Ground hardness and injury in community level Australian football.

PubMed

Twomey, Dara M; Finch, Caroline F; Lloyd, David G; Elliott, Bruce C; Doyle, Tim L A

2012-07-01

To describe the risk and details of injuries associated with ground hardness in community level Australian football (AF). Prospective injury surveillance with periodic objective ground hardness measurement. 112 ground hardness assessments were undertaken using a Clegg hammer at nine locations across 20 grounds, over the 2007 and 2008 AF seasons. Details of 352 injuries sustained by community level players on those grounds were prospectively collected as part of a large randomised controlled trial. The ground location of the injury was matched to the nearest corresponding ground hardness Clegg hammer readings, in gravities (g), which were classified from unacceptably low (<30 g) to unacceptably high hardness (>120 g). Clegg hammer readings ranged from 25 to 301 g. Clegg hammer hardness categories from low/normal to high/normal were associated with the majority of injuries, with only 3.7% (13 injuries) on unacceptably high hardness and 0.3% (1 injury) on the unacceptably low hardness locations. Relative to the preferred range of hardness, the risk of sustaining an injury on low/normal hardness locations was 1.31 (95%CI: 1.06-1.62) times higher and 1.82 (95%CI: 1.17-2.85) times higher on locations with unacceptably high hardness. The more severe injuries occurred with low/normal ground hardness. Despite the low number of injuries, the risk of sustaining an injury on low/normal and unacceptably hard grounds was significantly greater than on the preferred range of hardness. Notably, the severity of the injuries sustained on unacceptably hard grounds was lower than for other categories of hardness. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The future of hemodialysis membranes.

PubMed

Humes, H D; Fissell, W H; Tiranathanagul, K

2006-04-01

Hemodialytic treatment of patients with either acute or chronic renal failure has had a dramatic impact on the mortality rates of these patients. Unfortunately, this membrane-based therapy is still incomplete renal replacement, as the mortality and morbidity of these patients remain unacceptably high. Much progress must be made to improve the biocompatibility of hemodialysis membranes as well as their hydraulic and permselective properties to remove small solutes and 'middle molecules' in compact cartridges. The next directions of development will leverage materials and mechanical engineering technology, including microfluidics and nanofabrication, to further improve the clearance functions of the kidney to replicate glomerular permselectivity while retaining high rates of hydraulic permeability. The extension of membrane technology to biohybrid devices utilizing progenitor/stem cells will be another substantive advance for renal replacement therapy. The ability to not only replace solute and water clearance but also active reabsorptive transport and metabolic activity will add additional benefit to the therapy of patients suffering from renal failure. This area of translational research is rich in creative opportunities to improve the unmet medical needs of patients with either chronic or acute renal failure.

Pelvic radiation therapy for gynecologic malignancy in geriatric patients

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

Grant, P.T.; Jeffrey, J.F.; Fraser, R.C.

Thirty-one patients, aged 75 years or older, who received pelvic radiation therapy as part of primary treatment for a gynecologic malignancy, were reviewed. Ten patients (32%) failed to complete their treatment and 4 patients (13%) died of treatment-related complications. The treatment-related complications were independent of increasing age, but did correlate closely with the patients' pretreatment ECOG performance status. Ten patients with performance levels of 2 or higher had a mortality rate of 30%, while 70% failed to complete treatment. Treatment fractions of greater than 220 cGy per day also resulted in unacceptably high complication rates. Alternative treatment formats should bemore » considered in geriatric patients with poor initial performance levels.« less

Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience.

PubMed

Till, J S; Toole, J F; Howard, V J; Ford, C S; Williams, D

1987-01-01

The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities--2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates.

Economic evaluation of participatory learning and action with women's groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India.

PubMed

Sinha, Rajesh Kumar; Haghparast-Bidgoli, Hassan; Tripathy, Prasanta Kishore; Nair, Nirmala; Gope, Rajkumar; Rath, Shibanand; Prost, Audrey

2017-01-01

Neonatal mortality remains unacceptably high in many low and middle-income countries, including India. A community mobilisation intervention using participatory learning and action with women's groups facilitated by Accredited Social Health Activists (ASHAs) was conducted to improve maternal and newborn health. The intervention was evaluated through a cluster-randomised controlled trial conducted in Jharkhand and Odisha, eastern India. This aims to assess the cost-effectiveness this intervention. Costs were estimated from the provider's perspective and calculated separately for the women's group intervention and for activities to strengthen Village Health Sanitation and Nutrition Committees (VHNSC) conducted in all trial areas. Costs were estimated at 2017 prices and converted to US dollar (USD). The incremental cost-effectiveness ratio (ICER) was calculated with respect to a do-nothing alternative and compared with the WHO thresholds for cost-effective interventions. ICERs were calculated for cases of neonatal mortality and disability-adjusted life years (DALYs) averted. The incremental cost of the intervention was USD 83 per averted DALY (USD 99 inclusive of VHSNC strengthening costs), and the incremental cost per newborn death averted was USD 2545 (USD 3046 inclusive of VHSNC strengthening costs). The intervention was highly cost-effective according to WHO threshold, as the cost per life year saved or DALY averted was less than India's Gross Domestic Product (GDP) per capita. The robustness of the findings to assumptions was tested using a series of one-way sensitivity analyses. The sensitivity analysis does not change the conclusion that the intervention is highly cost-effective. Participatory learning and action with women's groups facilitated by ASHAs was highly cost-effective to reduce neonatal mortality in rural settings with low literacy levels and high neonatal mortality rates. This approach could effectively complement facility-based care in India and can be scaled up in comparable high mortality settings.

2. Newer aids in the diagnosis of blunt abdominal trauma.

PubMed Central

Taylor, B.

1977-01-01

The assessment of a case of blunt abdominal trauma can be complicated by many factors, and the resultant inaccurate or delayed diagnoses have contributed to the unacceptable mortality for this type of injury. Recently several useful diagnostic techniques have been developed that, if applied intelligently, may be instrumental in decreasing the high mortality among patients who present with ambiguous abdominal signs after sustaining blunt trauma. Although hematologic investigation and routine radiography have facilitated detection of intraperitoneal injury, peritoneal lavage has become the single most helpful aid. Scanning procedures are sometimes useful in recognizing splenic and hepatic defects especially; these may be confirmed or clarified by angiography. Although ultrasonography may be no more valuable than scintigraphy in outlining splenic and hepatic abnormalities, it is an important technique, especially in the diagnosis of retroperitoneal masses of traumatic origin. Laparoscopy also may be helpful in investigation if surgeons become more familiar with the procedure. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 PMID:608158

Simultaneously targeting inflammatory response and parasite sequestration in brain to treat Experimental Cerebral Malaria

PubMed Central

Dende, Chaitanya; Meena, Jairam; Nagarajan, Perumal; Panda, Amulya K.; Rangarajan, Pundi N.; Padmanaban, Govindarajan

2015-01-01

Malaria afflicts around 200 million people annually, with a mortality number close to 600,000. The mortality rate in Human Cerebral Malaria (HCM) is unacceptably high (15–20%), despite the availability of artemisinin-based therapy. An effective adjunct therapy is urgently needed. Experimental Cerebral Malaria (ECM) in mice manifests many of the neurological features of HCM. Migration of T cells and parasite-infected RBCs (pRBCs) into the brain are both necessary to precipitate the disease. We have been able to simultaneously target both these parameters of ECM. Curcumin alone was able to reverse all the parameters investigated in this study that govern inflammatory responses, CD8+ T cell and pRBC sequestration into the brain and blood brain barrier (BBB) breakdown. But the animals eventually died of anemia due to parasite build-up in blood. However, arteether-curcumin (AC) combination therapy even after the onset of symptoms provided complete cure. AC treatment is a promising therapeutic option for HCM. PMID:26227888

40 CFR Appendix B to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes

Code of Federal Regulations, 2010 CFR

2010-07-01

... Use Conditions Substitutes Application Substitute Decision Conditions Comments Electronics Cleaning w.... Electronics cleaning w/CFC-113 Dibromomethane Unacceptable High ODP; other alternatives exist. Electronics...

Predictors of mortality in the elderly after open repair for perforated peptic ulcer disease.

PubMed

Daniel, Vijaya T; Wiseman, Jason T; Flahive, Julie; Santry, Heena P

2017-07-01

As the U.S. population ages and the number of emergent surgical repairs for perforated peptic ulcer disease (PUD) rise, contemporary national data evaluating operative outcomes for open surgical repair for perforated PUD among the elderly are lacking. The National Surgical Quality Improvement Program (2007-2014) was queried for patients ≥65 y who underwent open surgical repair for perforated PUD. The primary outcome was 30-d mortality. Secondary outcomes included 30-d postoperative complications. Univariate and multivariable regression analyses were performed. Overall, 2131 patients underwent open surgical repair for perforated PUD. Among those who died, more used steroids preoperatively (15% versus 9%, P = 0.001) and fewer were independent preoperatively (55% versus 83%, P < 0.0001) compared to those who were alive 30-d postoperatively. Common postoperative complications were septic shock (15%) and pneumonia (12%). The overall 30-d mortality rate was 17.7%, with more deaths in subsequent decades of life (65-75 y 13% versus 75-84 y 18% versus >85 y 24%, P < 0.0001). After adjustment for other factors, mortality was significantly associated with older age (85+ versus 65-74 y) (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.8, 1.7), dependent functional status preoperatively ([OR], 0.2; 95% CI, 0.2, 0.3), and American Society of Anesthesiologist classification ≥4 (OR, 3.2; 95% CI, 2.4, 4.3). At U.S. hospitals, open surgical repair, the accepted treatment of perforated PUD, among the elderly is associated with significant 30-d morbidity and mortality rates that are unacceptably high in our contemporary era. Furthermore, mortality rates are associated with older age. Therefore, as the elderly population continues to increase in the United States, preoperative, perioperative, and postoperative measures must be taken to reduce this high morbidity and mortality rates. Copyright © 2017 Elsevier Inc. All rights reserved.

Kidney-Heart Interactions in Acute Kidney Injury.

PubMed

Doi, Kent

2016-01-01

Acute kidney injury (AKI) is a common complication in critically ill patients treated in intensive care units. Renal replacement therapy (RRT)-requiring AKI occurs in approximately 5-10% patients in intensive care unit and their mortality rate is unacceptably high (50-60%), despite sufficient control of uremia using remarkably advanced modern RRT techniques. This suggests that there are unrecognized organ interactions following AKI that could worsen the outcomes. Cardiorenal syndrome has been defined based on clinical observations that acute and chronic heart failure causes kidney injury and AKI and that chronic kidney disease worsens heart diseases. Possible pathways that connect these 2 organs have been suggested; however, the precise mechanisms are yet to be clarified, particularly in AKI-induced cardiac dysfunction. This review focuses on acute cardiac dysfunction in the setting of AKI. A recent animal study demonstrated the dysregulation of mitochondrial dynamics caused by an increased dynamin-related protein 1 expression and cellular apoptosis of the heart in a renal ischemia reperfusion model. Although the precise mechanisms that induce cardiac mitochondrial injury in AKI remain unclear, cardiac mitochondria injury could be a novel candidate of drug targets against high mortality in severe AKI. © 2016 S. Karger AG, Basel.

"Social marketing" for early neonatal care: saving newborn lives in Pakistan.

PubMed

Ejaz, Iram; Shaikh, Babar Tasneem

2010-01-01

According to the World Health Organization and the United Nations Children's Fund, developing countries carry a large share of neonatal mortality in the world. According to UNICEF, almost 450 newborn children die every hour, mostly from preventable causes. Restricted access to quality and hygienic delivery services and limited knowledge about handling the newborn aggravate the situation. South Asia, and Pakistan in particular, have reduced their child and infant mortality during the last decade; however, neonatal mortality still remains unacceptably high. There are multiple reasons, mainly related to practices and behaviours of communities and traditional birth attendants. Rural and poor populations suffer most in Pakistan, where three out of five deliveries still occur at home. Traditional community practices and conservative norms drastically affect neonatal health outcomes. Preventing sepsis at the umbilical cord, keeping the baby at the correct temperature after birth and early initiation of exclusive breastfeeding are three simple strategies or messages that need to be disseminated widely to prevent many neonatal mortalities and morbidities. Since inappropriate practices in handling newborns are directly linked with persistent and unremitting behaviours among health providers and the community at large, we suggest doing robust "social marketing" for saving newborn lives. The objective of the paper is to present a social-marketing strategy and a marketing mix that will help address and surmount actual barriers and promote alternative behaviours in early neonatal care.

Bugs and burns: effects of fire on ponderosa pine bark beetle (Project INT-F-07-02)

Treesearch

Thomas DeGomez; Thomas Kolb; Sabrina Kleinman; Kelly Williams

2013-01-01

Fire-damaged trees that otherwise would have survived can be killed by bark beetles (McCullough and others 1998, McHugh and others 2003). Wallin and others (2008) found that fire weakens a tree’s defense against bark beetles. An unacceptable level of tree mortality may occur after a controlled burn as a result of weakened tree defenses (Sullivan and others 2003)....

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

PubMed Central

Wichaidit, Wit; Alam, Mahbub-Ul; Halder, Amal K.; Unicomb, Leanne; Hamer, Davidson H.; Ram, Pavani K.

2016-01-01

Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC. PMID:27273640

Treatment of Gram-negative bacterial infections by potentiation of antibiotics.

PubMed

Zabawa, Thomas P; Pucci, Michael J; Parr, Thomas R; Lister, Troy

2016-10-01

Infections caused by antibiotic-resistant pathogens, particularly Gram-negative bacteria, represent significant treatment challenges for physicians resulting in high rates of morbidity and mortality. The outer membrane of Gram-negative bacteria acts as a permeability barrier to many compounds that would otherwise be effective antibacterial agents, including those effective against Gram-positive pathogens. Potentiator molecules disrupt this barrier allowing entry of otherwise impermeant molecules, thus providing a strategy to render multi-drug resistant pathogens susceptible to a broader range of antibiotics. Potentiator molecules are cationic and the mechanism of disruption involves interaction with the negatively charged outer membrane. This physical attribute, along with an often high degree of lipophilicity typically endears these molecules with unacceptable toxicity. Presented herein are examples of advanced potentiator molecules being evaluated for use in combination therapy for the treatment of resistant Gram-negative infections. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reducing maternal mortality in Yemen: challenges and lessons learned from baseline assessment.

PubMed

Al Serouri, Abdul Wahed; Al Rabee, Arwa; Bin Afif, Mohammed; Al Rukeimi, Abdullah

2009-04-01

The Yemen is a signatory of the Millennium Development Goals (MDGs) and one of 10 countries chosen for the UN Millennium Project. However, recent MDG progress reviews show that it is unlikely that the maternal health goal will be reached by 2015 and Yemen still has an unacceptably high maternal mortality of 365 per 100000 live births. Because 82% of deaths happen intrapartum, the purpose of this needs assessment was to identify and prioritize constraints in delivery of emergency obstetric care (EmOC). Four district hospitals and 16 health centers in 8 districts were assessed for functional capacity in terms of infrastructure; availability of essential equipment and drugs; EmOC technical competency and training needs; and Health Management Information System. We found poor obstetric services in terms of structure (staffing pattern, equipment, and supplies) and process (knowledge and management skills). The data argue for strengthening the 4 interlinked health system elements-human resources, and access to, use, and quality of services. The Government must address each of these elements to meet the Safe Motherhood MDG.

Gram-negative sepsis: a dilemma of modern medicine.

PubMed Central

Bone, R C

1993-01-01

Gram-negative sepsis is an increasingly common problem, with up to 300,000 cases occurring each year in the United States alone. Despite the ongoing development of new antibiotics, mortality from gram-negative sepsis remains unacceptably high. To stimulate earlier therapeutic intervention by physicians, a new set of broad definitions has been proposed to define the systemic inflammatory response characteristic of sepsis. In this review, the signs and symptoms of this progressive, injurious process are reviewed and its management is discussed, as are the mechanisms by which bacterial endotoxin triggers the biochemical events that lead to such serious complications as shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. These events often occur even when appropriate antimicrobial therapy has been instituted. An increased understanding of the structure of endotoxin and its role in the development of sepsis, together with advances in hybridoma technology, has led to the development of monoclonal antibodies that bind to endotoxin and significantly attenuate its adverse effects. These agents promise to substantially reduce the morbidity and mortality associated with gram-negative sepsis. PMID:8457980

Ex vivo lung perfusion: a comprehensive review of the development and exploration of future trends.

PubMed

Roman, Marius A; Nair, Sukumaran; Tsui, Steven; Dunning, John; Parmar, Jasvir S

2013-09-01

There is a critical mismatch between the number of donor lungs available and the demand for lungs for transplantation. This has created unacceptably high waiting-list mortality for lung transplant recipients. Currently (2012) in the United Kingdom, there are 216 patients on the lung transplant waiting list and 17 on heart and lung transplant list. The waiting times for suitable lungs average 412 days, with an increasing mortality and morbidity among the patients on the lung transplant list. Ex vivo lung perfusion (EVLP) has emerged as a technique for the assessment, resuscitation, and potential repair of suboptimal donor lungs. This is a rapidly developing field with significant clinical implications. In this review article, we critically appraise the background developments that have led to our current clinical practice. In particular, we focus on the human and animal experience, the different perfusion-ventilation strategies, and the impact of different perfusates and leukocyte filters. Finally, we examine EVLP as a potential research tool. This will provide insight into EVLP and its future development in the field of clinical lung transplantation.

Treatment of recurrent sigmoid volvulus in Parkinson's disease by percutaneous endoscopic colostomy

PubMed Central

Toebosch, Susan; Tudyka, Vera; Masclee, Ad; Koek, Ger

2012-01-01

The exact aetiology of sigmoid volvulus in Parkinson's disease (PD) remains unclear. A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients. Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus. Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion. If feasible, secondary sigmoidal resection should be performed. However, if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery, percutaneous endoscopic colostomy (PEC) should be considered. We describe an elderly PD patient who presented with sigmoid volvulus. She was treated conservatively with endoscopic detorsion. Surgery was consistently refused by the patient. After recurrence of the sigmoid volvulus a PEC was placed. PMID:23155325

Future challenges in the elimination of bacterial meningitis.

PubMed

Bottomley, Matthew J; Serruto, Davide; Sáfadi, Marco Aurélio Palazzi; Klugman, Keith P

2012-05-30

Despite the widespread implementation of several effective vaccines over the past few decades, bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis and Group B Streptococcus (GBS) still results in unacceptably high levels of human mortality and morbidity. A residual disease burden due to bacterial meningitis is also apparent due to a number of persistent or emerging pathogens, including Mycobacterium tuberculosis, Escherichia coli, Staphylococcus aureus, Salmonella spp. and Streptococcus suis. Here, we review the current status of bacterial meningitis caused by these pathogens, highlighting how past and present vaccination programs have attempted to counter these pathogens. We discuss how improved pathogen surveillance, implementation of current vaccines, and development of novel vaccines may be expected to further reduce bacterial meningitis and related diseases in the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

Use of a portable system with ultrasound and blood tests to improve prenatal controls in rural Guatemala.

PubMed

Crispín Milart, Patricia Hanna; Diaz Molina, César Augusto; Prieto-Egido, Ignacio; Martínez-Fernández, Andrés

2016-09-13

Maternal and neonatal mortality figures remain unacceptably high worldwide and new approaches are required to address this problem. This paper evaluates the impact on maternal and neonatal mortality of a pregnancy care package for rural areas of developing countries with portable ultrasound and blood/urine tests. An observational study was conducted, with intervention and control groups not randomly assigned. Rural areas of the districts of Senahu, Campur and Carcha, in Alta Verapaz Department (Guatemala). The control group is composed by 747 pregnant women attended by the community facilitator, which is the common practice in rural Guatemala. The intervention group is composed by 762 pregnant women attended under the innovative Healthy Pregnancy project. That project strengthens the local prenatal care program, providing local nurses training, portable ultrasound equipment and blood and urine tests. The information of each pregnancy is registered in a medical exchange tool, and is later reviewed by a gynecology specialist to ensure a correct diagnosis and improve nurses training. No maternal deaths were reported within the intervention group, versus five cases in the control group. Regarding neonatal deaths, official data revealed a 64 % reduction for neonatal mortality. A 37 % prevalence of anemia was detected. Non-urgent referral was recommended to 70 pregnancies, being fetal malpresentation the main reported cause. Impact data on maternal mortality (reduction to zero) and neonatal mortality (NMR was reduced to 36 %) are encouraging, although we are aware of the limitations of the study related to possible biasing and the small sample size. The major reduction of maternal and neonatal mortality provides promising prospects for these low-cost diagnostic procedures, which allow to provide high quality prenatal care in isolated rural communities of developing countries. This research was not registered because it is an observational study where the assignment of the medical intervention was not at the discretion of the investigators.

Occurrence of Organic Wastewater Contaminants, Pharmaceuticals, and Personal Care Products in Selected Water Supplies, Cape Cod, Massachusetts, June 2004

DTIC Science & Technology

2005-01-01

previously detected high nitrate concen- trations. (Phenol and d- limonene , detected in equipment blanks at unacceptably high concentrations, are not...both tables, were not counted twice. (Phenol and d- limonene , detected in equipment blanks at unaccept- ably high concentrations, are not included in...The surrogate recoveries (not included in table 2) for the PPCP method were 101 and 102 percent. Three compounds, d- limonene , phenol, and

Alcohol abuse and the injured host; Dysregulation of counteregulatory mechanisms Review

PubMed Central

Molina, Patricia E.; Sulzer, Jesse K.; Whitaker, Annie

2013-01-01

Traumatic injury ranks as the number one cause of death for the under 44 year old age group and 5th leading cause of death overall (www.nationaltraumainstitute.org/home/trauma_statistics.html). Although improved resuscitation of trauma patients has dramatically reduced immediate mortality from hemorrhagic shock, long-term morbidity and mortality continue to be unacceptably high during the post-resuscitation period, particularly as a result of impaired host immune responses to subsequent challenges such as surgery or infection. Acute alcohol intoxication (AAI) is a significant risk factor for traumatic injury; with intoxicating blood alcohol levels present in more than 40% of injured patients (1–5). Severity of trauma, hemorrhagic shock and injury is higher in intoxicated individuals than that of sober victims, resulting in higher mortality rates in this patient population. Necessary invasive procedures (surgery, anesthesia) and subsequent challenges (infection) that intoxicated trauma victims are frequently subjected to are additional stresses to an already compromised inflammatory and neuroendocrine milieu and further contribute to their morbidity and mortality. Thus, dissecting the dynamic imbalance produced by AAI during trauma is of critical relevance for a significant proportion of injured victims. This review outlines how AAI at the time of hemorrhagic shock not only prevents adequate responses to fluid resuscitation but also impairs the ability of the host to overcome a secondary infection. Moreover, it discusses the neuroendocrine mechanisms underlying alcohol-induced hemodynamic dysregulation and its relevance to host defense restoration of homeostasis following injury. PMID:23416555

Can Probiotics Reduce Diarrhea and Infant Mortality in Africa?: The Project of a Pilot Study.

PubMed

Del Piano, Mario; Coggiola, Francesco; Pane, Marco; Amoruso, Angela; Nicola, Stefania; Mogna, Luca

Diarrhea accounts for 9% of the mortality among children under 5 years of age worldwide, and it is significantly associated with malnutrition. Each year, diarrhea kills around 760,000 children under 5 years of age and most of these are in sub-Saharan Africa.In Uganda, the infant mortality rate of 58 per 1000 is unacceptably high, and the major contributors include malnutrition, diarrhea, pneumonia, malaria, prematurity, sepsis, and newborn illnesses.There is an urgent need for intervention to prevent and control diarrheal diseases. Our open-label, randomized controlled study has the primary endpoint of reducing diarrhea and infectious diseases (number of episodes/severity) and the secondary endpoint of decreasing infant mortality. The trial is currently conducted in Luzira, a suburb of Kampala, the capital of Uganda, and in Gulu and Lira, in the north of Uganda.The study is projected to enroll 4000 babies (control=2000 and treatment=2000) who will be followed till 1 year of life. As controls, 2000 babies of the same community are planned to be considered.The probiotic product selected for the trial is composed of 3 designated microorganisms, namely Bifidobacterium breve BR03 (DSM 16604), B. breve B632 (DSM 24706), and Lactobacillus delbrueckii subsp. delbrueckii LDD01 (DSM 22106). The concentration of the 3 bacteria is 10 viable cells/strain/daily dose (5 drops). For a total sample of 4000 babies, the study has an 80% power at a 5% significance level.

Intraperitoneal Continuous-Rate Infusion for the Maintenance of Anesthesia in Laboratory Mice (Mus musculus)

PubMed Central

Erickson, Rebecca L; Terzi, Matthew C; Jaber, Samer M; Hankenson, F Claire; McKinstry-Wu, Andrew; Kelz, Max B; Marx, James O

2016-01-01

Intraperitoneal injectable anesthetics are often used to achieve surgical anesthesia in laboratory mice. Because bolus redosing of injectable anesthetics can cause unacceptably high mortality, we evaluated intraperitoneal continuous-rate infusion (CRI) of ketamine with or without xylazine for maintaining surgical anesthesia for an extended period of time. Anesthesia was induced in male C57BL/6J mice by using ketamine (80 mg/kg) and xylazine (8 mg/kg) without or with acepromazine at 0.1 mg/kg or 0.5 mg/kg. At 10 min after induction, CRI for 90 min was initiated and comprised 25%, 50%, or 100% of the initial ketamine dose per hour or 50% of the initial doses of both ketamine and xylazine. Anesthetic regimens were compared on the basis of animal immobility, continuous surgical depth of anesthesia as determined by the absence of a pedal withdrawal reflex, and mortality. Consistent with previous studies, the response to anesthetics was highly variable. Regimens that provided the longest continuous surgical plane of anesthesia with minimal mortality were ketamine–xylazine–acepromazine (0.1 mg/kg) with CRI of 100% of the initial ketamine dose and ketamine–xylazine–acepromazine (0.5 mg/kg) with CRI of 50% of the initial ketamine and xylazine doses. In addition, heart rate and respiratory rate did not increase consistently in response to a noxious stimulus during CRI anesthesia, even when mice exhibited a positive pedal withdrawal reflex, suggesting that these parameters are unreliable indicators of anesthetic depth during ketamine–xylazine anesthesia in mice. We conclude that intraperitoneal CRI anesthesia in mice prolongs injectable anesthesia more consistently and with lower mortality than does bolus redosing. PMID:27657709

Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.

PubMed

Block, Geoffrey A; Klassen, Preston S; Lazarus, J Michael; Ofsthun, Norma; Lowrie, Edmund G; Chertow, Glenn M

2004-08-01

Mortality rates in ESRD are unacceptably high. Disorders of mineral metabolism (hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism) are potentially modifiable. For determining associations among disorders of mineral metabolism, mortality, and morbidity in hemodialysis patients, data on 40,538 hemodialysis patients with at least one determination of serum phosphorus and calcium during the last 3 mo of 1997 were analyzed. Unadjusted, case mix-adjusted, and multivariable-adjusted relative risks of death were calculated for categories of serum phosphorus, calcium, calcium x phosphorus product, and intact parathyroid hormone (PTH) using proportional hazards regression. Also determined was whether disorders of mineral metabolism were associated with all-cause, cardiovascular, infection-related, fracture-related, and vascular access-related hospitalization. After adjustment for case mix and laboratory variables, serum phosphorus concentrations >5.0 mg/dl were associated with an increased relative risk of death (1.07, 1.25, 1.43, 1.67, and 2.02 for serum phosphorus 5.0 to 6.0, 6.0 to 7.0, 7.0 to 8.0, 8.0 to 9.0, and >/=9.0 mg/dl). Higher adjusted serum calcium concentrations were also associated with an increased risk of death, even when examined within narrow ranges of serum phosphorus. Moderate to severe hyperparathyroidism (PTH concentrations >/=600 pg/ml) was associated with an increase in the relative risk of death, whereas more modest increases in PTH were not. When examined collectively, the population attributable risk percentage for disorders of mineral metabolism was 17.5%, owing largely to the high prevalence of hyperphosphatemia. Hyperphosphatemia and hyperparathyroidism were significantly associated with all-cause, cardiovascular, and fracture-related hospitalization. Disorders of mineral metabolism are independently associated with mortality and morbidity associated with cardiovascular disease and fracture in hemodialysis patients.

The effect of social marketing communication on safe driving.

PubMed

Yang, Dong-Jenn; Lin, Wan-Chen; Lo, Jyue-Yu

2011-12-01

Processing of cognition, affect, and intention was investigated in viewers of advertisements to prevent speeding while driving. Results indicated that anchoring-point messages had greater effects on viewers' cognition, attitude, and behavioral intention than did messages without anchoring points. Further, the changes in message anchoring points altered participants' perceptions of acceptable and unacceptable judgments: a higher anchoring point in the form of speeding mortality was more persuasive in promoting the idea of reducing driving speed. Implications for creation of effective safe driving communications are discussed.

Pentraxin-3 Predicts Short- and Mid-term Mortality in Patients with Sepsis and Septic Shock During Intensive Care Treatment.

PubMed

Hamed, Sonja; Behnes, Michael; Pauly, Dominic; Lepiorz, Dominic; Barre, Max; Becher, Tobias; Lang, Siegfried; Akin, Ibrahim; Borggrefe, Martin; Bertsch, Thomas; Hoffmann, Ursula

2018-06-01

The prognostic value of the acute phase protein Pentraxin 3 (PTX-3) is not well evaluated in patients with septic shock, which reveal an unacceptably high short- and long-term mortality. New Sepsis-3 definitions are not yet implemented in most biomarker studies. Therefore, this study assesses the prognostic value of PTX-3 for short- and mid-term mortality in patients with sepsis or septic shock, as defined by the latest definitions, treated at a medical intensive care unit (ICU). The study includes 213 ICU patients with clinical criteria of sepsis and septic shock. Plasma levels of PTX-3, procalcitonin (PCT) and interleukin-6 were measured on day 1, 3, and 8. All-cause mortality was followed up to 30 days and at 6 months. On all three days, PTX-3 levels were able to discriminate non-survivors from survivors at 30 days and 6 months (AUC range: 0.59 - 0.70; 95% CI: 0.52 - 0.79; p ≤ 0.02). Highest PTX-3 levels within the fourth quartiles during the first week of ICU treatment were associated with an increased mortality rate at 30 days (OR = 7; 95% CI: 2.0 - 23.5; p ≤ 0.002) and at 6 months (OR = 5; 95% CI: 2.1 - 11.4; p ≤ 0.006). Additionally, the prognostic value of PTX-3 was proven for all patients as well as in subcohorts of patients with sepsis and septic shock, according to Sepsis-3 criteria, both in univariate and multivariate analyses for 30-day and 6-months all-cause mortality, especially predicting all-cause mortality in septic shock (HRs range: 1.0 - 2.9; 95% CI: 0.3 - 5.1; p ≤ 0.03). PTX-3 offers prognostic value for the prediction of short- and mid-term all-cause mortality in patients suffering from sepsis and septic shock according to the latest Sepsis-3 criteria.

Preemptive mechanical ventilation can block progressive acute lung injury.

PubMed

Sadowitz, Benjamin; Jain, Sumeet; Kollisch-Singule, Michaela; Satalin, Joshua; Andrews, Penny; Habashi, Nader; Gatto, Louis A; Nieman, Gary

2016-02-04

Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS.

Preemptive mechanical ventilation can block progressive acute lung injury

PubMed Central

Sadowitz, Benjamin; Jain, Sumeet; Kollisch-Singule, Michaela; Satalin, Joshua; Andrews, Penny; Habashi, Nader; Gatto, Louis A; Nieman, Gary

2016-01-01

Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS. PMID:26855896

Role of kidney injury in sepsis.

PubMed

Doi, Kent

2016-01-01

Kidney injury, including acute kidney injury (AKI) and chronic kidney disease (CKD), has become very common in critically ill patients treated in ICUs. Many epidemiological studies have revealed significant associations of AKI and CKD with poor outcomes of high mortality and medical costs. Although many basic studies have clarified the possible mechanisms of sepsis and septic AKI, translation of the obtained findings to clinical settings has not been successful to date. No specific drug against human sepsis or AKI is currently available. Remarkable progress of dialysis techniques such as continuous renal replacement therapy (CRRT) has enabled control of "uremia" in hemodynamically unstable patients; however, dialysis-requiring septic AKI patients are still showing unacceptably high mortality of 60-80 %. Therefore, further investigations must be conducted to improve the outcome of sepsis and septic AKI. A possible target will be remote organ injury caused by AKI. Recent basic studies have identified interleukin-6 and high mobility group box 1 (HMGB1) as important mediators for acute lung injury induced by AKI. Another target is the disease pathway that is amplified by pre-existing CKD. Vascular endothelial growth factor and HMGB1 elevations in sepsis were demonstrated to be amplified by CKD in CKD-sepsis animal models. Understanding the role of kidney injury as an amplifier in sepsis and multiple organ failure might support the identification of new drug targets for sepsis and septic AKI.

Molecular mechanisms of cryptococcal meningitis

PubMed Central

Liu, Tong-Bao; Perlin, David; Xue, Chaoyang

2012-01-01

Fungal meningitis is a serious disease caused by a fungal infection of the central nervous system (CNS) mostly in individuals with immune system deficiencies. Fungal meningitis is often fatal without proper treatment, and the mortality rate remains unacceptably high even with antifungal drug interventions. Currently, cryptococcal meningitis is the most common fungal meningitis in HIV-1/AIDS, and its disease mechanism has been extensively studied. The key steps for fungi to infect brain and cause meningitis after establishment of local infection are the dissemination of fungal cells to the bloodstream and invasion through the blood brain barrier to reach the CNS. In this review, we use cryptococcal CNS infection as an example to describe the current molecular understanding of fungal meningitis, including the establishment of the infection, dissemination, and brain invasion. Host and microbial factors that contribute to these infection steps are also discussed. PMID:22460646

Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate-Magnitude and Determinants.

PubMed

Åström, Christofer; Åström, Daniel Oudin; Andersson, Camilla; Ebi, Kristie L; Forsberg, Bertil

2017-07-07

The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge.

Vulnerability Reduction Needed to Maintain Current Burdens of Heat-Related Mortality in a Changing Climate—Magnitude and Determinants

PubMed Central

Åström, Christofer; Oudin Åström, Daniel; Andersson, Camilla; L. Ebi, Kristie; Forsberg, Bertil

2017-01-01

The health burden from heatwaves is expected to increase with rising global mean temperatures and more extreme heat events over the coming decades. Health-related effects from extreme heat are more common in elderly populations. The population of Europe is rapidly aging, which will increase the health effects of future temperatures. In this study, we estimate the magnitude of adaptation needed to lower vulnerability to heat in order to prevent an increase in heat-related deaths in the 2050s; this is the Adaptive Risk Reduction (ARR) needed. Temperature projections under Representative Concentration Pathway (RCP) 4.5 and RCP 8.5 from 18 climate models were coupled with gridded population data and exposure-response relationships from a European multi-city study on heat-related mortality. In the 2050s, the ARR for the general population is 53.5%, based on temperature projections under RCP 4.5. For the population above 65 years in Southern Europe, the ARR is projected to be 45.9% in a future with an unchanged climate and 74.7% with climate change under RCP 4.5. The ARRs were higher under RCP 8.5. Whichever emission scenario is followed or population projection assumed, Europe will need to adapt to a great degree to maintain heat-related mortality at present levels, which are themselves unacceptably high, posing an even greater challenge. PMID:28686197

Using human rights in maternal mortality programs: from analysis to strategy.

PubMed

Freedman, L P

2001-10-01

This article describes an approach to maternal mortality reduction that uses human rights not simply to denounce the injustice of death in pregnancy and childbirth, but also to guide the design and implementation of maternal mortality policies and programs. As a first principle, programs and policies need to prioritize measures that promote universal access to high quality emergency obstetric care services, which we know from health research are essential to saving women's lives. With that priority, human rights principles can be integrated into programs at the clinical, facility management, and national policy levels. For example, a human rights 'audit' can help identify ways to encourage respectful, non-discriminatory treatment of patients, providers and staff in the clinical setting. Human rights principles of entitlement and accountability can inform mechanisms of community participation designed to improve responsiveness and functioning of health facilities. Human rights principles can inform analysis of health sector reform and its impact on access to emergency obstetric care. Whether applied to the intricacies of human relationships within a facility or to the impact of international financial institutions on health systems, the ultimate role of human rights is to identify the workings of power that keep unacceptable levels of maternal morality as they are and to use the human rights vision of dignity and social justice to work for the re-arrangements of power necessary for change.

Predictors of hip fracture mortality at a general hospital in South Brazil: an unacceptable surgical delay

PubMed Central

Ribeiro, Tiango Aguiar; Premaor, Melissa Orlandin; Larangeira, João Alberto; Brito, Luiz Giulian; Luft, Michel; Guterres, Leonardo Waihrich; Monticielo, Odirlei André

2014-01-01

OBJECTIVE: Hip fractures have been associated with increased mortality in the elderly. Several risk factors such as the time between the insult and the surgical repair have been associated with hip fracture mortality. Nevertheless, the risk of delayed surgical repair remains controversial. Few studies have examined this issue in Brazil. The aim of this study was to study the risk factors for death one year after hip fracture and in-hospital stay at a tertiary hospital in South Brazil. METHODS: A prospective cohort study was carried out from April 2005 to April 2011 at a tertiary university hospital at Santa Maria, Brazil. Subjects admitted for hip fracture who were 65 years of age or older were followed for one year. Information about fracture type, age, gender, clinical comorbidities, time to surgery, discharge, and American Society of Anesthesiologists score were recorded. Death was evaluated during the hospital stay and at one year. RESULTS: Four hundred and eighteen subjects were included in the final analysis. Of these, 4.3% died in-hospital and 15.3% were dead at one year. Time to surgery, American Society of Anesthesiologists score, Ischemic Heart Disease, and in-hospital stay were associated with death at one year in the univariate analysis. The American Society of Anesthesiologists score and time to surgery were one-year mortality predictors in the final regression model. In-hospital death was associated with American Society of Anesthesiologists score and age. CONCLUSION: Time to surgery is worryingly high at the South Brazil tertiary public health center studied here. Surgical delay is a risk factor that has the potential to be modified to improve mortality. PMID:24714833

Circulating cytokine/inhibitor profiles reshape the understanding of the SIRS/CARS continuum in sepsis and predict mortality.

PubMed

Osuchowski, Marcin F; Welch, Kathy; Siddiqui, Javed; Remick, Daniel G

2006-08-01

Mortality in sepsis remains unacceptably high and attempts to modulate the inflammatory response failed to improve survival. Previous reports postulated that the sepsis-triggered immunological cascade is multimodal: initial systemic inflammatory response syndrome (SIRS; excessive pro-, but no/low anti-inflammatory plasma mediators), intermediate homeostasis with a mixed anti-inflammatory response syndrome (MARS; both pro- and anti-inflammatory mediators) and final compensatory anti-inflammatory response syndrome (CARS; excessive anti-, but no/low proinflammatory mediators). To verify this, we examined the evolution of the inflammatory response during the early phase of murine sepsis by repetitive blood sampling of septic animals. Increased plasma concentrations of proinflammatory (IL-6, TNF, IL-1beta, KC, MIP-2, MCP-1, and eotaxin) and anti-inflammatory (TNF soluble receptors, IL-10, IL-1 receptor antagonist) cytokines were observed in early deaths (days 1-5). These elevations occurred simultaneously for both the pro- and anti-inflammatory mediators. Plasma levels of IL-6 (26 ng/ml), TNF-alpha (12 ng/ml), KC (33 ng/ml), MIP-2 (14 ng/ml), IL-1 receptor antagonist (65 ng/ml), TNF soluble receptor I (3 ng/ml), and TNF soluble receptor II (14 ng/ml) accurately predicted mortality within 24 h. In contrast, these parameters were not elevated in either the late-deaths (day 6-28) or survivors. Surprisingly, either pro- or anti-inflammatory cytokines were also reliable in predicting mortality up to 48 h before outcome. These data demonstrate that the initial inflammatory response directly correlates to early but not late sepsis mortality. This multifaceted response questions the use of a simple proinflammatory cytokine measurement for classifying the inflammatory status during sepsis.

Azithromycin to prevent post-discharge morbidity and mortality in Kenyan children: a protocol for a randomised, double-blind, placebo-controlled trial (the Toto Bora trial)

PubMed Central

Singa, Benson O; John-Stewart, Grace C; Richardson, Barbra A; Brander, Rebecca L; McGrath, Christine J; Tickell, Kirkby D; Amondi, Mary; Rwigi, Doreen; Babigumira, Joseph B; Kariuki, Sam; Nduati, Ruth; Walson, Judd L

2017-01-01

Introduction Child mortality due to infectious diseases remains unacceptably high in much of sub-Saharan Africa. Children who are hospitalised represent an accessible population at particularly high risk of death, both during and following hospitalisation. Hospital discharge may be a critical time point at which targeted use of antibiotics could reduce morbidity and mortality in high-risk children. Methods and analysis In this randomised, double-blind, placebo-controlled trial (Toto Bora Trial), 1400 children aged 1–59 months discharged from hospitals in Western Kenya, in Kisii and Homa Bay, will be randomised to either a 5-day course of azithromycin or placebo to determine whether a short course of azithromycin reduces rates of rehospitalisation and/or death in the subsequent 6-month period. The primary analysis will be modified intention-to-treat and will compare the rates of rehospitalisation or death in children treated with azithromycin or placebo using Cox proportional hazard regression. The trial will also evaluate the effect of a short course of azithromycin on enteric and nasopharyngeal infections and cause-specific morbidities. We will also identify risk factors for postdischarge morbidity and mortality and subpopulations most likely to benefit from postdischarge antibiotic use. Antibiotic resistance in Escherichia coli and Streptococcus pneumoniae among enrolled children and their primary caregivers will also be assessed, and cost-effectiveness analyses will be performed to inform policy decisions. Ethics and dissemination Study procedures were reviewed and approved by the institutional review boards of the Kenya Medical Research Institute, the University of Washington and the Kenyan Pharmacy and Poisons Board. The study is being externally monitored, and a data safety and monitoring committee has been assembled to monitor patient safety and to evaluate the efficacy of the intervention. The results of this trial will be published in peer-reviewed scientific journals and presented at relevant academic conferences and to key stakeholders. Trial registration number NCT02414399. PMID:29289941

Impact of training on emergency resuscitation skills: Impact on Millennium Development Goals (MDGs) 4 and 5.

PubMed

Gülmezoglu, A Metin; Lawrie, Theresa A

2015-11-01

Although significant progress has been made towards Millennium Development Goal (MDG) 4 and 5 targets, maternal and neonatal mortality rates remain unacceptably high in low- and middle-income countries (LMICs). The potential for improvements in maternal and neonatal health outcomes with increased facility utilization in these countries is undermined by a lack of appropriate and timely treatment. Skilful emergency resuscitation can be the difference between life and death; therefore, training in emergency resuscitation is essential for health-care practitioners at all levels, with regular refresher sessions to ensure skill retention. Whilst there is little robust evidence on the impact of resuscitation training interventions on practitioner skills or patient outcomes, such training interventions are likely to have the greatest impact if integrated into a broader approach to improve the quality of care. Accelerated investments in training must go hand in hand with ensuring the availability of quality equipment and upgrading infrastructure to reduce the gap between current MDG status and what is achieved by the end of 2015; and to accelerate reductions in mortality rates beyond 2015 towards new Countdown targets. Copyright © 2015 Elsevier Ltd. All rights reserved.

Why resort to illegal abortion in Zambia? Findings of a community-based study in Western Province.

PubMed

Koster-Oyekan, W

1998-05-01

This article presents part of the findings of a community-based study on the causes and effects of unplanned pregnancies in four districts of Western Province, Zambia. The study broke the silence around abortion in Western Province and revealed that induced abortion poses a public health problem. Using innovative methodology of recording and analyzing histories of deaths from induced abortion, the abortion mortality ratio was calculated for the study districts. Findings reveal all extremely high induced abortion mortality ratio of 120 induced abortion-related deaths per 100,000 live births. More than half the deaths were of schoolgirls. Although abortion in Zambia is legal on medical and social grounds, most women in Western Province resort to illegal abortions because legal abortion services are inaccessible and unacceptable. The main reasons women resort to abortion is for fear of being expelled from school, their unwillingness to reveal a secret relationship, to protect the health of their previous baby and common knowledge that postpartum sexual taboos have been transgressed. An inventory was made of abortion methods, taboos and abortion-providers. The article describes how health staff were involved throughout the study, and shows how recommendations were made by involving all parties concerned.

Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture.

PubMed

Malafarina, Vincenzo; Reginster, Jean-Yves; Cabrerizo, Sonia; Bruyère, Olivier; Kanis, John A; Martinez, J Alfredo; Zulet, M Angeles

2018-04-30

Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture.

Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture

PubMed Central

Reginster, Jean-Yves; Cabrerizo, Sonia; Bruyère, Olivier; Kanis, John A.; Zulet, M. Angeles

2018-01-01

Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture. PMID:29710860

Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to implementing evidence-based guidelines.

PubMed

Gerber, Karin

2010-01-01

To share an experience of examining the true extent of the number of patients with severe sepsis being admitted, and the overall compliance with existing treatment guidelines in a district general hospital (DGH). Because of its aggressive, multi-factorial nature, sepsis is a rapid killer. Mortality associated with severe sepsis remains unacceptably high: 30-50%. When shock is present, mortality is reported to be even higher: 50-60%. The rapid diagnosis and management of sepsis is vital to successful treatment. The International Surviving Sepsis Campaign (SSC) was developed to help meet the challenges of sepsis and to improve its management, diagnosis and treatment. The overall aim is to reduce mortality from sepsis by 25% by 2009. Data on the number of patients admitted with severe sepsis to the DGH were previously unknown. The aim of the baseline audits was to determine the true extent of the problem and baseline mortality rates, resulting in an action plan to provide evidence-based care to patients with sepsis regardless of where in the hospital they were located. It was found that 11% of the patients audited presented with signs of severe sepsis and demonstrated elements of poor compliance with some elements of existing treatment guidelines as set out by the resuscitation component of the Surviving Sepsis Care Bundle. As an international campaign introduced predominantly within critical care, within this DGH the SSC teams' innovative approach has resulted in: * Better educated staff; * Objectives agreed within multi-disciplinary teams; * The appropriate assessment of resources; * Standardization of practice in terms of patients presenting with severe sepsis.

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study.

PubMed

Baykara, Nur; Akalın, Halis; Arslantaş, Mustafa Kemal; Hancı, Volkan; Çağlayan, Çiğdem; Kahveci, Ferda; Demirağ, Kubilay; Baydemir, Canan; Ünal, Necmettin

2018-04-16

The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality. ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.

The Costs of Depression

PubMed Central

Kessler, Ronald C.

2011-01-01

Brief summary Data are reviewed on the societal costs of major depressive disorder (MDD). Early-onset MDD is found to predict difficulties in subsequent role transitions, including low educational attainment, high risk of teen child-bearing, marital disruption, and unstable employment. Among people with specific social and productive roles, MDD is found to predict significant decrements in role functioning (e.g., low marital quality, low work performance, low earnings). MDD is also associated with elevated risk of onset, persistence, and severity of a wide range of chronic physical disorders as well as with increased early mortality due to an even wider range of physical disorders and to suicide. Although effectiveness trials show that expanded MDD treatment can reverse many of these adverse effects, only a minority of people with MDD receives treatment and the quality of treatment is unacceptably low among the majority of those in treatment. PMID:22370487

The relevance of human stem cell-derived organoid models for epithelial translational medicine

PubMed Central

Hynds, Robert E.; Giangreco, Adam

2014-01-01

Epithelial organ remodeling is a major contributing factor to worldwide death and disease, costing healthcare systems billions of dollars every year. Despite this, most fundamental epithelial organ research fails to produce new therapies and mortality rates for epithelial organ diseases remain unacceptably high. In large part, this failure in translating basic epithelial research into clinical therapy is due to a lack of relevance in existing preclinical models. To correct this, new models are required that improve preclinical target identification, pharmacological lead validation, and compound optimization. In this review, we discuss the relevance of human stem cell-derived, three-dimensional organoid models for addressing each of these challenges. We highlight the advantages of stem cell-derived organoid models over existing culture systems, discuss recent advances in epithelial tissue-specific organoids, and present a paradigm for using organoid models in human translational medicine. PMID:23203919

Update on mucormycosis pathogenesis.

PubMed

Ibrahim, Ashraf S; Kontoyiannis, Dimitrios P

2013-12-01

Mucormycosis is an increasingly common fungal infection with unacceptably high mortality. The recent sequencing genome projects of Mucorales and the development of gene manipulation have enabled significant advances in understanding the pathogenesis of mucormycosis. Therefore, we review the pathogenesis of mucormycosis and highlight potential development of novel diagnostic and therapeutic modalities against this lethal disease. Much of the work has been focused on the role of iron uptake in the virulence of Mucorales. Additionally, host receptors and fungal ligands involved in the process of tissue invasion as well as sporangiospore size and sex loci and their contribution to virulence of Mucorales are discussed. Finally, the role of innate and adaptive immunity in protection against Mucorales and new evidence about drug-induced apoptosis in these fungi are discussed. Recent discoveries introduce several potentially novel diagnostic and therapeutic modalities, which are likely to improve management and outcome for mucormycosis. Future preclinical and clinical research is warranted to develop these diagnostic and therapeutic strategies.

Complement and innate immune evasion strategies of the human pathogenic fungus Candida albicans.

PubMed

Luo, Shanshan; Skerka, Christine; Kurzai, Oliver; Zipfel, Peter F

2013-12-15

Candida albicans is a medically important fungus that can cause a wide range of diseases ranging from superficial infections to disseminated disease, which manifests primarily in immuno-compromised individuals. Despite the currently applied anti-fungal therapies, both mortality and morbidity caused by this human pathogenic fungus are still unacceptably high. Therefore new prophylactic and therapeutic strategies are urgently needed to prevent fungal infection. In order to define new targets for combating fungal disease, there is a need to understand the immune evasion strategies of C. albicans in detail. In this review, we summarize different sophisticated immune evasion strategies that are utilized by C. albicans. The description of the molecular mechanisms used for immune evasion does on one hand help to understand the infection process, and on the other hand provides valuable information to define new strategies and diagnostic approaches to fight and interfere with Candida infections. Copyright © 2013 Elsevier Ltd. All rights reserved.

Economic burden of mucormycosis in the United States: can a vaccine be cost-effective?

PubMed

Ibrahim, Ashraf S; Edwards, John E; Bryant, Richard; Spellberg, Brad

2009-01-01

Mucormycosis is a life-threatening infection which causes unacceptably high morbidity and mortality despite treatment. Therefore, a vaccine to prevent mucormycosis is desirable. A major barrier to developing an anti-mucormycosis vaccine is the perception that such a vaccine would not be cost-effective to deploy because the disease is rare. We used data from a recent retrospective study to calculate the annual cost to the US healthcare system caused by mucormycosis infections. We created a model to estimate the cost-efficacy of a niche, anti-mucormycosis vaccine deployed in a targeted manner to high-risk patients. We found that each case of mucormycosis results in an average direct cost to the US healthcare system of $97,743, for an overall cost of mucormycosis of $50 million per year. In the base case scenario, targeted deployment of an anti-mucormycosis vaccine would result in a net cost per quality adjusted life year saved (QUALY) of $17,249. Variations in the price of the vaccine, its market penetration, or the cost of infection could dramatically decrease the net cost, and could even result in net savings per QUALY. In conclusion, mucormycosis causes considerable cost to the US health care system. Targeted deployment of a niche vaccine could decrease infection rates and mortality from mucormycosis in a cost-effective manner.

A comparison of two mobile electrode arrays for increasing mortality of Lake Trout embryos

USGS Publications Warehouse

Brown, Peter J.; Guy, Christopher S.; Meeuwig, Michael H.

2017-01-01

Conservation of sport fisheries and populations of several native fishes in the western United States is dependent on sustained success of removal programs targeting invasive Lake Trout Salvelinus namaycush. Gill-netting of spawning adults is one strategy used to decrease spawning success; however, additional complementary methods are needed to disrupt Lake Trout reproduction where bycatch in gill nets is unacceptable. We developed and tested two portable electrode arrays designed to increase Lake Trout embryo mortality in known spawning areas. Both arrays were powered by existing commercial electrofishing equipment. However, one array was moved across the substrate to simulate being towed behind a boat (i.e., towed array), while the other array was lowered from a boat and energized when sedentary (i.e., sedentary array). The arrays were tested on embryos placed within substrates of known spawning areas. Both arrays increased mortality of embryos (>90%) at the surface of substrates, but only the sedentary array was able to increase mortality to >90% at deeper burial depths. In contrast, embryos at increasingly deeper depths exhibited progressively lower mortality when exposed to the towed array. Mortality of embryos placed under 20 cm of substrate and exposed to the towed array was not significantly different from that of unexposed embryos in a control group. We suggest that the sedentary array could be used as a viable approach for increasing mortality of Lake Trout embryos buried to 20 cm and that it could be modified to be effective at deeper depths.

The place of James Arnott (1797-1883) in the development of local anaesthesia in dentistry.

PubMed

Silver, K; Silver, J

2016-03-11

Dental disease in the form of caries and abscesses has been known since antiquity. Before the advent of anaesthesia, operations upon the mouth were painful. The introduction of general anaesthesia in the form of ether and chloroform seemed to provide a solution, but there was an unacceptable level of mortality. James Arnott introduced local anaesthesia by means of freezing with ice, which he considered safer. He waged a long campaign and his method received recognition and was used in France and the USA. His method stimulated the development of pharmacological anaesthesia.

Challenges to the reproductive-health needs of African women: on religion and maternal health utilization in Ghana.

PubMed

Gyimah, Stephen Obeng; Takyi, Baffour K; Addai, Isaac

2006-06-01

How relevant is religion to our understanding of maternal health (MH) service utilization in sub-Saharan Africa? We ask this question mainly because while the effect of religion on some aspects of reproductive behavior (e.g., fertility, contraception) has not gone unnoticed in the region, very few studies have examined the possible link with MH service utilization. Understanding this link in the context of sub-Saharan Africa is particularly relevant given the overriding influence of religion on the social fabric of Africans and the unacceptably high levels of maternal mortality in the region. As African countries struggle to achieve their stipulated reductions in maternal and child mortality levels by two-thirds by 2015 as part of the Millennium Development Goals, the need to examine the complex set of macro- and micro-factors that affect maternal and child health in the region cannot be underestimated. Using data from the 2003 Ghana Demographic Survey, we found religion (measured by denominational affiliation) to be a significant factor in MH use. This is true even after we had controlled for socio-economic variables. In general, Moslem and traditional women were less likely to use such services compared with Christians. The findings are discussed with reference to our theoretical framework and some policy issues are highlighted.

Fibroblast Growth Factor-23: A Novel Biomarker for Cardiovascular Disease in Chronic Kidney Disease Patients.

PubMed

Papagianni, Aikaterini

2017-09-01

Fibroblast Growth Factor (FGF)-23 increase is considered one of the earliest biochemical abnormalities in chronic kidney disease-mineral bone disorder (CKD-MBD). Furthermore, accumulating data have provided evidence of a link between increased FGF-23 levels and cardiovascular morbidity and mortality in CKD patients as well as in several other populations including cardiology patients and general population. The cellular and molecular mechanisms underlying the deleterious effect of FGF-23 on the cardiovascular system are not yet completely defined and are the focus of intense research. However, animal and human studies have demonstrated important actions of FGF-23 in the heart and vessels through which could promote the development of cardiovascular complications in uremia. Moreover, significant interactions have been reported between FGF-23 and other well recognized cardiovascular risk factors such as renin-angiotensin system and inflammation which could account, at least in part, for the observed associations between FGF-23 and adverse clinical outcomes. Further studies are needed to clarify the mechanisms responsible for the pleiotropic actions of FGF-23 and moreover to identify whether it is a modifiable risk factor and a potential target of therapeutic interventions which could probably help to reduce the unacceptably high cardiovascular morbidity and mortality of CKD patients.

5 CFR 432.105 - Proposing and taking action based on unacceptable performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... unacceptable performance. 432.105 Section 432.105 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE BASED REDUCTION IN GRADE AND REMOVAL ACTIONS § 432.105 Proposing and taking action based on unacceptable performance. (a) Proposing action based on unacceptable performance...

Sepsis biomarkers.

PubMed

Prucha, Miroslav; Bellingan, Geoff; Zazula, Roman

2015-02-02

Sepsis is the most frequent cause of death in non-coronary intensive care units (ICUs). In the past 10 years, progress has been made in the early identification of septic patients and in their treatment and these improvements in support and therapy mean that the mortality is gradually decreasing but it still remains unacceptably high. Leaving clinical diagnosis aside, the laboratory diagnostics represent a complex range of investigations that can place significant demands on the system given the speed of response required. There are hundreds of biomarkers which could be potentially used for diagnosis and prognosis in septic patients. The main attributes of successful markers would be high sensitivity, specificity, possibility of bed-side monitoring, and financial accessibility. Only a fraction is used in routine clinical practice because many lack sufficient sensitivity or specificity. The following review gives a short overview of the current epidemiology of sepsis, its pathogenesis and state-of-the-art knowledge on the use of specific biochemical, hematological and immunological parameters in its diagnostics. Prospective approaches towards discovery of new diagnostic biomarkers have been shortly mentioned. Copyright © 2014 Elsevier B.V. All rights reserved.

Cultural factors constraining the introduction of family planning among the Kassena-Nankana of northern Ghana.

PubMed

Adongo, P B; Phillips, J F; Kajihara, B; Fayorsey, C; Debpuur, C; Binka, F N

1997-12-01

This study presents a focus group investigation of reasons why women in a rural, Sahelian community are reluctant to adopt family planning even when convenient services are made freely available. First, women opting to practice contraception must do so at considerable risk of social ostracism or familial conflict. Implementing individual preference is something that must be done without the support of others. Second, few women view personal decisions about contraceptives as theirs to make. Women and children are the property of the corporate family-kin and community militate against reproductive control. Third, although children are highly valued for a variety of economic, social, and cultural reasons, mortality risks remain extremely high. Low fertility imposes the unacceptable risk that a woman will have no surviving children at the end of her reproductive life. Taken together, these findings attest to the inadequacy of service strategies focused on the contribution of distribution, individual agency, or personal choice. Outreach should also build a sense of community legitimacy for the program, collective health action, and traditional leadership support for family planning behavior.

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial).

PubMed

Pasha, Omrana; Goldenberg, Robert L; McClure, Elizabeth M; Saleem, Sarah; Goudar, Shivaprasad S; Althabe, Fernando; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Mazariegos, Manolo; Kodkany, Bhala; Belizan, Jose M; Derman, Richard J; Hibberd, Patricia L; Carlo, Waldemar A; Liechty, Edward A; Hambidge, K Michael; Buekens, Pierre; Wallace, Dennis; Howard-Grabman, Lisa; Stalls, Suzanne; Koso-Thomas, Marion; Jobe, Alan H; Wright, Linda L

2010-12-14

Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries. ClinicalTrials.gov NCT01073488.

Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi

PubMed Central

2015-01-01

Background Maternal mortality, although largely preventable, remains unacceptably high in developing countries such as Malawi and creates a number of intergenerational impacts. Few studies have investigated the far-reaching impacts of maternal death beyond infant survival. This study demonstrates the short- and long-term impacts of maternal death on children, families, and the community in order to raise awareness of the true costs of maternal mortality and poor maternal health care in Neno, a rural and remote district in Malawi. Methods Qualitative in-depth interviews were conducted to assess the impact of maternal mortality on child, family, and community well-being. We conducted 20 key informant interviews, 20 stakeholder interviews, and six sex-stratified focus group discussions in the seven health centers that cover the district. Transcripts were translated, coded, and analyzed in NVivo 10. Results Participants noted a number of far-reaching impacts on orphaned children, their new caretakers, and extended families following a maternal death. Female relatives typically took on caregiving responsibilities for orphaned children, regardless of the accompanying financial hardship and frequent lack of familial or governmental support. Maternal death exacerbated children’s vulnerabilities to long-term health and social impacts related to nutrition, education, employment, early partnership, pregnancy, and caretaking. Impacts were particularly salient for female children who were often forced to take on the majority of the household responsibilities. Participants cited a number of barriers to accessing quality child health care or support services, and many were unaware of programming available to assist them in raising orphaned children or how to access these services. Conclusions In order to both reduce preventable maternal mortality and diminish the impacts on children, extended families, and communities, our findings highlight the importance of financing and implementing universal access to emergency obstetric and neonatal care, and contraception, as well as social protection programs, including among remote populations. PMID:26000733

Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol.

PubMed

Loan, James J M; Mankahla, Ncedile; Meintjes, Graeme; Fieggen, A Graham

2017-10-16

Hydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections. Symptomatic raised cerebrospinal fluid pressure can be treated with ventriculoperitoneal shunt insertion (VPS). In HIV-infected patients however, there is a concern that VPS might be associated with unacceptably high rates of mortality. We aim to systematically review and appraise published literature to determine reported outcomes and identify predictors of outcome following VPS in relevant subgroups of HIV-infected adults. The following electronic databases will be searched: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), LILACS (BIREME), Research Registry ( www.researchregistry.com ), the metaRegister of Controlled Trials (mRCT) ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrials.gov ) and OpenSIGLE database. Any randomised studies, cohort studies, case-control studies, interrupted time series or sequential case series reporting survival following VPS in HIV-infected individuals will be included. If high-quality homogenous studies exist, meta-analysis will be conducted to determine 1-, 6- and 12-month mortality with comparison made between underlying aetiologies of hydrocephalus. This study will generate a comprehensive review of VPS in HIV-infected patients for publication. The primary outcome of meta-analysis is 12-month survival. If only low-quality, heterogeneous studies are available, this study will demonstrate this deficiency and will be of value in justifying and aiding the design of future studies. PROSPERO CRD42016052239.

Cardiometabolic diseases of civilization: history and maturation of an evolving global threat. An update and call to action.

PubMed

Kones, Richard; Rumana, Umme

2017-05-01

Despite striking extensions of lifespan, leading causes of death in most countries now constitute chronic, degenerative diseases which outpace the capacity of health systems. Cardiovascular disease is the most common cause of death in both developed and undeveloped countries. In America, nearly half of the adult population has at least one chronic disease, and polypharmacy is commonplace. Prevalence of ideal cardiovascular health has not meaningfully improved over the past two decades. The fall in cardiovascular deaths in Western countries, half due to a fall in risk factors and half due to improved treatments, have plateaued, and this reversal is due to the dual epidemics of obesity and diabetes type 2. High burdens of cardiovascular risk factors are also evident globally. Undeveloped nations bear the burdens of both infectious diseases and high childhood death rates. Unacceptable rates of morbidity and mortality arise from insufficient resources to improve sanitation, pure water, and hygiene, ultimately linked to poverty and disparities. Simultaneously, about 80% of cardiovascular deaths now occur in low- and middle-income nations. For these reasons, risk factors for noncommunicable diseases, including poverty, health illiteracy, and lack of adherence, must be targeted with unprecedented vigor worldwide. Key messages In developed and relatively wealthy countries, chronic "degenerative" diseases have attained crisis proportions that threaten to reverse health gains made within the past decades. Although poverty, disparities, and poor sanitation still cause unnecessary death and despair in developing nations, they are now also burdened with increasing cardiovascular mortality. Poor adherence and low levels of health literacy contribute to the high background levels of cardiovascular risk.

Population viability analysis of the Florida manatee (Trichechus manatus latirostris), 1976-1991

USGS Publications Warehouse

Marmontel, M.; Humphrey, S.R.; O'Shea, T.J.

1997-01-01

Recent development of age-determination techniques for Florida manatees (Trichechus manatus latirostris) has permitted derivation of age-specific data on reproduction and survival of a sample of 1212 carcasses obtained throughout Florida from 1976–1991. Population viability analysis using these data projects a slightly negative growth rate (−0.003) and an unacceptably low probability of persistence (0.44) over 1000 years. The main factors affecting population projections were adult survival and fecundity. A 10% increase in adult mortality would drive the population to extinction over a 1000-year time scale, whereas a 10% decrease in adult mortality would allow slow population growth. A 10% decrease in reproduction would also result in extinction. We conclude that management must focus on retaining and improving the conditions under which manatee demography operates. The major identified agent of mortality is boat-manatee collisions, and rapidly increasing numbers of humans and registered boats portend an increase in manatee mortality. Zoning of manatee-occupied waters for reductions in boating activity and speed is essential to safeguard the manatee population. If boating regulations being implemented by the state of Florida in each of 13 key coastal counties are completed, enforced, and effective, manatees and human recreation could coexist indefinitely. If regulation is unsuccessful, the Florida manatee population is likely to decline slowly toward extinction.

40 CFR Appendix M to Subpart G - Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004

Code of Federal Regulations, 2010 CFR

2010-07-01

... —Rigid polyurethane slabstock and other foams —Polystyrene extruded insulation boardstock and billet...—Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004 Foam Blowing—Unacceptable Substitutes End-use Substitute Decision Comments All foam end-uses: HCFC-141b Unacceptable...

40 CFR Appendix M to Subpart G - Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004

Code of Federal Regulations, 2012 CFR

2012-07-01

... —Rigid polyurethane slabstock and other foams —Polystyrene extruded insulation boardstock and billet...—Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004 Foam Blowing—Unacceptable Substitutes End-use Substitute Decision Comments All foam end-uses: HCFC-141b Unacceptable...

40 CFR Appendix M to Subpart G - Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004

Code of Federal Regulations, 2011 CFR

2011-07-01

... —Rigid polyurethane slabstock and other foams —Polystyrene extruded insulation boardstock and billet...—Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004 Foam Blowing—Unacceptable Substitutes End-use Substitute Decision Comments All foam end-uses: HCFC-141b Unacceptable...

Where the lay and the technical meet: Using an anthropology of interfaces to explain persistent reproductive health disparities in West Africa.

PubMed

Jaffré, Yannick; Suh, Siri

2016-05-01

Despite impressive global investment in reproductive health programs in West Africa, maternal mortality remains unacceptably high and obstetric care is often inadequate. Fertility is among the highest in the world, while contraceptive prevalence remains among the lowest. This paper explores the social and technical dimensions of this situation. We argue that effective reproductive health programs require analyzing the interfaces between technical programs and the social logics and behaviors of health professionals and client populations. Significant gaps between health programs' goals and the behaviors of patients and health care professionals have been observed. While public health projects aim to manage reproduction, sexuality, fertility, and professional practices are regulated socially. Such projects may target technical practices, but access to care is greatly influenced by social norms and ethics. This paper shows how an empirical anthropology that investigates the social and technical interfaces of reproduction can contribute to improved global health. Copyright © 2016 Elsevier Ltd. All rights reserved.

Technological advances in renal replacement therapy: five years and beyond.

PubMed

Rastogi, Anjay; Nissenson, Allen R

2009-12-01

The worldwide epidemic of chronic kidney disease shows no signs of abating in the near future. Current dialysis forms of renal replacement therapy (RRT), even though successful in sustaining life and improving quality of life somewhat for patients with ESRD, have many limitations that result in still unacceptably high morbidity and mortality. Transplantation is an excellent option but is limited by the scarcity of organs. An ideal form of RRT would mimic the functions of natural kidneys and be transparent to the patient, as well as affordable to society. Recent advances in technology, although generally in early stages of development, might achieve these goals. The application of nanotechnology, microfluidics, bioreactors with kidney cells, and miniaturized sorbent systems to regenerate dialysate makes clinical reality seem closer than ever before. Finally, stem cells hold much promise, both for kidney disease and as a source of tissues and organs. In summary, nephrology is at an exciting crossroad with the application of innovative and novel technologies to RRT that hold considerable promise for the near future.

Update on mucormycosis pathogenesis

PubMed Central

Ibrahim, Ashraf S.; Kontoyiannis, Dimitrios P.

2014-01-01

Purpose of review Mucormycosis is an increasingly common fungal infection with unacceptably high mortality. The recent sequencing genome projects of Mucorales and the development of gene manipulation have enabled significant advances in understanding the pathogenesis of mucormycosis. Therefore, we review the pathogenesis of mucormycosis and highlight potential development of novel diagnostic and therapeutic modalities against this lethal disease. Recent findings Much of the work has been focused on the role of iron uptake in the virulence of Mucorales. Additionally, host receptors and fungal ligands involved in the process of tissue invasion as well as sporangiospore size and sex loci and their contribution to virulence of Mucorales are discussed. Finally, the role of innate and adaptive immunity in protection against Mucorales and new evidence about drug-induced apoptosis in these fungi are discussed. Summary Recent discoveries introduce several potentially novel diagnostic and therapeutic modalities, which are likely to improve management and outcome for mucormycosis. Future preclinical and clinical research is warranted to develop these diagnostic and therapeutic strategies. PMID:24126718

The pathophysiology of heart failure: a tale of two old paradigms revisited.

PubMed

Ashrafian, Houman; Williams, Lynne; Frenneaux, Michael P

2008-04-01

Although our current appreciation of the detrimental role of neurohumoral activation in heart failure (HF) has been intellectually appealing and has led to neurohumoral antagonism that has reduced morbidity and mortality from HF, the persisting disability and death rates remain unacceptably high. In the search for novel strategies to improve on these outcomes, we must reacquaint ourselves with basic cardiac physiology at levels ranging from the molecular to the systemic in order to identify new targets for the treatment of HF. This approach has already begun to yield results; in this review, two such aspects will be focused on: diastolic ventricular interaction and cardiac energetics. These two examples will be used to illuminate how fundamental research has elucidated age-old, although mechanistically elusive, principles (for example, the Frank-Starling law), explained why existing and emerging therapeutic approaches (for example, biventricular pacing in HF) have proved successful, and successfully identified novel therapy modes (for example, perhexiline as an energy augmentation agent).

Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options—a report from the 3rd Atrial Fibrillation Competence NETwork/European Heart Rhythm Association consensus conference

PubMed Central

Kirchhof, Paulus; Lip, Gregory Y.H.; Van Gelder, Isabelle C.; Bax, Jeroen; Hylek, Elaine; Kaab, Stefan; Schotten, Ulrich; Wegscheider, Karl; Boriani, Giuseppe; Brandes, Axel; Ezekowitz, Michael; Diener, Hans; Haegeli, Laurent; Heidbuchel, Hein; Lane, Deirdre; Mont, Luis; Willems, Stephan; Dorian, Paul; Aunes-Jansson, Maria; Blomstrom-Lundqvist, Carina; Borentain, Maria; Breitenstein, Stefanie; Brueckmann, Martina; Cater, Nilo; Clemens, Andreas; Dobrev, Dobromir; Dubner, Sergio; Edvardsson, Nils G.; Friberg, Leif; Goette, Andreas; Gulizia, Michele; Hatala, Robert; Horwood, Jenny; Szumowski, Lukas; Kappenberger, Lukas; Kautzner, Josef; Leute, Angelika; Lobban, Trudie; Meyer, Ralf; Millerhagen, Jay; Morgan, John; Muenzel, Felix; Nabauer, Michael; Baertels, Christoph; Oeff, Michael; Paar, Dieter; Polifka, Juergen; Ravens, Ursula; Rosin, Ludger; Stegink, W.; Steinbeck, Gerhard; Vardas, Panos; Vincent, Alphons; Walter, Maureen; Breithardt, Günter; Camm, A. John

2012-01-01

While management of atrial fibrillation (AF) patients is improved by guideline-conform application of anticoagulant therapy, rate control, rhythm control, and therapy of accompanying heart disease, the morbidity and mortality associated with AF remain unacceptably high. This paper describes the proceedings of the 3rd Atrial Fibrillation NETwork (AFNET)/European Heart Rhythm Association (EHRA) consensus conference that convened over 60 scientists and representatives from industry to jointly discuss emerging therapeutic and diagnostic improvements to achieve better management of AF patients. The paper covers four chapters: (i) risk factors and risk markers for AF; (ii) pathophysiological classification of AF; (iii) relevance of monitored AF duration for AF-related outcomes; and (iv) perspectives and needs for implementing better antithrombotic therapy. Relevant published literature for each section is covered, and suggestions for the improvement of management in each area are put forward. Combined, the propositions formulate a perspective to implement comprehensive management in AF. PMID:21791573

Non-adherence in Hypertension Management Deficit in Information or Trust?

PubMed

Retta, Tamrat M; Kwagyn, John; Randall, Otelio S

2017-01-01

Hypertension, a leading cause of cardiovascular morbidity and mortality worldwide, continues to challenge health professionals. There are too many patients with uncontrolled hypertension who end up with life altering or life ending complications. Over the years so much hypertension research has been conducted; and numerous effective antihypertensive drugs have been discovered and yet the rate of blood pressure control remains unacceptably low. It is high time that we focused our attention on the optimal use of the available knowledge and medications. More emphasis on teaching the patients and the public at large is required and patients need to have full trust of their health care providers in order to adhere to the prescriptions provided. If patients take their medications as prescribed and follow therapeutic lifestyle changes like physical activity and calorie and salt restrictions, there would be very few patients with uncontrolled hypertension and its complications. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

India at the crossroads of millennium development goals 4 and 5.

PubMed

Hazarika, Indrajit

2012-05-01

The current year marks the completion of two thirds of the period between the adoption of the millennium development goals (MDGs) and the target date of 2015. Although there has been some progress, it is incontestable that much more needs to be done. India contributes to 20% of births worldwide and has the highest proportion of children younger than 5 years. Global progress toward MDG 4 and 5 depends significantly on improvements in maternal and child health indicators in India. Although it has been reported that the country has made substantial progress, the pace has been slow and marred by vast regional variability. Certain states continue to have unacceptably high mortality and morbidity rates. This article provides a context to the current status of maternal and child health in India, highlights the achievements, and uses the available data effectively to emphasize the progress. The authors acknowledge the new initiatives and make recommendations for reinforcing the continuum of care.

[Lung and kidney failure. Pathogenesis, interactions, and therapy].

PubMed

John, S; Willam, C

2015-09-01

The lungs and kidneys represent the most often affected organs (acute respiratory distress syndrome, ARDS or kidney failure) in multiple organ failure (MOF) due to shock, trauma, or sepsis with a still unacceptable high mortality for both organ failures. Although the exact pathophysiological mechanisms of MOF are not completely elucidated, it appears that the lungs and kidneys share several pathophysiologic pathways and have the potential to further harm each other (kidney-lung crosstalk). Inflammatory signals in both directions and volume overload with consecutive edema formation in both organs may play a key role in this crosstalk. The organ replacement therapies used in both organ failures have the potential to further injure the other organ (ventilator trauma, dialyte trauma). On the other hand, renal replacement therapy can have positive effects on lung injury by restoring volume and acid-base homeostasis. The new development of "low-flow" extracorporeal CO2 removal on renal replacement therapy platforms may further help to decrease ventilator trauma in the future.

Strategies for prevention of hyperglycaemic emergencies in Nigeria.

PubMed

Balogun, Wo; Adeleye, Jo

2008-12-01

The mortality and morbidity of acute metabolic complications of diabetes, particularly DKA and HHS are unacceptably high in Nigeria. Prevention of occurrence of these hyperglycaemic emergencies (HE) is the only rational way for a resource poor country like Nigeria. Prevention requires careful identification of precipitating factors of HE. The leading precipitating factors of HE in Nigeria are infections, inadequate or inappropriate use of anti-diabetic agents, especially insulin. HE may also be the first presentation in persons previously unknown to have diabetes. Measures to prevent HE include creation of awareness in the public, effective and systematic education of the persons living with diabetes and capacity building and manpower development of the healthcare personnel. There should be critical appraisal of our healthcare system with a view to restructuring so it can be more accessible to patients and can deliver quality diabetes care. Finally government must sincerely provide an alternative of healthcare financing for the citizens, especially those living with chronic medical conditions like diabetes.

STRATEGIES FOR PREVENTION OF HYPERGLYCAEMIC EMERGENCIES IN NIGERIA

PubMed Central

Balogun, WO; Adeleye, JO

2008-01-01

The mortality and morbidity of acute metabolic complications of diabetes, particularly DKA and HHS are unacceptably high in Nigeria. Prevention of occurrence of these hyperglycaemic emergencies (HE) is the only rational way for a resource poor country like Nigeria. Prevention requires careful identification of precipitating factors of HE. The leading precipitating factors of HE in Nigeria are infections, inadequate or inappropriate use of anti-diabetic agents, especially insulin. HE may also be the first presentation in persons previously unknown to have diabetes. Measures to prevent HE include creation of awareness in the public, effective and systematic education of the persons living with diabetes and capacity building and manpower development of the healthcare personnel. There should be critical appraisal of our healthcare system with a view to restructuring so it can be more accessible to patients and can deliver quality diabetes care. Finally government must sincerely provide an alternative of healthcare financing for the citizens, especially those living with chronic medical conditions like diabetes. PMID:25161450

The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study.

PubMed

MacDonald, Tonya; Jackson, Suzanne; Charles, Marie-Carmèle; Periel, Marius; Jean-Baptiste, Marie-Véna; Salomon, Alex; Premilus, Éveillard

2018-06-20

In Haiti, the number of women dying in pregnancy, during childbirth and the weeks after giving birth remains unacceptably high. The objective of this research was to explore determinants of maternal mortality in rural Haiti through Community-Based Action Research (CBAR), guided by the delays that lead to maternal death. This paper focuses on socioecological determinants of maternal mortality from the perspectives of women of near-miss maternal experiences and community members, and their solutions to reduce maternal mortality in their community. The study draws on five semi-structured Individual Interviews with women survivors of near-misses, and on four Focus Group Discussions with Community Leaders and with Traditional Birth Attendants. Data collection took place in July 2013. A Community Research Team within a resource-limited rural community in Haiti undertook the research. The methods and analysis process were guided by participatory research and CBAR. Participants identified three delays that lead to maternal death but also described a fourth delay with respect to community responsibility for maternal mortality. They included women being carried from the community to a healthcare facility as a special example of the fourth delay. Women survivors of near-miss maternal experiences and community leaders suggested solutions to reduce maternal death that centered on prevention and community infrastructure. Most of the strategies for action were related to the fourth delay and include: community mobilization by way of the formation of Neighbourhood Maternal Health/Well-being Committees, and community support through the provision/sharing of food for undernourished women, offering monetary support and establishment of a communication relay/transport system in times of crisis. Finding sustainable ways to reduce maternal mortality requires a community-based/centred and community-driven comprehensive approach to maternal health/well-being. This includes engagement of community members that is dependent upon community knowledge, political will, mobilization, accountability and empowerment. An engaged/empowered community is one that is well placed to find ways that work in their community to reduce the fourth delay and in turn, maternal death. Potentially, community ownership of challenges and solutions can lead to more sustainable improvements in maternal health/well-being in Haiti.

Endovascular treatment of thoracic disease: patient selection and a proposal of a risk score.

PubMed

Rodrigues Alves, Claudia Maria; da Fonseca, José Honório Palma; de Souza, José Augusto Marcondes; Camargo Carvalho, Antonio Carlos; Buffolo, Enio

2002-04-01

Although selection criteria and subgroup analysis are still in the early developmental stages, endovascular treatment of aortic disease has become an alternative to surgery for many patients. From November 1996 to November 1999, 49 patients were treated with a self-expandable endoprosthesis at our institution. Most patients had acute aortic dissections. Thirteen of these patients did not follow the anatomic selection protocol. We retrospectively analyzed these patients to compare our numerical risk score (which includes clinical and anatomic criteria) between groups with or without success and between groups that followed the anatomic protocol (P) or did not follow the anatomic protocol (E [exception]). Success rates were similar in groups P and E, although mortality rates were higher in group E. Patients from group E had longer procedures and required multiple stents more frequently. The proposed risk score was able to differentiate between groups with or without success, as well as between groups P and E. In order to reduce mortality and morbidity rates, careful selection criteria must be followed when treating patients endovascularly. Although it is time-consuming, using objective criteria can help select patients for endovascular treatment. We propose that patients with a risk score higher than 11 should only undergo percutaneous treatment when they have an unacceptably high surgical risk, and even so only after a detailed discussion of the risks.

Characterizing the Benefits of Seismic Isolation for Nuclear Structures: A Framework for Risk-Based Decision Making

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

Bolisetti, Chandrakanth; Yu, Chingching; Coleman, Justin

This report provides a framework for assessing the benefits of seismic isolation and exercises the framework on a Generic Department of Energy Nuclear Facility (GDNF). These benefits are (1) reduction in the risk of unacceptable seismic performance and a dramatic reduction in the probability of unacceptable performance at beyond-design basis shaking, and (2) a reduction in capital cost at sites with moderate to high seismic hazard. The framework includes probabilistic risk assessment and estimates of overnight capital cost for the GDNF.

Fuel processor temperature monitoring and control

DOEpatents

Keskula, Donald H.; Doan, Tien M.; Clingerman, Bruce J.

2002-01-01

In one embodiment, the method of the invention monitors one or more of the following conditions: a relatively low temperature value of the gas stream; a relatively high temperature value of the gas stream; and a rate-of-change of monitored temperature. In a preferred embodiment, the rate of temperature change is monitored to prevent the occurrence of an unacceptably high or low temperature condition. Here, at least two temperatures of the recirculating gas stream are monitored over a period of time. The rate-of-change of temperature versus time is determined. Then the monitored rate-of-change of temperature is compared to a preselected rate-of-change of value. The monitoring of rate-of-change of temperature provides proactive means for preventing occurrence of an unacceptably high temperature in the catalytic reactor.

[Sexual violence in Congo-Kinshasa: necessity of decriminalizing abortion].

PubMed

Kalonda, J C Omba

2012-01-01

The sexual violence's committed in the Democratic Republic of Congo (DRC) are from their scales and consequences on women, real public health, politico-legal, and socio-economical challenges. More than a million of women have been victims of sexual violence on a period of less than fifteen years. Systematic rapes of women were used as war weapon by different groups involved in the Congolese war. Sexual violence against women has impacted public health by spreading sexually transmissible diseases including HIV/AIDS, causing unwanted pregnancies, leading to the gynaecological complications of rape-related injuries, and inflicting psychological trauma on the victims. Despite high level of unwanted pregnancies observed, the Congolese law is very restrictive and interdict induced abortion. This paper presents three arguments which plead in favour of legalizing abortion in DRC: 1) a restrictive law on abortion forces women to use unsafe abortion and increase incidence of injuries and maternal mortality ; 2) DRC has ratified the universal Declaration of human rights, the African union charter, and has than to promote equality between sexes, in this is included women reproductive rights; 3) an unwanted birth is an additional financial charge for a woman, a factor increasing poverty and psychologically unacceptable in case of rape. From the politico-legal point of view, ending rape impunity and decriminalizing abortion are recommended. Decriminalizing abortion give women choice and save victims and pregnant women from risks related to the pregnancy, a childbirth, or an eventual unsafe abortion. These risks increase the maternal mortality already high in DRC (between 950 and 3000 for 100000 live births).

Sub-national population policy: the case of North Sulawesi.

PubMed

Jones, G W

1989-04-01

Since the 1970s, Indonesia has placed increasing emphasis on the development of stronger planning capacity at the regional level; however, the concept of regional autonomy is still viewed with suspicion given Indonesia's history of regional separatist movements. This fact has implications for the need for national population policy to be formulated and implemented with a view toward the varying conditions faced by different provinces and regions. The author presents a case study of fertility, mortality, migration, urbanization, and the development of human capital in 1 Indonesian province--North Sulawesi--to illustrate that special characteristics and internal diversity can demand individualized responses by policy makers. In terms of these 5 areas, the following observations can be made about conditions in North Sulawesi: 1) mortality rates are already below the national average, although infant mortality remains unacceptably high; 2) fertility rates are also well below the national average and approaching replacement level without any aggressive family planning outreach activities, but there remains a need to identify the ultimate fertility target and the extent to which intervention is required; 3) there is little scope for absorbing transmigrants, but there are some major issues regarding population redistribution within the province; 4) although there are no large cities, the increasing dominance of Manado is a concern; and 5) the quality of education and an employment structure to match the well-educated labor force are more important than an expansion of these services. A central concern is the ability of North Sulawesi to prevent "brain drain" to Jakarta; however, the province's capacity to do so is dependent on decisions made in Jakarta about the allocation of revenue, regulations regarding the processing of copra and cloves, new air routes, and the extent of regional autonomy to be tolerated in decisions affecting provincial growth.

Ultrasound guided double injection of blood into cisterna magna: a rabbit model for treatment of cerebral vasospasm.

PubMed

Chen, Yongchao; Zhu, Youzhi; Zhang, Yu; Zhang, Zixuan; Lian, Juan; Luo, Fucheng; Deng, Xuefei; Wong, Kelvin K L

2016-02-06

Double injection of blood into cisterna magna using a rabbit model results in cerebral vasospasm. An unacceptably high mortality rate tends to limit the application of model. Ultrasound guided puncture can provide real-time imaging guidance for operation. The aim of this paper is to establish a safe and effective rabbit model of cerebral vasospasm after subarachnoid hemorrhage with the assistance of ultrasound medical imaging. A total of 160 New Zealand white rabbits were randomly divided into four groups of 40 each: (1) manual control group, (2) manual model group, (3) ultrasound guided control group, and (4) ultrasound guided model group. The subarachnoid hemorrhage was intentionally caused by double injection of blood into their cisterna magna. Then, basilar artery diameters were measured using magnetic resonance angiography before modeling and 5 days after modeling. The depth of needle entering into cisterna magna was determined during the process of ultrasound guided puncture. The mortality rates in manual control group and model group were 15 and 23 %, respectively. No rabbits were sacrificed in those two ultrasound guided groups. We found that the mortality rate in ultrasound guided groups decreased significantly compared to manual groups. Compared with diameters before modeling, the basilar artery diameters after modeling were significantly lower in manual and ultrasound guided model groups. The vasospasm aggravated and the proportion of severe vasospasms was greater in ultrasound guided model group than that of manual group. In manual model group, no vasospasm was found in 8 % of rabbits. The ultrasound guided double injection of blood into cisterna magna is a safe and effective rabbit model for treatment of cerebral vasospasm.

40 CFR Appendix E to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2011 CFR

2011-07-01

... Refrigeration and Air-Conditioning Sector Unacceptable Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses MT-31 Unacceptable Chemical contained in this blend presents...

40 CFR Appendix F to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

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2010-07-01

... Refrigeration and Air-Conditioning Sector UnacceptabLe Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses Hexafluoropropylene (HFP) and all HFP-containing blends Unacceptable...

40 CFR Appendix E to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2013 CFR

2013-07-01

... Refrigeration and Air-Conditioning Sector Unacceptable Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses MT-31 Unacceptable Chemical contained in this blend presents...

40 CFR Appendix E to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2012 CFR

2012-07-01

... Refrigeration and Air-Conditioning Sector Unacceptable Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses MT-31 Unacceptable Chemical contained in this blend presents...

40 CFR Appendix E to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2010 CFR

2010-07-01

... Refrigeration and Air-Conditioning Sector Unacceptable Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses MT-31 Unacceptable Chemical contained in this blend presents...

40 CFR Appendix F to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2012 CFR

2012-07-01

... Refrigeration and Air-Conditioning Sector UnacceptabLe Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses Hexafluoropropylene (HFP) and all HFP-containing blends Unacceptable...

40 CFR Appendix F to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2013 CFR

2013-07-01

... Refrigeration and Air-Conditioning Sector UnacceptabLe Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses Hexafluoropropylene (HFP) and all HFP-containing blends Unacceptable...

40 CFR Appendix F to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2011 CFR

2011-07-01

... Refrigeration and Air-Conditioning Sector UnacceptabLe Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses Hexafluoropropylene (HFP) and all HFP-containing blends Unacceptable...

40 CFR Appendix E to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2014 CFR

2014-07-01

... Refrigeration and Air-Conditioning Sector Unacceptable Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses MT-31 Unacceptable Chemical contained in this blend presents...

40 CFR Appendix F to Subpart G of... - Unacceptable Substitutes Listed in the January 26, 1999 Final Rule, Effective January 26, 1999

Code of Federal Regulations, 2014 CFR

2014-07-01

... Refrigeration and Air-Conditioning Sector UnacceptabLe Substitutes End-use Substitute Decision Comments All refrigeration and air-conditioning end uses Hexafluoropropylene (HFP) and all HFP-containing blends Unacceptable...

The case for immunomodulatory approaches in treating HSV encephalitis

PubMed Central

Ramakrishna, Chandran; Openshaw, Harry; Cantin, Edouard M

2013-01-01

HSV encephalitis (HSE) is the most prevalent sporadic viral encephalitis. Although safe and effective antiviral therapies and greatly improved noninvasive diagnostic procedures have significantly improved outcomes, mortality (~20%) and debilitating neurological sequelae in survivors remain unacceptably high. An encouraging new development is that the focus is now shifting away from the virus exclusively, to include consideration of the host immune response to infection in the pathology underlying development of HSE. In this article, the authors discuss results from recent studies in experimental mouse models, as well as clinical reports that demonstrate a role for exaggerated host inflammatory responses in the brain in the development of HSE that is motivating researchers and clinicians to consider new therapeutic approaches for treating HSE. The authors also discuss results from a few studies that have shown that immunomodulatory drugs can be highly protective against HSE, which supports a role for deleterious host inflammatory responses in HSE. The impressive outcomes of some immunomodulatory approaches in mouse models of HSE emphasize the urgent need for clinical trials to rigorously evaluate combination antiviral and immunomodulatory therapy in comparison with standard antiviral therapy for treatment of HSE, and support for such an initiative is gaining momentum. PMID:23956785

Microbiological examination of cold ready-to-eat sliced meats from catering establishments in the United Kingdom.

PubMed

Gillespie, I; Little, C; Mitchell, R

2000-03-01

A microbiological study of cold, ready-to-eat sliced meats from 2579 catering establishments (public houses, hotels, cafés, restaurants, residential homes and other catering premises) found that 2587 of 3494 samples (74%) were of acceptable quality, 892 (26%) were of unsatisfactory quality and 15 (<1%) were of unacceptable quality. Unacceptable results were due to high levels of Escherichia coli, Staphylococcus aureus, Listeria species and/or Clostridium perfringens. Unsatisfactory results were mostly due to high Aerobic Plate Counts. The microbiological quality of cold, ready-to-eat meats was associated with meat type, premises type, management training, hygienic practices, meat supplier and length of storage. The relationship between food hygiene training and microbiological quality is discussed.

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

PubMed Central

Wang, Yanping; Li, Xiaohong; Zhou, Maigeng; Luo, Shusheng; Liang, Juan; Liddell, Chelsea A; Coates, Matthew M; Gao, Yanqiu; Wang, Linhong; He, Chunhua; Kang, Chuyun; Liu, Shiwei; Dai, Li; Schumacher, Austin E; Fraser, Maya S; Wolock, Timothy M; Pain, Amanda; Levitz, Carly E; Singh, Lavanya; Coggeshall, Megan; Lind, Margaret; Li, Yichong; Li, Qi; Deng, Kui; Mu, Yi; Deng, Changfei; Yi, Ling; Liu, Zheng; Ma, Xia; Li, Hongtian; Mu, Dezhi; Zhu, Jun; Murray, Christopher J L; Wang, Haidong

2017-01-01

Summary Background In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. Methods We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. Findings In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%. Interpretation The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. Funding National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation. PMID:26510780

19 CFR 152.108 - Unacceptable bases of appraisement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 2 2013-04-01 2013-04-01 false Unacceptable bases of appraisement. 152.108 Section 152.108 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... Merchandise § 152.108 Unacceptable bases of appraisement. For the purposes of this subpart, imported...

19 CFR 152.108 - Unacceptable bases of appraisement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Unacceptable bases of appraisement. 152.108 Section 152.108 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... Merchandise § 152.108 Unacceptable bases of appraisement. For the purposes of this subpart, imported...

19 CFR 152.108 - Unacceptable bases of appraisement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Unacceptable bases of appraisement. 152.108 Section 152.108 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... Merchandise § 152.108 Unacceptable bases of appraisement. For the purposes of this subpart, imported...

19 CFR 152.108 - Unacceptable bases of appraisement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Unacceptable bases of appraisement. 152.108 Section 152.108 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... Merchandise § 152.108 Unacceptable bases of appraisement. For the purposes of this subpart, imported...

Honduras.

PubMed

1985-08-01

This discussion of Honduras covers the following: the history of the country's demographic situation; the government's overall approach to population problems; population data systems and development planning; institutional arrangements for the integration of population within development planning; the goverment's view of the importance of population policy in realizing development objectives; population size, growth, and natural increase; morbidity and mortality; fertility; international migration; and spatial distribution. Between the censuses of 1910-40, Honduras grew at an average annual rate of more than 1.5% per annum. The rate of population growth reached 2% per annum after 1940 and 3% after about 1955. By 1970-75 the rate of natural increase was estimated to be about 3.5% per annum, due to the net effect of a crude birthrate of 49/1000 and a crude death rate of about 14/1000. The rate of natural increase has remained around 3.5% in recent years, although the crude death rate has declined to 44/1000 and the crude death rate to about 10/1000. The government wants to substantially reduce the rate of population growth, primarily by means of modifying fertility and averting large-scale immigration of refugees in the future. It desires to reduce the country's high levels of mortality and to adjust patterns of spatial distribution, primarily to improve agricultural productivity and promote national economic intergration. The government also seeks to decrease the emigration of qualified personnel. In the past several years, the government of Honduras has increased its commitment to formulating and implementing explicit population policies as a means of attaining overall development objcetives. With a population of around 4.1 million inhabitants as of 1983, Honduras has been growing at an average annual rate of 3.4% in recent years. According to UN projections, the population is expected to grow to about 7 million by 2000. The average life expectancy at birth for both sexes was 55.3 years in 1974 and around 60 years as of 1982. The crude death rate was estimated to be 10/1000 during 1980-85; infant mortality declined from 117/1000 live births in 1971-72 to 86/1000 in 1978. Diarrheal disease is the single most important cause of death in Honduras, and mortality from other water-related diseases remains high in comparison with other Central American countries. Malnutrition also is serious. The government considers levels and trends of mortality to be unacceptable and is particularly concerned about the continuing high level of infant mortality. In recent years the crude birthrate averaged around 44/1000; the 1981 Contraceptive Prevalence Survey found the total fertility rate to be about 6.5 births/woman, which represents a 13% decline in the level of fertility between 1971-72 and 1981.

Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries.

PubMed

Chung, Sheng-Chia; Sundström, Johan; Gale, Chris P; James, Stefan; Deanfield, John; Wallentin, Lars; Timmis, Adam; Jernberg, Tomas; Hemingway, Harry

2015-08-07

To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom. Population based longitudinal cohort study using nationwide clinical registries. Nationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119,786 patients) and the UK (NICOR/MINAP, n=242; 391,077 patients), 2004-10. Between hospital variation in 30 day mortality of patients admitted with acute myocardial infarction. Case mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% v 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% v 6.6% in Sweden; 12.7% v 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals' use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries. Between hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction. Clinical trials registration Clinical trials NCT01359033. © Chung et al 2015.

The characteristics of unacceptable/taboo thoughts in obsessive-compulsive disorder.

PubMed

Brakoulias, Vlasios; Starcevic, Vladan; Berle, David; Milicevic, Denise; Moses, Karen; Hannan, Anthony; Sammut, Peter; Martin, Andrew

2013-10-01

In the quest to unravel the heterogeneity of obsessive-compulsive disorder (OCD), an increasing number of factor analytic studies are recognising unacceptable/taboo thoughts as one of the symptom dimensions of OCD. This study aims to examine the characteristics associated with unacceptable/taboo thoughts. Using the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (YBOCS-SC) with 154 individuals with OCD, obsessive-compulsive symptoms were subjected to principal components analysis. The characteristics associated with the resulting symptom dimensions were then assessed using logistic and linear regression techniques. Unacceptable/taboo thoughts comprised of sexual, religious and impulsive aggressive obsessions, and mental rituals. Higher scores on an unacceptable/taboo thoughts symptom dimension were predicted by higher Y-BOCS obsession subscores, Y-BOCS time preoccupied by obsessions scores, Y-BOCS distress due to obsessions scores, importance of control of thought ratings, male gender, and having had treatment prior to entering into the study. Unacceptable/taboo thoughts were also predicted by greater levels of hostility, and a past history of non-alcohol substance dependence. An unacceptable/taboo thought symptom dimension of OCD is supported by a unique set of associated characteristics that should be considered in the assessment and treatment of individuals with these symptoms. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Scenario-targeted toxicity assessment through multiple endpoint bioassays in a soil posing unacceptable environmental risk according to regulatory screening values.

PubMed

Rodriguez-Ruiz, A; Etxebarria, J; Boatti, L; Marigómez, I

2015-09-01

Lanestosa is a chronically polluted site (derelict mine) where the soil (Lanestosa (LA) soil) exceeds screening values (SVs) of regulatory policies in force (Basque Country; Europe) for Zn, Pb and Cd. A scenario-targeted toxicity assessment was carried out on the basis of a multi-endpoint bioassay approach. Acute and chronic toxicity bioassays were conducted with selected test species (Vibrio fischeri, Dictyostelium discoideum, Lactuca sativa, Raphanus sativus and Eisenia fetida) in combination with chemical analysis of soils and elutriates and with bioaccumulation studies in earthworms. Besides, the toxicity profile was compared with that of the mine runoff (RO) soil and of a fresh artificially polluted soil (LAAPS) resembling LA soil pollutant profile. Extractability studies in LA soil revealed that Pb, Zn and Cd were highly available for exchange and/or release into the environment. Indeed, Pb and Zn were accumulated in earthworms and LA soil resulted to be toxic. Soil respiration, V. fischeri, vegetative and developmental cycles of D. discoideum and survival and juvenile production of E. fetida were severely affected. These results confirmed that LA soil had unacceptable environmental risk and demanded intervention. In contrast, although Pb and Zn concentrations in RO soil revealed also unacceptable risk, both metal extractability and toxicity were much lower than in LA soil. Thus, within the polluted site, the need for intervention varied between areas that posed dissimilar risk. Besides, since LAAPS, with a high exchangeable metal fraction, was the most toxic, ageing under in situ natural conditions seemingly contributed to attenuate LA soil risk. As a whole, combining multi-endpoint bioassays with scenario-targeted analysis (including leaching and ageing) provides reliable risk assessment in soils posing unacceptable environmental risk according to SVs, which is useful to optimise the required intervention measures.

Assignment of C1q-binding HLA antibodies as unacceptable HLA antigens avoids positive CDC-crossmatches prior to transplantation of deceased donor organs.

PubMed

Juhl, David; Marget, Matthias; Hallensleben, Michael; Görg, Siegfried; Ziemann, Malte

2017-03-01

Soon, a virtual crossmatch shall replace the complement-dependent cytotoxicity (CDC) allocation crossmatch in the Eurotransplant region. To prevent positive CDC-crossmatches in the recipient centre, careful definition of unacceptable antigens is necessary. For highly sensitized patients, this is difficult by CDC alone. Assignment of all antibodies detected by sensitive assays, however, could prevent organ allocation. To assess the usefulness of the Luminex C1q-assay to prevent positive CDC-crossmatches, all CDC-crossmatches performed prior to deceased kidney transplantation in a 16-month-period were reviewed. Sera causing positive crossmatches were investigated by the C1q-assay. 31 out of 1432 crossmatches (2.2%) were positive. Sera involved in 26 positive crossmatches were available. C1q-binding donor-specific antibodies were detected in 19 sera (73.1%). The other sera were from recipients without any HLA antibodies detectable by CDC or common solid phase assays. Three patients had known Non-HLA antibodies causing positive CDC-results. Four crossmatches were only weak positive. Therefore, avoidance of donors with HLA antigens against whom C1q-binding antibodies were detected would have prevented all positive crossmatches due to HLA antibodies. Provided that all HLA specificities against which antibodies are detected by the Luminex C1q-assay are considered as unacceptable antigens, CDC-crossmatches prior to transplantation might safely be omitted in many patients. They should be maintained in highly immunized patients, however, for whom assignment of all C1q-positive antibodies as unacceptable antigens could lead to a significant delay or even prevention of transplantation. Copyright © 2017 Elsevier B.V. All rights reserved.

Timing of vasopressor initiation and mortality in septic shock: a cohort study

PubMed Central

2014-01-01

Introduction Despite recent advances in the management of septic shock, mortality remains unacceptably high. Earlier initiation of key therapies including appropriate antimicrobials and fluid resuscitation appears to reduce the mortality in this condition. This study examined whether early initiation of vasopressor therapy is associated with improved survival in fluid therapy-refractory septic shock. Methods Utilizing a well-established database, relevant information including duration of time to vasopressor administration following the initial documentation of recurrent/persistent hypotension associated with septic shock was assessed in 8,670 adult patients from 28 ICUs in Canada, the United States of America, and Saudi Arabia. The primary endpoint was survival to hospital discharge. Secondary endpoints were length of ICU and hospital stay as well as duration of ventilator support and vasopressor dependence. Analysis involved multivariate linear and logistic regression analysis. Results In total, 8,640 patients met the definition of septic shock with time of vasopressor/inotropic initiation documented. Of these, 6,514 were suitable for analysis. The overall unadjusted hospital mortality rate was 53%. Independent mortality correlates included liver failure (odds ratio (OR) 3.46, 95% confidence interval (CI), 2.67 to 4.48), metastatic cancer (OR 1.63, CI, 1.32 to 2.01), AIDS (OR 1.91, CI, 1.29 to 2.49), hematologic malignancy (OR 1.88, CI, 1.46 to 2.41), neutropenia (OR 1.78, CI, 1.27 to 2.49) and chronic hypertension (OR 0.62 CI, 0.52 to 0.73). Delay of initiation of appropriate antimicrobial therapy (OR 1.07/hr, CI, 1.06 to 1.08), age (OR 1.03/yr, CI, 1.02 to 1.03), and Acute Physiology and Chronic Health Evaluation (APACHE) II Score (OR 1.11/point, CI, 1.10 to 1.12) were also found to be significant independent correlates of mortality. After adjustment, only a weak correlation between vasopressor delay and hospital mortality was found (adjusted OR 1.02/hr, 95% CI 1.01 to 1.03, P <0.001). This weak effect was entirely driven by the group of patients with the longest delays (>14.1 hours). There was no significant relationship of vasopressor initiation delay to duration of vasopressor therapy (P = 0.313) and only a trend to longer duration of ventilator support (P = 0.055) among survivors. Conclusion Marked delays in initiation of vasopressor/inotropic therapy are associated with a small increase in mortality risk in patients with septic shock. PMID:24887489

21 CFR 1305.25 - Unaccepted and defective electronic orders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Unaccepted and defective electronic orders. 1305... SCHEDULE I AND II CONTROLLED SUBSTANCES Electronic Orders § 1305.25 Unaccepted and defective electronic orders. (a) No electronic order may be filled if: (1) The required data fields have not been completed...

21 CFR 1305.25 - Unaccepted and defective electronic orders.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Unaccepted and defective electronic orders. 1305... SCHEDULE I AND II CONTROLLED SUBSTANCES Electronic Orders § 1305.25 Unaccepted and defective electronic orders. (a) No electronic order may be filled if: (1) The required data fields have not been completed...

The Effect of Distinguished Educators on Academic Gain of Louisiana Academically Unacceptable Schools

ERIC Educational Resources Information Center

Scroggins, Ruby C.

2012-01-01

The purpose of this study was to examine the degree of academic growth of Academically Unacceptable schools in Louisiana which have been assigned a Distinguished Educator. Distinguished Educators are external change agents who are placed in Academically Unacceptable schools in Louisiana. The data were generated from the Louisiana Department of…

SYBR safeTM efficiently replaces ethidium bromide in Aspergillus fumigatus gene disruption.

PubMed

Canela, H M S; Takami, L A; Ferreira, M E S

2017-02-08

Invasive aspergillosis is a disease responsible for high mortality rates, caused mainly by Aspergillus fumigatus. The available drugs are limited and this disease continues to occur at an unacceptable frequency. Gene disruption is essential in the search for new drug targets. An efficient protocol for A. fumigatus gene disruption was described but it requires ethidium bromide, a genotoxic agent, for DNA staining. Therefore, the present study tested SYBR safe TM , a non-genotoxic DNA stain, in A. fumigatus gene disruption protocol. The chosen gene was cipC, which has already been disrupted successfully in our laboratory. A deletion cassette was constructed in Saccharomyces cerevisiae and used in A. fumigatus transformation. There was no statistical difference between the tested DNA stains. The success rate of S. cerevisiae transformation was 63.3% for ethidium bromide and 70% for SYBR safe TM . For A. fumigatus gene disruption, the success rate for ethidium bromide was 100 and 97% for SYBR safe TM . In conclusion, SYBR safe TM efficiently replaced ethidium bromide, making this dye a safe and efficient alternative for DNA staining in A. fumigatus gene disruption.

Pneumocystis jirovecii Pneumonia in Human Immunodeficiency Virus Infection.

PubMed

Siegel, Marc; Masur, Henry; Kovacs, Joseph

2016-04-01

The presentation of Pneumocystis pneumonia (PCP) in previously healthy men having sex with men (MSM) in San Francisco and New York City in 1981 heralded the beginning of the human immunodeficiency virus (HIV) pandemic. Despite a decreasing incidence of PCP among patients with HIV/AIDS (acquired immunodeficiency syndrome) since the advent of combination antiretroviral therapy in the mid-1990s, PCP remains one of the most common AIDS-defining opportunistic infections in the United States and Western Europe. Newer molecular diagnostic tests in conjunction with standard immunofluorescent or colorimetric tests have allowed for more rapid and accurate diagnosis. Although several effective oral and intravenous therapies exist to treat PCP, mortality rates in HIV-infected individuals remain unacceptably high, especially in those with advanced AIDS. The identification of specific mutations in Pneumocystis genes targeted by trimethoprim-sulfamethoxazole has raised concerns about the development of resistance to the drug of choice and may ultimately lead to greater utilization of alternative therapies to treat PCP in the future. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pakistan's maternal and child health policy: analysis, lessons and the way forward.

PubMed

Siddiqi, S; Haq, I U; Ghaffar, A; Akhtar, T; Mahaini, R

2004-07-01

An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden. The analysis of Pakistan's maternal and child health (MCH) and family planning (FP) policy covers the period 1990-2002, and focuses on macroeconomic influences, priority programs and gaps, adequacy of resources, equity and organizational aspects, and the process of policy formulation. The overall MCH/FP policy is well directed. MCH/FP has been a priority in all policies; resource allocation, although unacceptably low, has substantially increased during the last decade; and there is a progressive shift from MCH to the reproductive health (RH) agenda. Areas in need of improvement include greater use of evidence as a basis for policy; increased priority to nutrition programs, measures to reduce neonatal and perinatal mortality, provision of emergency obstetric care, availability of skilled birth attendants, and a clear policy on integrated management of childhood illnesses. Enhanced planning capacity, development of a balanced human resource, improved governance to reduce staff absenteeism and frequent transfers, and a greater role of the private sector in the provision of services are some organizational aspects that need the governments' consideration. There are several lessons to be learnt: (i) Ministries of Health need sustained stewardship and well-documented evidence to protect cuts in resource allocation; (ii) frequent policy announcement sends inappropriate signals to managers and weakens on-going implementation; (iii) MCH/FP policies unless informed by evidence and participation of interest groups are unlikely to address gaps in programs; (iv) distributional and equity objectives of MCH/FP be addressed while setting overall national goals; (v) institutional capacity is a vital ingredient in translating MCH/FP policies into effective services. The suggested strategic directions emphasize, among others, the need for a comprehensive MCH/FP framework; strengthened stewardship in ministry of health, cost-effective strategies to address the gaps identified and doubling of the public sector resource allocation to MCH/FP over the next 5 years. The ability to ensure delivery of quality health services remains the biggest challenge in the Pakistani health sector. Unless sound policies are backed by well-functioning programs they are likely to become a victim of poor implementation.

Plant photonics: application of optical coherence tomography to monitor defects and rots in onion

NASA Astrophysics Data System (ADS)

Meglinski, I. V.; Buranachai, C.; Terry, L. A.

2010-04-01

The incidence of physiological and/or pathological defects in many fresh produce types is still unacceptably high and accounts for a large proportion of waste. With increasing interest in food security their remains strong demand in developing reliable and cost effective technologies for non-destructive screening of internal defects and rots, these being deemed unacceptable by consumers. It is well recognized that the internal defects and structure of turbid scattering media can be effectively visualized by using optical coherence tomography (OCT). In the present study, the high spatial resolution and advantages of OCT have been demonstrated for imaging the skins and outer laminae (concentric tissue layers) of intact whole onion bulbs with a view to non-invasively visualizing potential incidence/severity of internal defects.

Changing Definitions of Sepsis

PubMed Central

Gül, Fethi; Arslantaş, Mustafa Kemal; Cinel, İsmail; Kumar, Anand

2017-01-01

Sepsis is one of the main causes of morbidity and mortality in critically ill patients despite the use of modern antibiotics and resuscitation therapies. Outcomes in sepsis have improved overall, probably because of an enhanced focus on early diagnosis and other improvements in supportive care, but mortality rates still remain unacceptably high. The diagnosis and definition of sepsis is a critical problem due to the heterogeneity of this disease process. Although it is apparent that much more needs to be done to advance our understanding, sepsis and related terms remain difficult to define. A 1991 consensus conference developed initial definitions that systemic inflammatory response syndrome (SIRS) to infection would be called sepsis. Definitions of sepsis and septic shock were revised in 2001 to incorporate the threshold values for organ damage. In early 2016, the new definitions of sepsis and septic shock have changed dramatically. Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The consensus document describes organ dysfunction as an acute increase in total Sequential Organ Failure Assessment (SOFA) score two points consequently to the infection. A significant change in the new definitions is the elimination of any mention of SIRS. The Sepsis-3 Task Force also introduced a new bedside index, called the qSOFA, to identify outside of critical care units patients with suspected infection who are likely to develop sepsis. Recently updated the consensus definitions improved specificity compared with the previous descriptions. PMID:28752002

Effects of the lampricide 3-trifluoromethyl-4-nitrophenol (TFM) on pH, net oxygen production, and respiration by algae

USGS Publications Warehouse

Scholefield, Ronald J.; Fredricks, Kim T.; Slaght, Karen S.; Seelye, James G.

1999-01-01

The lampricide 3-trifluoromethyl-4-nitrophenol (TFM) has been used in the United States and Canada for more than 35 years to control larval sea lampreys (Petromyzon marinus) in tributaries of the Great Lakes. Occasionally, during stream treatments with TFM, nontarget-fish mortality reaches unacceptable levels. These losses could be due to the presence of sensitive fish species, excess TFM, or a combination of factors that influence the toxicity of TFM, such as delays in daily stream reaeration by algae resulting in extended periods of low pH and low dissolved oxygen (DO). We determined the effects of a broad range of TFM concentrations on net DO production and respiration by two species of algae, in two culture media (high alkalinity and low alkalinity). The pH and DO in cultures of Chlorella pyrenoidosa and Selenastrum capricornutum were recorded at time zero and again after a 9-h exposure to TFM under either lighted or dark conditions. Algal cultures exposed to TFM concentrations typical of those used to control sea lampreys in streams showed only small changes in pH (<0.1) and small reductions in DO (about 8% in lighted conditions and 11% in dark conditions). Changes in pH and DO of this magnitude probably do not change the efficacy of TFM or cause nontarget fish mortality if algae are the predominant photosynthetic organisms in the stream.

Effectiveness of Kenya's Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study.

PubMed

Wangalwa, Gilbert; Cudjoe, Bennett; Wamalwa, David; Machira, Yvonne; Ofware, Peter; Ndirangu, Meshack; Ilako, Festus

2012-01-01

Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya. Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months. There was statistically significant (p < 0.05) increase in attendance of at least four antenatal care visits (39% to 62%), deliveries by skilled birth attendants (31% to 57%), receiving intermittent preventive treatment (23% to 57%), testing for HIV during pregnancy (73% to 90%) and exclusive breastfeeding (20% to 52%). The significant increase in essential maternal and neonatal care practices demonstrates that, community health strategy is an appropriate platform to deliver community based interventions. The findings will be used by actors in the child survival community to improve current approaches, policies and practice in maternal and neonatal care.

40 CFR Appendix M to Subpart G of... - Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004

Code of Federal Regulations, 2014 CFR

2014-07-01

... refrigeration, and sandwich panels —Rigid polyurethane slabstock and other foams —Polystyrene extruded... 29, 2004 Foam Blowing—Unacceptable Substitutes End-use Substitute Decision Comments All foam end-uses: HCFC-141b Unacceptable Alternatives exist with lower or zero = ODP. —Rigid polyurethane and...

40 CFR Appendix M to Subpart G of... - Unacceptable Substitutes Listed in the September 30, 2004 Final Rule, Effective November 29, 2004

Code of Federal Regulations, 2013 CFR

2013-07-01

... refrigeration, and sandwich panels —Rigid polyurethane slabstock and other foams —Polystyrene extruded... 29, 2004 Foam Blowing—Unacceptable Substitutes End-use Substitute Decision Comments All foam end-uses: HCFC-141b Unacceptable Alternatives exist with lower or zero = ODP. —Rigid polyurethane and...

21 CFR 1305.15 - Unaccepted and defective DEA Forms 222.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Unaccepted and defective DEA Forms 222. 1305.15... I AND II CONTROLLED SUBSTANCES DEA Form 222 § 1305.15 Unaccepted and defective DEA Forms 222. (a) A DEA Form 222 must not be filled if either of the following apply: (1) The order is not complete...

21 CFR 1305.15 - Unaccepted and defective DEA Forms 222.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Unaccepted and defective DEA Forms 222. 1305.15... I AND II CONTROLLED SUBSTANCES DEA Form 222 § 1305.15 Unaccepted and defective DEA Forms 222. (a) A DEA Form 222 must not be filled if either of the following apply: (1) The order is not complete...

Air and water cooled modulator

DOEpatents

Birx, Daniel L.; Arnold, Phillip A.; Ball, Don G.; Cook, Edward G.

1995-01-01

A compact high power magnetic compression apparatus and method for delivering high voltage pulses of short duration at a high repetition rate and high peak power output which does not require the use of environmentally unacceptable fluids such as chlorofluorocarbons either as a dielectric or as a coolant, and which discharges very little waste heat into the surrounding air. A first magnetic switch has cooling channels formed therethrough to facilitate the removal of excess heat. The first magnetic switch is mounted on a printed circuit board. A pulse transformer comprised of a plurality of discrete electrically insulated and magnetically coupled units is also mounted on said printed board and is electrically coupled to the first magnetic switch. The pulse transformer also has cooling means attached thereto for removing heat from the pulse transformer. A second magnetic switch also having cooling means for removing excess heat is electrically coupled to the pulse transformer. Thus, the present invention is able to provide high voltage pulses of short duration at a high repetition rate and high peak power output without the use of environmentally unacceptable fluids and without discharging significant waste heat into the surrounding air.

SDDOT : safety program

DOT National Transportation Integrated Search

2000-05-01

The current safety and loss control program for the South Dakota Department of Transportation is not reaching its full potential and does not adequately prevent accidents and injuries. The Department has experienced an unacceptably high number of acc...

Intensified treatment with high dose Rifampicin and Levofloxacin compared to standard treatment for adult patients with Tuberculous Meningitis (TBM-IT): protocol for a randomized controlled trial

PubMed Central

2011-01-01

Background Tuberculous meningitis is the most severe form of tuberculosis. Mortality for untreated tuberculous meningitis is 100%. Despite the introduction of antibiotic treatment for tuberculosis the mortality rate for tuberculous meningitis remains high; approximately 25% for HIV-negative and 67% for HIV positive patients with most deaths occurring within one month of starting therapy. The high mortality rate in tuberculous meningitis reflects the severity of the condition but also the poor antibacterial activity of current treatment regimes and relatively poor penetration of these drugs into the central nervous system. Improving the antitubercular activity in the central nervous system of current therapy may help improve outcomes. Increasing the dose of rifampicin, a key drug with known poor cerebrospinal fluid penetration may lead to higher drug levels at the site of infection and may improve survival. Of the second generation fluoroquinolones, levofloxacin may have the optimal pharmacological features including cerebrospinal fluid penetration, with a ratio of Area Under the Curve (AUC) in cerebrospinal fluid to AUC in plasma of >75% and strong bactericidal activity against Mycobacterium tuberculosis. We propose a randomized controlled trial to assess the efficacy of an intensified anti-tubercular treatment regimen in tuberculous meningitis patients, comparing current standard tuberculous meningitis treatment regimens with standard treatment intensified with high-dose rifampicin and additional levofloxacin. Methods/Design A randomized, double blind, placebo-controlled trial with two parallel arms, comparing standard Vietnamese national guideline treatment for tuberculous meningitis with standard treatment plus an increased dose of rifampicin (to 15 mg/kg/day total) and additional levofloxacin. The study will include 750 patients (375 per treatment group) including a minimum of 350 HIV-positive patients. The calculation assumes an overall mortality of 40% vs. 30% in the two arms, respectively (corresponding to a target hazard ratio of 0.7), a power of 80% and a two-sided significance level of 5%. Randomization ratio is 1:1. The primary endpoint is overall survival, i.e. time from randomization to death during a follow-up period of 9 months. Secondary endpoints are: neurological disability at 9 months, time to new neurological event or death, time to new or recurrent AIDS-defining illness or death (in HIV-positive patients only), severe adverse events, and rate of treatment interruption for adverse events. Discussion Currently very few options are available for the treatment of TBM and the mortality rate remains unacceptably high with severe disabilities seen in many of the survivors. This trial is based on the hypothesis that current anti-mycobacterial treatment schedules for TBM are not potent enough and that outcomes will be improved by increasing the CSF penetrating power of this regimen by optimising dosage and using additional drugs with better CSF penetration. Trial registration International Standard Randomised Controlled Trial Number ISRCTN61649292 PMID:21288325

Intensified treatment with high dose rifampicin and levofloxacin compared to standard treatment for adult patients with tuberculous meningitis (TBM-IT): protocol for a randomized controlled trial.

PubMed

Heemskerk, Dorothee; Day, Jeremy; Chau, Tran Thi Hong; Dung, Nguyen Huy; Yen, Nguyen Thi Bich; Bang, Nguyen Duc; Merson, Laura; Olliaro, Piero; Pouplin, Thomas; Caws, Maxine; Wolbers, Marcel; Farrar, Jeremy

2011-02-02

Tuberculous meningitis is the most severe form of tuberculosis. Mortality for untreated tuberculous meningitis is 100%. Despite the introduction of antibiotic treatment for tuberculosis the mortality rate for tuberculous meningitis remains high; approximately 25% for HIV-negative and 67% for HIV positive patients with most deaths occurring within one month of starting therapy. The high mortality rate in tuberculous meningitis reflects the severity of the condition but also the poor antibacterial activity of current treatment regimes and relatively poor penetration of these drugs into the central nervous system. Improving the antitubercular activity in the central nervous system of current therapy may help improve outcomes. Increasing the dose of rifampicin, a key drug with known poor cerebrospinal fluid penetration may lead to higher drug levels at the site of infection and may improve survival. Of the second generation fluoroquinolones, levofloxacin may have the optimal pharmacological features including cerebrospinal fluid penetration, with a ratio of Area Under the Curve (AUC) in cerebrospinal fluid to AUC in plasma of >75% and strong bactericidal activity against Mycobacterium tuberculosis. We propose a randomized controlled trial to assess the efficacy of an intensified anti-tubercular treatment regimen in tuberculous meningitis patients, comparing current standard tuberculous meningitis treatment regimens with standard treatment intensified with high-dose rifampicin and additional levofloxacin. A randomized, double blind, placebo-controlled trial with two parallel arms, comparing standard Vietnamese national guideline treatment for tuberculous meningitis with standard treatment plus an increased dose of rifampicin (to 15 mg/kg/day total) and additional levofloxacin. The study will include 750 patients (375 per treatment group) including a minimum of 350 HIV-positive patients. The calculation assumes an overall mortality of 40% vs. 30% in the two arms, respectively (corresponding to a target hazard ratio of 0.7), a power of 80% and a two-sided significance level of 5%. Randomization ratio is 1:1. The primary endpoint is overall survival, i.e. time from randomization to death during a follow-up period of 9 months. Secondary endpoints are: neurological disability at 9 months, time to new neurological event or death, time to new or recurrent AIDS-defining illness or death (in HIV-positive patients only), severe adverse events, and rate of treatment interruption for adverse events. Currently very few options are available for the treatment of TBM and the mortality rate remains unacceptably high with severe disabilities seen in many of the survivors. This trial is based on the hypothesis that current anti-mycobacterial treatment schedules for TBM are not potent enough and that outcomes will be improved by increasing the CSF penetrating power of this regimen by optimising dosage and using additional drugs with better CSF penetration. International Standard Randomised Controlled Trial Number ISRCTN61649292.

Federal High School Graduation Rate Policies and the Impact on Kansas

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Arkansas

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Alabama

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Connecticut

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Oregon

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Georgia

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Missouri

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Colorado

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on New Jersey

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Florida

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Illinois

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Ohio

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on New York

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Massachusetts

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Arizona

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on California

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Montana

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Kentucky

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Louisiana

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Maryland

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Alaska

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Idaho

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Maine

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Hawaii

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Oklahoma

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on New Hampshire

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on North Dakota

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on North Carolina

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Delaware

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Mississippi

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Indiana

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on New Mexico

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Minnesota

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Nebraska

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Nevada

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Federal High School Graduation Rate Policies and the Impact on Michigan

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

Serbia within the European context: An analysis of premature mortality.

PubMed

Santric Milicevic, Milena; Bjegovic, Vesna; Terzic, Zorica; Vukovic, Dejana; Kocev, Nikola; Marinkovic, Jelena; Vasic, Vladimir

2009-08-05

Based on the global predictions majority of deaths will be collectively caused by cancer, cardiovascular diseases, and traffic accidents over the coming 25 years. In planning future national health policy actions, inter - regional assessments play an important role. The purpose of the study was to analyze similarities and differences in premature mortality between Serbia, EURO A, EURO B, and EURO C regions in 2000. Mortality and premature mortality patterns were analysed according to cause of death, by gender and seven age intervals. The study results are presented in relative (%) and absolute terms (age-specific and age-standardized death rates per 100,000 population, and age-standardized rates of years of life lost - YLL per 1,000). Direct standardization of rates was undertaken using the standard population of Europe. The inter-regional comparison was based on a calculation of differences in YLL structures and with a ratio of age-standardized YLL rates per 1,000. A multivariate generalized linear model was used to explore mortality of Serbia and Europe sub-regions with ln age-specific death rates. The dissimilarity was achieved with a p

Overweight and obesity on the island of Ireland: an estimation of costs

PubMed Central

Dee, Anne; Callinan, Aoife; Doherty, Edel; O'Neill, Ciaran; McVeigh, Treasa; Sweeney, Mary Rose; Staines, Anthony; Kearns, Karen; Fitzgerald, Sarah; Sharp, Linda; Kee, Frank; Hughes, John; Balanda, Kevin; Perry, Ivan J

2015-01-01

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches. Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality. Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease. Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs. PMID:25776042

A Comparison of Mission Statements of National Blue Ribbon Schools and Unacceptable Texas High Schools

ERIC Educational Resources Information Center

Perfetto, John Charles; Holland, Glenda; Davis, Rebecca; Fedynich, La Vonne

2013-01-01

This study was conducted to determine the themes present in the context of high schools, to determine any significant differences in themes for high and low performing high schools, and to determine if significant differences were present for the same sample of high schools based on school size. An analysis of the content of mission statements…

Federal Graduation Rate Policies and the Impact on Iowa

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2009

2009-01-01

In today's economy, employers increasingly demand that workers have a high school diploma, yet America's graduation rates are unacceptably low, particularly among poor and minority students. Nationally, only about 70 percent of students graduate from high school on time with a regular diploma; for African American and Hispanic students, this…

The Factorial Validity of the Piers-Harris Children's Self-Concept Scale for Each of Three Samples of Elementary, Junior High, and Senior High School Students in a Large Metropolitan School District

ERIC Educational Resources Information Center

Michael, William B.; And Others

1975-01-01

The scale yielded three major dimensions that were essentially invariant across the three samples: physical appearance, socially unacceptable (bad) behavior, and academic or school status. (Author/RC)

Socioeconomic Influences on the Educational and Career Paths of Kentucky High School Seniors.

ERIC Educational Resources Information Center

Rever, Philip R.; And Others

The report is a response to Kentucky Higher Education Assistance Authority's concern about limiting factors which constrain students' choices of paths to follow after leaving high school, specifically unacceptable factors that prohibit students (1) from pursuing postsecondary education and (2) from entering postsecondary institutions of their…

Junior High Student Responsibilities for Basic Skills.

ERIC Educational Resources Information Center

Parker, Charles C.

This paper advances the thesis that students should be trained to recognize acceptable and unacceptable performances in basic skill areas and should assume responsibility for attaining proficiency in these areas. Among the topics discussed are the value of having junior high school students check their own assignments, discover their errors, and…

Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

PubMed Central

Sundström, Johan; Gale, Chris P; James, Stefan; Deanfield, John; Wallentin, Lars; Timmis, Adam; Jernberg, Tomas; Hemingway, Harry

2015-01-01

Objective To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom. Design Population based longitudinal cohort study using nationwide clinical registries. Setting and participants Nationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119 786 patients) and the UK (NICOR/MINAP, n=242; 391 077 patients), 2004-10. Main outcome measures Between hospital variation in 30 day mortality of patients admitted with acute myocardial infarction. Results Case mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% v 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% v 6.6% in Sweden; 12.7% v 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals’ use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries. Conclusion Between hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction. Clinical trials registration Clinical trials NCT01359033. PMID:26254445

Effectiveness of Kenya's Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study

PubMed Central

Wangalwa, Gilbert; Cudjoe, Bennett; Wamalwa, David; Machira, Yvonne; Ofware, Peter; Ndirangu, Meshack; Ilako, Festus

2012-01-01

Background Maternal mortality ratio and neonatal mortality rate trends in Kenya have remained unacceptably high in a decade. In 2007, the Ministry of Public Health and Sanitation adopted a community health strategy to reverse the poor health outcomes in order to meet Millennium Development Goals 4 and 5. It aims at strengthening community participation and its ability to take action towards health. The study aimed at evaluating the effectiveness of the strategy in improving maternal and neonatal health outcomes in Kenya. Methods Between 2008 and 2010, the African Medical and Research Foundation implemented a community-based maternal and newborn care intervention package in Busia County using the community health strategy approach. An interventional, non-randomized pre-test post test study design was used to evaluate change in essential maternal and neonatal care practices among mothers with children aged 0 - 23 months. Results There was statistically significant (p < 0.05) increase in attendance of at least four antenatal care visits (39% to 62%), deliveries by skilled birth attendants (31% to 57%), receiving intermittent preventive treatment (23% to 57%), testing for HIV during pregnancy (73% to 90%) and exclusive breastfeeding (20% to 52%). Conclusion The significant increase in essential maternal and neonatal care practices demonstrates that, community health strategy is an appropriate platform to deliver community based interventions. The findings will be used by actors in the child survival community to improve current approaches, policies and practice in maternal and neonatal care. PMID:23467438

Defining acceptable levels for ecological indicators: an approach for considering social values.

PubMed

Smyth, Robyn L; Watzin, Mary C; Manning, Robert E

2007-03-01

Ecological indicators can facilitate an adaptive management approach, but only if acceptable levels for those indicators have been defined so that the data collected can be interpreted. Because acceptable levels are an expression of the desired state of the ecosystem, the process of establishing acceptable levels should incorporate not just ecological understanding but also societal values. The goal of this research was to explore an approach for defining acceptable levels of ecological indicators that explicitly considers social perspectives and values. We used a set of eight indicators that were related to issues of concern in the Lake Champlain Basin. Our approach was based on normative theory. Using a stakeholder survey, we measured respondent normative evaluations of varying levels of our indicators. Aggregated social norm curves were used to determine the level at which indicator values shifted from acceptable to unacceptable conditions. For seven of the eight indicators, clear preferences were interpretable from these norm curves. For example, closures of public beaches because of bacterial contamination and days of intense algae bloom went from acceptable to unacceptable at 7-10 days in a summer season. Survey respondents also indicated that the number of fish caught from Lake Champlain that could be safely consumed each month was unacceptably low and the number of streams draining into the lake that were impaired by storm water was unacceptably high. If indicators that translate ecological conditions into social consequences are carefully selected, we believe the normative approach has considerable merit for defining acceptable levels of valued ecological system components.

Defining Acceptable Levels for Ecological Indicators: An Approach for Considering Social Values

NASA Astrophysics Data System (ADS)

Smyth, Robyn L.; Watzin, Mary C.; Manning, Robert E.

2007-03-01

Ecological indicators can facilitate an adaptive management approach, but only if acceptable levels for those indicators have been defined so that the data collected can be interpreted. Because acceptable levels are an expression of the desired state of the ecosystem, the process of establishing acceptable levels should incorporate not just ecological understanding but also societal values. The goal of this research was to explore an approach for defining acceptable levels of ecological indicators that explicitly considers social perspectives and values. We used a set of eight indicators that were related to issues of concern in the Lake Champlain Basin. Our approach was based on normative theory. Using a stakeholder survey, we measured respondent normative evaluations of varying levels of our indicators. Aggregated social norm curves were used to determine the level at which indicator values shifted from acceptable to unacceptable conditions. For seven of the eight indicators, clear preferences were interpretable from these norm curves. For example, closures of public beaches because of bacterial contamination and days of intense algae bloom went from acceptable to unacceptable at 7-10 days in a summer season. Survey respondents also indicated that the number of fish caught from Lake Champlain that could be safely consumed each month was unacceptably low and the number of streams draining into the lake that were impaired by storm water was unacceptably high. If indicators that translate ecological conditions into social consequences are carefully selected, we believe the normative approach has considerable merit for defining acceptable levels of valued ecological system components.

Injury risk associated with ground hardness in junior cricket.

PubMed

Twomey, Dara M; White, Peta E; Finch, Caroline F

2012-03-01

To establish if there is an association between ground hardness and injury risk in junior cricket. Nested case-series of players who played matches on specific grounds with objective ground hardness measures, within a prospective cohort study of junior community club cricket players. Monitoring of injuries and playing exposure occurred during 434 matches over the 2007/2008 playing season. Objective assessment of the hardness of 38 grounds was undertaken using a Clegg hammer at 13 sites on 19 different junior cricket grounds on the match eve across the season. Hardness readings were classified from unacceptably low (<30 g) to unacceptably high (>120 g) and two independent raters assessed the likelihood of each injury being related to ground hardness. Injuries sustained on tested grounds were related to the ground hardness measures. Overall, 31 match injuries were reported; 6.5% were rated as likely to be related to ground hardness, 16.1% as possibly related and 74.2% as unlikely to be related and 3.2% unknown. The two injuries likely to be related to ground hardness were sustained whilst diving to catch a ball resulting, in a graze/laceration from contact with hard ground. Overall, 31/38 (82%) ground assessments were rated as having 'unacceptably high' hardness and all others as 'high/normal' hardness. Only one injury occurred on an objectively tested ground. It remains unclear if ground hardness is a contributing factor to the most common injury mechanism of being struck by the ball, and needs to be confirmed in future larger-scale studies. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Air and water cooled modulator

DOEpatents

Birx, D.L.; Arnold, P.A.; Ball, D.G.; Cook, E.G.

1995-09-05

A compact high power magnetic compression apparatus and method are disclosed for delivering high voltage pulses of short duration at a high repetition rate and high peak power output which does not require the use of environmentally unacceptable fluids such as chlorofluorocarbons either as a dielectric or as a coolant, and which discharges very little waste heat into the surrounding air. A first magnetic switch has cooling channels formed therethrough to facilitate the removal of excess heat. The first magnetic switch is mounted on a printed circuit board. A pulse transformer comprised of a plurality of discrete electrically insulated and magnetically coupled units is also mounted on said printed board and is electrically coupled to the first magnetic switch. The pulse transformer also has cooling means attached thereto for removing heat from the pulse transformer. A second magnetic switch also having cooling means for removing excess heat is electrically coupled to the pulse transformer. Thus, the present invention is able to provide high voltage pulses of short duration at a high repetition rate and high peak power output without the use of environmentally unacceptable fluids and without discharging significant waste heat into the surrounding air. 9 figs.

Railroad right-of-way incident analysis research.

DOT National Transportation Integrated Search

2011-04-01

Locations of railroad right-of-way incidents in this research were identified as hotspots. These can be defined as highway-rail grade crossings or locations along the railroad right-of-way where collision or trespassing risk is unacceptably high and ...

Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder.

PubMed

Khosravani, Vahid; Sharifi Bastan, Farangis; Samimi Ardestani, Mehdi; Jamaati Ardakani, Razieh

2017-09-01

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

40 CFR Appendix A to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes

Code of Federal Regulations, 2011 CFR

2011-07-01

... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming potentials. Although actual contributions to global warming depend upon the quantities of PFCs emitted, the... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming...

40 CFR Appendix A to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes

Code of Federal Regulations, 2014 CFR

2014-07-01

... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming potentials. Although actual contributions to global warming depend upon the quantities of PFCs emitted, the... for PFCs is that they have long atmospheric lifetimes and high global warming potentials. Although...

40 CFR Appendix A to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes

Code of Federal Regulations, 2012 CFR

2012-07-01

... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming potentials. Although actual contributions to global warming depend upon the quantities of PFCs emitted, the... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming...

40 CFR Appendix A to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes

Code of Federal Regulations, 2013 CFR

2013-07-01

... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming potentials. Although actual contributions to global warming depend upon the quantities of PFCs emitted, the... characteristic of concern for PFCs is that they have long atmospheric lifetimes and high global warming...

50 years of pediatric immunology: progress and future, a clinical perspective.

PubMed

Singh, Surjit; Gupta, Anju; Rawat, Amit

2013-01-08

Rapidly evolving advances in the field of immunology over the last few decades have impacted the practice of clinical medicine in many ways. In fact, understanding the immunological basis of disease has been pivotal in deciphering the pathogenesis of several disease processes, infective or otherwise. As of today, there is hardly any specialty of medicine which is not influenced by immunology. Pediatric rheumatological disorders, vasculitides, Human Immunodeficiency Virus (HIV) infection, Primary Immunodeficiency Diseases (PIDs) and autoimmune disorders fall under the domain of clinical immunology. This specialty is poised to emerge as a major clinical specialty in our country. The gulf between bench and bedside is narrowing down as our understanding of the complex immunological mechanisms gets better. However, a lot still needs to be done in this field as the morbidity and mortality of some of these conditions is unacceptably high in the Indian setup. A number of medical schools and institutes in the country now have the resources and the wherewithal to develop into specialized centres of clinical immunology. We need to concentrate on training more physicians and pediatricians in this field. The future is bright and the prospects exciting.

Characteristics and outcome of tetanus in adolescent and adult patients admitted to the Lagos University Teaching Hospital between 2000 and 2009.

PubMed

Bankole, Idowu A; Danesi, Mustapha A; Ojo, Oluwadamilola O; Okubadejo, Njideka U; Ojini, Frank I

2012-12-15

This study was a case record review of adult patients with tetanus admitted into Lagos University Teaching Hospital between 2000 and 2009. Of 78,009 adults admitted, 190 had tetanus, constituting 0.25% of admission. Mean age was 30.4 ± 13.8 years. Male to female ratio was 3:1. The commonest occupation was commercial motorcyclists. 96% of the patients were unimmunized and 4% that had partial immunization had localized tetanus. Commonest presentation was trismus (83%). Twenty three patients had complications, 30% had autonomic dysfunction. Mean incubation period was 11.4 ± 4.8 days, and mean duration of onset was 72 ± 45.6h. 31 patients died, case fatality rate was 16.3%. Twelve percent of those with long period of onset died while 43% with short period of onset died (P=0.002). Patients with complications (78%) died of tetanus while only 8% of those without complication died (P<0.0001). Case fatality rate is still unacceptably high for a vaccine preventable disease. Attention to primary prevention of people at risk and active surveillance to prevent complications will further reduce mortality. Copyright © 2012 Elsevier B.V. All rights reserved.

Particulate delivery systems for vaccination against bioterrorism agents and emerging infectious pathogens

PubMed Central

Fan, Yuchen; Moon, James J.

2016-01-01

Bioterrorism agents that can be easily transmitted with high mortality rates and cause debilitating diseases pose major threats to national security and public health. The recent Ebola virus outbreak in West Africa and ongoing Zika virus outbreak in Brazil, now spreading throughout Latin America, are case examples of emerging infectious pathogens that have incited widespread fear and economic and social disruption on a global scale. Prophylactic vaccines would provide effective countermeasures against infectious pathogens and biological warfare agents. However, traditional approaches relying on attenuated or inactivated vaccines have been hampered by their unacceptable levels of reactogenicity and safety issues, whereas subunit antigen-based vaccines suffer from suboptimal immunogenicity and efficacy. In contrast, particulate vaccine delivery systems offer key advantages, including efficient and stable delivery of subunit antigens, co-delivery of adjuvant molecules to bolster immune responses, low reactogenicity due to the use of biocompatible biomaterials, and robust efficiency to elicit humoral and cellular immunity in systemic and mucosal tissues. Thus, vaccine nanoparticles and microparticles are promising platforms for clinical development of biodefense vaccines. In this review, we summarize the current status of research efforts to develop particulate vaccine delivery systems against bioterrorism agents and emerging infectious pathogens. PMID:27038091

Promoting equity to achieve maternal and child health.

PubMed

Thomsen, Sarah; Hoa, Dinh Thi Phuong; Målqvist, Mats; Sanneving, Linda; Saxena, Deepak; Tana, Susilowati; Yuan, Beibei; Byass, Peter

2011-11-01

Maternal and child mortality rates, the targets for two of the eight Millennium Development Goals, remain unacceptably high in many countries. Some countries have made significant advances in reducing deaths in pregnancy, childbirth, and childhood at the national level. However, on a sub-national basis most countries show wide disparities in health indices which are not necessarily reflected in national figures. This is a sign of inequitable access to and provision of health services. Yet there has been little attention to health equity in relation to the Millennium Development Goals. Instead, countries have focused on achieving national targets. This has led to an emphasis on utilitarian, as opposed to universalist, approaches to public health, which we discuss here. We recommend a policy of "proportionate universalism". In this approach, universal health care and a universal social policy are the ultimate goal, but in the interim actions are carried out with intensities proportionate to disadvantage. We also briefly describe an initiative that aims to promote evidence-based policy and interventions that will reduce inequity in access to maternal and child health care in China, India, Indonesia and Viet Nam. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Afghanistan.

PubMed

1983-05-01

In this discussion of Afghanistan, attention focuses on: the history of the country's demographic situation; the government's overall approach to population problems; population data systems and development planning; institutional arrangements for the integration of population within development objectives; population size, growth, and natural increase; morbidity and mortality; fertility; international migration; and spatial distribution. Only recently has there been a population census in the country; consequently, there has been relatively little reliable demographic information available, especially in a historical context. Afghanistan's total population was officially estimated at nearly 16 million in late 1967. According to UN estimates, the population totaled 8.3 million in 1960 and increased to 9.8 and 12.3 million in the following 2 decades to over 14 million by 1975. The rate of population growth, as estimated by the UN, is reported to have increased from 1.6% during 1950-55 to 2.4% by the following decade, reaching 2.9% during 1970-75. The crude birthrate declined slightly from 50.4 births/1000 during 1950-55 to 49.2 during 1970-75. The crude death rate declined from 34.6/1000 to 23.4 deaths/1000 during the same period. Although the rate of population growth is considered to be fairly high, the government does not perceive this as presenting a population problem for the country as a whole since the overall population density is relatively low (approximately 20 persons per square kilometer). A national statistical information system has been developed in Afghanistan over the past decades. The government has no explicit population policy, and a clear association between population and development issues has not been expressed. Policies in the area of population distribution indicate the government's concern with settlement and resettlement of certain segments of the population in connection with the overall economic and social development of sparsely populated areas. The government perceives the current rate of population growth as unsatisfactory because it is too high, but does not view this as presenting any particular population problem. Data on mortality rates based primarily on the 1979 census indicate a crude death rate of 22/1000 for the sedentary population. The government regards the levels off mortality to bbe unacceptable, and its official goal is to rapidly reduce mortality and morbidity. High priority is given to the prevention and treatment of morbidity among young children. The fertility levels are quite high, compared acceptability of these levels. Direct governmental support is givenn to the family planning program in terms of both access to informartion and family planning methods. Levels of immigration are not significant. No official policy concerning the spatial distribution of the population has been formulated.

CT Scan Screening for Lung Cancer: Risk Factors for Nodules and Malignancy in a High-Risk Urban Cohort

PubMed Central

Greenberg, Alissa K.; Lu, Feng; Goldberg, Judith D.; Eylers, Ellen; Tsay, Jun-Chieh; Yie, Ting-An; Naidich, David; McGuinness, Georgeann; Pass, Harvey; Tchou-Wong, Kam-Meng; Addrizzo-Harris, Doreen; Chachoua, Abraham; Crawford, Bernard; Rom, William N.

2012-01-01

Background Low-dose computed tomography (CT) for lung cancer screening can reduce lung cancer mortality. The National Lung Screening Trial reported a 20% reduction in lung cancer mortality in high-risk smokers. However, CT scanning is extremely sensitive and detects non-calcified nodules (NCNs) in 24–50% of subjects, suggesting an unacceptably high false-positive rate. We hypothesized that by reviewing demographic, clinical and nodule characteristics, we could identify risk factors associated with the presence of nodules on screening CT, and with the probability that a NCN was malignant. Methods We performed a longitudinal lung cancer biomarker discovery trial (NYU LCBC) that included low-dose CT-screening of high-risk individuals over 50 years of age, with more than 20 pack-year smoking histories, living in an urban setting, and with a potential for asbestos exposure. We used case-control studies to identify risk factors associated with the presence of nodules (n = 625) versus no nodules (n = 557), and lung cancer patients (n = 30) versus benign nodules (n = 128). Results The NYU LCBC followed 1182 study subjects prospectively over a 10-year period. We found 52% to have NCNs >4 mm on their baseline screen. Most of the nodules were stable, and 9.7% of solid and 26.2% of sub-solid nodules resolved. We diagnosed 30 lung cancers, 26 stage I. Three patients had synchronous primary lung cancers or multifocal disease. Thus, there were 33 lung cancers: 10 incident, and 23 prevalent. A sub-group of the prevalent group were stable for a prolonged period prior to diagnosis. These were all stage I at diagnosis and 12/13 were adenocarcinomas. Conclusions NCNs are common among CT-screened high-risk subjects and can often be managed conservatively. Risk factors for malignancy included increasing age, size and number of nodules, reduced FEV1 and FVC, and increased pack-years smoking. A sub-group of screen-detected cancers are slow-growing and may contribute to over-diagnosis and lead-time biases. PMID:22768300

HiveScience: A Citizen Science Project for Beekeepers##

EPA Science Inventory

Over the past decade, beekeepers have been experiencing unacceptably high colony losses while the demand for insect-pollinated crops has tripled during the same time period. Underscoring the need to develop reliable methods for predicting colony health, the United States Departme...

New Bedford Harbor Long Term Monitoring Program

EPA Science Inventory

New Bedford Harbor (NBH), located in southeastern Massachusetts, was designated as a Superfund site in 1983 due to unacceptably high levels of sediment contamination by polychlorinated biphenyls (PCBs). Based on human health and environmental concerns, the decision was made to d...

Addressing Uncertainty in Fecal Indicator Bacteria Dark Inactivation Rates

EPA Science Inventory

Fecal contamination is a leading cause of surface water quality degradation. Roughly 20% of all total maximum daily load assessments approved by the United States Environmental Protection Agency since 1995, for example, address water bodies with unacceptably high fecal indicator...

THERMODYNAMIC REACTION CONSTANTS FOR MODELING AQUEOUS ENVIRONMENTAL MERCURY SPECIATION

EPA Science Inventory

Unacceptably high fish tissue mercury residues are responsible for the majority of fish consumption advisories issued in 48 states of the United States of America. Mercury also has emerged as a transboundary contaminant of global concern. Although monomethylmercury is generally...

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-01-01

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015.

PubMed

Misganaw, Awoke; Haregu, Tilahun N; Deribe, Kebede; Tessema, Gizachew Assefa; Deribew, Amare; Melaku, Yohannes Adama; Amare, Azmeraw T; Abera, Semaw Ferede; Gedefaw, Molla; Dessalegn, Muluken; Lakew, Yihunie; Bekele, Tolesa; Mohammed, Mesoud; Yirsaw, Biruck Desalegn; Damtew, Solomon Abrha; Krohn, Kristopher J; Achoki, Tom; Blore, Jed; Assefa, Yibeltal; Naghavi, Mohsen

2017-07-21

Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.

STREAM RESTORATION STRATEGIES FOR REDUCING RIVER NITROGEN LOADS

EPA Science Inventory

Despite decades of work implementing agricultural and urban best management practices to reduce the movement of excess nitrogen (N) from the land to aquatic ecosystems, the amount of N moving down streams and rivers remains unacceptably high in many watersheds. During this same ...

Failure analysis of blistered gold plating on spot welded electrical relays

NASA Technical Reports Server (NTRS)

Sokolowski, Witold; O'Donnell, Tim

1989-01-01

Gold-plated stainless-steel sideplates, part of a JPL Galileo spacecraft electronic-relay assembly, exhibited blistering after resistance spot welding. Unacceptable relays had heavy nonuniform gold electrodeposited layers with thicknesses 4.5-11.5 microns. SEM and metallographic investigations indicated much higher heat input generated during the resistance spot welding in unacceptable relays. The attributes of acceptable welded relays are contrasted with unacceptable relays; the possible mechanism of laminar formation of polymeric material in the gold plating is discussed; and some recommendations are provided to prevent similar problems.

Threats to information security of real-time disease surveillance systems.

PubMed

Henriksen, Eva; Johansen, Monika A; Baardsgaard, Anders; Bellika, Johan G

2009-01-01

This paper presents the main results from a qualitative risk assessment of information security aspects for a new real-time disease surveillance approach in general, and for the Snow surveillance system in particular. All possible security threats and acceptable solutions, and the implications these solutions had to the design of the system, were discussed. Approximately 30 threats were identified. None of these got an unacceptable high risk level originally, but two got medium risk level, of which one was concluded to be unacceptable after further investigation. Of the remaining low risk threats, some have severe consequence, thus requiring particular assessment. Since it is very important to identify and solve all security threats before real-time solutions can be used in a wide scale, additional investigations are needed.

Trends in maternal deaths in HIV-infected women, on a background of changing HIV management guidelines in South Africa: 1997 to 2015.

PubMed

Mnyani, Coceka N; Buchmann, Eckhart J; Chersich, Matthew F; Frank, Karlyn A; McIntyre, James A

2017-11-01

As work begins towards the Sustainable Development Goal target of reducing the global maternal mortality ratio (MMR) to less than 70 deaths per 100,000 live births by 2030, much needs to be done in ending preventable maternal deaths. After 1990, South Africa experienced a reversal of gains in decreasing maternal mortality, with an increase in HIV-related maternal deaths. In this study, we assessed trends in maternal mortality in HIV-infected women, on a background of an evolving HIV care programme. This was a cross-sectional, retrospective record review of maternal deaths in the obstetrics unit at Chris Hani Baragwanath Academic Hospital, in Johannesburg, South Africa, a referral hospital in a high HIV prevalence setting where the prevalence among pregnant women has plateaued around 29.0% for the past decade. Trends in HIV diagnosis and management in pregnancy, and causes of maternal deaths in HIV-infected women were analysed over different time periods (1997 to 2003, 2004 to 2009, 2010 to 2012, and 2013 to 2015) reflecting major guideline changes. From January 1997 to December 2015, there were 692 maternal deaths in the obstetrics unit. Of the 490 (70.8%) maternal deaths with a documented HIV status, 335 (68.4%) were HIV-infected. A Chi-squared test for trends showed that the institutional MMR (iMMR) in women known to be HIV-infected peaked in the period 2004 to 2009 at 380 (95% CI 319 to 446) per 100,000 live births, with a decline to 267 (95% CI 198 to 353) in 2013 to 2015, p = 0.049. This decrease coincided with changes in the South African HIV management guidelines, mainly increased availability of antiretroviral therapy (ART). Non-pregnancy related infections were the leading cause of death throughout the review period, accounting for 61.5% (206/335) of deaths. Only 23.3% (78/335) of the women who died were on ART at the time of death, this in the context of advanced immune suppression and an overall median CD4 count of 136 cells/μl (interquartile ranges (IQR) 45 to 301). In this 19-year review of maternal deaths in Johannesburg, South Africa, there was evidence of a decrease in the iMMR among HIV-infected women, but it remains unacceptably high. Efforts to address drivers of mortality and barriers to accessing ART need to be accelerated if we are to see substantial decreases in maternal mortality. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Candidiasis drug discovery and development: new approaches targeting virulence for discovering and identifying new drugs

PubMed Central

Pierce, Christopher G.; Lopez-Ribot, Jose L.

2014-01-01

Introduction Targeting pathogenetic mechanisms rather than essential processes represents a very attractive alternative for the development of new antibiotics. This may be particularly important in the case of antimycotics, due to the urgent need for novel antifungal drugs and the paucity of selective fungal targets. The opportunistic pathogenic fungus Candida albicans is the main etiological agent of candidiasis, the most common human fungal infection. These infections carry unacceptably high mortality rates, a clear reflection of the many shortcomings of current antifungal therapy, including the limited armamentarium of antifungal agents, their toxicity, and the emergence of resistance. Moreover the antifungal pipeline is mostly dry. Areas covered This review covers some of the most recent progress towards understanding C. albicans pathogenetic processes and how to harness this information for the development of anti-virulence agents. The two principal areas covered are filamentation and biofilm formation, as C. albicans pathogenicity is intimately linked to its ability to undergo morphogenetic conversions between yeast and filamentous morphologies and to its ability to form biofilms. Expert opinion We argue that filamentation and biofilm formation represent high value targets, yet clinically unexploited, for the development of novel anti-virulence approaches against candidiasis. Although this has proved a difficult task despite increasing understanding at the molecular level of C. albicans virulence, we highlight new opportunities and prospects for antifungal drug development targeting these two important biological processes. PMID:23738751

Summary of regional response to the fourth inquiry.

PubMed

1979-01-01

Most of the governments that have responded to the 4th United Nations Population Growth Inquiry consider that the current rates of population growth are constraining the achievement of objectives of social economic development, and thus are unsatisfactory. The view of the governments of Iran, Pakistan, the Republic of Korea and Sri Lanka is that their current rates of growth constrain all aspects of development. The governments of Japan, Malaysia, and Singapore regard their current rates of growth as satisfactory and contributing to different aspects of economic and social development. As for mortality, most governments in the ESCAP region consider the current level of average life expectancy at birth acceptable, but present levels are unacceptable to the governments of Bangladesh, India, Iran, Nepal, Samoa and Thailand. Most governments consider their current levels of fertility to be too high and that they constrain the family well being, but the governments of Japan and Singapore believe that their fertility has contributed to the family well being. Additional attention in the inquiry was directed to obtaining information on the promotion of knowledge and policies (data collection and analysis; research; management, training, education and information; and development and evaluation of population policies). 10 governments have established a high level unit to deal with population policies, and 10 governments have indicated that they have integrated population measures and programs into comprehensive social and economic plans and programs.

Immune Protection against Lethal Fungal-Bacterial Intra-Abdominal Infections.

PubMed

Lilly, Elizabeth A; Ikeh, Melanie; Nash, Evelyn E; Fidel, Paul L; Noverr, Mairi C

2018-01-16

Polymicrobial intra-abdominal infections (IAIs) are clinically prevalent and cause significant morbidity and mortality, especially those involving fungi. Our laboratory developed a mouse model of IAI and demonstrated that intraperitoneal inoculation with Candida albicans or other virulent non- albicans Candida (NAC) species plus Staphylococcus aureus resulted in 70 to 80% mortality in 48 to 72 h due to robust local and systemic inflammation (sepsis). Surprisingly, inoculation with Candida dubliniensis or Candida glabrata with S. aureus resulted in minimal mortality, and rechallenge of these mice with lethal C. albicans / S. aureus (i.e., coninfection) resulted in >90% protection. The purpose of this study was to define requirements for C. dubliniensis / S. aureus -mediated protection and interrogate the mechanism of the protective response. Protection was conferred by C. dubliniensis alone or by killed C. dubliniensis plus live S. aureus S. aureus alone was not protective, and killed S. aureus compromised C. dubliniensis -induced protection. C. dubliniensis / S. aureus also protected against lethal challenge by NAC plus S. aureus and could protect for a long-term duration (60 days between primary challenge and C. albicans/S. aureus rechallenge). Unexpectedly, mice deficient in T and B cells (Rag-1 knockouts [KO]) survived both the initial C. dubliniensis/S. aureus challenge and the C. albicans/S. aureus rechallenge, indicating that adaptive immunity did not play a role. Similarly, mice depleted of macrophages prior to rechallenge were also protected. In contrast, protection was associated with high numbers of Gr-1 hi polymorphonuclear leukocytes (PMNLs) in peritoneal lavage fluid within 4 h of rechallenge, and in vivo depletion of Gr-1 + cells prior to rechallenge abrogated protection. These results suggest that Candida species can induce protection against a lethal C. albicans / S. aureus IAI that is mediated by PMNLs and postulated to be a unique form of trained innate immunity. IMPORTANCE Polymicrobial intra-abdominal infections are clinically devastating infections with high mortality rates, particularly those involving fungal pathogens, including Candida species. Even in patients receiving aggressive antimicrobial therapy, mortality rates remain unacceptably high. There are no available vaccines against IAI, which is complicated by the polymicrobial nature of the infection. IAI leads to lethal systemic inflammation (sepsis), which is difficult to target pharmacologically, as components of the inflammatory response are also needed to control the infection. Our studies demonstrate that prior inoculation with low-virulence Candida species provides strong protection against subsequent lethal infection with C. albicans and S. aureus Surprisingly, protection is long-lived but not mediated by adaptive (specific) immunity. Instead, protection is dependent on cells of the innate immune system (nonspecific immunity) and provides protection against other virulent Candida species. This discovery implies that a form of trained innate immunity may be clinically effective against polymicrobial IAI. Copyright © 2018 Lilly et al.

Secondary stroke prevention: challenges and solutions.

PubMed

Esenwa, Charles; Gutierrez, Jose

2015-01-01

Stroke is the leading cause of disability in the USA and a major cause of mortality worldwide. One out of four strokes is recurrent. Secondary stroke prevention starts with deciphering the most likely stroke mechanism. In general, one of the main goals in stroke reduction is to control vascular risk factors such as hypertension, diabetes, dyslipidemia, and smoking cessation. Changes in lifestyle like a healthy diet and aerobic exercise are also recommended strategies. In the case of cardioembolism due to atrial fibrillation, mechanical valves, or cardiac thrombus, anticoagulation is the mainstay of therapy. The role of anticoagulation is less evident in the case of bioprosthetic valves, patent foramen ovale, and dilated cardiomyopathy with low ejection fraction. Strokes due to larger artery atherosclerosis account for approximately a third of all strokes. In the case of symptomatic extracranial carotid stenosis, surgical intervention as close as possible in time to the index event seems highly beneficial. In the case of intracranial large artery atherosclerosis, the best medical therapy consists of antiplatelets, high-dose statins, aggressive controls of vascular risk factors, and lifestyle modifications, with no role for intracranial arterial stenting or angioplasty. For patients with small artery occlusion (ie, lacunar stroke), the therapy is similar to that used in patients with intracranial large artery atherosclerosis. Despite the constant new evidence on how to best treat patients who have suffered a stroke, the risk of stroke recurrence remains unacceptably high, thus evidencing the need for novel therapies.

Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence.

PubMed

Nieman, Gary F; Gatto, Louis A; Bates, Jason H T; Habashi, Nader M

2015-12-01

Trauma, hemorrhagic shock, or sepsis can incite systemic inflammatory response syndrome, which can result in early acute lung injury (EALI). As EALI advances, improperly set mechanical ventilation (MV) can amplify early injury into a secondary ventilator-induced lung injury that invariably develops into overt ARDS. Once established, ARDS is refractory to most therapeutic strategies, which have not been able to lower ARDS mortality below the current unacceptably high 40%. Low tidal volume ventilation is one of the few treatments shown to have a moderate positive impact on ARDS survival, presumably by reducing ventilator-induced lung injury. Thus, there is a compelling case to be made that the focus of ARDS management should switch from treatment once this syndrome has become established to the application of preventative measures while patients are still in the EALI stage. Indeed, studies have shown that ARDS incidence is markedly reduced when conventional MV is applied preemptively using a combination of low tidal volume and positive end-expiratory pressure in both patients in the ICU and in surgical patients at high risk for developing ARDS. Furthermore, there is evidence from animal models and high-risk trauma patients that superior prevention of ARDS can be achieved using preemptive airway pressure release ventilation with a very brief duration of pressure release. Preventing rather than treating ARDS may be the way forward in dealing with this recalcitrant condition and would represent a paradigm shift in the way that MV is currently practiced.

Modification of potato steroidal glycoalkaloids with silencing RNA constructs

USDA-ARS?s Scientific Manuscript database

Steroidal glycoalkaloids (SGAs), while found in many solanaceous plants, can accumulate to unacceptably high levels in potatoes. The two primary SGAs that occur in potatoes are the tri-glycosylated alkaloids, a-solanine and a-chaconine. The first glycosylation steps in their biosynthetic pathways ...

The effect of women's role on health: the paradox.

PubMed

Kabira, W M; Gachukia, E W; Matiangi, F O

1997-07-01

Most societies in Africa are patriarchal in nature. Traditional Africa has allocated the role of nurturing, and ensuring the health of the family and the community as a whole to women. From the age of six, girls begin to work with their mothers, cleaning, sweeping, nursing and caring for the younger children, the aged and the sick. Therefore, the female child is customarily socialized as the custodian of family health. Because women are traditionally responsible for health in African countries and their status in society is low, the status of the health sector has received less attention than other sectors. The paradox of entrusting the woman with the responsibility of health and at the same time denying her the opportunities to influence policies remains a major obstacle. Factors that influence women's health in Africa most commonly include poverty, poor education and poor nutrition. Access to education for African women is a major problem. The impact of a poorly educated mother is passed on to the daughter. In some parts of Africa, female circumcision contributes to the high school dropout rates. Once the girls are withdrawn from school to participate in the ceremonies, they do not return to school. They are encouraged and socialized towards marriage. Africa has the highest fertility rate, the lowest life expectancy (49 years for males and 52 for females, the highest infant mortality rate (114 deaths per 1000 live births); the highest maternal mortality rate and the highest dependency ratio (47% under 15 years and only 3% over 65). The foregoing factors call for urgent attention to health issues, especially those which affect women who are the traditional health providers. There is an unacceptably high rate of unsafe abortion which accounts for up to 30% of maternal mortality in some African countries, and there is growing concern over teenage pregnancies in some African countries. Nearly two-thirds of the cases of septic abortions are in the 15-19-year age group and yet African governments and the legal systems would rather not deal with abortion. The gap between mortality and fertility is widening; it doubled between 1972 and 1994 and is expected to double in 2017. In many African countries, children are the only 'goods' that women are expected to produce. Unless this attitude changes, fertility rates will continue to rise as women continue to search for their place in society and justify their place within marriages and relationships through child bearing.

Assessment of variations in control of asthma over time.

PubMed

Combescure, C; Chanez, P; Saint-Pierre, P; Daurès, J P; Proudhon, H; Godard, P

2003-08-01

Control and severity of asthma are two different but complementary concepts. The severity of asthma could influence the control over time. The aim of this study was to demonstrate this relationship. A total 365 patients with persistent asthma (severity) were enrolled and followed-up prospectively. Data were analysed using a continuous time homogeneous Markov model of the natural history of asthma. Control of asthma was defined according to three health states which were qualified: optimal, suboptimal and unacceptable control (states 1, 2 and 3). Transition forces (denoted lambda(ij) from state i to state j) and transition probabilities between control states were assessed and the results stratified by asthma severity were compared. Models were validated by comparing expected and observed numbers of patients in the different states. Transition probabilities stabilised between 100-250 days and more rapidly in patients with mild-to-moderate asthma. Patients with mild-to-moderate asthma in suboptimal or unacceptable control had a high probability of transition directly to optimal control. Patients with severe asthma had a tendency to remain in unacceptable control. A Markov model is a useful tool to model the control of asthma over time. Severity modified clearly the health states. It could be used to compare the performance of different approaches to asthma management.

Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries.

PubMed

Mahato, Preeti K; Waithaka, Elizabeth; van Teijlingen, Edwin; Pant, Puspa Raj; Biswas, Animesh

2018-04-01

Despite significant global improvements, maternal mortality in low-income countries remains unacceptably high. Increasing attention in recent years has focused on how social factors, such as family and peer influences, the community context, health services, legal and policy environments, and cultural and social values, can shape and influence maternal outcomes. Whereas verbal autopsy is used to attribute a clinical cause to a maternal death, the aim of social autopsy is to determine the non-clinical contributing factors. A social autopsy of a maternal death is a group interaction with the family of the deceased woman and her wider local community, where facilitators explore the social causes of the death and identify improvements needed. Although still relatively new, the process has proved useful to capture data for policy-makers on the social determinants of maternal deaths. This article highlights a second aspect of social autopsy - its potential role in health promotion. A social autopsy facilitates "community self-diagnosis" and identification of modifiable social and cultural factors that are attributable to the death. Social autopsy therefore has the potential not only for increasing awareness among community members, but also for promoting behavioural change at the individual and community level. There has been little formal assessment of social autopsy as a tool for health promotion. Rigorous research is now needed to assess the effectiveness and cost effectiveness of social autopsy as a preventive community-based intervention, especially with respect to effects on social determinants. There is also a need to document how communities can take ownership of such activities and achieve a sustainable impact on preventable maternal deaths.

Can the right to health inform public health planning in developing countries? A case study for maternal healthcare from Indonesia.

PubMed

D'Ambruoso, Lucia; Byass, Peter; Nurul Qomariyah, Siti

2008-09-09

Maternal mortality remains unacceptably high in developing countries despite international advocacy, development targets, and simple, affordable and effective interventions. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged. We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal healthcare. Our objective was to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective. Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased's relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death. In this case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year-old primagravida at 7 months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several serious health system failures were also apparent. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld. The rights-based approach could identify how and where to improve services. However, there are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning.

Evolving therapies for the management of chronic and acute decompensated heart failure.

PubMed

Cook, Jennifer C; Tran, Richard H; Patterson, J Herbert; Rodgers, Jo E

2016-11-01

The pharmacology, clinical efficacy, and safety profiles of evolving therapies for the management of chronic heart failure (HF) and acute decompensated heart failure (ADHF) are described. HF confers a significant financial burden despite the widespread use of traditional guideline-directed medical therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone receptor antagonists, and the rates of HF-related mortality and hospitalization have remained unacceptably high. In response to a demand for novel pharmacologic agents, several therapeutic compounds have recently gained approval or are currently under review by the Food and Drug Administration. Sacubitril-valsartan has demonstrated benefit in reducing cardiovascular mortality and HF-related hospitalizations in clinical trials, while ivabradine and ferric carboxymaltose have proven efficacious in reducing HF-related hospitalizations. Lastly, the role of serelaxin in ADHF is currently under investigation in an ongoing Phase III study. While large, outcome-driven clinical trials are fundamental in informing the clinical application of these therapeutic agents, careful patient selection is imperative to ensuring similar outcomes postmarketing. In addition, optimization of current guideline-directed medical therapy remains essential as new therapies emerge and are incorporated into guideline recommendations. Additional therapeutic agents currently undergoing investigation include bucindolol hydrochloride, cimaglermin alfa, nitroxyl, omecamtiv mecarbil, TRV027, and ularitide. Clinical practitioners should remain abreast of emerging literature so that new therapeutic entities are optimally applied and positive patient outcomes are achieved. Recently introduced agents for the treatment of patients with HF include sacubitril-valsartan, ivabradine, and ferric carboxymaltose. Additional agents worthy of attention include serelaxin and other therapies currently under investigation. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Effect of Treatment of Premature Infants with Respiratory Distress Using Low-cost Bubble CPAP in a Rural African Hospital.

PubMed

Myhre, Jennifer; Immaculate, Mutisya; Okeyo, Bob; Anand, Matthew; Omoding, Anastacia; Myhre, Luke; Okeyo, Lilian; Barasa, Immaculate; Letchford, Steve

2016-10-01

Kenya's neonatal mortality rate remains unacceptably high, at 22 deaths per 1000 live births, with a third of those attributable to prematurity. Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in the premature neonate. Continuous positive airway pressure (CPAP) is a proven modality of therapy but is rarely used in low-resource settings. We report on the introduction of bubble CPAP (BCPAP), a low-cost method of delivering CPAP appropriate to our setting, by comparing survival-to-discharge before and after the technology was introduced. The inpatient hospital records of all preterm infants (<37 weeks) diagnosed with RDS in the AIC Kijabe Hospital Nursery during two 18-month periods before and after the introduction of BCPAP (46 infants enrolled from 1 November 2007 to 30 April 2009 vs. 72 infants enrolled from 1 November 2009 to 30 April 2011) were reviewed. Differences in survival-to-discharge rates between the two time periods were analyzed. The survival-to-discharge rate was higher in Period 2 (after the introduction of BCPAP) than in Period 1 (pre-BCPAP) (85% vs. 61%, p  =  0.007). Similarly, there were lower referral rates of preterm infants with RDS in Period 2 than Period 1 (4% vs. 17%, p  =  0.037). BCPAP has contributed significantly to favorable outcomes for preterm infants with RDS at AIC Kijabe Hospital. The use of this simple technology should be considered and studied for expansion to all hospitals in Kenya that care for preterm infants. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Use of previous maternal health services has a limited role in reattendance for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia

PubMed Central

Kebede, Bekana; Gebeyehu, Abebaw; Andargie, Gashaw

2013-01-01

Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review. PMID:23459063

Overweight and obesity on the island of Ireland: an estimation of costs.

PubMed

Dee, Anne; Callinan, Aoife; Doherty, Edel; O'Neill, Ciaran; McVeigh, Treasa; Sweeney, Mary Rose; Staines, Anthony; Kearns, Karen; Fitzgerald, Sarah; Sharp, Linda; Kee, Frank; Hughes, John; Balanda, Kevin; Perry, Ivan J

2015-03-16

The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches. Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality. The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease. The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Is It safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

PubMed

Trust, Marc D; Teixeira, Pedro G; Brown, Lawrence H; Ali, Sadia; Coopwood, Ben; Aydelotte, Jayson D; Brown, Carlos V R

2018-01-01

Because of increased failure rates of nonoperative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting, and well-powered multicenter data are lacking. We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age < 65) and geriatric (age ≥ 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs. 4%, p < 0.0001). On logistic regression analysis, Injury Severity Score of 16 or higher was the only independent risk factor associated with failure of NOM in geriatric patients (odds ratio, 2.778; confidence interval, 1.769-4.363; p < 0.0001). There was no difference in mortality in geriatric patients who had successful vs. failed NOM (11% vs. 15%; p = 0.22). Independent risk factors for mortality in geriatric patients included admission hypotension, Injury Severity Score of 16 or higher, Glasgow Coma Scale score of 8 or less, and cardiac disease. However, failure of NOM was not independently associated with mortality (odds ratio, 1.429; confidence interval, 0.776-2.625; p = 0.25). Compared with younger patients, geriatric patients had a higher but comparable rate of failed NOM of BSI, and failure rates are lower than previously reported. Failure of NOM in geriatric patients is not an independent risk factor for mortality. Based on our results, NOM of BSI in geriatric patients is safe. Therapeutic, level IV.

47 CFR 22.878 - Obligation to abate unacceptable interference.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 22.878 Section 22.878 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.878 Obligation to abate unacceptable interference. This section applies only to commercial...

Health indicators and human development in the Arab region

PubMed Central

Boutayeb, Abdesslam; Serghini, Mansour

2006-01-01

Background The present paper deals with the relationship between health indicators and human development in the Arab region. Beyond descriptive analysis showing geographic similarities and disparities inter countries, the main purpose is to point out health deficiencies and to propose pragmatic strategies susceptible to improve health conditions and consequently enhance human development in the Arab world. Methods Data analysis using Principal Components Analysis is used to compare the achievements of the Arab countries in terms of direct and indirect health indicators. The variables (indicators) are seen to be well represented on the circle of correlation, allowing for interesting interpretation and analysis. The 19 countries are projected on the first and second plane respectively. Results The results given by the present analysis give a good panorama of the Arab countries with their geographic similarities and disparities. The high correlation between health indicators and human development is well illustrated and consequently, countries are classified by groups having similar human development. The analysis shows clearly how health deficits are impeding human development in the majority of Arab countries and allows us to formulate suggestions to improve health conditions and enhance human development in the Arab World. Discussion The discussion is based on the link between different direct and indirect health indicators and the relationship between these indicators and human development index. Without including the GDP indicator, our analysis has shown that the 19 Arab countries may be classified, independently of their geographic proximity, in three different groups according to their global human development level (Low, Medium and High). Consequently, while identifying health deficiencies in each group, the focus was made on the countries presenting a high potential of improvement in health indicators. In particular, maternal mortality and infant mortality which are really challenging health authorities of the first and third group were critically discussed. Conclusion The Arab countries have made substantial economic and social progress during the last decades by improving life expectancy and reducing maternal and infant mortality. However, considering its natural wealth and human resources, the Arab region has accomplished less than expected in terms of human development. Huge social inequalities and health inequities exist inter and intra Arab countries. In most Arab countries, a large percentage of populations, especially in rural areas, are deprived of access to health facilities. Consequently, many women still die during pregnancy and labour, yielding unacceptable levels of maternal and infant mortality. However, the problem is seen to be more complex, going beyond geography and technical accessibility to health care, it compasses, among others, levels of literacy, low social and economic status of women, qualification of health staff, general behaviour and interactions between patients and medical personnel (including corruption). PMID:17194309

Developing cold-chipping potato varieties by silencing the vacuolar invertase gene

USDA-ARS?s Scientific Manuscript database

Accumulation of reducing sugars during cold storage is a persistent and costly problem for the potato processing industry. High temperature processing of potato tubers with elevated amounts of reducing sugars results in potato chips, fries and other products that are unacceptable to consumers becaus...

Seed coat darkening in Cowpea bean

USDA-ARS?s Scientific Manuscript database

Seed coat of cowpea bean (Vigna unguiculata L. Walp) slowly browns to a darker color during storage. High temperature and humidity during storage might contribute to this color change. Variation in browning rate among seeds in a lot leads to a mixture of seed colors creating an unacceptable product...

[Ethical behavioral standards of medical students on examinations and studies].

PubMed

Tolkin, Lior; Glick, Shimon

2007-06-01

In recent years the medical literature has reflected an increasing interest in the medical ethics of physicians and medical students. Studies have shown that cheating in medical school is frequent enough to cause concern, that there is a positive correlation between students' ethical attitude and their ethical behavior and between cheating in school and cheating in patient care. This study aims to examine student attitudes towards cheating, their self-reported behavior, analyze cultural and sub-cultural differences, and to reach practical conclusions that might be incorporated into the teaching of ethics in medical schools. Anonymous questionnaires were distributed to 193 first and second year students of the Israeli and American programs at Ben-Gurion University. The questionnaire consisted of fifty three multiple choice questions. The students were asked to state their opinion on various cheating practices at medical school and dishonesty in patient care, to estimate how they would resolve various ethical dilemmas and to provide some demographic information. The results were analyzed using SPSS. T-tests, Chi-Square tests, one-way analysis of variance, and Pearson and Spearman's coefficients, all used as appropriate. Completed questionnaires were returned by 141 students (73%). The majority of the students regard cheating in an exam (93%) or on a final paper (85%) to be morally unacceptable behavior. Copying during an exam is regarded as more morally unacceptable than copying a homework exercise. The majority of the students consider faking a patient's laboratory results to be morally unacceptable behavior (98%). American students regard copying a homework exercise, reconstructing exam questions for the benefit of next year students and giving answers to a fellow student during an exam to be more morally unacceptable in comparison to the Israeli students. Married students consider cheating to be more morally unacceptable than unmarried students. A positive correlation was found between religiosity and the position that cheating is a morally negative practice. There is a positive correlation between cheating in high school and the position that cheating is morally acceptable. In addition, the more often a student cheated in high school the more that student claims that he or she would cheat if they were sure that they would not be caught. Amongst Israeli students, there was a correlation between the view that the faculty did not treat them well, and the position that cheating is morally acceptable, No correlation was found between cheating and gender, age, birth country of parents, army service, or type of high school. Students' attitude toward cheating is significantly determined by the cultural and sub-cultural characteristics of each student's background. Ethical discussions in which an ethical code would be formed, moral dilemmas analyzed and cultural differences addressed, may help improve the ethical behavior of students in medical school, and thus improve their ethical practice in patient care.

75 FR 3255 - Petitions for Modification

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-20

..., located in Barbour County, West Virginia. Regulation Affected: 30 CFR 75.1700 (Oil and gas wells... the immediate return. If mine air flows into the lateral as expected, or if gas inflow is acceptably... borehole plugging. If gas inflow from the well is unacceptably high (1.0% methane by volume, or higher, as...

Improving the Processing Quality of Existing Cultivars by Suppressing the Vacuolar Acid Invertase Gene

USDA-ARS?s Scientific Manuscript database

Storing potato tubers at low temperatures is highly advantageous in that it prevents sprouting, minimizes disease losses and increases the marketing window. Unfortunately, cold storage of existing cultivars causes an unacceptable accumulation of reducing sugars, a phenomenon referred to as cold-indu...

Predictive Modeling of Microbial Indicators for Timely Beach Notifications and Advisories at Marine Beaches

EPA Science Inventory

Marine beaches are occasionally contaminated by unacceptably high levels of fecal indicator bacteria (FIB) that exceed EPA water quality criteria. Here we describe application of a recent version of the software package Virtual Beach tool (VB 3.0.6) to build and evaluate multiple...

A Schoolwide Discipline Plan That Empowers Teachers and Gives Principals Time for Instructional Leadership.

ERIC Educational Resources Information Center

Borelli, Jan

1997-01-01

A high school principal explains her strategy for turning around a disorderly, gang-ridden middle school. Her discipline plan's success hinged on developing schoolwide expectations for behavior, developing positive consequences, compiling a list of unacceptable behaviors, and empowering teachers to administer consequences, including contacting…

Implementation and Impact of the Check & Connect Mentoring Program

ERIC Educational Resources Information Center

Heppen, Jessica; O'Cummings, Mindee; Poland, Lindsay; Zeiser, Krissy; Mills, Nicholas

2015-01-01

High school graduation rates remain unacceptably low in the U.S., especially among disadvantaged youth (Chapman, Laird, Ifill, & KelalRamani, 2011; Stillwell, 2010), with troubling implications for future earnings and employment status (Bureau of Labor Statistics, 2012). Check & Connect (C&C) is an individualized program that pairs…

Western Australian High School Students' Attitudes towards Biotechnology Processes

ERIC Educational Resources Information Center

Dawson, Vaille; Schibeci, Renato

2003-01-01

This study reports on the attitudes towards biotechnology of 905, 15-16 year-old students from 11 Western Australian schools. Students were asked to read 15 statements about biotechnology processes and to draw a line to separate what they considered "acceptable" statements from those they considered "unacceptable". Overall, the…

40 CFR 231.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES...) Unacceptable adverse effect means impact on an aquatic or wetland ecosystem which is likely to result in... unacceptability of such impacts, consideration should be given to the relevant portions of the section 404(b)(1...

40 CFR 231.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) OCEAN DUMPING SECTION 404(c) PROCEDURES...) Unacceptable adverse effect means impact on an aquatic or wetland ecosystem which is likely to result in... unacceptability of such impacts, consideration should be given to the relevant portions of the section 404(b)(1...

Adverse outcome pathway and risks of anticoagulant rodenticides to predatory wildlife

USGS Publications Warehouse

Rattner, Barnett A.; Lazarus, Rebecca S.; Elliott, John E.; Shore, Richard F.; van den Brink, Nico

2014-01-01

Despite a long history of successful use, routine application of some anticoagulant rodenticides (ARs) may be at a crossroad due to new regulatory guidelines intended to mitigate risk. An adverse outcome pathway for ARs was developed to identify information gaps and end points to assess the effectiveness of regulations. This framework describes chemical properties of ARs, established macromolecular interactions by inhibition of vitamin K epoxide reductase, cellular responses including altered clotting factor processing and coagulopathy, organ level effects such as hemorrhage, organism responses with linkages to reduced fitness and mortality, and potential consequences to predator populations. Risk assessments have led to restrictions affecting use of some second-generation ARs (SGARs) in North America. While the European regulatory community highlighted significant or unacceptable risk of ARs to nontarget wildlife, use of SGARs in most EU member states remains authorized due to public health concerns and the absence of safe alternatives. For purposes of conservation and restoration of island habitats, SGARs remain a mainstay for eradication of invasive species. There are significant data gaps related to exposure pathways, comparative species sensitivity, consequences of sublethal effects, potential hazards of greater AR residues in genetically resistant prey, effects of low-level exposure to multiple rodenticides, and quantitative data on the magnitude of nontarget wildlife mortality.

40 CFR Appendix G to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the March 3, 1999...

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Refrigerants Unacceptable Substitutes End-use Substitute Decision Comments CFC-12, R-502, and HCFC-22 Household... gas emissions from direct release of refrigerant to the atmosphere. [64 FR 10378, Mar. 3, 1999] ...

40 CFR Appendix G to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the March 3, 1999...

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Refrigerants Unacceptable Substitutes End-use Substitute Decision Comments CFC-12, R-502, and HCFC-22 Household... gas emissions from direct release of refrigerant to the atmosphere. [64 FR 10378, Mar. 3, 1999] ...

Measuring Attitudes toward Acceptable and Unacceptable Parenting Practices

ERIC Educational Resources Information Center

Budd, Karen S.; Behling, Steven; Li, Yan; Parikshak, Sangeeta; Gershenson, Rachel A.; Feuer, Rachel; Danko, Christina M.

2012-01-01

This study investigated the properties of a new rating instrument, the Parenting Questionnaire (PQ), designed to measure attitudes about acceptable and unacceptable parenting practices. In Study 1, subject matter experts representing culturally diverse psychologists, parents, and college students were consulted to identify 110 items receiving high…

Magnetic Resonance Imaging in Aneurysmal Subarachnoid Hemorrhage: Current Evidence and Future Directions.

PubMed

Nelson, Sarah E; Sair, Haris I; Stevens, Robert D

2018-04-09

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with an unacceptably high mortality and chronic disability in survivors, underscoring a need to validate new approaches for treatment and prognosis. The use of advanced imaging, magnetic resonance imaging (MRI) in particular, could help address this gap given its versatile capacity to quantitatively evaluate and map changes in brain anatomy, physiology and functional activation. Yet there is uncertainty about the real value of brain MRI in the clinical setting of aSAH. In this review, we discuss current and emerging MRI research in aSAH. PubMed was searched from inception to June 2017, and additional studies were then chosen on the basis of relevance to the topics covered in this review. Available studies suggest that brain MRI is a feasible, safe, and valuable testing modality. MRI detects brain abnormalities associated with neurologic examination, outcomes, and aneurysm treatment and thus has the potential to increase knowledge of aSAH pathophysiology as well as to guide management and outcome prediction. Newer pulse sequences have the potential to reveal structural and physiological changes that could also improve management of aSAH. Research is needed to confirm the value of MRI-based biomarkers in clinical practice and as endpoints in clinical trials, with the goal of improving outcome for patients with aSAH.

Stars and stripes in pancreatic cancer: role of stellate cells and stroma in cancer progression

PubMed Central

Wilson, Jeremy S.; Pirola, Romano C.; Apte, Minoti V.

2014-01-01

Pancreatic cancer is a devastating disease with an unacceptably high mortality to incidence ratio. Traditional therapeutic approaches such as surgery in combination with chemo- or radiotherapy have had limited efficacy in improving the outcome of this disease. Up until just under a decade ago, the prominent desmoplastic reaction which is a characteristic of the majority of pancreatic ductal adenocarcinomas (PDAC) had been largely ignored. However, since the identification of the pancreatic stellate cell (PSC) as the key cell responsible for the production of the collagenous stroma in PDAC, increasing attention has been paid to the role of the stromal reaction in pancreatic cancer pathobiology. There is now compelling evidence that PSCs interact not only with cancer cells themselves, but with several other cell types in the stroma (endothelial cells, immune cells, and possibly neuronal cells) to promote cancer progression. This review summarizes current knowledge in the field about the influence of PSCs and the stromal microenvironment on cancer behavior and discusses novel therapeutic approaches which reflect an increasing awareness amongst clinicians and researchers that targeting cancer cells alone is no longer sufficient to improve patient outcome and that combinatorial treatments targeting the stroma as well as the cancer cells will be required to change the clinical course of this disease. PMID:24592240

An overview of the socio-cultural and psychiatric aspects of women's reproductive health in West Africa.

PubMed

Aina, O F

2007-09-01

The challenges associated with women reproductive health in West African sub region have over the years become a source of concern to relevant world bodies such as WHO, UNFPA, World Bank etc. Some of these challenges include Infertility, Family Planning and Female Genital Mutilation (FGM). However, of greater concern is the scourge of Sexually Transmitted Diseases (STDs) most especially HIV/ AIDS and the unacceptably high maternal mortality in the sub region where Nigeria alone accounts for the highest percentage (10%) of the global 60,000 maternal deaths annually. Significant psychiatric complications such as anxiety and depression are associated with menstruation and menopause. However, the postpartum period is the most vulnerable with significant proportion of women developing such psychopathologies as Puerperal (maternity) blues, Postpartum Depression (PPD) and Acute Organic Brain Syndrome. Sociocultural factors, the dearth of psychiatrists in West Africa coupled with the poor or non-recognition of the psychiatric complications by the obstetric staff have not allowed enough clinical attention to be paid to these problems. It is thus advocated that improvement in the maternal and child health care component of the primary health care (PHC) services will go a long way to attenuate the psychiatric complications associated with childbirth.

Toward optimizing patient-specific IMRT QA techniques in the accurate detection of dosimetrically acceptable and unacceptable patient plans

PubMed Central

McKenzie, Elizabeth M.; Balter, Peter A.; Stingo, Francesco C.; Jones, Jimmy; Followill, David S.; Kry, Stephen F.

2014-01-01

Purpose: The authors investigated the performance of several patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA) dosimeters in terms of their ability to correctly identify dosimetrically acceptable and unacceptable IMRT patient plans, as determined by an in-house-designed multiple ion chamber phantom used as the gold standard. A further goal was to examine optimal threshold criteria that were consistent and based on the same criteria among the various dosimeters. Methods: The authors used receiver operating characteristic (ROC) curves to determine the sensitivity and specificity of (1) a 2D diode array undergoing anterior irradiation with field-by-field evaluation, (2) a 2D diode array undergoing anterior irradiation with composite evaluation, (3) a 2D diode array using planned irradiation angles with composite evaluation, (4) a helical diode array, (5) radiographic film, and (6) an ion chamber. This was done with a variety of evaluation criteria for a set of 15 dosimetrically unacceptable and 9 acceptable clinical IMRT patient plans, where acceptability was defined on the basis of multiple ion chamber measurements using independent ion chambers and a phantom. The area under the curve (AUC) on the ROC curves was used to compare dosimeter performance across all thresholds. Optimal threshold values were obtained from the ROC curves while incorporating considerations for cost and prevalence of unacceptable plans. Results: Using common clinical acceptance thresholds, most devices performed very poorly in terms of identifying unacceptable plans. Grouping the detector performance based on AUC showed two significantly different groups. The ion chamber, radiographic film, helical diode array, and anterior-delivered composite 2D diode array were in the better-performing group, whereas the anterior-delivered field-by-field and planned gantry angle delivery using the 2D diode array performed less well. Additionally, based on the AUCs, there was no significant difference in the performance of any device between gamma criteria of 2%/2 mm, 3%/3 mm, and 5%/3 mm. Finally, optimal cutoffs (e.g., percent of pixels passing gamma) were determined for each device and while clinical practice commonly uses a threshold of 90% of pixels passing for most cases, these results showed variability in the optimal cutoff among devices. Conclusions: IMRT QA devices have differences in their ability to accurately detect dosimetrically acceptable and unacceptable plans. Field-by-field analysis with a MapCheck device and use of the MapCheck with a MapPhan phantom while delivering at planned rotational gantry angles resulted in a significantly poorer ability to accurately sort acceptable and unacceptable plans compared with the other techniques examined. Patient-specific IMRT QA techniques in general should be thoroughly evaluated for their ability to correctly differentiate acceptable and unacceptable plans. Additionally, optimal agreement thresholds should be identified and used as common clinical thresholds typically worked very poorly to identify unacceptable plans. PMID:25471949

Toward optimizing patient-specific IMRT QA techniques in the accurate detection of dosimetrically acceptable and unacceptable patient plans.

PubMed

McKenzie, Elizabeth M; Balter, Peter A; Stingo, Francesco C; Jones, Jimmy; Followill, David S; Kry, Stephen F

2014-12-01

The authors investigated the performance of several patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA) dosimeters in terms of their ability to correctly identify dosimetrically acceptable and unacceptable IMRT patient plans, as determined by an in-house-designed multiple ion chamber phantom used as the gold standard. A further goal was to examine optimal threshold criteria that were consistent and based on the same criteria among the various dosimeters. The authors used receiver operating characteristic (ROC) curves to determine the sensitivity and specificity of (1) a 2D diode array undergoing anterior irradiation with field-by-field evaluation, (2) a 2D diode array undergoing anterior irradiation with composite evaluation, (3) a 2D diode array using planned irradiation angles with composite evaluation, (4) a helical diode array, (5) radiographic film, and (6) an ion chamber. This was done with a variety of evaluation criteria for a set of 15 dosimetrically unacceptable and 9 acceptable clinical IMRT patient plans, where acceptability was defined on the basis of multiple ion chamber measurements using independent ion chambers and a phantom. The area under the curve (AUC) on the ROC curves was used to compare dosimeter performance across all thresholds. Optimal threshold values were obtained from the ROC curves while incorporating considerations for cost and prevalence of unacceptable plans. Using common clinical acceptance thresholds, most devices performed very poorly in terms of identifying unacceptable plans. Grouping the detector performance based on AUC showed two significantly different groups. The ion chamber, radiographic film, helical diode array, and anterior-delivered composite 2D diode array were in the better-performing group, whereas the anterior-delivered field-by-field and planned gantry angle delivery using the 2D diode array performed less well. Additionally, based on the AUCs, there was no significant difference in the performance of any device between gamma criteria of 2%/2 mm, 3%/3 mm, and 5%/3 mm. Finally, optimal cutoffs (e.g., percent of pixels passing gamma) were determined for each device and while clinical practice commonly uses a threshold of 90% of pixels passing for most cases, these results showed variability in the optimal cutoff among devices. IMRT QA devices have differences in their ability to accurately detect dosimetrically acceptable and unacceptable plans. Field-by-field analysis with a MapCheck device and use of the MapCheck with a MapPhan phantom while delivering at planned rotational gantry angles resulted in a significantly poorer ability to accurately sort acceptable and unacceptable plans compared with the other techniques examined. Patient-specific IMRT QA techniques in general should be thoroughly evaluated for their ability to correctly differentiate acceptable and unacceptable plans. Additionally, optimal agreement thresholds should be identified and used as common clinical thresholds typically worked very poorly to identify unacceptable plans.

47 CFR 22.877 - Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air...

Code of Federal Regulations, 2010 CFR

2010-10-01

...-cellular 800 MHz licensees from commercial aviation air-ground systems. 22.877 Section 22.877 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Air-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.877 Unacceptable interference...

Eliminating the high abortion related complications and deaths in Cameroon: the restrictive legal atmosphere on abortions is no acceptable excuse.

PubMed

Bain, Luchuo Engelbert; Kongnyuy, Eugene Justine

2018-05-24

The abortion law in Cameroon is highly restrictive. The law permits induced abortions only when the woman's life is at risk, to preserve her physical and mental health, and on grounds of rape or incest. Unsafe abortions remain rampant with however rare reported cases of persecution, even when these abortions are proven to have been carried out illegally. Available public health interventions are cheap and feasible (Misoprostol and Manual Vacuum Aspiration in post abortion care, modern contraception, post-abortion counseling), and must be implemented to reduce unacceptably high maternal mortality rates in the country which still stand at as high as 596/100.000. Changes in the legal status of abortions might take a long time to come by. Albeit, advocacy efforts must be reinforced to render the law more liberal to permit women to seek safe abortion services. The frequency of abortions, generally clandestine, in this restrictive legal atmosphere has adverse economic, health and social justice implications. We argue that a non-optimal or restrictive legal atmosphere is not an acceptable excuse to justify these high maternal deaths resulting from unsafe abortions, especially in Cameroon where unsafe abortions remain rampant. Implementing currently available, cheap and effective evidence based practice guidelines are possible in the country. Expansion and use of Manual Vacuum Aspiration kits in health care facilities, post-abortion misoprostol and carefully considering the content of post abortion counseling packages deserve keen attention. More large scale qualitative and quantitative studies nationwide to identify and act on context specific barriers to contraception use and abortion related stigma are urgently needed.

Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens

PubMed Central

Jat, Tej Ram; Deo, Prakash R.; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

2015-01-01

Background Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery–related dimensions of maternal deaths in rural central India using a human rights lens. Design Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the ‘three delays’ framework and were examined by using a human rights lens. Results All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. Conclusions The study highlighted various socio-cultural and service delivery–related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality. PMID:25840595

Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.

PubMed

Jat, Tej Ram; Deo, Prakash R; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

2015-01-01

Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens. Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens. All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane.

PubMed

Lapin, S L; Auden, S M; Goldsmith, L J; Reynolds, A M

1999-01-01

We prospectively studied one hundred ASA physical status I-II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. Patients given oral midazolam premedication had significantly longer recovery times, but no delay in discharge home compared with those not premedicated. However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.

Pulse compression using a tapered microstructure optical fiber.

PubMed

Hu, Jonathan; Marks, Brian S; Menyuk, Curtis R; Kim, Jinchae; Carruthers, Thomas F; Wright, Barbara M; Taunay, Thierry F; Friebele, E J

2006-05-01

We calculate the pulse compression in a tapered microstructure optical fiber with four layers of holes. We show that the primary limitation on pulse compression is the loss due to mode leakage. As a fiber's diameter decreases due to the tapering, so does the air-hole diameter, and at a sufficiently small diameter the guided mode loss becomes unacceptably high. For the four-layer geometry we considered, a compression factor of 10 can be achieved by a pulse with an initial FWHM duration of 3 ps in a tapered fiber that is 28 m long. We find that there is little difference in the pulse compression between a linear taper profile and a Gaussian taper profile. More layers of air-holes allows the pitch to decrease considerably before losses become unacceptable, but only a moderate increase in the degree of pulse compression is obtained.

Denver's Public Schools: Reforms, Challenges, and the Future

ERIC Educational Resources Information Center

Bray, Judy; Medler, Alex

2009-01-01

Denver is currently in the national education spotlight, largely because of its willingness to try a unique combination of major education reforms not seen in other large urban school districts. While many observers hold these reforms in high regard, a steep road lies ahead. Current student results are unacceptable by all measures. The time is…

Identification of Childhood Disability in Jamaica: The Ten Question Screen.

ERIC Educational Resources Information Center

Thorburn, Marigold; And Others

1992-01-01

This study evaluated use of the Ten Question Screen (TQ) to identify disability in a 2-stage population-based survey of 5,478 children aged 2-9 years in Clarendon, Jamaica. Findings indicated varied sensitivity by different subgroups (age, gender, and disability) and an unacceptably high false positive rate. (Author/DB)

The Relationship Between Repetition Priming and Skill Acquisition

DTIC Science & Technology

1993-01-01

hours of cognitive testing. Given that most measures were of response latency, it neemed unacceptable to include subjects with high error rates indicative...U Leaf Crude Oil Paper Bug Spray Hair Sea Water Plastic Shampoo Rock Blood Cement Ink IF the word is Food, THEN check if its Solid or Liquid LF its

"Getting a Job": Vocationalism, Identity Formation, and Critical Ethnographic Inquiry

ERIC Educational Resources Information Center

Down, Barry; Smyth, John

2012-01-01

This article examines the highly disputed policy nexus around what on the surface appears to be the helpful field of vocational education and training. Despite the promises of vocational education and training to deliver individual labour market success and global competitiveness, the reality is that it serves to residualise unacceptably large…

Why We Test Students for Drugs

ERIC Educational Resources Information Center

Brady, Lisa A.

2008-01-01

Today, there is a collective national awareness that an unacceptable number of teens are involved in the use of dangerous drugs such as methamphetamine, ecstasy, and heroin, and they have access to high-grade marijuana. Alcohol use, even more pervasive, results in risky sexual behaviors, automobile accidents, and even death. To the dismay of many…

The Importance of Tooth Decay Prevention in Children under Three

ERIC Educational Resources Information Center

Milgrom, Peter; Huebner, Colleen; Chi, Donald

2010-01-01

Tooth decay and tooth loss was once the norm but public health interventions have led to major improvements for most people. Nevertheless, not all children have benefited. Dental disease in young children is unacceptably high. Tooth decay is preventable. Early childhood educators are often the first to notice the problem. Professional…

A Critical Review of the Massachusetts Next Generation Science and Technology/Engineering Standards. Policy Brief

ERIC Educational Resources Information Center

Metzenberg, Stan

2015-01-01

Stan Metzenberg offers a critical analysis of the draft "Massachusetts Science and Technology/Engineering Standards," which are for pre-Kindergarten to Grade 8 and introductory high school courses. Metzenberg claims that the document reveals significant, unacceptable gaps in science content, as well as some notable errors and…

Human System Drivers for Exploration Missions

NASA Technical Reports Server (NTRS)

Kundrot, Craig E.; Steinberg, Susan; Charles, John B.

2010-01-01

Evaluation of DRM4 in terms of the human system includes the ability to meet NASA standards, the inclusion of the human system in the design trade space, preparation for future missions and consideration of a robotic precursor mission. Ensuring both the safety and the performance capability of the human system depends upon satisfying NASA Space Flight Human System Standards.1 These standards in turn drive the development of program-specific requirements for Near-earth Object (NEO) missions. In evaluating DRM4 in terms of these human system standards, the currently existing risk models, technologies and biological countermeasures were used. A summary of this evaluation is provided below in a structure that supports a mission architecture planning activities. 1. Unacceptable Level of Risk The duration of the DRM4 mission leads to an unacceptable level of risk for two aspects of human system health: A. The permissible exposure limit for space flight radiation exposure (a human system standard) would be exceeded by DRM4. B. The risk of visual alterations and abnormally high intracranial pressure would be too high. 1

COMPARATIVE EFFECTIVENESS AND SAFETY BETWEEN AMPHOTERICIN B LIPID-FORMULATIONS: A SYSTEMATIC REVIEW.

PubMed

Grazziotin, Luiza Raquel; Moreira, Leila Beltrami; Ferreira, Maria Angelica Pires

2018-06-13

It is not yet established the advantages between amphotericin B lipid complex (ABLC) and liposomal (L-AmB) in patients with invasive fungal infections refractory to usual doses of conventional AmB (d-AmB), previous renal impairment, or unacceptable d-AmB renal toxicity. This systematic review aims to compare ABLC and L-AmB effectiveness and safety outcomes in these subgroups of patients. The search was performed on Medline, Cochrane Library, EMBASE, and LILACS databases. treatment comparing L-AmB with ABLC; patients who had (i) refractory infection after being treated with d-AmB, (ii) previous renal impairment, or (iii) unacceptable d-AmB toxicity. Two investigators independently screened the search results, assessed trial quality, and extracted data. A total of 1,054 articles were identified in the literature. Among those, eleven were selected for full-text reading and five met the inclusion criteria. The five articles included reported on four separate observational studies. Overall, no significant difference was found in clinical relevant outcomes as new-onset dialysis, length of hospital stay, or mortality when comparing both lipid formulations. The studies reported a trend toward lower nephrotoxicity in patients treated with L-AmB. However, the results were imprecise and heterogeneous and the studies presented important methodological biases. The studies included in this systematic review pointed toward less nephrotoxicity events in the L-AmB group. However, due to low quality of evidence and no statistically significant differences in other clinical relevant outcomes, there is no definitive evidence of overall superiority in effectiveness or safety outcomes regarding one lipid formulation or another in this population subgroup.

Parameters. US Army War College Quarterly. Volume 25. Number 1. Spring 1995,

DTIC Science & Technology

1995-01-01

major reason the fratricide rate remains so high is that imperfect human skills and judgment needed to employ weapon systems quickly degrade under...and rehearsals before the Desert Storm ground campaign, the residual rate of fratricide remained unacceptably high. Nor are the high rates at our combat...California State University, Fullerton. He is the editor and an author of The Search For Strategy: Politics and Strategic Vision. Spring 1995 31 Haiti, Peru

Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence.

PubMed

Buchtele, Nina; Schwameis, Michael; Gilbert, James C; Schörgenhofer, Christian; Jilma, Bernd

2018-06-01

Despite great efforts in stroke research, disability and recurrence rates in ischaemic stroke remain unacceptably high. To address this issue, one potential target for novel therapeutics is the glycoprotein von Willebrand factor (vWF), which increases in thrombogenicity especially under high shear rates as it bridges between vascular sub-endothelial collagen and platelets. The rationale for vWF as a potential target in stroke comes from four bodies of evidence. (1) Animal models which recapitulate the pathogenesis of stroke and validate the concept of targeting vWF for stroke prevention and the use of the vWF cleavage enzyme ADAMTS13 in acute stroke treatment. (2) Extensive epidemiologic data establishing the prognostic role of vWF in the clinical setting showing that high vWF levels are associated with an increased risk of first stroke, stroke recurrence or stroke-associated mortality. As such, vWF levels may be a suitable marker for further risk stratification to potentially fine-tune current risk prediction models which are mainly based on clinical and imaging data. (3) Genetic studies showing an association between vWF levels and stroke risk on genomic levels. Finally, (4) studies of patients with primary disorders of excess or deficiency of function in the vWF axis (e.g. thrombotic thrombocytopenic purpura and von Willebrand disease, respectively) which demonstrate the crucial role of vWF in atherothrombosis. Therapeutic inhibition of VWF by novel agents appears particularly promising for secondary prevention of stroke recurrence in specific sub-groups of patients such as those suffering from large artery atherosclerosis, as designated according to the TOAST classification. Schattauer GmbH Stuttgart.

A proposed new international convention supporting the rights of pregnant women and girls and their newborn infants.

PubMed

Winrow, Benjamin; Bile, Khalif; Hafeez, Assad; Davies, Hugh; Brown, Nick; Zafar, Shamsa; Cham, Mamady; Phillips, Barbara; MacDonald, Rhona; Southall, David P

2012-05-01

For a multitude of eminently modifiable reasons, death rates for pregnant women and girls and their newborn infants in poorly resourced countries remain unacceptably high. The concomitant high morbidity rates compound the situation. The rights of these vulnerable individuals are incompletely protected by existing United Nations human rights conventions, which many countries have failed to implement. The authors propose a novel approach grounded on both human rights and robust evidence-based clinical guidelines to create a 'human rights convention specifically for pregnant women and girls and their newborn infants'. The approach targets the 'right to health' of these large, vulnerable and neglected populations. The proposed convention is designed so that it can be monitored, audited and evaluated objectively. It should also foster a sense of national ownership and accountability as it is designed to be relevant to local situations and to be incorporated into local clinical governance systems. It may be of particular value to those countries that are not yet on target to meet the Millennium Development Goals (MDGs), especially MDGs 4 and 5, which target child and maternal mortality, respectively. To foster a sense of international responsibility, two additional initiatives are integral to its philosophy: the promotion of twinning between well and poorly resourced regions and a raising of awareness of how some well-resourced countries can damage the health of mothers and babies, for example, through the recruitment of health workers trained by national governments and taken from the public health system.

47 CFR 22.877 - Unacceptable interference to part 90 non-cellular 800 MHz licensees from commercial aviation air...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-cellular 800 MHz licensees from commercial aviation air-ground systems. 22.877 Section 22.877...-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.877 Unacceptable interference to part 90 non-cellular 800 MHz licensees from commercial aviation air-ground systems. The definition...

47 CFR 22.877 - Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-cellular 800 MHz licensees from commercial aviation air-ground systems. 22.877 Section 22.877...-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.877 Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air-ground systems. The definition...

47 CFR 22.877 - Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-cellular 800 MHz licensees from commercial aviation air-ground systems. 22.877 Section 22.877...-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.877 Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air-ground systems. The definition...

47 CFR 22.877 - Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-cellular 800 MHz licensees from commercial aviation air-ground systems. 22.877 Section 22.877...-Ground Radiotelephone Service Commercial Aviation Air-Ground Systems § 22.877 Unacceptable interference to Part 90 non-cellular 800 MHz licensees from commercial aviation air-ground systems. The definition...

30 CFR 250.136 - How will MMS determine if my operating performance is unacceptable?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false How will MMS determine if my operating performance is unacceptable? 250.136 Section 250.136 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT...) Accidents and their nature; (b) Pollution events, environmental damages and their nature; (c) Incidents of...

Pre-Crisis Intervention Strategies for Reducing Unacceptable Behaviors by Exceptional Students in a Public Elementary School.

ERIC Educational Resources Information Center

Levine-Brown, Linda S.

This report describes the implementation of a data-based program to reduce unacceptable student behaviors and decrease the number of administrative interventions with 21 students with severe emotional disturbances. A computerized database was developed to track classroom and transportation discipline infractions. Students met monthly to review…

Flow-through bioassay for measuring bioaccumulation of toxic substances from sediment

USGS Publications Warehouse

Mac, Michael J.; Edsall, Carol C.; Hesselberg, Robert J.; Sayers, Richard E.

1984-01-01

Over 10 million cubic meters of sediment are dredged annually from Great Lakes waterways. Because much of this material is taken from harbors, connecting channels, and other nearshore areas that often are contaminated with toxic substances, the sediments proposed for dredging need to be evaluated for the presence of bioavailable contaminants and the potential for toxicity to the biota. Sound decisions on the appropriate disposal of the dredged material can be made only after such an evaluation. Presently, no standardized procedure exists for evaluating dredged material in freshwater systems although current criteria for discharge of dredged material into marine water have been developed (USEPA/CE 1977). In the ocean discharge guideline, it is recommended that bioassays be conducted on liquid, solid, and suspended particulate phases of dredged material. because it appears that the solid phase has the greatest potential for environmental damage and because measurement of bioaccumulation must be made to evaluate sediments for disposal (USEPA/CE 1977, Seeyle and Mac 1983), we developed a bioassay for testing the solid phase of dredged material that measures the survival of organisms and, perhaps more important, the bioaccumulation of toxic substances by aquatic organisms from naturally contaminated sediments (Peddicord et al. 1980; Rubinstein et al. 1980, 1983; Seeyle st al. 1982), several have used testing methods that result in unacceptable mortality to control organisms (Bahnick et al. 1981, Prater et al. 1983). Our bioassay is intended to estimate the potential for bioaccumlation of contaminants from sediments that are not acutely toxic to test organisms, but are suspected of containing persistent contaminants. By using test organisms that are not highly susceptible to toxic compounds, the bioaccumulation test allows estimation of the potential food-chain accumulation of contaminants that may occur in local biota from surficial sediments. In practice, bioaccumulation observed in this bioassay by organisms exposed to test sediments (sediments to be dredged) would be compared to bioaccumulation observed from sediments collected from a reference site (e.g. a disposal site or open lake), and also from control sediments (relatively clean sediment). Decisions could then be based on a comparison of results between tests and reference sediments to determine if disposal would cause dehydration to the habitat, and between reference and control sediment to determine if even the reference material is seriously contaminated. Although the test is not intended to be a toxicity test per se, use of test, reference, and control sediments enables interpretation of any mortality of organisms that may occur during the bioassays. High mortality in bioassays with test or reference sediment would indicate acute toxicity of sediments in the project area. However if high mortality occurs in all three sediments, it can be assumed that the organisms were not in a healthy state at the time of testing. We describe the results of 10-day sediment bioassays in which both mortality and bioaccumulation were measured in four aquatic organisms. We exposed two infaunal organisms and two species of fish to test and control sediments in the laboratory.

Verification of Dose Distribution in Carbon Ion Radiation Therapy for Stage I Lung Cancer

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

Irie, Daisuke; Saitoh, Jun-ichi, E-mail: junsaito@gunma-u.ac.jp; Shirai, Katsuyuki

Purpose: To evaluate robustness of dose distribution of carbon-ion radiation therapy (C-ion RT) in non-small cell lung cancer (NSCLC) and to identify factors affecting the dose distribution by simulated dose distribution. Methods and Materials: Eighty irradiation fields for delivery of C-ion RT were analyzed in 20 patients with stage I NSCLC. Computed tomography images were obtained twice before treatment initiation. Simulated dose distribution was reconstructed on computed tomography for confirmation under the same settings as actual treatment with respiratory gating and bony structure matching. Dose-volume histogram parameters, such as %D95 (percentage of D95 relative to the prescribed dose), were calculated.more » Patients with any field for which the %D95 of gross tumor volume (GTV) was below 90% were classified as unacceptable for treatment, and the optimal target margin for such cases was examined. Results: Five patients with a total of 8 fields (10% of total number of fields analyzed) were classified as unacceptable according to %D95 of GTV, although most patients showed no remarkable change in the dose-volume histogram parameters. Receiver operating characteristic curve analysis showed that tumor displacement and change in water-equivalent pathlength were significant predictive factors of unacceptable cases (P<.001 and P=.002, respectively). The main cause of degradation of the dose distribution was tumor displacement in 7 of the 8 unacceptable fields. A 6-mm planning target volume margin ensured a GTV %D95 of >90%, except in 1 extremely unacceptable field. Conclusions: According to this simulation analysis of C-ion RT for stage I NSCLC, a few fields were reported as unacceptable and required resetting of body position and reconfirmation. In addition, tumor displacement and change in water-equivalent pathlength (bone shift and/or chest wall thickness) were identified as factors influencing the robustness of dose distribution. Such uncertainties should be regarded in planning.« less

Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries

PubMed Central

Corsi, Daniel J; Gilmore, Anna B; Kruger, Annamarie; Igumbor, Ehimario; Chifamba, Jephat; Yang, Wang; Wei, Li; Iqbal, Romaina; Mony, Prem; Gupta, Rajeev; Vijayakumar, Krishnapillai; Mohan, V; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Ismail, Noorhassim; Zatonska, Katarzyna; Altuntas, Yuksel; Rosengren, Annika; Bahonar, Ahmad; Yusufali, AfzalHussein; Dagenais, Gilles; Lear, Scott; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Rangarajan, Sumathy; Teo, Koon; McKee, Martin; Yusuf, Salim

2017-01-01

Objectives This study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio. Setting 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014. Participants Community audits and surveys of adults (35–70 years, n=12 953). Primary and secondary outcome measures Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models. Results Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1). Conclusions This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women. PMID:28363924

Long Duration Space Missions: Human Subsystem Risks and Requirements

NASA Technical Reports Server (NTRS)

Kundrot, Criag E.

2011-01-01

This viewgraph presentation reviews the human health and performance risks associated with long duration space flight beyond low earth orbit. The contents include: 1) Human Research Program; 2) Human Subsystem Risks; 3) Human Exploration Framework Team (HEFT) Architecture Elements; 4) Potentially Unacceptable Risks -1; 5) Potentially Unacceptable Risks-2; and 6) Major Mission Drivers of Risk.

Fuel cell flooding detection and correction

DOEpatents

DiPierno Bosco, Andrew; Fronk, Matthew Howard

2000-08-15

Method and apparatus for monitoring an H.sub.2 -O.sub.2 PEM fuel cells to detect and correct flooding. The pressure drop across a given H.sub.2 or O.sub.2 flow field is monitored and compared to predetermined thresholds of unacceptability. If the pressure drop exists a threshold of unacceptability corrective measures are automatically initiated.

47 CFR 22.970 - Unacceptable interference to part 90 non-cellular 800 MHz licensees from cellular radiotelephone...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-cellular 800 MHz licensees from cellular radiotelephone or part 90-800 MHz cellular systems. 22.970 Section... MOBILE SERVICES Cellular Radiotelephone Service § 22.970 Unacceptable interference to part 90 non-cellular 800 MHz licensees from cellular radiotelephone or part 90-800 MHz cellular systems. (a) Definition...

The Perfect Place to Work? Australian Academic Libraries and Unacceptable Behaviour

ERIC Educational Resources Information Center

Moorcroft, Heather

2009-01-01

Despite the stereotype of libraries as peaceful retreats, unacceptable behaviour is a reality that desk staff have to deal with. This paper outlines the results of two surveys conducted at Charles Darwin University Library to investigate the extent to which this is a problem in Australian academic libraries. The first survey went to CAUL (Council…

47 CFR 22.970 - Unacceptable interference to part 90 non-cellular 800 MHz licensees from cellular radiotelephone...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 22.970 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.970 Unacceptable interference to part 90 non... −104 dBm or higher, as measured at the R.F. input of the receiver of a mobile unit; or (B) A median...

Health research in the developing world: a gastroenterological view from Bangladesh.

PubMed

Hamilton, J R

1997-01-01

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that when prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centered in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.

The Budget of the United States Government. Department of Defense Extract for Fiscal Year 1985

DTIC Science & Technology

1984-02-01

with real GNP rising over 6% and industrial production by 16%. Unemployment, though still unacceptably high , has declined by a record 2l/z...the administration will focus its legislative effort on three of those proposals, in modified form: cost-of-living adjustment (COLA) reform, a high 5...computer matching, adjusted payment schedules, contractor and grantee performance incentives, and a streamlined field structure. All of these efforts

Intercomparison of CO 2 measurements

NASA Astrophysics Data System (ADS)

Poisson, A.; Culkin, F.; Ridout, P.

1990-10-01

Seawater samples, of four different salinities, were analysed for total alkalinity, total CO 2, pH and pCO 2 by up to 12 laboratories. The results showthat although most laboratories are capable of high precision in these determinations, there is an unacceptably high disagreement between their analyses of the same samples. For global programmes involving studies of the CO 2 system in seawater, it is strongly recommended that standard reference materials be made widely available.

Shooting for Stars: Cross-Sector Lessons for Retaining High-Performing Educators. Building an Opportunity Culture for America's Teachers

ERIC Educational Resources Information Center

Ableidinger, Joe; Kowal, Julie

2010-01-01

As the United States continues to grapple with unacceptable education results, "a great teacher for every student" has risen to a national imperative. In response, many districts have increased retention efforts through teacher induction programs, professional development, mentoring, and other strategies. But education actually has lower…

Connecting Caring and Action through Responsive Teaching: How One Team Accomplished Success in a Struggling Middle School

ERIC Educational Resources Information Center

Strahan, David B.; Layell, Krystal

2006-01-01

In "Turning Points 2000," Jackson and Davis noted that "changes in middle grades practices have least often occurred where they are needed most: in high-poverty urban and rural communities where unacceptably poor student achievement is rampant". Even so, in many struggling schools, some teams have achieved success. Their…

Collection Development "Dog Care & Training": The Well-Behaved Dog

ERIC Educational Resources Information Center

Alpi, Kristine M.; Sherman, Barbara L.

2008-01-01

Dogs are indeed people's best friends. A majority of owners report that their dog is a "member of the family," and that acceptable canine behavior and optimal care are high priorities for them. The human-animal bond, the close connection between people and their pets, is forged by positive interactions, but unacceptable canine behaviors that…

Challenging Traditional Assumptions of High School Science through the Physics and Everyday Thinking Curriculum™

ERIC Educational Resources Information Center

Ross, Michael J.

2013-01-01

Science education in the U.S. has failed for over a century to bring the experience of scientific induction to classrooms, from elementary science to undergraduate courses. The achievement of American students on international comparisons of science proficiency is unacceptable, and the disparities between groups underrepresented in STEM and others…

Making Training More Cognitively Effective: Making Videos Interactive

ERIC Educational Resources Information Center

Cherrett, Tom; Wills, Gary; Price, Joe; Maynard, Sarah; Dror, Itiel E.

2009-01-01

The cost of health and safety (H&S) failures to the UK industry is currently estimated at up to 6.5 billion British Pounds per annum, with the construction sector suffering unacceptably high levels of work-related incidents. Better H&S education across all skill levels in the industry is seen as an integral part of any solution.…

The Efficacy of a Multifaceted Weight Management Program for Children and Young Adolescents

ERIC Educational Resources Information Center

Kihm, Holly Spencer

2014-01-01

The incidence of overweight and obesity among children and young adolescents remains unacceptably high and places our youth at risk for several negative outcomes. Recognizing the need for a youth-focused weight management program in our community, the researcher developed, implemented, and evaluated a small pilot study, FitKids. The aims of…

EPA publishes notice to extend comment period to close 6/16/16 on proposal to list new substitutes and prohibit certain high-GWP HFCs as alternatives under SNAP

EPA Pesticide Factsheets

Proposed New Listings of Substitutes; Changes of Listing Status; and Reinterpretation of Unacceptability for Closed Cell Foam Products Under the Significant New Alternatives Policy Program; and Revision of Clean Air Act Section 608 Venting Prohibition for

Synchronous Half-Wave Rectifier

NASA Technical Reports Server (NTRS)

Rippel, Wally E.

1989-01-01

Synchronous rectifying circuit behaves like diode having unusually low voltage drop during forward-voltage half cycles. Circuit particularly useful in power supplies with potentials of 5 Vdc or less, where normal forward-voltage drops in ordinary diodes unacceptably large. Fabricated as monolithic assembly or as hybrid. Synchronous half-wave rectifier includes active circuits to attain low forward voltage drop and high rectification efficiency.

Influence of season and type of restaurants on sashimi microbiota.

PubMed

Miguéis, S; Moura, A T; Saraiva, C; Esteves, A

2016-10-01

In recent years, an increase in the consumption of Japanese food in European countries has been verified, including in Portugal. These specialities made with raw fish, typical Japanese meals, have been prepared in typical and on non-typical restaurants, and represent a challenge to risk analysis on HACCP plans. The aim of this study was to evaluate the influence of the type of restaurant, season and type of fish used on sashimi microbiota. Sashimi samples (n = 114) were directly collected from 23 sushi restaurants and were classified as Winter and Summer Samples. They were also categorized according to the type of restaurant where they were obtained: as typical or non-typical. The samples were processed using international standards procedures. A middling seasonality influence was observed in microbiota using mesophilic aerobic bacteria, psychrotrophic microorganisms, Lactic acid bacteria, Pseudomonas spp., H 2 S positive bacteria, mould and Bacillus cereus counts parameters. During the Summer Season, samples classified as unacceptable or potentially Hazardous were observed. Non-typical restaurants had the most cases of Unacceptable/potentially hazardous samples 83.33%. These unacceptable results were obtained as a result of high values of pathogenic bacteria like Listeria monocytogenes and Staphylococcus aureus No significant differences were observed on microbiota counts from different fish species. The need to implement more accurate food safety systems was quite evident, especially in the warmer season, as well as in restaurants where other kinds of food, apart from Japanese meals, was prepared. © Crown copyright 2016.

47 CFR 90.672 - Unacceptable interference to non-cellular 800 MHz licensees from 800 MHz cellular systems or part...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Unacceptable interference to non-cellular 800 MHz licensees from 800 MHz cellular systems or part 22 Cellular Radiotelephone systems, and within the 900 MHz Business/Industrial Land Transportation Pool. 90.672 Section 90.672 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY...

Relating (Un)acceptability to Interpretation. Experimental Investigations on Negation

PubMed Central

Etxeberria, Urtzi; Tubau, Susagna; Deprez, Viviane; Borràs-Comes, Joan; Espinal, M. Teresa

2018-01-01

Although contemporary linguistic studies routinely use unacceptable sentences to determine the boundary of what falls outside the scope of grammar, investigations far more rarely take into consideration the possible interpretations of such sentences, perhaps because these interpretations are commonly prejudged as irrelevant or unreliable across speakers. In this paper we provide the results of two experiments in which participants had to make parallel acceptability and interpretation judgments of sentences presenting various types of negative dependencies in Basque and in two varieties of Spanish (Castilian Spanish and Basque Country Spanish). Our results show that acceptable sentences are uniformly assigned a single negation reading in the two languages. However, while unacceptable sentences consistently convey single negation in Basque, they are interpreted at chance in both varieties of Spanish. These results confirm that judgment data that distinguish between acceptable and unacceptable negative utterances can inform us not only about an adult’s grammar of his/her particular language but also about interesting cross-linguistic differences. We conclude that the acceptability and interpretation of (un)grammatical negative sentences can serve linguistic theory construction by helping to disentangle basic assumptions about the nature of various negative dependencies. PMID:29456515

The Cell-CT 3D Cell Imaging Technology Platform Enables the Detection of Lung Cancer Using the Non-Invasive LuCED Sputum Test

PubMed Central

Meyer, Michael G.; Hayenga, Jon; Neumann, Thomas; Katdare, Rahul; Presley, Chris; Steinhauer, David; Bell, Timothy; Lancaster, Christy; Nelson, Alan C.

2015-01-01

The war against cancer has yielded important advances in the early diagnosis and treatment of certain cancer types, but the poor detection rate and 5-year survival rate for lung cancer remains little changed over the past 40 years. Early detection through emerging lung cancer screening programs promises the most reliable means of improving mortality. Sputum cytology has been tried without success because sputum contains few malignant cells that are difficult for cytologists to detect. However, research has shown that sputum contains diagnostic malignant cells and could serve as a means of lung cancer detection if those cells could be detected and correctly characterized. Recently, the National Lung Cancer Screening Trial reported that screening by three consecutive low-dose X-ray CT scans provides a 20% reduction in lung cancer mortality compared to chest X-ray. This reduction in mortality, however, comes with an unacceptable false positive rate that increases patient risks and the overall cost of lung cancer screening. This article reviews the LuCED® test for detecting early lung cancer. LuCED is based on patient sputum that is enriched for bronchial epithelial cells. The enriched sample is then processed on the Cell-CT®, which images cells in three dimensions with sub-micron resolution. Algorithms are applied to the 3D cell images to extract morphometric features that drive a classifier to identify cells that have abnormal characteristics. The final status of these candidate abnormal cells is established by the pathologist's manual review. LuCED promotes accurate cell classification which could enable cost effective detection of lung cancer. PMID:26148817

A review of life expectancy and infant mortality estimations for Australian Aboriginal people

PubMed Central

2014-01-01

Background Significant variation exists in published Aboriginal mortality and life expectancy (LE) estimates due to differing and evolving methodologies required to correct for inadequate recording of Aboriginality in death data, under-counting of Aboriginal people in population censuses, and unexplained growth in the Aboriginal population attributed to changes in the propensity of individuals to identify as Aboriginal at population censuses. The objective of this paper is to analyse variation in reported Australian Aboriginal mortality in terms of LE and infant mortality rates (IMR), compared with all Australians. Methods Published data for Aboriginal LE and IMR were obtained and analysed for data quality and method of estimation. Trends in reported LE and IMR estimates were assessed and compared with those in the entire Australian population. Results LE estimates derived from different methodologies vary by as much as 7.2 years for the same comparison period. Indirect methods for estimating Aboriginal LE have produced LE estimates sensitive to small changes in underlying assumptions, some of which are subject to circular reasoning. Most indirect methods appear to under-estimate Aboriginal LE. Estimated LE gaps between Aboriginal people and the overall Australian population have varied between 11 and 20 years. Latest mortality estimates, based on linking census and death data, are likely to over-estimate Aboriginal LE. Temporal LE changes by each methodology indicate that Aboriginal LE has improved at rates similar to the Australian population overall. Consequently the gap in LE between Aboriginal people and the total Australian population appears to be unchanged since the early 1980s, and at the end of the first decade of the 21st century remains at least 11–12 years. In contrast, focussing on the 1990–2010 period Aboriginal IMR declined steeply over 2001–08, from more than 12 to around 8 deaths per 1,000 live births, the same level as Australia overall in 1993–95. The IMR gap between Aboriginal people and the total Australian population, while still unacceptable, has declined considerably, from over 8 before 2000 to around 4 per 1,000 live births by 2008. Conclusions Regardless of estimation method used, mortality and LE gaps between Aboriginal and non-Aboriginal people are substantial, but remain difficult to estimate accurately. PMID:24383435

Self-Arrangement of Fleeting Student Pairs: A Web 2.0 Approach for Peer Tutoring

ERIC Educational Resources Information Center

Westera, Wim; de Bakker, Gijs; Wagemans, Leo

2009-01-01

This article presents a Web 2.0 approach for the arrangement of peer tutoring in online learning. In online learning environments, the learners' expectations of obtaining frequent, one-to-one support from their teachers tend to increase the teachers' workloads to unacceptably high levels. To address this problem of workload a self-organised peer…

Policy Responses to the Recent Poor Performance of the U.S. Labor Market

ERIC Educational Resources Information Center

Haveman, Robert; Heinrich, Carolyn; Smeeding, Timothy

2012-01-01

Since the onset of the Great Recession, the U.S. labor market has been reeling. Public concern has largely focused on the unemployment rate, which rose to double digits and has since been stalled at just over 9 percent. This rate is unacceptably high, and macroeconomic policy efforts have been unsuccessful in bringing it down. The overall…

The Preschool Nap as a Protective Factor in the Fight against Childhood Obesity: An Exploratory Study

ERIC Educational Resources Information Center

Kihm, Holly Spencer; Rolling, Peggy

2014-01-01

Although the prevalence of childhood obesity has not increased in recent years, it remains unacceptably high and warrants continued study. The purpose of this study was to explore the potential relationship between weight status and length of sleep (both daytime and nighttime) among preschool children. Special attention was given to the role…

When Will Our Values Finally Result in the Creation of New Pathways for Change--Change that We Can Believe In?

ERIC Educational Resources Information Center

Rusch, Frank R.; Wolfe, Pamela

2008-01-01

Despite efforts over the past several decades to improve the delivery of transition services for youth with disabilities, outcomes continue to be unacceptably dismal for most youth, including high rates of unemployment, residential independence, and financial dependence, concurrent with low rates of enrollment in college or other postsecondary…

Citation Help in Databases: The More Things Change, the More They Stay the Same

ERIC Educational Resources Information Center

Van Ullen, Mary; Kessler, Jane

2012-01-01

In 2005, the authors reviewed citation help in databases and found an error rate of 4.4 errors per citation. This article describes a follow-up study that revealed a modest improvement in the error rate to 3.4 errors per citation, still unacceptably high. The most problematic area was retrieval statements. The authors conclude that librarians…

Do Ethical Judgments Depend on the Type of Response Scale? Comparing Acceptability versus Unacceptability Judgments in the Case of Life-Ending Procedures

ERIC Educational Resources Information Center

Sastre, Maria Teresa Munoz; Gonzalez, Charlene; Lhermitte, Astrid; Sorum, Paul C.; Mullet, Etienne

2010-01-01

Using Functional Measurement (Anderson, 2008), Frileux, Lelievre, Munoz Sastre, Mullet, and Sorum (2003) examined the joint impact of several key factors on lay people's judgments of the acceptability of physicians' interventions to end patients' lives. The level of acceptability was high, and the information integration rule that best described…

Aspirations to Achievement: Men of Color and Community Colleges. A Special Report from the Center for Community College Student Engagement

ERIC Educational Resources Information Center

Center for Community College Student Engagement, 2014

2014-01-01

Consistently and unmistakably, data show a persistent gap separating Latinos and Black males from other student groups on measures of academic progress and college completion. These gaps exist across higher education. They are undeniable and unacceptable. Men of color have high aspirations when they begin higher education. Why are these…

A summary analysis of the 3rd inquiry.

PubMed

1977-01-01

20 ESCAP member countries responded to the "Third Population Inquiry among Governments: Population policies in the context of development in 1976." The questionnaire sent to the member countries covered economic and social development and population growth, mortality, fertility and family formation, population distribution and internal migration, international migration, population data collection and research, training, and institutional arrangements for the formulation of population policies within development. Most of the governments in the ESCAP region that responded indicate that the present rate of population growth constrains their social and economic development. Among the governments that consider the present rate of population growth to constrain economic and social development, 13 countries regarded the most appropriate response to the constraint would include an adjustment of both socioeconomic and demographic factors. 11 of the governments regarded their present levels of average life expectancy at birth "acceptable" and 7 identified their levels as "unacceptable." Most of the governments who responded consider that, in general, their present level of fertility is too high and constrains family well-being. Internal migration and population distribution are coming to be seen as concerns for government population policy. The most popular approaches to distributing economic and social activities are rural development, urban and regional development and industrial dispersion. There was much less concern among the governments returning the questionnaire about the effect of international migration than internal migration on social and economic development.

Pregnancy, parturition and preeclampsia in women of African ancestry.

PubMed

Nakimuli, Annettee; Chazara, Olympe; Byamugisha, Josaphat; Elliott, Alison M; Kaleebu, Pontiano; Mirembe, Florence; Moffett, Ashley

2014-06-01

Maternal and associated neonatal mortality rates in sub-Saharan Africa remain unacceptably high. In Mulago Hospital (Kampala, Uganda), 2 major causes of maternal death are preeclampsia and obstructed labor and their complications, conditions occurring at the extremes of the birthweight spectrum, a situation encapsulated as the obstetric dilemma. We have questioned whether the prevalence of these disorders occurs more frequently in indigenous African women and those with African ancestry elsewhere in the world by reviewing available literature. We conclude that these women are at greater risk of preeclampsia than other racial groups. At least part of this susceptibility seems independent of socioeconomic status and likely is due to biological or genetic factors. Evidence for a genetic contribution to preeclampsia is discussed. We go on to propose that the obstetric dilemma in humans is responsible for this situation and discuss how parturition and birthweight are subject to stabilizing selection. Other data we present also suggest that there are particularly strong evolutionary selective pressures operating during pregnancy and delivery in Africans. There is much greater genetic diversity and less linkage disequilibrium in Africa, and the genes responsible for regulating birthweight and placentation may therefore be easier to define than in non-African cohorts. Inclusion of African women into research on preeclampsia is an essential component in tackling this major disparity of maternal health. Copyright © 2014 Mosby, Inc. All rights reserved.

Pregnancy, parturition and preeclampsia in women of African ancestry

PubMed Central

Nakimuli, Annettee; Chazara, Olympe; Byamugisha, Josaphat; Elliott, Alison M.; Kaleebu, Pontiano; Mirembe, Florence; Moffett, Ashley

2014-01-01

Maternal and associated neonatal mortality rates in sub-Saharan Africa remain unacceptably high. In Mulago Hospital (Kampala, Uganda), 2 major causes of maternal death are preeclampsia and obstructed labor and their complications, conditions occurring at the extremes of the birthweight spectrum, a situation encapsulated as the obstetric dilemma. We have questioned whether the prevalence of these disorders occurs more frequently in indigenous African women and those with African ancestry elsewhere in the world by reviewing available literature. We conclude that these women are at greater risk of preeclampsia than other racial groups. At least part of this susceptibility seems independent of socioeconomic status and likely is due to biological or genetic factors. Evidence for a genetic contribution to preeclampsia is discussed. We go on to propose that the obstetric dilemma in humans is responsible for this situation and discuss how parturition and birthweight are subject to stabilizing selection. Other data we present also suggest that there are particularly strong evolutionary selective pressures operating during pregnancy and delivery in Africans. There is much greater genetic diversity and less linkage disequilibrium in Africa, and the genes responsible for regulating birthweight and placentation may therefore be easier to define than in non-African cohorts. Inclusion of African women into research on preeclampsia is an essential component in tackling this major disparity of maternal health. PMID:24184340

Chemoimmunotherapy and withdrawal of immunosupression for monomorphic post-transplant lymphoproliferative disorders

PubMed Central

Podoltsev, Nikolai; Zhang, Bingnan; Yao, Xiaopan; Bustillo, Ivan; Deng, Yanhong; Cooper, Dennis L.

2013-01-01

Introduction Monomorphic post-transplant lymphoproliferative disorders (PTLD) are the most aggressive type of PTLD occurring after solid organ transplantation (SOT). Current guidelines for treatment suggest a stepwise approach that includes a reduction of immunosuppression (RIS) with or without rituximab, followed by chemotherapy if there is no response. Nevertheless, recommendations regarding the extent and duration of RIS are non-standardized and RIS as an initial strategy may be associated with an unacceptably high frequency of graft loss and disease progression. Patients and Methods We reviewed the outcome of a combination program of aggressive chemo-immunotherapy and complete withdrawal of immunosuppression in treating 22 patients with monomorphic PTLD between January 1995 and August 2012. Results 12 of 22 patients (55%) received CHOP-R every 2 weeks (dose dense CHOP-R) and 10 patients received other doxorubicin-based regimens. There was no treatment related mortality (TRM). Complete response (CR) was seen in 91% of patients. Median overall survival was 9.61 years with 95% CI (5.21-10.74). Median progression free survival (PFS) was 5.39 years with 95% CI (2.10-10.74). The graft-rejection rate was 18% with 95% CI (0.03-0.34). Conclusion We conclude that the use of aggressive chemo-immunotherapy in combination with withdrawal of immunosuppression approach yields excellent results and should be prospectively studied in a multi-institutional setting. PMID:24035715

European Consensus on Primary Prevention of Coronary Heart Disease.

PubMed

Assmann, G

1988-07-01

The European Consensus on Primary Prevention of Coronary Heart Disease has recommended that providing care for individuals at particular risk for coronary artery disease (CAD) requires case finding through medical examinations in primary care, hospital and employment health examination settings. Decisions concerning management of elevated lipid levels should be based on overall cardiovascular risk. The goal of reducing cholesterol levels through risk reduction can ultimately be accomplished only with the implementation of health education efforts directed toward all age groups and actions by government and supranational agencies, including adequate food labelling to identify fat content, selective taxation to encourage healthful habits and wider availability of exercise facilities. Only measures directed at the overall population can eventually reach the large proportion of individuals at mildly to moderately increased risk for CAD. The European Policy Statement on the Prevention of Coronary Heart Disease recognizes that the question of lipid elevation as a risk factor for CAD involves assessment, not only of cholesterol level alone, but also of triglycerides and the HDL cholesterol lipid fraction. Five specific categories of dyslipidemia have been identified, with individualized screening and treatment strategies advised for each. It is the consensus of the study group panel members that these procedures are both practical and feasible. They begin the necessary long term process to reduce the unacceptably high levels of morbidity and mortality due to CAD throughout the European community.

Rationale and pre-clinical efficacy of a novel anti-EMP2 antibody for the treatment of invasive breast cancer

PubMed Central

Fu, Maoyong; Maresh, Erin L.; Helguera, Gustavo F.; Kiyohara, Meagan; Qin, Yu; Ashki, Negin; Daniels-Wells, Tracy R.; Aziz, Najib; Gordon, Lynn K.; Braun, Jonathan; Elshimali, Yahya; Soslow, Robert A.; Penichet, Manuel L.; Goodglick, Lee; Wadehra, Madhuri

2014-01-01

Despite significant advances in biology and medicine, the incidence and mortality due to breast cancer world-wide is still unacceptably high. Thus, there is an urgent need to discover new molecular targets. In this paper, we show evidence for a novel target in human breast cancer, the tetraspan protein epithelial membrane protein-2 (EMP2). Using tissue tumor arrays, protein expression of EMP2 was measured and found to be minimal in normal mammary tissue, but it was upregulated in 63% of invasive breast cancer tumors and in 73% of triple negative tumors tested. To test the hypothesis that EMP2 may be a suitable target for therapy, we constructed a fully human IgG1 antibody specific for a conserved domain of human and murine EMP2. Treatment of breast cancer cells with the anti-EMP2 IgG1 significantly inhibited EMP2 mediated signaling, blocked FAK/Src signaling, inhibited invasion, and promoted apoptosis in vitro. In both human xenograft and syngeneic metastatic tumor monotherapy models, anti-EMP2 IgG1 retarded tumor growth without detectable systemic toxicity. This anti-tumor effect was in part attributable to a potent ADCC response as well as direct cytotoxicity induced by the monoclonal antibody. Together, these results identify EMP2 as a novel therapeutic target for invasive breast cancer. PMID:24448822

Rationale and preclinical efficacy of a novel anti-EMP2 antibody for the treatment of invasive breast cancer.

PubMed

Fu, Maoyong; Maresh, Erin L; Helguera, Gustavo F; Kiyohara, Meagan; Qin, Yu; Ashki, Negin; Daniels-Wells, Tracy R; Aziz, Najib; Gordon, Lynn K; Braun, Jonathan; Elshimali, Yahya; Soslow, Robert A; Penichet, Manuel L; Goodglick, Lee; Wadehra, Madhuri

2014-04-01

Despite significant advances in biology and medicine, the incidence and mortality due to breast cancer worldwide is still unacceptably high. Thus, there is an urgent need to discover new molecular targets. In this article, we show evidence for a novel target in human breast cancer, the tetraspan protein epithelial membrane protein-2 (EMP2). Using tissue tumor arrays, protein expression of EMP2 was measured and found to be minimal in normal mammary tissue, but it was upregulated in 63% of invasive breast cancer tumors and in 73% of triple-negative tumors tested. To test the hypothesis that EMP2 may be a suitable target for therapy, we constructed a fully human immunoglobulin G1 (IgG1) antibody specific for a conserved domain of human and murine EMP2. Treatment of breast cancer cells with the anti-EMP2 IgG1 significantly inhibited EMP2-mediated signaling, blocked FAK/Src signaling, inhibited invasion, and promoted apoptosis in vitro. In both human xenograft and syngeneic metastatic tumor monotherapy models, anti-EMP2 IgG1 retarded tumor growth without detectable systemic toxicity. This antitumor effect was, in part, attributable to a potent antibody-dependent cell-mediated cytotoxicity response as well as direct cytotoxicity induced by the monoclonal antibody. Together, these results identify EMP2 as a novel therapeutic target for invasive breast cancer.

Inflammatory markers in SIRS, sepsis and septic shock.

PubMed

Herzum, I; Renz, H

2008-01-01

Despite great advancement in the understanding of the pathophysiology and in the development of novel therapeutic approaches, mortality of sepsis still remains unacceptably high. Adequate laboratory diagnostics represents a major requirement for the improvement of this situation. For a better understanding of the immunological dysregulation in this disease, several markers are now available for routine diagnostics in the clinical laboratory. They include the cytokines interleukin (IL) -6, IL-8, procalcitonin and the LPS-binding protein (LBP). These novel markers will be compared to the conventional procedure of diagnosing inflammatory and infectious disease, such as measurements of C-reactive protein (CRP) as a major acute phase protein and differential blood counting. Important questions addressed in this review are the usefulness of these markers for early diagnosis, their role as prognostic markers and in the risk assessment of patients. Furthermore, we will discuss whether these parameters are to differentiate between systemic inflammatory response syndrome (SIRS) and sepsis at its different degrees. In the case of an infectious nature of the disease, it is important to differentiate between viral or bacterial origin and to monitor the responsiveness of antibiotic therapies. The literature was analysed with focus on the evidence for diagnostic and analytical performance. For this purpose international definition and staging criteria were used in context of criteria for assay performance including sensitivity, specificity, negative and positive predictive values, ROC analysis and other analytical criteria.

40 CFR Appendix G to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the March 3, 1999...

Code of Federal Regulations, 2012 CFR

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... Restrictions and Unacceptable Substitutes Listed in the March 3, 1999, Final rule, Effective April 2, 1999. G Appendix G to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. G Appendix G to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix G to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the March 3, 1999...

Code of Federal Regulations, 2013 CFR

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... Restrictions and Unacceptable Substitutes Listed in the March 3, 1999, Final rule, Effective April 2, 1999. G Appendix G to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. G Appendix G to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix G to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the March 3, 1999...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Restrictions and Unacceptable Substitutes Listed in the March 3, 1999, Final rule, Effective April 2, 1999. G Appendix G to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. G Appendix G to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

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Code of Federal Regulations, 2010 CFR

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Code of Federal Regulations, 2014 CFR

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... Restrictions and Unacceptable Substitutes Listed in the July 22, 2002, Final Rule, Effective August 21, 2002 K Appendix K to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. K Appendix K to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

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Code of Federal Regulations, 2012 CFR

2012-07-01

... Restrictions and Unacceptable Substitutes Listed in the July 22, 2002, Final Rule, Effective August 21, 2002 K Appendix K to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. K Appendix K to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix K to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the July 22, 2002...

Code of Federal Regulations, 2013 CFR

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... Restrictions and Unacceptable Substitutes Listed in the July 22, 2002, Final Rule, Effective August 21, 2002 K Appendix K to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. K Appendix K to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix K to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the July 22, 2002...

Code of Federal Regulations, 2011 CFR

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... Restrictions and Unacceptable Substitutes Listed in the July 22, 2002, Final Rule, Effective August 21, 2002 K Appendix K to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. K Appendix K to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix C to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the May 22, 1996...

Code of Federal Regulations, 2012 CFR

2012-07-01

... Restrictions and Unacceptable Substitutes Listed in the May 22, 1996 Final Rule, Effective June 21, 1996 C Appendix C to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. C Appendix C to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix C to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the May 22, 1996...

Code of Federal Regulations, 2014 CFR

2014-07-01

... Restrictions and Unacceptable Substitutes Listed in the May 22, 1996 Final Rule, Effective June 21, 1996 C Appendix C to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. C Appendix C to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

40 CFR Appendix C to Subpart G of... - Substitutes Subject to Use Restrictions and Unacceptable Substitutes Listed in the May 22, 1996...

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... Restrictions and Unacceptable Substitutes Listed in the May 22, 1996 Final Rule, Effective June 21, 1996 C Appendix C to Subpart G of Part 82 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Pt. 82, Subpt. G, App. C Appendix C to Subpart G of Part 82—Substitutes Subject to Use Restrictions...

Real-Time Pretreatment Review Limits Unacceptable Deviations on a Cooperative Group Radiation Therapy Technique Trial: Quality Assurance Results of RTOG 0933

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

Gondi, Vinai, E-mail: vgondi@chicagocancer.org; University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin; Cui, Yunfeng

2015-03-01

Purpose: RTOG 0933 was a phase II trial of hippocampal avoidance during whole brain radiation therapy for patients with brain metastases. The results demonstrated improvement in short-term memory decline, as compared with historical control individuals, and preservation of quality of life. Integral to the conduct of this trial were quality assurance processes inclusive of pre-enrollment credentialing and pretreatment centralized review of enrolled patients. Methods and Materials: Before enrolling patients, all treating physicians and sites were required to successfully complete a “dry-run” credentialing test. The treating physicians were credentialed based on accuracy of magnetic resonance imaging–computed tomography image fusion and hippocampal andmore » normal tissue contouring, and the sites were credentialed based on protocol-specified dosimetric criteria. Using the same criteria, pretreatment centralized review of enrolled patients was conducted. Physicians enrolling 3 consecutive patients without unacceptable deviations were permitted to enroll further patients without pretreatment review, although their cases were reviewed after treatment. Results: In all, 113 physicians and 84 sites were credentialed. Eight physicians (6.8%) failed hippocampal contouring on the first attempt; 3 were approved on the second attempt. Eight sites (9.5%) failed intensity modulated radiation therapy planning on the first attempt; all were approved on the second attempt. One hundred thirteen patients were enrolled in RTOG 0933; 100 were analyzable. Eighty-seven cases were reviewed before treatment; 5 (5.7%) violated the eligibility criteria, and 21 (24%) had unacceptable deviations. With feedback, 18 cases were approved on the second attempt and 2 cases on the third attempt. One patient was treated off protocol. Twenty-two cases were reviewed after treatment; 1 (4.5%) violated the eligibility criteria, and 5 (23%) had unacceptable deviations. Conclusions: Although >95% of the cases passed the pre-enrollment credentialing, the pretreatment centralized review disqualified 5.7% of reviewed cases, prevented unacceptable deviations in 24% of reviewed cases, and limited the final unacceptable deviation rate to 5%. Thus, pretreatment review is deemed necessary in future hippocampal avoidance trials and is potentially useful in other similarly challenging radiation therapy technique trials.« less

Designing a Low-Cost Multifunctional Infant Incubator.

PubMed

Tran, Kevin; Gibson, Aaron; Wong, Don; Tilahun, Dagmawi; Selock, Nicholas; Good, Theresa; Ram, Geetha; Tolosa, Leah; Tolosa, Michael; Kostov, Yordan; Woo, Hyung Chul; Frizzell, Michael; Fulda, Victor; Gopinath, Ramya; Prasad, J Shashidhara; Sudarshan, Hanumappa; Venkatesan, Arunkumar; Kumar, V Sashi; Shylaja, N; Rao, Govind

2014-06-01

Every year, an unacceptably large number of infant deaths occur in developing nations, with premature birth and asphyxia being two of the leading causes. A well-regulated thermal environment is critical for neonatal survival. Advanced incubators currently exist, but they are far too expensive to meet the needs of developing nations. We are developing a thermodynamically advanced low-cost incubator suitable for operation in a low-resource environment. Our design features three innovations: (1) a disposable baby chamber to reduce infant mortality due to nosocomial infections, (2) a passive cooling mechanism using low-cost heat pipes and evaporative cooling from locally found clay pots, and (3) insulated panels and a thermal bank consisting of water that effectively preserve and store heat. We developed a prototype incubator and visited and presented our design to our partnership hospital site in Mysore, India. After obtaining feedback, we have determined realistic, nontrivial design requirements and constraints in order to develop a new prototype incubator for clinical trials in hospitals in India. © 2014 Society for Laboratory Automation and Screening.

Impact of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing on mortality and cost effectiveness in hospitalized patients with bacteraemia: a decision model.

PubMed

Brown, Jack; Paladino, Joseph A

2010-01-01

Patients hospitalized with Staphylococcus aureus bacteraemia have an unacceptably high mortality rate. Literature available to date has shown that timely selection of the most appropriate antibacterial may reduce mortality. One tool that may help with this selection is a polymerase chain reaction (PCR) assay that distinguishes methicillin (meticillin)-resistant S. aureus (MRSA) from methicillin-susceptible S. aureus (MSSA) in less than 1 hour. To date, no information is available evaluating the impact of this PCR technique on clinical or economic outcomes. To evaluate the effect of a rapid PCR assay on mortality and economics compared with traditional empiric therapy, using a literature-derived model. A literature search for peer-reviewed European (EU) and US publications regarding treatment regimens, outcomes and costs was conducted. Information detailing the rates of infection, as well as the specificity and sensitivity of a rapid PCR assay (Xpert MRSA/SA Blood Culture PCR) were obtained from the peer-reviewed literature. Sensitivity analysis varied the prevalence rate of MRSA from 5% to 80%, while threshold analysis was applied to the cost of the PCR test. Hospital and testing resource consumption were valued with direct medical costs, adjusted to year 2009 values. Adjusted life-years were determined using US and WHO life tables. The cost-effectiveness ratio was defined as the cost per life-year saved. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the additional cost necessary to produce additional effectiveness. All analyses were performed using TreeAge Software (2008). The mean mortality rates were 23% for patients receiving empiric vancomycin subsequently switched to semi-synthetic penicillin (SSP) for MSSA, 36% for patients receiving empiric vancomycin treatment for MRSA, 59% for patients receiving empiric SSP subsequently switched to vancomycin for MRSA and 12% for patients receiving empiric SSP for MSSA. Furthermore, with an MRSA prevalence of 30%, the numbers of patients needed to test in order to save one life were 14 and 16 compared with empiric vancomycin and SSP, respectively. The absolute mortality difference for MRSA prevalence rates of 80% and 5% favoured the PCR testing group at 2% and 10%, respectively, compared with empiric vancomycin and 18% and 1%, respectively, compared with empiric SSP. In the EU, the cost-effectiveness ratios for empiric vancomycin- and SSP-treated patients were Euro 695 and Euro 687 per life-year saved, respectively, compared with Euro 636 per life-year saved for rapid PCR testing. In the US, the cost-effectiveness ratio was $US 898 per life-year saved for empiric vancomycin and $US 820 per life-year saved for rapid PCR testing. ICERs demonstrated dominance of the PCR test in all instances. Threshold analysis revealed that PCR testing would be less costly overall, even at greatly inflated assay prices. Rapid PCR testing for MRSA appears to have the potential to reduce mortality rates while being less costly than empiric therapy in the EU and US, across a wide range of MRSA prevalence rates and PCR test costs.

The relation of childhood trauma to suicide ideation in patients suffering from obsessive-compulsive disorder with lifetime suicide attempts.

PubMed

Khosravani, Vahid; Kamali, Zoleikha; Jamaati Ardakani, Razieh; Samimi Ardestani, Mehdi

2017-09-01

The aim of this study was to evaluate the relations of childhood trauma (CT) and obsessive-compulsive (OC) symptom dimensions to suicide ideation in patients with obsessive-compulsive disorder (OCD). Seventy OCD outpatients with lifetime suicide attempts and 60 controls were included. Participants completed the Scale for Suicide Ideation (SSI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). Among OCD patients, 97.1% had current suicide ideation. OCD patients revealed higher scores on CT, suicide ideation, depression and anxiety than controls. The CT history of sexual abuse (SA) and OC symptom dimension of unacceptable thoughts explained suicide ideation. It was concluded that SA and unacceptable thoughts may contribute to high suicidality and have important implications for the assessment and treatment of suicide risk in OCD patients with lifetime suicide attempts. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Seismic performance assessment of base-isolated safety-related nuclear structures

USGS Publications Warehouse

Huang, Y.-N.; Whittaker, A.S.; Luco, N.

2010-01-01

Seismic or base isolation is a proven technology for reducing the effects of earthquake shaking on buildings, bridges and infrastructure. The benefit of base isolation has been presented in terms of reduced accelerations and drifts on superstructure components but never quantified in terms of either a percentage reduction in seismic loss (or percentage increase in safety) or the probability of an unacceptable performance. Herein, we quantify the benefits of base isolation in terms of increased safety (or smaller loss) by comparing the safety of a sample conventional and base-isolated nuclear power plant (NPP) located in the Eastern U.S. Scenario- and time-based assessments are performed using a new methodology. Three base isolation systems are considered, namely, (1) Friction Pendulum??? bearings, (2) lead-rubber bearings and (3) low-damping rubber bearings together with linear viscous dampers. Unacceptable performance is defined by the failure of key secondary systems because these systems represent much of the investment in a new build power plant and ensure the safe operation of the plant. For the scenario-based assessments, the probability of unacceptable performance is computed for an earthquake with a magnitude of 5.3 at a distance 7.5 km from the plant. For the time-based assessments, the annual frequency of unacceptable performance is computed considering all potential earthquakes that may occur. For both assessments, the implementation of base isolation reduces the probability of unacceptable performance by approximately four orders of magnitude for the same NPP superstructure and secondary systems. The increase in NPP construction cost associated with the installation of seismic isolators can be offset by substantially reducing the required seismic strength of secondary components and systems and potentially eliminating the need to seismically qualify many secondary components and systems. ?? 2010 John Wiley & Sons, Ltd.

Corrected Panel-Reactive Antibody Positivity Rates for Hypersensitized Patients in Turkish Population With Calculated Panel-Reactive Antibody Software.

PubMed

Karadeniz, S T; Akgul, S U; Ogret, Y; Ciftci, H S; Bayraktar, A; Bakkaloglu, H; Caliskan, Y; Yelekci, K; Turkmen, A; Aydin, A E; Oguz, F S; Carin, M; Aydin, F

2017-04-01

High rates of panel-reactive antibody (PRA) may decrease the chance of kidney transplantation and may result in long waiting periods before transplantation. The calculated PRA (cPRA) is performed based on unacceptable HLA antigens. These antigens are identified by a program that was created based on the antibodies that developed against the HLA antigens circulating in serum and on the risk of binding of these antibodies to antigens. The antigen profile of the population and antigen frequencies can be measured, and more realistic cPRA positivity rates may be obtained using this method. We developed a program based on the HLA antigens of 494 blood donors in 2 European Federation for Immunogenetics-accredited Tissue Typing Laboratories in Turkey. Next-generation sequencing-based tissue typing (HLA-A, -B, -C, -DR, -DQ, 4 digits) of the samples was performed. The PRA screening test was performed on 380 patients who were waiting for organ transplant from a cadaver in Istanbul Faculty of Medicine. The single antigen bead assay testing was performed to identify the antibody profiles on 48 hypersensitized patients. The PRA testing results using the current methods were 44.6% ± 18.5%, and the cPRA rate was 86.2% ± 5.1%. The mean PRA positivity of the sensitized patients using the current methods was 44.6%; however, the rate was 86.2% using the cPRA. cPRA shows the rate of the rejected donors according to all unacceptable antigens. The need for a list of unacceptable antigens in place of the PRA positivity rate is a real change in the sensitization-dependent calculation as cPRA positivity rate. In principal, implementation of cPRA will encourage many centers and laboratories to adopt a standard measurement of sensitization in Turkey. It will increase the chances of better donor match, particularly for hypersensitized patients, by the creation of an unacceptable mismatch program using cPRA software. Copyright © 2017 Elsevier Inc. All rights reserved.

An evaluation of flight path management automation in transport category aircraft

NASA Technical Reports Server (NTRS)

Chandra, D.; Bussolari, S. R.

1991-01-01

A desk-top simulation of a Boeing 757/767 Electronic Flight Instrumentation System (EFIS) and Control Display Unit (CDU) was used in an experiment to compare three modes of communication for the clearance amendment process: standard voice procedures, a textual delivery method, and a graphical delivery method. Eight qualified Boeing 757/767 pilots served as subjects. Each flew nine landing scenarios with three amendments given in each scenario. Both acceptable and unacceptable clearance amendments were presented in order to assess situational awareness. Times for comprehension and execution of the amendment were recorded along with workload ratings, responses to unacceptable amendments, and subjective impressions. The graphical mode was found to be superior in terms of the time measures and subjective ratings. No difference was found between the modes in the ability to detect unacceptable clearances.

High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa

PubMed Central

Benzekri, Noelle A.; Sambou, Jacques; Diaw, Binetou; Sall, El Hadji Ibrahima; Sall, Fatima; Niang, Alassane; Ba, Selly; Ngom Guèye, Ndèye Fatou; Diallo, Mouhamadou Baïla; Hawes, Stephen E.; Seydi, Moussa; Gottlieb, Geoffrey S.

2015-01-01

Background Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes. Methods We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Results One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01). Conclusions Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population. PMID:26529509

High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa.

PubMed

Benzekri, Noelle A; Sambou, Jacques; Diaw, Binetou; Sall, El Hadji Ibrahima; Sall, Fatima; Niang, Alassane; Ba, Selly; Ngom Guèye, Ndèye Fatou; Diallo, Mouhamadou Baïla; Hawes, Stephen E; Seydi, Moussa; Gottlieb, Geoffrey S

2015-01-01

Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes. We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01). Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.

Standardization of a spinal cord lesion model and neurologic evaluation using mice

PubMed Central

Borges, Paulo Alvim; Cristante, Alexandre Fogaça; de Barros-Filho, Tarcísio Eloy Pessoa; Natalino, Renato Jose Mendonça; dos Santos, Gustavo Bispo; Marcon, Raphael Marcus

2018-01-01

OBJECTIVE: To standardize a spinal cord lesion mouse model. METHODS: Thirty BALB/c mice were divided into five groups: four experimental groups and one control group (sham). The experimental groups were subjected to spinal cord lesion by a weight drop from different heights after laminectomy whereas the sham group only underwent laminectomy. Mice were observed for six weeks, and functional behavior scales were applied. The mice were then euthanized, and histological investigations were performed to confirm and score spinal cord lesion. The findings were evaluated to prove whether the method of administering spinal cord lesion was effective and different among the groups. Additionally, we correlated the results of the functional scales with the results from the histology evaluations to identify which scale is more reliable. RESULTS: One mouse presented autophagia, and six mice died during the experiment. Because four of the mice that died were in Group 5, Group 5 was excluded from the study. All the functional scales assessed proved to be significantly different from each other, and mice presented functional evolution during the experiment. Spinal cord lesion was confirmed by histology, and the results showed a high correlation between the Basso, Beattie, Bresnahan Locomotor Rating Scale and the Basso Mouse Scale. The mouse function scale showed a moderate to high correlation with the histological findings, and the horizontal ladder test had a high correlation with neurologic degeneration but no correlation with the other histological parameters evaluated. CONCLUSION: This spinal cord lesion mouse model proved to be effective and reliable with exception of lesions caused by a 10-g drop from 50 mm, which resulted in unacceptable mortality. The Basso, Beattie, Bresnahan Locomotor Rating Scale and Basso Mouse Scale are the most reliable functional assessments, and but the horizontal ladder test is not recommended. PMID:29561931

Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: retrospective cohort study.

PubMed

Gebremichael, Delelegn Yilma

2015-12-21

Malnutrition remains to be one of the most common causes of morbidity and mortality among children in developing countries. The prevalence of wasting in Ethiopia remained about 10 % for the past ten years. Mortality rate of children with severe acute malnutrition treated in inpatient set ups has remained unacceptably high. A retrospective cohort study was conducted in Southern Ethiopia. The study population were children with severe acute malnutrition aged from 6 to 59 months who have been managed at Karat and Fasha stabilization centers between September 30, 2013, and Sep. 29, 2014. The total sample size was 420 and pretested questionnaire was used. Kaplan Meier analysis was used to estimate time to nutritional recovery and Cox proportional-hazard regression analysis was carried out to determine independent predictors. Nutritional recovery rate was 3.61 per 100 person day observations. Median nutritional recovery time was 22 and 29 days for edematous malnourished and severely wasted children respectively. The independent predictors of nutritional recovery rate were: stabilization center (AHR = 1.4, 95 % CI: 1.1-1.7), malnutrition status (AHR = 1.8, 95 % CI: 1.3-2.4), weight (AHR = 1.5, 95 % CI: 1.2-1.9), mid- upper arm circumference (AHR = 1.4, 95 % CI: 1.1-1.9), inpatient complications (AHR = 2.2, 95 % CI: 1.4-3.5) and did not lose edema within four days of inpatient treatment (AHR = 2.3, 95 % CI: 1.1-4.8). The findings of this study confirm the probability of surviving gets slimmer with inpatient complications and staying longer in stabilization centers. So, to prevent complications and enhance recovery rate due emphasis should be given in improving early detection and treatment of severely malnourished children in Ethiopia.

Can the right to health inform public health planning in developing countries? A case study for maternal healthcare from Indonesia

PubMed Central

D'Ambruoso, Lucia; Byass, Peter; Nurul Qomariyah, Siti

2008-01-01

Background Maternal mortality remains unacceptably high in developing countries despite international advocacy, development targets, and simple, affordable and effective interventions. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged. Objective We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal healthcare. Our objective was to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective. Design Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased's relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death. Results In this case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year-old primagravida at 7 months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several serious health system failures were also apparent. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld. Conclusion The rights-based approach could identify how and where to improve services. However, there are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning. PMID:20027244

Transparent and Open Discussion of Errors Does Not Increase Malpractice Risk in Trauma Patients

PubMed Central

Stewart, Ronald M.; Corneille, Michael G.; Johnston, Joe; Geoghegan, Kathy; Myers, John G.; Dent, Daniel L.; McFarland, Marilyn; Alley, Joshua; Pruitt, Basil A.; Cohn, Stephen M.

2006-01-01

Objective: We set out to determine if there is an increased medical malpractice lawsuit rate when trauma patient cases are presented at an open, multidisciplinary morbidity and mortality conference (M&M). Introduction: Patient safety proponents emphasize the importance of transparency with respect to medical errors. In contrast, the tort system focuses on blame and punishment, which encourages secrecy. Our question: Can the goals of the patient safety movement be met without placing care providers and healthcare institutions at unacceptably high malpractice risk? Methods: The trauma registry, a risk management database, along with the written minutes of the trauma morbidity and mortality conference (M&M) were used to determine the number and incidence of malpractice suits filed following full discussion at an open M&M conference at an academic level I trauma center. Results: A total of 20,749 trauma patients were admitted. A total of 412 patients were discussed at M&M conference and a total of seven lawsuits were filed. Six of the patients were not discussed at M&M prior to the lawsuit being filed. One patient was discussed at M&M prior to the lawsuit being filed. The incidence of lawsuit was calculated in three groups: all trauma patients, all trauma patients with complications, and all patients presented at trauma M&M conference. The ratio of lawsuits filed to patients admitted and incidence in the three groups is as follows: All Patients, 7 lawsuits/20,479 patients (4.25 lawsuits/100,000 patients/year); M&M Presentation, 1 lawsuit/421 patients (29.6 lawsuits/100,000 patients/year); All Trauma Complications, 7 lawsuits/6,225 patients (14 lawsuits/100,000 patients/year). Patients with a complication were more likely to sue (P < 0.01); otherwise, there were no statistical differences between groups. Conclusions: A transparent discussion of errors, complications, and deaths does not appear to lead to an increased risk of lawsuit. PMID:16632999

A blueprint for a sepsis protocol.

PubMed

Shapiro, Nathan I; Howell, Michael; Talmor, Daniel

2005-04-01

Despite numerous advances in medicine, sepsis remains an unconquered challenge. Although outcomes have improved slightly over decades, the unacceptably high mortality rate of 30%-50% for severe sepsis and septic shock continues. However, after years of unsuccessful clinical trials, several investigations over the last few years have reported survival benefit in the treatment of sepsis. Physicians now have several proven therapies to treat sepsis, but have yet to implement them on a widespread, systematic basis. This led 11 international professional societies spanning multiple specialties and continents to come together to create the Surviving Sepsis Campaign. The product of their work is an international effort organized to improve care of patients with sepsis and includes consensus, evidence-based guidelines for care that improves survival in septic patients, and an action plan for change. Given the clear role of early identification and treatment in stopping the sepsis cascade, therapy must start early in the emergency department (ED) and continue throughout the hospital course. The first of the recommendations by the Surviving Sepsis Campaign is the aggressive resuscitation strategy of early goal-directed therapy (EGDT). EGDT is reported to reduce absolute mortality by a staggering 16%. The use of recombinant activated protein C was demonstrated to confer a 6% absolute survival benefit. Steroid supplementation in adrenal insufficiency produced a 10% benefit. Additionally, early and appropriate use of antibiotics remains a cornerstone of therapy. Although no randomized trial will be performed, the effects are undisputed. Finally, although predominantly intensive care unit therapies, tight glucose control and low-tidal-volume ventilation strategies have also led to improved survival. Armed with these new therapies, the medical community must rise to this call to action. Clinicians must change the approach to this disease, as well as the way the septic patient is viewed. Although complex and challenging, these therapies must be brought to the patient's bedside. We propose and describe the Multiple Urgent Sepsis Therapies (MUST) protocol as a practical way to implement a comprehensive treatment plan using available evidence-based therapies.

No choice. Human beings must continue to be fertile and to increase, but they must do so responsibly.

PubMed

Tagle Ra

1993-06-01

Commentary is provided on the transition mankind has made from a maintained population growth rate of 2% to adaptation to a more civilized age. When the agricultural age began 100,000 years ago, man was still tribal, and it may well be that scientists are correct in postulating that adaptation is slow. Homo sapiens are still tribal or tried to family or kin groups, rather than to the nations state. These ties to family and tribe may contribute to present day "ethnic cleansing" and the illusion of the notion of a family of all peoples. In the past, families had to be large in order to sustain life; there was still a high death rate which slowed population growth. Population reached 2 billion in 1930 after a million years of growth. Mankind's tinkering with nature produced science and technology, which eliminated the natural balance of mortality. The consequence was a doubling of population in 47 years between 1930 to 1977 to 4 billion people. BY 1987, in just 10 years, another billion was added. Homo sapiens must not act responsible and influence the birth side by practicing "contraception control." Unfortunately, the force of habit has obliterated the reasons for large families, and humans have "unwittingly defied procreation from being merely a means to the status of an end." There is nothing in the Bible that forbids contraception or mentions multiplying in an irresponsible way. Neither this vast increase in population, which presently grows at 95 million per year, nor scientific advancement has eliminated mortality or disease. Million suffer from malnutrition and starvation, and the distribution of resources has been unequal and moves in the direction of resource depletion and environmental degradation. The formula for living must change; families need to plan for few children. Fighting to kill as a means of population control is unacceptable. Human beings possess the intelligence to preserve individual and social human life in a responsible way.

Systematic review of birth cohort studies in Africa

PubMed Central

Campbell, Alasdair; Rudan, Igor

2011-01-01

Aim In sub-Saharan Africa, unacceptably high rates of mortality amongst women and children continue to persist. The emergence of research employing new genomic technologies is advancing knowledge on cause of disease. This review aims to identify birth cohort studies conducted in sub-Saharan Africa and to consider their suitability as a platform to support genetic epidemiological studies. Methods A systematic literature review was conducted to identify birth cohort studies in sub-Saharan Africa across the following databases: MEDLINE, EMBASE, AFRO and OpenSIGLE. A total of 8110 papers were retrieved. Application of inclusion/exclusion criteria retained only 189 papers, of which 71 met minimum quality criteria and were retained for full text analysis. Results The search revealed 28 birth cohorts: 14 of which collected biological data, 10 collected blood samples and only one study collected DNA for storage. These studies face many methodological challenges: notably, high rates of attrition and lack of funding for several rounds of study follow up. Population-based ‘biobanks’ have emerged as a major approach to harness genomic technologies in health research and yet the sub-Saharan African region still awaits large scale birth cohort biobanks collecting DNA and associated health and lifestyle data. Conclusion Investment in this field, together with related endeavours to foster and develop research capacity for these studies, may lead to an improved understanding of the determinants of intrauterine growth and development, birth outcomes such as prematurity and low birth weight, the links between maternal and infant health, survival of infectious diseases in the first years of life, and response to vaccines and antibiotic treatment. PMID:23198102

Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries.

PubMed

Chow, Clara K; Corsi, Daniel J; Gilmore, Anna B; Kruger, Annamarie; Igumbor, Ehimario; Chifamba, Jephat; Yang, Wang; Wei, Li; Iqbal, Romaina; Mony, Prem; Gupta, Rajeev; Vijayakumar, Krishnapillai; Mohan, V; Kumar, Rajesh; Rahman, Omar; Yusoff, Khalid; Ismail, Noorhassim; Zatonska, Katarzyna; Altuntas, Yuksel; Rosengren, Annika; Bahonar, Ahmad; Yusufali, AfzalHussein; Dagenais, Gilles; Lear, Scott; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Rangarajan, Sumathy; Teo, Koon; McKee, Martin; Yusuf, Salim

2017-03-31

This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio. 545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014. Community audits and surveys of adults (35-70 years, n=12 953). Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression models. Average tobacco control policy score was greater in communities from HIC. Overall 56.1% (306/545) of communities had >2 outlets selling cigarettes and in 28.6% (154/539) there was access to cheap cigarettes (<5cents/cigarette) (3.2% (3/93) in HIC, 0% UMIC, 52.6% (90/171) LMIC and 40.4% (61/151) in LIC). Effective bans (no tobacco advertisements) were in 63.0% (341/541) of communities (81.7% HIC, 52.8% UMIC, 65.1% LMIC and 57.6% LIC). In 70.4% (379/538) of communities, >80% of participants disapproved youth smoking (95.7% HIC, 57.6% UMIC, 76.3% LMIC and 58.9% LIC). The average knowledge score was >80% in 48.4% of communities (94.6% HIC, 53.6% UMIC, 31.8% LMIC and 35.1% LIC). Summary scores of policy implementation, social unacceptability and knowledge were positively and significantly associated with quit ratio and the associations varied by gender, for example, communities in the highest quintile of the combined scores had 5.0 times the quit ratio in men (Odds ratio (OR) 5·0, 95% CI 3.4 to 7.4) and 4.1 times the quit ratio in women (OR 4.1, 95% CI 2.4 to 7.1). This study suggests that more focus is needed on ensuring the tobacco control policy is actually implemented, particularly in LMICs. The gender-related differences in associations of policy, social unacceptability and knowledge suggest that different strategies to promoting quitting may need to be implemented in men compared to women. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Toward the definition of specific protection goals for the environmental risk assessment of chemicals: A perspective on environmental regulation in Europe.

PubMed

Brown, A Ross; Whale, Graham; Jackson, Mathew; Marshall, Stuart; Hamer, Mick; Solga, Andreas; Kabouw, Patrick; Galay-Burgos, Malyka; Woods, Richard; Nadzialek, Stephanie; Maltby, Lorraine

2017-01-01

This critical review examines the definition and implementation of environmental protection goals for chemicals in current European Union (EU) legislation, guidelines, and international agreements to which EU countries are party. The European chemical industry is highly regulated, and prospective environmental risk assessments (ERAs) are tailored for different classes of chemical, according to their specific hazards, uses, and environmental exposure profiles. However, environmental protection goals are often highly generic, requiring the prevention of "unacceptable" or "adverse" impacts on "biodiversity" and "ecosystems" or the "environment as a whole." This review aims to highlight working examples, challenges, solutions, and best practices for defining specific protection goals (SPGs), which are seen to be essential for refining and improving ERA. Specific protection goals hinge on discerning acceptable versus unacceptable adverse effects on the key attributes of relevant, sensitive ecological entities (ranging from organisms to ecosystems). Some isolated examples of SPGs for terrestrial and aquatic biota can be found in prospective ERA guidance for plant protection products (PPPs). However, SPGs are generally limited to environmental or nature legislation that requires environmental monitoring and retrospective ERA. This limitation is due mainly to the availability of baselines, which define acceptable versus unacceptable environmental effects on the key attributes of sentinel species, populations and/or communities, such as reproductive status, abundance, or diversity. Nevertheless, very few regulatory case examples exist in which SPGs incorporate effect magnitude, spatial extent, and temporal duration. We conclude that more holistic approaches are needed for defining SPGs, particularly with respect to protecting population sustainability, ecosystem function, and integrity, which are implicit in generic protection goals and explicit in the International Programme for Chemical Safety (IPCS) definition of "adverse effect." A possible solution, which the chemical industry is currently assessing, is wider application of the ecosystem services approach proposed by the European Food Safety Authority (EFSA) for the risk assessment of PPPs. Integr Environ Assess Manag 2017;13:17-37. © 2016 SETAC. © 2016 SETAC.

Bias due to Preanalytical Dilution of Rodent Serum for Biochemical Analysis on the Siemens Dimension Xpand Plus

PubMed Central

Johns, Jennifer L.; Moorhead, Kaitlin A.; Hu, Jing; Moorhead, Roberta C.

2018-01-01

Clinical pathology testing of rodents is often challenging due to insufficient sample volume. One solution in clinical veterinary and exploratory research environments is dilution of samples prior to analysis. However, published information on the impact of preanalytical sample dilution on rodent biochemical data is incomplete. The objective of this study was to evaluate the effects of preanalytical sample dilution on biochemical analysis of mouse and rat serum samples utilizing the Siemens Dimension Xpand Plus. Rats were obtained from end of study research projects. Mice were obtained from sentinel testing programs. For both, whole blood was collected via terminal cardiocentesis into empty tubes and serum was harvested. Biochemical parameters were measured on fresh and thawed frozen samples run straight and at dilution factors 2–10. Dilutions were performed manually, utilizing either ultrapure water or enzyme diluent per manufacturer recommendations. All diluted samples were generated directly from the undiluted sample. Preanalytical dilution caused clinically unacceptable bias in most analytes at dilution factors four and above. Dilution-induced bias in total calcium, creatinine, total bilirubin, and uric acid was considered unacceptable with any degree of dilution, based on the more conservative of two definitions of acceptability. Dilution often caused electrolyte values to fall below assay range precluding evaluation of bias. Dilution-induced bias occurred in most biochemical parameters to varying degrees and may render dilution unacceptable in the exploratory research and clinical veterinary environments. Additionally, differences between results obtained at different dilution factors may confound statistical comparisons in research settings. Comparison of data obtained at a single dilution factor is highly recommended. PMID:29497614

A Comparison of Spectacles Purchased Online and in UK Optometry Practice.

PubMed

Alderson, Alison J; Green, Alison; Whitaker, David; Scally, Andrew J; Elliott, David B

2016-10-01

To compare spectacles bought online with spectacles from optometry practices. Thirty-three participants consisting of single vision spectacle wearers with either a low (N = 12, mean age 34 ± 14 years) or high prescription (N = 11, mean age 28 ± 9 years) and 10 presbyopic participants (mean age 59 ± 4 years) wearing progressive addition lenses (PALs) purchased 154 pairs of spectacles online and 154 from UK optometry practices. The spectacles were compared via participant-reported preference, acceptability, and safety; the assessment of lens, frame, and fit quality; and the accuracy of the lens prescriptions to international standard ISO 21987:2009. Participants preferred the practice spectacles (median ranking 4th, IQR 1-6) more than online (6th, IQR 4-8; Mann-Whitney U = 7345, p < 0.001) and practice PALs (median ranking 2nd, IQR 1-4) were particularly preferred (online 6.5th, IQR 4-9, Mann-Whitney U = 455, p < 0.001). Of those deemed unacceptable and unsafe, significantly more were bought online (unacceptable: online 43/154 vs. practice 15/154, Fisher's exact p = 0.0001; unsafe: online 14/154 vs. practice 5/154, Fisher's exact p = 0.03). Participants preferred spectacles from optometry practice rather than those bought online, despite lens quality and prescription accuracy being similar. A greater number of online spectacles were deemed unsafe or unacceptable because of poor spectacle frame fit, poor cosmetic appearance, and inaccurate optical centration. This seems particularly pertinent to PAL lenses, which are known to increase falls risk. Recommendations are made to improve both forms of spectacle provision.

One State's Systems Change Efforts to Reduce Child Care Expulsion: Taking the Pyramid Model to Scale

ERIC Educational Resources Information Center

Vinh, Megan; Strain, Phil; Davidon, Sarah; Smith, Barbara J.

2016-01-01

This article describes the efforts funded by the state of Colorado to address unacceptably high rates of expulsion from child care. Based on the results of a 2006 survey, the state of Colorado launched two complementary policy initiatives in 2009 to impact expulsion rates and to improve the use of evidence-based practices related to challenging…

Paying our way: thinking strategically to offset the cost of reducing fire hazard in western forests.

Treesearch

Rhonda Mazza

2008-01-01

The fire hazard in many western forests is unacceptably high, posing risks to human health and property, wildlife habitat, and air and water quality. Cost is an inhibiting factor for reducing hazardous fuel, given the amount of acreage needing treatment. Thinning overly dense forests is one way to reduce fuel loads. Much of the product removed during these treatments...

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. PACTR201311000681314.

Using immunization delivery strategies to accelerate progress in Africa towards achieving the Millennium Development Goals.

PubMed

Clements, C John; Nshimirimanda, Deo; Gasasira, Alex

2008-04-07

Integration of health services brings together common functions within and between organizations to solve common problems, developing a commitment to a shared vision and goals, and using common technologies and resources to achieve these goals. Integration has been the frustrated rally call of Primary Health Care for 30 years. This paper discusses the process of integrating child survival strategies and other heath services with immunization in Africa. Immunization is arguably the most successful health programme throughout the continent, making it the logical vehicle for add-on services. Strong health systems are the best way of delivering cost-effective child survival interventions in a most sustainable manner. But the reality in many African countries is that health systems have been weak for a number of reasons. Joining additional cost-effective child survival interventions on to immunization services may provide the needed boost. The unacceptably high childhood mortality in parts of Africa makes it the ideal location to undertake this exercise. The urgency to scale-up child survival interventions that have proven cost-effective is especially important if the Millennium Development Goals (MDGs) are to be met by 2015. Africa has more to loose than most in failing to scale up to meet these goals, bearing as it does the highest burden of childhood mortality in the world. But so far, prospects do not look good for achieving MDG-4 for the countries with the highest mortality rates. The timeliness of this initiative towards integration could not be better. In the last five years, countries in Africa have received massive injections of financial resources for polio eradication and measles control as well as additional funding for a range of immunization-strengthening activities and the introduction of new and under-utilized vaccines. While the data to support integration are limited, the information to hand suggests the effectiveness of the strategy. Where immunization performance is strong, immunization contacts may be excellent vehicles for additional interventions such as de-worming or Integrated Management of Childhood Illness (IMCI). But where an immunization service is struggling, adding another child survival intervention on to immunization might be the straw that breaks its back. Health managers have a wide range of options for adding on to immunization services, but the best choice will depend very much on local situations.

[Analysis the relationship between the found ways and first diagnosis age for large vestibular aqueduct children].

PubMed

Yang, Yali; Huang, Lihui; Cheng, Xiaohua; Fu, Xinxing; Liu, Jiaxing; Ni, Tingting

2014-11-01

To explore the found ways and first diagnosis age of children with large vestibular aqueduct, and their relations with hearing loss. Medical histories of 122 cases of children diagnosed with large vestibular aqueduct by HRCT or MRI had been collected from January 2009 to April 2014 in our hospital children's hearing diagnosis center clinic. Found ways comprise of accepting universal newborn hearing screening (UNHS) group and unaccepting UNHS group. Accepting UNHS children were divided into two ears unpassing group, single ear unpassing group and passing group. The patients in unaccepting UNHS group were divided into not sensitive to sounds, speech stunting, sudden hearing loss, and other group. Analysis the relationship between the found ways and first diagnosis age and their relations with hearing loss. There are 84 cases (68.85%) accepting UNHS, the average age of first diagnosis was (17.24 ± 17.08) months; 37 cases (31.15%) are not accepting UNHS. The average age of first diagnosis was (30.92 ± 18.21) months. The average first diagnosis age of accepting UNHS group was more earlier than the unaccepting UNHS group. The difference was statistically signif- icant (P < 0.01). There were 57 cases (67.85%) whose two ears not pass UNHS; 15 cases (17.86%) single ear not pass; namely the referral rate was 85.71%; 12 cases (14.29%) pass the test. The first diagnosis age of passing UNHS group was more later than two ears unpassing group (P < 0.001). In the unaccepting UNHS group, the average first diagnosis age of not sensitive to sounds group (19.69 ± 11.16 months) was more earlier than words dysplasia group (37.13 ± 15.62 months) and sudden hearing loss group (47.40 ± 24.70 months) (P < 0.01). The difference in the degree of hearing loss between accepting UNHS and unaccepting UNHS group had no statistical significance (P > 0.05). In unaccepting UNHS group ,the average first diagnosis age of the mild-to-moderate hearing loss group was later than the very severe hearing loss group (P < 0.01). Most of large vestibular aqueduct children can be found and receive diagnosis early by UNHS. But part of these patients with late-onset or progressive hearing loss, especially these with mild-to-moderate hearing loss cannot be found early, which should arouse our attention.

Test and Evaluation Master Plan (TEMP) for the Navy Occupational Health Information Management System (NOHIMS). Appendix A through Appendix U.

DTIC Science & Technology

1985-04-24

reliability/ downtime/ communication lines/ man-machine interface/ other: 2. A noticeable (to the user) failure happens about and that number has been...improving/ steady/ getting.worse. 3. The number of failures /errors for NOHIMS is acceptable/ somewhat acceptable/ somewhat unacceptable/ unacceptable...somewhat fast/ somewhat slow/ slow. 7. When a NWHIMS failure occurs, it affects the day-to-day provision of medical care because work procedures must

Beliefs about Emotions, Depression, Anxiety and Fatigue: A Mediational Analysis.

PubMed

Sydenham, Mia; Beardwood, Jennifer; Rimes, Katharine A

2017-01-01

Beliefs that it is unacceptable to experience or express negative emotions have been found to be associated with various clinical problems. It is unclear how such beliefs, which could be viewed as a form of unhelpful perfectionism about emotions, may contribute to symptomatology. This study investigated two hypotheses: a) greater endorsement of beliefs about the unacceptability of negative emotions will be associated with greater emotional avoidance and lower levels of support-seeking and self-compassion; b) these beliefs about emotions will be associated with higher levels of symptoms of depression, anxiety and fatigue and that this relationship will be mediated by social support-seeking, emotional avoidance and self-compassion. Online questionnaires were completed by 451 community participants. Mediational analyses were undertaken to investigate emotional avoidance, social support-seeking and self-compassion as mediators of the relationship between beliefs about emotions and symptoms of depression, anxiety and fatigue. Beliefs about the unacceptability of negative emotions were significantly associated with more emotional avoidance and less self-compassion and support-seeking. The relationships between beliefs about emotions and depression, anxiety and fatigue were significantly mediated by self-compassion and emotional avoidance but not social support-seeking. Future research should investigate whether interventions that pay particular attention to emotional avoidance and self-compassion, such as mindfulness-based therapy or modified forms of CBT, may be beneficial in reducing distress and fatigue associated with beliefs about the unacceptability of negative emotions.

The attitudes of dental students towards socially acceptable and unacceptable group working practices.

PubMed

Sisson, K; Newton, J

2007-08-01

To explore the attitudes of undergraduate dental students towards academically unacceptable behaviour. Three sets of vignettes were designed exploring; attitudes towards sharing essays which students present as their own work (set 1), attitudes towards purchasing an essay from a commercial website (set 2), and attitudes towards working in a group (set 3). Eighty-nine dental students read the vignettes, then indicated whether they felt the student depicted should engage in the behaviour, and whether any assessment of the work would be a fair assessment of the student's ability. In addition for the group working vignette, respondents were asked to indicate whether in that situation they would speak to the tutor about their own contribution to the group product. Twenty-one respondents (24%) reported that students should share essays, 11 (12%) felt that the essay would be a fair assessment; 13 (15%) felt that students should buy commercially produced essays, five (6%) felt it would be a fair assessment. For the vignettes involving group work, 31 (35%) respondents felt that group-based assessments were fair, 65 (73%) of respondents felt it unlikely that they would speak to the tutor about their individual contribution. A disturbing proportion of dental students report that cheating is acceptable, the majority feel that unacceptable academic practices are not a fair indication of students' ability. The respondents reported that they were unlikely to report the unacceptable working practices of fellow students.

Pediatric nurses' differentiations between acceptable and unacceptable parent discipline behaviors: a Q-study.

PubMed

Ho, Grace W K; Gross, Deborah A

2015-01-01

Nurses are mandated to report suspected cases of child maltreatment. However, it is unclear how nurses decide what constitutes child abuse or evidence for reporting. It is crucial to examine how nurses define various forms of child maltreatment, including child abuse and its differentiation from physical discipline, to enhance our services to families with young children. The present study examined pediatric nurses' views on acceptable versus unacceptable discipline behaviors to better understand parent behaviors that nurses are likely to deem reportable to child protective services. Using Q methodology, a convenience sample of 48 pediatric nurses from one urban medical center sorted 71 statements related to the behavior or outcome of punishing a child via the Internet application FlashQ. The statements were sorted on a predefined continuum ranging from "Most Unacceptable" to "Most Acceptable." By-person factor analysis was used to uncover groups of nurses with similar sorts and to generate a unique sort that represented the viewpoint of nurses in that group. Two distinct viewpoints were uncovered. Although there was consensus on what constitutes most acceptable and most unacceptable parent behaviors, nurses varied on their endorsement of using physical force as a form of discipline, suggesting a potential for discrepant tendencies to identify and report child abuse. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

MRI-Guided Laser Interstitial Thermal Therapy for Epilepsy.

PubMed

North, Robert Y; Raskin, Jeffrey S; Curry, Daniel J

2017-10-01

MRI-guided laser interstitial thermal therapy for epilepsy (LITT-E) has become an established, minimally invasive alternative to traditional epilepsy surgery. LITT-E is particularly valuable in cases in which open surgery poses unacceptably high morbidity or patient preference precludes craniotomy. Here we present a focused review of technical details and application of LITT to both focal and generalized epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.

Comments on Economides and Ehlig-Economides,"Sequestering carbon dioxide in a closed underground volume," SPE 124430, October 2009

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

Oldenburg, Curt; Pruess, Karsten; Birkholzer, Jens

The paper examines the pressure increase resulting from injection of CO2 into a 1D radial system with closed boundaries. The finding is that unacceptably high pressures are obtained when only 1% or less of the pore volume is occupied by injected CO2. These results are used to make the general conclusion that large-scale CCS is not feasible.

Cardiac output and systemic vascular resistance: Clinical assessment compared with a noninvasive objective measurement in children with shock.

PubMed

Razavi, Asma; Newth, Christopher J L; Khemani, Robinder G; Beltramo, Fernando; Ross, Patrick A

2017-06-01

To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support. Two to 3 physicians clinically assessed cardiac output and systemic vascular resistance, categorizing them as high, normal, or low. An investigator simultaneously measured cardiac index (CI) and systemic vascular resistance index (SVRI) with USCOM categorized as high, normal, or low. Overall agreement between physician and USCOM for CI (48.5% [κ = 0.18]) and SVRI (45.9% [κ = 0.16]) was poor. Interobserver agreement was also poor for CI (58.7% [κ = 0.33]) and SVRI (52.3% [κ = 0.28]). Comparing theoretical physician interventions to "acceptable" or "unacceptable" clinical interventions, based on USCOM measurement, 56 (21%) physician interventions were found to be "unacceptable." There is poor agreement between physician-assessed CI and SVRI and USCOM, with significant interobserver variability among physicians. Objective measurement of CI and SVRI may reduce variability and improve diagnostic accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

A Comparison of Spectacles Purchased Online and in UK Optometry Practice

PubMed Central

Alderson, Alison J.; Green, Alison; Whitaker, David; Scally, Andrew J.; Elliott, David B.

2016-01-01

ABSTRACT Purpose To compare spectacles bought online with spectacles from optometry practices. Methods Thirty-three participants consisting of single vision spectacle wearers with either a low (N = 12, mean age 34 ± 14 years) or high prescription (N = 11, mean age 28 ± 9 years) and 10 presbyopic participants (mean age 59 ± 4 years) wearing progressive addition lenses (PALs) purchased 154 pairs of spectacles online and 154 from UK optometry practices. The spectacles were compared via participant-reported preference, acceptability, and safety; the assessment of lens, frame, and fit quality; and the accuracy of the lens prescriptions to international standard ISO 21987:2009. Results Participants preferred the practice spectacles (median ranking 4th, IQR 1–6) more than online (6th, IQR 4–8; Mann-Whitney U = 7345, p < 0.001) and practice PALs (median ranking 2nd, IQR 1–4) were particularly preferred (online 6.5th, IQR 4–9, Mann-Whitney U = 455, p < 0.001). Of those deemed unacceptable and unsafe, significantly more were bought online (unacceptable: online 43/154 vs. practice 15/154, Fisher’s exact p = 0.0001; unsafe: online 14/154 vs. practice 5/154, Fisher’s exact p = 0.03). Conclusions Participants preferred spectacles from optometry practice rather than those bought online, despite lens quality and prescription accuracy being similar. A greater number of online spectacles were deemed unsafe or unacceptable because of poor spectacle frame fit, poor cosmetic appearance, and inaccurate optical centration. This seems particularly pertinent to PAL lenses, which are known to increase falls risk. Recommendations are made to improve both forms of spectacle provision. PMID:27536974

Predicting children's behaviour during dental treatment under oral sedation.

PubMed

Lourenço-Matharu, L; Papineni McIntosh, A; Lo, J W

2016-06-01

The primary aim of this study was to assess whether parents' own anxiety and their perception of their child's dental fear and child's general fear can predict preoperatively their child's behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child's age, gender and ASA classification grade are associated with a child's behaviour under oral sedation. Cross-sectional prospective study. The Corah's Dental Anxiety Scale (DAS), Children's Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children's Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ (2), t test and logistic regression analysis. In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children. The level of a child's dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child's dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33-3.88, p = 0.003). CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.

The needs of persons with lupus and health care providers: a qualitative study aimed toward the development of the Lupus Interactive Navigator™.

PubMed

Neville, C; Da Costa, D; Mill, C; Rochon, M; Aviña-Zubieta, J A; Pineau, C A; Eng, D; Fortin, P R

2014-02-01

Systemic lupus erythematosus is an inflammatory autoimmune disease associated with high morbidity and unacceptable mortality. A major challenge for persons with lupus is coping with their illness and complex care. Our objective was to identify the informational and resource needs of persons with lupus, rheumatologists, and allied health professionals treating lupus. Our findings will be applied toward the development of an innovative web-based technology, the Lupus Interactive Navigator (LIN™), to facilitate and support engagement and self-management for persons with lupus. Eight focus groups were conducted: four groups of persons with lupus (n=29), three groups of rheumatologists (n=20), and one group of allied health professionals (n=8). The groups were held in British Columbia, Ontario, and Quebec. All sessions were audio-recorded and transcribed verbatim. Qualitative analysis was performed using grounded theory. The transcripts were reviewed independently and coded by the moderator and co-moderator using 1) qualitative data analysis software developed by Provalis Research, Montreal, Canada, and 2) manual coding. Four main themes emerged: 1) specific information and resource needs; 2) barriers to engagement in health care; 3) facilitators of engagement in health care; and 4) tools identified as helpful for the self-management of lupus. These findings will help guide the scope of LIN™ with relevant information topics and specific tools that will be most helpful to the diverse needs of persons with lupus and their health care providers.

Impact of increasing capacity for generating and using research on maternal and perinatal health practices in South East Asia (SEA-ORCHID Project).

PubMed

Lumbiganon, P; McDonald, S J; Laopaiboon, M; Turner, T; Green, S; Crowther, C A

2011-01-01

Maternal and neonatal mortality and morbidity remain unacceptably high in many low and middle income countries. SEA-ORCHID was a five year international collaborative project in South East Asia which aimed to determine whether health care and health outcomes for mothers and babies could be improved by developing capacity for research generation, synthesis and use. Nine hospitals in Indonesia, Malaysia, the Philippines and Thailand participated in SEA-ORCHID. These hospitals were supported by researchers from three Australian centres. Health care practices and outcomes were assessed for 1000 women at each hospital both before and after the intervention. The capacity development intervention was tailored to the needs and context of each hospital and delivered over an 18 month period. Main outcomes included adherence to forms of care likely to be beneficial and avoidance of forms of care likely to be ineffective or harmful. We observed substantial variation in clinical practice change between sites. The capacity development intervention had a positive impact on some care practices across all countries, including increased family support during labour and decreased perineal shaving before birth, but in some areas there was no significant change in practice and a few beneficial practices were followed less often. The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change.

Alcohol and hospitalized road traffic injuries in the Philippines.

PubMed

O'Connor, Lydia R; Ruiz, Roberto Andres Llanes

2014-09-01

Each year, there are approximately 1.24 million deaths due to road traffic injuries, the majority of which occur in low- and middle-income countries. Since 2008, 35 countries have passed legislation to implement road safety strategies. However, many countries have yet to pass comprehensive legislation while others lack adequate enforcement of current policies. The annual global mortality rate due to road trauma remains unacceptably high and reflects the need for governments to prioritize the passage and implementation of road safety legislation. Alcohol is a leading risk factor for road trauma globally and the leading cause of death and disability in the Western Pacific region. Despite the overwhelming evidence that strict enforcement of drunk-driving policies can lead to a drastic reduction in alcohol-related road incidents, many countries in the Western Pacific lack sufficient data that could facilitate the design of appropriate drunk-driving interventions. This paper provides an analysis of the current status of policies and attitudes related to alcohol and road injuries throughout the Western Pacific region, with a specific focus on the Philippines. Following the passage of drunk-driving legislation in 2013, a medical records review of alcohol-related road trauma patients in Manila Doctors Hospital was conducted. The findings of this pilot project further highlight the pervasive problem of missing or unreliable data regarding alcohol's role in road trauma. Assessing the burden of drunk driving is an important step in designing effective interventions and systematically changing attitudes about driving under the influence.

Epidemiology of violent deaths in the world

PubMed Central

Reza, A; Mercy, J; Krug, E

2001-01-01

Objective—This study describes epidemiologic patterns of mortality due to suicide, homicide, and war for the world in order to serve as a benchmark against which to measure future progress and to raise awareness about violence as a global public health problem. Setting—The world and its eight major regions. Method—Data were derived from The Global Burden of Disease series and the US National Center for Health Statistics to estimate crude rates, age adjusted rates, sex rate ratios, and the health burden for suicide, homicide, and war related deaths for the world and its eight major regions in 1990. Results—In 1990, an estimated 1 851 000 people died from violence (35.3 per 100 000) in the world. There were an estimated 786 000 suicides. Overall suicide rates ranged from 3.4 per 100 000 in Sub-Saharan Africa to 30.4 per 100 000 in China. There were an estimated 563 000 homicides. Overall homicide rates ranged from 1.0 per 100 000 in established market economies to 44.8 per 100 000 in Sub-Saharan Africa with peaks among males aged 15–24 years old, and among females aged 0–4 years old. There were an estimated 502 000 war related deaths with peaks in rates for both sexes among people aged 0–4, 15–29, and 60–69 years old. Conclusion—The number of violence related deaths in the world is unacceptably high. Coordinated prevention and control efforts are urgently needed. PMID:11428556

Transcatheter Potts shunt creation in patients with severe pulmonary arterial hypertension: initial clinical experience.

PubMed

Esch, Jesse J; Shah, Pinak B; Cockrill, Barbara A; Farber, Harrison W; Landzberg, Michael J; Mehra, Mandeep R; Mullen, Mary P; Opotowsky, Alexander R; Waxman, Aaron B; Lock, James E; Marshall, Audrey C

2013-04-01

Patients with severe pulmonary arterial hypertension (PAH) face significant morbidity and death as a consequence of progressive right heart failure. Surgical shunt placement between the left PA and descending aorta (Potts shunt) appears promising for PAH palliation in children; however, surgical mortality is likely to be unacceptably high in adults with PAH. We describe a technique for transcatheter Potts shunt (TPS) creation by fluoroscopically guided retrograde needle perforation of the descending aorta at the site of apposition to the left PA to create a tract for deployment of a covered stent between these vessels. This covered stent-anchored by the vessel walls and surrounding tissue-serves as the shunt. TPS creation was considered in 7 patients and performed in 4. The procedure was technically successful in 3 patients; 1 patient died during the procedure as a result of uncontrolled hemothorax. One acute survivor, critically ill at the time of TPS creation, later died of comorbidities. The 2 mid-term survivors (follow-up of 10 and 4 months) are well at home, with symptomatic improvement and no late complications. The 3 candidate patients in whom the procedure was not performed died within 1 month of consideration, underscoring the tenuous nature of this population. TPS creation is feasible and may offer symptomatic relief to select patients with refractory PAH. Further study of this innovative approach is warranted. Copyright © 2013 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

The Effect of Soil Properties on Metal Bioavailability: Field Scale Validation to Support Regulatory Acceptance

DTIC Science & Technology

2014-06-01

unacceptable levels of the toxic metal(loid)s arsenic (As), cadmium (Cd), chromium (Cr), and lead (Pb). With the exception of Pb contaminated soils, human...remediation and closure. Lead (Pb), arsenic (As), chromium (Cr), and cadmium (Cd) are toxic (i.e., capable of producing an unwanted, deleterious effect...lagoon are contaminated with high concentrations of lead , chromium, and cadmium . 14 Deseret Chemical Depot: The Deseret Chemical Depot is

Management of post-neurosurgical meningitis: narrative review.

PubMed

Hussein, K; Bitterman, R; Shofty, B; Paul, M; Neuberger, A

2017-09-01

Infections complicating neurosurgery pose unacceptable mortality and morbidity. To summarize what is known about the epidemiology, diagnosis and treatment of post-neurosurgical meningitis (PNM). PubMed, references of identified studies and reviews, and personal experience when evidence was lacking. The incidence and pathogen distribution of PNM is highly variable. A shift towards Gram-negative bacteria has been observed with use of antibiotic prophylaxis and antibiotic-coated devices directed mainly against Gram-positive bacteria. However, knowledge of the local epidemiology is necessary to treat PNM. The diagnosis of PNM is difficult because, unlike community-acquired meningitis, symptoms are less specific; patients are ill at baseline and many neurosurgical conditions mimic meningitis and cause cerebrospinal fluid (CSF) abnormalities. Pivotal CSF findings for diagnosis of PNM are the CSF glucose, CSF lactate and Gram stain. CSF leucocyte counts are not specific in PNM. Current diagnostic capabilities leave a non-negligible category of patients with microbiologically negative, uncertain diagnosis of PNM. There is no high-quality evidence on several cardinal issues in PNM management, including the effectiveness of intraventricular or intrathecal (IV/IT) antibiotics, effectiveness of dual antibiotic therapy for multidrug-resistant Gram-negative bacteria; clinical benefit of routine therapeutic drug monitoring; and safest timing of shunt replacement. Some data point to a potential benefit of IV/IT antibiotic treatment, mainly for PNM caused by carbapenem-resistant Gram-negative bacteria. Carbapenem-colistin combination therapy is suggested for PNM caused by carbapenem-resistant Gram-negative bacteria with a carbapenem MIC ≤8 mg/L. Guiding the optimal management of PNM will necessitate collaborative multicentre efforts and unique study designs. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Health inequities, environmental insecurity and the attainment of the millennium development goals in sub-Saharan Africa: the case study of Zambia.

PubMed

Anyangwe, Stella C E; Mtonga, Chipayeni; Chirwa, Ben

2006-09-01

The United Nations Millennium Development Goals (MDGs) are a series of 8 goals and 18 targets aimed at ending extreme poverty by 2015, and there are 48 quantifiable indicators for monitoring the process. Most of the MDGs are health or health-related goals. Though the MDGs might sound ambitious, it is imperative that the world, and sub-Saharan Africa in particular, wake up to the persistent and unacceptably high rates of extreme poverty that populations live in, and find lasting solutions to age-old problems. Extreme poverty is a cause and consequence of low income, food insecurity and hunger, education and gender inequities, high disease burden, environmental degradation, insecure shelter, and lack of access to safe drinking water and basic sanitation. It is also directly linked to unsound governance and inequitable distribution of public wealth. While many regions in the world will strive to attain the MDGs by 2015, most of the countries in sub-Saharan Africa, with major human development challenges associated with socio-economic disparities, will not. Zambia's MDG progress reports of 2003 and 2005 show that despite laudable political commitment and some advances made towards achieving universal primary education, gender equality, improvement of child health and management of the HIV/AIDS epidemic, it is not likely that Zambia will achieve even half of the goals. Zambia's systems have been weakened by high disease burden and excess mortality, natural and man-made environmental threats and some negative effects of globalization such as huge external debt, low world prices for commodities and the human resource "brain drain", among others. Urgent action must follow political will, and some tried and tested strategies or "quick wins" that have been proven to produce high positive impact in the short term, need to be rapidly embarked upon by Zambia and other countries in sub-Saharan Africa if they are to achieve the Millennium Development Goals.

Mozambique.

PubMed

1982-10-01

Focus in this discussion of Mozambique is on the following: history of the demographic situation; the government's overall approach to population problems; population data systems and development planning; institutional arrangements for the integration of population within development planning; the government's view of the importance of population policy in achieving development objectives; population size, growth, and natural increase; morbidity and mortality; fertility; international migration; and spatial distribution. According to the 1970 general census, Mozambique's population totaled 8.2 million with an estimated annual rate of natural increase of 2.2%. According to the UN Population Division, the crude birthrate for the 1975-80 period was estimated at 44.8/1000 population and the crude death rate at 19.0/1000; life expectancy at birth was estimated at 46 years for both sexes. In 1974 Mozambique achieved independence. From the time of Independence, the government planners have emphasized the reconstruction of agriculture and associated elements of the rural economy. In later stages, emphasis is to be given to associated secondary industries and to construction of heavy industry. Although the government is not known to have expressed a policy with regard to the demographic situation as a whole, it has taken a position concerning some aspects of spatial distribution and emigration. The government has also formulated and implemented certain health policies that emphasize maternal and child health, family planning, and the status of women. These policies have been formulated as components of social policy. There are no institutions specifically established to integrate population with development planning. The government considers levels and trends of population growth to be satisfactory because the country's natural resources are very large given the current population. The UN estimates the level of infant mortality for 1980-85 to be high at 110 deaths/1000 live births. The government considers the levels and trends of morbidity and mortality to be unacceptable because they are too high and are among the most serious problems confronting the country. The government has launched an enthusiastic campaign to eliminate unhygienic traditions, giving priority to preventive medicine in line with the current capacity and facilities of the country. In 1980 the UN estimated the gross and net reproduction rates as 3.0 and 2.1 respectively for the 1975-80 period, the total fertility rate as 6.1, and a general fertility rate of 196/1000 women. The government considers the levels and trends of fertility to be satisfactory in relation to population growth, though it may consider them somewhat unsatisfactory in relation to family well-being. The government considers present levels and trends of emigration to be not significant and satisfactory and its present population distribution as appropriate.

Testing of selected pharmacological agents for capturing waterfowl [Annual Progress Report

USGS Publications Warehouse

Cline, D.R.

1970-01-01

The response of game-farm mallards (Frost strain) to seven pharmacological immobilizing agents was evaluated in Phase I of a planned four-phase study. A limited amount of testing was also done with wild mallards. Single dosages were administered to determine the mean effective dose (ED50) and mean lethal dose (LD50), The therapeutic index, or safety factor (LD50/ED50), and palatability were also established. Optimum dosage rates of compounds administered orally on baits were not considered in this phase of the study. Compounds were-administered by intubation and calculated in terms of mg/kg. All except one compound produced narcosis within 5 minutes at the effective dose rate.Immobilization periods for the seven compounds ranged from 7-24 minutes, and recovery periods from 1.0-6.5 hours. Such wide variations in actions of the compounds can be attributed to a compound's rate of absorption, the ease with which it passes the blood-brain barrier, its solubility in tissues, and its rate of metabolism in the liver and kidneys. Length of both the immobilization and recovery periods were extended when dosages were increased. There was no delayed mortality among survivors with any of the seven compounds at either the ED50 or LD50. Females were generally more sensitive to the anesthetizing agents than males. The ED50 for wild mallards was substantially higher than that for the experimental game-farm birds for the two compounds on which this was tested.Tribromoethanol (Avertin of Winthrop Laboratories) satisfied all test criteria an Phase I and will be subjected to more intensive investigation in ensuing tests. Thiopental sodium (Pentothal of Amdal Company) and pentobarbital sodium (Nembutal of Abbott Laboratories) were judged to be marginal. Although their therapeutic indexes were good (5.00), recovery periods were prolonged and toxic convulsions occurred at medium to high dose rates as the LD50 was approached.Alpha-chloralose (Fisher Scientific) proved least promising of the seven compounds, mainly because of its unacceptable therapeutic index (2.25) and because it possesses prolonged induction and recovery periods. Two new experimental drugs, methoxymol and metomidate (Pitman-Moore), appeared effective and safe when administered by intubation but produced a taste aversion when added to bait. Rejection because of taste was also a problem with secobarbital (Seconal of Elanco Products), and its therapeutic index of 2.75 was unacceptable. Monitoring of heart and respiratory rates, and body temperature by telemetry showed promise as a technique for determining physiological response to drug action.

Quality Assurance in Trichiasis Surgery: a methodology

PubMed Central

Buchan, John C; Limburg, Hans; Burton, Matthew J

2013-01-01

SUMMARY Trachoma remains a significant cause of blindness in many parts of the world. The major route to blindness involves upper lid entropion leading to trachomatous trichiasis (TT) which promotes progressive corneal opacification. The provision of surgery to correct TT in the populations most severely affected is a major challenge for the global effort to eliminate Trachoma blindness by the year 2020. Most attention has been paid to increasing the quantity of TT surgery performed, and large numbers of non-doctor operators have been trained to this end. Surgical audit by those performing TT surgery is not a routine part of any national trachoma control programme, and no effective mechanism exists for identifying surgeons experiencing poor outcomes. We propose a methodology for surgical audit at the level of the individual surgeon based on Lot Quality Assurance. A set number of patients operated on previously for upper eyelid TT are examined to detect the recurrence of TT. The number of recurrent cases found will lead to categorisation of the TT surgeon to either “high recurrence” or “low recurrence” with reasonable confidence. The threshold of unacceptability can be set by individual programmes according to previous local studies of recurrence rates or those from similar settings. Identification of surgeons delivering unacceptably high levels of recurrent TT will guide managers on the need for remedial intervention such as re-training. PMID:20881027

Proceedings of the National Conference on Climate Change and Water Resources Management (1st) Held in Albuquerque, New Mexico on November 4-7, 1991

DTIC Science & Technology

1993-12-01

mean water temperatures are not much in excess of 25° C . From the global climate model predictions summarized in Figures 4 and 5, all the models suggest...that the mean diurnal water temperatures could exceed 25° C under high-summer conditions, with water temperatures rising to around 30’ C or more for some...allocation, C = 41,500 acre-feet, a 20 percent increase in the mean inflow produces what we consider a priori to be an unacceptably high flood

Cataract, cost: curious questions.

PubMed

Moran, D J

1999-02-01

An investigation of the pricing of implantable prosthetic devices in Australia reveals some alarming practices. A governmental mechanism exists to prop up the pricing of 7500 listed devices to levels that are unacceptably high by world standards. Private hospitals and doctors are able, legally, to profit by marking up the cost of these devices from the market price to this artificially inflated price. Even the open market prices of implantable prosthetic items, such as intra-ocular lenses, are high by international standards. In a time of budgetary constraint for health spending and rapidly increasing use of these devices, these issues urgently need to be addressed in Australia.

Nonproliferation Challenges in Space Defense Technology - PANEL

NASA Technical Reports Server (NTRS)

Houts, Michael G.

2016-01-01

The use of highly enriched uranium (HEU) almost always "helps" space fission systems. Nuclear Thermal Propulsion (NTP) and high power fission electric systems appear able to use < 20% enriched uranium with minimal / acceptable performance impacts. However, lower power, "entry level" systems may be needed for space fission technology to be developed and utilized. Low power (i.e. approx.1 kWe) fission systems may have an unacceptable performance penalty if LEU is used instead of HEU. Are there Ways to Support Non-Proliferation Objectives While Simultaneously Helping Enable the Development and Utilization of Modern Space Fission Power and Propulsion Systems?

Thermal Control Method for High-Current Wire Bundles by Injecting a Thermally Conductive Filler

NASA Technical Reports Server (NTRS)

Rodriguez-Ruiz, Juan; Rowles, Russell; Greer, Greg

2011-01-01

A procedure was developed to inject thermal filler material (a paste-like substance) inside the power wire bundle coming from solar arrays. This substance fills in voids between wires, which enhances the heat path and reduces wire temperature. This leads to a reduced amount of heat generated. This technique is especially helpful for current and future generation high-power spacecraft (1 kW or more), because the heat generated by the power wires is significant enough to cause unacceptable overheating to critical components that are in close contact with the bundle.

Damping Goes the Distance in Golf

NASA Technical Reports Server (NTRS)

2004-01-01

In the late 1980s, Dr. Benjamin Dolgin of NASA s Jet Propulsion Laboratory developed a concept for a high-damping graphite/viscoelastic material for the Strategic Defense Initiative (popularly referred to as "Star Wars"), as part of a space-based laser anti-missile program called "Asterix." Dolgin drummed up this concept with the intention of stabilizing weapons launch platforms in space, where there is no solid ground to firmly support these structures. Without the inclusion of high-damping material, the orbital platforms were said to vibrate for 20 minutes after force was applied - a rate deemed "unacceptable" by leaders of the Strategic Defense Initiative.

Lung Transplant in Patients with Scleroderma Compared with Pulmonary Fibrosis. Short- and Long-Term Outcomes.

PubMed

Crespo, Maria M; Bermudez, Christian A; Dew, Mary Amanda; Johnson, Bruce A; George, M Patricia; Bhama, Jay; Morrell, Matthew; D'Cunha, Jonathan; Shigemura, Norihisa; Richards, Thomas J; Pilewski, Joseph M

2016-06-01

Patients with advanced lung disease due to systemic sclerosis have long been considered suboptimal and often unacceptable candidates for lung transplant. To examine post-lung transplant survival of patients with systemic sclerosis compared with patients with pulmonary fibrosis and to identify risk factors for 1-year mortality. In a retrospective cohort study, we compared post-lung transplant outcomes of 72 patients with scleroderma with those of 311 patients with pulmonary fibrosis between June 2005 and September 2013 at our institution. Actuarial survival estimates were calculated using Kaplan-Meier curves. In Cox regression models, we determined risk factors for post-transplant mortality, controlling for whether patients had scleroderma or pulmonary fibrosis. Post-transplant survival did not differ significantly between scleroderma and pulmonary fibrosis at year 1 (81% scleroderma vs. 79% pulmonary fibrosis; P = 0.743), at year 5 conditional on 1-year survival (66% vs. 58%; P = 0.249), or overall (P = 0.385). In multivariate analysis, body mass index greater than or equal to 35 kg/m(2) predicted poor 1-year survival in pulmonary fibrosis (hazard ratio, 2.76; P = 0.003). Acute cellular rejection-free survival did not differ significantly between the scleroderma and pulmonary fibrosis cohorts. Patients with scleroderma had significantly better bronchiolitis obliterans syndrome stage 1 or higher-free survival than did patients with pulmonary fibrosis. Our findings that 1- and 5-year survival rates of patients with scleroderma were similar to those of patients with pulmonary fibrosis indicate that lung transplant is a reasonable treatment option in selected patients with scleroderma.

A Framework to Evaluate Wildlife Feeding in Research, Wildlife Management, Tourism and Recreation.

PubMed

Dubois, Sara; Fraser, David

2013-10-11

Feeding of wildlife occurs in the context of research, wildlife management, tourism and in opportunistic ways. A review of examples shows that although feeding is often motivated by good intentions, it can lead to problems of public safety and conservation and be detrimental to the welfare of the animals. Examples from British Columbia illustrate the problems (nuisance animal activity, public safety risk) and consequences (culling, translocation) that often arise from uncontrolled feeding. Three features of wildlife feeding can be distinguished: the feasibility of control, the effects on conservation and the effects on animal welfare. An evaluative framework incorporating these three features was applied to examples of feeding from the literature. The cases of feeding for research and management purposes were generally found to be acceptable, while cases of feeding for tourism or opportunistic feeding were generally unacceptable. The framework should allow managers and policy-makers to distinguish acceptable from unacceptable forms of wildlife feeding as a basis for policy, public education and enforcement. Many harmful forms of wildlife feeding seem unlikely to change until they come to be seen as socially unacceptable.

Perineal hygiene in patients with pelvic fractures.

PubMed

Hossain, Mohammad A; Pearce, Rachel; Bircher, Martin D

2008-08-01

At the tertiary referral Orthopaedic Unit of St. Georges Hospital, it was noted that there was an unacceptably high number of soiled perinea in patients transferred from Base Hospitals. This not only exposed the patients to increased infection [Jepsen O. The effectiveness of preoperative skin preparations: an integrated review of the literature. AORN J 1993;58:477-82; and Nix D, Ermer-Seltun J. A review of perineal skin care protocols and skin barrier product use. Ostomy Wound Manage 2004;50:59-67] but was also undignified and unacceptable for them. We decided to audit the problem with a view to finding out why this was happening and to improve the situation. A 2-year study was carried out over three distinct phases (phase 1: February-June 2004, phase 2: July-November 2004, phase 3: February-November 2005). Observations of soiling were recorded in a questionnaire by the surgeon prior to surgery. Key system and clinical guidelines were implemented during the second phase, and the audit process was repeated. The percentage of clean perinea in phase 1 was 32%, phase 2 68% and phase 3 99.5% indicating a clear improvement in the overall system.

Prevalence and predictors of postoperative pain after ear, nose, and throat surgery.

PubMed

Sommer, Michael; Geurts, José W J M; Stessel, Bjorn; Kessels, Alfons G H; Peters, Madelon L; Patijn, Jacob; van Kleef, Maarten; Kremer, Bernd; Marcus, Marco A E

2009-02-01

To determine postoperative pain in different types of ear, nose, and throat (ENT) surgery and their psychological preoperative predictors. Prospective cohort study. Academic hospital. A total of 217 patients undergoing ENT surgery. All ENT, neck, and salivary gland surgery. Postoperative pain and predictors for postoperative pain. Fifty percent of the patients undergoing surgery on the oral, pharyngeal, and laryngeal region and on the neck and salivary gland region had a visual analog scale score higher than 40 mm on day 1. In the patients who underwent oropharyngeal region operations the VAS score remained high on all 4 days. A VAS pain score higher than 40 mm was found in less than 30% of patients after endoscopic procedures and less than 20% after ear and nose surgery. After bivariate analysis, 6 variables--age, sex, preoperative pain, expected pain, short-term fear, and pain catastrophizing--had a predictive value. Multivariate analysis showed only preoperative pain, pain catastrophizing, and anatomical site of operation as independent predictors. Differences exist in the prevalence of unacceptable postoperative pain between ENT operations performed on different anatomical sites. A limited set of variables can be used to predict the occurrence of unacceptable postoperative pain after ENT surgery.

Unintentional injury outcomes secondary to pedestrian traffic crashes: a descriptive analysis from a major medical center.

PubMed

Ifesanya, Adeleke O; Afuwape, Dolapo; Okoje, Victoria N; Agunloye, Atinuke; Odole, Olusola; Okolo, Clement A; Alonge, Temitope O

2009-01-01

An environment in which traffic regulations are not strictly enforced often is characterized by carnage from motor vehicular crashes resulting in severe injuries with unacceptably high mortality. The descriptive demographics and injury characteristics of pedestrian road crash victims presenting to a tertiary medical center in southwestern Nigeria are presented in order to provide baseline epidemiology as a first step in determining areas of potential mitigation for care of unintentional injuries. Consecutive pedestrian road traffic crash patients treated in the Accident and Emergency Department of a tertiary hospital were prospectively reviewed from March 2007 to February 2008 to determine baseline demographics and clinical outcomes. A total of 184 patients with a mean value of the ages of 31.4 years were studied; 27% of the patients were <11 years of age. The male to female ratio was 1.6:1. Fifty-four percent of the victims were struck by automobiles and 29% were struck by motorcycles. Sixty-five percent were struck while crossing common thoroughfares. Head injury was sustained in 61% of patients. The mortality rate was 31.0% (n = 57). The clinical course leading to death showed 22.8% of the patients who died initially experienced hemorrhagic shock, 17.5% suffered a severe head injury, and 17.5% suffered aspiration. Autopsy confirmed brainstem herniation in 28.1% of the patients who died. The average interval between injury and death was 5.5 +/-13.6 days (range: 0-77 days). In this setting, three out of every ten patients experiencing pedestrian vehicular trauma will die before leaving the hospital. The elderly are most at risk, with two-thirds of victims dying from injuries sustained. This raises serious questions about the prehospital- and hospital-based emergency services for vehicular road crash victims in this environment, and confirms the World Health Organization findings that Africa has the highest rate overall for unintentional injury deaths. A system-wide program must be put in place that addresses proven prevention measures across all sectors of the community.

The relationship of women's status and empowerment with skilled birth attendant use in Senegal and Tanzania.

PubMed

Shimamoto, Kyoko; Gipson, Jessica D

2015-07-24

Maternal mortality remains unacceptably high in sub-Saharan Africa with 179,000 deaths occurring each year, accounting for 2-thirds of maternal deaths worldwide. Progress in reducing maternal deaths and increasing Skilled Birth Attendant (SBA) use at childbirth has stagnated in Africa. Although several studies demonstrate the important influences of women's status and empowerment on SBA use, this evidence is limited, particularly in Africa. Furthermore, few studies empirically test the operationalization of women's empowerment and incorporate multidimensional measures to represent the potentially disparate influence of women's status and empowerment on SBA use across settings. This study examined the relationship of women's status and empowerment with SBA use in two African countries--Senegal and Tanzania--using the 2010 Demographic and Health Surveys (weighted births n = 10,688 in SN; 6748 in TZ). Factor analysis was first conducted to identify the structure and multiple dimensions of empowerment. Then, a multivariate regression analysis was conducted to examine associations between these empowerment dimensions and SBA use. Overall, women's status and empowerment were positively related to SBA use. Some sociodemographic characteristics showed similar effects across countries (e.g., age, wealth, residence, marital relationship, parity); however, women's status and empowerment influence SBA use differently by setting. Namely, women's education directly and positively influenced SBA use in Tanzania, but not in Senegal. Further, each of the dimensions of empowerment influenced SBA use in disparate ways. In Tanzania women's higher household decision-making power and employment were related to SBA use, while in Senegal more progressive perceptions of gender norms and older age at first marriage were related to SBA use. This study provides evidence of the disparate influences of women's status and empowerment on SBA use across settings. Results indicate that efforts to increase SBA use and to reduce maternal mortality through the improvement of women's status and empowerment should focus both on improving girls' education and delaying marriage, as well as transforming gender norms and decision-making power. However, given the multi-dimensional and contextual nature of women's status and empowerment, it is critical to identify key drivers to increase SBA use in a given setting for contextually tailored policy and programming.

Integrated controls for a new aircraft generation

NASA Technical Reports Server (NTRS)

Mace, W. D.; Howell, W. E.

1978-01-01

Many of the commercial aircraft now flying will have to be phased out in the early 1980s because of fuel inefficiency and unacceptable noise levels. This paper discusses the role of new digital technology in making aircraft more fuel efficient, more reliable, and quieter. Attention is given to the integration of sensing and control functions in an aircraft in order to provide a simple, lightweight, and high-redundancy system. Technology under development now is expected to come on-line in the 1990s.

Behavior of hydrogen in alpha-iron at lower temperatures

NASA Technical Reports Server (NTRS)

Weizer, V. G.

1973-01-01

Evidence is presented that the low temperature anomalies in the hydrogen occlusive behavior of alpha iron can be explained by means of a molecular occlusion theory. This theory proposes that the stable state of the absorbed hydrogen changes from atomic at high temperatures to molecular as the temperature is lowered below a critical value. Theories proposing to explain the anomalous behavior as being due to the capture, at lower temperatures, of hydrogen in traps are shown to be unacceptable.

Universal Health Coverage - The Critical Importance of Global Solidarity and Good Governance Comment on "Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage".

PubMed

Reis, Andreas A

2016-06-07

This article provides a commentary to Ole Norheim' s editorial entitled "Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage." It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC). © 2016 by Kerman University of Medical Sciences.

Ghana.

PubMed

1981-09-01

The government of Ghana sees the country's population as a valuable natural resource and emphasizes national population policy as an important part of overall socioeconomic planning and development. A formal system of development planning has been in effect since 1951. Decennial censuses are conducted relatively regularly but vital registration is thought to be incomplete. The current population size is 11,679,000 and the current rate of natural increase (3.1%) is considered too high, constraining the achievement of socioeconomic development. The high rate of growth is taxing on employment and public services. High fertility rates are influenced both by regional norms, such as early and universal marriage, and demographic factors, i.e., an increasingly higher proportion of the population in the 0-14 age group. The government sponsors family planning services which can be obtained free or at subsidized rates and seeks to upgrade the health and living standards of the population. Sterilization is permitted for medical reasons only, and abortions are restricted. Crude death rates have declined steadily and are currently estimated at 21-23/1000 population. The infant mortality rate is approximately 125.7/1000 live births. These rates are considered unacceptable and budget allocations for curative and preventive services have continuously risen. Uneven regional distribution of services continues to be problematic. Efforts to curb immigration in 1969 are thought to have resulted in the current satisfactory situation. Restrictive measures to prevent the emigration of skilled personnel are in effect. 60-65% of the population are urban dwellers and the proportion is expected to increase. The current spatial distribution of the population is considered inappropriate, rapid urbanization is causing rural depopulation, overburdening urban services and accentuating rural-urban disparaties. 2 approaches to the problem have been implemented: the urban increase is accomodated by increasing outlays for services, and new public investments are widely dispersed, particularly in rural areas. The industrial policy is expected to shift to exploitation of the country's natural resources in order to develop the interior.

Alexithymia and perfectionism traits are associated with suicidal risk in patients with obsessive-compulsive disorder.

PubMed

Kim, Heeyeon; Seo, Jiwoo; Namkoong, Kee; Hwang, Eun Hee; Sohn, Sung Yun; Kim, Se Joo; Kang, Jee In

2016-03-01

There is limited evidence on suicidality and its associated factors in patients with obsessive-compulsive disorder (OCD). The present study investigated the potential contributing traits such as alexithymia and perfectionism and clinical risk factors including symptom dimensions associated with high suicidality in OCD patients. A total of 81 patients with OCD were included (mean age: 28.89 years, SD=7.95 years, 62% men). Suicidal risk was assessed using the Scale for Suicide Ideation and history taking. To assess alexithymia and perfectionism, the Toronto Alexithymia Scale-20 and the Measure of Constructs Underlying Perfectionism were applied. Clinical characteristics of OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Obsessive-Compulsive Scale, and the Montgomery-Asberg Depression Rating Scale. Among OCD patients, 37% had a history of previous suicidal attempt, and 56.8% had current suicidal ideation. Those with lifetime suicide attempts scored significantly higher for alexithymia and ego-dystonic perfectionism than those without such history. In the binary logistic regression analysis, high score for alexithymia and the responsibility for harm, injury, or bad luck were significant determinants for lifetime suicide attempts. As for current suicide ideation, ego-dystonic perfectionism and the dimension of unacceptable thought were significant predictors of suicidal risk. The classification of suicidal risk and personality traits relied on self-report measures. The present findings indicate that personality traits such as alexithymia and perfectionism may contribute to high suicidality in patients with OCD, and patients suffering with unacceptable thoughts need to be assessed more carefully for warning signs of suicide. Copyright © 2015 Elsevier B.V. All rights reserved.

Chapter 5 - Tree Mortality

Treesearch

Mark J. Ambrose

2018-01-01

Tree mortality is a natural process in all forest ecosystems. High mortality can be an indicator of forest health problems. On aregional scale, high mortality levels may indicate widespread insect or disease impacts. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands. The approach...

Tree Mortality

Treesearch

Mark J. Ambrose

2012-01-01

Tree mortality is a natural process in all forest ecosystems. However, extremely high mortality also can be an indicator of forest health issues. On a regional scale, high mortality levels may indicate widespread insect or disease problems. High mortality may also occur if a large proportion of the forest in a particular region is made up of older, senescent stands....

Psychiatric Adverse Effects of Rimonobant in Adults with Prader-Willi syndrome

PubMed Central

Motaghedi, Roja; Lipman, Elizabeth G; Hogg, Jeannette E.; Christos, Paul J.; Vogiatzi, Maria G.; Angulo, Moris A.

2010-01-01

Background Prader Willi syndrome (PWS) without strict environmental modifications can lead to obesity associated with significant morbidity and mortality. In addition to increased appetite, these individuals have decreased energy expenditure with lower insulin like growth factor 1 (IGF-1), which contributes to adiposity. No effective treatment is available for this condition. Endocannabinoid receptor CB1 antagonist, rimonobant, has been effective for treatment of obesity in adult subjects. Rimonabant promotes weight loss by multiple proposed mechanisms, including decreased appetite and lipogenesis, and increased energy expenditure. Therefore, we conducted this pilot study to evaluate the effect of rimonabant on body weight and composition of adults with PWS. Method This was a double blind placebo controlled study. Body weight, total fat mass, fasting ghrelin, leptin, IGF1 and insulin like growth factor binding protein (IGFBP3) were collected at baseline, and after 90 and 180 days of treatment with placebo or 20 mg of rimonabant. Results Due to psychiatric adverse effects, 50% of subjects in the rimonabant group withdrew, and the study was terminated early (N=10) for safety concerns. There was a trend for weight loss, lower fat mass and higher IGF1 level at the end of study in this group. Leptin followed the fat mass and decreased with rimonabant treatment. Conclusion Rimonabant administration may be efficacious for weight loss in adults with PWS; unfortunately it is associated with an unacceptably high risk of psychiatric side effects. Future CB1 antagonists will need a better psychiatric profile before considered in the treatment of obesity in this genetic condition. PMID:20965292

Human and animal health surveys among pastoralists.

PubMed

Schelling, E; Greter, H; Kessely, H; Abakar, M F; Ngandolo, B N; Crump, L; Bold, B; Kasymbekov, J; Baljinnyam, Z; Fokou, G; Zinsstag, J; Bonfoh, B; Hattendorf, J; Béchir, M

2016-11-01

Valid human and livestock health surveys, including longitudinal follow-up, are feasible among mobile pastoralists and provide fundamental information to agencies for interventions that are responsive to realities and effective in addressing the needs of pastoralists. However, pastoralists are often excluded from studies, surveillance systems and health programmes. The occurrence of preventable and treatable diseases such as perinatal tetanus, measles and tuberculosis are indicative of limited access to health providers and information. It is difficult for health services to include effective outreach with their available financial and human resources. One consequence is that maternal mortality rates among pastoralists are unacceptably high. Environmental determinants such as the quality of water and the pasture ecosystems further influence the morbidity of pastoralists. In the Sahel, the nutritional status of pastoralist children is seasonally better than that of settled children; but pastoralist women tend to have higher acute malnutrition rates. Pastoralist women are more vulnerable than men to exclusion from health services for different context-specific reasons. Evidence-based control measures can be assessed in cluster surveys with simultaneous assessments of health among people and livestock, where data on costs of disease and interventions are also collected. These provide important arguments for governmental and non-governmental agencies for intervention development. New, integrated One Health surveillance systems making use of mobile technology and taking into account local concepts and the experiences and priorities of pastoralist communities, combined with sound field data, are essential to develop and provide adapted human and animal health services that are inclusive for mobile pastoralist communities and allow them to maintain their mobile way of life.

A cluster of cases of nosocomial legionnaires disease linked to a contaminated hospital decorative water fountain.

PubMed

Palmore, Tara N; Stock, Frida; White, Margaret; Bordner, MaryAnn; Michelin, Angela; Bennett, John E; Murray, Patrick R; Henderson, David K

2009-08-01

Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit. We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates. The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered. This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.

Midwifery capacity building in Papua New Guinea: Key achievements and ways forward.

PubMed

Dawson, Angela; Kililo, Mary; Geita, Lahui; Mola, Glen; Brodie, Pat M; Rumsey, Michele; Copeland, Felicity; Neill, Amanda; Homer, Caroline S E

2016-04-01

Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Near "real" time magnetic resonance images as a monitoring system for interstitial laser therapy: experimental protocols

NASA Astrophysics Data System (ADS)

Castro, Dan J.; Farahani, Keyvan; Soudant, Jacques; Zwarun, Andrew A.; Lufkin, Robert B.

1992-06-01

The failure rate of cancer treatment remains unacceptably high, still being a leading cause of mortality in adults and children despite major advances over the past 50 years in the fields of surgery, radiation therapy and, more recently, chemo and immunotherapy. Surgical access to some deep tumors of the head and neck and other areas often require extensive dissections with residual functional and cosmetic deformities. Repeated treatment is not possible after maximum dose radiotherapy and chemotherapy is still limited by its systemic toxicity. An attractive solution to these problems would be the development of a new adjunctive method combining the best features of interstitial laser therapy for selective tumor destruction via minimally invasive techniques for access and 3-D magnetic resonance imaging (MRI) as a monitoring system for laser-tissue interactions. Interstitial laser therapy (ILT) via fiberoptics allow laser energy to be delivered directly into deeper tissues. However, this concept will become clinically useful only when noninvasive, accurate, and reproducible monitoring methods are developed to measure energy delivery to tissues. MRI has numerous advantages in evaluating the irreversible effects of laser treatment in tissues, since laser energy includes changes not only in the thermal motions of hydrogen protons within the tissue, but also in the distribution and mobility of water and lipids. These techniques should greatly improve the use of ILT in combination with MRI to allow treatment of deeper, more difficult to reach tumors of head and neck and other anatomical areas with a single needle stick.

Pelvic fracture in multiple trauma: are we still up-to-date with massive fluid resuscitation?

PubMed

Burkhardt, Markus; Kristen, Alexander; Culemann, Ulf; Koehler, Daniel; Histing, Tina; Holstein, Joerg H; Pizanis, Antonius; Pohlemann, Tim

2014-10-01

Until today the mortality of complex pelvic trauma remains unacceptably high. On the one hand this could be attributed to a biological limit of the survivable trauma load, on the other hand side an ongoing inadequate treatment might be conceivable too. For the management of multiple trauma patients with life-threatening pelvic fractures, there is ongoing international debate on the adequate therapeutic strategy, e.g. arterial embolization or pelvic packing, as well as aggressive or restrained volume therapy. Whereas traditional pelvis-specific trauma algorithms still recommend massive fluid resuscitation, there is upcoming evidence that a restrained volume therapy in the preclinical setting may improve trauma outcomes. Less intravenous fluid administration may also reduce haemodilution and concomitant trauma-associated coagulopathy. After linking the data of the TraumaRegister DGU(®) and the German Pelvic Injury Register, for the first time, the initial fluid management for complex pelvic traumas as well as for different Tile/OTA types of pelvic ring fractures could be addressed. Unfortunately, the results could not answer the question of the adequate fluid resuscitation but confirmed the actuality of massive fluid resuscitation in the prehospital and emergency room setting. Low-volume resuscitation seems not yet accepted in practice in managing multiple trauma patients with pelvic fractures at least in Germany. Nevertheless, prevention of exsanguination and of complications like multiple organ dysfunction syndrome still poses a major challenge in the management of complex pelvic ring injuries. Even nowadays, fluid management for trauma, not only for pelvic fractures, remains a controversial area and further research is mandatory. Copyright © 2014 Elsevier Ltd. All rights reserved.

A cluster of nosocomial Legionnaire’s disease linked to a contaminated hospital decorative water fountain

PubMed Central

Palmore, Tara N.; Stock, Frida; White, Margaret; Bordner, MaryAnn; Michelin, Angela; Bennett, John E.; Murray, Patrick R.; Henderson, David K.

2009-01-01

Background Nosocomial outbreaks of Legionnaire’s disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of nosocomial pneumonia due to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit. Methods We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella spp. from those sources. We used an air sampler in an attempt to detect aerosolized Legionella, and pulsed-field gel electrophoresis to compare clinical and environmental isolates. Results The most likely sources identified were the water supply in the patients’ rooms and a decorative fountain in the radiation oncology suite. Samples from the patients’ rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients’ infections were identified early and treated promptly, and both recovered. Conclusions This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaire’s disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients. PMID:19580436

Blocking NMDA receptors delays death in rats with acute liver failure by dual protective mechanisms in kidney and brain.

PubMed

Cauli, Omar; González-Usano, Alba; Cabrera-Pastor, Andrea; Gimenez-Garzó, Carla; López-Larrubia, Pilar; Ruiz-Sauri, Amparo; Hernández-Rabaza, Vicente; Duszczyk, Malgorzata; Malek, Michal; Lazarewicz, Jerzy W; Carratalá, Arturo; Urios, Amparo; Miguel, Alfonso; Torregrosa, Isidro; Carda, Carmen; Montoliu, Carmina; Felipo, Vicente

2014-06-01

Treatment of patients with acute liver failure (ALF) is unsatisfactory and mortality remains unacceptably high. Blocking NMDA receptors delays or prevents death of rats with ALF. The underlying mechanisms remain unclear. Clarifying these mechanisms will help to design more efficient treatments to increase patient's survival. The aim of this work was to shed light on the mechanisms by which blocking NMDA receptors delays rat's death in ALF. ALF was induced by galactosamine injection. NMDA receptors were blocked by continuous MK-801 administration. Edema and cerebral blood flow were assessed by magnetic resonance. The time course of ammonia levels in brain, muscle, blood, and urine; of glutamine, lactate, and water content in brain; of glomerular filtration rate and kidney damage; and of hepatic encephalopathy (HE) and intracranial pressure was assessed. ALF reduces kidney glomerular filtration rate (GFR) as reflected by reduced inulin clearance. GFR reduction is due to both reduced renal perfusion and kidney tubular damage as reflected by increased Kim-1 in urine and histological analysis. Blocking NMDA receptors delays kidney damage, allowing transient increased GFR and ammonia elimination which delays hyperammonemia and associated changes in brain. Blocking NMDA receptors does not prevent cerebral edema or blood-brain barrier permeability but reduces or prevents changes in cerebral blood flow and brain lactate. The data show that dual protective effects of MK-801 in kidney and brain delay cerebral alterations, HE, intracranial pressure increase and death. NMDA receptors antagonists may increase survival of patients with ALF by providing additional time for liver transplantation or regeneration.

Metabolomics - A wide-open door to personalized treatment in chronic heart failure?

PubMed

Marcinkiewicz-Siemion, M; Ciborowski, M; Kretowski, A; Musial, W J; Kaminski, K A

2016-09-15

Heart failure (HF) is a complex syndrome representing a final stage of various cardiovascular diseases. Despite significant improvement in the diagnosis and treatment (e.g. ACE-inhibitors, β-blockers, aldosterone antagonists, cardiac resynchronization therapy) of the disease, prognosis of optimally treated patients remains very serious and HF mortality is still unacceptably high. Therefore there is a strong need for further exploration of novel analytical methods, predictive and prognostic biomarkers and more personalized treatment. The metabolism of the failing heart being significantly impaired from its baseline state may be a future target not only for biomarker discovery but also for the pharmacologic intervention. However, an assessment of a particular, isolated metabolite or protein cannot be fully informative and makes a correct interpretation difficult. On the other hand, metabolites profile analysis may greatly assist investigator in an interpretation of the altered pathway dynamics, especially when combined with other lines of evidence (e.g. metabolites from the same pathway, transcriptomics, proteomics). Despite many prior studies on metabolism, the knowledge of peripheral and cardiac pathophysiological mechanisms responsible for the metabolic imbalance and progression of the disease is still insufficient. Metabolomics enabling comprehensive characterization of low molecular weight metabolites (e.g. lipids, sugars, organic acids, amino acids) that reflects the complete metabolic phenotype seems to be the key for further potential improvement in HF treatment (diet-based or biochemical-based). Will this -omics technique one day open a door to easy patients identification before they have a heart failure onset or its decompensation? Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An overview of EU and USA intestinal transplant current activity.

PubMed

Lauro, A; Panaro, F; Iyer, K R

2017-04-01

To report the current activity of intestinal transplantation in Europe (EU) and Unites States of America (USA), underlining outcomes in the last 5 years and discussing possible trends. Data review of results was performed through analysis of ITR and UNOS registries, Eurotransplant and newsletter transplant reports, congress abstracts, international published literature, personal communications and hospital web sites. The absence in Europe of a sole organization collecting donors and the presence of many low-volume centers (less than 5 cases/year) makes the difference with USA: in the last 5 years (2010-2014), 222 intestinal/multivisceral transplants have been performed in EU countries (most of them in the UK), while in USA, the number of transplants achieved 634 procedures in the same period of time. Waiting list mortality remains unacceptable in both continents. Improved short-term results, with over 80% survival at 1 year, have been achieved in the busiest transplant centers likely due to immune-induction agents, more recently to innovative cross match strategies and optimizing organ allocation, but long term outcomes are still inferior to other organ transplants. Most long-term survivors were reintegrated to society with self-sustained socioeconomic status. The economic burden for the society is high and related costs are different between USA and EU (and inside Europe between member state's health-care systems), but cost-effectiveness for intestinal transplantation still needs to be proved. Overall intestinal transplantation continues to develop in EU and USA together with surgical and medical rehabilitation of patients affected by short gut syndrome. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Positive-pressure ventilation during transport: a randomized crossover study of self-inflating and flow-inflating resuscitators in a simulation model.

PubMed

Lucy, Malcolm J; Gamble, Jonathan J; Daku, Brian L; Bryce, Rhonda D; Rana, Masud

2014-12-01

Positive-pressure ventilation during transport of intubated patients is generally delivered via a hand-pressurized device. Of these devices, self-inflating resuscitators (SIR) and flow-inflating resuscitators (FIR) constitute the two major types used. Selection of a particular device for transport, however, remains largely an institutional practice. To evaluate the hypothesis that transport ventilation goals of intubated pediatric patients are better achieved using an FIR compared to an SIR. This randomized crossover simulation study compared the performance of SIR and FIR among anesthesia providers in a pediatric transport scenario. Subjects hand-ventilated a test lung while simultaneously maneuvering a stretcher bed to simulate patient transport. Hand ventilation was carried out using a Jackson-Rees circuit (FIR) and a Laerdal pediatric silicone resuscitator (SIR). The primary outcome was the proportion of total breaths delivered within the predefined target PIP/PEEP range (30+/- 3, 10+/- 3 cm H2O). Secondary outcomes included proportion of total breaths delivered with operationally defined unacceptable breath variables (PIP > 35 cm H2O or PEEP < 5 cm H2O). Overall, participants were four times more likely to deliver target breaths and one-third less likely to deliver unacceptable breaths using the FIR compared to the SIR. When comparing device performance, a 44% increase in the proportions of target breaths and a 40.4% decrease in unacceptable breaths using the FIR were observed (P < 0.0001 for both). Hand ventilation during patient transport is superior using the FIR compared to the SIR to achieve target ventilatory goals and avoid unacceptable ventilatory cycles. © 2014 John Wiley & Sons Ltd.

The normative dimension and legal meaning of endangered and recovery in the U.S. Endangered Species Act.

PubMed

Vucetich, John A; Nelson, Michael P; Phillips, Michael K

2006-10-01

The ethical, legal, and social significance of the U.S. Endangered Species Act of 1973 (ESA) is widely appreciated. Much of the significance of the act arises from the legal definitions that the act provides for the terms threatened species and endangered species. The meanings of these terms are important because they give legal meaning to the concept of a recovered species. Unfortunately, the meanings of these terms are often misapprehended and rarely subjected to formal analysis. We analyzed the legal meaning of recovered species and illustrate key points with details from "recovery" efforts for the gray wolf (Canis lupus). We focused on interpreting the phrase "significant portion of its range," which is part of the legal definition of endangered species. We argue that recovery and endangerment entail a fundamentally normative dimension (i.e., specifying conditions of endangerment) and a fundamentally scientific dimension (i.e., determining whether a species meets the conditions of endangerment). Specifying conditions for endangerment is largely normative because it judges risks of extinction to be either acceptable or unacceptable. Like many other laws that specify what is unacceptable, the ESA largely specifies the conditions that constitute unacceptable extinction risk. The ESA specifies unacceptable risks of extinction by defining endangered species in terms of the portion of a species' range over which a species is "in danger of extinction." Our analysis indicated that (1) legal recovery entails much more than the scientific notion of population viability, (2) most efforts to recover endangered species are grossly inadequate, and (3) many unlisted species meet the legal definition of an endangered or threatened species.

Projected trends in high-mortality heatwaves under different scenarios of climate, population, and adaptation in 82 US communities.

PubMed

Anderson, G Brooke; Oleson, Keith W; Jones, Bryan; Peng, Roger D

2018-02-01

Some rare heatwaves have extreme daily mortality impacts; moderate heatwaves have lower daily impacts but occur much more frequently at present and so account for large aggregated impacts. We applied health-based models to project trends in high-mortality heatwaves, including proportion of all heatwaves expected to be high-mortality, using the definition that a high-mortality heatwave increases mortality risk by ≥20 %. We projected these trends in 82 US communities in 2061-2080 under two scenarios of climate change (RCP4.5, RCP8.5), two scenarios of population change (SSP3, SSP5), and three scenarios of community adaptation to heat (none, lagged, on-pace) for large- and medium-ensemble versions of the National Center for Atmospheric Research's Community Earth System Model. More high-mortality heatwaves were expected compared to present under all scenarios except on-pace adaptation, and population exposure was expected to increase under all scenarios. At least seven more high-mortality heatwaves were expected in a twenty-year period in the 82 study communities under RCP8.5 than RCP4.5 when assuming no adaptation. However, high-mortality heatwaves were expected to remain <1 % of all heatwaves and heatwave exposure under all scenarios. Projections were most strongly influenced by the adaptation scenario- going from a scenario of on-pace to lagged adaptation or from lagged to no adaptation more than doubled the projected number of and exposure to high-mortality heatwaves. Based on our results, fewer high-mortality heatwaves are expected when following RCP4.5 versus RCP8.5 and under higher levels of adaptation, but high-mortality heatwaves are expected to remain a very small proportion of total heatwave exposure.

NHS patients, staff, and visitor viewpoints of smoking within a hospitals' ground: a qualitative analysis.

PubMed

Serafin, Alina; Franklin, Sarah; Mehta, Rashesh; Crosby, Scott; Lee, Diane; Edlin, Becky; Bewick, Bridgette M

2014-09-29

Smoking is a public health concern and an avoidable cause of morbidity and mortality. Widening tobacco control policies might help shift social norms, the acceptability of exposing others to second-hand smoke, and cultural attitudes towards smoking. This study explored patient, staff, and visitor viewpoints of smoking within the grounds of a National Health Service hospital. Analysis of free text responses given as part of a larger repeat cross sectional questionnaire study. Free text qualitative responses analysed using thematic analysis. Pinderfields Hospital, a UK National Health Service hospital in the county of Yorkshire, provides a health service to around half a million people living in the Wakefield and North Kirklees area. Surveys were distributed 10th-18th September and 17th-21st December 2012. Of the n=952 participants who completed an anonymous survey n=306 participants provided a response to the optional free text question. Thematic analysis revealed 5 distinct themes: (1) smoking is a dirty problem; (2) smokers are free to do as they wish; (3) the poor smoker; (4) smoke in our space: the battleground; and (5) no smoking please. Of the n=272 represented by the five themes, generally people accepted that smoking is socially unacceptable but their understanding of smoking behaviours and attitudes towards management and control of smoking differed. There was a strong sense that action is needed to separate the space smokers and non-smokers share. We identified a distinct group of participants that supported a hard line approach and suggested enforcing the no smoking policy through fines and monitoring. Smoking on hospital grounds remains a contentious issue. Participants acknowledge that smoking is an increasingly unacceptable social behaviour but their understanding and acceptance of smokers vary. There is a strong sense of dislike about the impact of smoke and smokers on the shared hospital environment, with a focus on the hospital entrance. Participants suggest separating smokers and non-smokers and moving smokers away from the hospital entrance with the introduction of smoking shelters. These results suggest a complex narrative that should be investigated further to inform the implementation of the no-smoking policy across hospital settings.

Use of a secondary host by non-outbreak populations of the gypsy moth. [Pinus rigida; Quercus spp; Lymantria dispar

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

Rossiter, M.

1987-08-01

Oaks are the favored host of gypsy moths in the northeastern US, although the herbivore expands its host range dramatically during an outbreak. Pitch pine, a secondary host because of its unacceptability for early development, was found to be frequently used for oviposition in oak-pitch pine forests with non-outbreak populations. This observation led to the study of ecological and behavioral factors that can contribute to the use of a secondary host under low-density conditions by an irruptive herbivore species. A series of manipulative field and laboratory experiments plus a study of natural history provided data on the pattern of pitchmore » pine use during the life cycle of the gypsy moth, the effect of pitch pine on larval growth, and the differential impact of natural enemies depending on host use. It was found that: 1) egg masses occurred far more frequently on pitch pine than was expected based on the frequency of pitch pine in forests with low-density gypsy moth populations; 2) in the laboratory, early-instar larvae could not survive on pitch pine while late-instar larvae grew well; 3) in the field, larvae began to use pitch pine to feed and rest after the onset of the fourth instar. Compared to oak, 4) egg masses on pitch pine experienced less parasitism; 5) the microhabitat of pitch pine held less nuclear polyhedrosis virus (NPV), a major mortality agent of the gypsy moth; 6) individuals hatching from eggs laid on pitch pine were less infected with NPV; and 7) larvae dosed with a known amount of NPV survived longer when feeding on pitch pine foliage. The use of pitch pine by individuals in low-density gypsy moth populations appeared to be beneficial and may have an important effect on population dynamics. The mobility associated with host switching by late-instar larvae and with dispersal by first-instar larvae oviposited on unacceptable food may represent an important mechanism for host-range extension.« less

Rotordynamic Characteristics of the HPOTP (High Pressure Oxygen Turbopump) of the SSME (Space Shuttle Main Engine)

NASA Technical Reports Server (NTRS)

Childs, D. W.

1984-01-01

Rotational stability of turbopump components in the space shuttle main engine was studied via analysis of component and structural dynamic models. Subsynchronous vibration caused unacceptable migration of the rotor/housing unit with unequal load sharing of the synchronous bearings that resulted in the failure of the High Pressure Oxygen Turbopump. Linear analysis shows that a shrouded inducer eliminates the second critical speed and the stability problem, a stiffened rotor improves the rotordynamic characteristics of the turbopump, and installing damper boost/impeller seals reduces bearing loads. Nonlinear analysis shows that by increasing the "dead band' clearances, a marked reduction in peak bearing loads occurs.

Dross treatment in a rotary arc furnace with graphite electrodes

NASA Astrophysics Data System (ADS)

Drouet, Michel G.; Handfield, My; Meunier, Jean; Laflamme, Claude B.

1994-05-01

Aluminum baths are always covered with a layer of dross resulting from the aluminum surface oxidation. This dross represents 1-10% of the melt and may contain up to 75wt.% aluminum. Since aluminum production is highly energy intensive, dross recycling is very attractive from both energy and economic standpoints. The conventional recycling process using salt rotary furnaces is thermally inefficient and environmentally unacceptable because of the production of salt slags. Hydro-Quebec has developed a new technology using a rotary arc furnace with graphite electrodes. This process provides aluminum recovery rates of 80-90%, using a highly energy efficient, environmentally sound production method.

The elimination of scabies: a task for our generation.

PubMed

McLean, Florence E

2013-10-01

Scabies prevalence remains unacceptably high in many regions throughout the world. Infestation with scabies significantly impacts quality of life and is linked to pyoderma and consequently to severe long-term sequelae such as post-streptococcal glomerulonephritis. In the past, control programs using topical treatments have met with poor compliance; however, the highly effective oral agent ivermectin may offer a new paradigm in scabies management. Problems still exist with insensitive diagnostic tests, questions concerning mite reservoirs, and restrictions on who can receive ivermectin. Despite these difficulties, the elimination of scabies in communities worst affected may soon be possible. © 2013 The International Society of Dermatology.

Cognitive Support During High-Consequence Episodes of Care in Cardiovascular Surgery.

PubMed

Conboy, Heather M; Avrunin, George S; Clarke, Lori A; Osterweil, Leon J; Christov, Stefan C; Goldman, Julian M; Yule, Steven J; Zenati, Marco A

2017-03-01

Despite significant efforts to reduce preventable adverse events in medical processes, such events continue to occur at unacceptable rates. This paper describes a computer science approach that uses formal process modeling to provide situationally aware monitoring and management support to medical professionals performing complex processes. These process models represent both normative and non-normative situations, and are validated by rigorous automated techniques such as model checking and fault tree analysis, in addition to careful review by experts. Context-aware Smart Checklists are then generated from the models, providing cognitive support during high-consequence surgical episodes. The approach is illustrated with a case study in cardiovascular surgery.

Heavy metals contamination and human health risk assessment around Obuasi gold mine in Ghana.

PubMed

Bempah, Crentsil Kofi; Ewusi, Anthony

2016-05-01

Gold mining has increased the prevalence and occurrence of heavy metals contamination at the Earth's surface and is causing major concern due to the potential risk involved. This study investigated the impact of gold mine on heavy metals (As, Cd, Cr, Cu, Pb, Hg, Ni, Fe, Mn, and Zn) pollution and evaluated the potential health risks to local residents via consumption of polluted groundwater, agricultural soils, and vegetable crops grown at three community farms surrounding the mine at Obuasi municipality of Ghana. The results showed levels of As, Cd, Cr, Hg, Fe, and Mn higher than the allowable drinking water standards. The vegetable samples analyzed showed high accumulation of As and Ni above the normal value. Bioaccumulation factors of heavy metals were significantly higher for vegetables grown in the Sanso soils. Estimated average daily intake and hazard quotient for As in drinking water as well as As, Pb, and Hg in vegetable samples exceeded permissible limit. Unacceptable non-cancer health risk levels were found in vegetable samples analyzed for As, Pb, and Hg. An unacceptable cancer risk was found via drinking of groundwater, in consumption of vegetables, and in soil. The hazard index for vegetables was higher than 1, indicating very high health risk to heavy metals contamination through consumption of vegetables grown around the sampling sites. The results recommend the need for regular monitoring of groundwater and food crops to protect consumers' health.

How much would each researcher receive if competitive government research funding were distributed equally among researchers?

PubMed Central

Katzav, Joel

2017-01-01

Scientists are increasingly dissatisfied with funding systems that rely on peer assessment and, accordingly, have suggested several proposals for reform. One of these proposals is to distribute available funds equally among all qualified researchers, with no interference from peer review. Despite its numerous benefits, such egalitarian sharing faces the objection, among others, that it would lead to an unacceptable dilution of resources. The aim of the present paper is to assess this particular objection. We estimate (for the Netherlands, the U.S. and the U.K.) how much researchers would receive were they to get an equal share of the government budgets that are currently allocated through competitive peer assessment. For the Netherlands, we furthermore estimate what researchers would receive were we to differentiate between researchers working in low-cost, intermediate-cost and high-cost disciplines. Given these estimates, we then determine what researchers could afford in terms of PhD students, Postdocs, travel and equipment. According to our results, researchers could, on average, maintain current PhD student and Postdoc employment levels, and still have at their disposal a moderate (the U.K.) to considerable (the Netherlands, U.S.) budget for travel and equipment. This suggests that the worry that egalitarian sharing leads to unacceptable dilution of resources is unjustified. Indeed, our results strongly suggest that there is room for far more egalitarian distribution of funds than happens in the highly competitive funding schemes so prevalent today. PMID:28886054

How much would each researcher receive if competitive government research funding were distributed equally among researchers?

PubMed

Vaesen, Krist; Katzav, Joel

2017-01-01

Scientists are increasingly dissatisfied with funding systems that rely on peer assessment and, accordingly, have suggested several proposals for reform. One of these proposals is to distribute available funds equally among all qualified researchers, with no interference from peer review. Despite its numerous benefits, such egalitarian sharing faces the objection, among others, that it would lead to an unacceptable dilution of resources. The aim of the present paper is to assess this particular objection. We estimate (for the Netherlands, the U.S. and the U.K.) how much researchers would receive were they to get an equal share of the government budgets that are currently allocated through competitive peer assessment. For the Netherlands, we furthermore estimate what researchers would receive were we to differentiate between researchers working in low-cost, intermediate-cost and high-cost disciplines. Given these estimates, we then determine what researchers could afford in terms of PhD students, Postdocs, travel and equipment. According to our results, researchers could, on average, maintain current PhD student and Postdoc employment levels, and still have at their disposal a moderate (the U.K.) to considerable (the Netherlands, U.S.) budget for travel and equipment. This suggests that the worry that egalitarian sharing leads to unacceptable dilution of resources is unjustified. Indeed, our results strongly suggest that there is room for far more egalitarian distribution of funds than happens in the highly competitive funding schemes so prevalent today.

Low immunisation uptake: Is the process the problem?

PubMed Central

Harrington, P.; Woodman, C.; Shannon, W.

2000-01-01

OBJECTIVE—To examine mothers' satisfaction with the process of immunisation and its possible contribution to suboptimal immunisation uptake.
DESIGN—In depth interviews with mothers.
SETTING—Two Community Care Areas, Dublin city, Ireland.
PARTICIPANTS—In depth interviews of 23 mothers of children 1-2 years old, recruited purposively from a birth cohort born in 1994.
MAIN RESULTS—Mothers preferred general practice to Health Centre immunisation (11:5) for predominantly emotional compared with practical reasons (4:1). Health Centre immunisation was seen, at times, as unacceptably rough and inhuman. Many mothers experienced severe emotional distress at the prospect of inflicting the pain of immunisation on their babies. The non-empathic stance of some immunising doctors was unacceptable to mothers. They valued attempts by health professionals to acknowledge the pain of immunisation and to engage with their baby. Adverse experiences contributed to deferral of future visits and to defaulting behaviour.
CONCLUSIONS—Low empathy mass immunisation in clinic type settings may be unacceptable to mothers in the 1990s, and may in part explain suboptimal uptake in health care systems that use such clinics.


Keywords: immunisation; health behaviour; immunisation uptake PMID:10814662

Effect of sexual excitation on testosterone and nitric oxide levels of water buffalo bulls (Bubalus bubalis) with different categories of sexual behavior and their correlation with each other.

PubMed

Swelum, Ayman Abdel-Aziz; Saadeldin, Islam M; Zaher, Hany A; Alsharifi, Sawsan A M; Alowaimer, Abdullah N

2017-06-01

We studied the effect of sexual excitation on serum testosterone and nitric oxide (NO) levels in water buffalo bulls with different categories of sexual behavior and their correlation with each other. Buffalo bulls were classified according to their sexual behavior (including reaction time, sexual aggressiveness and mating ability): acceptable (good to excellent) (n=5), fair (n=5), and unacceptable (poor) (n=5) sexual behavior. Blood samples were collected from all animals immediately before and after sexual teasing and/or mounting to estimate the testosterone and NO levels using a commercial radioimmunoassay kit and Griess reaction test, respectively. Comparisons among groups were evaluated using a mixed-design analysis of variance. Pearson's correlation coefficients were calculated to determine the relationship between testosterone and NO levels before and after sexual excitation besides sexual behavior. The level of testosterone before sexual excitation was higher (p≤0.05) in bulls with acceptable and fair sexual behavior than in bulls with unacceptable sexual behavior (0.86±0.01, 0.69±0.02, and 0.29±0.02ng/mL, respectively). The level of NO was higher (p≤0.05) in bulls with acceptable and fair sexual behavior than in bulls with unacceptable sexual behavior (8.00±0.03, 7.66±0.19, and 6.29±0.33μM, respectively). Sexual excitation significantly (p<0.05) increase testosterone and NO levels in bulls with acceptable (1.45±0.01ng/mL and 19.04±0.32μM, respectively) or fair (0.92±0.02ng/mL and 14.95±0.34μM, respectively) sexual behavior, but not in bulls with unacceptable sexual behavior. The unacceptable sexual behavior bulls had significantly lower testosterone and NO levels than the other bulls. There was a strong correlation and association between serum testosterone and NO levels besides sexual behavior of buffalo bulls. In conclusion, the alteration in the testosterone and NO levels after sexual excitation depends on the sexual behavior category of buffalo-bull. Testosterone and NO can be used to create a sexual behavior score. The testosterone and NO levels of can be predicted via evaluation of sexual behavior of buffalo bull. Copyright © 2017 Elsevier B.V. All rights reserved.

Poverty and cancer.

PubMed

Tomatis, L

1997-01-01

Despite the attraction of certain utopias and the convincing strength of some of the social and philosophical theories underlying attempts to change the social structure and to achieve a more egalitarian society, social inequalities have not disappeared and seem even to be increasing worldwide. Inequalities in health are part of the social inequalities present in our society and one of their most convincing indices. Sanitary conditions are worse, mortality higher, survival rates of cancer patients lower, and life expectancy shorter in developing countries than in industrialized countries. Similar if not identical differences can be seen within industrialized countries between socioeconomically less and more favoured population groups. In many areas of the industrialized countries social and environmental conditions comparable with those existing in the poorest countries last century have been recreated. Occupational risks are becoming a serious problem in developing countries, largely as a consequence of the transfer of hazardous industries from industrialized countries where certain industries are judged to be unacceptable. A similar double standard is applied to tobacco advertising and sales in the industrialized and developing countries. The projections of the total number of cancer cases in the next decades indicate a generalized increase, proportionally greater in developing than in industrialized countries.

Socioeconomic disparities in health in the US: an agenda for action.

PubMed

Moss, N

2000-12-01

Inequality of income and wealth in the US has been growing rapidly since 1972. Evidence of socioeconomic effects on health is documented for many endpoints, and there is evidence that socioeconomic disparities in health are increasing. In Europe, equity in health and health care is a target of the World Health Organization, and has led to a variety of activities to reduce socioeconomic disparities in morbidity and mortality. In the US, activities in the public and private sectors have increased in recent years but attention, especially among the public-at-large in addition to elites, needs to be shifted to socioeconomic disparities. The paper suggests action strategies drawn from the European experience and other US efforts to place public health priorities on the policy agenda. A first step is to create a climate of unacceptability for socioeconomic disparities in health. Recommended activities include improvement and utilization of existing data; dissemination to broad audiences; building on existing initiatives; creating multi-sectoral alliances; formation of state and community task forces; attention to human capital as well as social justice issues; creative use of media; attraction of new funders; and implementation of quantitative targets.

Estimating the true global burden of mental illness.

PubMed

Vigo, Daniel; Thornicroft, Graham; Atun, Rifat

2016-02-01

We argue that the global burden of mental illness is underestimated and examine the reasons for under-estimation to identify five main causes: overlap between psychiatric and neurological disorders; the grouping of suicide and self-harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes. Using published data, we estimate the disease burden for mental illness to show that the global burden of mental illness accounts for 32·4% of years lived with disability (YLDs) and 13·0% of disability-adjusted life-years (DALYs), instead of the earlier estimates suggesting 21·2% of YLDs and 7·1% of DALYs. Currently used approaches underestimate the burden of mental illness by more than a third. Our estimates place mental illness a distant first in global burden of disease in terms of YLDs, and level with cardiovascular and circulatory diseases in terms of DALYs. The unacceptable apathy of governments and funders of global health must be overcome to mitigate the human, social, and economic costs of mental illness. Copyright © 2016 Elsevier Ltd. All rights reserved.

Review of hypoxaemia in anaesthetized horses: predisposing factors, consequences and management.

PubMed

Auckburally, Adam; Nyman, Görel

2017-05-01

To discuss how hypoxaemia might be harmful and why horses are particularly predisposed to developing it, to review the strategies that are used to manage hypoxaemia in anaesthetized horses, and to describe how successful these strategies are and the adverse effects associated with them. Google Scholar and PubMed, using the search terms horse, pony, exercise, anaesthesia, hypoxaemia, oxygen, mortality, morbidity and ventilation perfusion mismatch. Although there is no evidence that hypoxaemia is associated with increased morbidity and mortality in anaesthetized horses, most anaesthetists would agree that it is important to recognise and prevent or treat it. Favourable anatomical and physiological adaptations of a horse for exercise adversely affect gas exchange once the animal is recumbent. Hypoxaemia is recognised more frequently in horses than in other domestic species during general anaesthesia, although its incidence in healthy horses remains unreported. Management of hypoxaemia in anaesthetized horses is challenging and often unsuccessful. Positive pressure ventilation strategies to address alveolar atelectasis in humans have been modified for implementation in recumbent anaesthetized horses, but are often accompanied by unpredictable and unacceptable cardiopulmonary adverse effects, and some strategies are difficult or impossible to achieve in adult horses. Furthermore, anticipated beneficial effects of these techniques are inconsistent. Increasing the inspired fraction of oxygen during anaesthesia is often unsuccessful since much of the impairment in gas exchange is a direct result of shunt. Alternative approaches to the problem involve manipulation of pulmonary blood away from atelectatic regions of the lung to better ventilated areas. However, further work is essential, with particular focus on survival associated with general anaesthesia in horses, before any technique can be accepted into widespread clinical use. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Traditional and MLC based dose compensator design for patients with hip prostheses undergoing pelvic radiation therapy.

PubMed

Alecu, R; Alecu, M; Loomis, T; Ochran, T; He, T

1999-01-01

Perturbations in the dose distribution caused by a hip prosthesis when treating pelvic malignancies can result in unacceptable dose inhomogeneities within the target volume. Our results, obtained by in vivo exit dose measurements with diodes, showed a 55% reduction in the dose at the exit dmax of a lateral 15 MV photon beam after passing through a bilateral cobalt-chrome alloy hip prosthesis. Such an inhomogeneous dose distribution may decrease the curability. Solutions such as treatment techniques to avoid the prosthesis are often not the best choice as the dose to the rectum may be unacceptably high. In this work an alternative method of dose compensator is presented. Two types of dose compensators were designed based on a 3-D treatment planning system and CT images of a pelvic phantom containing a hip prosthesis: one was fabricated from a polyethylene-lead slab in the representation of step fringes and placed on a tray in the path of the beam while the other was produced by the use of several fields shaped with a multileaf collimator. The calculation procedures developed by the authors for generating the compensators are described. Results of film measurements performed in a phantom with and without the compensators in place are discussed.

The challenges for scientific publishing, 60 years on.

PubMed

Hausmann, Laura; Murphy, Sean P

2016-10-01

The most obvious difference in science publishing between 'then' and 'now' is the dramatic change in the communication of data and in their interpretation. The democratization of science via the Internet has brought not only benefits but also challenges to publishing including fraudulent behavior and plagiarism, data and statistics reporting standards, authorship confirmation and other issues which affect authors, readers, and publishers in different ways. The wide accessibility of data on a global scale permits acquisition and meta-analysis to mine for novel synergies, and has created a highly commercialized environment. As we illustrate here, identifying unacceptable practices leads to changes in the standards for data reporting. In the past decades, science publishing underwent dramatic changes in the communication of data and in their interpretation, in the increasing pressure and commercialization, and the democratization of science on a global scale via the Internet. This article reviews the benefits and challenges to publishing including fraudulent behavior and plagiarism, data and statistics reporting standards, authorship confirmation and other issues, with the aim to provide readers with practical examples and hands-on guidelines. As we illustrate here, identifying unacceptable practices leads to changes in the standards for data reporting. This article is part of the 60th Anniversary special issue. © 2016 International Society for Neurochemistry.

Site-specific probabilistic ecological risk assessment of a volatile chlorinated hydrocarbon-contaminated tidal estuary.

PubMed

Hunt, James; Birch, Gavin; Warne, Michael St J

2010-05-01

Groundwater contaminated with volatile chlorinated hydrocarbons (VCHs) was identified as discharging to Penrhyn Estuary, an intertidal embayment of Botany Bay, New South Wales, Australia. A screening-level hazard assessment of surface water in Penrhyn Estuary identified an unacceptable hazard to marine organisms posed by VCHs. Given the limitations of hazard assessments, the present study conducted a higher-tier, quantitative probabilistic risk assessment using the joint probability curve (JPC) method that accounted for variability in exposure and toxicity profiles to quantify risk (delta). Risk was assessed for 24 scenarios, including four areas of the estuary based on three exposure scenarios (low tide, high tide, and both low and high tides) and two toxicity scenarios (chronic no-observed-effect concentrations [NOEC] and 50% effect concentrations [EC50]). Risk (delta) was greater at low tide than at high tide and varied throughout the tidal cycle. Spatial distributions of risk in the estuary were similar using both NOEC and EC50 data. The exposure scenario including data combined from both tides was considered the most accurate representation of the ecological risk in the estuary. When assessing risk using data across both tides, the greatest risk was identified in the Springvale tributary (delta=25%)-closest to the source area-followed by the inner estuary (delta=4%) and the Floodvale tributary (delta=2%), with the lowest risk in the outer estuary (delta=0.1%), farthest from the source area. Going from the screening level ecological risk assessment (ERA) to the probabilistic ERA changed the risk from unacceptable to acceptable in 50% of exposure scenarios in two of the four areas within the estuary. The probabilistic ERA provided a more realistic assessment of risk than the screening-level hazard assessment. Copyright (c) 2010 SETAC.

Comparison between auricular and standard rectal thermometers for the measurement of body temperature in dogs

PubMed Central

Sousa, Marlos G.; Carareto, Roberta; Pereira-Junior, Valdo A.; Aquino, Monally C.C.

2011-01-01

Although the rectal mucosa remains the traditional site for measuring body temperature in dogs, an increasing number of clinicians have been using auricular temperature to estimate core body temperature. In this study, 88 mature healthy dogs had body temperatures measured with auricular and rectal thermometers. The mean temperature and confidence intervals were similar for each method, but Bland-Altman plots showed high biases and limits of agreement unacceptable for clinical purposes. The results indicate that auricular and rectal temperatures should not be interpreted interchangeably. PMID:21731094

Comparison between auricular and standard rectal thermometers for the measurement of body temperature in dogs.

PubMed

Sousa, Marlos G; Carareto, Roberta; Pereira-Junior, Valdo A; Aquino, Monally C C

2011-04-01

Although the rectal mucosa remains the traditional site for measuring body temperature in dogs, an increasing number of clinicians have been using auricular temperature to estimate core body temperature. In this study, 88 mature healthy dogs had body temperatures measured with auricular and rectal thermometers. The mean temperature and confidence intervals were similar for each method, but Bland-Altman plots showed high biases and limits of agreement unacceptable for clinical purposes. The results indicate that auricular and rectal temperatures should not be interpreted interchangeably.

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

Fox, K. M.; Johnson, F. C.

Increased loading of high level waste in glass can lead to crystallization within the glass. Some crystalline species, such as spinel, have no practical impact on the chemical durability of the glass, and therefore may be acceptable from both a processing and a product performance standpoint. In order to operate a melter with a controlled amount of crystallization, options must be developed for remediating an unacceptable accumulation of crystals. This report describes preliminary experiments designed to evaluate the ability to dissolve spinel crystals in simulated waste glass melts via the addition of glass forming chemicals (GFCs).

Chemical and chemically-related considerations associated with sluicing tank C-106 waste to tank AY-102

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

Reynolds, D.A.

1997-04-04

New data on tank 241-C-106 were obtained from grab sampling and from compatibility testing of tank C-106 and tank AY-102 wastes. All chemistry-associated and other compatibility Information compiled in this report strongly suggests that the sluicing of the contents of tank C-106, in accord with appropriate controls, will pose no unacceptable risk to workers, public safety, or the environment. In addition, it is expected that the sluicing operation will successfully resolve the High-Heat Safety Issue for tank C-106.

Loss aversion, large deviation preferences and optimal portfolio weights for some classes of return processes

NASA Astrophysics Data System (ADS)

Duffy, Ken; Lobunets, Olena; Suhov, Yuri

2007-05-01

We propose a model of a loss averse investor who aims to maximize his expected wealth under certain constraints. The constraints are that he avoids, with high probability, incurring an (suitably defined) unacceptable loss. The methodology employed comes from the theory of large deviations. We explore a number of fundamental properties of the model and illustrate its desirable features. We demonstrate its utility by analyzing assets that follow some commonly used financial return processes: Fractional Brownian Motion, Jump Diffusion, Variance Gamma and Truncated Lévy.

Materials interactions between the thermoelectric converter and the 5kwe reactor system

NASA Technical Reports Server (NTRS)

Ferry, P. B.

1973-01-01

The integration of a compact thermoelectric converter with a 5-kwe reactor system is described. Material interaction uncertainties study is also presented. This includes degradation of the required austenitic - refractory metal transition joint during operation at high temperatures; loss of corrosion resistance; embrittlement by the presence of hydrogen; and loss of design margin by transport of interstitial elements. Analysis and limited experimental evidence indicate that these potential materials interactions can be adequately controlled. Group 5-2 refractory metals can be utilized without unacceptable adverse effect on system reliability.

Evaluation of hydrogen as a cryogenic wind tunnel test gas

NASA Technical Reports Server (NTRS)

Haut, R. C.

1977-01-01

The nondimensional ratios used to describe various flow situations in hydrogen were determined and compared with the corresponding ideal diatomic gas ratios. The results were used to examine different inviscid flow configurations. The relatively high value of the characteristic rotational temperature causes the behavior of hydrogen, under cryogenic conditions, to deviate substantially from the behavior of an ideal diatomic gas in the compressible flow regime. Therefore, if an idea diatomic gas is to be modeled, cryogenic hydrogen is unacceptable as a wind tunnel test gas in a compressible flow situation.

The Hybrid Propellant Module (HPM): A New Concept for Space Transfer in the Earth's Neighborhood and Beyond

NASA Technical Reports Server (NTRS)

Mankins, John C.; Mazanek, Daniel D.

2001-01-01

The safe, affordable and effective transfer of ever-larger payloads and eventually personnel beyond Low Earth Orbit (LEO) is a major challenge facing future commercial development and human exploration of space. Without reusable systems, sustained exploration or large scale development beyond LEO appears to be economically non-viable. However, reusable systems must be capable of both good fuel efficiency and "high utilization of capacity", or else economic costs will remain unacceptably high. Various options exist that can provide high fuel efficiency - for example, Solar Electric Propulsion Systems (SEPS) - but only at the cost of low thrust and concomitant long transit times. Chemical propulsion systems offer the potential for high thrust and short transit times - including both cryogenic and non-cryogenic options - but only at the cost of relatively low specific impulse (Isp). Nuclear thermal propulsion systems offer relatively good thrust-to-weight and Isp - but involve public concerns that may be insurmountable for all except the most-critical of public purposes. Fixed infrastructures have been suggested as one approach to solving this challenge; for example, rotating tether approaches. However, these systems tend to suffer from high initial costs or unacceptable operational constraints. A new concept has been identified - the Hybrid Propellant Module (HPM) - that integrates the best features of both chemical and solar electric transportation architectures. The HPM approach appears to hold promise of solving the issues associated with other approaches, opening a new family of capabilities for future space exploration and development of near-Earth space and beyond. This paper provides a summary overview of the challenge of Earth neighborhood transportation and discusses how various systems concepts might be applied to meet the needs of these architectures. The paper describes a new approach, the HPM, and illustrates the application of the concept for a typical mission concept. The paper concludes with a discussion of needed technologies and a possible timeline for the development and evolution of this class of systems concepts.

Educational Differences in U.S. Adult Mortality: A Cohort Perspective*

PubMed Central

Masters, Ryan K.; Hummer, Robert A.; Powers, Daniel A.

2014-01-01

We use hierarchical cross-classified random-effects models to simultaneously measure age, period, and cohort patterns of mortality risk between 1986 and 2006 for non-Hispanic white and non-Hispanic black men and women with less than a high school education, a high school education, and more than a high school education. We examine all-cause mortality risk and mortality risk from heart disease, lung cancer, and unpreventable cancers. Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality. Findings also demonstrate that disparate cohort effects between education groups widened the education gap in all-cause mortality risk and mortality risk from heart disease and lung cancer across this time period. Educational disparities in mortality risk from unpreventable cancers, however, did not change. This research uncovers widening educational differences in adult mortality and demonstrates that a cohort perspective provides valuable insights for understanding recent temporal changes in U.S. mortality risk. PMID:25346542

Causes and implications of the correlation between forest productivity and tree mortality rates

USGS Publications Warehouse

Stephenson, Nathan L.; van Mantgem, Philip J.; Bunn, Andrew G.; Bruner, Howard; Harmon, Mark E.; O'Connell, Kari B.; Urban, Dean L.; Franklin, Jerry F.

2011-01-01

For only one of these four mechanisms, competition, can high mortality rates be considered to be a relatively direct consequence of high NPP. The remaining mechanisms force us to adopt a different view of causality, in which tree growth rates and probability of mortality can vary with at least a degree of independence along productivity gradients. In many cases, rather than being a direct cause of high mortality rates, NPP may remain high in spite of high mortality rates. The independent influence of plant enemies and other factors helps explain why forest biomass can show little correlation, or even negative correlation, with forest NPP.

Self-healing failures in the aerial plant

NASA Astrophysics Data System (ADS)

Kiss, Gabor D.

1994-03-01

This account begins in the wee hours of a bitterly cold night in the winter of '92 - '93. A fiber optic transmission system starts to incur unacceptable errors and switches to a protect channel. The system is being run at 1550 nm because it is a route which is long enough to otherwise require a repeater at 1310 nm. OTDR measurement shows high splice losses. By dawn the high-loss splices have partially recovered so the system is switched back to the original fibers. Failure of the mechanical splices is suspected, the RBOC requests post-mortem assistance from Bellcore, and a team is dispatched immediately to work with RBOC personnel in determining the cause of the failure.

Associations between tobacco control policy awareness, social acceptability of smoking and smoking cessation. Findings from the International Tobacco Control (ITC) Europe Surveys.

PubMed

Rennen, Els; Nagelhout, Gera E; van den Putte, Bas; Janssen, Eva; Mons, Ute; Guignard, Romain; Beck, François; de Vries, Hein; Thrasher, James F; Willemsen, Marc C

2014-02-01

This study examined whether awareness of tobacco control policies was associated with social unacceptability of smoking and whether social unacceptability had an effect on smoking cessation in three European countries. Representative samples (n = 3865) of adult smokers in France, the Netherlands and Germany were used from two survey waves of the longitudinal International Tobacco Control Europe Surveys. Associations were examined of aspects of social unacceptability of smoking (i.e. feeling uncomfortable, important people disapproval and societal disapproval) with tobacco policy awareness (i.e. awareness of warning labels, anti-tobacco information and smoking restrictions at work) and smoking cessation. Only the positive association of awareness of anti-tobacco information with feeling uncomfortable about smoking was significant in each of the three countries. Important people disapproval predicted whether smokers attempted to quit, although this did not reach significance in the French and German samples in multivariate analyses. Our findings suggest that anti-tobacco information campaigns about the dangers of second-hand smoke in France and about smoking cessation in the Netherlands and Germany might have reduced the social acceptability of smoking in these countries. However, campaigns that influence the perceived disapproval of smoking by important people may be needed to ultimately increase attempts to quit smoking.

Associations between tobacco control policy awareness, social acceptability of smoking and smoking cessation. Findings from the International Tobacco Control (ITC) Europe Surveys

PubMed Central

Rennen, Els; Nagelhout, Gera E.; van den Putte, Bas; Janssen, Eva; Mons, Ute; Guignard, Romain; Beck, François; de Vries, Hein; Thrasher, James F.; Willemsen, Marc C.

2014-01-01

This study examined whether awareness of tobacco control policies was associated with social unacceptability of smoking and whether social unacceptability had an effect on smoking cessation in three European countries. Representative samples (n = 3865) of adult smokers in France, the Netherlands and Germany were used from two survey waves of the longitudinal International Tobacco Control Europe Surveys. Associations were examined of aspects of social unacceptability of smoking (i.e. feeling uncomfortable, important people disapproval and societal disapproval) with tobacco policy awareness (i.e. awareness of warning labels, anti-tobacco information and smoking restrictions at work) and smoking cessation. Only the positive association of awareness of anti-tobacco information with feeling uncomfortable about smoking was significant in each of the three countries. Important people disapproval predicted whether smokers attempted to quit, although this did not reach significance in the French and German samples in multivariate analyses. Our findings suggest that anti-tobacco information campaigns about the dangers of second-hand smoke in France and about smoking cessation in the Netherlands and Germany might have reduced the social acceptability of smoking in these countries. However, campaigns that influence the perceived disapproval of smoking by important people may be needed to ultimately increase attempts to quit smoking. PMID:23861478

Impact of diurnal temperature range on mortality in a high plateau area in southwest China: A time series analysis.

PubMed

Ding, Zan; Guo, Pi; Xie, Fang; Chu, Huifang; Li, Kun; Pu, Jingbo; Pang, Shaojie; Dong, Hongli; Liu, Yahui; Pi, Fuhua; Zhang, Qingying

2015-09-01

Diurnal temperature range (DTR) is an important meteorological indicator that reflects weather stability and is associated with global climate change and urbanization. Previous studies have explored the effect of DTR on human health in coastal cities with small daily temperature variations, but we have little evidence for high plateau regions where large DTRs usually occur. Using daily mortality data (2007-2013), we conducted a time-series analysis to assess the effect of DTR on daily mortality in Yuxi, a high plateau city in southwest China. Poisson regression with distributed lag non-linear model was used to estimate DTR effects on daily mortality, controlling for daily mean temperature, relative humidity, sunshine duration, wind speed, atmospheric pressure, day of the week, and seasonal and long-term trends. The cumulative effects of DTR were J-shaped curves for non-accidental, cardiorespiratory and cardiovascular mortality, with a U-shaped curve for respiratory mortality. Risk assessments showed strong monotonic increases in mortality starting at a DTR of approximately 16 °C. The relative risk of non-accidental morality with extreme high DTR at lag 0 and 0-21 days was 1.03 (95% confidence interval: 0.95-1.11) and 1.33 (0.94-1.89), respectively. The risk of mortality with extreme high DTR was greater for males and age <75 years than females and age ≥75 years. The effect of DTR on mortality was non-linear, with high DTR associated with increased mortality. A DTR of 16 °C may be a cut-off point for mortality prognosis and has implications for developing intervention strategies to address high DTR exposure. Copyright © 2015 Elsevier B.V. All rights reserved.

Gestational Age Patterns of Fetal and Neonatal Mortality in Europe: Results from the Euro-Peristat Project

PubMed Central

Mohangoo, Ashna D.; Buitendijk, Simone E.; Szamotulska, Katarzyna; Chalmers, Jim; Irgens, Lorentz M.; Bolumar, Francisco; Nijhuis, Jan G.; Zeitlin, Jennifer

2011-01-01

Background The first European Perinatal Health Report showed wide variability between European countries in fetal (2.6–9.1‰) and neonatal (1.6–5.7‰) mortality rates in 2004. We investigated gestational age patterns of fetal and neonatal mortality to improve our understanding of the differences between countries with low and high mortality. Methodology/Principal Findings Data on 29 countries/regions participating in the Euro-Peristat project were analyzed. Most European countries had no limits for the registration of live births, but substantial variations in limits for registration of stillbirths before 28 weeks of gestation existed. Country rankings changed markedly after excluding deaths most likely to be affected by registration differences (22–23 weeks for neonatal mortality and 22–27 weeks for fetal mortality). Countries with high fetal mortality ≥28 weeks had on average higher proportions of fetal deaths at and near term (≥37 weeks), while proportions of fetal deaths at earlier gestational ages (28–31 and 32–36 weeks) were higher in low fetal mortality countries. Countries with high neonatal mortality rates ≥24 weeks, all new member states of the European Union, had high gestational age-specific neonatal mortality rates for all gestational-age subgroups; they also had high fetal mortality, as well as high early and late neonatal mortality. In contrast, other countries with similar levels of neonatal mortality had varying levels of fetal mortality, and among these countries early and late neonatal mortality were negatively correlated. Conclusions For valid European comparisons, all countries should register births and deaths from at least 22 weeks of gestation and should be able to distinguish late terminations of pregnancy from stillbirths. After excluding deaths most likely to be influenced by existing registration differences, important variations in both levels and patterns of fetal and neonatal mortality rates were found. These disparities raise questions for future research about the effectiveness of medical policies and care in European countries. PMID:22110575

Models of Mass Transport During Microgravity Crystal Growth of Alloyed Semiconductors in a Magnetic Field

NASA Technical Reports Server (NTRS)

Ma, Nancy

2003-01-01

Alloyed semiconductor crystals, such as germanium-silicon (GeSi) and various II-VI alloyed crystals, are extremely important for optoelectronic devices. Currently, high-quality crystals of GeSi and of II-VI alloys can be grown by epitaxial processes, but the time required to grow a certain amount of single crystal is roughly 1,000 times longer than the time required for Bridgman growth from a melt. Recent rapid advances in optoelectronics have led to a great demand for more and larger crystals with fewer dislocations and other microdefects and with more uniform and controllable compositions. Currently, alloyed crystals grown by bulk methods have unacceptable levels of segregation in the composition of the crystal. Alloyed crystals are being grown by the Bridgman process in space in order to develop successful bulk-growth methods, with the hope that the technology will be equally successful on earth. Unfortunately some crystals grown in space still have unacceptable segregation, for example, due to residual accelerations. The application of a weak magnetic field during crystal growth in space may eliminate the undesirable segregation. Understanding and improving the bulk growth of alloyed semiconductors in microgravity is critically important. The purpose of this grant to to develop models of the unsteady species transport during the bulk growth of alloyed semiconductor crystals in the presence of a magnetic field in microgravity. The research supports experiments being conducted in the High Magnetic Field Solidification Facility at Marshall Space Flight Center (MSFC) and future experiments on the International Space Station.

Excellent outcomes of liver transplantation using severely steatotic grafts from brain-dead donors.

PubMed

Wong, Tiffany C L; Fung, James Y Y; Chok, Kenneth S H; Cheung, Tan To; Chan, Albert C Y; Sharr, William W; Dai, Wing Chiu; Chan, See Ching; Lo, Chung Mau

2016-02-01

Liver grafts with macrovesicular steatosis of > 60% are considered unsuitable for deceased donor liver transplantation (DDLT) because of the unacceptably high risk of primary nonfunction (PNF) and graft loss. This study reports our experience in using such grafts from brain-dead donors. Prospectively collected data of DDLT recipient outcomes from 1991 to 2013 were retrospectively analyzed. Macrovesicular steatosis > 60% at postperfusion graft biopsy was defined as severe steatosis. In total, 373 patients underwent DDLT. Nineteen patients received severely steatotic grafts (ie, macrovesicular steatosis > 60%), and 354 patients had grafts with ≤ 60% steatosis (control group). Baseline demographics were comparable except that recipient age was older in the severe steatosis group (51 versus 55 years; P = 0.03). Median Model for End-Stage Liver Disease (MELD) score was 20 in the severe steatosis group and 22 in the control group. Cold ischemia time (CIT) was 384 minutes in the severe steatosis group and 397.5 minutes in the control group (P = 0.66). The 2 groups were similar in duration of stay in the hospital and in the intensive care unit. Risk of early allograft dysfunction (0/19 [0%] versus 1/354 [0.3%]; P>0.99) and 30-day mortality (0/19 [0%] versus 11/354 [3.1%]; P = 0.93) were also similar between groups. No patient developed PNF. The 1-year and 3-year overall survival rates in the severe steatosis group were both 94.7%. The corresponding rates in the control group were 91.8% and 85.8% (P = 0.55). The use of severely steatotic liver grafts from low-risk donors was safe, and excellent outcomes were achieved; however, these grafts should be used with caution, especially in patients with high MELD score. Keeping a short CIT was crucial for the successful use of such grafts in liver transplantation. © 2015 American Association for the Study of Liver Diseases.

An Assessment of Peri-Urban Groundwater Quality from Shallow Dug Wells, Mzuzu, Malawi

NASA Astrophysics Data System (ADS)

Holm, R.; Felsot, A.

2012-12-01

Throughout Malawi, governmental, non-governmental, religious and civic organizations are targeting the human need for water. Diarrheal diseases, often associated with unsafe drinking water, are a leading cause of mortality in children under five in Malawi with over 6,000 deaths per year (World Health Organization, 2010). From January to March 2012, a field study was undertaken in Malawi to study water quality and develop a public health risk communication strategy. The region studied, Area 1B, represents a comparatively new peri-urban area on the edge of Mzuzu city. Area 1B is serviced by a piped municipal water supply, but many shallow dug wells are also used for household water. Groundwater samples were collected from 30 shallow dug well sites and analyzed for nitrate, total coliform, Escherichia coli, total hardness, total alkalinity and pH. In addition to water quality analyses, a structured household questionnaire was administered to address water use, sanitation, health, consumption patterns, and socioeconomics. Results showed that more than half of the groundwater samples would be considered of unacceptable quality based on World Health Organization (WHO) standards for E. coli contamination. Low levels of nitrate were found in groundwater, but only one well exceeded WHO standards. The structured questionnaire revealed that some residents were still consuming groundwater despite the access to safer municipal water. In general, the widespread E. coli contamination was not statistically correlated with well depth, latrine proximity, or surface features. Similarly, nitrate concentrations were not significantly correlated with proximity to latrines. On the other hand, nitrate was correlated with well depth, which is expected given the high potential for leaching of anionic highly water soluble compounds. E. coli was significantly correlated with nitrate concentration. Projects targeting the need for clean water need to recognize that households with access to a safe piped municipal water service may still be consuming unsafe groundwater.

Effectiveness of community based Safe Motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania.

PubMed

Mushi, Declare; Mpembeni, Rose; Jahn, Albrecht

2010-04-01

In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%), only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs). Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (rho < 0.05). Early ANC booking (4 to 16 weeks) rose significantly from 18.7% at baseline to 37.7% in 2005 and 56.9% (rho < 0.001) at final assessment. After two years 44 (88%) of the SMPs were still active, 79% of pregnant women were visited. Further benefits included the enhancement of male involvement in safe motherhood issues. The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

Gynecologic Oncology Group quality assurance audits: analysis and initiatives for improvement.

PubMed

Blessing, John A; Bialy, Sally A; Whitney, Charles W; Stonebraker, Bette L; Stehman, Frederick B

2010-08-01

The Gynecologic Oncology Group (GOG) is a multi-institution, multi-discipline Cooperative Group funded by the National Cancer Institute (NCI) to conduct clinical trials which investigate the treatment, prevention, control, quality of survivorship, and translational science of gynecologic malignancies. In 1982, the NCI initiated a program of on-site quality assurance audits of participating institutions. Each is required to be audited at least once every 3 years. In GOG, the audit mandate is the responsibility of the GOG Quality Assurance Audit Committee and it is centralized in the Statistical and Data Center (SDC). Each component (Regulatory, Investigational Drug Pharmacy, Patient Case Review) is classified as Acceptable, Acceptable, follow-up required, or Unacceptable. To determine frequently occurring deviations and develop focused innovative solutions to address them. A database was created to examine the deviations noted at the most recent audit conducted at 57 GOG parent institutions during 2004-2007. Cumulatively, this involved 687 patients and 306 protocols. The results documented commendable performance: Regulatory (39 Acceptable, 17 Acceptable, follow-up, 1 Unacceptable); Pharmacy (41 Acceptable, 3 Acceptable, follow-up, 1 Unacceptable, 12 N/A): Patient Case Review (31 Acceptable, 22 Acceptable, follow-up, 4 Unacceptable). The nature of major and lesser deviations was analyzed to create and enhance initiatives for improvement of the quality of clinical research. As a result, Group-wide proactive initiatives were undertaken, audit training sessions have emphasized recurring issues, and GOG Data Management Subcommittee agendas have provided targeted instruction and training. The analysis was based upon parent institutions only; affiliate institutions and Community Clinical Oncology Program participants were not included, although it is assumed their areas of difficulty are similar. The coordination of the GOG Quality Assurance Audit program in the SDC has improved data quality by enhancing our ability to identify frequently occurring deviations and develop innovative solutions to avoid or minimize their occurrence in the future.

T Cell-Replete Peripheral Blood Haploidentical Hematopoietic Cell Transplantation with Post-Transplantation Cyclophosphamide Results in Outcomes Similar to Transplantation from Traditionally Matched Donors in Active Disease Acute Myeloid Leukemia.

PubMed

How, Joan; Slade, Michael; Vu, Khoan; DiPersio, John F; Westervelt, Peter; Uy, Geoffrey L; Abboud, Camille N; Vij, Ravi; Schroeder, Mark A; Fehniger, Todd A; Romee, Rizwan

2017-04-01

Outcomes for patients with acute myeloid leukemia (AML) who fail to achieve complete remission remain poor. Hematopoietic cell transplantation (HCT) has been shown to induce long-term survival in AML patients with active disease. HCT is largely performed with HLA-matched unrelated or HLA-matched related donors. Recently, HCT with HLA-haploidentical related donors has been identified as a feasible option when HLA-matched donors are not immediately available. However, there are little data comparing outcomes for AML patients with active disease who receive haploidentical versus traditionally matched HCT. We retrospectively analyzed data from 99 AML patients with active disease undergoing allogeneic HCT at a single institution. Forty-three patients received unrelated donor HCT, 32 patients received matched related donor HCT, and 24 patients received peripheral blood haploidentical HCT with post-transplantation cyclophosphamide. We found no significant differences between treatment groups in terms of overall survival (OS), event-free survival, transplantation-related mortality, cumulative incidence of relapse, and cumulative incidence of acute and chronic graft-versus-host disease (GVHD). We performed univariate regression analysis of variables that modified OS in all patients and found only younger age at transplantation and development of chronic GVHD significantly improved outcome. Although limited by our relatively small sample size, these results indicate that haploidentical HCT in active AML patients have comparable outcomes to HCT with traditionally matched donors. Haploidentical HCT can be considered in this population of high-risk patients when matched donors are unavailable or when wait times for transplantation are unacceptably long. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Development of Anti-Virulence Approaches for Candidiasis via a Novel Series of Small-Molecule Inhibitors of Candida albicans Filamentation

PubMed Central

Romo, Jesus A.; Pierce, Christopher G.; Chaturvedi, Ashok K.; Lazzell, Anna L.; McHardy, Stanton F.

2017-01-01

ABSTRACT Candida albicans remains the main etiologic agent of candidiasis, the most common fungal infection and now the third most frequent infection in U.S. hospitals. The scarcity of antifungal agents and their limited efficacy contribute to the unacceptably high morbidity and mortality rates associated with these infections. The yeast-to-hypha transition represents the main virulence factor associated with the pathogenesis of C. albicans infections. In addition, filamentation is pivotal for robust biofilm development, which represents another major virulence factor for candidiasis and further complicates treatment. Targeting pathogenic mechanisms rather than growth represents an attractive yet clinically unexploited approach in the development of novel antifungal agents. Here, we performed large-scale phenotypic screening assays with 30,000 drug-like small-molecule compounds within ChemBridge’s DIVERSet chemical library in order to identify small-molecule inhibitors of C. albicans filamentation, and our efforts led to the identification of a novel series of bioactive compounds with a common biaryl amide core structure. The leading compound of this series, N-[3-(allyloxy)-phenyl]-4-methoxybenzamide, was able to prevent filamentation under all liquid and solid medium conditions tested, suggesting that it impacts a common core component of the cellular machinery that mediates hypha formation under different environmental conditions. In addition to filamentation, this compound also inhibited C. albicans biofilm formation. This leading compound also demonstrated in vivo activity in clinically relevant murine models of invasive and oral candidiasis. Overall, our results indicate that compounds within this series represent promising candidates for the development of novel anti-virulence approaches to combat C. albicans infections. PMID:29208749

Invasive Candidiasis in Various Patient Populations: Incorporating Non-Culture Diagnostic Tests into Rational Management Strategies

PubMed Central

Clancy, Cornelius J.; Shields, Ryan K.; Nguyen, M. Hong

2016-01-01

Mortality rates due to invasive candidiasis remain unacceptably high, in part because the poor sensitivity and slow turn-around time of cultures delay the initiation of antifungal treatment. β-d-glucan (Fungitell) and polymerase chain reaction (PCR)-based (T2Candida) assays are FDA-approved adjuncts to cultures for diagnosing invasive candidiasis, but their clinical roles are unclear. We propose a Bayesian framework for interpreting non-culture test results and developing rational patient management strategies, which considers test performance and types of invasive candidiasis that are most common in various patient populations. β-d-glucan sensitivity/specificity for candidemia and intra-abdominal candidiasis is ~80%/80% and ~60%/75%, respectively. In settings with 1%–10% likelihood of candidemia, anticipated β-d-glucan positive and negative predictive values are ~4%–31% and ≥97%, respectively. Corresponding values in settings with 3%–30% likelihood of intra-abdominal candidiasis are ~7%–51% and ~78%–98%. β-d-glucan is predicted to be useful in guiding antifungal treatment for wide ranges of populations at-risk for candidemia (incidence ~5%–40%) or intra-abdominal candidiasis (~7%–20%). Validated PCR-based assays should broaden windows to include populations at lower-risk for candidemia (incidence ≥~2%) and higher-risk for intra-abdominal candidiasis (up to ~40%). In the management of individual patients, non-culture tests may also have value outside of these windows. The proposals we put forth are not definitive treatment guidelines, but rather represent starting points for clinical trial design and debate by the infectious diseases community. The principles presented here will be applicable to other assays as they enter the clinic, and to existing assays as more data become available from different populations. PMID:29376927

Homeless children: the lives of a group of Brazilian street children.

PubMed

Ribeiro, M O; Trench Ciampone, M H

2001-07-01

To evaluate the life trajectories of a group of school-age street children frequenting two São Paulo city public shelters. A large proportion of the Brazilian child population suffers extreme disadvantage, although the Brazilian government gave the issue 'absolute priority' in 1990. Maternal and Under 5 mortality rates remain unacceptably high. In the metropolitan region of São Paulo an estimated 200 000 minors do not live with their mothers. Brazilian street children live lives of extreme personal and social risk. The data were collected through individual, semi-structured interviews, with 14 school age (7-12 years) participants frequenting two city public refuges, with their legal guardians' consent. Data analysis was based on Social Representation Theory and used content analysis. The children's most meaningful experiences were grouped into the thematic categories of family, the street, friends, drugs, the police, the shelters and the future. Synthesis of these categories showed the lives of these children to be permeated by violence, resulting in experiences restricting their full development. The solution to their problems depends on pressure being put on the State by the civilian community in order to establish social and health policies that conform to the Child and Adolescent Statute (ECA). We consider that assisting street children involves attitudes that go beyond professional performance and demands acts of citizenship. The development of an ethical-political attitude by professionals to the problems of homeless street children is essential, and educational curricula should be appropriately constituted. Political projects to develop health and welfare policies and education should be directed to these children and their relatives, and include participation by health professionals to provide the necessary preventive and curative services.

Complications of hematopoietic stem transplantation: Fungal infections.

PubMed

Omrani, Ali S; Almaghrabi, Reem S

2017-12-01

Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are at increased risk of invasive fungal infections, especially during the early neutropenic phase and severe graft-versus-host disease. Mold-active prophylaxis should be limited to the highest risk groups. Empiric antifungal therapy for HSCT with persistent febrile neutropenia is associated with unacceptable response rates, unnecessary antifungal therapy, increased risk of toxicity, and inflated costs. Empiric therapy should not be a substitute for detailed work up to identify the cause of fever in such patients. The improved diagnostic performance of serum biomarkers such as galactomannan and β-D-glucan, as well as polymerase chain reaction assays has allowed the development of diagnostic-driven antifungal therapy strategies for high risk patients. Diagnostic-driven approaches have resulted in reduced unnecessary antifungal exposure, improved diagnosis of invasive fungal disease, and reduced costs without increased risk of mortality. The appropriateness of diagnostic-driven antifungal strategy for individual HSCT centers depends on the availability and turnaround times for diagnostics, multidisciplinary expertise, and the local epidemiology of invasive fungal infections. Echinocandins are the treatment of choice for invasive candidiasis in most HSCT recipients. Fluconazole may be used for the treatment of invasive candidiasis in hemodynamically stable patients with no prior azole exposure. The primary treatment of choice for invasive aspergillosis is voriconazole. Alternatives include isavuconazole and lipid formulations of amphotericin. Currently available evidence does not support routine primary combination antifungal therapy for invasive aspergillosis. However, combination salvage antifungal therapy may be considered in selected patients. Therapeutic drug monitoring is recommended for the majority of HSCT recipients on itraconazole, posaconazole, or voriconazole. Copyright © 2017 King Faisal Specialist Hospital & Research Centre. Published by Elsevier B.V. All rights reserved.

Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys - an experimental porcine model of ischaemic heart failure.

PubMed

Møller-Helgestad, Ole K; Poulsen, Christian B; Christiansen, Evald H; Lassen, Jens F; Ravn, Hanne B

2015-01-15

Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. 13 pigs were anesthetised and left ventricular failure was induced by occluding the proximal LAD for 45min followed by 30min of reperfusion. Blood flow was measured in the carotid artery, the LAD, and the renal artery. The Impella® and IABP were inserted via the femoral arteries, and the two devices were tested individually and combined after induction of heart failure. Carotid- (p=0.01) and renal blood flow (p=0.045) were higher on Impella®-support, compared to no support. None of the devices altered the blood flow in the LAD. Cardiac power output (p<0.005) and left ventricular work (p<0.00) were also higher on Impella®-support compared to no support. Haemodynamics and blood flow to the brain and kidneys were significantly better on Impella®-support, suggesting that the Impella® is superior to the IABP in a state of ischaemia induced left ventricular failure. These data, however, needs to be confirmed in a proper clinical trial with patients in cardiogenic shock. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Toxicity of six insecticides to predatory mite Amblyseius cucumeris (Oudemans) (Acari: Phytoseiidae) in- and off-field.

PubMed

Cheng, Shenhang; Lin, Ronghua; Zhang, Nan; Yuan, Shankui; Zhou, Xinxin; Huang, Jian; Ren, Xiaodong; Wang, Shoushan; Jiang, Hui; Yu, Caihong

2018-06-22

Amblyseius cucumeris (Oudemans) is a beneficial non-target arthropod (NTA) and a key predator of tetranychid mites in integrated pest management (IPM) programs across China. Evaluating the toxic effects of insecticides on such predatory mites is essential for the success and development of IPM. We tested six insecticides to determine the risk of neonicotinoid insecticide toxicity to predatory mites, using the 'open glass plate method' and adult female A. cucumeris in a "worst case laboratory exposure" scenario. A 48-h toxicity test was performed using the hazard quotient (HQ) approach to evaluate the risk of each insecticide. The LR 50 values (application rate that caused 50% mortality) of acetamiprid, thiamethoxam, imidacloprid, and dinotefuran were 76.4, 104.5, 84.9, and 224.6 g active ingredient (a.i.) ha -1 , respectively, with in-field HQ values of 0.40, 1.28, 0.49, and 0.82, respectively. The HQ values were lower than the trigger value of 2, and were consistent with off-field values. The risks of the four neonicotinoid insecticides to adult female A. cucumeris were acceptable in two exposure scenarios in field and off field. The 48-h LR 50 values for bifenthrin and malathion were 0.008 and 0.062 g. a.i. ha -1 , respectively, which were much lower than the recommended field application rates. The HQ values were much higher than the trigger values for both in- and off-field, indicating that the risks of these two insecticides were unacceptable. Bifenthrin and malathion posed an extremely high risk to the test species, and their use should be restricted to reduce risks to the field with augmentative releases of A. cucumeris. Copyright © 2018 Elsevier Inc. All rights reserved.

Determinants of domestic violence against women in Ghana.

PubMed

Owusu Adjah, Ebenezer S; Agbemafle, Isaac

2016-05-02

The prevalence of domestic violence remains unacceptably high with numerous consequences ranging from psychological to maternal and neonatal mortality and morbidity outcomes in pregnant women. The aim of this study was to identify factors that increased the likelihood of an event of domestic violence as reported by ever married Ghanaian women. Data from the 2008 Ghana Demographic and Health Survey (GDHS) was analysed using a multivariate logistic model and risk factors were obtained using the forward selection procedure. Of the 1524 ever married women in this study, 33.6 % had ever experienced domestic violence. The risk of ever experiencing domestic violence was 35 % for women who reside in urban areas. Risk of domestic violence was 41 % higher for women whose husbands ever experienced their father beating their mother. Women whose mother ever beat their father were three times more likely to experience domestic violence as compared to women whose mother did not beat their father. The risk of ever experiencing domestic violence was 48 % less likely for women whose husbands had higher than secondary education as compared to women whose husbands never had any formal education. Women whose husbands drink alcohol were 2.5 times more likely to experience domestic violence as compared to women whose husbands do not drink alcohol. Place of residence, alcohol use by husband and family history of violence do increase a woman's risk of ever experiencing domestic violence. Higher than secondary education acted as a protective buffer against domestic violence. Domestic violence against women is still persistent and greater efforts should be channelled into curtailing it by using a multi-stakeholder approach and enforcing stricter punishments to perpetrators.

Reliable and developmentally appropriate study end points are needed to achieve drug development for treatment of pediatric pulmonary arterial hypertension.

PubMed

Sun, H; Stockbridge, N; Ariagno, R L; Murphy, D; Nelson, R M; Rodriguez, W

2016-12-01

To identify suitable end points and surrogates for pediatric pulmonary arterial hypertension (PAH) as the lack of developmentally appropriate end point and clinical trials contribute to the unmet medical need. Reviewed the efficacy end points and surrogates for all trials (1995 to 2013) that were submitted to the Food and Drug Administration (FDA) to support the approval of PAH therapy and conducted literature search. An increase in the 6 min walking distance (6MWD) was used as a primary end point in 8/9 adult PAH trials. This end point is not suitable for infants and young children because of performance limitations and lack of control data. One adult PAH trial used time to the first morbidity or mortality event as a primary end point, which could potentially be used in pediatric PAH trials. In the sildenafil pediatric PAH trial, the change in pulmonary vascular resistance index or mean pulmonary artery pressure was used as a surrogate for the 6MWD to assess exercise capacity. However, two deaths and three severe adverse events during the catheterizations made this an unacceptably high-risk surrogate. The INOmax persistent pulmonary hypertension of the newborn trial used a reduction in initiation of extracorporeal membrane oxygenation treatment as a primary end point, which is not feasible for other pediatric PAH trials. A Literature review revealed none of the existing noninvasive markers are fully validated as surrogates to assess PAH efficacy and long-term safety. For pediatric PAH trials, clinical end points are acceptable, and novel validated surrogates would be helpful. FDA seeks collaboration with academia, industry and parents to develop other suitable and possibly more efficient efficacy end points to facilitate pediatric PAH drug development.

Administrative issues involved in disaster management in India.

PubMed

Kaur, Jagdish

2006-12-01

India as a country is vulnerable to a number of disasters, from earthquakes to floods. Poor and weaker members of the society have always been more vulnerable to various types of disasters. Disasters result in unacceptably high morbidity and mortality amongst the affected population. Damage to infrastructure and reduction in revenues from the affected region due to low yield add to the economic losses. Poor co-ordination at the local level, lack of early-warning systems, often very slow responses, paucity of trained dedicated clinicians, lack of search and rescue facilities and poor community empowerment are some of the factors, which have been contributing to poor response following disasters in the past. The first formal step towards development of policies relating to disaster care in India was the formulation of the National Disaster Response Plan (NDRP) which was formulated initially by the Government of India for managing natural disasters only. However, this was subsequently amended to include man-made disasters as well. It sets the scene for formulating state and district level plans in all states to bring cohesiveness and a degree of uniform management in dealing with disasters. A National Disaster Management Authority has been constituted which aims to provide national guidelines and is headed by the Prime Minister of India. It is the highest decision-making body for the management of disasters in the country. The authority has the responsibility for co-ordinating response and post-disaster relief and rehabilitation. Each state is required to set up Disaster Management Authorities and District Disaster Management Committees for co-ordination and close supervision of activities and efforts related to the management of disasters.

Monitoring of live and woody elements

NASA Astrophysics Data System (ADS)

Guastini, Enrico; Preti, Federico

2013-04-01

This study deals with surveys operated on crib walls in Casentino and Versilia (Tuscany), where Salix alba cuttings did not develop as expected from literature data. After more then 10 years since realization and and an initial very high survival rate, a few plants are yet alive among those put in place and the root strengthening is localized in the first 0.30 m just below the structure front face, while at further depth the detected root area ratio (R.A.R.) does not determine a noticeable increase in soil cohesion (Guastini et al., 2012). Mortality curve in willow cuttings is comparable with growing curve in Alnus nigra plants born in front of the structure, due to shading as failing cause. Assessing quantitatively the residual strength of the timber elements and estimating their possible duration allow comparison with the time needed for a complete stabilisation of the para-natural succession. The two spans of time must be almost similar to avoid unexpected collapse of the frame or unacceptable costs for oversized structures. Since the realization of a new live crib-wall in Casentino we sampled Alnus and Salix cuttings to compare rooting, survivability and evolution in randomized block design. Tests with Resistograph carried out on timber elements gives a good relationship between test results and density; through the non-destructive test it is possible to differentiate portions of wood with a noticeable residual strength from the decayed parts without any more load bearing capacity. MOR value (flexural strength) of timber elements has been estimated on the basis of the effective section verified by the Resistograph (Guastini et al., 2012), and then confirmed through rupture in bending of the same elements (Wood Technology DEISTAF lab), by proving the non-destructive test utility.

Outcomes after Deep Vein Thrombosis and Pulmonary Embolism in the Community: The Worcester Venous Thromboembolism Study

PubMed Central

Spencer, Frederick A.; Gore, Joel M.; Lessard, Darleen; Douketis, James D.; Emery, Cathy; Goldberg, Robert J.

2009-01-01

Background Despite advances in the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), there are relatively few contemporary data describing and comparing outcomes in patients with these common conditions from a more generalizable community-based perspective. The purpose of this study was to measure and compare clinical characteristics and outcomes of patients with validated symptomatic PE and isolated DVT in a New England community. Methods The medical records of residents from the Worcester (MA) area with ICD-9 codes consistent with possible venous thromboembolism (VTE) during 1999, 2001, and 2003 were independently validated and reviewed by trained abstractors. Results Patients presenting with PE or isolated DVT experienced similar rates of subsequent PE, overall venous thromboembolism (VTE), and major bleeding during 3-year follow-up (5.9% vs. 5.1%, 15% vs. 17.9%, 15.6% vs. 12.4%, respectively). Mortality was significantly increased at 1-month follow-up in patients initially presenting with PE (13.0% vs. 5.4%) - this difference persisted at 3 years (35.3% vs. 29.6%). Patients whose course was complicated by major bleeding were more likely to suffer recurrent VTE or to die at 3 years than those without these complications. Conclusions Patients presenting with PE had similar rates of subsequent PE or recurrent VTE as patients with isolated DVT. However, rates of recurrent VTE and major bleeding following DVT and PE remain unacceptably high in the community setting. Efforts remain needed to identify patients most at risk for VTE-associated complications and development of better anticoagulation strategies conducive to long-term use in the community setting. PMID:18299499

Natural Killer Cells in Antifungal Immunity.

PubMed

Schmidt, Stanislaw; Tramsen, Lars; Lehrnbecher, Thomas

2017-01-01

Invasive fungal infections are still an important cause of morbidity and mortality in immunocompromised patients such as patients suffering from hematological malignancies or patients undergoing hematopoietic stem cell transplantion. In addition, other populations such as human immunodeficiency virus-patients are at higher risk for invasive fungal infection. Despite the availability of new antifungal compounds and better supportive care measures, the fatality rate of invasive fungal infection remained unacceptably high. It is therefore of major interest to improve our understanding of the host-pathogen interaction to develop new therapeutic approaches such as adoptive immunotherapy. As experimental methodologies have improved and we now better understand the complex network of the immune system, the insight in the interaction of the host with the fungus has significantly increased. It has become clear that host resistance to fungal infections is not only associated with strong innate immunity but that adaptive immunity (e.g., T cells) also plays an important role. The antifungal activity of natural killer (NK) cells has been underestimated for a long time. In vitro studies demonstrated that NK cells from murine and human origin are able to attack fungi of different genera and species. NK cells exhibit not only a direct antifungal activity via cytotoxic molecules but also an indirect antifungal activity via cytokines. However, it has been show that fungi exert immunosuppressive effects on NK cells. Whereas clinical data are scarce, animal models have clearly demonstrated that NK cells play an important role in the host response against invasive fungal infections. In this review, we summarize clinical data as well as results from in vitro and animal studies on the impact of NK cells on fungal pathogens.

An analysis of suicide and undetermined deaths in 17 predominantly Islamic countries contrasted with the UK.

PubMed

Pritchard, Colin; Amanullah, S

2007-03-01

Suicide is expressly condemned in the Qu'ran, and traditionally few Islamic countries have reported suicide. Undetermined deaths are classified by the World Health Organization (WHO) as Other Violent Deaths (OVD) in ICD-9, or Other External Causes (OEC) in ICD-10. It has been suggested that to avoid under-reporting of suicides, both formal suicide verdicts and OVD should be considered together because OVD may contain 'hidden' suicides. The latest WHO mortality data, by age and gender, were analysed and tested by chi2 tests. Levels of suicide and OVD in 17 Islamic countries were examined and contextually compared with UK rates. The regional Islamic cultural differences in Middle Eastern, South Asian, European Islam countries and those of the former Union of Socialist Soviet Republics (FUSSR) were analysed separately to test the hypotheses that there would be no difference between regional suicide and OVD rates per million (pm) and 17 Islamic countries and UK rates. Suicide rates were higher for males than females, and 'older' (65+) higher than 'younger' (15-34) rates in every country reviewed. The rate for Middle Eastern males was 0-36 pm, South Asian 0-12 pm, European 53-177 pm and FUSSR 30-506 pm, with three countries exceeding the UK rate of 116 pm. The Western male average OVD rate was 22 pm; the UK 55 pm rate was highest. Middle Eastern OVD was 1-420 pm, South Asian 0-166 pm, European 1-66 pm and FUSSR 11-361 pm. OVD rates in 10 Islamic countries were considerably higher than the Western average and eight had OVD rates considerably higher than their suicide rates. Islamic suicide rates varied widely and the high OVD rates, especially the Middle Eastern, may be a repository for hiding culturally unacceptable suicides.

Combined angiotensin receptor/neprilysin inhibitors: a review of the new paradigm in the management of chronic heart failure.

PubMed

Macdonald, Peter S

2015-10-01

The aims of this article were to review the rationale behind the development of combined angiotensin receptor/neprilysin inhibitors (ARNIs) for the management of chronic heart failure (HF) and to review the major clinical trials of LCZ696, the first drug in this class, that have been conducted to date. A selected review was undertaken of publications examining the preclinical and clinical studies of drugs aimed at enhancing the activity of the endogenous natriuretic peptide system and their combination with inhibitors of the renin-angiotensin-aldosterone system, initially angiotensin-converting enzyme inhibitors (ACEIs) and more recently angiotensin II type 1 receptor blockers. Selective neprilysin inhibitors are unlikely to be of benefit and may be associated with adverse effects when used in isolation in HF. Combining NIs with ACEIs is unsafe because of an unacceptably high prevalence of angioedema, which may be mediated by elevated levels of endogenous bradykinin. Combining a neprilysin inhibitor with an angiotensin II type 1 receptor blockers avoids the risk for angioedema. The ARNI LCZ696 was associated with greater reductions both mortality and morbidity compared with those with enalapril in a large-scale, Phase III clinical trial in patients with HF with reduced ejection fraction. Findings from a Phase II clinical trial suggested that LCZ696 may also be beneficial in HF with preserved ejection fraction, and a Phase III clinical trial of LCZ696 used for this indication is under way. ARNIs have been described as a "game changer" by cardiologists. Based on findings from clinical trials conducted to date, there is an expectation that they will replace ACEIs as a building block of the pharmacologic treatment of chronic HF. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Radiation Hardened, Modulator ASIC for High Data Rate Communications

NASA Technical Reports Server (NTRS)

McCallister, Ron; Putnam, Robert; Andro, Monty; Fujikawa, Gene

2000-01-01

Satellite-based telecommunication services are challenged by the need to generate down-link power levels adequate to support high quality (BER approx. equals 10(exp 12)) links required for modem broadband data services. Bandwidth-efficient Nyquist signaling, using low values of excess bandwidth (alpha), can exhibit large peak-to-average-power ratio (PAPR) values. High PAPR values necessitate high-power amplifier (HPA) backoff greater than the PAPR, resulting in unacceptably low HPA efficiency. Given the high cost of on-board prime power, this inefficiency represents both an economical burden, and a constraint on the rates and quality of data services supportable from satellite platforms. Constant-envelope signals offer improved power-efficiency, but only by imposing a severe bandwidth-efficiency penalty. This paper describes a radiation- hardened modulator which can improve satellite-based broadband data services by combining the bandwidth-efficiency of low-alpha Nyquist signals with high power-efficiency (negligible HPA backoff).

A never-ending succession of epidemics? Mortality in early-modern York.

PubMed

Galley, C

1994-04-01

Early-modern cities are often perceived to be centres of high mortality and under constant siege from a barrage of epidemics. However, few urban mortality rates have been calculated and by employing parish register evidence from the regional capital of York, the thesis that the city was subjected to continual sudden increases in mortality can be firmly rejected. Infant mortality was high but remained virtually constant between 1561 and 1700. About a quarter of all infants did not survive to reach their first birthday and neonatal mortality was especially severe. From the mid-seventeenth century a series of epidemics increased child mortality although overall levels of mortality were not significantly affected. Relatively little can be said about adult mortality and apart from two periods of 'crisis' mortality there is little to suggest that adults were greatly affected by epidemics. Indeed, for many adults the urban environment appears to have posed no great threat to health and most could look forward to a relatively long life in the city. York's mortality regime was very similar to that of the smaller market town of Gainsborough where high levels of mortality remained stable throughout much of the early-modern period.

Toward an image compression algorithm for the high-resolution electronic still camera

NASA Technical Reports Server (NTRS)

Nerheim, Rosalee

1989-01-01

Taking pictures with a camera that uses a digital recording medium instead of film has the advantage of recording and transmitting images without the use of a darkroom or a courier. However, high-resolution images contain an enormous amount of information and strain data-storage systems. Image compression will allow multiple images to be stored in the High-Resolution Electronic Still Camera. The camera is under development at Johnson Space Center. Fidelity of the reproduced image and compression speed are of tantamount importance. Lossless compression algorithms are fast and faithfully reproduce the image, but their compression ratios will be unacceptably low due to noise in the front end of the camera. Future efforts will include exploring methods that will reduce the noise in the image and increase the compression ratio.

Electrostatic antenna space environment interaction study

NASA Technical Reports Server (NTRS)

Katz, I.

1981-01-01

The interactions of the electrostatic antenna with the space environment in both low Earth orbit and geosynchronous orbit are investigated. It is concluded that the electrostatically controlled membrane mirror is a viable concept for space applications. However, great care must be taken to enclose the high voltage electrodes in a Faraday cage structure to separate the high voltage region from the ambient plasma. For this reason, metallized cloth is not acceptable as a membrane material. Conventional spacecraft charging at geosynchronous orbit should not be a problem provided ancillary structures (such as booms) are given nonnegligible conductivity and adequate grounding. Power loss due to plasma electrons entering the high field region is a potentially serious problem. In low earth orbit any opening whatever in the Faraday cage is likely to produce an unacceptable power drain.

The microbiological quality of ready-to-eat foods with added spices.

PubMed

Little, C L; Omotoye, R; Mitchell, R T

2003-03-01

A microbiological study of ready-to-eat foods with added spices or spice ingredients was undertaken to identify any risk factors in the production, storage and display of this product and to establish their effect on microbiological quality. Examination of 1946 ready-to-eat foods from sandwich bars, cafés, public houses, restaurants, specialist sandwich producers, bakers, delicatessens, market stalls and mobile vendors found that 1291 (66%) were of satisfactory/acceptable microbiological quality, 609 (32%) were of unsatisfactory quality, and 46 (2%) were of unacceptable quality. Unacceptable results were due to high levels of B. cereus and/or other Bacillus spp. (>/=10(5) cfu g(-1)). Unsatisfactory results were mostly due to high Aerobic Colony Counts (up to >/=10(7) cfu g(-1)), Enterobacteriaceae (>/=10(4) cfu g(-1)), Escherichia coli (>/=10(2) cfu g(-1)), and Bacillus spp (>/=10(4) cfu g(-1)). Examination of 750 spices and spice ingredients revealed that B. cereus were present in 142 (19%) samples, other Bacillus spp. in 399 (53%) samples, and Salmonella spp. (S. enteritidis PT 11) in one (<1%) sample. Approximately a third (222) of spice and spice ingredients examined contained high counts (>/=10(4) cfu g(-1)) of B. cereus and/or other Bacillus spp., and appeared to be associated with the corresponding ready-to-eat foods containing similar high counts of these organisms (P<0.0001). Acceptable microbiological quality of ready-to-eat foods to which spices or spice ingredients have been added was associated with premises that had management food hygiene training and hazard analysis in place. Poor microbiological quality was associated with preparation on the premises, premises type, little or no confidence in the food business management of food hygiene, and small premises as indicated by local authority inspectors' confidence in management and consumer at risk scores.

Mortality from ischaemic heart disease by country, region, and age: statistics from World Health Organisation and United Nations.

PubMed

Finegold, Judith A; Asaria, Perviz; Francis, Darrel P

2013-09-30

Ischaemic heart disease (IHD) is the leading cause of death worldwide. The World Health Organisation (WHO) collects mortality data coded using the International Statistical Classification of Diseases (ICD) code. We analysed IHD deaths world-wide between 1995 and 2009 and used the UN population database to calculate age-specific and directly and indirectly age-standardised IHD mortality rates by country and region. IHD is the single largest cause of death worldwide, causing 7,249,000 deaths in 2008, 12.7% of total global mortality. There is more than 20-fold variation in IHD mortality rates between countries. Highest IHD mortality rates are in Eastern Europe and Central Asian countries; lowest rates in high income countries. For the working-age population, IHD mortality rates are markedly higher in low-and-middle income countries than in high income countries. Over the last 25 years, age-standardised IHD mortality has fallen by more than half in high income countries, but the trend is flat or increasing in some low-and-middle income countries. Low-and-middle income countries now account for more than 80% of global IHD deaths. The global burden of IHD deaths has shifted to low-and-middle income countries as lifestyles approach those of high income countries. In high income countries, population ageing maintains IHD as the leading cause of death. Nevertheless, the progressive decline in age-standardised IHD mortality in high income countries shows that increasing IHD mortality is not inevitable. The 20-fold mortality difference between countries, and the temporal trends, may hold vital clues for handling IHD epidemic which is migratory, and still burgeoning. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Dual impact of temperature on growth and mortality of marine fish larvae in a shallow estuarine habitat

NASA Astrophysics Data System (ADS)

Arula, Timo; Laur, Kerli; Simm, Mart; Ojaveer, Henn

2015-12-01

High individual growth and mortality rates of herring Clupea harengus membras and goby Pomatoschistus spp. larvae were observed in the estuarine habitat of the Gulf of Riga, Baltic Sea. Both instantaneous mortality (0.76-1.05) as well as growth rate (0.41-0.82 mm day-1) of larval herring were amongst highest observed elsewhere previously. Mortality rates of goby larvae were also high (0.57-1.05), while first ever data on growth rates were provided in this study (0.23-0.35 mm day-1). Our study also evidenced that higher growth rate of marine fish larvae did not result in lower mortalities. We suggest that high growth and mortality rates primarily resulted from a rapidly increasing and high (>18 °C) water temperature that masked potential food-web effects. The explanation for observed patterns lies in the interactive manner temperature contributed: i) facilitating prey production, which supported high growth rate and decreased mortalities; ii) exceeding physiological thermal optimum of larvae, which resulted in decreased growth rate and generally high mortalities. Our investigation suggests that the projected climate warming may have significant effect on early life history stages of the dominating marine fish species inhabiting shallow estuaries.

Microbiological safety of retail vacuum-packed and modified-atmosphere-packed cooked meats at end of shelf life.

PubMed

Sagoo, S K; Little, C L; Allen, G; Williamson, K; Grant, K A

2007-04-01

A study of retail modified-atmosphere-packed and vacuum-packed cooked ready-to-eat meats was undertaken from September through mid-November 2003 to determine the microbiological quality at the end of shelf life and to establish any risk factors in the production, storage, and display of this product. Examination of 2,981 samples using Microbiological Guidelines criteria revealed that 66% were of satisfactory or acceptable microbiology quality, 33% were of unsatisfactory quality mainly due to high aerobic colony counts and Enterobacteriaceae concentrations, and 1% were of unacceptable quality due to the presence of Listeria monocytogenes at 100 CFU/g or higher (27 samples; range of 10(2) to 106 CFU/g) and Campylobacter jejuni (1 sample), indicating a risk to health. All samples at the end of the shelf life had satisfactory (<20 CFU/g) and/or acceptable (<102 CFU/g) levels of Staphylococcus aureus and Clostridium perfringens, four samples (<1%) had unsatisfactory levels of Escherichia coli (range of 102 to 106 CFU/g) and 5.5% of the samples contained L. monocytogenes at <20 CFU/g (4.8%) or between 20 and 100 CFU/g (0.7%). More samples of chicken (45%; 224 of 495 samples), beef (43%; 160 of 371 samples), and turkey (41%; 219 of 523 samples) were of unsatisfactory or unacceptable quality compared with ham (23%; 317 of 1,351 samples) or pork (32%; 67 of 206 samples). Twelve different L. monocytogenes typing characters (serotype-amplified fragment length polymorphism type-phage type) were evaluated for isolates recovered from samples of unacceptable quality, and the 1/2-IX-NT type was recovered from almost half (48%) of these samples. Salmonella was not detected in any samples examined. Risk factors identified for cooked meats that were microbiologically contaminated more frequently included vacuum packaging, packaging on retail premises, slicing, temperature not monitored in display units, and no hazard analysis system in place. Results from this study also suggest that the shelf life assigned to some modified-atmosphere-packed and vacuum-packed meats may not be appropriate.

High blood glucose independent of pre-existing diabetic status predicts mortality in patients initiating peritoneal dialysis therapy.

PubMed

Chung, Sung Hee; Han, Dong Cheol; Noh, Hyunjin; Jeon, Jin Seok; Kwon, Soon Hyo; Lindholm, Bengt; Lee, Hi Bahl

2015-06-01

Poor glycemic control associates with increased mortality in diabetic (DM) dialysis patients, but it is less well established whether high blood glucose (BG) independent of pre-existing diabetic status associates with mortality in dialysis patients. We assessed factors affecting BG at the start of peritoneal dialysis (PD) and its mortality-predictive impact in Korean PD patients. In 174 PD patients (55 % males, 56 % DM), BG, nutritional status, comorbidity (CMD), and residual renal function (RRF) were assessed in conjunction with dialysis initiation. Determinants of BG and its association with mortality after a mean follow-up period of 30 ± 24 months were analyzed. On Cox proportional hazards analysis comprising all patients, old age, high CMD score, presence of protein energy wasting, and low serum albumin (Salb) concentration were independent predictors of mortality but not a high-BG level, while in patients without pre-existing diabetic status, high BG, together with old age and high CMD score, was an independent predictor of mortality. After adjustment for age, CMD score, and Salb, the risk ratio for mortality increased by 12 % per 1 mg/dL increase in BG in the non-DM patients. Patient survival in patients without pre-existing diabetic status with high BG did not differ from DM patients, but the survival of patients with high BG was significantly lower than in patients with low BG. In patients without pre-existing diabetic status, in multiple regression analysis, high BG at initiation of PD associated with high age, high body mass index, and low RRF. High blood glucose at initiation of PD associated with an increased mortality risk in PD patients without pre-existing diabetic status suggesting that blood glucose monitoring and surveillance of factors contributing to poor glycemic control are warranted in patients initiating PD therapy.

Mortality Attributable to Low Levels of Education in the United States.

PubMed

Krueger, Patrick M; Tran, Melanie K; Hummer, Robert A; Chang, Virginia W

2015-01-01

Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.

Mortality Attributable to Low Levels of Education in the United States

PubMed Central

Krueger, Patrick M.; Tran, Melanie K.; Hummer, Robert A.; Chang, Virginia W.

2015-01-01

Background Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. Methods We use the National Health Interview Survey data (1986–2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. Results If adults aged 25–85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Conclusions Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality. PMID:26153885

Identifying and Targeting Mortality Disparities: A Framework for Sub-Saharan Africa Using Adult Mortality Data from South Africa

PubMed Central

Sartorius, Benn; Sartorius, Kurt

2013-01-01

Background Health inequities in developing countries are difficult to eradicate because of limited resources. The neglect of adult mortality in Sub-Saharan Africa (SSA) is a particular concern. Advances in data availability, software and analytic methods have created opportunities to address this challenge and tailor interventions to small areas. This study demonstrates how a generic framework can be applied to guide policy interventions to reduce adult mortality in high risk areas. The framework, therefore, incorporates the spatial clustering of adult mortality, estimates the impact of a range of determinants and quantifies the impact of their removal to ensure optimal returns on scarce resources. Methods Data from a national cross-sectional survey in 2007 were used to illustrate the use of the generic framework for SSA and elsewhere. Adult mortality proportions were analyzed at four administrative levels and spatial analyses were used to identify areas with significant excess mortality. An ecological approach was then used to assess the relationship between mortality “hotspots” and various determinants. Population attributable fractions were calculated to quantify the reduction in mortality as a result of targeted removal of high-impact determinants. Results Overall adult mortality rate was 145 per 10,000. Spatial disaggregation identified a highly non-random pattern and 67 significant high risk local municipalities were identified. The most prominent determinants of adult mortality included HIV antenatal sero-prevalence, low SES and lack of formal marital union status. The removal of the most attributable factors, based on local area prevalence, suggest that overall adult mortality could be potentially reduced by ∼90 deaths per 10,000. Conclusions The innovative use of secondary data and advanced epidemiological techniques can be combined in a generic framework to identify and map mortality to the lowest administration level. The identification of high risk mortality determinants allows health authorities to tailor interventions at local level. This approach can be replicated elsewhere. PMID:23967209

A design for integration.

PubMed

Fenna, D

1977-09-01

For nearly two decades, the development of computerized information systems has struggled for acceptable compromises between the unattainable "total system" and the unacceptable separate applications. Integration of related applications is essential if the computer is to be exploited fully, yet relative simplicity is necessary for systems to be implemented in a reasonable time-scale. This paper discusses a system being progressively developed from minimal beginnings but which, from the outset, had a highly flexible and fully integrated system basis. The system is for batch processing, but can accommodate on-line data input; it is similar in its approach to many transaction-processing real-time systems.

Tree Mortality

Treesearch

Mark J. Ambrose

2011-01-01

Tree mortality is a natural process in all forest ecosystems, but it can also be an indicator of forest health issues. On a regional scale, high-mortality levels may indicate widespread insect or disease problems. Regionally high mortality may also occur if a large proportion of the forests in an area are made up of older, senescent stands.

Platelet count and total and cause-specific mortality in the Women's Health Initiative.

PubMed

Kabat, Geoffrey C; Kim, Mimi Y; Verma, Amit K; Manson, JoAnn E; Lin, Juan; Lessin, Lawrence; Wassertheil-Smoller, Sylvia; Rohan, Thomas E

2017-04-01

We used data from the Women's Health Initiative to examine the association of platelet count with total mortality, coronary heart disease (CHD) mortality, cancer mortality, and non-CHD/noncancer mortality. Platelet count was measured at baseline in 159,746 postmenopausal women and again in year 3 in 75,339 participants. Participants were followed for a median of 15.9 years. Cox proportional hazards models were used to estimate the relative mortality hazards associated with deciles of baseline platelet count and of the mean of baseline + year 3 platelet count. Low and high deciles of both baseline and mean platelet count were positively associated with total mortality, CHD mortality, cancer mortality, and non-CHD/noncancer mortality. The association was robust and was not affected by adjustment for a number of potential confounding factors, exclusion of women with comorbidity, or allowance for reverse causality. Low- and high-platelet counts were associated with all four outcomes in never smokers, former smokers, and current smokers. In this large study of postmenopausal women, both low- and high-platelet counts were associated with total and cause-specific mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

Sigma metric analysis for performance of creatinine with fresh frozen serum.

PubMed

Kang, Fengfeng; Zhang, Chuanbao; Wang, Wei; Wang, Zhiguo

2016-01-01

Six sigma provides an objective and quantitative methodology to describe the laboratory testing performance. In this study, we conducted a national trueness verification scheme with fresh frozen serum (FFS) for serum creatinine to evaluate its performance in China. Two different concentration levels of FFS, targeted with reference method, were sent to 98 laboratories in China. Imprecision and bias of the measurement procedure were calculated for each participant to further evaluate the sigma value. Quality goal index (QGI) analysis was used to investigate the reason of unacceptable performance for laboratories with σ < 3. Our study indicated that the sample with high concentration of creatinine had preferable sigma values. For the enzymatic method, 7.0% (5/71) to 45.1% (32/71) of the laboratories need to improve their measurement procedures (σ < 3). And for the Jaffe method, the percentages were from 11.5% (3/26) to 73.1% (19/26). QGI analysis suggested that most of the laboratories (62.5% for the enzymatic method and 68.4% for the Jaffe method) should make an effort to improve the trueness (QGI > 1.2). Only 3.1-5.3% of the laboratories should improve both of the precision and trueness. Sigma metric analysis of the serum creatinine assays is disappointing, which was mainly due to the unacceptable analytical bias according to the QGI analysis. Further effort is needed to enhance the trueness of the creatinine measurement.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2017-12-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

Effects of diurnal temperature range on mortality in Hefei city, China

NASA Astrophysics Data System (ADS)

Tang, Jing; Xiao, Chang-chun; Li, Yu-rong; Zhang, Jun-qing; Zhai, Hao-yuan; Geng, Xi-ya; Ding, Rui; Zhai, Jin-xia

2018-05-01

Although several studies indicated an association between diurnal temperature range (DTR) and mortality, the results about modifiers are inconsistent, and few studies were conducted in developing inland country. This study aims to evaluate the effects of DTR on cause-specific mortality and whether season, gender, or age might modify any association in Hefei city, China, during 2007-2016. Quasi-Poisson generalized linear regression models combined with a distributed lag non-linear model (DLNM) were applied to evaluate the relationships between DTR and non-accidental, cardiovascular, and respiratory mortality. We observed a J-shaped relationship between DTR and cause-specific mortality. With a DTR of 8.3 °C as the reference, the cumulative effects of extremely high DTR were significantly higher for all types of mortality than effects of lower or moderate DTR in full year. When stratified by season, extremely high DTR in spring had a greater impact on all cause-specific mortality than other three seasons. Male and the elderly (≥ 65 years) were consistently more susceptible to extremely high DTR effect than female and the youth (< 65 years) for non-accidental and cardiovascular mortality. To the contrary, female and the youth were more susceptible to extremely high DTR effect than male and the elderly for respiratory morality. The study suggests that extremely high DTR is a potential trigger for non-accidental mortality in Hefei city, China. Our findings also highlight the importance of protecting susceptible groups from extremely high DTR especially in the spring.

14 CFR 33.25 - Accessory attachments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... mounting attachment must include provisions for sealing to prevent contamination of, or unacceptable... loss of oil and to prevent contamination from sources outside the chamber enclosing the drive...

32 CFR 236.1 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... DEFENSE (DOD)-DEFENSE INDUSTRIAL BASE (DIB) VOLUNTARY CYBER SECURITY AND INFORMATION ASSURANCE (CS/IA) ACTIVITIES § 236.1 Purpose. Cyber threats to DIB unclassified information systems represent an unacceptable...

32 CFR 236.1 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... DEFENSE (DOD)-DEFENSE INDUSTRIAL BASE (DIB) VOLUNTARY CYBER SECURITY AND INFORMATION ASSURANCE (CS/IA) ACTIVITIES § 236.1 Purpose. Cyber threats to DIB unclassified information systems represent an unacceptable...

Diabetes in sub-Saharan Africa – from policy to practice to progress: targeting the existing gaps for future care for diabetes

PubMed Central

Pastakia, Sonak D; Pekny, Chelsea R; Manyara, Simon M; Fischer, Lydia

2017-01-01

The global prevalence and impact of diabetes has increased dramatically, particularly in sub-Saharan Africa. This region faces unique challenges in combating the disease including lack of funding for noncommunicable diseases, lack of availability of studies and guidelines specific to the population, lack of availability of medications, differences in urban and rural patients, and inequity between public and private sector health care. Because of these challenges, diabetes has a greater impact on morbidity and mortality related to the disease in sub-Saharan Africa than any other region in the world. In order to address these unacceptably poor trends, contextualized strategies for the prevention, identification, management, and financing of diabetes care within this population must be developed. This narrative review provides insights into the policy landscape, epidemiology, pathophysiology, care protocols, medication availability, and health care systems to give readers a comprehensive summary of many factors in these domains as they pertain to diabetes in sub-Saharan Africa. In addition to providing a review of the current evidence available in these domains, potential solutions to address the major gaps in care will be proposed to reverse the negative trends seen with diabetes in sub-Saharan Africa. PMID:28790858

Biosensors for Whole-Cell Bacterial Detection

PubMed Central

Rushworth, Jo V.; Hirst, Natalie A.; Millner, Paul A.

2014-01-01

SUMMARY Bacterial pathogens are important targets for detection and identification in medicine, food safety, public health, and security. Bacterial infection is a common cause of morbidity and mortality worldwide. In spite of the availability of antibiotics, these infections are often misdiagnosed or there is an unacceptable delay in diagnosis. Current methods of bacterial detection rely upon laboratory-based techniques such as cell culture, microscopic analysis, and biochemical assays. These procedures are time-consuming and costly and require specialist equipment and trained users. Portable stand-alone biosensors can facilitate rapid detection and diagnosis at the point of care. Biosensors will be particularly useful where a clear diagnosis informs treatment, in critical illness (e.g., meningitis) or to prevent further disease spread (e.g., in case of food-borne pathogens or sexually transmitted diseases). Detection of bacteria is also becoming increasingly important in antibioterrorism measures (e.g., anthrax detection). In this review, we discuss recent progress in the use of biosensors for the detection of whole bacterial cells for sensitive and earlier identification of bacteria without the need for sample processing. There is a particular focus on electrochemical biosensors, especially impedance-based systems, as these present key advantages in terms of ease of miniaturization, lack of reagents, sensitivity, and low cost. PMID:24982325

Optical analysis of high power free electron laser resonators

NASA Astrophysics Data System (ADS)

Knapp, C. E.; Viswanathan, V. K.; Appert, Q. D.; Bender, S. C.; McVey, B. D.

1987-06-01

The first part of this paper briefly describes the optics code used at Los Alamos National Laboratory to do optical analyses of various components of a free electron laser. The body of the paper then discusses the recent results in modeling low frequency gratings and ripple on the surfaces of liquid-cooled mirrors. The ripple is caused by structural/thermal effects in the mirror surface due to heating by optical absorption in high power resonators. Of interest is how much ripple can be permitted before diffractive losses or optical mode distortions become unacceptable. Preliminary work is presented involving classical diffraction problems to support the ripple study. The limitations of the techniques are discussed and the results are compared to experimental results where available.

Preventing Continuous Positive Airway Pressure Failure: Evidence-Based and Physiologically Sound Practices from Delivery Room to the Neonatal Intensive Care Unit.

PubMed

Wright, Clyde J; Sherlock, Laurie G; Sahni, Rakesh; Polin, Richard A

2018-06-01

Routine use of continuous positive airway pressure (CPAP) to support preterm infants with respiratory distress is an evidenced-based strategy to decrease incidence of bronchopulmonary dysplasia. However, rates of CPAP failure remain unacceptably high in very premature neonates, who are at high risk for developing bronchopulmonary dysplasia. Using the GRADE framework to assess the quality of available evidence, this article reviews strategies aimed at decreasing CPAP failure, starting with delivery room interventions and followed through to system-based efforts in the neonatal intensive care unit. Despite best efforts, some very premature neonates fail CPAP. Also reviewed are predictors of CPAP failure in this vulnerable population. Copyright © 2018 Elsevier Inc. All rights reserved.

Influence of a surface film on the particles on the electrorheological response

NASA Astrophysics Data System (ADS)

Wu, C. W.; Conrad, H.

1997-01-01

A conduction model is developed for the dc electrorheological (ER) response of highly conducting particles (e.g., metal particles) suspended in a weakly conducting oil. The numerical analyses show that a surface film with some conductivity is desired, but not a completely insulating film as previously proposed. Increasing the film conductivity leads to an increase in the ER yield stress. However, too high a conductivity will give an unacceptable level of current density. The film should also have an intermediate thickness. A small thickness increases the possibility of electrical breakdown in the film; too large a thickness decreases the ER effect. Good agreement exists between the yield stress and the current density predicted by our model and those measured.

Total elbow arthroplasty in primary osteoarthritis of the elbow.

PubMed

Kozak, T K; Adams, R A; Morrey, B F

1998-10-01

Primary osteoarthritis of the elbow is an infrequent condition typically managed by some form of debridement. There is no comment in the literature regarding prosthetic replacement for this condition. We report 5 patients (mean age, 68), with a minimum assessment of 3 years (range, 37-125 years) after total elbow arthroplasty. Complications in 4 patients included subluxation, fracture of a humeral component with particulate synovitis, heterotopic ossification, recurrent osteophyte formation, and transient ulnar neuropathy. Although revision was required in 2 of the 5, currently all experience had satisfactory outcomes. While replacement has proven ultimately to be a successful option for this high-demand patient group because of the high complication rate, we do not recommend replacement unless alternate operative options are deemed unacceptable.

The Impact of Symptom Dimensions on Outcome for Exposure and Ritual Prevention Therapy in Obsessive-Compulsive Disorder

PubMed Central

Williams, Monnica T.; Farris, Samantha G.; Turkheimer, Eric N.; Franklin, Martin E.; Simpson, H. Blair; Liebowitz, Michael; Foa, Edna B.

2014-01-01

Objective Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. Method The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n = 87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. Results The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β = .27, p = .02) and hoarding dimensions (β = .23, p = .04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. Conclusions EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed. PMID:24983796

Assessment of the microbiological safety of salad vegetables and sauces from kebab take-away restaurants in the United Kingdom.

PubMed

Meldrum, R J; Little, C L; Sagoo, S; Mithani, V; McLauchlin, J; de Pinna, E

2009-09-01

The purpose of this study was to establish the microbiological safety of salad vegetables and sauces served in kebab take-away restaurants. Comparison with published microbiological guidelines revealed that 4.7% of 1213 salad vegetable samples were of unsatisfactory microbiological quality due to Escherichia coli and/or Staphylococcus aureus levels at > or =10(2) cfu g(-1). Another 0.3% of salad samples were of unacceptable quality due to S. aureus at > or =10(4) cfu g(-1) (2 samples) or the presence of Salmonella Kentucky (1 sample). Cucumber was the most contaminated salad vegetable with regards to unsatisfactory levels of E. coli (6.0%) or S. aureus (4.5%). Five percent of 1208 sauce samples were of unsatisfactory microbiological quality due to E. coli, S. aureus at > or =10(2) cfu g(-1) and/or Bacillus cereus and other Bacillus spp. at > or =10(4) cfu g(-1). A further 0.6% of sauce samples were of unacceptable quality due to Bacillus spp. (Bacillus subtilis, Bacillus pumilus, Bacillus licheniformis) at > or =10(5) cfu g(-1) or the presence of Salmonella Agbeni (1 sample). More samples of chili sauce (8.7%) were of unsatisfactory or unacceptable microbiological quality than any other sauce types. The results emphasize the need for good hygiene practices in kebab take-away restaurants handling these types of ready-to-eat products.

The impact of symptom dimensions on outcome for exposure and ritual prevention therapy in obsessive-compulsive disorder.

PubMed

Williams, Monnica T; Farris, Samantha G; Turkheimer, Eric N; Franklin, Martin E; Simpson, H Blair; Liebowitz, Michael; Foa, Edna B

2014-08-01

Obsessive-compulsive disorder (OCD) is a severe condition with varied symptom presentations. The behavioral treatment with the most empirical support is exposure and ritual prevention (EX/RP). This study examined the impact of symptom dimensions on EX/RP outcomes in OCD patients. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to determine primary symptoms for each participant. An exploratory factor analysis (EFA) of 238 patients identified five dimensions: contamination/cleaning, doubts about harm/checking, hoarding, symmetry/ordering, and unacceptable/taboo thoughts (including religious/moral and somatic obsessions among others). A linear regression was conducted on those who had received EX/RP (n=87) to examine whether scores on the five symptom dimensions predicted post-treatment Y-BOCS scores, accounting for pre-treatment Y-BOCS scores. The average reduction in Y-BOCS score was 43.0%, however the regression indicated that unacceptable/taboo thoughts (β=.27, p=.02) and hoarding dimensions (β=.23, p=.04) were associated with significantly poorer EX/RP treatment outcomes. Specifically, patients endorsing religious/moral obsessions, somatic concerns, and hoarding obsessions showed significantly smaller reductions in Y-BOCS severity scores. EX/RP was effective for all symptom dimensions, however it was less effective for unacceptable/taboo thoughts and hoarding than for other dimensions. Clinical implications and directions for research are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

77 FR 20823 - Jyotin Parikh: Debarment Order

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-06

... failing to properly investigate, log and archive questionable, aberrant, and unacceptable laboratory... market new product lines. In furtherance of the conspiracy, in or around March 2003, Mr. Parikh...

32 CFR 236.1 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... DEFENSE (DoD)-DEFENSE INDUSTRIAL BASE (DIB) VOLUNTARY CYBER SECURITY AND INFORMATION ASSURANCE (CS/IA) ACTIVITIES § 236.1 Purpose. Cyber threats to DIB unclassified information systems represent an unacceptable...

Variation in mortality of ischemic and hemorrhagic strokes in relation to high temperature.

PubMed

Lim, Youn-Hee; Kim, Ho; Hong, Yun-Chul

2013-01-01

Outdoor temperature has been reported to have a significant influence on the seasonal variations of stroke mortality, but few studies have investigated the effect of high temperature on the mortality of ischemic and hemorrhagic strokes. The main study goal was to examine the effect of temperature, particularly high temperature, on ischemic and hemorrhagic strokes. We investigated the association between outdoor temperature and stroke mortality in four metropolitan cities in Korea during 1992-2007. We used time series analysis of the age-adjusted mortality rate for ischemic and hemorrhagic stroke deaths by using generalized additive and generalized linear models, and estimated the percentage change of mortality rate associated with a 1°C increase of mean temperature. The temperature-responses for the hemorrhagic and ischemic stroke mortality differed, particularly in the range of high temperature. The estimated percentage change of ischemic stroke mortality above a threshold temperature was 5.4 % (95 % CI, 3.9-6.9 %) in Seoul, 4.1 % (95 % CI, 1.6-6.6 %) in Incheon, 2.3 % (-0.2 to 5.0 %) in Daegu and 3.6 % (0.7-6.6 %) in Busan, after controlling for daily mean humidity, mean air pressure, day of the week, season, and year. Additional adjustment of air pollution concentrations in the model did not change the effects. Hemorrhagic stroke mortality risk significantly decreased with increasing temperature without a threshold in the four cities after adjusting for confounders. These findings suggest that the mortality of hemorrhagic and ischemic strokes show different patterns in relation to outdoor temperature. High temperature was harmful for ischemic stroke but not for hemorrhagic stroke. The risk of high temperature to ischemic stroke did not differ by age or gender.

Variation in mortality of ischemic and hemorrhagic strokes in relation to high temperature

NASA Astrophysics Data System (ADS)

Lim, Youn-Hee; Kim, Ho; Hong, Yun-Chul

2013-01-01

Outdoor temperature has been reported to have a significant influence on the seasonal variations of stroke mortality, but few studies have investigated the effect of high temperature on the mortality of ischemic and hemorrhagic strokes. The main study goal was to examine the effect of temperature, particularly high temperature, on ischemic and hemorrhagic strokes. We investigated the association between outdoor temperature and stroke mortality in four metropolitan cities in Korea during 1992-2007. We used time series analysis of the age-adjusted mortality rate for ischemic and hemorrhagic stroke deaths by using generalized additive and generalized linear models, and estimated the percentage change of mortality rate associated with a 1°C increase of mean temperature. The temperature-responses for the hemorrhagic and ischemic stroke mortality differed, particularly in the range of high temperature. The estimated percentage change of ischemic stroke mortality above a threshold temperature was 5.4 % (95 % CI, 3.9-6.9 %) in Seoul, 4.1 % (95 % CI, 1.6-6.6 %) in Incheon, 2.3 % (-0.2 to 5.0 %) in Daegu and 3.6 % (0.7-6.6 %) in Busan, after controlling for daily mean humidity, mean air pressure, day of the week, season, and year. Additional adjustment of air pollution concentrations in the model did not change the effects. Hemorrhagic stroke mortality risk significantly decreased with increasing temperature without a threshold in the four cities after adjusting for confounders. These findings suggest that the mortality of hemorrhagic and ischemic strokes show different patterns in relation to outdoor temperature. High temperature was harmful for ischemic stroke but not for hemorrhagic stroke. The risk of high temperature to ischemic stroke did not differ by age or gender.

Development and Validation of a High-Quality Composite Real-World Mortality Endpoint.

PubMed

Curtis, Melissa D; Griffith, Sandra D; Tucker, Melisa; Taylor, Michael D; Capra, William B; Carrigan, Gillis; Holzman, Ben; Torres, Aracelis Z; You, Paul; Arnieri, Brandon; Abernethy, Amy P

2018-05-14

To create a high-quality electronic health record (EHR)-derived mortality dataset for retrospective and prospective real-world evidence generation. Oncology EHR data, supplemented with external commercial and US Social Security Death Index data, benchmarked to the National Death Index (NDI). We developed a recent, linkable, high-quality mortality variable amalgamated from multiple data sources to supplement EHR data, benchmarked against the highest completeness U.S. mortality data, the NDI. Data quality of the mortality variable version 2.0 is reported here. For advanced non-small-cell lung cancer, sensitivity of mortality information improved from 66 percent in EHR structured data to 91 percent in the composite dataset, with high date agreement compared to the NDI. For advanced melanoma, metastatic colorectal cancer, and metastatic breast cancer, sensitivity of the final variable was 85 to 88 percent. Kaplan-Meier survival analyses showed that improving mortality data completeness minimized overestimation of survival relative to NDI-based estimates. For EHR-derived data to yield reliable real-world evidence, it needs to be of known and sufficiently high quality. Considering the impact of mortality data completeness on survival endpoints, we highlight the importance of data quality assessment and advocate benchmarking to the NDI. © 2018 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust.

Effects of cryptic mortality and the hidden costs of using length limits in fishery management

USGS Publications Warehouse

Coggins, L.G.; Catalano, M.J.; Allen, M.S.; Pine, William E.; Walters, C.J.

2007-01-01

Fishery collapses cause substantial economic and ecological harm, but common management actions often fail to prevent overfishing. Minimum length limits are perhaps the most common fishing regulation used in both commercial and recreational fisheries, but their conservation benefits can be influenced by discard mortality of fish caught and released below the legal length. We constructed a computer model to evaluate how discard mortality could influence the conservation utility of minimum length regulations. We evaluated policy performance across two disparate fish life-history types: short-lived high-productivity (SLHP) and long-lived low-productivity (LLLP) species. For the life-history types, fishing mortality rates and minimum length limits that we examined, length limits alone generally failed to achieve sustainability when discard mortality rate exceeded about 0.2 for SLHP species and 0.05 for LLLP species. At these levels of discard mortality, reductions in overall fishing mortality (e.g. lower fishing effort) were required to prevent recruitment overfishing if fishing mortality was high. Similarly, relatively low discard mortality rates (>0.05) rendered maximum yield unobtainable and caused a substantial shift in the shape of the yield response surfaces. An analysis of fishery efficiency showed that length limits caused the simulated fisheries to be much less efficient, potentially exposing the target species and ecosystem to increased negative effects of the fishing process. Our findings suggest that for overexploited fisheries with moderate-to-high discard mortality rates, reductions in fishing mortality will be required to meet management goals. Resource managers should carefully consider impacts of cryptic mortality sources (e.g. discard mortality) on fishery sustainability, especially in recreational fisheries where release rates are high and effort is increasing in many areas of the world. ?? 2007 Blackwell Publishing Ltd.

Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study.

PubMed

Jena, Anupam B; Sun, Eric C; Romley, John A

2013-12-24

Studies of whether inpatient mortality in US teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (July effect) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Using the US Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention rates, and bleeding complication rates, for high- and low-risk patients with acute myocardial infarction admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted acute myocardial infarction mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, P<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, P=0.70). Among patients in the lowest three quartiles of predicted acute myocardial infarction mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, P=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, P=0.21). Differences in percutaneous coronary intervention and bleeding complication rates could not explain the observed July mortality effect among high risk patients. High-risk acute myocardial infarction patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low-risk patients experience no such July effect in teaching-intensive hospitals.

Mortality among High Risk Patients with Acute Myocardial Infarction Admitted to U.S. Teaching-Intensive Hospitals in July: A Retrospective Observational Study

PubMed Central

Jena, Anupam B.; Sun, Eric C.; Romley, John A.

2014-01-01

Background Studies of whether inpatient mortality in U.S. teaching hospitals rises in July as a result of organizational disruption and relative inexperience of new physicians (‘July effect’) find small and mixed results, perhaps because study populations primarily include low-risk inpatients whose mortality outcomes are unlikely to exhibit a July effect. Methods and Results Using the U.S. Nationwide Inpatient sample, we estimated difference-in-difference models of mortality, percutaneous coronary intervention (PCI) rates, and bleeding complication rates, for high and low risk patients with acute myocardial infarction (AMI) admitted to 98 teaching-intensive and 1353 non-teaching-intensive hospitals during May and July 2002 to 2008. Among patients in the top quartile of predicted AMI mortality (high risk), adjusted mortality was lower in May than July in teaching-intensive hospitals (18.8% in May, 22.7% in July, p<0.01), but similar in non-teaching-intensive hospitals (22.5% in May, 22.8% in July, p=0.70). Among patients in the lowest three quartiles of predicted AMI mortality (low risk), adjusted mortality was similar in May and July in both teaching-intensive hospitals (2.1% in May, 1.9% in July, p=0.45) and non-teaching-intensive hospitals (2.7% in May, 2.8% in July, p=0.21). Differences in PCI and bleeding complication rates could not explain the observed July mortality effect among high risk patients. Conclusions High risk AMI patients experience similar mortality in teaching- and non-teaching-intensive hospitals in July, but lower mortality in teaching-intensive hospitals in May. Low risk patients experience no such “July effect” in teaching-intensive hospitals. PMID:24152859

Mortality prediction system for heart failure with orthogonal relief and dynamic radius means.

PubMed

Wang, Zhe; Yao, Lijuan; Li, Dongdong; Ruan, Tong; Liu, Min; Gao, Ju

2018-07-01

This paper constructs a mortality prediction system based on a real-world dataset. This mortality prediction system aims to predict mortality in heart failure (HF) patients. Effective mortality prediction can improve resources allocation and clinical outcomes, avoiding inappropriate overtreatment of low-mortality patients and discharging of high-mortality patients. This system covers three mortality prediction targets: prediction of in-hospital mortality, prediction of 30-day mortality and prediction of 1-year mortality. HF data are collected from the Shanghai Shuguang hospital. 10,203 in-patients records are extracted from encounters occurring between March 2009 and April 2016. The records involve 4682 patients, including 539 death cases. A feature selection method called Orthogonal Relief (OR) algorithm is first used to reduce the dimensionality. Then, a classification algorithm named Dynamic Radius Means (DRM) is proposed to predict the mortality in HF patients. The comparative experimental results demonstrate that mortality prediction system achieves high performance in all targets by DRM. It is noteworthy that the performance of in-hospital mortality prediction achieves 87.3% in AUC (35.07% improvement). Moreover, the AUC of 30-day and 1-year mortality prediction reach to 88.45% and 84.84%, respectively. Especially, the system could keep itself effective and not deteriorate when the dimension of samples is sharply reduced. The proposed system with its own method DRM can predict mortality in HF patients and achieve high performance in all three mortality targets. Furthermore, effective feature selection strategy can boost the system. This system shows its importance in real-world applications, assisting clinicians in HF treatment by providing crucial decision information. Copyright © 2018 Elsevier B.V. All rights reserved.

Stroke mortality in Tennessee: an eco-epidemiologic perspective.

PubMed

Flowers, Joanne; Vutla, Balaji; Aldrich, Tim E

2008-04-01

Prevention of stroke mortality in Tennessee is a statewide public health priority. These analyses describe how the distribution of Caucasian stroke mortality is greater among the state's Appalachian Counties. For African-American residents, the elevated stroke mortality risk is not distinctive for geographic regions, although Upper East Tennessee rates are elevated. If the Caucasian criteria for assigning "high" rates were used with African-American stroke mortality data, the entire state would be designated as having elevated levels for stroke mortality. Race-gender specific analyses at the county-level (ecological attributes) illustrate the greater risks for "high" county-level stroke mortality rates are present for urban and poor communities in our state. African-American males are a clear exception, where the poorer, rural communities show a protective effect for "high" county-level stroke mortality rates. We support implementing stroke prevention programming and public health interventions based on the mortality data distributions; compatible statewide initiatives are underway We recommend strategic over-sampling of the state's priority populations for stroke risk to facilitate the monitoring of prevention and intervention program impacts over time.

The Geography of the Alzheimer's Disease Mortality in Spain: Should We Focus on Industrial Pollutants Prevention?

PubMed

2017-11-25

Alzheimer's disease (AD) has a high worldwide prevalence but little is known about its aetiology and risk factors. Recent research suggests environmental factors might increase AD risk. We aim to describe the association between AD mortality and the presence of highly polluting industry in small areas in Spain between 1999 and 2010. We calculated AD age-adjusted Standardized Mortality Ratio (SMR), stratified by sex, grouped by industrial pollution density, compared for each small area of Spain. In the small areas with the highest mortality, the SMR among women was at least 25% greater than the national average (18% in men). The distribution of AD mortality was generally similar to that of high industrial pollution (higher mortality in the north, the Mediterranean coast and in some southern areas). The risk of AD mortality among women was 140% higher (123% among men) in areas with the highest industrial density in comparison to areas without polluting industries. This study has identified a geographical pattern of small areas with higher AD mortality risk and an ecological positive association with the density of highly polluting industry. Further research is needed on the potential impact of this type of industry pollution on AD aetiology and mortality.

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

PubMed

Sonneveldt, Emily; DeCormier Plosky, Willyanne; Stover, John

2013-01-01

A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births. Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied. This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

47 CFR 22.971 - Obligation to abate unacceptable interference.

Code of Federal Regulations, 2010 CFR

2010-10-01

... interference, with full cooperation and utmost diligence, in the shortest time practicable. Interfering... severally responsible for abating interference, with full cooperation and utmost diligence, in the shortest...

Student Classroom Misbehavior: An Exploratory Study Based on Teachers' Perceptions

PubMed Central

Sun, Rachel C. F.; Shek, Daniel T. L.

2012-01-01

This study aimed to examine the conceptions of junior secondary school student misbehaviors in classroom, and to identify the most common, disruptive, and unacceptable student problem behaviors from teachers' perspective. Twelve individual interviews with teachers were conducted. A list of 17 student problem behaviors was generated. Results showed that the most common and disruptive problem behavior was talking out of turn, followed by nonattentiveness, daydreaming, and idleness. The most unacceptable problem behavior was disrespecting teachers in terms of disobedience and rudeness, followed by talking out of turn and verbal aggression. The findings revealed that teachers perceived student problem behaviors as those behaviors involving rule-breaking, violating the implicit norms or expectations, being inappropriate in the classroom settings and upsetting teaching and learning, which mainly required intervention from teachers. PMID:22919297

When Wife-Beating Is Not Necessarily Abuse: A Feminist and Cross-Cultural Analysis of the Concept of Abuse as Expressed by Tibetan Survivors of Domestic Violence.

PubMed

Rajan, Hamsa

2016-11-20

This article describes the views of Tibetan women who have experienced physical violence from male intimate partners. How they conceptualise abuse, their views on acceptable versus unacceptable hitting, and the acts besides hitting which they felt to be unacceptable or abusive, are explored. Views of survivors' relatives/friends and men who have hit their wives are also included. Western-based domestic violence theory is shown to be incommensurate with abuse in particular socio-cultural settings. As feminist scholars emphasize listening deeply to voices of women in the global South, this article demonstrates how such listening might be undertaken when the views expressed by women diverge from feminism. © The Author(s) 2016.

Mortality predictors in a 60-year follow-up of adolescent males: exploring delinquency, socioeconomic status, IQ, high-school drop-out status, and personality.

PubMed

Trumbetta, Susan L; Seltzer, Benjamin K; Gottesman, Irving I; McIntyre, Kathleen M

2010-01-01

To examine whether socioeconomic status (SES), high school (HS) completion, IQ, and personality traits that predict delinquency in adolescence also could explain men's delinquency-related (Dq-r) mortality risk across the life span. Through a 60-year Social Security Death Index (SSDI) follow-up of 1812 men from Hathaway's adolescent normative Minnesota Multiphasic Personality Inventory (MMPI) sample, we examined mortality risk at various ages and at various levels of prior delinquency severity. We examined SES (using family rent level), HS completion, IQ, and MMPI indicators simultaneously as mortality predictors and tested for SES (rent level) interactions with IQ and personality. We ascertained 418 decedents. Dq-r mortality peaked between ages 45 years to 64 years and continued through age 75 years, with high delinquency severity showing earlier and higher mortality risk. IQ and rent level failed to explain Dq-r mortality. HS completion robustly conferred mortality protection through ages 55 years and 75 years, explained IQ and rent level-related risk, but did not fully explain Dq-r risk. Dq-r MMPI scales, Psychopathic Deviate, and Social Introversion, respectively, predicted risk for and protection from mortality by age 75 years, explaining mortality risk otherwise attributable to delinquency. Wiggins' scales also explained Dq-r mortality risk, as Authority Conflict conferred risk for and Social Maladjustment and Hypomania conferred protection from mortality by age 75 years. HS completion robustly predicts mortality by ages 55 years and 75 years. Dq-r personality traits predict mortality by age 75 years, accounting, in part, for Dq-r mortality.

Mortality of aspen on the Gros Ventre elk winter range

Treesearch

Richard G. Krebill

1972-01-01

Stands of aspen on the Gros Ventre elk winter range of northwestern Wyoming are suffering high mortality and are not regenerating satisfactorily. If the 1970 mortality rate (3.6 percent) continues, about a two-thirds reduction in the numbers of tree-sized aspen can be expected by year 2000. Collected evidence suggests that the mortality rate is unusually high because...