care to build a best practice model based upon the commonalities and uniqueness of each of the individual university programs and their practice sites.

  5. VEGF-B promotes cancer metastasis through a VEGF-A-independent mechanism and serves as a marker of poor prognosis for cancer patients.

    PubMed

    Yang, Xiaojuan; Zhang, Yin; Hosaka, Kayoko; Andersson, Patrik; Wang, Jian; Tholander, Fredrik; Cao, Ziquan; Morikawa, Hiromasa; Tegnér, Jesper; Yang, Yunlong; Iwamoto, Hideki; Lim, Sharon; Cao, Yihai

    2015-06-02

    The biological functions of VEGF-B in cancer progression remain poorly understood. Here, we report that VEGF-B promotes cancer metastasis through the remodeling of tumor microvasculature. Knockdown of VEGF-B in tumors resulted in increased perivascular cell coverage and impaired pulmonary metastasis of human melanomas. In contrast, the gain of VEGF-B function in tumors led to pseudonormalized tumor vasculatures that were highly leaky and poorly perfused. Tumors expressing high levels of VEGF-B were more metastatic, although primary tumor growth was largely impaired. Similarly, VEGF-B in a VEGF-A-null tumor resulted in attenuated primary tumor growth but substantial pulmonary metastases. VEGF-B also led to highly metastatic phenotypes in Vegfr1 tk(-/-) mice and mice treated with anti-VEGF-A. These data indicate that VEGF-B promotes cancer metastasis through a VEGF-A-independent mechanism. High expression levels of VEGF-B in two large-cohort studies of human patients with lung squamous cell carcinoma and melanoma correlated with poor survival. Taken together, our findings demonstrate that VEGF-B is a vascular remodeling factor promoting cancer metastasis and that targeting VEGF-B may be an important therapeutic approach for cancer metastasis.

  6. Predicting Volleyball Serve-Reception

    PubMed Central

    Paulo, Ana; Zaal, Frank T. J. M.; Fonseca, Sofia; Araújo, Duarte

    2016-01-01

    Serve and serve-reception performance have predicted success in volleyball. Given the impact of serve-reception on the game, we aimed at understanding what it is in the serve and receiver's actions that determines the selection of the type of pass used in serve-reception and its efficacy. Four high-level volleyball players received jump-float serves from four servers in two reception zones—zone 1 and 5. The ball and the receiver's head were tracked with two video cameras, allowing 3D world-coordinates reconstruction. Logistic-regression models were used to predict the type of pass used (overhand or underhand) and serve-reception efficacy (error, out, or effective) from variables related with the serve kinematics and related with the receiver's on-court positioning and movement. Receivers' initial position was different when in zone 1 and 5. This influenced the serve-related variables as well as the type of pass used. Strong predictors of using an underhand rather than overhand pass were higher ball contact of the server, reception in zone 1, receiver's initial position more to the back of the court and backward receiver movement. Receiver's larger longitudinal displacements and an initial position more to the back of the court had a strong relationship with the decreasing of the serve-reception efficacy. Receivers' positioning and movement were the factors with the largest impact on the type of pass used and the efficacy of the reception. Reception zone affected the variance in the ball's kinematics (with the exception of the ball's lateral displacement), as well as in the receivers' positioning (distances from the net and from the target). Also the reception zone was associated with the type of pass used by the receiver but not with reception efficacy. Given volleyball's rotation rule, the receiver needs to master receiving in the different reception zones; he/she needs to adapt to the diverse constraints of each zone to maintain performance efficacy. Thus

  7. Predicting Volleyball Serve-Reception.

    PubMed

    Paulo, Ana; Zaal, Frank T J M; Fonseca, Sofia; Araújo, Duarte

    2016-01-01

    Serve and serve-reception performance have predicted success in volleyball. Given the impact of serve-reception on the game, we aimed at understanding what it is in the serve and receiver's actions that determines the selection of the type of pass used in serve-reception and its efficacy. Four high-level volleyball players received jump-float serves from four servers in two reception zones-zone 1 and 5. The ball and the receiver's head were tracked with two video cameras, allowing 3D world-coordinates reconstruction. Logistic-regression models were used to predict the type of pass used (overhand or underhand) and serve-reception efficacy (error, out, or effective) from variables related with the serve kinematics and related with the receiver's on-court positioning and movement. Receivers' initial position was different when in zone 1 and 5. This influenced the serve-related variables as well as the type of pass used. Strong predictors of using an underhand rather than overhand pass were higher ball contact of the server, reception in zone 1, receiver's initial position more to the back of the court and backward receiver movement. Receiver's larger longitudinal displacements and an initial position more to the back of the court had a strong relationship with the decreasing of the serve-reception efficacy. Receivers' positioning and movement were the factors with the largest impact on the type of pass used and the efficacy of the reception. Reception zone affected the variance in the ball's kinematics (with the exception of the ball's lateral displacement), as well as in the receivers' positioning (distances from the net and from the target). Also the reception zone was associated with the type of pass used by the receiver but not with reception efficacy. Given volleyball's rotation rule, the receiver needs to master receiving in the different reception zones; he/she needs to adapt to the diverse constraints of each zone to maintain performance efficacy. Thus, being

  8. Individual vulnerability to addiction.

    PubMed

    Swendsen, Joel; Le Moal, Michel

    2011-01-01

    The process of addiction is often studied in the neurosciences as a function of the quantity or type of substance consumed, with the ultimate goal of counteracting these effects by other pharmacological means. However, epidemiology and clinical research have extensively demonstrated that most individuals who use drugs do not develop dependence. Numerous factors may explain an individual's propensity to addiction. This review discusses these paradigms and summarizes research on individual differences that encompass cultural and sociodemographic factors, psychiatric or psychological vulnerability, and biological or genetic propensity to addiction. Although these different factors often interact in the expression of vulnerable phenotypes, it is possible to alter or control specific sources of vulnerability. For these reasons, integrating individual vulnerability to addiction across different research disciplines is likely to provide the greatest advances for intervention and prevention efforts. © 2011 New York Academy of Sciences.

  9. With responsibility comes vulnerability.

    PubMed

    Pearce, Lynne

    2016-03-09

    The Medical Defence Union warns that as nurses take on more responsibilities, they are more vulnerable to complaints and clinical negligence cases. Advanced nurse practitioners are advised to work within their competence, communicate clearly and apologise when things go wrong.

  10. Vulnerability of Approximate Targets

    DTIC Science & Technology

    1993-06-01

    of Fuzzy Models." Mathematical Modelling 9. pp. 669-690, 1987. CelmigS, A. " Possibilistic Vulnerability Measures." BRL-TR-3064, U.S. Army Ballistic... Possibilistic vulnerability analyses can be particularly useful for the early development phases of weapon systems. 14. SUBJECT TERMS IS. NUMBER OF PAGES...specifically developed to handle such uncertainties. This report describes the application of possibilistic concepts and techniques to the estimation of

  11. Narcissistic grandiosity and narcissistic vulnerability in psychotherapy.

    PubMed

    Pincus, Aaron L; Cain, Nicole M; Wright, Aidan G C

    2014-10-01

    This article briefly summarizes the empirical and clinical literature underlying a contemporary clinical model of pathological narcissism. Unlike the DSM Narcissistic Personality Disorder (NPD), this clinical model identifies and differentiates between two phenotypic themes of dysfunction-narcissistic grandiosity and narcissistic vulnerability-that can be expressed both overtly and covertly in patients' ways of thinking, feeling, behaving, and participating in treatment. Clinical recognition that narcissistic patients can and often do present for psychotherapy in vulnerable states of depression, anxiety, shame, and even suicidality increases the likelihood of accurate diagnosis and effective treatment planning. This article provides case examples derived from psychotherapies with narcissistic patients to demonstrate how narcissistic grandiosity and narcissistic vulnerability concurrently present in patients who seek treatment.

  12. Facility Environmental Vulnerability Assessment

    SciTech Connect

    Van Hoesen, S.D.

    2001-07-09

    From mid-April through the end of June 2001, a Facility Environmental Vulnerability Assessment (FEVA) was performed at Oak Ridge National Laboratory (ORNL). The primary goal of this FEVA was to establish an environmental vulnerability baseline at ORNL that could be used to support the Laboratory planning process and place environmental vulnerabilities in perspective. The information developed during the FEVA was intended to provide the basis for management to initiate immediate, near-term, and long-term actions to respond to the identified vulnerabilities. It was expected that further evaluation of the vulnerabilities identified during the FEVA could be carried out to support a more quantitative characterization of the sources, evaluation of contaminant pathways, and definition of risks. The FEVA was modeled after the Battelle-supported response to the problems identified at the High Flux Beam Reactor at Brookhaven National Laboratory. This FEVA report satisfies Corrective Action 3A1 contained in the Corrective Action Plan in Response to Independent Review of the High Flux Isotope Reactor Tritium Leak at the Oak Ridge National Laboratory, submitted to the Department of Energy (DOE) ORNL Site Office Manager on April 16, 2001. This assessment successfully achieved its primary goal as defined by Laboratory management. The assessment team was able to develop information about sources and pathway analyses although the following factors impacted the team's ability to provide additional quantitative information: the complexity and scope of the facilities, infrastructure, and programs; the significantly degraded physical condition of the facilities and infrastructure; the large number of known environmental vulnerabilities; the scope of legacy contamination issues [not currently addressed in the Environmental Management (EM) Program]; the lack of facility process and environmental pathway analysis performed by the accountable line management or facility owner; and poor

  13. Military Cultural Competency: Understanding How to Serve Those Who Serve

    ERIC Educational Resources Information Center

    Bonura, Kimberlee Bethany; Lovald, Nicole

    2015-01-01

    The aim of this essay is to define and describe the different constituents of the military population, and present the challenges this demographic faces when pursuing higher education. The essay also discusses key aspects higher education professionals must understand in order to better serve military populations, such as federal regulations and…

  14. TB in Vulnerable Populations

    PubMed Central

    Ugarte-Gil, César; Caro, Godofredo; Aylas, Rula; Castro, César; Lema, Claudia

    2016-01-01

    Abstract This article analyzes the factors associated with vulnerability of the Ashaninka, the most populous indigenous Peruvian Amazonian people, to tuberculosis (TB). By applying a human rights-based analytical framework that assesses public policy against human rights standards and principles, and by offering a step-by-step framework for a full assessment of compliance, it provides evidence of the relationship between the incidence of TB among the Ashaninka and Peru’s poor level of compliance with its human rights obligations. The article argues that one of the main reasons for the historical vulnerability of the Ashaninka to diseases such as TB is a lack of political will on the part of the national government to increase public health spending, ensure that resources reach the most vulnerable population, and adopt and invest in a culturally appropriate health system. PMID:27780999

  15. Energy vulnerability relationships

    SciTech Connect

    Shaw, B.R.; Boesen, J.L.

    1998-02-01

    The US consumption of crude oil resources has been a steadily growing indicator of the vitality and strength of the US economy. At the same time import diversity has also been a rapidly developing dimension of the import picture. In the early 1970`s, embargoes of crude oil from Organization of Producing and Exporting Countries (OPEC) created economic and political havoc due to a significant lack of diversity and a unique set of economic, political and domestic regulatory circumstances. The continued rise of imports has again led to concerns over the security of our crude oil resource but threats to this system must be considered in light of the diversity and current setting of imported oil. This report develops several important issues concerning vulnerability to the disruption of oil imports: (1) The Middle East is not the major supplier of oil to the United States, (2) The US is not vulnerable to having its entire import stream disrupted, (3) Even in stable countries, there exist vulnerabilities to disruption of the export stream of oil, (4) Vulnerability reduction requires a focus on international solutions, and (5) DOE program and policy development must reflect the requirements of the diverse supply. Does this increasing proportion of imported oil create a {open_quotes}dependence{close_quotes}? Does this increasing proportion of imported oil present a vulnerability to {open_quotes}price shocks{close_quotes} and the tremendous dislocations experienced during the 1970`s? Finally, what is the vulnerability of supply disruptions from the current sources of imported oil? If oil is considered to be a finite, rapidly depleting resource, then the answers to these questions must be {open_quotes}yes.{close_quotes} However, if the supply of oil is expanding, and not limited, then dependence is relative to regional supply sources.

  16. Plutonium Vulnerability Management Plan

    SciTech Connect

    1995-03-01

    This Plutonium Vulnerability Management Plan describes the Department of Energy`s response to the vulnerabilities identified in the Plutonium Working Group Report which are a result of the cessation of nuclear weapons production. The responses contained in this document are only part of an overall, coordinated approach designed to enable the Department to accelerate conversion of all nuclear materials, including plutonium, to forms suitable for safe, interim storage. The overall actions being taken are discussed in detail in the Department`s Implementation Plan in response to the Defense Nuclear Facilities Safety Board (DNFSB) Recommendation 94-1. This is included as Attachment B.

  17. Vulnerability of dynamic systems

    NASA Technical Reports Server (NTRS)

    Siljak, D. D.

    1976-01-01

    Directed graphs are associated with dynamic systems in order to determine in any given system if each state can be reached by at least one input (input reachability), or can each state reach at least one output (output reachability). Then, the structural perturbations of a dynamic system are identified as lines or points removals from the corresponding digraph, and a system is considered vulnerable at those lines or points of the digraph whose removal destroys its input or output reachability. A suitable framework is formulated for resolving the problems of reachability and vulnerability which applies to both linear and nonlinear systems alike.

  18. Offer Versus Serve. Training Manual.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Health and Drug Education and Services.

    A growing awareness about food supplies, food shortages, and conservation of natural resources has resulted in public concern over food waste within the National School Lunch Program. Prior to 1976, all participating students were required to take all five items offered on a planned menu. In October 1975, the Offer v. Serve Provision was enacted…

  19. Offer Versus Serve. Training Manual.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Health and Drug Education and Services.

    A growing awareness about food supplies, food shortages, and conservation of natural resources has resulted in public concern over food waste within the National School Lunch Program. Prior to 1976, all participating students were required to take all five items offered on a planned menu. In October 1975, the Offer v. Serve Provision was enacted…

  20. Meals Served in Public Schools.

    ERIC Educational Resources Information Center

    Vivigal, Lisa

    The Physicians Committee for Responsible Medicine (PCRM) contacted public school districts around the United States to determine if they offered low-fat, healthful meals. The PCRM ranked the schools according to whether they served low-fat and vegetarian meals daily, whether these meals varied through the week, and whether children needed to…

  1. Biological Vulnerability to Alcoholism.

    ERIC Educational Resources Information Center

    Schuckit, Marc A.

    1987-01-01

    Reviews the role of biological factors in the risk for alcoholism. Notes the importance of the definition of primary alcoholism and highlights data indicating that this disorder is genetically influenced. In studies of men at high risk for the future development of alcoholism, vulnerability shows up in reactions to ethanol brain wave amplitude and…

  2. Biological Vulnerability to Alcoholism.

    ERIC Educational Resources Information Center

    Schuckit, Marc A.

    1987-01-01

    Reviews the role of biological factors in the risk for alcoholism. Notes the importance of the definition of primary alcoholism and highlights data indicating that this disorder is genetically influenced. In studies of men at high risk for the future development of alcoholism, vulnerability shows up in reactions to ethanol brain wave amplitude and…

  3. Delinquent Recidivists: Vulnerable Children.

    ERIC Educational Resources Information Center

    Moore, Roslyn; And Others

    1984-01-01

    This study examines the relationship between vulnerability factors and recidivism of juvenile offenders. Four factors are identified which distinguish recedivists from nonrecidivists in a sample of 96 first offenders matched by age and sex. Results are discussed from an epidemiological and early intervention perspective. (Author/BS)

  4. Responses to stress in patients with psychotic disorders compared to persons with varying levels of vulnerability to psychosis, persons with depression and healthy controls.

    PubMed

    Lincoln, Tania M; Köther, Ulf; Hartmann, Maike; Kempkensteffen, Jürgen; Moritz, Steffen

    2015-06-01

    An experimental design was used to test whether self-reported, psychophysiological and symptomatic stress-responses increase as a function of the underlying vulnerability to psychosis as proposed by vulnerability-stress-models. Stress-responses of participants with psychotic disorders (PSY, n = 35) were compared to those of participants with attenuated positive symptoms (AS, n = 29), first-degree relatives of persons with psychotic disorders (REL, n = 26), healthy controls (HC, n = 28) and controls with depression (DEP, n = 30). Using a repeated measures design, participants were assigned to a noise stressor, a social stressor and a no stress condition in random order. Stress-responses were assessed via self-report, salivary cortisol levels, heart rate and skin conductance levels. State-paranoia and depression were assessed with clinical scales. PSY reported to be significantly more stressed than HC, AS and REL across all conditions which went along with increased heart rate and decreased overall cortisol release. In contrast, AS showed elevated levels of cortisol. PSY showed a stronger response of self-reported stress to the noise condition compared to the no stress condition than HC, but no stronger response than the other samples. Furthermore, the stressors did not trigger stronger psychophysiological responses or symptom-increases in PSY. The social stressor was brief and not individualized and did not have an effect on cortisol. The findings support the notion that subjective stress-responsiveness increases with vulnerability, but not the assumption that symptoms arise directly as a function of stress and vulnerability. Also, the generally high levels of arousal seem to be more relevant to psychosis than the responsiveness to specific stressors. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Vulnerability to Climate Change in Rural Nicaragua

    NASA Astrophysics Data System (ADS)

    Byrne, T. R.; Townshend, I.; Byrne, J. M.; McDaniel, S. A.

    2013-12-01

    While there is a growing recognition of the impact that climate change may have on human development, there has been a shift in focus from an impacts-led assessment approach towards a vulnerability-led assessment approach. This research operationalizes the IPCC's definition of vulnerability in a sub-national assessment to understand how different factors that shape vulnerability to climate change vary spatially across rural Nicaragua. The research utilizes the Food and Agriculture Organization of the United Nations' (FAO UN) CropWat model to evaluate how the annual yield of two of Nicaragua's staple crops may change under projected changes in temperature and precipitation. This analysis of agricultural sensitivity under exposure to climate change is then overlain with an indicator-based assessment of adaptive capacity in rural Nicaraguan farming households. Adaptive capacity was evaluated using household survey data from the 2001 National Household Survey on Living Standards Measurement, which was provided to us by the FAO UN. The result is a map representing current vulnerability to future climate change, and can serve as a basis for targeting policy interventions in rural Nicaragua.

  6. Vulnerabilities in snakebites in Sao Paulo, Brazil

    PubMed Central

    Bertolozzi, Maria Rita; Scatena, Camila Morato da Conceição; França, Francisco Oscar de Siqueira

    2015-01-01

    ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites. PMID:26603351

  7. S100A9 and ORM1 serve as predictors of therapeutic response and prognostic factors in advanced extranodal NK/T cell lymphoma patients treated with pegaspargase/gemcitabine

    PubMed Central

    Zhou, Zhiyuan; Li, Zhaoming; Sun, Zhenchang; Zhang, Xudong; Lu, Lisha; Wang, Yingjun; Zhang, Mingzhi

    2016-01-01

    Pegaspargase combined with gemcitabine have greatly improved the outcomes of advanced extranodal NK/T cell lymphoma (ENKL). However, patients frequently undergo recurrent disease due to chemoresistance, and few predictive parameters are available. The present study explored potential biomarkers to predict the therapeutic response of advanced ENKL treated with pegaspargase/gemcitabine and evaluate the prognostic significance. Through serum proteomic analysis, we identified 61 upregulated and 22 downregulated proteins in nonresponders compared with responders. We further validated that patients with unfavourable treatment outcomes displayed higher levels of S100A9 and ORM1 via enzyme-linked immunosorbent assay (ELISA). Moreover, the sensitivity and specificity for detecting refractory patients were 81.5% and 71.4% for S100A9 > 62.0 ng/ml, 85.2% and 77.1% for ORM1 > 1436 ug/ml, 100% and 57.1% for S100A9 combined with ORM1. Furthermore, in multivariate analysis elevated levels of S100A9 were associated with poor 2-year OS (40.2% vs. 76.6%, RR = 2.92, p = 0.005) and 2-year PFS (33.1% vs. 61.1%, RR = 2.61 p = 0.011). High ORM1 also predicted inferior 2-year OS (38.7% vs.76.1, RR = 2.46, p = 0.023) and 2-year PFS (18.4% vs. 73.2%, RR = 2.86, p = 0.009). Our results indicated that S100A9 and ORM1 could serve as reliable predictors of therapeutic response and independent prognostic factors of survival in advanced ENKL patients treated with pegaspargase/gemcitabine. PMID:27021626

  8. Assurance Limits for Vulnerable Area

    DTIC Science & Technology

    1975-08-01

    IN» At) Ml* 11(t RIA-80-U373 TECHNICAL LffiRARY AD* 0/4, "Wfr NWSC/CR/RDTR-10 ASSURANCE LIMITS FOR 5 0712 01001493 3 VULNERABLE AREA...ASSURANCE LIMITS FOR VULNERABLE AREA DATA ANALYSIS TECHNIQUES OF VULNERABILITY ASSESSMENTS PARTIAL FULFILLMENT OF FY 75 ASSESSMENT...RECIPIENT’S CATALOG NUMBER 4. TITLE (and Subtltla) ASSURANCE LIMITS FOR VULNERABLE AREA B. TYPE OF REPORT * PERIOD COVERED 1. AUTHORS

  9. Dynamic vulnerability assessment.

    SciTech Connect

    Nelson, Cynthia Lee

    2004-09-01

    With increased terrorist threats in the past few years, it is no longer feasible to feel confident that a facility is well protected with a static security system. Potential adversaries often research their targets, examining procedural and system changes, in order to attack at a vulnerable time. Such system changes may include scheduled sensor maintenance, scheduled or unscheduled changes in the guard force, facility alert level changes, sensor failures or degradation, etc. All of these changes impact the system effectiveness and can make a facility more vulnerable. Currently, a standard analysis of system effectiveness is performed approximately every six months using a vulnerability assessment tool called ASSESS (Analytical Systems and Software for Evaluating Safeguards and Systems). New standards for determining a facility's system effectiveness will be defined by tools that are currently under development, such as ATLAS (Adversary Time-line Analysis System) and NextGen (Next Generation Security Simulation). Although these tools are useful to model analyses at different spatial resolutions and can support some sensor dynamics using statistical models, they are limited in that they require a static system state as input. They cannot account for the dynamics of the system through day-to-day operations. The emphasis of this project was to determine the feasibility of dynamically monitoring the facility security system and performing an analysis as changes occur. Hence, the system effectiveness is known at all times, greatly assisting time-critical decisions in response to a threat or a potential threat.

  10. ADVANCING PATIENT-CENTERED CARE FOR STRUCTURALLY VULNERABLE DRUG-USING POPULATIONS: A QUALITATIVE STUDY OF THE PERSPECTIVES OF PEOPLE WHO USE DRUGS REGARDING THE POTENTIAL INTEGRATION OF HARM REDUCTION INTERVENTIONS INTO HOSPITALS

    PubMed Central

    McNeil, Ryan; Kerr, Thomas; Pauly, Bernie; Wood, Evan; Small, Will

    2015-01-01

    Aims To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g., supervised drug consumption services, opioid assisted treatment) into hospitals; and, (2) the implications of these interventions for patient-centered care, hospital outcomes, and drug-related risks and harms. Design Semi-structured qualitative interviews. Setting Vancouver, Canada. Participants 30 structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past two years, and hospitalized multiple times over the past five years. Measurements Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions. Findings Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g., pain and withdrawal symptoms); and, (3) fostering ‘culturally safe’ care. Conclusions Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid assisted treatment, can potentially improve hospital care retention, promote patient-centred care, and reduce adverse health outcomes among people who use drugs. PMID:26498577

  11. Advancing patient-centered care for structurally vulnerable drug-using populations: a qualitative study of the perspectives of people who use drugs regarding the potential integration of harm reduction interventions into hospitals.

    PubMed

    McNeil, Ryan; Kerr, Thomas; Pauly, Bernie; Wood, Evan; Small, Will

    2016-04-01

    To explore the perspectives of structurally vulnerable people who use drugs (PWUD) regarding: (1) the potential integration of harm reduction interventions (e.g. supervised drug consumption services, opioid-assisted treatment) into hospitals; and (2) the implications of these interventions for patient-centered care, hospital outcomes and drug-related risks and harms. Semi-structured qualitative interviews. Vancouver, Canada. Thirty structurally vulnerable PWUD who had been discharged from hospital against medical advice within the past 2 years, and hospitalized multiple times over the past 5 years. Semi-structured interview guide including questions to elicit perspectives on hospital-based harm reduction interventions. Participant accounts highlighted that hospital-based harm reduction interventions would promote patient-centered care by: (1) prioritizing hospital care access and risk reduction over the enforcement of abstinence-based drug policies; (2) increasing responsiveness to subjective health needs (e.g. pain and withdrawal symptoms); and (3) fostering 'culturally safe' care. Hospital-based harm reduction interventions for people who use drugs, such as supervised drug consumption services and opioid-assisted treatment, can potentially improve hospital care retention, promote patient-centered care and reduce adverse health outcomes among people who use drugs. © 2015 Society for the Study of Addiction.

  12. Vulnerability survival analysis: a novel approach to vulnerability management

    NASA Astrophysics Data System (ADS)

    Farris, Katheryn A.; Sullivan, John; Cybenko, George

    2017-05-01

    Computer security vulnerabilities span across large, enterprise networks and have to be mitigated by security engineers on a routine basis. Presently, security engineers will assess their "risk posture" through quantifying the number of vulnerabilities with a high Common Vulnerability Severity Score (CVSS). Yet, little to no attention is given to the length of time by which vulnerabilities persist and survive on the network. In this paper, we review a novel approach to quantifying the length of time a vulnerability persists on the network, its time-to-death, and predictors of lower vulnerability survival rates. Our contribution is unique in that we apply the cox proportional hazards regression model to real data from an operational IT environment. This paper provides a mathematical overview of the theory behind survival analysis methods, a description of our vulnerability data, and an interpretation of the results.

  13. Could local dynamic stability serve as an early predictor of falls in patients with moderate neurological gait disorders? A reliability and comparison study in healthy individuals and in patients with paresis of the lower extremities.

    PubMed

    Reynard, Fabienne; Vuadens, Philippe; Deriaz, Olivier; Terrier, Philippe

    2014-01-01

    Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of

  14. Serving young adults requires creativity.

    PubMed

    Keller, S

    1997-01-01

    Sexually active young adults tend to be poorly informed about their contraceptive choices and risks of contracting a sexually transmitted disease (STD). Some who venture to clinics are refused services or treated rudely. Inconvenient hours and high costs may also be obstacles to clinic uptake. However, compared to older men and women, adolescents are more likely to have sex with multiple partners. In many countries, adolescents have high rates of unwanted pregnancy and STD. Worldwide, people under age 25 years account for 50% of all HIV infections. The age of puberty is declining worldwide, partly due to better nutrition, while the age at marriage in many countries is rising. These conditions expand the number of years for sexual experimentation and involvement before marriage. It is important to find creative, effective ways to serve the reproductive health needs of youth. Sex education, embarrassment, access to condoms, and confronting denial about sexual risks are discussed.

  15. Aging and Neuronal Vulnerability

    PubMed Central

    Mattson, Mark P.; Magnus, Tim

    2011-01-01

    Everyone ages, but only some will acquire a neurodegenerative disorder in the process. Disease might occur when cells fail to respond adaptively to age-related increases in oxidative, metabolic and ionic stress resulting in excessive accumulation of damaged proteins, DNA and membranes. Determinants of neuronal vulnerability might include cell size and location, metabolism of disease-specific proteins, and repertoire of signal transduction pathways and stress resistance mechanisms. Emerging evidence on protein interaction networks that monitor and respond to the normal aging process suggests that successful neural aging is possible for most, but also cautions that cures for neurodegenerative disorders are unlikely in the near future. PMID:16552414

  16. An Integrated Approach for Urban Earthquake Vulnerability Analyses

    NASA Astrophysics Data System (ADS)

    Düzgün, H. S.; Yücemen, M. S.; Kalaycioglu, H. S.

    2009-04-01

    -economical, structural, coastal, ground condition, organizational vulnerabilities, as well as accessibility to critical services within the framework. The proposed framework has the following eight components: Seismic hazard analysis, soil response analysis, tsunami inundation analysis, structural vulnerability analysis, socio-economic vulnerability analysis, accessibility to critical services, GIS-based integrated vulnerability assessment, and visualization of vulnerabilities in 3D virtual city model The integrated model for various vulnerabilities obtained for the urban area is developed in GIS environment by using individual vulnerability assessments for considered elements at risk and serve for establishing the backbone of the spatial decision support system. The stages followed in the model are: Determination of a common mapping unit for each aspect of urban earthquake vulnerability, formation of a geo-database for the vulnerabilities, evaluation of urban vulnerability based on multi attribute utility theory with various weighting algorithms, mapping of the evaluated integrated earthquake risk in geographic information systems (GIS) in the neighborhood scale. The framework is also applicable to larger geographical mapping scales, for example, the building scale. When illustrating the results in building scale, 3-D visualizations with remote sensing data is used so that decision-makers can easily interpret the outputs. The proposed vulnerability assessment framework is flexible and can easily be applied to urban environments at various geographical scales with different mapping units. The obtained total vulnerability maps for the urban area provide a baseline for the development of risk reduction strategies for the decision makers. Moreover, as several aspects of elements at risk for an urban area is considered through vulnerability analyses, effect on changes in vulnerability conditions on the total can easily be determined. The developed approach also enables decision makers to

  17. Vulnerability Assessment of Selected Buildings Designated as Shelters: Dominica.

    ERIC Educational Resources Information Center

    Agency for International Development (IDCA), Washington, DC.

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Dominica to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  18. Vulnerability Assessment of Selected Buildings Designated as Shelters: Grenada.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools, located in Grenada, to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the input…

  19. Vulnerability Assessment of Selected Buildings Designated as Shelters: Anguilla.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Anguilla to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with some of the…

  20. Self-serving confabulation in prose recall.

    PubMed

    Fotopoulou, Aikaterini; Conway, Martin A; Solms, Mark; Tyrer, Stephen; Kopelman, Michael

    2008-04-01

    Recent studies suggest that the content of confabulation is mainly positive and self-enhancing. In this group study, we aimed to investigate whether this positive bias is specific to self-referent information. Confabulating amnesic patients, amnesic non-confabulating patients and healthy controls were asked to reproduce a series of short stories. We manipulated the emotional valence of the material by including positive, negative and neutral story plots. We also manipulated the self-reference of the material by including self-referent versus other-referent encoding instructions. Confabulating patients were as impaired as a group of amnesic patients in the amount of information they recalled, both groups being worse than healthy controls. Importantly, confabulating patients showed a selective bias in the negative self-referent condition, in that they recalled such information in a manner which portrayed a more positive image of themselves. This positive bias was not present in stories that were not encoded in a self-referent manner and it was not significantly correlated to patients' self-reported mood. We propose that both confabulation and its motivated content result from a deficit in the control and regulation of memory retrieval, which allows motivational factors to acquire a greater role than usual in determining which memories are selected for retrieval. To this extent, the self-enhancing content of confabulation could be explained as a neurogenic exaggeration of normal self-serving memory distortion.

  1. Optimizing health care delivery by integrating workplaces, homes, and communities: how occupational and environmental medicine can serve as a vital connecting link between accountable care organizations and the patient-centered medical home.

    PubMed

    McLellan, Robert K; Sherman, Bruce; Loeppke, Ronald R; McKenzie, Judith; Mueller, Kathryn L; Yarborough, Charles M; Grundy, Paul; Allen, Harris; Larson, Paul W

    2012-04-01

    momentum and evolving among physicians. But, the potential exists for implementation of both of these concepts across a much broader community of patients. By extending the well-conceived integrative concepts of the PCMH model and ACOs into the workforce via occupational and environmental medicine (OEM) physicians, the power of these concepts would be significantly enhanced. Occupational and environmental medicine provides a well-established infrastructure and parallel strategies that could serve as a force multiplier in achieving the fundamental goals of the PCMH model and ACOs. In this paradigm, the workplace-where millions of Americans spend a major portion of their daily lives-becomes an essential element, next to communities and homes, in an integrated system of health anchored by the PCMH and ACO concepts. To be successful, OEM physicians will need to think and work innovatively about how they can provide today's employer health services-ranging from primary care and preventive care to workers' compensation and disability management-within tomorrow's PCMH and ACO models.

  2. [Homicides and social vulnerability].

    PubMed

    Tavares, Ricardo; Catalan, Valeria Dutra Batista; Romano, Pedro Machado de Melo; Melo, Elza Machado

    2016-03-01

    The goal of this study was to analyze the spatial distribution of homicide rates (H) according to the social vulnerability index (SVI) and the quality of urban life index (QUL) in Betim, State of Minas Gerais, from 2006 to 2011. Descriptive analysis was performed using Moran's spatial correlation analysis, and the H, SVI and QUL spatial analyses. During this period there were 1,383 deaths, mostly of males (91.9%), aged 15-24 years (46.9%), brown/black (76.9%), with secondary education (51.1%), and single (83.9%). No spatial autocorrelation was revealed, indicating that the distribution of homicide rates is random; the same occurred with the SVI and the QUL index. Taken together, however, the H, SVI and QUL index overlapped, which was analyzed using different theories of crime, such as those addressing socioeconomic issues, arms of drugs dealing and Durkheim's and Habermas' theories, namely anomie and colonization of the lifeworld. social vulnerability and homicide are associated from both empirical and theoretical perspectives.

  3. Arizona - Social Vulnerability Index

    EPA Pesticide Factsheets

    The Social Vulnerability Index is derived from the 2000 US Census data. The fields included are percent minority, median household income, age (under 18 and over 64), population without a high school diploma, linguistically isolated households, and single female head of households with own children under 18 (single moms). The data is at the block group level. Each field for each block group is assigned an index score of 0-3, based on whether the value of that dataset falls in the top quartile (score=3), second quartile (score=2), third quartile (score=1), or bottom quartile (score=0). The scores for each field are then added together to assign a comprehensive score to each block group (0-21). The highest scores are block groups that have the highest percentage of sensitive populations (highest percent minority, lowest per capita income, highest percent of population under 18 and over 64, highest percentage of population without a high school degree, highest percent of linguistically isolated households, and highest percent of single female head of households). Zoe Heller of the US EPA Region 9's Communities and Ecosystems Division, is responsible for the design and development of the Social Vulnerability Index data set.

  4. A preliminary analysis of quantifying computer security vulnerability data in "the wild"

    NASA Astrophysics Data System (ADS)

    Farris, Katheryn A.; McNamara, Sean R.; Goldstein, Adam; Cybenko, George

    2016-05-01

    A system of computers, networks and software has some level of vulnerability exposure that puts it at risk to criminal hackers. Presently, most vulnerability research uses data from software vendors, and the National Vulnerability Database (NVD). We propose an alternative path forward through grounding our analysis in data from the operational information security community, i.e. vulnerability data from "the wild". In this paper, we propose a vulnerability data parsing algorithm and an in-depth univariate and multivariate analysis of the vulnerability arrival and deletion process (also referred to as the vulnerability birth-death process). We find that vulnerability arrivals are best characterized by the log-normal distribution and vulnerability deletions are best characterized by the exponential distribution. These distributions can serve as prior probabilities for future Bayesian analysis. We also find that over 22% of the deleted vulnerability data have a rate of zero, and that the arrival vulnerability data is always greater than zero. Finally, we quantify and visualize the dependencies between vulnerability arrivals and deletions through a bivariate scatterplot and statistical observations.

  5. How electroencephalography serves the anesthesiologist.

    PubMed

    Marchant, Nicolas; Sanders, Robert; Sleigh, Jamie; Vanhaudenhuyse, Audrey; Bruno, Marie-Aurélie; Brichant, Jean François; Laureys, Steven; Bonhomme, Vincent

    2014-01-01

    Major clinical endpoints of general anesthesia, such as the alteration of consciousness, are achieved through effects of anesthetic agents on the central nervous system, and, more precisely, on the brain. Historically, clinicians and researchers have always been interested in quantifying and characterizing those effects through recordings of surface brain electrical activity, namely electroencephalography (EEG). Over decades of research, the complex signal has been dissected to extract its core substance, with significant advances in the interpretation of the information it may contain. Methodological, engineering, statistical, mathematical, and computer progress now furnishes advanced tools that not only allow quantification of the effects of anesthesia, but also shed light on some aspects of anesthetic mechanisms. In this article, we will review how advanced EEG serves the anesthesiologist in that respect, but will not review other intraoperative utilities that have no direct relationship with consciousness, such as monitoring of brain and spinal cord integrity. We will start with a reminder of anesthestic effects on raw EEG and its time and frequency domain components, as well as a summary of the EEG analysis techniques of use for the anesthesiologist. This will introduce the description of the use of EEG to assess the depth of the hypnotic and anti-nociceptive components of anesthesia, and its clinical utility. The last part will describe the use of EEG for the understanding of mechanisms of anesthesia-induced alteration of consciousness. We will see how, eventually in association with transcranial magnetic stimulation, it allows exploring functional cerebral networks during anesthesia. We will also see how EEG recordings during anesthesia, and their sophisticated analysis, may help corroborate current theories of mental content generation.

  6. Serving the world's poor, profitably.

    PubMed

    Prahalad, C K; Hammond, Allen

    2002-09-01

    By stimulating commerce and development at the bottom of the economic pyramid, multi-nationals could radically improve the lives of billions of people and help create a more stable, less dangerous world. Achieving this goal does not require MNCs to spearhead global social-development initiatives for charitable purposes. They need only act in their own self-interest. How? The authors lay out the business case for entering the world's poorest markets. Fully 65% of the world's population earns less than $2,000 per year--that's 4 billion people. But despite the vastness of this market, it remains largely untapped. The reluctance to invest is easy to understand, but it is, by and large, based on outdated assumptions of the developing world. While individual incomes may be low, the aggregate buying power of poor communities is actually quite large, representing a substantial market in many countries for what some might consider luxury goods like satellite television and phone services. Prices, and margins, are often much higher in poor neighborhoods than in their middle-class counterparts. And new technologies are already steadily reducing the effects of corruption, illiteracy, inadequate infrastructure, and other such barriers. Because these markets are in the earliest stages of economic development, revenue growth for multi-nationals entering them can be extremely rapid. MNCs can also lower costs, not only through low-cost labor but by transferring operating efficiencies and innovations developed to serve their existing operations. Certainly, succeeding in such markets requires MNCs to think creatively. The biggest change, though, has to come from executives: Unless business leaders confront their own preconceptions--particularly about the value of high-volume, low-margin businesses--companies are unlikely to master the challenges or reap the rewards of these developing markets.

  7. [Trust and palliative care, the risk of vulnerability].

    PubMed

    Miniac, Véronique

    2013-10-01

    Patients receiving palliative care experience extreme vulnerability reminding them of the fragility of their human condition. How are they to trust nurses bearing bad news in these crucial moments? Trust is built on team coherence and rigorous support.

  8. Multiscale vulnerability of complex networks.

    PubMed

    Boccaletti, Stefano; Buldú, Javier; Criado, Regino; Flores, Julio; Latora, Vito; Pello, Javier; Romance, Miguel

    2007-12-01

    We present a novel approach to quantify the vulnerability of a complex network, i.e., the capacity of a graph to maintain its functional performance under random damages or malicious attacks. The proposed measure represents a multiscale evaluation of vulnerability, and makes use of combined powers of the links' betweenness. We show that the proposed approach is able to properly describe some cases for which earlier measures of vulnerability fail. The relevant applications of our method for technological network design are outlined.

  9. An Analysis of Botnet Vulnerabilities

    DTIC Science & Technology

    2007-06-01

    significant vulnerabilities were found. While this research does not eliminate the possibility that a critical vulnerability is present in the Unreal...are designed for malicious purposes. Bots are distinguished from other malicious code like viruses and worms by a communication channel linking...vulnerability poses a risk to users connecting to an Unreal IRCd server, but does not suggest possible ways to exploit the server. 2.5 Dynamic DNS A bot

  10. Adolescent (in)vulnerability.

    PubMed

    Quadrel, M J; Fischhoff, B; Davis, W

    1993-02-01

    Three groups of subjects were asked to judge the probability that they and several target others (a friend, an acquaintance, a parent, a child) would experience various risks. Subjects were middle-class adults, their teenage children, and high-risk adolescents from treatment homes. All three groups saw themselves as facing somewhat less risk than the target others. However, this perception of relative invulnerability was no more pronounced for adolescents than for adults. Indeed, the parents were viewed as less vulnerable than their teenage children by both the adults and those teens. These results are consistent with others showing small differences in the cognitive decision-making processes of adolescents and adults. Underestimating teens' competence can mean misdiagnosing the sources of their risk behaviors, denying them deserved freedoms, and failing to provide needed assistance.

  11. VuWiki: An Ontology-Based Semantic Wiki for Vulnerability Assessments

    NASA Astrophysics Data System (ADS)

    Khazai, Bijan; Kunz-Plapp, Tina; Büscher, Christian; Wegner, Antje

    2014-05-01

    vulnerability assessments with the possibility for any user to retrieve assessments using specific research criteria. Furthermore, Vuwiki can serve as a collaborative knowledge platform that allows for the active participation of those generating and using the knowledge represented in the wiki.

  12. Attending to social vulnerability when rationing pandemic resources.

    PubMed

    Vawter, Dorothy E; Garrett, J Eline; Gervais, Karen G; Prehn, Angela Witt; DeBruin, Debra A

    2011-01-01

    Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response. Some plans that concern rationing during a severe pandemic recommend ways to protect socially vulnerable groups without prioritizing access to scarce resources based on social vulnerability per se. The Minnesota Pandemic Ethics Project (MPEP), a public engagement project on rationing scarce health resources during a severe influenza pandemic, agrees and recommends an integrated set of ways to attend to the needs of socially vulnerable people and avoid exacerbation of health disparities during a severe influenza pandemic. Among other things, MPEP recommends: 1. Engaging socially vulnerable populations to clarify unique needs and effective strategies; 2. Engaging socially vulnerable populations to elicit ethical values and perspectives on rationing; 3. Rejecting rationing based on race, socioeconomic class, citizenship, quality of life, length of life-extension and first-come, first-served; 4. Prioritizing those in the general population for access to resources based on combinations of risk (of death or severe complications from influenza, exposure to influenza, transmitting influenza to vulnerable groups) and the likelihood of responding well to the resource in question. 5. Protecting critical infrastructures on which vulnerable populations and the general public rely; 6. Identifying and removing access barriers during pandemic planning and response; and 7. Collecting and promptly analyzing data during the pandemic to identify groups at disproportionate risk of influenza-related mortality and

  13. Patterns of Electronic Portal Use among Vulnerable Patients in a Nationwide Practice-based Research Network: From the OCHIN Practice-based Research Network (PBRN)

    PubMed Central

    Wallace, Lorraine S.; Angier, Heather; Huguet, Nathalie; Gaudino, James A.; Krist, Alex; Dearing, Marla; Killerby, Marie; Marino, Miguel; DeVoe, Jennifer E.

    2017-01-01

    Background Underserved patient populations experience barriers to accessing and engaging within the complex health care system. Electronic patient portals have been proposed as a potential new way to improve access and engagement. We studied patient portal use for 12 consecutive months (365 days) among a large, nationally distributed, underserved patient population within the OCHIN (originally created as the Oregon Community Health Information Network and renamed OCHIN as other states joined) practice-based research network (PBRN). Methods We retrospectively assessed adoption and use of Epic’s MyChart patient portal in the first 12 months after MyChart was made available to the OCHIN PBRN. We examined electronic health record data from 36,549 patients aged ≥18 years who were offered a MyChart access code between May 1, 2012, and April 30, 2013, across the OCHIN PBRN in 13 states. Results Overall, 29% of patients offered an access code logged into their MyChart account. Superusers (minimum of 2 logins per month over a 12-month period) accounted for 6% of users overall. Men, nonwhite patients, Hispanic patients, Spanish-speaking patients, and those with the lowest incomes were significantly less likely to activate. Publicly insured and uninsured patients were also less likely to log in to their MyChart account, but once activated they were more likely than privately insured patients to use MyChart functions. Conclusions Our findings suggest that, compared with others, certain patient groups may be less interested in using patient portals or may have experienced significant barriers that prevented use. Making portal access available is a first step. Additional studies need to specifically identify health system–, clinic-, and patient-level barriers and facilitators to portal adoption and use. PMID:27613792

  14. Vendor System Vulnerability Testing Test Plan

    SciTech Connect

    James R. Davidson

    2005-01-01

    The Idaho National Laboratory (INL) prepared this generic test plan to provide clients (vendors, end users, program sponsors, etc.) with a sense of the scope and depth of vulnerability testing performed at the INL’s Supervisory Control and Data Acquisition (SCADA) Test Bed and to serve as an example of such a plan. Although this test plan specifically addresses vulnerability testing of systems applied to the energy sector (electric/power transmission and distribution and oil and gas systems), it is generic enough to be applied to control systems used in other critical infrastructures such as the transportation sector, water/waste water sector, or hazardous chemical production facilities. The SCADA Test Bed is established at the INL as a testing environment to evaluate the security vulnerabilities of SCADA systems, energy management systems (EMS), and distributed control systems. It now supports multiple programs sponsored by the U.S. Department of Energy, the U.S. Department of Homeland Security, other government agencies, and private sector clients. This particular test plan applies to testing conducted on a SCADA/EMS provided by a vendor. Before performing detailed vulnerability testing of a SCADA/EMS, an as delivered baseline examination of the system is conducted, to establish a starting point for all-subsequent testing. The series of baseline tests document factory delivered defaults, system configuration, and potential configuration changes to aid in the development of a security plan for in depth vulnerability testing. The baseline test document is provided to the System Provider,a who evaluates the baseline report and provides recommendations to the system configuration to enhance the security profile of the baseline system. Vulnerability testing is then conducted at the SCADA Test Bed, which provides an in-depth security analysis of the Vendor’s system.b a. The term System Provider replaces the name of the company/organization providing the system

  15. The Vulnerability of Elderly Consumers.

    ERIC Educational Resources Information Center

    McGhee, Jerrie L.

    1983-01-01

    Reviews research on the vulnerability of the elderly to consumer fraud. Patterns of consumption, situational characteristics, education and product knowledge, psychological losses, social isolation, and psychosocial transitions influence the elderly's vulnerability and ability to cope with consumer abuse. Higher educational attainment and greater…

  16. The Naïve nurse: revisiting vulnerability for nursing

    PubMed Central

    2012-01-01

    Background Nurses in the Western world have given considerable attention to the concept of vulnerability in recent decades. However, nurses have tended to view vulnerability from an individualistic perspective, and have rarely taken into account structural or collective dimensions of the concept. As the need grows for health workers to engage in the global health agenda, nurses must broaden earlier works on vulnerability, noting that conventional conceptualizations and practical applications on the notion of vulnerability warrant extension to include more collective conceptualizations thereby making a more complete understanding of vulnerability in nursing discourse. Discussion The purpose of this paper is to examine nursing contributions to the concept of vulnerability and consider how a broader perspective that includes socio-political dimensions may assist nurses to reach beyond the immediate milieu of the patient into the dominant social, political, and economic structures that produce and sustain vulnerability. Summary By broadening nurse’s conceptualization of vulnerability, nurses can obtain the consciousness needed to move beyond a peripheral role of nursing that has been dominantly situated within institutional settings to contribute in the larger arena of social, economic, political and global affairs. PMID:22520841

  17. Locating and communicating with at-risk populations about emergency preparedness: the vulnerable populations outreach model.

    PubMed

    Klaiman, Tamar; Knorr, Deborah; Fitzgerald, Shannon; Demara, Philip; Thomas, Chad; Heake, George; Hausman, Alice

    2010-10-01

    Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.

  18. Schizophrenia: vulnerability versus disease.

    PubMed Central

    Tsuang, Ming T.; Stone, William S.; Faraone, Stephen V.

    2000-01-01

    One of the most important trends in the treatment of schizophrenia involves its early diagnosis and intervention. The ultimate goal of research is the prevention of the disorder, A major impediment to the development of prevention strategies, however, is that we do not yet know what the liability for schizophrenia is before the onset of psychosis. Consequently, early treatment attempts are focused on the “prodrome,” which involves the early symptoms of psychosis. In a companion paper, we recently suggested that prevention work should focus not only on the prodrome, but also on “schizotaxia,” which is a clinically meaningful condition that may reflect the vulnerability to schizophrenia in the absence of psychosis. Because schizotaxia can be assessed prior to the prodrome, studies of schizotaxia might lead to more effective prevention programs. We continue the characterization of schizotaxia in this paper by focusing on the etiological roots of schizotaxia, plus its likely neurodevelopmental course, clinical expression, and treatment. Finally, the importance of including neurobiological variables in the conceptualization and eventual diagnosis of schizotaxia is reviewed. PMID:22034456

  19. Reduction of Behavioral Psychological Symptoms of Dementia by Multimodal Comprehensive Care for Vulnerable Geriatric Patients in an Acute Care Hospital: A Case Series

    PubMed Central

    Honda, Miwako; Ito, Mio; Ishikawa, Shogo; Takebayashi, Yoichi; Tierney, Lawrence

    2016-01-01

    Management of Behavioral and Psychological Symptoms of Dementia (BPSD) is a key challenge in geriatric dementia care. A multimodal comprehensive care methodology, Humanitude, with eye contact, verbal communication, and touch as its elements, was provided to three geriatric dementia patients for whom conventional nursing care failed in an acute care hospital. Each episode was evaluated by video analysis. All patients had advanced dementia with BPSD. Failure of care was identified by patient's shouting, screaming, or abrupt movements of limbs. In this case series, conventional care failed for all three patients. Each element of care communication was much shorter than in Humanitude care, which was accepted by the patients. The average of the elements performed during the care was eye contact 0.6%, verbal communication 15.7%, and touch 0.1% in conventional care and 12.5%, 54.8%, and 44.5% in Humanitude care, respectively. The duration of aggressive behavior of each patient during care was 25.0%, 25.4%, and 66.3% in conventional care and 0%, 0%, and 0.3% in Humanitude, respectively. In our case series, conventional care was provided by less eye contact, verbal communication, and touch. The multimodal comprehensive care approach, Humanitude, decreased BPSD and showed success by patients' acceptance of care. PMID:27069478

  20. A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

    PubMed

    Rocque, Rhea; Leanza, Yvan

    2015-01-01

    Communication difficulties persist between patients and physicians. In order to improve care, patients' experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients' experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients' experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients' experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients' evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all

  1. CompuServe in the Classroom.

    ERIC Educational Resources Information Center

    Riedl, Richard

    1986-01-01

    Describes a student magazine publishing project in which the participating junior high school students accessed the information utility, CompuServe, to gather current and accurate background information for their magazine articles. Student use of CompuServe is described, and the value and costs of using CompuServe are discussed. (MBR)

  2. CompuServe in the Classroom.

    ERIC Educational Resources Information Center

    Riedl, Richard

    1986-01-01

    Describes a student magazine publishing project in which the participating junior high school students accessed the information utility, CompuServe, to gather current and accurate background information for their magazine articles. Student use of CompuServe is described, and the value and costs of using CompuServe are discussed. (MBR)

  3. Reduced cardiac autonomic response to deep breathing: A heritable vulnerability trait in patients with schizophrenia and their healthy first-degree relatives.

    PubMed

    Liu, Yu-Wen; Tzeng, Nian-Sheng; Yeh, Chin-Bin; Kuo, Terry B J; Huang, San-Yuan; Chang, Chuan-Chia; Chang, Hsin-An

    2016-09-30

    Reduced resting heart rate variability (HRV) has been observed in patients with schizophrenia and their relatives, suggesting genetic predispositions. However, findings have not been consistent. We assessed cardiac autonomic response to deep breathing in first-degree relatives of patients with schizophrenia (n=45; 26 female; aged 39.69±14.82 years). Data were compared to healthy controls (n=45; 26 female; aged 38.27±9.79 years) matched for age, gender, body mass index and physical activity as well as to unmedicated patients with acute schizophrenia (n=45; 25 female; aged 37.31±12.65 years). Electrocardiograms were recorded under supine resting and deep-breathing conditions (10-12breaths/min). We measured HRV components including variance, low-frequency (LF) power, which may reflect baroreflex function, high-frequency (HF) power, which reflects cardiac parasympathetic activity, and LF/HF ratio, which may reflect sympatho-vagal balance. Patients rather than relatives exhibited lower resting-state HRV (variance, LF, and HF) than controls. As expected, deep breathing induced an increase in variance and HF-HRV in controls. However, such a response was significantly reduced in both patients and their relatives. In conclusion, the diminished cardiac autonomic reactivity to deep breathing seen in patients and their unaffected relatives indicates that this pattern of cardiac autonomic dysregulation may be regarded as a genetic trait marker for schizophrenia.

  4. Research with vulnerable human beings.

    PubMed

    Tangwa, Godfrey B

    2009-11-01

    Some categories of human beings are particularly vulnerable vis-à-vis medical research. Vulnerability could be considered as the liability to be harmed, exploited, deceived, cheated, wronged, or otherwise unfairly treated, in roughly that descending order of importance. Vulnerable human beings obviously include the incompetent (minors and mentally handicapped adults), the desperately poor, ill or ignorant, prisoners, refugees, pregnant women, subordinates in highly authoritarian systems, etc. Vulnerability in itself does not imply that no research whatsoever should be carried out with such categories of humans but only that it should be carried out only under very special conditions. In this paper I treat of vulnerability in research of particularly developing world populations; of the types of research which exploit such vulnerability, and of why and how research subjects should be protected. The aim in this paper is to stimulate practical reflection on the possible vulnerabilities of potential research subjects that researchers or investigators need to avoid exploiting rather than on an adequate theoretical treatment of the issue.

  5. Identifying Frailty Among Vulnerable Populations

    PubMed Central

    Salem, Benissa E.; Nyamathi, Adeline; Phillips, Linda R.; Mentes, Janet; Sarkisian, Catherine; Brecht, Lynn

    2014-01-01

    Frailty is a significant public health issue which is experienced by homeless and other vulnerable adults; to date, a frailty framework has not been proposed to guide researchers who study this hard-to-reach population. The Frailty Framework among Homeless and other Vulnerable Populations (FFHVP) has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, i.e. situational, health-related, behavioral, resource, biological, and environmental factors which contribute to physical, psychological and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions. PMID:24469090

  6. Safeguard Vulnerability Analysis Program (SVAP)

    SciTech Connect

    Gilman, F.M.; Dittmore, M.H.; Orvis, W.J.; Wahler, P.S.

    1980-06-23

    This report gives an overview of the Safeguard Vulnerability Analysis Program (SVAP) developed at Lawrence Livermore National Laboratory. SVAP was designed as an automated method of analyzing the safeguard systems at nuclear facilities for vulnerabilities relating to the theft or diversion of nuclear materials. SVAP addresses one class of safeguard threat: theft or diversion of nuclear materials by nonviolent insiders, acting individually or in collusion. SVAP is a user-oriented tool which uses an interactive input medium for preprocessing the large amounts of safeguards data. Its output includes concise summary data as well as detailed vulnerability information.

  7. Severe hypoglycemia identifies vulnerable patients with type 2 diabetes at risk for premature death and all-site cancer: the Hong Kong diabetes registry.

    PubMed

    Kong, Alice P S; Yang, Xilin; Luk, Andrea; Ma, Ronald C W; So, Wing Yee; Ozaki, Risa; Ting, Rose; Cheung, Kitty; Ho, Chung Shun; Chan, Michael H M; Chow, Chun Chung; Chan, Juliana C N

    2014-04-01

    OBJECTIVE We examined the associations of clinical profiles in type 2 diabetic patients who developed severe hypoglycemia and their clinical outcomes, including death and all-site cancer. RESEARCH DESIGN AND METHODS A consecutive cohort of 8,767 type 2 diabetic patients with and without severe hypoglycemia in the 12 months before enrollment were recruited between 1995 and 2007, with follow-up until 2009. Severe hypoglycemia was defined by ICD-9 codes as hospitalizations resulting from hypoglycemia. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% CIs of clinical factors collected at enrollment for severe hypoglycemia. RESULTS In this cohort, mean age was 57.4 (SD 13.2) years and median disease duration of diabetes was 5 (interquartile range [IQR] 1-11) years. During a median follow-up of 6.71 (IQR 3.47-10.38) years, 235 patients had severe hypoglycemia (incidence 3.96 [95% CI 3.45-4.46] per 1,000 patient-years). At enrollment, patients with and without severe hypoglycemia had similar cancer rates. During follow-up, patients with severe hypoglycemia had a higher incidence of all-site cancer (13.4 vs. 6.4%, P < 0.0001) and mortality (32.8 vs. 11.2%, P < 0.0001) than those without severe hypoglycemia. After adjusting for confounders, old age, low BMI, high glycated hemoglobin, low triglyceride (TG), low LDL cholesterol (LDL-C), albuminuria, and chronic kidney disease were independent predictors for severe hypoglycemia. CONCLUSIONS In type 2 diabetes, severe hypoglycemia is associated with advanced age, renal dysfunction, poor glycemic control, and cancer subphenotypes (low BMI, low LDL-C, and low TG).

  8. Attentional biases and vulnerability to depression.

    PubMed

    Gallardo Pérez, M; Baños Rivera, R M; Belloch Fuster, A; Ruipérez Rodríguez, M A

    1999-05-01

    This study was designed to examine selective processing of emotional information in depression. It focuses on possible attentional biases in depression, and whether such biases constitute a cognitive vulnerability factor to suffer from the disorder or, on the contrary, they reflect a feature associated exclusively with the clinical level of depression. 81 participants were included in the study: 15 with a diagnosis of Major Depression; 17 were diagnosed as Dysthymia; 11 participants scored over 18 in the Beck Depression Inventory (Beck, Rush, Shaw, & Emery, 1979); 15 participants, in whom a sad mood state was induced by an experimental mood induction (Velten technique + music, or biographical recall + music); and 23 participants as a normal-control group. All participants were presented with the emotional Stroop task. The data indicated that attentional bias was only present in the group of patients with Major Depression, so it does not seem to be a cognitive vulnerability factor for this disorder.

  9. Vulnerable child syndrome, parental perception of child vulnerability, and emergency department usage.

    PubMed

    Chambers, Patricia L; Mahabee-Gittens, E Melinda; Leonard, Anthony C

    2011-11-01

    Vulnerable child syndrome (VCS) describes children perceived to be at risk for behavioral, developmental, or medical problems. Families with the dynamics of VCS overuse health care resources with frequent visits to doctors' offices. The objective of the study was to explore the relationship between VCS, parental perception of child vulnerability (PPCV), and frequency of emergency department (ED) visits. Parents of patients 1 to 15 years old presenting with nonurgent complaints to a pediatric ED were eligible. Participants completed questionnaires in which the Vulnerable Child Scale was used to generate a measure of PPCV. Primary outcomes included number of ED visits and PPCV assignment. Children were divided into 2 PPCV groups by Vulnerable Child Scale score: less than 40 (high PPCV) versus 40 or greater (low PPCV). The cutoff point was chosen as 1 SD (7.3) from the sample mean (46.8) on the vulnerable end of the scale (low scores). The mean ages of the 351 parents and children were 30 (SD, 7.7) years and 5 (SD, 3.9) years, respectively; 17% of children had high PPCV. Eleven variables differed statistically between subjects with high and low PPCV including number of ED visits and hospital admissions, excellent reported child health, pregnancy problems, delivery problems, child mental health problems, parent mental health problems, and child developmental problems. Our results reveal that children with higher PPCV had an increased number of ED visits, and risk factors for higher perceived vulnerability scores were identified. Future investigation on ways to intervene with families with the dynamics of VCS may be warranted.

  10. Inductionless or limited shock testing is possible in most patients with implantable cardioverter- defibrillators/cardiac resynchronization therapy defibrillators: results of the multicenter ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations).

    PubMed

    Day, John D; Doshi, Rahul N; Belott, Peter; Birgersdotter-Green, Ulrika; Behboodikhah, Mahnaz; Ott, Peter; Glatter, Kathryn A; Tobias, Serge; Frumin, Howard; Lee, Byron K; Merillat, John; Wiener, Isaac; Wang, Samuel; Grogin, Harlan; Chun, Sung; Patrawalla, Rob; Crandall, Brian; Osborn, Jeffrey S; Weiss, J Peter; Lappe, Donald L; Neuman, Stacey

    2007-05-08

    Implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators have relied on multiple ventricular fibrillation (VF) induction/defibrillation tests at implantation to ensure that the device can reliably sense, detect, and convert VF. The ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations) is the first large, multicenter, prospective trial comparing vulnerability safety margin testing versus defibrillation safety margin testing with a single VF induction/defibrillation. A total of 426 patients receiving an implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator underwent vulnerability safety margin or defibrillation safety margin screening at 14 J in a randomized order. After this, patients underwent confirmatory testing, which required 2 VF conversions without failure at < or = 21 J. Patients who passed their first 14-J and confirmatory tests, irrespective of the results of their second 14-J test, had their devices programmed to a 21-J shock for ventricular tachycardia (VT) or VF > or = 200 bpm and were followed up for 1 year. Of 420 patients who underwent 14-J vulnerability safety margin screening, 322 (76.7%) passed. Of these, 317 (98.4%) also passed 21-J confirmatory tests. Of 416 patients who underwent 14-J defibrillation safety margin screening, 343 (82.5%) passed, and 338 (98.5%) also passed 21-J confirmatory tests. Most clinical VT/VF episodes (32 of 37, or 86%) were terminated by the first shock, with no difference in first shock success. In all observed cases in which the first shock was unsuccessful, subsequent shocks terminated VT/VF without complication. Although spontaneous episodes of fast VT/VF were limited, there was no difference in the odds of first shock efficacy between groups. Screening with vulnerability safety margin or defibrillation safety

  11. Cognitive vulnerabilities as mediators between emotional abuse and depressive symptoms.

    PubMed

    Padilla Paredes, Patricia; Calvete, Esther

    2014-01-01

    This study tested whether childhood parental emotional abuse and peer emotional bullying serve as antecedents of depression in adolescence and identified the cognitive mechanisms involved in this process. It was hypothesized that the experience of emotional abuse would predict depressive symptoms via development of rumination and negative inferences. A 3-wave longitudinal study was carried out with 998 adolescents (471 girls and 526 boys) between 13 and 17 years of age. Results showed that emotional abuse by parents and peers at Time 1 predicted a worsening of several cognitive vulnerabilities at Time 2. In addition, brooding mediated between the experiences of abuse and the increase of depressive symptoms at Time 3. Thus, findings suggest that the experiences of childhood emotional abuse by parents and peers serve as antecedents to develop a negative cognitive style, vulnerability that, once developed, is a risk factor for the onset of depressive symptoms in adolescence.

  12. Association between IVUS findings and adverse outcomes in patients with coronary artery disease: the VIVA (VH-IVUS in Vulnerable Atherosclerosis) Study.

    PubMed

    Calvert, Patrick A; Obaid, Daniel R; O'Sullivan, Michael; Shapiro, Leonard M; McNab, Duncan; Densem, Cameron G; Schofield, Peter M; Braganza, Denise; Clarke, Sarah C; Ray, Kausik K; West, Nick E J; Bennett, Martin R

    2011-08-01

    The purpose of this study was to determine whether thin-capped fibroatheromata (TCFA) identified by virtual histology intravascular ultrasound (VH-IVUS) are associated with major adverse cardiac events (MACE) on individual plaque or whole patient analysis. Post-mortem studies have identified TCFA as the substrate for most myocardial infarctions. However, little is known about the natural history of individual TCFA and their link with MACE. VH-IVUS provides a method of identifying plaques in vivo that are similar (although not identical) to histologically defined TCFA, and has been validated in human atherectomy and post-mortem studies. One hundred seventy patients with stable angina or troponin-positive acute coronary syndrome referred for percutaneous coronary intervention (PCI) were prospectively enrolled and underwent 3-vessel VH-IVUS pre-PCI and also post-PCI in the culprit vessel. MACE consisted of death, myocardial infarction, or unplanned revascularization. In all, 30,372 mm of VH-IVUS were analyzed. Eighteen MACE occurred in 16 patients over a median follow-up of 625 days (interquartile range: 463 to 990 days); 1,096 plaques were classified, and 19 lesions resulted in MACE (13 nonculprit lesions and 6 culprit lesions). Nonculprit lesion factors associated with nonrestenotic MACE included VHTCFA (hazard ratio [HR]: 7.53, p = 0.038) and plaque burden >70% (HR: 8.13, p = 0.011). VHTCFA (HR: 8.16, p = 0.007), plaque burden >70% (HR: 7.48, p < 0.001), and minimum luminal area <4 mm(2) (HR: 2.91, p = 0.036) were associated with total MACE. On patient-based analysis, the only factor associated with nonrestenotic MACE was 3-vessel noncalcified VHTCFA (HR: 1.79, p = 0.004). VH-IVUS TCFA was associated with nonrestenotic and total MACE on individual plaque analysis, and noncalcified VHTCFA was associated with nonrestenotic and total MACE on whole-patient analysis, demonstrating that VH-IVUS can identify plaques at increased risk of subsequent events. The preservation

  13. Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey

    PubMed Central

    2013-01-01

    Background Data on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes. Methods From September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher’s exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA). Results Of the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete

  14. Depression prevalence and primary care among vulnerable patients at a free outpatient clinic in Paris, France, in 2010: results of a cross-sectional survey.

    PubMed

    Rondet, Claire; Cornet, Philippe; Kaoutar, Bacha; Lebas, Jacques; Chauvin, Pierre

    2013-10-11

    Data on the prevalence of depression and on how a depressive episode prompts the sufferer to seek primary care are not scarce, but the available evidence on the prevalence of depression among immigrants and poor people who frequent general practice facilities is scarce. The Baudelaire Outpatient Clinic at the Saint-Antoine Hospital in Paris provides free medical and social assistance to the poor and/or uninsured. The goal of our study was to estimate the prevalence of depression among these outpatients, to characterize this depressed population, and to analyze its demand for primary care for depressive episodes. From September to December 2010, we conducted a cross-sectional, observational survey among users of the Baudelaire Outpatient Clinic. French-speaking patients attending the clinic between September 15 and December 30, 2010 who agreed to answer a questionnaire administered face-to-face before their consultation were included in the study. The chi-squared test (or Fisher's exact test for small samples) was used for the comparisons of proportions. Logistic regression models were estimated, along with the odds ratios (OR) and their 95% confidence intervals (95% CIs), for the multivariate analysis of factors associated with depression and healthcare-seeking. Models were estimated separately for men and women, since sex was an interaction factor. The statistical analyses were performed using Stata v. 10 software (StataCorp LP, College Station, Texas, USA). Of the 250 patients included (mean age: 45 years), 52.0% were men and 52.4% were immigrants. Close to 40% of them reported having no supplemental health insurance. The estimated prevalence of depression in this population was 56.7%. Depression was more prevalent among the women, immigrants, and people from the poorer socioeconomic groups. Only half of these depressed patients, mostly women, reported having discussed their depression with a physician. French nationality and complete health insurance coverage

  15. [Professional or private? Physician's role between success and vulnerability].

    PubMed

    Vetlesen, A J

    2001-03-30

    This article discusses the role of the doctor in relation to the patient. How can the doctor succeed in presenting himself of herself as both professional and personal? It is argued that these two aspects need not be in conflict but may complement each other. The appreciation of this dual dimension of being a doctor is, however, threatened by exaggerated emphasis on the doctor as a particularly successful person. Contemporary medical education does not sufficiently counter the widespread perception of doctors as in some way "above" other people, including their patients. In contrast, the significance of vulnerability, understood as a deep-seated, non-optional feature of being human, is brought to bear on the way the doctor should be perceived--by himself and by society--as no less vulnerable than other people. Correctly understood, the vulnerability that doctors share with patients is a prerequisite for relating to the patient's ills and concerns.

  16. Assessing the Agricultural Vulnerability for India under Changing Climate

    NASA Astrophysics Data System (ADS)

    Sharma, Tarul; Vardhan Murari, Harsha; Karmakar, Subhankar; Ghosh, Subimal; Singh, Jitendra

    2016-04-01

    Global climate change has proven to show majorly negative impacts for the far future. These negative impacts adversely affect almost all the fields including agriculture, water resources, tourism, and marine ecosystem. Among these, the effects on agriculture are considered to be of prime importance since its regional impacts can directly affect the global food security. Under such lines, it becomes essential to understand how climate change directs agricultural production for a region along with its vulnerability. In India, rice and wheat are considered as major staple diet and hence understanding its production loss/gain due to regional vulnerability to climate change becomes necessary. Here, an attempt has been made to understand the agricultural vulnerability for rice and wheat, considering yield as a function of temperature and precipitation during growing period. In order to accomplish this objective, the ratio of actual to potential evapo-transpiration has been considered which serves as a reliable indicator; with more this ratio towards unity, less vulnerable will be the region. The current objective needs an integration of climatic, hydrological and agricultural parameters; that can be achieved by simulating a climate data driven hydrologic (Variable Infiltration Capacity, VIC) model and a crop (Decision Support System for Agrotechnology Transfer, DSSAT) model. The proposed framework is an attempt to derive a crop vulnerability map that can facilitate in strategizing adaption practices which can reduce the adverse impacts of climate change in future.

  17. Vulnerability, disability, and palliative end-of-life care.

    PubMed

    Stienstra, Deborah; Chochinov, Harvey Max

    2006-01-01

    Palliative care has paid exceedingly little attention to the needs of disabled people nearing the end of life. It is often assumed that these individuals, like all patients with little time left to live, arrive at palliative care with various needs and vulnerabilities that by and large, can be understood and accommodated within routine standards of practice. However, people with longstanding disabilities have lived with and continue to experience various forms of prejudice, bias, disenfranchisement, and devaluation. Each of these impose heightened vulnerability, requiring an honest, thoughtful, yet difficult revisiting of the standard model of palliative care. A proposed Vulnerability Model of Palliative Care attempts to incorporate the realities of life with disability and how a contextualized understanding of vulnerability can inform how we approach quality, compassionate palliative care for marginalized persons approaching death.

  18. Multimodal spectroscopy detects features of vulnerable atherosclerotic plaque

    PubMed Central

    Šćepanović, Obrad R.; Fitzmaurice, Maryann; Miller, Arnold; Kong, Chae-Ryon; Volynskaya, Zoya; Dasari, Ramachandra R.; Kramer, John R.; Feld, Michael S.

    2011-01-01

    Early detection and treatment of rupture-prone vulnerable atherosclerotic plaques is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy—termed multimodal spectroscopy (MMS)—provides detailed biochemical information about tissue and can detect vulnerable plaque features: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), and thrombus. Ex vivo MMS spectra are collected from 12 patients that underwent carotid endarterectomy or femoral bypass surgery. Data are collected by means of a unitary MMS optical fiber probe and a portable clinical instrument. Blinded histopathological analysis is used to assess the vulnerability of each spectrally evaluated artery lesion. Modeling of the ex vivo MMS spectra produce objective parameters that correlate with the presence of vulnerable plaque features: TFC with fluorescence parameters indicative of collagen presence; NC∕SFC with a combination of diffuse reflectance β-carotene∕ceroid absorption and the Raman spectral signature of lipids; and thrombus with its Raman signature. Using these parameters, suspected vulnerable plaques can be detected with a sensitivity of 96% and specificity of 72%. These encouraging results warrant the continued development of MMS as a catheter-based clinical diagnostic technique for early detection of vulnerable plaques. PMID:21280896

  19. Multimodal spectroscopy detects features of vulnerable atherosclerotic plaque

    NASA Astrophysics Data System (ADS)

    Šćepanović, Obrad R.; Fitzmaurice, Maryann; Miller, Arnold; Kong, Chae-Ryon; Volynskaya, Zoya; Dasari, Ramachandra R.; Kramer, John R.; Feld, Michael S.

    2011-01-01

    Early detection and treatment of rupture-prone vulnerable atherosclerotic plaques is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy-termed multimodal spectroscopy (MMS)-provides detailed biochemical information about tissue and can detect vulnerable plaque features: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), and thrombus. Ex vivo MMS spectra are collected from 12 patients that underwent carotid endarterectomy or femoral bypass surgery. Data are collected by means of a unitary MMS optical fiber probe and a portable clinical instrument. Blinded histopathological analysis is used to assess the vulnerability of each spectrally evaluated artery lesion. Modeling of the ex vivo MMS spectra produce objective parameters that correlate with the presence of vulnerable plaque features: TFC with fluorescence parameters indicative of collagen presence; NC/SFC with a combination of diffuse reflectance β-carotene/ceroid absorption and the Raman spectral signature of lipids; and thrombus with its Raman signature. Using these parameters, suspected vulnerable plaques can be detected with a sensitivity of 96% and specificity of 72%. These encouraging results warrant the continued development of MMS as a catheter-based clinical diagnostic technique for early detection of vulnerable plaques.

  20. Groundwater vulnerability on small islands

    NASA Astrophysics Data System (ADS)

    Holding, S.; Allen, D. M.; Foster, S.; Hsieh, A.; Larocque, I.; Klassen, J.; van Pelt, S. C.

    2016-12-01

    The majority of naturally occurring freshwater on small islands is groundwater, which is primarily recharged by precipitation. Recharge rates are therefore likely to be impacted by climate change. Freshwater resources on small islands are particularly vulnerable to climate change because they are limited in size and easily compromised. Here we have compiled available aquifer system characteristics and water-use data for 43 small island developing states distributed worldwide, based on local expert knowledge, publications and regional data sets. Current vulnerability was assessed by evaluating the recharge volume per capita. For future vulnerability, climate change projections were used to estimate changes in aquifer recharge. We find that 44% of islands are in a state of water stress, and while recharge is projected to increase by as much as 117% on 12 islands situated in the western Pacific and Indian Ocean, recharge is projected to decrease by up to 58% on the remaining 31 islands. Of great concern is the lack of enacted groundwater protection legislation for many of the small island developing states identified as highly vulnerable to current and future conditions. Recharge indicators, shown alongside the state of legal groundwater protections, provide a global picture of groundwater supply vulnerability under current and future climate change conditions.

  1. Are Vulnerability Disclosure Deadlines Justified?

    SciTech Connect

    Miles McQueen; Jason L. Wright; Lawrence Wellman

    2011-09-01

    Vulnerability research organizations Rapid7, Google Security team, and Zero Day Initiative recently imposed grace periods for public disclosure of vulnerabilities. The grace periods ranged from 45 to 182 days, after which disclosure might occur with or without an effective mitigation from the affected software vendor. At this time there is indirect evidence that the shorter grace periods of 45 and 60 days may not be practical. However, there is strong evidence that the recently announced Zero Day Initiative grace period of 182 days yields benefit in speeding up the patch creation process, and may be practical for many software products. Unfortunately, there is also evidence that the 182 day grace period results in more vulnerability announcements without an available patch.

  2. Identifying and mapping community vulnerability.

    PubMed

    Morrow, B H

    1999-03-01

    Disaster vulnerability is socially constructed, i.e., it arises out of the social and economic circumstances of everyday living. Most often discussed from the perspective of developing nations, this article extends the argument using American demographic trends. Examples from recent disasters, Hurricane Andrew in particular, illustrate how certain categories of people, such as the poor, the elderly, women-headed households and recent residents, are at greater risk throughout the disaster response process. Knowledge of where these groups are concentrated within communities and the general nature of their circumstances is an important step towards effective emergency management. Emergency planners, policy-makers and responding organisations are encouraged to identify and locate high-risk sectors on Community Vulnerability Maps, integrating this information into GIS systems where feasible. Effective disaster management calls for aggressively involving these neighbourhoods and groups at all levels of planning and response, as well as mitigation efforts that address the root causes of vulnerability.

  3. [Mapping environmental vulnerability from ETM + data in the Yellow River Mouth Area].

    PubMed

    Wang, Rui-Yan; Yu, Zhen-Wen; Xia, Yan-Ling; Wang, Xiang-Feng; Zhao, Geng-Xing; Jiang, Shu-Qian

    2013-10-01

    The environmental vulnerability retrieval is important to support continuing data. The spatial distribution of regional environmental vulnerability was got through remote sensing retrieval. In view of soil and vegetation, the environmental vulnerability evaluation index system was built, and the environmental vulnerability of sampling points was calculated by the AHP-fuzzy method, then the correlation between the sampling points environmental vulnerability and ETM + spectral reflectance ratio including some kinds of conversion data was analyzed to determine the sensitive spectral parameters. Based on that, models of correlation analysis, traditional regression, BP neural network and support vector regression were taken to explain the quantitative relationship between the spectral reflectance and the environmental vulnerability. With this model, the environmental vulnerability distribution was retrieved in the Yellow River Mouth Area. The results showed that the correlation between the environmental vulnerability and the spring NDVI, the September NDVI and the spring brightness was better than others, so they were selected as the sensitive spectral parameters. The model precision result showed that in addition to the support vector model, the other model reached the significant level. While all the multi-variable regression was better than all one-variable regression, and the model accuracy of BP neural network was the best. This study will serve as a reliable theoretical reference for the large spatial scale environmental vulnerability estimation based on remote sensing data.

  4. Chronic Stress-Induced Hippocampal Vulnerability: The Glucocorticoid Vulnerability Hypothesis

    PubMed Central

    Conrad, Cheryl D.

    2009-01-01

    Synopsis The hippocampus, a limbic structure important in learning and memory, is particularly sensitive to chronic stress and to glucocorticoids. While glucocorticoids are essential for an effective stress response, their oversecretion was originally hypothesized to contribute to agerelated hippocampal degeneration. However, conflicting findings were reported on whether prolonged exposure to elevated glucocorticoids endangered the hippocampus and whether the primate hippocampus even responded to glucocorticoids as the rodent hippocampus did. This review discusses the seemingly inconsistent findings about the effects of elevated and prolonged glucocorticoids on hippocampal health and proposes that a chronic stress history, which includes repeated elevation of glucocorticoids, may make the hippocampus vulnerable to potential injury. Studies are described to show that chronic stress or prolonged exposure to glucocorticoids can compromise the hippocampus by producing dendritic retraction, a reversible form of plasticity that includes dendritic restructuring without irreversible cell death. Conditions that produce dendritic retraction are hypothesized to make the hippocampus vulnerable to neurotoxic or metabolic challenges. Of particular interest is the finding that the hippocampus can recover from dendritic retraction without any noticeable cell loss. When conditions surrounding dendritic retraction are present, the potential for harm is increased because dendritic retraction may persist for weeks, months or even years, thereby broadening the window of time during which the hippocampus is vulnerable to harm, called the Glucocorticoid Vulnerability Hypothesis. The relevance of these findings is discussed with regard to conditions exhibiting parallels in hippocampal plasticity, including Cushing’s disease, Major Depressive Disorder (MDD), and Post-Traumatic Stress Disorder (PTSD). PMID:19317179

  5. Food Chain Security and Vulnerability

    NASA Astrophysics Data System (ADS)

    Brunet, Sébastien; Delvenne, Pierre; Claisse, Frédéric

    In our contemporary societies, the food chain could be defined as a macro-technical system, which depends on a wide variety of actors and risks analysis methods. In this contribution, risks related to the food chain are defined in terms of "modern risks" (Beck 1992). The whole national economic sector of food production/distribution is vulnerable to a local accident, which can affect the functioning of food chain, the export programs and even the political system. Such a complex socio-technical environment is undoubtedly vulnerable to intentional act such as terrorism.

  6. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray in its stowed position. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  7. Calories and fat per serving (image)

    MedlinePlus

    ... and stores the rest in the form of fat. A calorie is a calorie, whether it comes ... between them is the number of calories, nutrients, fat, and other ingredients in a typical serving . Calories ...

  8. Healthy Foods under $1 Per Serving

    MedlinePlus

    ... vitamin A Homemade or Canned Beans (kidney, pinto, garbanzo or navy) Great for: Green salads, casseroles, stews, ... beans and black beans to white beans and garbanzo beans. What's a serving? Each can contains about ...

  9. The unintended consequences of The Centers for Medicare and Medicaid Services pay-for-performance structures on safety-net hospitals and the low-income, medically vulnerable population.

    PubMed

    Fos, Elmer B

    2017-02-01

    Safety-net hospitals are hospitals with patient mix that is substantially composed of the uninsured, underinsured, and low-income, medically vulnerable patient populations. They are the hospitals of last resort for poor patients. This article examined the impact of The Centers for Medicare and Medicaid Services pay-for-performance reimbursement policies on the financial viability of safety-net hospitals. Studies showed that these policies, which are based on the principle of reward and punishment, might have unintentionally placed safety-net hospitals on financial disadvantage compared to other hospital organizations. Several studies implied that these payment structures might have resulted in a situation where safety-net hospitals that are serving poor patient populations become more susceptible to penalties than hospitals that are serving affluent patients.

  10. The Vulnerable Plaque: the Real Villain in Acute Coronary Syndromes

    PubMed Central

    Liang, Michael; Puri, Aniket; Devlin, Gerard

    2011-01-01

    The term "vulnerable plaque" refers to a vascular lesion that is prone to rupture and may result in life-threatening events which include myocardial infarction. It consists of thin-cap fibroatheroma and a large lipid core which is highly thrombogenic. Acute coronary syndromes often result from rupture of vulnerable plaques which frequently are only moderately stenosed and not visible by conventional angiography. Several invasive and non-invasive strategies have been developed to assess the burden of vulnerable plaques. Intravascular ultrasound provides a two-dimensional cross-sectional image of the arterial wall and can help assess the plaque burden and composition. Optical coherent tomography offers superior resolution over intravascular ultrasound. High-resolution magnetic resonance imaging provides non-invasive imaging for visualizing fibrous cap thickness and rupture in plaques. In addition, it may be of value in assessing the effects of treatments, such as lipid-lowering therapy. Technical issues however limit its clinical applicability. The role of multi-slice computed tomography, a well established screening tool for coronary artery disease, remains to be determined. Fractional flow reserve (FFR) may provide physiological functional assessment of plaque vulnerability; however, its role in the management of vulnerable plaque requires further studies. Treatment of the vulnerable patient may involve systemic therapy which currently include statins, ACE inhibitors, beta-blockers, aspirin, and calcium-channel blockers and in the future local therapeutic options such as drug-eluting stents or photodynamic therapy. PMID:21673834

  11. Vulnerability in research ethics: a way forward.

    PubMed

    Lange, Margaret Meek; Rogers, Wendy; Dodds, Susan

    2013-07-01

    Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducibly contextual and that Institutional Review Boards (Research Ethics Committees) can only identify vulnerable participants by carefully examining the details of the proposed research. Hurst, in contrast, defines the vulnerable as those especially at risk of incurring the wrongs to which all research ethics participants are exposed. We offer a more substantive conception of vulnerability than Luna but one that gives rise to a different rubric of responsibilities from Hurst's. While we understand vulnerability to be an ontological condition of human existence, in the context of research ethics, we take the vulnerable to be research subjects who are especially prone to harm or exploitation. Our analysis rests on developing a typology of sources of vulnerability and showing how distinct sources generate distinct obligations on the part of the researcher. Our account emphasizes that the researcher's first obligation is not to make the research participant even more vulnerable than they already are. To illustrate our framework, we consider two cases: that of a vulnerable population involved in international research and that of a domestic population of people with diminished capacity. © 2013 John Wiley & Sons Ltd.

  12. Prioritizing the Components of Vulnerability: A Genetic Algorithm Minimization of Flood Risk

    NASA Astrophysics Data System (ADS)

    Bongolan, Vena Pearl; Ballesteros, Florencio; Baritua, Karessa Alexandra; Junne Santos, Marie

    2013-04-01

    We define a flood resistant city as an optimal arrangement of communities according to their traits, with the goal of minimizing the flooding vulnerability via a genetic algorithm. We prioritize the different components of flooding vulnerability, giving each component a weight, thus expressing vulnerability as a weighted sum. This serves as the fitness function for the genetic algorithm. We also allowed non-linear interactions among related but independent components, viz, poverty and mortality rate, and literacy and radio/ tv penetration. The designs produced reflect the relative importance of the components, and we observed a synchronicity between the interacting components, giving us a more consistent design.

  13. The Vulnerability Assessment & Mitigation Methodology

    DTIC Science & Technology

    2003-01-01

    Defense Systems........................................ 111 A.37. Vulnerabilities That Can Be Incurred from Vaccination ........... 112 A.38...protect against future threats or system failures while mitigating current and past threats and weaknesses. Also, sophisticated adver - saries are...and recovery • Adaptability and learning • Immunological defense systems • Vaccination ISR and Self-Awareness • Intelligence operations • Self

  14. REGIONAL VULNERABILITY: A CONCEPTUAL FRAMEWORK

    EPA Science Inventory

    Regional vulnerability assessment, or ReVA, is an approach to place-based ecological risk assessment that is currently under development by the Office of Research and Development of the U.S. Environmental Protection Agency (EPA). The assessment is done at the scale of EPA region...

  15. Measuring Vulnerability to Stereotype Threat

    ERIC Educational Resources Information Center

    Barnard, Lucy; Burley, Hansel; Olivarez, Arturo; Crooks, Steven

    2008-01-01

    Introduction: In this study, we examined the psychometric properties of an instrument intended to measure vulnerability to stereotype threat. Method: We revised the instrument through assessing score reliability and then examined a domain specific model using confirmatory factor analyses. After examining the responses of the total sample…

  16. Interactive Vulnerability Analysis Enhancement Results

    DTIC Science & Technology

    2012-12-01

    PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD- MM -YYYY) DECEMBER 2012 2. REPORT TYPE FINAL TECHNICAL REPORT 3. DATES...application. Here is a screenshot of IAST finding a Cross-Site Scripting (XSS) vulnerability in a “ Hello World” Scala application: Approved for Public

  17. Glaciology: Vulnerable Antarctic ice shelves

    NASA Astrophysics Data System (ADS)

    Siegert, Martin

    2017-01-01

    The decay of floating ice shelves around Antarctica speeds up ice flow from the continent and contributes to increased sea-level rise. Now, meltwater attributed to warm winds has been discovered on an East Antarctic ice shelf, suggesting greater vulnerability than previously thought.

  18. Selective Neuronal Vulnerability to Oxidative Stress in the Brain

    PubMed Central

    Wang, Xinkun; Michaelis, Elias K.

    2010-01-01

    Oxidative stress (OS), caused by the imbalance between the generation and detoxification of reactive oxygen and nitrogen species (ROS/RNS), plays an important role in brain aging, neurodegenerative diseases, and other related adverse conditions, such as ischemia. While ROS/RNS serve as signaling molecules at physiological levels, an excessive amount of these molecules leads to oxidative modification and, therefore, dysfunction of proteins, nucleic acids, and lipids. The response of neurons to this pervasive stress, however, is not uniform in the brain. While many brain neurons can cope with a rise in OS, there are select populations of neurons in the brain that are vulnerable. Because of their selective vulnerability, these neurons are usually the first to exhibit functional decline and cell death during normal aging, or in age-associated neurodegenerative diseases, such as Alzheimer's disease. Understanding the molecular and cellular mechanisms of selective neuronal vulnerability (SNV) to OS is important in the development of future intervention approaches to protect such vulnerable neurons from the stresses of the aging process and the pathological states that lead to neurodegeneration. In this review, the currently known molecular and cellular factors that contribute to SNV to OS are summarized. Included among the major underlying factors are high intrinsic OS, high demand for ROS/RNS-based signaling, low ATP production, mitochondrial dysfunction, and high inflammatory response in vulnerable neurons. The contribution to the selective vulnerability of neurons to OS by other intrinsic or extrinsic factors, such as deficient DNA damage repair, low calcium-buffering capacity, and glutamate excitotoxicity, are also discussed. PMID:20552050

  19. ServAR: An augmented reality tool to guide the serving of food.

    PubMed

    Rollo, Megan E; Bucher, Tamara; Smith, Shamus P; Collins, Clare E

    2017-05-12

    Accurate estimation of food portion size is a difficult task. Visual cues are important mediators of portion size and therefore technology-based aids may assist consumers when serving and estimating food portions. The current study evaluated the usability and impact on estimation error of standard food servings of a novel augmented reality food serving aid, ServAR. Participants were randomised into one of three groups: 1) no information/aid (control); 2) verbal information on standard serving sizes; or 3) ServAR, an aid which overlayed virtual food servings over a plate using a tablet computer. Participants were asked to estimate the standard serving sizes of nine foods (broccoli, carrots, cauliflower, green beans, kidney beans, potato, pasta, rice, and sweetcorn) using validated food replicas. Wilcoxon signed-rank tests compared median served weights of each food to reference standard serving size weights. Percentage error was used to compare the estimation of serving size accuracy between the three groups. All participants also performed a usability test using the ServAR tool to guide the serving of one randomly selected food. Ninety adults (78.9% female; a mean (95%CI) age 25.8 (24.9-26.7) years; BMI 24.2 (23.2-25.2) kg/m(2)) completed the study. The median servings were significantly different to the reference portions for five foods in the ServAR group, compared to eight foods in the information only group and seven foods for the control group. The cumulative proportion of total estimations per group within ±10%, ±25% and ±50% of the reference portion was greater for those using ServAR (30.7, 65.2 and 90.7%; respectively), compared to the information only group (19.6, 47.4 and 77.4%) and control group (10.0, 33.7 and 68.9%). Participants generally found the ServAR tool easy to use and agreed that it showed potential to support optimal portion size selection. However, some refinements to the ServAR tool are required to improve the user experience. Use of the

  20. [Vulnerability and National Health Service].

    PubMed

    Lima, Cristina

    2006-01-01

    to value life. The article concludes drawing attention to the need to invest in health education, which is just as important as the fair distribution of precious health care resources in reducing harmful risks to the most vulnerable patients.

  1. The run-off resistance (ROR) assessed on MR angiograms may serve as a valid scoring system in patients with symptomatic peripheral arterial disease (PAD) and correlates with the ankle-brachial pressure index (ABI).

    PubMed

    Gorny, O; Santner, W; Fraedrich, G; Jaschke, W; Greiner, A; Schocke, M F

    2012-06-01

    To investigate the correlation between the hemodynamic parameter ankle-brachial pressure index (ABI) and the run-off resistance (ROR) assessed on MR angiograms (MRA) in patients with peripheral arterial disease (PAD) Fontaine Stage I and II and its potential as reliable reporting system in clinical routine. Contrast-enhanced MRA was performed in 321 PAD patients using a 1.5T MR scanner with moving bed technique. The ROR and resting ABI were determined in each patient's leg and correlation analysis was performed using the Pearson test. A significant negative correlation (r = -.513; p<.001) between ROR (mean 11.03±5.42) and resting ABI (mean .81±.26) was identified. An even more pronounced correlation was found in patients younger than median age who had higher ABI values (r = -.608; p<.001). The ROR scoring system evaluated in this series correlates better with the ABI than previously published scoring systems and could be suggested as reporting system for routine MRA evaluation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  2. Depicted serving size: cereal packaging pictures exaggerate serving sizes and promote overserving.

    PubMed

    Tal, Aner; Niemann, Stina; Wansink, Brian

    2017-02-06

    Extensive work has focused on the effects of nutrition label information on consumer behavior on the one hand, and on the effects of packaging graphics on the other hand. However, little work has examined how serving suggestion depictions - graphics relating to serving size - influence the quantity consumers serve themselves. The current work examines the prevalence of exaggerated serving size depictions on product packaging (study 1) and its effects on food serving in the context of cereal (study 2). Study 1 was an observational field survey of cereal packaging. Study 2 was a mixed experimental cross-sectional design conducted at a U.S. university, with 51 student participants. Study 1 coded 158 US breakfast cereals and compared the serving sizes depicted on the front of the box with the suggested serving size stated on the nutrition facts panel. Study 2 measured the amount of cereal poured from exaggerated or accurate serving size depictions. Study 1 compared average servings via t-tests. Study 2 used a mixed model with cereal type as the repeated measure and a compound symmetry covariance matrix. Study 1 demonstrated that portion size depictions on the front of 158 cereal boxes were 64.7% larger (221 vs. 134 calories) than the recommended portions on nutrition facts panels of those cereals. Study 2 showed that boxes that depicted exaggerated serving sizes led people to pour 17.8% more cereal compared to pouring from modified boxes that depicted a single-size portion of cereal matching suggested serving size. This was 42% over the suggested serving size. Biases in depicted serving size depicted on cereal packaging are prevalent in the marketplace. Such biases may lead to overserving, which may consequently lead to overeating. Companies should depict the recommended serving sizes, or otherwise indicate that the depicted portion represents an exaggerated serving size.

  3. Global trends and vulnerabilities of mangrove forests

    NASA Astrophysics Data System (ADS)

    Simard, M.; Fatoyinbo, T. E.; Rivera-Monroy, V. H.; Castaneda, E.; Roy Chowdhury, R.

    2015-12-01

    Mangrove forests are located along Earth's coastlines and estuaries within tropical and subtropical latitudes. They provide numerous services functioning as an extraordinary carbon sequestration system and serving as habitat and nursery for fish, crustaceans and amphibians. To coastal populations, they provide livelihood, food, lumber and act as an effective protection against tsunamis, storm surges and hurricanes. Their vulnerability to sea level rise is strongly related to their extraordinary ability to accumulate soils, which is in part related to their productivity and therefore canopy structure. As a first step to understand their vulnerability, we seek to understand mangrove dependencies on environmental and geophysical setting. To achieve this, we mapped mangrove canopy height and above ground biomass (AGB) at the Global scale. To identify mangrove forests, existing maps derived from a collection of Landsat data around the 2000 era were used. Using the Shuttle Radar Topography Mission elevation data collected in February of 2000, we produced a Global map of mangrove canopy height. The estimated heights were validated with the ICESat/Geoscience Altimeter System (GLAS) and in situ field data. Most importantly, field data were also used to derive relationships between canopy height and AGB. While the geographical coverage of in situ data is limited, ICESat/GLAS data provided extensive geographical coverage with independent estimates of maximum canopy height. These estimates were used to calibrate SRTM-estimates of height at the Global scale. We found the difference between GLAS RH100 and SRTM resulted from several sources of uncertainty that are difficult to isolate. These include natural variations of canopy structure with time, system errors from GLAS and SRTM, geo-location errors and discrepancies in spatial resolution. The Global canopy height map was trnasormed into AGB using the field-derived allometry. Depending on the scale of analysis and geographical

  4. Blink rate is associated with drug-induced parkinsonism in patients with severe mental illness, but does not meet requirements to serve as a clinical test: the Curacao extrapyramidal syndromes study XIII.

    PubMed

    Mentzel, Charlotte L; Bakker, P Roberto; van Os, Jim; Drukker, Marjan; Matroos, Glenn E; Tijssen, Marina A J; van Harten, Peter N

    2017-08-25

    Drug-induced parkinsonism (DIP) has a high prevalence and is associated with poorer quality of life. To find a practical clinical tool to assess DIP in patients with severe mental illness (SMI), the association between blink rate and drug-induced parkinsonism (DIP) was assessed. In a cohort of 204 SMI patients receiving care from the only mental health service of the previous Dutch Antilles, blink rate per minute during conversation was assessed by an additional trained movement disorder specialist. DIP was rated on the Unified Parkinson's Disease Rating Scale (UPDRS) in 878 assessments over a period of 18 years. Diagnostic values of blink rate were calculated. DIP prevalence was 36%, average blink rate was 14 (standard deviation (SD) 11) for patients with DIP, and 19 (SD 14) for patients without. There was a significant association between blink rate and DIP (p < 0.001). With a blink rate cut-off of 20 blinks per minute, sensitivity was 77% and specificity was 38%. A 10% percentile cut-off model resulted in an area under the ROC curve of 0.61. A logistic prediction model between dichotomous DIP and continuous blink rate per minute an area under the ROC curve of 0.70. There is a significant association between blink rate and DIP as diagnosed on the UPDRS. However, blink rate sensitivity and specificity with regard to DIP are too low to replace clinical rating scales in routine psychiatric practice. The study was started over 20 years ago in 1992, at the time registering a trial was not common practice, therefore the study was never registered.

  5. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    PubMed

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials.

  6. Assessing European wild fire vulnerability

    NASA Astrophysics Data System (ADS)

    Oehler, F.; Oliveira, S.; Barredo, J. I.; Camia, A.; Ayanz, J. San Miguel; Pettenella, D.; Mavsar, R.

    2012-04-01

    Wild fire vulnerability is a measure of potential socio-economic damage caused by a fire in a specific area. As such it is an important component of long-term fire risk management, helping policy-makers take informed decisions about adequate expenditures for fire prevention and suppression, and to target those regions at highest risk. This paper presents a first approach to assess wild fire vulnerability at the European level. A conservative approach was chosen that assesses the cost of restoring the previous land cover after a potential fire. Based on the CORINE Land Cover, a restoration cost was established for each land cover class at country level, and an average restoration time was assigned according to the recovery capacity of the land cover. The damage caused by fire was then assessed by discounting the cost of restoring the previous land cover over the restoration period. Three different vulnerability scenarios were considered assuming low, medium and high fire severity causing different levels of damage. Over Europe, the potential damage of wild land fires ranges from 10 - 13, 732 Euro*ha-1*yr-1 for low fire severity, 32 - 45,772 Euro*ha-1*yr-1 for medium fire severity and 54 - 77,812 Euro*ha-1*yr-1 for high fire severity. The least vulnerable are natural grasslands, moors and heathland and sclerophyllous vegetation, while the highest cost occurs for restoring broad-leaved forest. Preliminary validation comparing these estimates with official damage assessments for past fires shows reasonable results. The restoration cost approach allows for a straightforward, data extensive assessment of fire vulnerability at European level. A disadvantage is the inherent simplification of the evaluation procedure with the underestimation of non-markets goods and services. Thus, a second approach has been developed, valuing individual wild land goods and services and assessing their annual flow which is lost for a certain period of time in case of a fire event. However

  7. Vulnerable Subjects: Why Does Informed Consent Matter?

    PubMed

    Goodwin, Michele

    2016-09-01

    This special issue of the Journal Law, Medicine & Ethics takes up the concern of informed consent, particularly in times of controversy. The dominant moral dilemmas that frame traditional bioethical concerns address medical experimentation on vulnerable subjects; physicians assisting their patients in suicide or euthanasia; scarce resource allocation and medical futility; human trials to develop drugs; organ and tissue donation; cloning; xenotransplantation; abortion; human enhancement; mandatory vaccination; and much more. The term "bioethics" provides a lens, language, and guideposts to the study of medical ethics. It is worth noting, however, that medical experimentation is neither new nor exclusive to one country. Authors in this issue address thorny subjects that span borders and patients: from matters dealing with children and vaccination to the language and perception of consent. © 2016 American Society of Law, Medicine & Ethics.

  8. Routing in DiffServ multicast environment

    NASA Astrophysics Data System (ADS)

    Verma, Shekhar

    2002-07-01

    QOS aware applications have propelled the development of two complementary technologies, Multicasting and Differentiated Services. To provide the required QOS on the Internet, either the bandwidth needs to be increased (Multicasting) or limited bandwidth prioritized among users (DiffServ). Although, the bandwidth on the Internet is continually increasing, the backbone is still insufficient to support QOS without resource allocations. Hence, there is a need to map multicasting in a DiffServ Environment to conserve network bandwidth and to provision this bandwidth in an appropriate fashion. In this regard, two issues have to be addressed. One, the key difference between multicast and DiffServe routing is the structure of the multicast tree. This tree is maintained in multicast aware routers whereas in DiffServe, the core routers maintain no state information regarding the flows. Second, the task of restructuring the multicast tree when members join/leave. Currently, the first issue is addressed by embedding the multicast information within the packet itself as an additional header field. In this paper, we propose a neural network based heuristic approach to address the second problem of routing in a dynamic DiffServe Multicast environment. Many dynamic multicast routing algorithms have been proposed. The greedy algorithm creates a near optimal tree when a node is added but requires many query/reply messages. The PSPT algorithm cannot construct a cost optimal tree. The VTDM algorithm requires the estimated number of nodes that will join and is not flexible. The problem of building an optimal tree to satisfy QOS requirements at minimum cost and taking minimum network resources is NP- complete and none of the above solutions give an optimal solution. We have modeled this combinatorial optimization as a nonlinear programming problem and trained an artificial neural network to solve the problem. The problem is tractable only when the QOS parameters are combined into DiffServe

  9. MID-ATLANTIC REGIONAL VULNERABILITY ASSESSMENT

    EPA Science Inventory

    ORD's Regional Vulnerability Assessment (REVA) Program is developing and demonstrating approaches to assess current and future environmental vulnerabilities so that risk management activities can be targeted. The sister program to EMA.P (Environmental Monitoring Assessment Progr...

  10. MID-ATLANTIC REGIONAL VULNERABILITY ASSESSMENT

    EPA Science Inventory

    ORD's Regional Vulnerability Assessment (REVA) Program is developing and demonstrating approaches to assess current and future environmental vulnerabilities so that risk management activities can be targeted. The sister program to EMA.P (Environmental Monitoring Assessment Progr...

  11. Infrastructure Vulnerability Assessment Model (I-VAM).

    PubMed

    Ezell, Barry Charles

    2007-06-01

    Quantifying vulnerability to critical infrastructure has not been adequately addressed in the literature. Thus, the purpose of this article is to present a model that quantifies vulnerability. Vulnerability is defined as a measure of system susceptibility to threat scenarios. This article asserts that vulnerability is a condition of the system and it can be quantified using the Infrastructure Vulnerability Assessment Model (I-VAM). The model is presented and then applied to a medium-sized clean water system. The model requires subject matter experts (SMEs) to establish value functions and weights, and to assess protection measures of the system. Simulation is used to account for uncertainty in measurement, aggregate expert assessment, and to yield a vulnerability (Omega) density function. Results demonstrate that I-VAM is useful to decisionmakers who prefer quantification to qualitative treatment of vulnerability. I-VAM can be used to quantify vulnerability to other infrastructures, supervisory control and data acquisition systems (SCADA), and distributed control systems (DCS).

  12. 49 CFR 105.35 - Serving documents in PHMSA proceedings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HAZARDOUS MATERIALS PROGRAM DEFINITIONS AND GENERAL PROCEDURES General Procedures Serving Documents § 105.35... electronically serve documents on us. (ii) Serve documents electronically through the Internet at...

  13. 49 CFR 105.35 - Serving documents in PHMSA proceedings.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HAZARDOUS MATERIALS PROGRAM DEFINITIONS AND GENERAL PROCEDURES General Procedures Serving Documents § 105.35... electronically serve documents on us. (ii) Serve documents electronically through the Internet at...

  14. 49 CFR 105.35 - Serving documents in PHMSA proceedings.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HAZARDOUS MATERIALS PROGRAM DEFINITIONS AND GENERAL PROCEDURES General Procedures Serving Documents § 105.35... electronically serve documents on us. (ii) Serve documents electronically through the Internet at...

  15. A GIS Approach to Identifying Socially and Medically Vulnerable Older Adult Populations in South Florida.

    PubMed

    Hames, Elizabeth; Stoler, Justin; Emrich, Christopher T; Tewary, Sweta; Pandya, Naushira

    2016-08-05

    We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Vulnerability genes or plasticity genes?

    PubMed Central

    Belsky, J; Jonassaint, C; Pluess, M; Stanton, M; Brummett, B; Williams, R

    2009-01-01

    The classic diathesis–stress framework, which views some individuals as particularly vulnerable to adversity, informs virtually all psychiatric research on behavior–gene–environment (G × E) interaction. An alternative framework of ‘differential susceptibility' is proposed, one which regards those most susceptible to adversity because of their genetic make up as simultaneously most likely to benefit from supportive or enriching experiences—or even just the absence of adversity. Recent G × E findings consistent with this perspective and involving monoamine oxidase-A, 5-HTTLPR (5-hydroxytryptamine-linked polymorphic region polymorphism) and dopamine receptor D4 (DRD4) are reviewed for illustrative purposes. Results considered suggest that putative ‘vulnerability genes' or ‘risk alleles' might, at times, be more appropriately conceptualized as ‘plasticity genes', because they seem to make individuals more susceptible to environmental influences—for better and for worse. PMID:19455150

  17. Childhood Cancer and Vulnerability for Significant Academic Underachievement.

    ERIC Educational Resources Information Center

    Ott, Jeanne S.; And Others

    1982-01-01

    Learning difficulties related to childhood cancer were examined by comparison of 22 oncology patients and 22 children (6 to 17 years old) referred for psychiatric/psychological evaluation. Findings demonstrated, among children undergoing treatment of cancer, some academic vulnerabilities for which psychosocial aspects may not fully account.…

  18. Unipolar Depression, Life Context Vulnerabilities, and Drinking to Cope

    ERIC Educational Resources Information Center

    Holahan, Charles J.; Moos, Rudolf H.; Holahan, Carole K.; Cronkite, Ruth C.; Randall, Patrick K.

    2004-01-01

    This study followed baseline samples of 424 unipolar depressed patients and 424 community controls across 10 years to investigate the association between depression and alcohol-related coping and to examine how life context vulnerabilities underlie the risk for depressed individuals to rely on drinking to cope. Findings supported all hypotheses.…

  19. Childhood Cancer and Vulnerability for Significant Academic Underachievement.

    ERIC Educational Resources Information Center

    Ott, Jeanne S.; And Others

    1982-01-01

    Learning difficulties related to childhood cancer were examined by comparison of 22 oncology patients and 22 children (6 to 17 years old) referred for psychiatric/psychological evaluation. Findings demonstrated, among children undergoing treatment of cancer, some academic vulnerabilities for which psychosocial aspects may not fully account.…

  20. Vulnerabilities

    DTIC Science & Technology

    2009-05-04

    in keeping with the Chinese military tradition. Ralph Sawyer notes that the concept of 9 unorthodox warfare is quite common in the Chinese...military tradition, dating back at least to the writings Sun-Tzu. 21 Sawyer asserts that the Chinese concept of chi roughly translates to “unorthodox...when used in terms of military strategy and is consistently found in both ancient and modern Chinese military philosophy. 22 Sawyer notes that Mao

  1. Vulnerability to coastal cholera ecology.

    PubMed

    Collins, Andrew E

    2003-10-01

    The battle to completely control cholera continues. Multiple strains, high levels of morbidity in some regions of the world, and a complex of influences on its distribution in people and the environment are accompanied by only rough resolution prediction of outbreaks. Uncertainty as to the most effective array of interventions for one of the most researched infectious diseases thwarts further progress in providing cost-effective solutions. Progress on the research front consistently points towards the importance of disease ecology, coastal environments, and the sea. However, evaluation of the link between cholera in people and environment can only be effective with analysis of human vulnerability to variable coastal cholera ecologies. As there are some clear links between the organism, cholera incidence and the sea, it is appropriate that cholera research should examine the nature of coastal population vulnerability to the disease. The paper reviews the cholera risks of human-environment interactions in coastal areas as one component of the evaluation of cholera management. This points to effective intervention through integrative knowledge of changing human and environmental ecologies, requiring improved detection, but also an acceptance of complex causality. The challenge is to identify indicators and interventions for case specific ecologies in variable locales of human vulnerability and disease hazard. Further work will therefore aim to explore improved surveillance and intervention across the socio-behavioural and ecological spectrum. Furthermore, the story of cholera continues to inform us about how we should more effectively view emergent and resurgent infectious disease hazards more generally.

  2. Cotton genetic resources and crop vulnerability

    USDA-ARS?s Scientific Manuscript database

    A report on the genetic vulnerability of cotton was provided to the National Genetic Resources Advisory Council. The report discussed crop vulnerabilities associated with emerging diseases, emerging pests, and a narrowing genetic base. To address these crop vulnerabilities, the report discussed the ...

  3. Making a Difference by Serving All Students

    ERIC Educational Resources Information Center

    Olley, Rivka I.

    2009-01-01

    Randi Brown came to school psychology almost as a family business. Her grandmother was a school psychologist and the first licensed psychologist in the state of New York. Randi graduated with a doctoral degree from Yeshiva University and has served students in Westchester County, New York, for 18 years. She exemplifies the dedication typical of so…

  4. How Finland Serves Gifted and Talented Pupils

    ERIC Educational Resources Information Center

    Tirri, Kirsi; Kuusisto, Elina

    2013-01-01

    The purpose of this article is to provide an overview of the ways gifted and talented pupils are served in Finland. The trend toward individualism and freedom of choice as well as national policy affecting gifted education are discussed. Empirical research on Finnish teachers' attitudes toward gifted education with respect to the national…

  5. Serving the Gifted in Rural Areas.

    ERIC Educational Resources Information Center

    Roeper Review, 1989

    1989-01-01

    Five papers are presented on serving rural gifted students, discussing: advanced academic courses offered through telecommunications; an electronic bulletin board and videotape exchange network; staff development and networking through telecommunications; acceleration strategies in elementary schools; and rural and urban gifted high-school…

  6. Secondary Prevention--Serving Families at Risk.

    ERIC Educational Resources Information Center

    Thyen, Ute; And Others

    1995-01-01

    The Child Protection Center in Lubeck (Germany) offers a nonpunitive, self-help approach to prevent child abuse by encouraging families to determine their own needs. Over half of families served over a two-year period were self-reported and almost one-fifth received help to prevent violence against children before the occurrence of child abuse or…

  7. Serving Ethnic Minorities. Topical Paper 73.

    ERIC Educational Resources Information Center

    Harcleroad, Fred F.; And Others

    Dedicated to the memory of Raymond E. Schultz, the essays in this monograph discuss the role of the community college in serving minority students. An introductory essay by Fred F. Harcleroad summarizes Schultz's contributions to community college education. John E. Roueche then discusses the provision of equal educational opportunity to…

  8. 77 FR 13173 - Best Equipped Best Served

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-05

    ... technical input on proposed operational incentive scenarios for possible implementation in the 2012-2014... scenarios. The candidate proposals for discussion have been designed to deliver on the best equipped, best performing, best served concept for implementation in the 2012-2014 timeframe. The proposed scenarios...

  9. Serving Distant Learners through Instructional Technologies.

    ERIC Educational Resources Information Center

    Drea, John T.; Armistead, L. Pendleton

    John Wood Community College (JWCC) serves a district population of approximately 90,000 in a predominantly rural section of west-central Illinois. In an effort to address the needs of the rural long-distance learner, JWCC has implemented a variety of instructional delivery techniques. Since its inception, JWCC has contracted with other area…

  10. 350 Ways Colleges are Serving Adult Learners.

    ERIC Educational Resources Information Center

    College Entrance Examination Board, New York, NY. Future Directions for a Learning Society.

    Designed for colleges and universities desiring to serve adult students, this booklet presents new practices that have been effective on campuses throughout the U.S. Listed are 350 practices reported in a telephone survey of approximately fifty representive institutions. The first of nine sections lists practices for assessing needs. Section 2,…

  11. Serving Business in an Information Economy.

    ERIC Educational Resources Information Center

    The Bookmark, 1988

    1988-01-01

    The 23 articles in this theme issue focus on various aspects of library services to business in an information economy: "Serving Business in an Information Economy" (C. Bain); "New York's Resurging Economy and State Economic Development Information" (R. G. Paolino); "Department of Economic Development Library: Services to…

  12. Getting It Together: Serving the Adult Community.

    ERIC Educational Resources Information Center

    Bakshis, Robert D.

    1979-01-01

    Describes a community needs assessment survey conducted by the College of DuPage (Illinois) which served to advertise existing programs, provide public relations for the adult education council, and obtain measures of need for existing or expanded educational and leisure activities. (MB)

  13. Getting It Together: Serving the Adult Community.

    ERIC Educational Resources Information Center

    Bakshis, Robert D.

    1979-01-01

    Describes a community needs assessment survey conducted by the College of DuPage (Illinois) which served to advertise existing programs, provide public relations for the adult education council, and obtain measures of need for existing or expanded educational and leisure activities. (MB)

  14. Serving up Success! Team Nutrition Days, 1997.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    This publication presents success stories and actual activities from Team Nutrition Days 1997 to serve as a starting point for other schools wanting to create their own nutrition education activities. Team Nutrition Days was a 1-week celebration that used innovative, interactive activities to teach children that nutrition is the link between…

  15. Students Serving Students. Linking Learning with Life.

    ERIC Educational Resources Information Center

    Wright, Jan; Smink, Jay; Duckenfield, Marty

    The National Dropout Prevention Center designed a project, Student Serving Students, to see if students in kindergarten through twelfth grade could help other students who were at risk of dropping out of school. Communities in Florida, Georgia, and South Carolina developed a variety of ways for students to meet the needs of children at risk.…

  16. "Gateway" Districts Struggle to Serve Immigrant Parents

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2012-01-01

    As thousands of communities--especially in the South--became booming gateways for immigrant families during the 1990s and the early years of the new century, public schools struggled with the unfamiliar task of serving the large numbers of English-learners arriving in their classrooms. Instructional programs were built from scratch. Districts had…

  17. Making a Difference by Serving All Students

    ERIC Educational Resources Information Center

    Olley, Rivka I.

    2009-01-01

    Randi Brown came to school psychology almost as a family business. Her grandmother was a school psychologist and the first licensed psychologist in the state of New York. Randi graduated with a doctoral degree from Yeshiva University and has served students in Westchester County, New York, for 18 years. She exemplifies the dedication typical of so…

  18. Serving the Gifted in Rural Areas.

    ERIC Educational Resources Information Center

    Roeper Review, 1989

    1989-01-01

    Five papers are presented on serving rural gifted students, discussing: advanced academic courses offered through telecommunications; an electronic bulletin board and videotape exchange network; staff development and networking through telecommunications; acceleration strategies in elementary schools; and rural and urban gifted high-school…

  19. Measuring the Velocity of a Tennis Serve.

    ERIC Educational Resources Information Center

    Eng, John; Lietman, Thomas

    1994-01-01

    Presents an alternative to the use of a radar to determine how fast an individual can serve a tennis ball. Equipped with a tape recorder and a Macintosh computer, students determine the velocity of a tennis ball by analyzing the sounds and echoes heard on the court. (ZWH)

  20. "Gateway" Districts Struggle to Serve Immigrant Parents

    ERIC Educational Resources Information Center

    Maxwell, Lesli A.

    2012-01-01

    As thousands of communities--especially in the South--became booming gateways for immigrant families during the 1990s and the early years of the new century, public schools struggled with the unfamiliar task of serving the large numbers of English-learners arriving in their classrooms. Instructional programs were built from scratch. Districts had…

  1. Serving Stakeholders at a Small Regional University

    ERIC Educational Resources Information Center

    Burrage, Sean

    2015-01-01

    The Southeastern Oklahoma State University Honors Program serves a unique role in a small, rural setting such as Durant, Oklahoma. The honors program has a traditional mission in a university that offers a nontraditional setting and history within the context of higher education. The program thus offers special rewards to its students and to the…

  2. Graduate Students Serve Extension as Evaluation Consultants

    ERIC Educational Resources Information Center

    McClure, Megan; Fuhrman, Nicholas E.

    2011-01-01

    In an effort to provide graduate students at a distance with field-based learning experiences and evaluation resources to statewide Extension programs, 24 Master's students participating in a distance-delivered program evaluation course served as evaluation consultants for Extension programs. State evaluation specialists unable to conduct…

  3. Pyramid Servings Database (PSDB) for NHANES III

    Cancer.gov

    The National Cancer Institute developed a database to examine dietary data from the National Center for Health Statistics' Third National Health and Nutrition Examination Survey in terms of servings from each of United States Department of Agriculture's The Food Guide Pyramid's major and minor food groups.

  4. Serving Business in an Information Economy.

    ERIC Educational Resources Information Center

    The Bookmark, 1988

    1988-01-01

    The 23 articles in this theme issue focus on various aspects of library services to business in an information economy: "Serving Business in an Information Economy" (C. Bain); "New York's Resurging Economy and State Economic Development Information" (R. G. Paolino); "Department of Economic Development Library: Services to…

  5. Asthma Care Quality for Children with Minority-Serving Providers

    PubMed Central

    Galbraith, Alison A.; Smith, Lauren A.; Bokhour, Barbara; Miroshnik, Irina L.; Sawicki, Gregory S.; Glauber, James H.; Hohman, Katherine H.; Gay, Charlene; Lieu, Tracy A.

    2015-01-01

    Objective To compare asthma care quality for children with and without minority-serving providers. Design Cross-sectional telephone survey of parents, linked with a mailed survey of their children’s providers. Setting A Medicaid-predominant health plan and multispecialty provider group in Massachusetts. Participants Children with persistent asthma identified from claims and encounter data. Main Exposure Whether the child’s provider was minority-serving (>25% of patients black or Latino). Outcomes Parent report of whether the child had: 1) ever received inhaled steroids; 2) received influenza vaccination during the past season and 3) received an asthma action plan in the past year. Results The study included 563 children. In unadjusted analyses, Latino children and those with minority-serving providers were more likely to have never received inhaled steroids. In adjusted models, the odds of never receiving inhaled steroids were not significantly different for children with minority-serving providers (OR 1.29, 95% CI 0.63–2.64), or for Latino vs. white children (OR 1.76, 95% CI 0.74–4.18); odds were increased for children receiving care in community health centers (OR 4.88, 95% CI 1.70–14.02) or hospital clinics (OR 4.53, 95% CI 1.09–18.92) vs. multi-specialty practices. Such differences were not seen for influenza vaccinations or action plans. Conclusions Children with persistent asthma were less likely to receive inhaled steroids if they received care in community health centers or hospital clinics. Practice setting mediated initially-observed disparities in inhaled steroid use by Latino children and those with minority-serving providers. No differences by race/ethnicity or minority-serving provider were observed for influenza vaccinations and asthma action plans. PMID:20048240

  6. Vulnerability factors for common mental illnesses.

    PubMed

    Goldberg, D

    2001-04-01

    Twin studies suggest that shared early family environment is of only minor importance in the aetiology of depression, most of the variance being attributable either to genetic or to individual 'non-shared' environmental factors. To examine the respective roles of personality and social experiences on the risk for common mental disorders, with special reference to depression. Analysis of preliminary findings from two large-scale British population surveys: (a) a multi-centre study of general practice patients, and (b) a study of working-class women in Manchester. (a) Persons recently separated from their partners have raised mean scores for psychological distress, but the relative excess is due entirely to persons with high ratings for introversion; (b) while severe life events were associated with physiological responses characteristic of depression, the probability of experiencing such life events varied between 0.2 monthly for low scorers and 1.5 monthly for high scorers on a vulnerability measure. Social factors do appear to influence the prevalence of depression, but this effect is not independent of genetically determined vulnerability.

  7. Vulnerabilities to misinformation in online pharmaceutical marketing

    PubMed Central

    De Freitas, Julian; Falls, Brian A; Haque, Omar S; Bursztajn, Harold J

    2013-01-01

    Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users’ vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain. PMID:23761527

  8. Vulnerabilities to misinformation in online pharmaceutical marketing.

    PubMed

    De Freitas, Julian; Falls, Brian A; Haque, Omar S; Bursztajn, Harold J

    2013-05-01

    Given the large percentage of Internet users who search for health information online, pharmaceutical companies have invested significantly in online marketing of their products. Although online pharmaceutical marketing can potentially benefit both physicians and patients, it can also harm these groups by misleading them. Indeed, some pharmaceutical companies have been guilty of undue influence, which has threatened public health and trust. We conducted a review of the available literature on online pharmaceutical marketing, undue influence and the psychology of decision-making, in order to identify factors that contribute to Internet users' vulnerability to online pharmaceutical misinformation. We find five converging factors: Internet dependence, excessive trust in the veracity of online information, unawareness of pharmaceutical company influence, social isolation and detail fixation. As the Internet continues to change, it is important that regulators keep in mind not only misinformation that surrounds new web technologies and their contents, but also the factors that make Internet users vulnerable to misinformation in the first place. Psychological components are a critical, although often neglected, risk factor for Internet users becoming misinformed upon exposure to online pharmaceutical marketing. Awareness of these psychological factors may help Internet users attentively and safely navigate an evolving web terrain.

  9. Intensified tuberculosis case finding amongst vulnerable communities in southern India.

    PubMed

    Reddy, K K; Ananthakrishnan, R; Jacob, A G; Das, M; Isaakidis, P; Kumar, A M V

    2015-12-21

    India mainly uses passive case finding to detect tuberculosis (TB) patients through the Revised National Tuberculosis Control Programme (RNTCP). An intensified case finding (ICF) intervention was conducted among vulnerable communities in two districts of Karnataka during July-December 2013; 658 sputum smear-positive TB cases were detected. The number of smear-positive cases detected increased by 8.8% relative to the pre-intervention period (July-December 2012) in intervention communities as compared to an 8.6% decrease in communities without the ICF intervention. ICF activities brought TB services closer to vulnerable communities, moderately increasing TB case detection rates.

  10. Health status of vulnerable populations.

    PubMed

    Aday, L A

    1994-01-01

    The notion of risk underlying the concept of vulnerability implies that everyone is potentially vulnerable (or at risk), that is, there is always a chance of developing health problems. The risk is, however, greater for those with the least social status, social capital, and human capital resources to either prevent or ameliorate the origins and consequences of poor physical, psychological, or social health. The completeness and accuracy of information on the health status of the vulnerable populations examined here varies substantially across groups. Methodological work is needed to derive standardized definitions of terms, specify the content and timing for collecting information for minimum basic data sets, and develop uniform standards for evaluating and reporting data quality on the health status of vulnerable populations. The variety of indicators of vulnerable populations examined indicates that during the decade of the 1980s the incidence of serious physical, psychological, and/or social needs increased (at worst) and was unameliorated (at best) for millions of Americans. AIDS emerged as a new and deadly threat from a handful of cases classified as Gay-Related Immune Deficiency in the early part of the 1980s to what now may be over a million Americans who are HIV-positive. The number of homeless has increased an average of 20% a year to estimates now ranging up to one million men, women, or children homeless on any given night to twice that number who may be homeless sometime during the year. Over seven million people immigrated to the United States during the period from 1981 to 1990--an increasing proportion of whom are refugees carrying with them the physical, psychological, and social wounds of war. The number of children abused by family members or other intimates has burgeoned to an estimated 1.6 to 1.7 million per year, and with the greater use of firearms, intentional acts of violence towards oneself or others are becoming increasingly deadly in

  11. Chronic obstructive pulmonary disease readmissions at minority-serving institutions.

    PubMed

    Prieto-Centurion, Valentin; Gussin, Hélène A; Rolle, Andrew J; Krishnan, Jerry A

    2013-12-01

    About 20% of patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are readmitted within 30 days. High 30-day risk-standardized readmission rates after COPD exacerbations will likely place hospitals at risk for financial penalties from the Centers for Medicare and Medicaid Services starting in fiscal year 2015. Factors contributing to hospital readmissions include healthcare quality, access to care, coordination of care between hospital and ambulatory settings, and factors linked to socioeconomic resources (e.g., social support, stable housing, transportation, and food). These concerns are exacerbated at minority-serving institutions, which provide a disproportionate share of care to patients with low socioeconomic resources. Solutions tailored to the needs of minority-serving institutions are urgently needed. We recommend research that will provide the evidence base for strategies to reduce readmissions at minority-serving institutions. Promising innovative approaches include using a nontraditional healthcare workforce, such as community health workers and peer-coaches, and telemedicine. These strategies have been successfully used in other conditions and need to be studied in patients with COPD.

  12. Measuring vulnerability to disaster displacement

    NASA Astrophysics Data System (ADS)

    Brink, Susan A.; Khazai, Bijan; Power, Christopher; Wenzel, Friedemann

    2015-04-01

    Large scale disasters can cause devastating impacts in terms of population displacement. Between 2008 and 2013, on average 27 million people were displaced annually by disasters (Yonetani 2014). After large events such as hurricane Katrina or the Port-au-Prince earthquake, images of inadequate public shelter and concerns about large scale and often inequitable migration have been broadcast around the world. Population displacement can often be one of the most devastating and visible impacts of a natural disaster. Despite the importance of population displacement in disaster events, measures to understand the socio-economic vulnerability of a community often use broad metrics to estimate the total socio-economic risk of an event rather than focusing on the specific impacts that a community faces in a disaster. Population displacement is complex and multi-causal with the physical impact of a disaster interacting with vulnerability arising from the response, environmental issues (e.g., weather), cultural concerns (e.g., expectations of adequate shelter), and many individual factors (e.g., mobility, risk perception). In addition to the complexity of the causes, population displacement is difficult to measure because of the wide variety of different terms and definitions and its multi-dimensional nature. When we speak of severe population displacement, we may refer to a large number of displaced people, an extended length of displacement or associated difficulties such as poor shelter quality, risk of violence and crime in shelter communities, discrimination in aid, a lack of access to employment or other difficulties that can be associated with large scale population displacement. We have completed a thorough review of the literature on disaster population displacement. Research has been conducted on historic events to understand the types of negative impacts associated with population displacement and also the vulnerability of different groups to these impacts. We

  13. Repeated Mild Traumatic Brain Injury: Mechanisms of Cerebral Vulnerability

    PubMed Central

    Alexander, Daya; Giza, Christopher C.; Hovda, David A.

    2013-01-01

    Abstract Among the 3.5 million annual new head injury cases is a subpopulation of children and young adults who experience repeated traumatic brain injury (TBI). The duration of vulnerability after a single TBI remains unknown, and biomarkers have yet to be determined. Decreases in glucose metabolism (cerebral metabolic rate of glucose [CMRglc]) are consistently observed after experimental and human TBI. In the current study, it is hypothesized that the duration of vulnerability is related to the duration of decreased CMRglc and that a single mild TBI (mTBI) increases the brain's vulnerability to a second insult for a period, during which a subsequent mTBI will worsen the outcome. Postnatal day 35 rats were given sham, single mTBI, or two mTBI at 24-h or 120-h intervals. 14C-2-deoxy-D-glucose autoradiography was conducted at 1 or 3 days post-injury to calculate CMRglc. At 24 h after a single mTBI, CMRglc is decreased by 19% in both the parietal cortex and hippocampus, but approached sham levels by 3 days post-injury. When a second mTBI is introduced during the CMRglc depression of the first injury, the consequent CMRglc is depressed (36.5%) at 24 h and remains depressed (25%) at 3 days. In contrast, when the second mTBI is introduced after the metabolic recovery of the first injury, the consequent CMRglc depression is similar to that seen with a single injury. Results suggest that the duration of metabolic depression reflects the time-course of vulnerability to second injury in the juvenile brain and could serve as a valuable biomarker in establishing window of vulnerability guidelines. PMID:23025820

  14. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California.

    PubMed

    Howard, Jeanette K; Klausmeyer, Kirk R; Fesenmyer, Kurt A; Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V E; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B; Ode, Peter R; Peek, Ryan; Quiñones, Rebecca M; Rehn, Andrew C; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D; Slusark, Joe; Viers, Joshua H; Wright, Amber; Morrison, Scott A

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  15. Patterns of Freshwater Species Richness, Endemism, and Vulnerability in California

    PubMed Central

    Furnish, Joseph; Gardali, Thomas; Grantham, Ted; Katz, Jacob V. E.; Kupferberg, Sarah; McIntyre, Patrick; Moyle, Peter B.; Ode, Peter R.; Peek, Ryan; Quiñones, Rebecca M.; Rehn, Andrew C.; Santos, Nick; Schoenig, Steve; Serpa, Larry; Shedd, Jackson D.; Slusark, Joe; Viers, Joshua H.; Wright, Amber; Morrison, Scott A.

    2015-01-01

    The ranges and abundances of species that depend on freshwater habitats are declining worldwide. Efforts to counteract those trends are often hampered by a lack of information about species distribution and conservation status and are often strongly biased toward a few well-studied groups. We identified the 3,906 vascular plants, macroinvertebrates, and vertebrates native to California, USA, that depend on fresh water for at least one stage of their life history. We evaluated the conservation status for these taxa using existing government and non-governmental organization assessments (e.g., endangered species act, NatureServe), created a spatial database of locality observations or distribution information from ~400 data sources, and mapped patterns of richness, endemism, and vulnerability. Although nearly half of all taxa with conservation status (n = 1,939) are vulnerable to extinction, only 114 (6%) of those vulnerable taxa have a legal mandate for protection in the form of formal inclusion on a state or federal endangered species list. Endemic taxa are at greater risk than non-endemics, with 90% of the 927 endemic taxa vulnerable to extinction. Records with spatial data were available for a total of 2,276 species (61%). The patterns of species richness differ depending on the taxonomic group analyzed, but are similar across taxonomic level. No particular taxonomic group represents an umbrella for all species, but hotspots of high richness for listed species cover 40% of the hotspots for all other species and 58% of the hotspots for vulnerable freshwater species. By mapping freshwater species hotspots we show locations that represent the top priority for conservation action in the state. This study identifies opportunities to fill gaps in the evaluation of conservation status for freshwater taxa in California, to address the lack of occurrence information for nearly 40% of freshwater taxa and nearly 40% of watersheds in the state, and to implement adequate

  16. Does physical activity protect against drug abuse vulnerability?

    PubMed

    Bardo, Michael T; Compton, Wilson M

    2015-08-01

    The current review examined recent literature to determine our state of knowledge about the potential ability of physical activity serve as a protectant against drug abuse vulnerability. Both preclinical and clinical studies were examined using either associational or random assignment study designs. In addition to examining drug use as an outcome variable, the potential neural mediators linking physical activity and drug abuse vulnerability were examined. Several important conclusions may be drawn. First, the preclinical evidence is solid in showing that physical activity in various forms is able to serve as both a preventive and treatment intervention that reduces drug use, although voluntary alcohol drinking appears to be an exception to this conclusion. Second, the clinical evidence provides some evidence, albeit mixed, to suggest a beneficial effect of physical activity on tobacco dependent individuals. In contrast, there exists only circumstantial evidence that physical activity may reduce use of drugs other than nicotine, and there is essentially no solid information from random control studies to know if physical activity may prevent initiation of problem use. Finally, both preclinical and clinical evidence shows that various brain systems are altered by physical activity, with the medial prefrontal cortex (mPFC) serving as one potential node that may mediate the putative link between physical activity and drug abuse vulnerability. It is concluded that novel neurobehavioral approaches taking advantage of novel techniques for assessing the physiological impact of physical activity are needed and can be used to inform the longitudinal random control studies that will answer definitively the question posed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Research on security vulnerability of chip

    NASA Astrophysics Data System (ADS)

    Chen, Zhifeng; Li, Qingbao; Li, Zhou

    2013-03-01

    The 21st century is the information era. IC (Integrated Circuit) is the basis of the modern information industry. The security vulnerability or back door of IC is directly related to the entire information system security. From the perspective of information security, security vulnerability of chip is led out through the practical examples and then the importance of security vulnerability of chip is emphasized. By comparing the security vulnerability of chip with the software virus, the characteristics of the chip vulnerabilities are summed up. Moreover, this paper describes the security vulnerability models of different control logic chips, combinational and sequential logic chips models. Finally it puts forward two kinds of detecting methods of security vulnerability of chip against the two models.

  18. Acquaintance molestation and youth-serving organizations.

    PubMed

    Lanning, Kenneth V; Dietz, Park

    2014-10-01

    This article is based not only on the research literature but also on the extensive field experience of the authors in consulting with investigators, attorneys, and organizations on the prevention, investigation, prosecution, and civil litigation of molestation of children within or in connection with youth-serving organizations. Acquaintance molesters have often pursued careers or sought out paid or volunteer work with organizations through which they can meet children. To address the problem of such offenders, it is necessary for youth-serving organizations to recognize the diversity of sexual activity, the phenomena of "nice-guy" offenders and compliant child victims, and the grooming/seduction process, each of which is reviewed here. The four most important protection practices for organizations are screening; management, and supervision; response to suspicions, allegations, and complaints; and prevention and awareness programs. The authors recommend general approaches to each of these and describe the reasons many organizations resist implementing available preventive measures.

  19. Complicating a Latina/o-Serving Identity at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Garcia, Gina A.

    2016-01-01

    As institutions not founded to "serve" Latina/o students, Hispanic Serving Institutions (HSIs) are criticized for solely being "Hispanic-enrolling," with access and graduation rates being hypothesized as indicators of an organizational identity for HSIs. Drawing from a case study with 88 participants, the purpose of this…

  20. Culturally Relevant Practices That "Serve" Students at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Garcia, Gina A.; Okhidoi, Otgonjargal

    2015-01-01

    As institutions not founded to "serve" Latina/o students, Hispanic Serving Institutions (HSIs) must actively change their curricula and programs to meet the needs of their diverse population, including Latina/o, low income, and first generation students. Using a case study approach, including interviews and focus groups, this study…

  1. Minority-Serving Institutions of Higher Education: Serving Communities, Revitalizing the Nation

    ERIC Educational Resources Information Center

    US Department of Housing and Urban Development, 2009

    2009-01-01

    Institutions of higher education (IHEs) that serve minority populations are unique both in their missions and in their day-to-day operations. Some of these colleges and universities are located in remote regions of the country, while others serve congested urban neighborhoods. Their constituents range from Native Americans, the country's oldest…

  2. Emerging Hispanic-Serving Institutions (HSIs): Serving Latino Students. Executive Summary

    ERIC Educational Resources Information Center

    Excelencia in Education (NJ1), 2010

    2010-01-01

    The invention of Hispanic-serving Institutions (HSIs) in the 1980s was grounded in the theory that institutions enrolling a large concentration of Latino students would adapt their institutional practices to serve these students better. Specifically, critical mass theory suggests once a definable group reaches a certain size within an…

  3. Equipment for Hot-to-serve Foods

    NASA Technical Reports Server (NTRS)

    Smith, D. P.

    1985-01-01

    Patented surface heating devices with a much faster air-to-solid heat transfer rate than previous air ovens were developed. The accelerated surface heating can brown, sear or crisp much more rapidly than in conventional ovens so that partially prepared food can be finished quickly and tastefully immediately before serving. The crisp, freshly browned surfaces result from the faster heat transfer which does not dry out the food. The devices are then compared to convection ovens and microwave heating processes.

  4. Equipment for Hot-to-serve Foods

    NASA Technical Reports Server (NTRS)

    Smith, D. P.

    1985-01-01

    Patented surface heating devices with a much faster air-to-solid heat transfer rate than previous air ovens were developed. The accelerated surface heating can brown, sear or crisp much more rapidly than in conventional ovens so that partially prepared food can be finished quickly and tastefully immediately before serving. The crisp, freshly browned surfaces result from the faster heat transfer which does not dry out the food. The devices are then compared to convection ovens and microwave heating processes.

  5. ISS Benefits for Humanity: Serving the World

    NASA Image and Video Library

    2015-10-06

    Published on Oct 6, 2015 A picture is worth a thousand words, but in the case of International Space Station imagery, a picture also may be worth a thousand lives. An imaging system aboard the station, ISS SERVIR Environmental Research and Visualization System (ISERV), captured photographs of Earth from space for use in developing countries affected by natural disasters This is yet another way the orbiting laboratory is serving humanity Off the Earth, For the Earth.

  6. A Peer-to-Peer Health Education Program for Vulnerable Children in Uganda

    ERIC Educational Resources Information Center

    Falk, Diane S.; Pettet, Kristen; Mpagi, Charles

    2016-01-01

    In this paper, children attending a U.S.-sponsored private primary school serving orphaned and vulnerable children in Uganda were interviewed in focus groups about their participation in a peer-to-peer health education program in which they used music, dance, poetry, art, and drama to convey health information. The children reported enhanced…

  7. Vulnerability Assessment of Selected Buildings Designated as Shelters: St. Kitts--Nevis.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on St. Kitts and Nevis to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  8. Vulnerability Assessment of Selected Buildings Designated as Shelters: Antigua and Barbuda.

    ERIC Educational Resources Information Center

    Gibbs, Tony

    Educational facilities in the Caribbean often serve roles as shelters during natural hazards, but they often sustain as much damage as other buildings. This study investigated the physical vulnerability of schools located on Antigua and Barbuda to wind forces, torrential rain, and seismic forces in order to provide relevant local agencies with…

  9. Spatial characteristics of professional tennis serves with implications for serving aces: A machine learning approach.

    PubMed

    Whiteside, David; Reid, Machar

    2017-04-01

    This study sought to determine the features of an ideal serve in men's professional tennis. A total of 25,680 first serves executed by 151 male tennis players during Australian Open competition were classified as either aces or returned into play. Spatiotemporal (impact location, speed, projection angles, landing location and relative player locations) and contextual (score) features of each serve were extracted from Hawk-Eye data and used to construct a classification tree model (with decision rules) that predicted serve outcome. k-means clustering was applied to the landing locations to quantify optimal landing locations for aces. The classification tree revealed that (1) serve directionality, relative to the returner; (2) the ball's landing proximity to the nearest service box line and (3) serve speed classified aces with an accuracy of 87.02%. Hitting aces appeared more contingent on accuracy than speed, with serves directed >5.88° from the returner and landing <15.27 cm from a service box line most indicative of an ace. k-means clustering revealed four distinct locations (≈0.73 m wide × 2.35 m deep) in the corners of the service box that corresponded to aces. These landing locations provide empirically derived target locations for players to adhere to during practice and competition.

  10. Integrated Estimation of Seismic Physical Vulnerability of Tehran Using Rule Based Granular Computing

    NASA Astrophysics Data System (ADS)

    Sheikhian, H.; Delavar, M. R.; Stein, A.

    2015-08-01

    Tehran, the capital of Iran, is surrounded by the North Tehran fault, the Mosha fault and the Rey fault. This exposes the city to possibly huge earthquakes followed by dramatic human loss and physical damage, in particular as it contains a large number of non-standard constructions and aged buildings. Estimation of the likely consequences of an earthquake facilitates mitigation of these losses. Mitigation of the earthquake fatalities may be achieved by promoting awareness of earthquake vulnerability and implementation of seismic vulnerability reduction measures. In this research, granular computing using generality and absolute support for rule extraction is applied. It uses coverage and entropy for rule prioritization. These rules are combined to form a granule tree that shows the order and relation of the extracted rules. In this way the seismic physical vulnerability is assessed, integrating the effects of the three major known faults. Effective parameters considered in the physical seismic vulnerability assessment are slope, seismic intensity, height and age of the buildings. Experts were asked to predict seismic vulnerability for 100 randomly selected samples among more than 3000 statistical units in Tehran. The integrated experts' point of views serve as input into granular computing. Non-redundant covering rules preserve the consistency in the model, which resulted in 84% accuracy in the seismic vulnerability assessment based on the validation of the predicted test data against expected vulnerability degree. The study concluded that granular computing is a useful method to assess the effects of earthquakes in an earthquake prone area.

  11. Mountain torrents: Quantifying vulnerability and assessing uncertainties

    PubMed Central

    Totschnig, Reinhold; Fuchs, Sven

    2013-01-01

    Vulnerability assessment for elements at risk is an important component in the framework of risk assessment. The vulnerability of buildings affected by torrent processes can be quantified by vulnerability functions that express a mathematical relationship between the degree of loss of individual elements at risk and the intensity of the impacting process. Based on data from the Austrian Alps, we extended a vulnerability curve for residential buildings affected by fluvial sediment transport processes to other torrent processes and other building types. With respect to this goal to merge different data based on different processes and building types, several statistical tests were conducted. The calculation of vulnerability functions was based on a nonlinear regression approach applying cumulative distribution functions. The results suggest that there is no need to distinguish between different sediment-laden torrent processes when assessing vulnerability of residential buildings towards torrent processes. The final vulnerability functions were further validated with data from the Italian Alps and different vulnerability functions presented in the literature. This comparison showed the wider applicability of the derived vulnerability functions. The uncertainty inherent to regression functions was quantified by the calculation of confidence bands. The derived vulnerability functions may be applied within the framework of risk management for mountain hazards within the European Alps. The method is transferable to other mountain regions if the input data needed are available. PMID:27087696

  12. Scenarios for coastal vulnerability assessment

    USGS Publications Warehouse

    Nicholls, Robert J.; Woodroffe, Colin D.; Burkett, Virginia; Hay, John; Wong, Poh Poh; Nurse, Leonard; Wolanski, Eric; McLusky, Donald S.

    2011-01-01

    Coastal vulnerability assessments tend to focus mainly on climate change and especially on sea-level rise. Assessment of the influence of nonclimatic environmental change or socioeconomic change is less well developed and these drivers are often completely ignored. Given that the most profound coastal changes of the twentieth century due to nonclimate drivers are likely to continue through the twenty-first century, this is a major omission. It may result in not only overstating the importance of climate change but also overlooking significant interactions of climate change and other drivers. To support the development of policies relating to climate change and coastal management, integrated assessments of climatic change in coastal areas are required, including the effects of all the relevant drivers. This chapter explores the development of scenarios (or "plausible futures") of relevant climate and nonclimate drivers that can be used for coastal analysis, with an emphasis on the nonclimate drivers. It shows the importance of analyzing the impacts of climate change and sea-level rise in a broader context of coastal change and all its drivers. This will improve the analysis of impacts, key vulnerabilities, and adaptation needs and, hence, inform climate and coastal policy. Stakeholder engagement is important in the development of scenarios, and the underlying assumptions need to be explicit, transparent, and open to scientific debate concerning their uncertainties/realism and likelihood.

  13. Vulnerability of network of networks

    NASA Astrophysics Data System (ADS)

    Havlin, S.; Kenett, D. Y.; Bashan, A.; Gao, J.; Stanley, H. E.

    2014-10-01

    Our dependence on networks - be they infrastructure, economic, social or others - leaves us prone to crises caused by the vulnerabilities of these networks. There is a great need to develop new methods to protect infrastructure networks and prevent cascade of failures (especially in cases of coupled networks). Terrorist attacks on transportation networks have traumatized modern societies. With a single blast, it has become possible to paralyze airline traffic, electric power supply, ground transportation or Internet communication. How, and at which cost can one restructure the network such that it will become more robust against malicious attacks? The gradual increase in attacks on the networks society depends on - Internet, mobile phone, transportation, air travel, banking, etc. - emphasize the need to develop new strategies to protect and defend these crucial networks of communication and infrastructure networks. One example is the threat of liquid explosives a few years ago, which completely shut down air travel for days, and has created extreme changes in regulations. Such threats and dangers warrant the need for new tools and strategies to defend critical infrastructure. In this paper we review recent advances in the theoretical understanding of the vulnerabilities of interdependent networks with and without spatial embedding, attack strategies and their affect on such networks of networks as well as recently developed strategies to optimize and repair failures caused by such attacks.

  14. Vulnerable to HIV / AIDS. Migration.

    PubMed

    Fernandez, I

    1998-01-01

    This special report discusses the impact of globalization, patterns of migration in Southeast Asia, gender issues in migration, the links between migration and HIV/AIDS, and spatial mobility and social networks. Migrants are particularly marginalized in countries that blame migrants for transmission of infectious and communicable diseases and other social ills. Effective control of HIV/AIDS among migrant and native populations requires a multisectoral approach. Programs should critically review the privatization of health care services and challenge economic models that polarize the rich and the poor, men and women, North and South, and migrant and native. Programs should recognize the equality between locals and migrants in receipt of health services. Countermeasures should have input from migrants in order to reduce the conditions that increase vulnerability to HIV/AIDS. Gender-oriented research is needed to understand women's role in migration. Rapid assessment has obscured the human dimension of migrants' vulnerability to HIV. Condom promotion is not enough. Migration is a major consequence of globalization, which holds the promise, real or imagined, of prosperity for all. Mass migration can be fueled by explosive regional developments. In Southeast Asia, migration has been part of the process of economic development. The potential to emigrate increases with greater per capita income. "Tiger" economies have been labor importers. Safe sex is not practiced in many Asian countries because risk is not taken seriously. Migrants tend to be used as economic tools, without consideration of social adjustment and sex behavior among singles.

  15. Dynamics of immune system vulnerabilities

    NASA Astrophysics Data System (ADS)

    Stromberg, Sean P.

    The adaptive immune system can be viewed as a complex system, which adapts, over time, to reflect the history of infections experienced by the organism. Understanding its operation requires viewing it in terms of tradeoffs under constraints and evolutionary history. It typically displays "robust, yet fragile" behavior, meaning common tasks are robust to small changes but novel threats or changes in environment can have dire consequences. In this dissertation we use mechanistic models to study several biological processes: the immune response, the homeostasis of cells in the lymphatic system, and the process that normally prevents autoreactive cells from entering the lymphatic system. Using these models we then study the effects of these processes interacting. We show that the mechanisms that regulate the numbers of cells in the immune system, in conjunction with the immune response, can act to suppress autoreactive cells from proliferating, thus showing quantitatively how pathogenic infections can suppress autoimmune disease. We also show that over long periods of time this same effect can thin the repertoire of cells that defend against novel threats, leading to an age correlated vulnerability. This vulnerability is shown to be a consequence of system dynamics, not due to degradation of immune system components with age. Finally, modeling a specific tolerance mechanism that normally prevents autoimmune disease, in conjunction with models of the immune response and homeostasis we look at the consequences of the immune system mistakenly incorporating pathogenic molecules into its tolerizing mechanisms. The signature of this dynamic matches closely that of the dengue virus system.

  16. Region 9 - Social Vulnerability Index

    EPA Pesticide Factsheets

    The Social Vulnerability Index is derived from the 2000 US Census data. The fields included are percent minority, median household income, age (under 18 and over 64), population without a high school diploma, linguistically isolated households, and single female head of households with own children under 18 (single moms). The data is at the block group level. Each field for each block group is assigned an index score of 0-3, based on whether the value of that dataset falls in the top quartile (score=3), second quartile (score=2), third quartile (score=1), or bottom quartile (score=0). The scores for each field are then added together to assign a comprehensive score to each block group (0-21). The highest scores are block groups that have the highest percentage of sensitive populations (highest percent minority, lowest per capita income, highest percent of population under 18 and over 64, highest percentage of population without a high school degree, highest percent of linguistically isolated households, and highest percent of single female head of households). Zoe Heller of the US EPA Region 9's Communities and Ecosystems Division, is responsible for the design and development of the Social Vulnerability Index data set.

  17. Maternal screening for early postnatal vulnerability.

    PubMed

    Vivilaki, V G; Dafermos, V; Patelarou, Ev; Bick, D; Syngelaki, Ar; Tsopelas, N D; Bitsios, P; Petridou, E T; Vgontzas, Al N; Lionis, Chr

    2016-01-01

    -Efficacy (Factor III: Eigen- value=3.144) and especially attitudes regarding body image, sex and coping resources and options of dealing with the stressor, has been demonstrated that serve as a mediator or buffer for psychological distress. The results of this study have implications for the prevention and intervention of postnatal adjustment difficulties both of which need to be intensified in order to minimise perinatal mental vulnerability.

  18. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray with food, drink, and utensils. The tray contained heating elements for preparing the individual food packets. The food on Skylab was a great improvement over that on earlier spaceflights. It was no longer necessary to squeeze liquified food from plastic tubes. Skylab's kitchen in the Orbital Workshop wardroom was so equipped that each crewman could select his own menu and prepare it to his own taste. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  19. Skylab Food Heating and Serving Tray

    NASA Technical Reports Server (NTRS)

    1970-01-01

    Shown here is the Skylab food heating and serving tray with food, drink, and utensils. The tray contained heating elements for preparing the individual food packets. The food on Skylab was a great improvement over that on earlier spaceflights. It was no longer necessary to squeeze liquified food from plastic tubes. Skylab's kitchen in the Orbital Workshop wardroom was so equipped that each crewman could select his own menu and prepare it to his own taste. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

  20. PREPARING HEALTH PROFESSIONS VOLUNTEERS TO SERVE GLOBALLY.

    PubMed

    Carey, Rebekah E; Carter-Templeton, Heather; Paltzer, Jason

    2015-01-01

    Scant literature exists to describe the global health and collaboration competence of international healthcare professional volunteers. An educational program to prepare volunteers for short-term service in resource-poor settings was developed. Pre- and post- program competence and team collaboration levels were assessed in 18 healthcare professionals. A significant improvement (p < .05) occurred in global health competence after education. Formal educational preparation of international health volunteers can enhance their overall effectiveness when serving in resource-poor settings. Extensive resources for global health education are referenced.

  1. Pipelines jockey to serve Florida gas market

    SciTech Connect

    Not Available

    1992-09-07

    This paper reports that Florida Gas Transmission Corp. (FGT), Houston, appears to have taken the lead in competition to serve Florida's growing gas markets. Florida Power and Light (FPL), Miami, decided to reserve transportation capacity on FGT's proposed Phase III expansion rather than the Sun Coast pipeline proposed by United Gas Pipe Line Co. (UGPL), Houston, and Coastal Corp. unit ANR Pipeline Co., Detroit (OGJ, Aug. 31, p. 31). Withdrawal of FPL, Florida's largest electric utility, from Sun Coast left the proposed 560 mile, 400 MMcfd intrastate gas transmission pipeline with only one major prospective client, Florida Power Corp., St. Petersburg. That forces UGPL and ANR to dissolve the partnership.

  2. Assessing human vulnerability: Daytime residential distribution as a vulnerability indicator

    NASA Astrophysics Data System (ADS)

    Gokesch, Karin; Promper, Catrin; Papathoma-Köhle, Maria; Glade, Thomas

    2014-05-01

    Natural hazard risk management is based on detailed information on potential impacts of natural hazards. Especially concerning fast onset hazards such as flash floods, earthquakes but also debris flows and landslides, knowing potential hotspots of impact to both, assets and human lives is essential. This information is important for emergency management and decision making in the response phase of the disaster management cycle. Emergency managers are in need of information regarding not only the number of humans being potentially affected but also the respective vulnerability of the group affected based on characteristics such as age, income, health condition, mobility, etc. regarding a certain hazard. The analysis presented focuses on the distribution of the population, assuming a certain pattern of people in a certain radius of action. The method applied is based on a regular pattern of movement of different groups of people and a pattern of presence in certain units, e.g. schools, businesses or residential buildings. The distribution is calculated on a minimum of available data including the average household size, as well as information on building types. The study area is located in the Southwest of Lower Austria, Austria. The city of Waidhofen/Ybbs can be regarded as a regional center providing basic infrastructure, shops and schools. The high concentration of buildings combining shops and residential units leads to a high damage potential throughout the whole study area. The presented results indicate the population distribution within the study area on an average working day. It is clear that explicitly high numbers of people are located in specific buildings (e.g. schools and hospitals) which also include highly vulnerable groups especially to fast onset hazards. The results provide emergency services with the information that they need in order to intervene directly where large numbers of victims or people that need to be evacuated are located. In this

  3. An holistic view on aquifer vulnerability based on a distinction of different types of vulnerability

    NASA Astrophysics Data System (ADS)

    De Luca, Domenico Antonio; Lasagna, Manuela; Franchino, Elisa

    2016-04-01

    AN HOLISTIC VIEW ON AQUIFER VULNERABILITY BASED ON A DISTINCTION OF DIFFERENT TYPES OF VULNERABILITY D.A. De Luca1 , M. Lasagna1, E. Franchino1 1Department of Earth Sciences, University of Turin The concept of vulnerability is certainly useful in the field of groundwater protection. Nevertheless, within the scientific community, the definition of groundwater vulnerability is still debatable and not clear and conclusive. This is probably due to the fact that researchers often have very different experiences and education. A positive effect of it is a constant exchange of ideas, but there are also negative consequences and difficulties in deepening the issue. The different approaches are very important but they are usable only if the concept of vulnerability is standardized: thus, for the sake of clarity, a number of definitions should be laid down, based on the different types of vulnerability. These definitions can then provide the necessary holistic view for the aquifer vulnerability assessment. Nowadays vulnerability methods focus on the degree of vulnerability and the parameters needed for its evaluation, often neglecting to clarify what is the type of vulnerability the proposed methods are referred. The type of vulnerability, indeed, is both logically and hierarchically superior to the degree of vulnerability. More specifically the type of vulnerability represents the evaluation of the hydrogeological conditions considered in the vulnerability assessment and able to influence the way in which the contamination can take place. Currently the only distinction, based on of the type of vulnerability, is referred to intrinsic and specific vulnerability. Intrinsic vulnerability assesses the susceptibility of the receptor based on the natural properties of the land and subsurface; specific vulnerability also includes properties of the analyzed contaminant. This distinction is useful but not exhaustive. In addition to this, e.g., a distinction of vertical vulnerability

  4. Metadata for selecting or submitting generic seismic vulnerability functions via GEM's vulnerability database

    USGS Publications Warehouse

    Jaiswal, Kishor

    2013-01-01

    This memo lays out a procedure for the GEM software to offer an available vulnerability function for any acceptable set of attributes that the user specifies for a particular building category. The memo also provides general guidelines on how to submit the vulnerability or fragility functions to the GEM vulnerability repository, stipulating which attributes modelers must provide so that their vulnerability or fragility functions can be queried appropriately by the vulnerability database. An important objective is to provide users guidance on limitations and applicability by providing the associated modeling assumptions and applicability of each vulnerability or fragility function.

  5. The brain norepinephrine system, stress and cardiovascular vulnerability.

    PubMed

    Wood, Susan K; Valentino, Rita J

    2017-03-01

    Chronic exposure to psychosocial stress has adverse effects on cardiovascular health, however the stress-sensitive neurocircuitry involved remains to be elucidated. The anatomical and physiological characteristics of the locus coeruleus (LC)-norepinephrine (NE) system position it to contribute to stress-induced cardiovascular disease. This review focuses on cardiovascular dysfunction produced by social stress and a major theme highlighted is that differences in coping strategy determine individual differences in social stress-induced cardiovascular vulnerability. The establishment of different coping strategies and cardiovascular vulnerability during repeated social stress has recently been shown to parallel a unique plasticity in LC afferent regulation, resulting in either excitatory or inhibitory input to the LC. This contrasting regulation of the LC would translate to differences in cardiovascular regulation and may serve as the basis for individual differences in the cardiopathological consequences of social stress. The advances described suggest new directions for developing treatments and/or strategies for decreasing stress-induced cardiovascular vulnerability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Drug abuse: vulnerability and transition to addiction.

    PubMed

    Le Moal, M

    2009-05-01

    Intrinsic vulnerability is central to the transition of recreational drug use to misuse. Several factors contribute to vulnerability, inherent or acquired, and they account for the huge individual differences observed concerning the propensity to enter in the addiction process. Some of the multifactional causes for a vulnerable phenotype will be examined: genetic factors, age and gender influences, various comorbidities and epidemiological observations. Stress-induced vulnerability will be particularly reviewed because it provides a good model for a pathophysiological research and for relating environmental events to biological consequences of drug vulnerability, namely through the striato-cortical dopamine system. Experimental studies are generally blind concerning these historical factors that contribute vulnerability and a critical evaluation of current animal models is needed. The transition of the last stage of the process, addiction, is conceptualized as a progression from homeostasis to allostasis and then, to pathology.

  7. Assessing the Security Vulnerabilities of Correctional Facilities

    SciTech Connect

    Morrison, G.S.; Spencer, D.S.

    1998-10-27

    The National Institute of Justice has tasked their Satellite Facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps to identi~ the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion fi-om outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees, In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these initial assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  8. NV: Nessus Vulnerability Visualization for the Web

    SciTech Connect

    Harrison, Lane; Spahn, Riley B; Iannacone, Michael D; Downing, Evan P; Goodall, John R

    2012-01-01

    Network vulnerability is a critical component of network se- curity. Yet vulnerability analysis has received relatively lit- tle attention from the security visualization community. In this paper we describe nv, a web-based Nessus vulnerability visualization. Nv utilizes treemaps and linked histograms to allow system administrators to discover, analyze, and man- age vulnerabilities on their networks. In addition to visual- izing single Nessus scans, nv supports the analysis of sequen- tial scans by showing which vulnerabilities have been fixed, remain open, or are newly discovered. Nv was also designed to operate completely in-browser, to avoid sending sensitive data to outside servers. We discuss the design of nv, as well as provide case studies demonstrating vulnerability analysis workflows which include a multiple-node testbed and data from the 2011 VAST Challenge.

  9. Vulnerability and resilience: a critical nexus.

    PubMed

    Lotz, Mianna

    2016-02-01

    Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves (for example, when we decide to trust or forgive, enter into intimate relationships with others, become a parent, become a subject of medical or psychotherapeutic treatment, and the like). In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions.

  10. Mapping community determinants of heat vulnerability.

    PubMed

    Reid, Colleen E; O'Neill, Marie S; Gronlund, Carina J; Brines, Shannon J; Brown, Daniel G; Diez-Roux, Ana V; Schwartz, Joel

    2009-11-01

    The evidence that heat waves can result in both increased deaths and illness is substantial, and concern over this issue is rising because of climate change. Adverse health impacts from heat waves can be avoided, and epidemiologic studies have identified specific population and community characteristics that mark vulnerability to heat waves. We situated vulnerability to heat in geographic space and identified potential areas for intervention and further research. We mapped and analyzed 10 vulnerability factors for heat-related morbidity/mortality in the United States: six demographic characteristics and two household air conditioning variables from the U.S. Census Bureau, vegetation cover from satellite images, and diabetes prevalence from a national survey. We performed a factor analysis of these 10 variables and assigned values of increasing vulnerability for the four resulting factors to each of 39,794 census tracts. We added the four factor scores to obtain a cumulative heat vulnerability index value. Four factors explained > 75% of the total variance in the original 10 vulnerability variables: a) social/environmental vulnerability (combined education/poverty/race/green space), b) social isolation, c) air conditioning prevalence, and d) proportion elderly/diabetes. We found substantial spatial variability of heat vulnerability nationally, with generally higher vulnerability in the Northeast and Pacific Coast and the lowest in the Southeast. In urban areas, inner cities showed the highest vulnerability to heat. These methods provide a template for making local and regional heat vulnerability maps. After validation using health outcome data, interventions can be targeted at the most vulnerable populations.

  11. Using assessing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders.

    PubMed

    Arora, Vineet M; Johnson, Martha; Olson, Jared; Podrazik, Paula M; Levine, Stacie; Dubeau, Catherine E; Sachs, Greg A; Meltzer, David O

    2007-11-01

    To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). Prospective cohort study. Single academic medical center. Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3-83.7% vs 75.8%, 95% CI=70.5-81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3-83.7 vs 31.4% 95% CI=27.5-35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care.

  12. [Clinical trials: vulnerability and ethical relativism].

    PubMed

    Lima, Cristina

    2005-01-01

    Research in human beings is an important chapter of medical ethics. In recent years, investigation has been taken over by profit driven corporations that must guarantee the medical and commercial application of results. This new model of investigation has generated conflicts of interest in doctor-patient, researcher-subject relationship. The inevitable debate and media reaction has led. These trials of controversial design to regions of the globe where the vulnerability of the populations continues to allow their undertaking. This article includes a historical perspective on experimentation in human beings and the conditions that led to its regulation: the Nuremberg CODE, followed by the Helsinky Declaration in its different versions, and the Belmont Report, that defend the subject according to the ethic of principles used in western medicine. There is then a review of the attempts to change international regulation to reintroduce clinical trials with placebo--which since 1996 is only permitted where there are no therapeutic or diagnostic methods--on populations that would otherwise have no access to treatment. This then leads on to the issue of double standards in medical investigation defended by many investigators and some official entities. The article concludes that it may be prudent to allow local ethical commissions to approve deviation from the established norm if such is necessary to resolve urgent questions of health in the country, but it is unacceptable that any such emergency is used as a reason to reduce the ethical prerequisites, in clinical trials. It also concludes that true urgency is in making available to all who need it the effective products already in existence. Furthermore, that the acceptance of ethical relativism can result in the exploitation of vulnerable third world populations for research programmes that cannot be undertaken in their sponsoring countries due to the ethical restrictions in place.

  13. Mining Bug Databases for Unidentified Software Vulnerabilities

    SciTech Connect

    Dumidu Wijayasekara; Milos Manic; Jason Wright; Miles McQueen

    2012-06-01

    Identifying software vulnerabilities is becoming more important as critical and sensitive systems increasingly rely on complex software systems. It has been suggested in previous work that some bugs are only identified as vulnerabilities long after the bug has been made public. These vulnerabilities are known as hidden impact vulnerabilities. This paper discusses the feasibility and necessity to mine common publicly available bug databases for vulnerabilities that are yet to be identified. We present bug database analysis of two well known and frequently used software packages, namely Linux kernel and MySQL. It is shown that for both Linux and MySQL, a significant portion of vulnerabilities that were discovered for the time period from January 2006 to April 2011 were hidden impact vulnerabilities. It is also shown that the percentage of hidden impact vulnerabilities has increased in the last two years, for both software packages. We then propose an improved hidden impact vulnerability identification methodology based on text mining bug databases, and conclude by discussing a few potential problems faced by such a classifier.

  14. Proliferation Vulnerability Red Team report

    SciTech Connect

    Hinton, J.P.; Barnard, R.W.; Bennett, D.E.

    1996-10-01

    This report is the product of a four-month independent technical assessment of potential proliferation vulnerabilities associated with the plutonium disposition alternatives currently under review by DOE/MD. The scope of this MD-chartered/Sandia-led study was limited to technical considerations that could reduce proliferation resistance during various stages of the disposition processes below the Stored Weapon/Spent Fuel standards. Both overt and covert threats from host nation and unauthorized parties were considered. The results of this study will be integrated with complementary work by others into an overall Nonproliferation and Arms Control Assessment in support of a Secretarial Record of Decision later this year for disposition of surplus U.S. weapons plutonium.

  15. Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals

    PubMed Central

    Pascal, Jean; Abbey-Huguenin, Hélène; Leux, Christophe; Lombrail, Pierre; Lert, France

    2009-01-01

    Background Outpatients attending consultations at public hospitals may have unmet needs for preventive medical care. The present study aimed to identify and assess the association between these needs, social vulnerability, and mode of healthcare use. Methods In a multicentre epidemiological study, a group of socially vulnerable outpatients was compared with a non-vulnerable group in a sample of 1316 outpatients selected in hospital consultations, using a validated tool for detection of social vulnerability. Before the patient was seen by medical staff, investigators collected data on social characteristics, healthcare use and preventive medical care received (interventions and advice). Results More than 75% of outpatients stated that they were regularly followed by a physician, usually a general practitioner, but fewer vulnerable than non-vulnerable outpatients were followed (77% vs 89%, p<10−3). For the majority of preventive interventions (vaccinations, screening for cardiovascular risk factors and gynaecological cancers), vulnerable outpatients presented a more marked shortage than non-vulnerable patients, but there was an overall shortage in both groups. When recommended preventive interventions had not been delivered, they had rarely been offered in either group. After adjustment for mode of healthcare use, the differences in preventive care received persisted to the disadvantage of vulnerable outpatients with regard to technical preventive interventions, but there was no difference between the two groups regarding advice received to reduce risk behaviours. Conclusion Unmet needs for preventive care primarily resulted from social inequalities in secondary access to such care. It may be necessary to set up specific interventions targeting vulnerable patients within hospital consultations. PMID:19307244

  16. Attack Vulnerability of Network Controllability

    PubMed Central

    2016-01-01

    Controllability of complex networks has attracted much attention, and understanding the robustness of network controllability against potential attacks and failures is of practical significance. In this paper, we systematically investigate the attack vulnerability of network controllability for the canonical model networks as well as the real-world networks subject to attacks on nodes and edges. The attack strategies are selected based on degree and betweenness centralities calculated for either the initial network or the current network during the removal, among which random failure is as a comparison. It is found that the node-based strategies are often more harmful to the network controllability than the edge-based ones, and so are the recalculated strategies than their counterparts. The Barabási-Albert scale-free model, which has a highly biased structure, proves to be the most vulnerable of the tested model networks. In contrast, the Erdős-Rényi random model, which lacks structural bias, exhibits much better robustness to both node-based and edge-based attacks. We also survey the control robustness of 25 real-world networks, and the numerical results show that most real networks are control robust to random node failures, which has not been observed in the model networks. And the recalculated betweenness-based strategy is the most efficient way to harm the controllability of real-world networks. Besides, we find that the edge degree is not a good quantity to measure the importance of an edge in terms of network controllability. PMID:27588941

  17. Utilities` ``obligation to serve`` under deregulation

    SciTech Connect

    Alexander, C.B.

    1997-02-01

    The utility no longer has protected status, and the traditional franchise concept is under attack. Exclusive rights once conveyed to the utilities are being denied and not just in the area of gas sales. Exclusive rights once conveyed to utilities will be denied in more areas. State by state, the utilities` franchise is being examined to see which, if any, of its provisions are necessary in a deregulated environment. Can the free market provide everything that`s been provided for many years under monopolistic arrangements? Some of the most critical and difficult of these provisions concern the obligation to serve, which utilities, in most states, have assumed as part of their franchise agreement. Regulators, courts, utilities, marketers and others are busy sorting through these issues, but resolution could take years. The paper discusses deregulation, universal service fee, representation without taxation, suppliers and marketer restrictions.

  18. Spatial-temporal eco-environmental vulnerability assessment and its influential factors based on Landsat data

    NASA Astrophysics Data System (ADS)

    Anh, N. K.; Liou, Y. A.; Ming-Hsu, L.

    2016-12-01

    Regional land use/land cover (LULC) changes lead to various changes in ecological processes and, in turn, alter regional micro-climate. To understand eco-environmental responses to LULC changes, eco-environmental evaluation is thus required with aims to identify vulnerable regions and influential factors, so that practical measures for environmental protection and management may be proposed. The Thua Thien - Hue Province has been experiencing urbanization at a rapid rate in both population and physical size. The urban land, agricultural land, and aquaculture activities have been invasively into natural space and caused eco-environment deterioration by land desertification, soil erosion, shrinking forest resources,…etc. In this study, an assessment framework that is composed by 11 variables with 9 of them constructed from Landsat time series is proposed to serve as basis to examine eco-environmental vulnerability in the Thua Thien - Hue Province in years 1989, 2003, and 2014. An eco-environmental vulnerability map is assorted into six vulnerability levels consisting of potential, slight, light, medium, heavy, and very heavy vulnerabilities. Result shows that there is an increasing trend in eco-environmental vulnerability in general with expected evolving distributions in heavy and very heavy vulnerability levels, which mainly lying on developed land, bare land, semi bare land, agricultural land, and poor and recovery forests. In contrast, there is a significant decline in potential vulnerability level. The contributing factors of an upward trend in medium, heavy, and very heavy levels include: (i) a large natural forest converted to plantation forest and agriculture land; and (ii) significant expansion of developed land leading to difference in thermal signatures in urban areas as compared with those of the surrounding areas. It is concluded that anthropogenic processes with transformation on LULC has amplified the vulnerability of eco-environment in the study

  19. Proposal of a Mediterranean Diet Serving Score

    PubMed Central

    Monteagudo, Celia; Mariscal-Arcas, Miguel; Rivas, Ana; Lorenzo-Tovar, María Luisa; Tur, Josep A.; Olea-Serrano, Fátima

    2015-01-01

    Background and Aims Numerous studies have demonstrated a relationship between Mediterranean Diet (MD) adherence and the prevention of cardiovascular diseases, cancer, and diabetes, etc. The study aim was to validate a novel instrument to measure MD adherence based on the consumption of food servings and food groups, and apply it in a female population from southern Spain and determining influential factors. Methods and Results The study included 1,155 women aged 12-83 yrs, classified as adolescents, adults, and over-60-yr-olds. All completed a validated semi-quantitative food frequency questionnaire (FFQ). The Mediterranean Dietary Serving Score (MDSS) is based on the latest update of the Mediterranean Diet Pyramid, using the recommended consumption frequency of foods and food groups; the MDSS ranges from 0 to 24. The discriminative power or correct subject classification capacity of the MDSS was analyzed with the Receiver Operating Characteristic (ROC) curve, using the MDS as reference method. Predictive factors for higher MDSS adherence were determined with a logistic regression model, adjusting for age. According to ROC curve analysis, MDSS evidenced a significant discriminative capacity between adherents and non-adherents to the MD pattern (optimal cutoff point=13.50; sensitivity=74%; specificity=48%). The mean MDSS was 12.45 (2.69) and was significantly higher with older age (p<0.001). Logistic regression analysis showed highest MD adherence by over 60-year-olds with low BMI and no habit of eating between meals. Conclusions The MDSS is an updated, easy, valid, and accurate instrument to assess MD adherence based on the consumption of foods and food groups per meal, day, and week. It may be useful in future nutritional education programs to prevent the early onset of chronic non-transmittable diseases in younger populations. PMID:26035442

  20. Variability in vulnerability assessment of older people by individual general practitioners: a cross-sectional study.

    PubMed

    Drewes, Yvonne M; Blom, Jeanet W; Assendelft, Willem J J; Stijnen, Theo; den Elzen, Wendy P J; Gussekloo, Jacobijn

    2014-01-01

    In clinical practice, GPs appeared to have an internalized concept of "vulnerability." This study investigates the variability between general practitioners (GPs) in their vulnerability-assessment of older persons. Seventy-seven GPs categorized their 75-plus patients (n = 11392) into non-vulnerable, possibly vulnerable, and vulnerable patients. GPs personal and practice characteristics were collected. From a sample of 2828 patients the following domains were recorded: sociodemographic, functional [instrumental activities in daily living (IADL), basic activities in daily living (BADL)], somatic (number of diseases, polypharmacy), psychological (Mini-Mental State Examination, 15-item Geriatric Depression Scale; GDS-15) and social (De Jong-Gierveld Loneliness Scale; DJG). Variability in GPs' assessment of vulnerability was tested with mixed effects logistic regression. P-values for variability (pvar) were calculated by the log-likelihood ratio test. Participating GPs assessed the vulnerability of 10,361 patients. The median percentage of vulnerable patients was 32.0% (IQR 19.5 to 40.1%). From the somatic and psychological domains, GPs uniformly took into account the patient characteristics 'total number of diseases' (OR 1.7, 90% range  = 0, p var = 1), 'polypharmacy' (OR 2.3, 90% range  = 0, p var = 1) and 'GDS-15' (OR 1.6, 90% range  = 0, p var = 1). GPs vary in the way they assessed their patients' vulnerability in the functional domain (IADL: median OR 2.8, 90% range 1.6, p var < 0.001, BADL: median OR 2.4, 90% range 2.9, p var < 0.001) and the social domain (DJG: median OR 1.2, 90% range  = 1.2, p var < 0.001). GPs seem to share a medical concept of vulnerability, since they take somatic and psychological characteristics uniformly into account in the vulnerability-assessment of older persons. In the functional and social domains, however, variability was found. Vulnerability assessment by GPs might be a promising instrument to select older people for

  1. Does nurses' vulnerability affect their ability to care?

    PubMed

    Heaslip, Vanessa; Board, Michele

    Recent reports from the Department of Health (2008), the Parliamentary and Health Service Ombudsman (2011) and the Commission on Dignity in Care for Older People (2012) have been highly critical regarding the care that some patients have experienced. They have highlighted that fundamental aspects of care are missing resulting in a lack of high quality individualised nursing care, which is in contrast with holistic nursing philosophy. We have to ask ourselves what is happening within nursing, as many enter the profession owing to a desire to 'make a difference'. Drawing on focus group data exploring perceptions of caring for residents with dementia in a care home setting, the authors found that nurses and healthcare assistants experience a mutual vulnerability with patients. This paper explores whether this mutual vulnerability could lead to nurses focusing on the clinical aspects of their role to the detriment of the compassionate, caring components of nursing.

  2. Determining carotid plaque vulnerability using ultrasound center frequency shifts.

    PubMed

    Erlöv, Tobias; Cinthio, Magnus; Edsfeldt, Andreas; Segstedt, Simon; Dias, Nuno; Nilsson, Jan; Gonçalves, Isabel

    2016-03-01

    The leading cause of morbidity and mortality worldwide is atherosclerotic cardiovascular disease, most commonly caused by rupture of a high-risk plaque and subsequent thrombosis resulting in stroke, myocardial infarction or sudden death depending on the affected arterial territory. Accurate, non-invasive methods to identify such lesions known as vulnerable or high-risk plaques are currently sub-optimal. Our aim was to validate a new non-invasive ultrasound method to identify high-risk carotid plaques. We evaluated a new method based on the center frequency shift (CFS) of the ultrasound radio frequency data obtained from carotid plaques compared to a reference phantom. We evaluated the method both ex vivo, on 157 sections from 18 plaques, and in vivo, in 39 patients 1-day prior to carotid plaque removal, and correlated the data with histology. The CFS correlated with a plaque vulnerability index based on histological areas stained for lipids, macrophages, hemorrhage, smooth muscle cells and collagen (r = -0.726, P = 1.7 × 10(-8)). Plaques with CFS below median had larger cores, more macrophages and were less rich in collagen in agreement with the definition of rupture-prone plaques. The accuracy to detect plaques with high vulnerability index was 78% (confidence interval (CI) 61-89%), with sensitivity 77% (CI 61-89%) and specificity 78% (CI 62-89%). Our method is the first to characterize atherosclerotic plaque components that affect plaque vulnerability using CFS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Effect of whiskey on atrial vulnerability and "holiday heart".

    PubMed

    Engel, T R; Luck, J C

    1983-03-01

    Vulnerability to atrial fibrillation and flutter was examined in 11 alcohol abusers who did not have cardiomyopathy or manifest heart failure. Atrial extrastimulation was done with rapid pacing (drive cycle length 500 ms) to facilitate induction of atrial vulnerability, seen in four alcohol abusers. The remaining seven were retested 30 minutes after drinking 60 to 120 ml of 86 proof whiskey (ethanol blood levels were 49 to 101 mg/100 ml but pulmonary capillary wedge pressure remained normal in all) and atrial fibrillation or flutter was induced in three of the drinkers. Three nondrinkers, symptomatic with sinus bradycardia but not in heart failure, were found not to be vulnerable to atrial fibrillation or flutter, but flutter was induced in two of the three after drinking whiskey. Whiskey did not alter atrial functional refractory periods (mean +/- standard error of the mean 297 +/- 14 to 290 +/- 12 ms) or widen the dispersion among three disparate right atrial sites (57 +/- 13 to 47 +/- 12 ms). Thus, whiskey enhanced vulnerability to atrial fibrillation and flutter in patients without heart failure or cardiomyopathy, substantiating the "holiday heart" syndrome.

  4. Vulnerabilities of children admitted to a pediatric inpatient care unit☆

    PubMed Central

    de Oliveira, Larissa Natacha; Breigeiron, Márcia Koja; Hallmann, Sofia; Witkowski, Maria Carolina

    2014-01-01

    OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family. PMID:25511001

  5. Le Bistro serves up cultural change.

    PubMed

    Leggitt, Mark S; Potrepka, Virginia N; Kukolja, Teresa J

    2003-01-01

    Bristol Hospital, a 134-bed community health care system in Connecticut, has consistently been nationally ranked in the top tier of hospitals for its patient satisfaction scores. A key to this long-term distinction has been its commitment to a culture built around patient satisfaction and service excellence. Empowerment, vigilance, recognition, and celebration are the cultural cornerstones. The change has enabled the hospital to increase its market share, increase its satisfaction rankings, increase its employee retention, and enjoy consistent financial success.

  6. Vulnerable Youth and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Xie, Rongbing; Sen, Bisakha; Foster, E. Michael

    2014-01-01

    This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

  7. Design Vulnerability Assessments for Safeguards Sealing Systems

    SciTech Connect

    Brockman, Linda; Johnston, Roger; Kravtchenko, Victor; Undem, Halvor A.; Wishard, Bernard

    2010-08-11

    The International Atomic Energy Agency (the "Agency") engages in a rigorous equipment authorization process prior to deploying Safeguards instrumentation, including Safeguards sealing systems, for world-wide use. A positive result from a vulnerability assessment is one of the many requirements that must be met prior to instrumentation deployment. Given the long time period in the Safeguards instrumentation development cycle, the substantial Member State investments made, and the significant Agency staff time required, a negative result for the vulnerability assessment can result in the loss of time, considerable additional expense, or even the failure to deploy an instrument or sealing system at all. First suggested in 1998 by the General Physics Institute in Moscow, an approach that incorporates a design vulnerability assessment minimizes the risk of deployment failure by teaming a public sector vulnerability assessment team with the instrument or sealing system design team in order to identify, at the earliest possible design stage, inherent vulnerabilities. Involving the vulnerability assessors early and often in the design and development process avoids many of the problems inherent in evaluating security vulnerabilities only after the design is finalized. The disadvantages include increased costs and time to deployment. An improved pressure-sensitive adhesive label seal, called the "VOID-3 seal" was developed for the Agency using this design vulnerability assessment process.

  8. Climate change vulnerability assessment in Georgia

    Treesearch

    Binita KC; J. Marshall Shepherd; Cassandra Johnson Gaither

    2015-01-01

    Climate change is occurring in the Southeastern United States, and one manifestation is changes in frequency and intensity of extreme events. A vulnerability assessment is performed in the state of Georgia (United States) at the county level from 1975 to 2012 in decadal increments. Climate change vulnerability is typically measured as a function of exposure to physical...

  9. Predicting Vulnerability Risks Using Software Characteristics

    ERIC Educational Resources Information Center

    Roumani, Yaman

    2012-01-01

    Software vulnerabilities have been regarded as one of the key reasons for computer security breaches that have resulted in billions of dollars in losses per year (Telang and Wattal 2005). With the growth of the software industry and the Internet, the number of vulnerability attacks and the ease with which an attack can be made have increased. From…

  10. Callahan's Vulnerability Thesis and "Dissatisfaction Theory."

    ERIC Educational Resources Information Center

    Iannaccone, Laurence

    1996-01-01

    In discussing school superintendent vulnerability, the paper addresses diverse meanings among scholars of Callahan's vulnerability thesis, highlighting other articles within this theme issue. The paper reflects on discussions of Callahan's "Education and the Cult of Efficacy" before its 1962 publication and investigates the relation…

  11. Opportunistic Interruptions: Interactional Vulnerabilities Deriving from Linearization

    ERIC Educational Resources Information Center

    Gibson, David R.

    2005-01-01

    Speaking involves "linearizing" a message into a string of words. This process leaves us vulnerable to being interrupted in such a way that the aborted turn is a misrepresentation of the intended message. Further, because we linearize our messages in standard ways, we are recurrently vulnerable to interruptions at particular…

  12. Predicting Vulnerability Risks Using Software Characteristics

    ERIC Educational Resources Information Center

    Roumani, Yaman

    2012-01-01

    Software vulnerabilities have been regarded as one of the key reasons for computer security breaches that have resulted in billions of dollars in losses per year (Telang and Wattal 2005). With the growth of the software industry and the Internet, the number of vulnerability attacks and the ease with which an attack can be made have increased. From…

  13. Vulnerable Youth and Transitions to Adulthood

    ERIC Educational Resources Information Center

    Xie, Rongbing; Sen, Bisakha; Foster, E. Michael

    2014-01-01

    This chapter focuses on vulnerable youth, the challenges they face during their transitions to adulthood, and the adverse effects of limited support systems on those transitions. The authors offer recommendations on how adult educators can help facilitate smooth transitions into adulthood for vulnerable youth.

  14. Chemical facility vulnerability assessment project.

    PubMed

    Jaeger, Calvin D

    2003-11-14

    Sandia National Laboratories, under the direction of the Office of Science and Technology, National Institute of Justice, conducted the chemical facility vulnerability assessment (CFVA) project. The primary objective of this project was to develop, test and validate a vulnerability assessment methodology (VAM) for determining the security of chemical facilities against terrorist or criminal attacks (VAM-CF). The project also included a report to the Department of Justice for Congress that in addition to describing the VAM-CF also addressed general observations related to security practices, threats and risks at chemical facilities and chemical transport. In the development of the VAM-CF Sandia leveraged the experience gained from the use and development of VAs in other areas and the input from the chemical industry and Federal agencies. The VAM-CF is a systematic, risk-based approach where risk is a function of the severity of consequences of an undesired event, the attack potential, and the likelihood of adversary success in causing the undesired event. For the purpose of the VAM-CF analyses Risk is a function of S, L(A), and L(AS), where S is the severity of consequence of an event, L(A) is the attack potential and L(AS) likelihood of adversary success in causing a catastrophic event. The VAM-CF consists of 13 basic steps. It involves an initial screening step, which helps to identify and prioritize facilities for further analysis. This step is similar to the prioritization approach developed by the American Chemistry Council (ACC). Other steps help to determine the components of the risk equation and ultimately the risk. The VAM-CF process involves identifying the hazardous chemicals and processes at a chemical facility. It helps chemical facilities to focus their attention on the most critical areas. The VAM-CF is not a quantitative analysis but, rather, compares relative security risks. If the risks are deemed too high, recommendations are developed for

  15. Cogeneration plant serves Prague sewage works

    SciTech Connect

    1995-10-01

    The new cogeneration plant at the sewage works in Prague, Czech Republic, was commissioned in June of this year. The plant is based on three gas engine modules from Deutz MWM-Gastechnik, which supply power and heat from the sewage gas. Also installed was a central plant control system (CPCS) for automation of the power plant, including long-term data storage for operation optimization. The gas engines are equipped with an individual total electronic management system (TEM) that optimizes engine operation and heat transfer. The TEM system also serves for safety monitoring of the relevant modules. Data communication between the TEM system and the CPCS is realized via a serial interface. The CPCS can thus test the availability of the individual heat generators and, depending on the condition of an individual module, switch over to another. With due consideration to environmental protection, Deutz MWM-Gastechnik guarantees NO{sub x} emissions of less than 500 mg/Nm{sup 3} (at 5% O{sub 2}) and CO emissions of less than 650 mg/Nm{sup 3}. The plant operator has also encapsulated the three gas engine modules in soundproofing enclosures in order to reduce noise emissions from 105 down to 78 dB(A).

  16. Serving Data to the GLAST Users Community

    SciTech Connect

    Stephens, Thomas E.

    2007-07-12

    The scientific community will access the public GLAST data through the website of the GLAST Science Support Center (GSSC). For most data products the GSSC website will link to the NASA High Energy Astrophysics Science Archive Research Center's (HEASARC) Browse interface, which will actually serve the data. For example, data from the GLAST Burst Monitor (GBM) from a given burst will be packaged together and accessible through Browse. However, the photon and event data produced by the Large Area Telescope (LAT), GLAST's primary instrument, will be distributed through a custom GSSC interface. These data will be collected over the LAT's large field-of-view, usually while the LAT is scanning the sky, and thus photons from a particular direction cannot be attributed to a single 'observation' in the traditional sense. Users will request all photons detected from a region on the sky over a specified time and energy range. Through its website the GSSC will also provide long and short term science timelines, spacecraft position and attitude histories, exposure maps and other scientific data products. The different data products provided by the GSSC will be described.

  17. Biodiversity Information Serving Our Nation (BISON)

    USGS Publications Warehouse

    ,

    2013-01-01

    Researchers collect species occurrence data, records of an organism at a particular time in a particular place, as a primary or ancillary function of many biological field investigations. Presently, these data reside in numerous distributed systems and formats (including publications) and are consequently not being used to their full potential. As a step toward addressing this challenge, the Core Science Analytics and Synthesis (CSAS) program of the US Geological Survey (USGS) is developing Biodiversity Information Serving Our Nation (BISON), an integrated and permanent resource for biological occurrence data from the United States. BISON will leverage the accumulated human and infrastructural resources of the long-term USGS investment in research and information management and delivery. CSAS is also the U.S. Node of the Global Biodiversity Information Facility (GBIF), an international, government-initiated and funded effort focused on making biodiversity data freely available for scientific research, conservation and sustainable development. CSAS, with its partners at Department of Energy's Oak Ridge National Laboratory (ORNL), hosts a full mirror of the hundreds of millions of global records to which GBIF provides access. BISON has been initiated with the 110 million records GBIF makes available from the U.S. and is integrating millions more records from other sources each year.

  18. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

    PubMed

    Bourgois, Philippe; Holmes, Seth M; Sue, Kim; Quesada, James

    2017-03-01

    The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

  19. Serving Those Who Serve: Meeting the Complex Needs of Students Returning Home from War

    ERIC Educational Resources Information Center

    Veislind, Emili

    2013-01-01

    As community colleges across the country strive to improve completion rates and serve a growing number of students returned home from war, the need for programs that meet the unique needs of veterans--including job training, social acclimation, referral programs for mental health counseling, and academic tutoring, to name a few--is more pressing…

  20. Offer versus Serve or Serve Only: Does Service Method Affect Elementary Children's Fruit and Vegetable Consumption?

    ERIC Educational Resources Information Center

    Goggans, Margaret Harbison; Lambert, Laurel; Chang, Yunhee

    2011-01-01

    Purpose/Objectives: The purpose of this study was to determine if the use of the Offer versus Serve (OVS) provision in the National School Lunch Program would result in a significant difference in fruit and vegetable consumption by fourth and fifth grade elementary students, and in plate waste cost. Methods: Weighed and visual plate waste data…

  1. Effectively Serving AB 540 and Undocumented Students at a Hispanic Serving Institution

    ERIC Educational Resources Information Center

    Person, Dawn; Gutierrez Keeton, Rebecca; Medina, Noemy; Gonzalez, Jacquelyn; Minero, Laura P.

    2017-01-01

    This mixed-methods study examined the experiences of undocumented students at a 4-year Hispanic Serving Institution. Barriers identified by these students included a lack of resources and minimal career opportunities after graduation. Faculty and staff perceived this historically underserved population as exhibiting high levels of optimism and…

  2. Serving Those Who Serve: Meeting the Complex Needs of Students Returning Home from War

    ERIC Educational Resources Information Center

    Veislind, Emili

    2013-01-01

    As community colleges across the country strive to improve completion rates and serve a growing number of students returned home from war, the need for programs that meet the unique needs of veterans--including job training, social acclimation, referral programs for mental health counseling, and academic tutoring, to name a few--is more pressing…

  3. How Online Schools Serve and Fail to Serve At-Risk Students

    ERIC Educational Resources Information Center

    Figueiredo-Brown, Regina

    2013-01-01

    Purpose: Online schools were initially designed to provide access to diverse courses to advanced and homeschooled students, however, many online schools now market their programs specifically to students whose needs place them at-risk in traditional schools. The capacity of technology to address any of the needs of under-served students is largely…

  4. Offer versus Serve or Serve Only: Does Service Method Affect Elementary Children's Fruit and Vegetable Consumption?

    ERIC Educational Resources Information Center

    Goggans, Margaret Harbison; Lambert, Laurel; Chang, Yunhee

    2011-01-01

    Purpose/Objectives: The purpose of this study was to determine if the use of the Offer versus Serve (OVS) provision in the National School Lunch Program would result in a significant difference in fruit and vegetable consumption by fourth and fifth grade elementary students, and in plate waste cost. Methods: Weighed and visual plate waste data…

  5. Oxytocin and vulnerable romantic relationships.

    PubMed

    Grebe, Nicholas M; Kristoffersen, Andreas Aarseth; Grøntvedt, Trond Viggo; Emery Thompson, Melissa; Kennair, Leif Edward Ottesen; Gangestad, Steven W

    2017-04-01

    Oxytocin (OT) has been implicated in the formation and maintenance of various social relationships, including human romantic relationships. Competing models predict, alternatively, positive or negative associations between naturally-occurring OT levels and romantic relationship quality. Empirical tests of these models have been equivocal. We propose a novel hypothesis ('Identify and Invest') that frames OT as an allocator of psychological investment toward valued, vulnerable relationships, and test this proposal in two studies. In one sample of 75 couples, and a second sample of 148 romantically involved individuals, we assess facets of relationships predicting changes in OT across a thought-writing task regarding one's partner. In both studies, participants' OT change across the task corresponded positively with multiple dimensions of high relationship involvement. However, increases in participants' OT also corresponded to their partners reporting lower relationship involvement. OT increases, then, reflected discrepancies between assessments of self and partner relationship involvement. These findings are robust in a combined analysis of both studies, and do not significantly differ between samples. Collectively, our findings support the 'Identify and Invest' hypothesis in romantic couples, and we argue for its relevance across other types of social bonds. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 49 CFR 105.35 - Serving documents in PHMSA proceedings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Serving documents in PHMSA proceedings. (a) Service by PHMSA. We may serve the document by one of the... document by one of the following methods, except where a different method of service is specifically...), you may electronically serve documents on us. (ii) Serve documents electronically through the Internet...

  7. The role of vulnerability factors in individuals with an at-risk mental state of psychosis.

    PubMed

    Papmeyer, Martina; Würsch, Irène; Studerus, Erich; Stieglitz, Rolf-Dieter; Riecher-Rössler, Anita

    2016-03-01

    Several indicators of heightened vulnerability to psychosis and relevant stressors have been identified. However, it has rarely been studied prospectively to what extent these vulnerability factors are in fact more frequently present in individuals with an at-risk mental state for psychosis. Moreover, it remains unknown whether any of these contribute to the prediction of psychosis onset in at-risk mental state individuals. There were 28 healthy controls, 86 first-episode psychosis patients and 127 at-risk mental state individuals recruited within the Basel "Früherkennung von Psychosen" project. Relative frequencies of selected vulnerability factors for psychosis were compared between healthy controls, psychosis patients, those at-risk mental state individuals with subsequent psychosis onset (n = 31) and those without subsequent psychosis onset (n = 55). Survival analyses were applied to determine associations between time to transition to psychosis and vulnerability factors in all 127 at-risk mental state individuals. The vulnerability factors/indicators such as "difficulties during school education or vocational training", "difficulties during employment", "being single", "difficulties with intimate relationships" and "being burdened with specific stressful situations" were more commonly found in the at-risk mental state and first-episode psychosis group than in healthy controls. At-risk mental state and first-episode psychosis individuals more frequently present with vulnerability factors. Individual vulnerability factors appear, however, not to be predictive for an onset of psychosis.

  8. Development and implementation of a Bayesian-based aquifer vulnerability assessment in Florida

    USGS Publications Warehouse

    Arthur, J.D.; Wood, H.A.R.; Baker, A.E.; Cichon, J.R.; Raines, G.L.

    2007-01-01

    The Florida Aquifer Vulnerability Assessment (FAVA) was designed to provide a tool for environmental, regulatory, resource management, and planning professionals to facilitate protection of groundwater resources from surface sources of contamination. The FAVA project implements weights-of-evidence (WofE), a data-driven, Bayesian-probabilistic model to generate a series of maps reflecting relative aquifer vulnerability of Florida's principal aquifer systems. The vulnerability assessment process, from project design to map implementation is described herein in reference to the Floridan aquifer system (FAS). The WofE model calculates weighted relationships between hydrogeologic data layers that influence aquifer vulnerability and ambient groundwater parameters in wells that reflect relative degrees of vulnerability. Statewide model input data layers (evidential themes) include soil hydraulic conductivity, density of karst features, thickness of aquifer confinement, and hydraulic head difference between the FAS and the watertable. Wells with median dissolved nitrogen concentrations exceeding statistically established thresholds serve as training points in the WofE model. The resulting vulnerability map (response theme) reflects classified posterior probabilities based on spatial relationships between the evidential themes and training points. The response theme is subjected to extensive sensitivity and validation testing. Among the model validation techniques is calculation of a response theme based on a different water-quality indicator of relative recharge or vulnerability: dissolved oxygen. Successful implementation of the FAVA maps was facilitated by the overall project design, which included a needs assessment and iterative technical advisory committee input and review. Ongoing programs to protect Florida's springsheds have led to development of larger-scale WofE-based vulnerability assessments. Additional applications of the maps include land-use planning

  9. Vulnerability, Health Agency and Capability to Health.

    PubMed

    Straehle, Christine

    2016-01-01

    One of the defining features of the capability approach (CA) to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability.

  10. Groundwater vulnerability mapping of Qatar aquifers

    NASA Astrophysics Data System (ADS)

    Baalousha, Husam Musa

    2016-12-01

    Qatar is one of the most arid countries in the world with limited water resources. With little rainfall and no surface water, groundwater is the only natural source of fresh water in the country. Whilst the country relies mainly on desalination of seawater to secure water supply, groundwater has extensively been used for irrigation over the last three decades, which caused adverse environmental impact. Vulnerability assessment is a widely used tool for groundwater protection and land-use management. Aquifers in Qatar are carbonate with lots of fractures, depressions and cavities. Karst aquifers are generally more vulnerable to contamination than other aquifers as any anthropogenic-sourced contaminant, especially above a highly fractured zone, can infiltrate quickly into the aquifer and spread over a wide area. The vulnerability assessment method presented in this study is based on two approaches: DRASTIC and EPIK, within the framework of Geographical Information System (GIS). Results of this study show that DRASTIC vulnerability method suits Qatar hydrogeological settings more than EPIK. The produced vulnerability map using DRASTIC shows coastal and karst areas have the highest vulnerability class. The southern part of the country is located in the low vulnerability class due to occurrence of shale formation within aquifer media, which averts downward movement of contaminants.

  11. The meaning of vulnerability to older persons.

    PubMed

    Sarvimäki, Anneli; Stenbock-Hult, Bettina

    2016-06-01

    Vulnerability is an important concept in nursing and nursing ethics. Vulnerability and ageing have generally been associated with frailty, which gives a limited view of both vulnerability and ageing. The aim of this study was to illuminate the meaning of vulnerability to older persons themselves. A qualitative design based on interpretive description was adopted. The data were collected by interviews that were analysed by qualitative content analysis as interplay between analysis, interpretation and meaning construction. In total, 14 older persons aged 70-96 years were interviewed, 2 men and 12 women. Some of the participants lived in their own homes, some in service houses and some in nursing homes. The ethical principles of informed consent, confidentiality and non-identification were respected. The core meaning was a deeper sense of vulnerability as you grow old. This was expressed in six themes: Being easily harmed, Becoming an old person, Being an old person in society, Reactions when being violated and hurt, Protection and Vulnerability as strength. The themes include frailty and threats to the dignity of older persons and also capacity to feel and develop. The results showed that although the frailty perspective dominated, vulnerability also had positive meanings for the older persons. © The Author(s) 2014.

  12. Heat Wave Vulnerability Mapping for India.

    PubMed

    Azhar, Gulrez; Saha, Shubhayu; Ganguly, Partha; Mavalankar, Dileep; Madrigano, Jaime

    2017-03-30

    Assessing geographic variability in heat wave vulnerability forms the basis for planning appropriate targeted adaptation strategies. Given several recent deadly heatwaves in India, heat is increasingly being recognized as a public health problem. However, to date there has not been a country-wide assessment of heat vulnerability in India. We evaluated demographic, socioeconomic, and environmental vulnerability factors and combined district level data from several sources including the most recent census, health reports, and satellite remote sensing data. We then applied principal component analysis (PCA) on 17 normalized variables for each of the 640 districts to create a composite Heat Vulnerability Index (HVI) for India. Of the total 640 districts, our analysis identified 10 and 97 districts in the very high and high risk categories (> 2SD and 2-1SD HVI) respectively. Mapping showed that the districts with higher heat vulnerability are located in the central parts of the country. On examination, these are less urbanized and have low rates of literacy, access to water and sanitation, and presence of household amenities. Therefore, we concluded that creating and mapping a heat vulnerability index is a useful first step in protecting the public from the health burden of heat. Future work should incorporate heat exposure and health outcome data to validate the index, as well as examine sub-district levels of vulnerability.

  13. Determining Vulnerability Importance in Environmental Impact Assessment

    SciTech Connect

    Toro, Javier; Duarte, Oscar; Requena, Ignacio; Zamorano, Montserrat

    2012-01-15

    The concept of vulnerability has been used to describe the susceptibility of physical, biotic, and social systems to harm or hazard. In this sense, it is a tool that reduces the uncertainties of Environmental Impact Assessment (EIA) since it does not depend exclusively on the value assessments of the evaluator, but rather is based on the environmental state indicators of the site where the projects or activities are being carried out. The concept of vulnerability thus reduces the possibility that evaluators will subjectively interpret results, and be influenced by outside interests and pressures during projects. However, up until now, EIA has been hindered by a lack of effective methods. This research study analyzes the concept of vulnerability, defines Vulnerability Importance and proposes its inclusion in qualitative EIA methodology. The method used to quantify Vulnerability Importance is based on a set of environmental factors and indicators that provide a comprehensive overview of the environmental state. The results obtained in Colombia highlight the usefulness and objectivity of this method since there is a direct relation between this value and the environmental state of the departments analyzed. - Research Highlights: Black-Right-Pointing-Pointer The concept of vulnerability could be considered defining Vulnerability Importance included in qualitative EIA methodology. Black-Right-Pointing-Pointer The use of the concept of environmental vulnerability could reduce the subjectivity of qualitative methods of EIA. Black-Right-Pointing-Pointer A method to quantify the Vulnerability Importance proposed provides a comprehensive overview of the environmental state. Black-Right-Pointing-Pointer Results in Colombia highlight the usefulness and objectivity of this method.

  14. Vulnerability indicators of sea water intrusion.

    PubMed

    Werner, Adrian D; Ward, James D; Morgan, Leanne K; Simmons, Craig T; Robinson, Neville I; Teubner, Michael D

    2012-01-01

    In this paper, simple indicators of the propensity for sea water intrusion (SWI) to occur (referred to as "SWI vulnerability indicators") are devised. The analysis is based on an existing analytical solution for the steady-state position of a sharp fresh water-salt water interface. Interface characteristics, that is, the wedge toe location and sea water volume, are used in quantifying SWI in both confined and unconfined aquifers. Rates-of-change (partial derivatives of the analytical solution) in the wedge toe or sea water volume are used to quantify the aquifer vulnerability to various stress situations, including (1) sea-level rise; (2) change in recharge (e.g., due to climate change); and (3) change in seaward discharge. A selection of coastal aquifer cases is used to apply the SWI vulnerability indicators, and the proposed methodology produces interpretations of SWI vulnerability that are broadly consistent with more comprehensive investigations. Several inferences regarding SWI vulnerability arise from the analysis, including: (1) sea-level rise impacts are more extensive in aquifers with head-controlled rather than flux-controlled inland boundaries, whereas the opposite is true for recharge change impacts; (2) sea-level rise does not induce SWI in constant-discharge confined aquifers; (3) SWI vulnerability varies depending on the causal factor, and therefore vulnerability composites are needed that differentiate vulnerability to such threats as sea-level rise, climate change, and changes in seaward groundwater discharge. We contend that the approach is an improvement over existing methods for characterizing SWI vulnerability, because the method has theoretical underpinnings and yet calculations are simple, although the coastal aquifer conceptualization is highly idealized.

  15. Bone marrow osteoblast vulnerability to chemotherapy.

    PubMed

    Gencheva, Marieta; Hare, Ian; Kurian, Susan; Fortney, Jim; Piktel, Debbie; Wysolmerski, Robert; Gibson, Laura F

    2013-06-01

    Osteoblasts are a major component of the bone marrow microenvironment, which provide support for hematopoietic cell development. Functional disruption of any element of the bone marrow niche, including osteoblasts, can potentially impair hematopoiesis. We have studied the effect of two widely used drugs with different mechanisms of action, etoposide (VP16) and melphalan, on murine osteoblasts at distinct stages of maturation. VP16 and melphalan delayed maturation of preosteoblasts and altered CXCL12 protein levels, a key regulator of hematopoietic cell homing to the bone marrow. Sublethal concentrations of VP16 and melphalan also decreased the levels of several transcripts which contribute to the composition of the extracellular matrix (ECM) including osteopontin (OPN), osteocalcin (OCN), and collagen 1A1 (Col1a1). The impact of chemotherapy on message and protein levels for some targets was not always aligned, suggesting differential responses at the transcription and translation or protein stability levels. As one of the main functions of a mature osteoblast is to synthesize ECM of a defined composition, disruption of the ratio of its components may be one mechanism by which chemotherapy affects the ability of osteoblasts to support hematopoietic recovery coincident with altered marrow architecture. Collectively, these observations suggest that the osteoblast compartment of the marrow hematopoietic niche is vulnerable to functional dysregulation by damage imposed by agents frequently used in clinical settings. Understanding the mechanistic underpinning of chemotherapy-induced changes on the hematopoietic support capacity of the marrow microenvironment may contribute to improved strategies to optimize patient recovery post-transplantation.

  16. Specific vulnerability of substantia nigra compacta neurons.

    PubMed

    Smidt, Marten P

    2009-01-01

    The specific loss of substantia nigra compacta (SNc) neurons in Parkinson's disease (PD) has been the main driving force in initiating research efforts to unravel the apparent SNc-specific vulnerability. Initially, metabolic constraints due to high dopamine turnover have been the main focus in the attempts to solve this issue. Recently, it has become clear that fundamental differences in the molecular signature are adding to the neuronal vulnerability and provide specific molecular dependencies. Here, the different processes that define the molecular background of SNc vulnerability are summarized.

  17. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem.

    PubMed

    Williams, Patricia Ah; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat.

  18. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

    PubMed Central

    Williams, Patricia AH; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  19. Reducing Mental Health Emergency Services for Children Served Through California's Full Service Partnerships.

    PubMed

    Cordell, Katharan D; Snowden, Lonnie R

    2017-03-01

    Children's Full Service Partnerships (FSP), created through California's Mental Health Services Act of 2004 are comprehensive treatment and support programs incorporating a wraparound model designed to serve undertreated families with children who have a serious emotional disturbance and are at risk for suicide, violence, residential instability, criminal justice involvement, or involuntary hospitalization. This study investigated whether FSP programs resulted in reduced crisis-related mental health emergency services (MHES) for the children they served. Using a statewide data set for 464,880 children and youth ages 11to <18 served by California's county mental health systems between 2004 and 2012, the study compared age-related trajectories of MHES use for FSP-served children before and after treatment alongside children in usual care. Estimates were made within stratified age groups (11 to <15 and 15 to <18), utilizing propensity score adjusted random effects for each child's increasing age to control individual differences in MHES likelihood and trajectory, while controlling for age, cohort, county of service, and clinical and demographic covariates. Before treatment in FSP, FSP-served children showed higher and increasing MHES rates initially, reflecting greater severity. After FSP treatment, FSP-served children's MHES trajectory declined more rapidly than those of controls. There is strong evidence for the success of FSP's aggressive approach in reducing dangerous, increasing trajectories in MHES use. More research is needed, but key efficacious components within the program may be candidates for broader application when providing community-based, crisis-averting care for the most socially and economically vulnerable, seriously mentally ill children and youth.

  20. Dermatitis artefacta in a vulnerable adult with a dissociative state.

    PubMed

    Ahmed, A; Bewley, A; Taylor, R

    2013-12-01

    Dermatitis artefacta (DA), a factitious skin disorder, often occurs as a response to traumatic life events or as a factitious behaviour, which may result in secondary gain. It can be difficult to get patients to engage with health services, and they seldom admit to causing the lesions themselves. The possibility of DA lesions occurring in dissociative states is less well known. We present a case of DA diagnosed in a vulnerable adult, who we believe caused the lesions during periods of dissociation. We discuss the way in which the concept of dissociation can provide an acceptable way of discussing the behaviour with patients and initiating psychological therapy. © 2013 British Association of Dermatologists.

  1. Do hospital factors impact readmissions and mortality after colorectal resections at minority-serving hospitals?

    PubMed

    Hechenbleikner, Elizabeth M; Zheng, Chaoyi; Lawrence, Samuel; Hong, Young; Shara, Nawar M; Johnson, Lynt B; Al-Refaie, Waddah B

    2017-03-01

    Minority-serving hospitals have greater readmission rates after operative procedures including colectomy; however, little is known about the contribution of hospital factors to readmission risk and mortality in this setting. This study evaluated the impact of hospital factors on readmissions and inpatient mortality after colorectal resections at minority-serving hospitals in the context of patient- and procedure-related factors. More than 168,000 patients who underwent colorectal resections in 374 California hospitals (2004-2011) were analyzed using the State Inpatient Database and American Hospital Association Hospital Survey data. Sequential logistic regression analyses were performed to determine the associations between minority-serving hospital status and 30-day, 90-day, and repeated readmissions. Thirty-day, 90-day, and repeated readmission rates were 11.2%, 16.9%, and 2.9%, respectively. Odds for 30-day, 90-day, and repeated readmissions after colorectal resections were 19%, 20%, and 38% more likely at minority-serving hospitals versus non-minority-serving hospitals, respectively (P < .01), after controlling for age, sex, comorbidities, year, and procedure type. Patient factors accounted for up to 65% of the observed increase in odds for readmission at minority-serving hospitals while hospital-level factors contributed roughly 40%. Inpatient mortality was significantly greater at minority-serving hospitals versus non-minority-serving hospitals (4.9% vs 3.8%; P < .001). Risk factors significantly associated with readmissions and inpatient mortality included Medicaid/Medicare primary insurance, emergent operation, and ostomy creation. Low procedure volume was significantly associated with increased odds for inpatient mortality. Patient-level factors seemed to dominate the increased readmission risk after colorectal resections at minority-serving hospitals while hospital factors were less contributory. These findings need to be further validated to shape

  2. Indicators of Terrorism Vulnerability in Africa

    DTIC Science & Technology

    2015-03-26

    the terror threat and vulnerabilities across Africa. Key words: Terrorism, Africa, Negative Binomial Regression, Classification Tree iv I would like...70 viii Page 5.3 Classification Tree Description...66 6 Classification Tree for Full Model

  3. Vulnerable Zone Indicator System (Option 2)

    EPA Pesticide Factsheets

    Enter your latitude and longitude to access the Vulnerable Zone Indicator System. VZIS can help you determine if your area could be affected by a chemical accident at a facility that submitted a Risk Management Plan (RMP).

  4. [Aged woman's vulnerability related to AIDS].

    PubMed

    Silva, Carla Marins; Lopes, Fernanda Maria do Valle Martins; Vargens, Octavio Muniz da Costa

    2010-09-01

    This article is a systhematic literature review including the period from 1994 to 2009, whose objective was to discuss the aged woman's vulnerability in relation to Acquired Imunodeficiency Syndrome (Aids). The search for scientific texts was accomplished in the following databases: Biblioteca Virtual em Saúde, Scientific Eletronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE). The descriptors used were vulnerability, woman and Aids. Eighteen texts were analyzed, including articles in scientific journals, thesis and dissertations. As a conclusion, it was noted that aged women and vulnerability to Aids are directly related, through gender characteristics including submission and that were built historical and socially. We consider as fundamental the development of studies which may generate publications accessible to women, in order to help them see themselves as persons vulnerable to Aids contagion just for being women.

  5. Salt vulnerability assessment methodology for urban streams

    NASA Astrophysics Data System (ADS)

    Betts, A. R.; Gharabaghi, B.; McBean, E. A.

    2014-09-01

    De-icing agents such as road salts while used for winter road maintenance can cause negative effects on urban stream water quality and drinking water supplies. A new methodology using readily available spatial data to identify Salt Vulnerable Areas (SVAs) for urban streams is used to prioritize implementation of best management practices. The methodology calculates the probable chloride concentration statistics at specified points in the urban stream network and compares the results with known aquatic species exposure tolerance limits to characterize the vulnerability scores. The approach prioritizes implementation of best management practices to areas identified as vulnerable to road salt. The vulnerability assessment is performed on seven sites in four watersheds in the Greater Toronto Area and validated using the Hanlon Creek watershed in Guelph. The mean annual in-stream chloride concentration equation uses readily available spatial data - with province-wide coverage - that can be easily used in any urban watershed.

  6. Extinction vulnerability of coral reef fishes

    PubMed Central

    Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron MacNeil, M; McClanahan, Tim R; Öhman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

    2011-01-01

    With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. PMID:21320260

  7. Early Brain Vulnerability in Wolfram Syndrome

    PubMed Central

    Hershey, Tamara; Lugar, Heather M.; Shimony, Joshua S.; Rutlin, Jerrel; Koller, Jonathan M.; Perantie, Dana C.; Paciorkowski, Alex R.; Eisenstein, Sarah A.; Permutt, M. Alan

    2012-01-01

    Wolfram Syndrome (WFS) is a rare autosomal recessive disease characterized by insulin-dependent diabetes mellitus, optic nerve atrophy, diabetes insipidus, deafness, and neurological dysfunction leading to death in mid-adulthood. WFS is caused by mutations in the WFS1 gene, which lead to endoplasmic reticulum (ER) stress-mediated cell death. Case studies have found widespread brain atrophy in late stage WFS. However, it is not known when in the disease course these brain abnormalities arise, and whether there is differential vulnerability across brain regions and tissue classes. To address this limitation, we quantified regional brain abnormalities across multiple imaging modalities in a cohort of young patients in relatively early stages of WFS. Children and young adults with WFS were evaluated with neurological, cognitive and structural magnetic resonance imaging measures. Compared to normative data, the WFS group had intact cognition, significant anxiety and depression, and gait abnormalities. Compared to healthy and type 1 diabetic control groups, the WFS group had smaller intracranial volume and preferentially affected gray matter volume and white matter microstructural integrity in the brainstem, cerebellum and optic radiations. Abnormalities were detected in even the youngest patients with mildest symptoms, and some measures did not follow the typical age-dependent developmental trajectory. These results establish that WFS is associated with smaller intracranial volume with specific abnormalities in the brainstem and cerebellum, even at the earliest stage of clinical symptoms. This pattern of abnormalities suggests that WFS has a pronounced impact on early brain development in addition to later neurodegenerative effects, representing a significant new insight into the WFS disease process. Longitudinal studies will be critical for confirming and expanding our understanding of the impact of ER stress dysregulation on brain development. PMID:22792385

  8. Camana, Peru, and Tsunami Vulnerability

    NASA Technical Reports Server (NTRS)

    2002-01-01

    A tsunami washed over the low-lying coastal resort region near Camana, southern Peru, following a strong earthquake on June 23, 2001. The earthquake was one of the most powerful of the last 35 years and had a magnitude of 8.4. After the initial quake, coastal residents witnessed a sudden drawdown of the ocean and knew a tsunami was imminent. They had less than 20 minutes to reach higher ground before the tsunami hit. Waves as high as 8 m came in four destructive surges reaching as far as 1.2 km inland. The dashed line marks the approximate area of tsunami inundation. Thousands of buildings were destroyed, and the combined earthquake and tsunami killed as many as 139 people. This image (ISS004-ESC-6128) was taken by astronauts onboard the International Space Station on 10 January 2002. It shows some of the reasons that the Camana area was so vulnerable to tsunami damage. The area has a 1 km band of coastal plain that is less than 5 m in elevation. Much of the plain can be seen by the bright green fields of irrigated agriculture that contrast with the light-colored desert high ground. Many of the tsunami-related deaths were workers in the onion fields in the coastal plain that were unwilling to leave their jobs before the end of the shift. A number of lives were spared because the tsunami occurred during the resort off-season, during the daylight when people could see the ocean drawdown, and during one of the lowest tides of the year. Information on the Tsunami that hit Camana can be found in a reports on the visit by the International Tsunami Survey Team and the USC Tsunami Research Lab. Earthquake Epicenter, Peru shows another image of the area. Image provided by the Earth Sciences and Image Analysis Laboratory at Johnson Space Center. Additional images taken by astronauts and cosmonauts can be viewed at the NASA-JSC Gateway to Astronaut Photography of Earth.

  9. Camana, Peru, and Tsunami Vulnerability

    NASA Technical Reports Server (NTRS)

    2002-01-01

    A tsunami washed over the low-lying coastal resort region near Camana, southern Peru, following a strong earthquake on June 23, 2001. The earthquake was one of the most powerful of the last 35 years and had a magnitude of 8.4. After the initial quake, coastal residents witnessed a sudden drawdown of the ocean and knew a tsunami was imminent. They had less than 20 minutes to reach higher ground before the tsunami hit. Waves as high as 8 m came in four destructive surges reaching as far as 1.2 km inland. The dashed line marks the approximate area of tsunami inundation. Thousands of buildings were destroyed, and the combined earthquake and tsunami killed as many as 139 people. This image (ISS004-ESC-6128) was taken by astronauts onboard the International Space Station on 10 January 2002. It shows some of the reasons that the Camana area was so vulnerable to tsunami damage. The area has a 1 km band of coastal plain that is less than 5 m in elevation. Much of the plain can be seen by the bright green fields of irrigated agriculture that contrast with the light-colored desert high ground. Many of the tsunami-related deaths were workers in the onion fields in the coastal plain that were unwilling to leave their jobs before the end of the shift. A number of lives were spared because the tsunami occurred during the resort off-season, during the daylight when people could see the ocean drawdown, and during one of the lowest tides of the year. Information on the Tsunami that hit Camana can be found in a reports on the visit by the International Tsunami Survey Team and the USC Tsunami Research Lab. Earthquake Epicenter, Peru shows another image of the area. Image provided by the Earth Sciences and Image Analysis Laboratory at Johnson Space Center. Additional images taken by astronauts and cosmonauts can be viewed at the NASA-JSC Gateway to Astronaut Photography of Earth.

  10. Methods to Secure Databases Against Vulnerabilities

    DTIC Science & Technology

    2015-12-01

    destroy the database, and even gain access to the computer on which the database is installed [27]. While the SQL injection vulnerability is well known... injection attack can come from a variety of sources. The most well understood source is that of a user providing some form of input through a presentation...compromise of personal information for millions of people. This thesis identifies common vulnerabilities affecting database management systems: injection

  11. Application of PRA to HEMP vulnerability analysis

    SciTech Connect

    Mensing, R.W.

    1985-09-01

    Vulnerability analyses of large systems, e.g., control and communication centers, aircraft, ships, are subject to many uncertainties. A basic source of uncertainty is the random variation inherent in the physical world. Thus, vulnerability is appropriately described by an estimate of the probability of survival (or failure). A second source of uncertainty that also needs to be recognized is the uncertainty associated with the analysis or estimation process itself. This uncertainty, often called modeling uncertainty, has many contributors. There are the approximations introduced by using mathematical models to describe reality. Also, the appropriate values of the model parameters are derived from several sources, e.g., based on experimental or test data, based on expert judgment and opinion. In any case, these values are subject to uncertainty. This uncertainty must be considered in the description of vulnerability. Thus, the estimate of the probability of survival is not a single value but a range of values. Probabilistic risk analysis (PRA) is a methodology which deals with these uncertainty issues. This report discusses the application of PRA to HEMP vulnerability analyses. Vulnerability analysis and PRA are briefly outlined and the need to distinguish between random variation and modeling uncertainty is discussed. Then a sequence of steps appropriate for applying PRA to vulnerability problems is outlined. Finally, methods for handling modeling uncertainty are identified and discussed.

  12. Global Distributions of Vulnerability to Climate Change

    SciTech Connect

    Yohe, Gary; Malone, Elizabeth L.; Brenkert, Antoinette L.; Schlesinger, Michael; Meij, Henk; Xiaoshi, Xing

    2006-12-01

    Signatories of the United Nations Framework Convention on Climate Change (UNFCCC) have committed themselves to addressing the “specific needs and special circumstances of developing country parties, especially those that are particularly vulnerable to the adverse effects of climate change”.1 The Intergovernmental Panel on Climate Change (IPCC) has since concluded with high confidence that “developing countries will be more vulnerable to climate change than developed countries”.2 In their most recent report, however, the IPCC notes that “current knowledge of adaptation and adaptive capacity is insufficient for reliable prediction of adaptations” 3 because “the capacity to adapt varies considerably among regions, countries and socioeconomic groups and will vary over time”.4 Here, we respond to the apparent contradiction in these two statements by exploring how variation in adaptive capacity and climate impacts combine to influence the global distribution of vulnerability. We find that all countries will be vulnerable to climate change, even if their adaptive capacities are enhanced. Developing nations are most vulnerable to modest climate change. Reducing greenhouse-gas emissions would diminish their vulnerabilities significantly. Developed countries would benefit most from mitigation for moderate climate change. Extreme climate change overwhelms the abilities of all countries to adapt. These findings should inform both ongoing negotiations for the next commitment period of the Kyoto Protocol and emerging plans for implementing UNFCCC-sponsored adaptation funds.

  13. Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review

    PubMed Central

    2014-01-01

    Tuberculosis is a contagious infectious disease mainly caused by the bacteria Mycobacterium tuberculosis that still meets the priority criteria - high magnitude, transcendence and vulnerability - due to the threat it poses to public health. When taking into consideration the vulnerability conditions that favor the onset of the disease, this article aimed to investigate the implications originated from individual and social vulnerability conditions in which tuberculosis patients are inserted. Databases like MEDLINE, LILACS and SciELO were searched in Portuguese, Spanish and English using the descriptors tuberculosis and vulnerability, and 183 articles were found. After the selection criterion was applied, there were 22 publications left to be discussed. Some of the aspects that characterize the vulnerability to tuberculosis are: low-income and low-education families, age, poor living conditions, chemical dependency, pre-existing conditions/aggravations like diabetes mellitus and malnutrition, indigenous communities, variables related to health professionals, intense border crossings and migration, difficulty in accessing information and health services and lack of knowledge on tuberculosis. Much as such aspects are present and favor the onset of the disease, several reports show high incidence rates of tuberculosis in low vulnerability places, suggesting that some factors related to the disease are still unclear. In conclusion, health promotion is important in order to disfavor such conditions or factors of vulnerability to tuberculosis, making them a primary target in the public health planning process and disease control. PMID:25067955

  14. Performance of racial and ethnic minority-serving hospitals on delivery-related indicators.

    PubMed

    Creanga, Andreea A; Bateman, Brian T; Mhyre, Jill M; Kuklina, Elena; Shilkrut, Alexander; Callaghan, William M

    2014-12-01

    We sought to explore how racial/ethnic minority-serving hospitals perform on 15 delivery-related indicators, and examine whether indicators vary by race/ethnicity within the same type of hospitals. We used 2008 through 2011 linked State Inpatient Database and American Hospital Association data from 7 states, and designated hospitals with >50% of deliveries to non-Hispanic white, non-Hispanic black, and Hispanic women as white-, black-, and Hispanic-serving, respectively. We calculated indicator rates per 1000 deliveries by hospital type and, separately, for non-Hispanic white, non-Hispanic black, and Hispanic women within each hospital type. We fitted multivariate Poisson regression models to examine associations between delivery-related indicators and patient and hospital characteristics by hospital type. White-serving hospitals offer obstetric care to an older and wealthier population than black- or Hispanic-serving hospitals. Rates of the most prevalent indicators examined (complicated vaginal delivery, complicated cesarean delivery, obstetric trauma) were lowest in Hispanic-serving hospitals. Generally, indicator rates were similar in Hispanic- and white-serving hospitals. Black-serving hospitals performed worse than other hospitals on 12 of 15 indicators. Indicator rates varied greatly by race/ethnicity in white- and Hispanic-serving hospitals, with non-Hispanic blacks having 1.19-3.27 and 1.15-2.68 times higher rates than non-Hispanic whites, respectively, for 11 of 15 indicators. Conversely, there were few indicator rate differences by race/ethnicity in black-serving hospitals, suggesting an overall lower performance of these hospitals compared to white- and Hispanic-serving hospitals. We found considerable differences in delivery-related indicators by hospital type and patients' race/ethnicity. Obstetric care quality measures are needed to track racial/ethnic disparities at the facility and population levels. Published by Elsevier Inc.

  15. Drought vulnerability assesssment and mapping in Morocco

    NASA Astrophysics Data System (ADS)

    Imani, Yasmina; Lahlou, Ouiam; Bennasser Alaoui, Si; Naumann, Gustavo; Barbosa, Paulo; Vogt, Juergen

    2014-05-01

    Drought vulnerability assessment and mapping in Morocco Authors: Yasmina Imani 1, Ouiam Lahlou 1, Si Bennasser Alaoui 1 Paulo Barbosa 2, Jurgen Vogt 2, Gustavo Naumann 2 1: Institut Agronomique et Vétérinaire Hassan II (IAV Hassan II), Rabat Morocco. 2: European Commission, Joint Research Centre (JRC), Institute for Environment and Sustainability (IES), Ispra, Italy. In Morocco, nearly 50% of the population lives in rural areas. They are mostly small subsistent farmers whose production depends almost entirely on rainfall. They are therefore very sensitive to drought episodes that may dramatically affect their incomes. Although, as a consequence of the increasing frequency, length and severity of drought episodes in the late 90's, the Moroccan government decided, to move on from a crisis to a risk management approach, drought management remains in practice mainly reactive and often ineffective. The lack of effectiveness of public policy is in part a consequence of the poor understanding of drought vulnerability at the rural community level, which prevents the development of efficient mitigation actions and adaptation strategies, tailored to the needs and specificities of each rural community. Thus, the aim of this study is to assess and map drought vulnerability at the rural commune level in the Oum Er-Rbia basin which is a very heterogeneous basin, showing a big variability of climates, landscapes, cropping systems and social habits. Agricultural data collected from the provincial and local administrations of Agriculture and socio-economic data from the National Department of Statistics were used to compute a composite vulnerability index (DVI) integrating four different components: (i) the renewable natural capacity, (ii) the economic capacity, (iii) human and civic resources, and (iv) infrastructure and technology. The drought vulnerability maps that were derived from the computation of the DVI shows that except very specific areas, most of the Oum er Rbia

  16. Linking local vulnerability to climatic hazard damage assessment for integrated river basin management

    NASA Astrophysics Data System (ADS)

    Hung, Hung-Chih; Liu, Yi-Chung; Chien, Sung-Ying

    2015-04-01

    1. Background Major portions of areas in Asia are expected to increase exposure and vulnerability to climate change and weather extremes due to rapid urbanization and overdevelopment in hazard-prone areas. To prepare and confront the potential impacts of climate change and related hazard risk, many countries have implemented programs of integrated river basin management. This has led to an impending challenge for the police-makers in many developing countries to build effective mechanism to assess how the vulnerability distributes over river basins, and to understand how the local vulnerability links to climatic (climate-related) hazard damages and risks. However, the related studies have received relatively little attention. This study aims to examine whether geographic localities characterized by high vulnerability experience significantly more damages owing to onset weather extreme events at the river basin level, and to explain what vulnerability factors influence these damages or losses. 2. Methods and data An indicator-based assessment framework is constructed with the goal of identifying composite indicators (including exposure, biophysical, socioeconomic, land-use and adaptive capacity factors) that could serve as proxies for attributes of local vulnerability. This framework is applied by combining geographical information system (GIS) techniques with multicriteria decision analysis (MCDA) to evaluate and map integrated vulnerability to climatic hazards across river basins. Furthermore, to explain the relationship between vulnerability factors and disaster damages, we develop a disaster damage model (DDM) based on existing disaster impact theory. We then synthesize a Zero-Inflated Poisson regression model with a Tobit regression analysis to identify and examine how the disaster impacts and vulnerability factors connect to typhoon disaster damages and losses. To illustrate the proposed methodology, the study collects data on the vulnerability attributes of

  17. 76 FR 59499 - National Hispanic-Serving Institutions Week, 2011

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-26

    ... Documents#0;#0; ] Proclamation 8718 of September 21, 2011 National Hispanic-Serving Institutions Week, 2011... National Hispanic-Serving Institutions (HSIs) Week, we renew our commitment to strengthening and expanding... education institutions serving Hispanic students to provide the best education possible. This week, as we...

  18. 75 FR 58283 - National Hispanic-Serving Institutions Week, 2010

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-23

    ... Documents#0;#0; ] Proclamation 8566 of September 17, 2010 National Hispanic-Serving Institutions Week, 2010... stage. This week, we celebrate the contributions of the more than 200 Hispanic-Serving Institutions in... proclaim September 19 through September 25, 2010, as National Hispanic-Serving Institutions Week. I call...

  19. 27 CFR 31.42 - Restaurants serving liquors with meals.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Restaurants serving... Part Certain Organizations, Agencies, and Persons § 31.42 Restaurants serving liquors with meals. Proprietors of restaurants and other persons who serve liquors with meals to paying customers, even if no...

  20. 49 CFR 365.305 - Serving copies of pleadings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Serving copies of pleadings. 365.305 Section 365.305 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER... Serving copies of pleadings. (a) An applicant must serve all pleadings and letters on the FMCSA and all...

  1. 49 CFR 105.35 - Serving documents in PHMSA proceedings.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 2 2012-10-01 2012-10-01 false Serving documents in PHMSA proceedings. 105.35 Section 105.35 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS... Serving documents in PHMSA proceedings. (a) Service by PHMSA. We may serve the document by one of...

  2. Unexpected high vulnerability of functions in wilderness areas: evidence from coral reef fishes

    PubMed Central

    Vigliola, Laurent; Graham, Nicholas A. J.; Wantiez, Laurent; Parravicini, Valeriano; Villéger, Sébastien; Mou-Tham, Gerard; Frolla, Philippe; Friedlander, Alan M.; Kulbicki, Michel; Mouillot, David

    2016-01-01

    High species richness is thought to support the delivery of multiple ecosystem functions and services under changing environments. Yet, some species might perform unique functional roles while others are redundant. Thus, the benefits of high species richness in maintaining ecosystem functioning are uncertain if functions have little redundancy, potentially leading to high vulnerability of functions. We studied the natural propensity of assemblages to be functionally buffered against loss prior to fishing activities, using functional trait combinations, in coral reef fish assemblages across unfished wilderness areas of the Indo-Pacific: Chagos Archipelago, New Caledonia and French Polynesia. Fish functional diversity in these wilderness areas is highly vulnerable to fishing, explained by species- and abundance-based redundancy packed into a small combination of traits, leaving most other trait combinations (60%) sensitive to fishing, with no redundancy. Functional vulnerability peaks for mobile and sedentary top predators, and large species in general. Functional vulnerability decreases for certain functional entities in New Caledonia, where overall functional redundancy was higher. Uncovering these baseline patterns of functional vulnerability can offer early warning signals of the damaging effects from fishing, and may serve as baselines to guide precautionary and even proactive conservation actions. PMID:27928042

  3. Unexpected high vulnerability of functions in wilderness areas: evidence from coral reef fishes.

    PubMed

    D'agata, Stéphanie; Vigliola, Laurent; Graham, Nicholas A J; Wantiez, Laurent; Parravicini, Valeriano; Villéger, Sébastien; Mou-Tham, Gerard; Frolla, Philippe; Friedlander, Alan M; Kulbicki, Michel; Mouillot, David

    2016-12-14

    High species richness is thought to support the delivery of multiple ecosystem functions and services under changing environments. Yet, some species might perform unique functional roles while others are redundant. Thus, the benefits of high species richness in maintaining ecosystem functioning are uncertain if functions have little redundancy, potentially leading to high vulnerability of functions. We studied the natural propensity of assemblages to be functionally buffered against loss prior to fishing activities, using functional trait combinations, in coral reef fish assemblages across unfished wilderness areas of the Indo-Pacific: Chagos Archipelago, New Caledonia and French Polynesia. Fish functional diversity in these wilderness areas is highly vulnerable to fishing, explained by species- and abundance-based redundancy packed into a small combination of traits, leaving most other trait combinations (60%) sensitive to fishing, with no redundancy. Functional vulnerability peaks for mobile and sedentary top predators, and large species in general. Functional vulnerability decreases for certain functional entities in New Caledonia, where overall functional redundancy was higher. Uncovering these baseline patterns of functional vulnerability can offer early warning signals of the damaging effects from fishing, and may serve as baselines to guide precautionary and even proactive conservation actions.

  4. Molecular Imaging of Vulnerable Atherosclerotic Plaques in Animal Models

    PubMed Central

    Gargiulo, Sara; Gramanzini, Matteo; Mancini, Marcello

    2016-01-01

    Atherosclerosis is characterized by intimal plaques of the arterial vessels that develop slowly and, in some cases, may undergo spontaneous rupture with subsequent heart attack or stroke. Currently, noninvasive diagnostic tools are inadequate to screen atherosclerotic lesions at high risk of acute complications. Therefore, the attention of the scientific community has been focused on the use of molecular imaging for identifying vulnerable plaques. Genetically engineered murine models such as ApoE−/− and ApoE−/−Fbn1C1039G+/− mice have been shown to be useful for testing new probes targeting biomarkers of relevant molecular processes for the characterization of vulnerable plaques, such as vascular endothelial growth factor receptor (VEGFR)-1, VEGFR-2, intercellular adhesion molecule (ICAM)-1, P-selectin, and integrins, and for the potential development of translational tools to identify high-risk patients who could benefit from early therapeutic interventions. This review summarizes the main animal models of vulnerable plaques, with an emphasis on genetically altered mice, and the state-of-the-art preclinical molecular imaging strategies. PMID:27618031

  5. Partnering with those we serve: using experiential learning activities to support community nursing practice.

    PubMed

    Fries, Kathleen; Stewart, Julie G

    2012-01-01

    The concept of community is multidimensional and may include geographical boundaries and/or the shared interests of its members. Community nursing practice involves nurses, patients, and families who collaborate to address health issues and to promote positive health initiatives. Informed by community health theorists, experiential learning activities provide the structure to promote partnering in community nursing practice to achieve outcomes that benefit those who serve and those who are served.

  6. Vulnerability of Subarctic and Arctic breeding birds.

    PubMed

    Hof, Anouschka R; Rodríguez-Castañeda, Genoveva; Allen, Andrew M; Jansson, Roland; Nilsson, Christer

    2017-01-01

    Recent research predicts that future climate change will result in substantial biodiversity loss associated with loss of habitat for species. However, the magnitude of the anticipated biodiversity impacts are less well known. Studies of species vulnerability to climate change through species distribution models are often limited to assessing the extent of species' exposure to the consequences of climate change to their local environment, neglecting species sensitivity to global change. The likelihood that species or populations will decline or go extinct due to climate change also depends on the general sensitivity and adaptive capacity of species. Hence, analyses should also obtain more accurate assessments of their vulnerability. We addressed this by constructing a vulnerability matrix for 180 bird species currently breeding in Subarctic and Arctic Europe that integrates a climatic exposure-based vulnerability index and a natural-history trait-based vulnerability index. Species that may need extra conservation attention based on our matrix include the Great Snipe (Gallinago media), the Rough-legged Buzzard (Buteo lagopus), the Red-throated Pipit (Anthus cervinus), the Common Swift (Apus apus), the Horned Lark (Eremophila alpestris), and the Bar-tailed Godwit (Limosa lapponica). Our vulnerability matrix stresses the importance of looking beyond exposure to climate change when species conservation is the aim. For the species that scored high in our matrix the future in the region looks grim and targeted conservation actions, incorporating macroecological and global perspectives, may be needed to alleviate severe population declines. We further demonstrate that climate change is predicted to significantly reduce the current breeding range of species adapted to cold climates in Subarctic and Arctic Europe. The number of incubation days and whether the species was a habitat specialist or not were also among the variables most strongly related to predicted contraction

  7. Bone marrow osteoblast vulnerability to chemotherapy

    PubMed Central

    Gencheva, Marieta; Hare, Ian; Kurian, Susan; Fortney, Jim; Piktel, Debbie; Wysolmerski, Robert; Gibson, Laura F.

    2013-01-01

    Osteoblasts are a major component of the bone marrow microenvironment which provide support for hematopoietic cell development. Functional disruption of any element of the bone marrow niche, including osteoblasts, can potentially impair hematopoiesis. We have studied the effect of two widely used drugs with different mechanisms of action, etoposide (VP16) and melphalan, on murine osteoblasts at distinct stages of maturation. VP16 and melphalan delayed maturation of preosteoblasts and altered CXCL12 protein levels, a key regulator of hematopoietic cell homing to the bone marrow. Sublethal concentrations of VP16 and melphalan also decreased the levels of several transcripts which contribute to the composition of the extracellular matrix (ECM) including osteopontin (OPN), osteocalcin (OCN) and collagen 1A1 (Col1a1). The impact of chemotherapy on message and protein levels for some targets was not always aligned, suggesting differential responses at the transcription and translation or protein stability levels. Since one of the main functions of a mature osteoblast is to synthesize ECM of a defined composition, disruption of the ratio of its components may be one mechanism by which chemotherapy affects the ability of osteoblasts to support hematopoietic recovery coincident with altered marrow architecture. Collectively, these observations suggest that the osteoblast compartment of the marrow hematopoietic niche is vulnerable to functional dysregulation by damage imposed by agents frequently used in clinical settings. Understanding the mechanistic underpinning of chemotherapy-induced changes on the hematopoietic support capacity of the marrow microenvironment may contribute to improved strategies to optimize patient recovery post-transplantation. PMID:23551534

  8. Structural vulnerability assessment using reliability of slabs in avalanche area

    NASA Astrophysics Data System (ADS)

    Favier, Philomène; Bertrand, David; Eckert, Nicolas; Naaim, Mohamed

    2013-04-01

    Improvement of risk assessment or hazard zoning requires a better understanding of the physical vulnerability of structures. To consider natural hazard issue such as snow avalanches, once the flow is characterized, highlight on the mechanical behaviour of the structure is a decisive step. A challenging approach is to quantify the physical vulnerability of impacted structures according to various avalanche loadings. The main objective of this presentation is to introduce methodology and outcomes regarding the assessment of vulnerability of reinforced concrete buildings using reliability methods. Reinforced concrete has been chosen as it is one of the usual material used to