77 FR 63420 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to Executive Order 12978

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... INMOBILIARIA HOTELERA DEL CARIBE LTDA., Barranquilla, Colombia; c/o INVERSIONES HOTELERAS DEL LITORAL LTDA., Barranquilla, Colombia; c/o INVERSIONES PRADO TRADE CENTER LTDA., Barranquilla, Colombia; c/o NEGOCIOS Y... VIEJO, Alfredo, c/o INVERSIONES EL PROGRESO S.A., Cartagena, Colombia; DOB 15 Dec 1954; Cedula No...

Duty of care or a matter of conduct -- can a doctor refuse a person in need of urgent medical attention?

PubMed

Dean, Jessica; Mahar, Patrick; Loh, Erwin; Ludlow, Karinne

2013-10-01

Medical practitioners may have their particular skills called upon outside a direct professional context. The responsibilities of medical practitioners outside their defined scope of clinical practice may not be clear to all clinicians. To consider the possible legal consequences of a doctor refusing to assist a person in need of urgent medical attention both in terms of medical negligence and professional misconduct. Where an established clinical relationship does not exist, and a doctor does not wish to render aid, three particular scenarios may arise. A doctor may actively deny being a doctor, passively avoid identifying themselves as a doctor or acknowledge being a doctor, but refuse to render assistance. Aside from any ethical issues, how a doctor chooses to act and represent themselves may lead to different legal ramifications. There exists significant variation in state provisions relating to legal obligations to render aid, which may benefit from review and revision at a national level.

Generating Clean Water

ERIC Educational Resources Information Center

Barth, Katie; Bahr, Damon; Shumway, Steven

2017-01-01

Across the United States, political leaders, educators, and business persons are issuing an urgent call for reform in STEM education (NGSS Lead States 2013). One important response to this call is Integrated STEM, which the National Governor's Association (2007, p. 7) says involves, "... an emphasis on design and problem solving in…

Dropouts, Stopouts, Optouts at Del Mar College: Spring 1991. Report of a Joint Research Project.

ERIC Educational Resources Information Center

Luckie, Jo Ann I.; Bonham, L. Adrianne

A research project investigated 2,313 persons who attended Del Mar College (Texas) during fall 1990 but did not enroll for spring 1991. Four sets of data were collected: (1) limited demographic information on the total student body; (2) demographic information drawn from school records to describe all nonreturnees; (3) demographic information…

Incentivos para atraer y retener personal de salud de zonas rurales del Perú: un estudio cualitativo

PubMed Central

Huicho, Luis; Canseco, Francisco Díez; Lema, Claudia; Miranda, J. Jaime; Lescano, Andrés G.

2014-01-01

El objetivo fue identificar incentivos de atracción y retención en zonas rurales y distantes de Ayacucho, Perú. Fueron realizadas entrevistas en profundidad con 80 médicos, enfermeras, obstetras y técnicos (20 por grupo) de las zonas más pobres y con 11 funcionarios. No existen políticas sistemáticas de atracción y retención de personal de salud en Ayacucho. Los principales incentivos, en orden de importancia, fueron mejoras salariales, oportunidades de formación y capacitación, estabilidad laboral y nombramiento, mejoras en infraestructura y equipos, e incremento del personal. Se mencionaron también mejoras en la vivienda y alimentación, mayor cercanía con la familia y reconocimiento por el sistema de salud. Existen coincidencias y singularidades entre los distintos grupos sobre los incentivos clave para estimular el trabajo rural, que deben considerarse al diseñar políticas públicas. Las iniciativas del Estado deben comprender procesos rigurosos de monitoreo y evaluación, para asegurar que las mismas tengan el impacto deseado. PMID:22488318

How Do Management Fees Affect Retirement Wealth under Mexico's Personal Retirement Accounts System?

PubMed

Aguila, Emma; Hurd, Michael D; Rohwedder, Susann

2014-12-01

In 1997, Mexico transformed its pay-as-you-go social security system to a fully funded system with personal retirement accounts, including management fees. This article examines changes in retirement wealth resulting from this new system. It shows that management fees have drained a significant proportion of individuals' retirement wealth and have increased the number of persons claiming a government-subsidized minimum pension, particularly from the time the system was introduced in 1997 until adjustment to management fees in 2008. Since 2008, retirement wealth accumulation has been similar to that of the previous system. En 1997, México transformó su sistema de pensiones basado en cotizaciones individuales a uno de ahorro para el retiro que incluyen cuotas por la administración de las cuentas. El presente estudio examina los cambios en el monto de las pensiones como resultado de la introducción del nuevo sistema. Los resultados muestran que las cuotas de administración han drenado una proporción significativa del ahorro para el retiro de los individuos por lo que ha aumentado el número de personas que solicita la pensión mínima garantizada subsidiada por el gobierno desde que se introdujo el sistema en 1997 hasta que se hicieron ajustes en las cuotas de administración de los fondos de pensiones en 2008. A partir de 2008, la acumulación del ahorro para el retiro ha sido similar que la del sistema anterior.

How Do Management Fees Affect Retirement Wealth under Mexico's Personal Retirement Accounts System?

PubMed Central

Aguila, Emma; Hurd, Michael D.; Rohwedder, Susann

2014-01-01

In 1997, Mexico transformed its pay-as-you-go social security system to a fully funded system with personal retirement accounts, including management fees. This article examines changes in retirement wealth resulting from this new system. It shows that management fees have drained a significant proportion of individuals' retirement wealth and have increased the number of persons claiming a government-subsidized minimum pension, particularly from the time the system was introduced in 1997 until adjustment to management fees in 2008. Since 2008, retirement wealth accumulation has been similar to that of the previous system. En 1997, México transformó su sistema de pensiones basado en cotizaciones individuales a uno de ahorro para el retiro que incluyen cuotas por la administración de las cuentas. El presente estudio examina los cambios en el monto de las pensiones como resultado de la introducción del nuevo sistema. Los resultados muestran que las cuotas de administración han drenado una proporción significativa del ahorro para el retiro de los individuos por lo que ha aumentado el número de personas que solicita la pensión mínima garantizada subsidiada por el gobierno desde que se introdujo el sistema en 1997 hasta que se hicieron ajustes en las cuotas de administración de los fondos de pensiones en 2008. A partir de 2008, la acumulación del ahorro para el retiro ha sido similar que la del sistema anterior. PMID:25601893

May Gödel's Ideas Be Addressed Philosophically?

NASA Astrophysics Data System (ADS)

Dokulil, Miloš

2007-11-01

Gödel emphasised philosophy as an important tool in science. Much less is known about his religious background. We should bear in mind that our evaluational perspective differs very much from the one in which Gödel lived. He was personally sure that there must be another existence after death-an afterlife (''of unlimited life span''). As a ''Baptized Lutheran'' he did not include ''Trinity'' in his creed. He was also certain that mind is separate from matter. This text tries to include Libet's ''readiness potential'' into the debate concerning the specificity of the mind. Neither Gödel's identification of materialism with mechanism nor his vision of the ''spirit'' are a viable solution of the problem.

The Theoretical Analysis of the Phenomenon of Anticipation in Psychology

ERIC Educational Resources Information Center

Akhmetzyanova, Anna I.

2016-01-01

At the modern stage one of the urgent tasks of development of psychology and pedagogy is the study of the basic directions, trends and developmental priorities of research of the specifics of psychological indicators of anticipation of people with whose mental development corresponds to age norms and persons with intellectual and mental…

Affective Load and Engagement in Second Life: Experiencing Urgent, Persistent, and Long-Term Information Needs

ERIC Educational Resources Information Center

Nahl, Diane

2010-01-01

New users of virtual environments face a steep learning curve, requiring persistence and determination to overcome challenges experienced while acclimatizing to the demands of avatar-mediated behavior. Concurrent structured self-reports can be used to monitor the personal affective and cognitive struggles involved in virtual world adaptation to…

Intercultural Philosophy and the Nondual Wisdom of "Basic Goodness": Implications for Contemplative and Transformative Education

ERIC Educational Resources Information Center

Eppert, Claudia; Vokey, Daniel; Nguyen, Tram Truong Anh; Bai, Heesoon

2015-01-01

Radical personal and systemic social transformation is urgently needed to address world-wide violence and inequality, pervasive moral confusion and corruption, and the rapid, unprecedented global destruction of our environment. Recent years have seen an embrace of intersubjectivity within discourse on educational transformation within academia and…

The Urgent Need for Career Preview: Student Expectations and Graduate Realities in Music and Dance

ERIC Educational Resources Information Center

Bennett, Dawn; Bridgstock, Ruth

2015-01-01

Unlike the work available in many creative disciplines, musicians and dancers have the possibility of company-based employment; however, participants outweigh the number of positions. As a result, many graduates become "enforced entrepreneurs" as they shape their work to meet personal and professional needs. The similarities between…

Psicolinguistica, psicologia del linguaggio e "Analisi elettroacustica del linguaggio" di P. Agostino Gemelli (Psycholinguistics, Psychology of Language and P. Agostino Gemelli's "Electric-Acoustical Analysis of Language").

ERIC Educational Resources Information Center

Titone, Renzo

1987-01-01

Discusses the contribution of the little-known linguist Gemelli who favors a holistic approach to human language emphasizing the human personality as an essential factor in the expression of speech. Gemelli makes clear the breadth of the field of language psychology in contrast with the narrowness of psycholinguistics. (CFM)

A Comparison of Mental Health, Substance Use, and Sexual Risk Behaviors Between Rural and Non-Rural Transgender Persons

PubMed Central

HORVATH, KEITH J.; IANTAFFI, ALEX; SWINBURNE-ROMINE, REBECCA; BOCKTING, WALTER

2014-01-01

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed. PMID:24380580

A comparison of mental health, substance use, and sexual risk behaviors between rural and non-rural transgender persons.

PubMed

Horvath, Keith J; Iantaffi, Alex; Swinburne-Romine, Rebecca; Bockting, Walter

2014-01-01

The aim of this study was to compare the mental health, substance use, and sexual risk behaviors of rural and non-rural transgender persons. Online banner advertisements were used to recruit 1,229 self-identified rural and non-rural transgender adults (18+ years) residing in the United States. Primary findings include significant differences in mental health between rural and non-rural transmen; relatively low levels of binge drinking across groups, although high levels of marijuana use; and high levels of unprotected sex among transwomen. The results confirm that mental and physical health services for transgender persons residing in rural areas are urgently needed.

[The discrete horror of cloning].

PubMed

Guibourg, Ricardo A

2009-01-01

The author raises the topic of cloning after the decision of the Argentine government, which concerned for the "dignity of the human person", passed a decree of need and urgency, No. 200/97 (Annex), prohibiting cloning experiments with human beings. Therefore, considering that the topic is so terribly urgent and necessary, the author feels it is timely to consider it.

A Look in the Mirror: Self-Development and Transformational Learning in Medical Students

ERIC Educational Resources Information Center

Walcher, Mary Elizabeth

2011-01-01

Given the call for change in medical school curriculum towards a more humanistic approach, it remains clear that there is an urgent need to study the effects of personal development classes on medical students' skill level. Using participants from an ethical influence communications class, this study explored the impact of the use of…

Take Action on 5 Policies America Must Adopt To Reduce and Prevent Substance Abuse.

ERIC Educational Resources Information Center

Join Together, Boston, MA.

The Join Together National Policy Panel presents five policies that can help communities reduce and prevent substance abuse. They are: (1) compel substance abuse treatment for criminal offenders; (2) ensure that every person who has an addiction gets treatment; (3) make substance abuse prevention an urgent priority in every community; (4) increase…

Marriage, mental illness and law

PubMed Central

Sharma, Indira; Reddy, Karri Rama; Kamath, Rabindra Mukund

2015-01-01

The Special Marriage Act (SMA), 1954 and the Hindu Marriage Act (HMA), 1955 have put restrictions on the marriage of persons with mental illness, which are proving to be detrimental to patients and their families. There is an urgent need to address this problem. The deficiencies in the existing legislation have been projected and constructive suggestions have been put forward. PMID:26330652

STUDIES TO ADDRESS THE ASSOCIATION BETWEEN PARTICULATE MATTER (PM) EXPOSURE AND DEVELOPMENT/EXACERBATION OF LUNG INJURY, INFLAMMATION, AND INCREASED AIRWAY RESPONSIVENESS.

EPA Science Inventory

Asthma, an inflammatory airways disease, has become an urgent health problem affecting an estimated 17 million persons in the United States alone (CDC 1998 MMWR 47). Since 1979, the death rate from asthma has increased by almost 56%. Epidemiologic studies have demonstrated posit...

Preservice Elementary Teachers' Emotional Connections and Disconnections to Climate Change in a Science Course

ERIC Educational Resources Information Center

Hufnagel, Elizabeth

2015-01-01

Due to emotions' evaluative nature, they provide a lens for understanding personal and urgent engagement with events and experiences. Grounding this work in ethnography and sociolinguistics, I utilized discourse analysis to study the emotions of 30 preservice elementary teachers expressed about climate change in a science course. I describe the…

Value of subjective visual reduction in patients with acute-onset floaters and/or flashes.

PubMed

Hurst, Jonathan; Johnson, Davin; Law, Christine; Schweitzer, Kelly; Sharma, Sanjay

2015-08-01

To quantify the association between subjective visual reduction (SVR) and retinal pathology in patients with acute-onset monocular floaters or flashes, or both. Prospective cohorts study involving all new patients referred for acute-onset floaters or flashes, or both, to a tertiary care emergency eye clinic in Kingston, Ontario, between July 1, 2011, and June 29, 2012 (n = 333). All patients were evaluated for the presence of SVR in a standardized fashion, as well as other known risk factors for retina pathology including a family history of retinal tear or retinal detachment, a personal history of retinal tear or detachment, high myopia, and ocular trauma. Our major outcome was urgent retinal pathology, defined as retina pathology requiring a same-day referral to a retina specialist for evaluation, management, or both. SVR was strongly associated with retinal pathology (likelihood ratio 7.9, 95% CI 5.2-12.1). Patients with SVR are at increased risk for urgent retinal pathology and should be triaged for urgent ophthalmologic examination. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

El Mejoramiento de la Efectividad del Personal de las Diferentes Unidades del Ejrcito de Guatemala Involucradas en la Integracin de Contingentes Desplegados en Diferentes Misiones de Paz de la Organizacin de las Naciones Unidas (Improving the Effectiveness of Guatemalan Army Units that Provide Soldiers to Units Deployed in United Nations Peace Missions)

DTIC Science & Technology

2017-06-09

del Ejército de EE.UU. Colegio de Comando y Estado Mayor en el cumplimiento parcial de los requisitos para el grado de MAESTRÍA EN CIENCIAS Y...Rev. 8-98) Prescribed by ANSI Std. Z39.18 iii MAESTRÍA EN CIENCIAS Y ARTES MILITARES PAGINA DE APROBACIÓN DE LA TESIS Name of Candidate: Major... Ciencias Militares. A mi honorable comité de tesis, Doctor Edwin Roldán, Coronel Francisco Rivera Pérez del Ejército de Guatemala y al Mayor Rafael

[Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal].

PubMed

Pérez Rodríguez, M; de Carlos Errea, J; Dorronsoro Auzmendi, M; Batllori Gastón, M

2013-12-01

Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined. The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia. We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Salud/Servicios Personales. Libro del Profesor. (Health/Personal Services. Teacher's Guide). B2. CHOICE (Challenging Options in Career Education).

ERIC Educational Resources Information Center

Mid-Hudson Migrant Education Center, New Paltz, NY.

Written in Spanish, the guide comprises the first grade unit of a career education curriculum developed for migrant students. The guide covers 12 health and personal service occupations--blacksmith, television repairer, hairdresser/barber, day care worker, waitress, gas station attendant, family doctor, ambulance driver/attendant, dietician,…

DEL phenotype.

PubMed

Kwon, Dong H; Sandler, S G; Flegel, Willy A

2017-09-01

DEL red blood cells (RBCs) type as D- by routine serologic methods and are transfused routinely, without being identified as expressing a very weak D antigen, to D- recipients. DEL RBCs are detected only by adsorption and elution of anti-D or by molecular methods. Most DEL phenotypes have been reported in population studies conducted in East Asia, although DEL phenotypes have been detected also among Caucasian individuals. Approximately 98 percent of DEL phenotypes in East Asians are associated with the RHD*DEL1 or RHD*01EL.01 allele. The prevalence of DEL phenotypes has been reported among D- Han Chinese (30%), Japanese (28%), and Korean (17%) populations. The prevalence of DEL phenotypes is significantly lower among D- Caucasian populations (0.1%). Among the 3-5 percent of African individuals who are D-, there are no reports of the DEL phenotype. Case reports from East Asia indicate that transfusion of DEL RBCs to D- recipients has been associated with D alloimmunization. East Asian immigrants constitute 2.1 percent of the 318.9 million persons residing in the United States, and an estimated 2.8 percent are blood donors. Using these statistics, we estimate that 68-683 units of DEL RBCs from donors of East Asian ancestry are transfused as D- annually in the United States. Given the reports from East Asia of D alloimmunization attributed to transfusion of DEL RBCs, one would expect an occasional report of D alloimmunization in the United States following transfusion of DEL RBCs to a D- recipient. If such cases do occur, the most likely reason that they are not detected is the absence of active post-transfusion monitoring for formation of anti-D.

CROSS-DISCIPLINARY PHYSICS AND RELATED AREAS OF SCIENCE AND TECHNOLOGY: Diffusion-Based Recommendation in Collaborative Tagging Systems

NASA Astrophysics Data System (ADS)

Shang, Ming-Sheng; Zhang, Zi-Ke

2009-11-01

Recently, collaborative tagging systems have attracted more and more attention and have been widely applied in web systems. Tags provide highly abstracted information about personal preferences and item content, and therefore have the potential to help in improving better personalized recommendations. We propose a diffusion-based recommendation algorithm considering the personal vocabulary and evaluate it in a real-world dataset: Del.icio.us. Experimental results demonstrate that the usage of tag information can significantly improve the accuracy of personalized recommendations.

Urgently awaiting implementation: The right to be free from exploitation, violence and abuse in Article 16 of the Convention on the Rights of Persons with Disabilities (CRPD).

PubMed

Bartlett, Peter; Schulze, Marianne

The Convention on the Rights of Persons with Disabilities (CRPD) enshrines the freedom from exploitation, violence and abuse, a provision, which has hitherto received little attention. Exploring the contents of Article 16, this paper seeks to unpack both the potential for violence prevention as well as the implementation challenges. It situates violence protection within related treaty provisions and touches on specific challenges in institutional care as well as the private realm. Copyright © 2017. Published by Elsevier Ltd.

Prevalence of 185delAG and 5382insC mutations in BRCA1, and 6174delT in BRCA2 in women of Ashkenazi Jewish origin in southern Brazil

PubMed Central

Dillenburg, Crisle Vignol; Bandeira, Isabel Cristina; Tubino, Taiana Valente; Rossato, Luciana Grazziotin; Dias, Eleonora Souza; Bittelbrunn, Ana Cristina; Leistner-Segal, Sandra

2012-01-01

Certain mutations in BRCA1 and BRCA2 genes are frequent in the Ashkenazi Jewish population. Several factors contribute to this increased frequency, including consanguineous marriages and an event known as a “bottleneck”, which occurred in the past and caused a drastic reduction in the genetic variability of this population. Several studies were performed over the years in an attempt to elucidate the role of BRCA1 and BRCA2 genes in susceptibility to breast cancer. The aim of this study was to estimate the carrier frequency of certain common mutations in the BRCA1 (185delAG and 5382insC) and BRCA2 (6174delT) genes in an Ashkenazi Jewish population from Porto Alegre, Brazil. Molecular analyses were done by PCR followed by RFLP (ACRS). The carrier frequencies for BRCA1 185delAG and 5382insC were 0.78 and 0 respectively, and 0.4 for the BRCA2 6174deT mutation. These findings are similar to those of some prior studies but differ from others, possibly due to excluding individuals with a personal or family history of cancer. Our sample was drawn from the community group and included individuals with or without a family or personal history of cancer. Furthermore, increased dispersion among Ashkenazi subpopulations may be the result of strong genetic drift and/or admixture. It is therefore necessary to consider the effects of local admixture on the mismatch distributions of various Jewish populations. PMID:23055798

Prevalence of 185delAG and 5382insC mutations in BRCA1, and 6174delT in BRCA2 in women of Ashkenazi Jewish origin in southern Brazil.

PubMed

Dillenburg, Crisle Vignol; Bandeira, Isabel Cristina; Tubino, Taiana Valente; Rossato, Luciana Grazziotin; Dias, Eleonora Souza; Bittelbrunn, Ana Cristina; Leistner-Segal, Sandra

2012-07-01

Certain mutations in BRCA1 and BRCA2 genes are frequent in the Ashkenazi Jewish population. Several factors contribute to this increased frequency, including consanguineous marriages and an event known as a "bottleneck", which occurred in the past and caused a drastic reduction in the genetic variability of this population. Several studies were performed over the years in an attempt to elucidate the role of BRCA1 and BRCA2 genes in susceptibility to breast cancer. The aim of this study was to estimate the carrier frequency of certain common mutations in the BRCA1 (185delAG and 5382insC) and BRCA2 (6174delT) genes in an Ashkenazi Jewish population from Porto Alegre, Brazil. Molecular analyses were done by PCR followed by RFLP (ACRS). The carrier frequencies for BRCA1 185delAG and 5382insC were 0.78 and 0 respectively, and 0.4 for the BRCA2 6174deT mutation. These findings are similar to those of some prior studies but differ from others, possibly due to excluding individuals with a personal or family history of cancer. Our sample was drawn from the community group and included individuals with or without a family or personal history of cancer. Furthermore, increased dispersion among Ashkenazi subpopulations may be the result of strong genetic drift and/or admixture. It is therefore necessary to consider the effects of local admixture on the mismatch distributions of various Jewish populations.

Foreign Language Education: Principles of Teaching English to Adults at Commercial Language Schools and Centers

ERIC Educational Resources Information Center

Tarnopolsky, Oleg

2016-01-01

The ever-increasing spread of English as the language of global communication leads to ever-increasing demand for learning it among adult populations of non-English-speaking countries. If such people did not have a chance of acquiring English during their school or university years but urgently need it for professional or personal purposes, they…

The $375-Billion Question: Why Does College Cost so Much?

ERIC Educational Resources Information Center

Bluemnstyk, Goldie

2008-01-01

From the halls of Congress to the kitchen tables of American families, that long-simmering complaint--Why does college cost so much?--is getting louder and more urgent. As a slew of recent reports, public forums, and growing media interest suggest, the rising cost of college looms larger and larger as a personal and national concern. In this…

The Reliability, Validity and Practical Utility of Measuring Supports Using the I-CAN Instrument: Part II

ERIC Educational Resources Information Center

Riches, Vivienne C.; Parmenter, Trevor R.; Llewellyn, Gwynnyth; Hindmarsh, Gabrielle; Chan, Jeff

2009-01-01

Background: There is an urgent need for developing reliable, valid and practical instruments that assess and classify the support needed by persons with disability to function in their chosen living, working and social environments. I-CAN is an instrument that addresses the frequency and level of support needed (not individual skills or deficits)…

Personal protective equipment and improving compliance among healthcare workers in high-risk settings.

PubMed

Honda, Hitoshi; Iwata, Kentaro

2016-08-01

Personal protective equipment (PPE) protects healthcare workers (HCWs) from infection by highly virulent pathogens via exposure to body fluids and respiratory droplets. Given the recent outbreaks of contagious infectious diseases worldwide, including Ebola virus and Middle Eastern respiratory syndrome, there is urgent need for further research to determine optimal PPE use in high-risk settings. This review intends to provide a general understanding of PPE and to provide guidelines for appropriate use based on current evidence. Although previous studies have focused on the efficacy of PPE in preventing transmission of pathogens, recent studies have examined the dangers to HCWs during removal of PPE when risk of contamination is highest. Access to adequate PPE supplies is crucial to preventing transmission of pathogens, especially in resource-limited settings. Adherence to appropriate PPE use is a challenge due to inadequate education on its usage, technical difficulties, and tolerability of PPE in the workplace. Future projects aim at ameliorating this situation, including redesigning PPE which is crucial to improving the safety of HCWs. PPE remains the most important strategy for protecting HCW from potentially fatal pathogens. Further research into optimal PPE design and use to improve the safety of HCWs is urgently needed.

Reversing hard won victories in the name of human rights: a critique of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities.

PubMed

Freeman, Melvyn Colin; Kolappa, Kavitha; de Almeida, Jose Miguel Caldas; Kleinman, Arthur; Makhashvili, Nino; Phakathi, Sifiso; Saraceno, Benedetto; Thornicroft, Graham

2015-09-01

The UN Convention on the Rights of Persons with Disabilities (CRPD) is a major milestone in safeguarding the rights of persons with disabilities. However, the General Comment on Article 12 of the CRPD threatens to undermine critical rights for persons with mental disabilities, including the enjoyment of the highest attainable standard of health, access to justice, the right to liberty, and the right to life. Stigma and discrimination might also increase. Much hinges on the Committee on the Rights of Persons with Disabilities' view that all persons have legal capacity at all times irrespective of mental status, and hence involuntary admission and treatment, substitute decision-making, and diversion from the criminal justice system are deemed indefensible. The General Comment requires urgent consideration with the full participation of practitioners and a broad range of user and family groups. Copyright © 2015 Elsevier Ltd. All rights reserved.

78 FR 28835 - Del Ranch Company; Supplemental Notice That Initial Market-Based Rate Filing Includes Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... link to log on and submit the intervention or protests. Persons unable to file electronically should... file with the Federal Energy Regulatory Commission, 888 First Street NE., Washington, DC 20426, in... service, persons with Internet access who will eFile a document and/or be listed as a contact for an...

Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization.

PubMed

Clements-Nolle, Kristen; Marx, Rani; Katz, Mitchell

2006-01-01

To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population.

Personality disorder and alcohol treatment outcome: systematic review and meta-analysis.

PubMed

Newton-Howes, Giles M; Foulds, James A; Guy, Nicola H; Boden, Joseph M; Mulder, Roger T

2017-07-01

Background Personality disorders commonly coexist with alcohol use disorders (AUDs), but there is conflicting evidence on their association with treatment outcomes. Aims To determine the size and direction of the association between personality disorder and the outcome of treatment for AUD. Method We conducted a systematic review and meta-analysis of randomised trials and longitudinal studies. Results Personality disorders were associated with more alcohol-related impairment at baseline and less retention in treatment. However, during follow-up people with a personality disorder showed a similar amount of improvement in alcohol outcomes to that of people without such disorder. Synthesis of evidence was hampered by variable outcome reporting and a low quality of evidence overall. Conclusions Current evidence suggests the pessimism about treatment outcomes for this group of patients may be unfounded. However, there is an urgent need for more consistent and better quality reporting of outcomes in future studies in this area. © The Royal College of Psychiatrists 2017.

Hacia la Realizacion de la Autoestima. Informe Definitivo del Comite Estatal en Pro de la Autoestima y de la Responsabilidad Personal y Social (Toward a State of Esteem. Final Report of the State Committee to Promote Self-Esteem and Personal and Social Responsibility).

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento.

This is the Spanish version of the final report of a California Task Force created to promote self-esteem and personal responsibility. It begins with an executive summary listing key principles of the task force and providing recommendations and discussions in each of six major areas upon which the report focuses. The next section presents the…

78 FR 20390 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-04

.../o NEGOCIOS INTERNACIONALES DEL ECUADOR NIDEGROUP S.A., Quito, Pichincha, Ecuador; c/o SNACK PARTY...); alt. Passport 02952296-8 (Uruguay) (individual) [SDNTK]. Entity SNACK PARTY, Los Vinedos 19 y...

Swimming against the mainstream: the early years from chilly tributary to transformative mainstream.

PubMed

Bandura, Albert

2004-06-01

This article traces the transformative paradigm shift in the theory and practice of personal change. Within a decade, new conceptual models, analytic methodologies and modes of treatment were created. Treatments were altered in the content, locus, and agents of change. This enterprising period also witnessed a sweeping shift in the public acceptance of behaviorally oriented treatments. The present article also analyzes the evolving theorizing and applications of social cognitive theory rooted in modeling, self-regulatory, and self-efficacy mechanisms of psychosocial change. This model of change is implemented from an agentic perspective to promote personal, institutional, and society-wide changes that address some of the most urgent global problems.

Research on personalized recommendation algorithm based on spark

NASA Astrophysics Data System (ADS)

Li, Zeng; Liu, Yu

2018-04-01

With the increasing amount of data in the past years, the traditional recommendation algorithm has been unable to meet people's needs. Therefore, how to better recommend their products to users of interest, become the opportunities and challenges of the era of big data development. At present, each platform enterprise has its own recommendation algorithm, but how to make efficient and accurate push information is still an urgent problem for personalized recommendation system. In this paper, a hybrid algorithm based on user collaborative filtering and content-based recommendation algorithm is proposed on Spark to improve the efficiency and accuracy of recommendation by weighted processing. The experiment shows that the recommendation under this scheme is more efficient and accurate.

77 FR 54948 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to Executive Order 12978

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

...., Bogota, Colombia; c/ o INVERSIONES AGROINDUSTRIALES DEL OCCIDENTE LTDA., Bogota, Colombia; c/o CANADUZ S... COLOMBO-ANDINAS LTDA., Bogota, Colombia; c/o INVERSIONES Y CONSTRUCCIONES ABC S.A., Cali, Colombia; c/ o...

Early Intervention for Borderline Personality Disorder: Psychodynamic Therapy in Adolescents.

PubMed

Salzer, Simone; Cropp, Carola; Streeck-Fischer, Annette

2014-01-01

Borderline personality disorder (BPD) should be understood as a disorder of development (Streeck-Fischer 2008, 2013) that has its first manifestation in late childhood and adolescence. There are only few treatment studies of adolescents meeting the diagnostic criteria of borderline personality disorder, although early interventions for these patients are urgently needed (see Chanen & McCutcheon 2013). We examined the effectiveness of an inpatient psychodynamic therapy (PDT). Twenty-eight adolescents fulfilling the DSM-IV diagnostic criteria of borderline personality disorder were treated with psychodynamic therapy. The mean duration of treatment was 29.87 weeks (SD = 15.88). Outcomes were remission rates, GAF, GSI, SDQ, IIP and BPI scores. Assessments were made at admission and after treatment. Pre-post comparisons and comparisons with normative data were conducted. At the end of treatment 39.29% of the patients were remitted. We found significant improvements for the GAF, GSI, SDQ, IIP (all p0.001) and the BPI (p = 0.006). These clinically relevant improvements demonstrate the effectiveness of psychodynamic therapy in adolescents with borderline personality disorder and stress the usefulness of an early intervention for these patients.

Treatment of antisocial personality disorder: Development of a practice focused framework.

PubMed

van den Bosch, L M C; Rijckmans, M J N; Decoene, S; Chapman, A L

There is little to no evidence of effective treatment methods for patients with an antisocial personality disorder (ASPD). One of the reasons could be the fact that they are often excluded from mental healthcare and thus from studies. A treatment framework based on 'state of the art' methods and best practices, offering guidelines on the treatment of ASP and possibilities for more systematical research, is urgently needed. This research involved a literature search and an international Delphi-study (N = 61 experts in research, management and clinical practice focused on ASPD). The results suggested important preconditions with regard to organization of care, healthcare workers and therapy. Conclusions are that there are many ways to coordinate effective treatment and management and work toward the increased availability of evidence based care for persons with ASPD. Copyright © 2018 Elsevier Ltd. All rights reserved.

Evaluation of the need for routine clinical testing of PALB2 c.1592delT mutation in BRCA negative Northern Finnish breast cancer families.

PubMed

Haanpää, Maria; Pylkäs, Katri; Moilanen, Jukka S; Winqvist, Robert

2013-08-13

Testing for mutations in the BRCA1 and BRCA2 genes among high-risk breast cancer patients has become a routine practice among clinical geneticists. Unfortunately, however, the genetic background of a majority of the cases coming to the clinics remains currently unexplained, making genetic counseling rather challenging. In recent years it has become evident world-wide that also women carrying a heterozygous germline mutation in PALB2 are at significantly increased risk of getting breast cancer. We have previously studied the clinical as well as biological impact of the PALB2 c.1592delT founder mutation occurring in about 1% of Finnish breast cancer patients unselected for their family history of disease, and our results demonstrated a 40% increased breast cancer risk by age 70 for female mutation carriers. Thus, this relatively common mutation in PALB2 is associated with a high risk of developing breast cancer. The aim of the current study was to analyze whether female index individuals of breast cancer families who had tested negative for germline mutations in BRCA1/BRCA2 as part of genetic counseling services should be offered mutation testing for PALB2 c.1592delT. The study cohort consisted of altogether 223 individuals who had contacted the Department of Clinical Genetics at the Oulu University Hospital in Finland between the years 1997 and 2011 for counseling on hereditary breast and/or ovarian cancer risk. 101 of them met our inclusion criteria. Of these, 10 persons were now deceased, but 6 of them had participated in one of our previous studies on PALB2. Seventy (77%) of the remaining 91 persons responded positively to our study invitation. Chart review of updated pedigree data led to the exclusion of 14 further individuals not meeting the selection criteria. Of the 56 alive affected female individuals screened for PALB2 c.1592delT, altogether two (3.6%) tested positive for this mutation. In addition, of the previously tested but now deceased 6 persons eligible for the current study, one more mutation carrier was observed. Therefore, overall 4.8% (3/62) of the tested individuals belonging to the Northern Finnish 1997-2011 study cohort turned out to be carriers of the PALB2 c.1592delT allele. Given the potential benefits versus harms of this testing, the result of our study suggest that PALB2 c.1592delT should be a routine part of the genetic counseling protocol for Finnish high-risk breast cancer cases tested negative for mutations in BRCA1/BRCA2.

Stress and PTSD Mechanisms as Targets for Pharmacotherapy of Alcohol Abuse, Addiction, and Relapse

DTIC Science & Technology

2014-10-01

hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed , and...new staff person needed for the proposed studies and have also implemented new methods that were not in the original proposal but that make the...in year 3, due to the urgent need for new therapies to prevent PTSD in response to trauma. The remaining proposed studies using rat models to

Population specific genetic heterogeneity of familial hypercholesterolemia in South Africa.

PubMed

Smyth, Natalie; Ramsay, Michèle; Raal, Frederick J

2018-04-01

To describe the prevalence and population-specific genetic heterogeneity of familial hypercholesterolemia in South Africa. This review highlights the paucity of data on familial hypercholesterolemia in South Africa, and the urgent need to uncover the mutation profiles in lipid-associated genes, causing an increase in LDL-cholesterol in the different ethnic groups. Case reports and small studies have shown that familial hypercholesterolemia, although apparently uncommon, is present in black Africans. Local founder effects have led to an increased prevalence of familial hypercholesterolemia in several South African populations: Afrikaner founder mutations (c.681 C>G, c.1285 G>A, c.523 G>A), Ashkenazi founder mutation (c.654_656del) and possible Indian founder mutation (c.2054 C>T). Preliminary data in black Africans with elevated LDL-cholesterol identified a possible common mutation, c.137_142del. The South African multiethnic society and well described founder effects emphasize the need for differential approaches to diagnosis and management of familial hypercholesterolemia. Studies involving larger cohorts and inclusive of different ethnicities are paramount to establishing an accurate prevalence of familial hypercholesterolemia in black Africans, not only in South Africa but in the Sub-Saharan African region. It is clear that the estimated world prevalence of one in 250 cannot be generally applied across African populations.

77 FR 40614 - Change in Bank Control Notices; Acquisitions of Shares of a Bank or Bank Holding Company

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

... Board of Governors. Interested persons may express their views in writing to the Reserve Bank indicated..., Sartell, Minnesota; to retain and acquire, and Steven M. Zaun, Marina Del Ray, California, to acquire...

Fluidity of the Subsyndromal Phenomenology of Borderline Personality Disorder Over 16 Years of Prospective Follow-Up.

PubMed

Zanarini, Mary C; Frankenburg, Frances R; Reich, D Bradford; Fitzmaurice, Garrett M

2016-07-01

The purpose of this study was to determine the cumulative rates of 2- and 4-year remission, and the recurrences that follow them, of 24 symptoms of borderline personality disorder over 16 years of prospective follow-up. A total of 290 inpatients meeting rigorous criteria for borderline personality disorder and 72 axis II comparison subjects were assessed during their index admission using a series of semistructured diagnostic interviews. The same instruments were readministered at eight contiguous 2-year time periods. The 12 acute symptoms (e.g., self-mutilation, help-seeking suicide attempts) of borderline personality disorder were more likely to remit for a period of 2 years and for a period of 4 years than the 12 temperamental symptoms (e.g., chronic anger/frequent angry acts, intolerance of aloneness) of this disorder. They were also less likely to recur after a remission lasting 2 years or a remission lasting 4 years. Taken together, the symptoms of borderline personality disorder are quite fluid, with remissions and recurrences being common. However, the more clinically urgent acute symptoms of borderline personality disorder seem to have a better prognosis than the less turbulent temperamental symptoms of the disorder.

Fluidity of the Subsyndromal Phenomenology of Borderline Personality Disorder over 16 Years of Prospective Follow-up

PubMed Central

Zanarini, Mary C.; Frankenburg, Frances R.; Reich, D. Bradford; Fitzmaurice, Garrett M.

2016-01-01

Objective The purpose of this study was to determine the cumulative rates of two and four-year remission, and the recurrences that follow them, of 24 symptoms of borderline personality disorder over 16 years of prospective follow-up. Method 290 inpatients meeting rigorous criteria for borderline personality disorder and 72 axis II comparison subjects were assessed during their index admission using a series of semistructured diagnostic interviews. The same instruments were readministered at eight contiguous two-year time periods. Results The 12 acute symptoms (e.g., self-mutilation, help-seeking suicide attempts) of borderline personality disorder were more likely to remit for a period of two years and for a period of four years than the 12 temperamental symptoms (e.g., chronic anger/frequent angry acts, intolerance of aloneness) of this disorder. They were also less likely to recur after a remission lasting two years or a remission lasting four years. Conclusions Taken together, the symptoms of borderline personality disorder are quite fluid, with remissions and recurrences being common. However, the more clinically urgent acute symptoms of borderline personality disorder seem to have a better prognosis than the less turbulent temperamental symptoms of the disorder. PMID:26869248

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study.

PubMed

Schnitker, Linda M; Beattie, Elizabeth R A; Martin-Khan, Melinda; Burkett, Ellen; Gray, Leonard C

2016-05-01

The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). This was a multi-centre (n=8) observational study of a convenience sample of older (≥70y) ED patients (n=579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n=191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semi-urgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), dependence in activities in daily living (81/190, 43%), issues in nutrition (73/182, 40%), vision and hearing impairment (93% (160/172) and 26% (44/171) respectively). Increased understanding of these presenting characteristics and their impacts on patient risk facilitates tailoring the quality of emergency care to better suit the needs and improve outcomes of this increasing ED population. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

A patient navigation intervention for drug-involved former prison inmates.

PubMed

Binswanger, Ingrid A; Whitley, Elizabeth; Haffey, Paul-Ryan; Mueller, Shane R; Min, Sung-Joon

2015-01-01

Former prison inmates experience high rates of hospitalizations and death during the transition from prison to the community, particularly from drug-related causes and early after release. The authors designed a randomized controlled trial (RCT) of patient navigation to reduce barriers to health care and hospitalizations for former prison inmates. Forty former prison inmates with a history of drug involvement were recruited and randomized within 15 days after prison release. Participants were randomized to receive 3 months of patient navigation (PN) with facilitated enrollment into an indigent care discount program (intervention) or facilitated enrollment into an indigent care discount program alone (control). Structured interviews were conducted at baseline, 3 months, and 6 months. Outcomes were measured as a change in self-reported barriers to care and as the rate of health service use per 100 person-days. The mean number of reported barriers to care was reduced at 3 and 6 months in both groups. At 6 months, the rate of emergency department/urgent care visits per 100 person-days since baseline was 1.1 among intervention participants and 0.5 among control participants (P = .04), whereas the rate of hospitalizations per 100 person-days was 0.2 in intervention participants and 0.6 in control participants (P = .04). Recruitment of former inmates into an RCT of patient navigation was highly feasible, but follow-up was limited by rearrests. Results suggest a significantly lower rate of hospitalizations among navigation participants, although the rate of emergency department/urgent care visits was not improved. Patient navigation is a promising, pragmatic intervention that may be effective at reducing high-cost health care utilization in former prison inmates.

Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa.

PubMed

Levitt, Naomi S; Puoane, Thandi; Denman, Catalina A; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A

2015-01-01

We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

The debate in Chile on organ donation revisited.

PubMed

Kottow Lang, Miguel Hugo

2016-08-29

The worldwide scarcity of cadaveric organs for transplants is on the rise, due in part to extended medical indications and longevity of chronic patients with organic insufficiencies. Chile has an extremely low donor rate of 6.7 per million. Although consent is presumed by law, and recently amended to include a “reciprocity principle”, nearly four million persons have expressed in writing their unwillingness to donate and, of those remaining, 53% of families have rejected donating the organs of their deceased. New proposals are urgently needed, even if some of them have previously been rejected: nonmaterial incentives, partial donations and unveiling anonymity to enhance personal ties between donors and recipients. Transparency, information and assistance are to be reinforced in order to regain trust in transplant procedures.

When time matters.

PubMed

Theadore, Jason C

2011-01-01

The most important organizational resource is energy. The most important resource in time management is energy. Managing energy, not time, can help create encouraging time management skills and appropriate work life balance. Once a leader understands that time should be spent on things that are important instead of everything that is urgent, you can begin to develop a balance that will support your values, your family, and your organization. When leaders find meaningful ways to add a sense of purpose to their work they can personally improve themselves and their organizations. If your personal values do not align with the values of your organization you will never work with a true sense of purpose. Make the time to manage your energy. You will be surprised how much free time you find.

Translating change: the development of a person-centred triage training programme for emergency nurses.

PubMed

McBrien, Barry

2009-01-01

Within health care, there has been a change in practice from an illness-orientated service to one that is more health-focused and person-centred. The concept of person-centredness is frequently espoused by practitioners as being not only a desirable, but a necessary element of health care provision. Indeed, nationally and internationally, person-centred care has underpinned many healthcare documents and policies. Person-centred practice focuses on providing care, utilising a variety of processes that operationalise person-centred nursing and include working with patients' beliefs and values, engagement, presence, sharing decision-making and providing for physical needs. In the field of emergency nursing, the incorporation of person-centred care and its holistic foundation may require a significant shift in practice. There is evidence to suggest that emergency nurses view their role as one, which is predominantly concerned with providing urgent physical care, rather than one, which espouses the theories of holistic healthcare. To this extent, being person-centred in the context of emergency care, requires the nurse to move beyond the traditional notions of his/her role and to embrace the more holistic aspects of patient care. The aim of this article is to critically analyse how a change in nurse-led triage training in one Irish Emergency Department facilitated an improved person-centred approach in practice.

Future directions in personality, occupational and medical selection: myths, misunderstandings, measurement, and suggestions.

PubMed

Ferguson, Eamonn; Lievens, Filip

2017-05-01

This paper has two objectives: (1) presenting recent advances in personality theory whereby personality traits are conceptualized within a framework that focuses on the dynamic interactions of behaviour, biology, context, and states, and (2) discussing the implications of these developments for measurement and medical selection. We start by presenting evidence that traits are no longer regarded as stable deterministic predictors of behaviour. Instead, traits are found to change across generations, the life span, and in response to environmental contingencies. Thus, there is an urgent need to explore how traits change as function of medical education. Second, drawing on recent theory and research (behavioural reaction norms and the density distribution model) we highlight evidence to show how the expression of trait relevant behaviour is dependent on context, and is distributed with an average (typical behaviour or personality) and a variance (plasticity or adaptability), with traditional personality measure associated with typical responding. Third, we demystify that some traits are better than others showing that so-called "good" traits have a dark-side. Fourth, we show how these developments impact on how personality might be assessed, thereby presenting recent evidence on the use of contextualized personality measures, situational judgment tests, other reports, and implicit measures. Throughout the paper, we outline the key implications of these developments for medical selection practices.

An urgent need to understand and address the safety and well-being of hospital "sitters".

PubMed

Schoenfisch, Ashley L; Pompeii, Lisa A; Lipscomb, Hester J; Smith, Claudia D; Upadhyaya, Mudita; Dement, John M

2015-12-01

Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II). Data from surveys, focus groups, individual interviews at six U.S. hospitals were used to characterize the prevalence of and circumstance surrounding type II violence against sitters, as well as broader issues related to sitter use. Sitter respondents had a high 12-month prevalence of physical assault, physical threat, and verbal abuse compared to other workers in the hospital setting. Sitters and other staff indicated the need for clarification of sitters' roles regarding patient care and sitter well-being (e.g., calling for assistance, taking lunch/restroom breaks), training of sitters in personal safety and de-escalation, methods to communicate patient/visitor behaviors, and unit-level support. The burden of type II violence against hospital sitters is concerning. Policies surrounding sitters' roles and violence prevention training are urgently needed. © 2015 Wiley Periodicals, Inc.

Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action.

PubMed

Guan, Wei-Jie; Zheng, Xue-Yan; Chung, Kian Fan; Zhong, Nan-Shan

2016-10-15

In China, where air pollution has become a major threat to public health, public awareness of the detrimental effects of air pollution on respiratory health is increasing-particularly in relation to haze days. Air pollutant emission levels in China remain substantially higher than are those in developed countries. Moreover, industry, traffic, and household biomass combustion have become major sources of air pollutant emissions, with substantial spatial and temporal variations. In this Review, we focus on the major constituents of air pollutants and their impacts on chronic respiratory diseases. We highlight targets for interventions and recommendations for pollution reduction through industrial upgrading, vehicle and fuel renovation, improvements in public transportation, lowering of personal exposure, mitigation of the direct effects of air pollution through healthy city development, intervention at population-based level (systematic health education, intensive and individualised intervention, pre-emptive measures, and rehabilitation), and improvement in air quality. The implementation of a national environmental protection policy has become urgent. Copyright © 2016 Elsevier Ltd. All rights reserved.

Ayahuasca and human destiny.

PubMed

McKenna, Dennis J

2005-06-01

In this essay, the author shares his personal reflections gleaned from a lifetime of research with ayahuasca, and speculates on the societal, political, planetary, and evolutionary implications of humanity's aeons-old symbiosis with this shamanic plant. The thesis is developed that at this critical historical juncture, ayahuasca has developed a strategy to broadcast its message to a wider world--a reflection of the urgent need to avert global ecological catastrophe. While ayahuasca has much to teach us, the critical question is, will humanity hear it, and heed it, in time?

Caring Economics: A New Framework for Conceptualizing and Measuring Economic Activity.

PubMed

Ghosh, Indradeep

2015-01-01

This article introduces the reader to a new framework for conceptualizing and measuring economic activity called caring economics. Going beyond the conventional understanding of economic activity as that which unfolds in markets, caring economics highlights the work of care and caregiving that occurs within households and is often unpaid. This article also unveils a new set of measures based on the framework of caring economics that are urgently needed by policymakers and business leaders to foster personal, business, and national economic success.

[Research as attractiveness parameter for young surgeons].

PubMed

Vollmar, B

2012-04-01

Increasing concern has been expressed about the significant shortage of new trainees in surgery. As research in the context of surgical education and training is an essential element of attraction for the field of surgery, there is an urgent priority to implement clear room for research in the concepts of education and training. In this article the relevance of both the thesis accompanying the study and research training during surgical residency for the clinical self-image, personal satisfaction and academic development of young surgeons will be presented.

Can We Afford Not to Evaluate Services for Elderly Persons with Dementia?

PubMed Central

Worrall, Graham; Chambers, Larry W.

1989-01-01

With the increasing expenditure on health-care programs for seniors, there is an urgent need to evaluate such programs. The Measurement Iterative Loop is a tool that can provide both health administrators and health researchers with a method of evaluation of existing programs and identification of gaps in knowledge, and forms a rational basis for health-care policy decisions. In this article, the Loop is applied to one common problem of the elderly: dementia. PMID:21248993

[Clinico-statistical analysis of arterial hypertension complicated with hypertensive crisis in Moscow in 2005-2009].

PubMed

Gaponova, N I; Plavunov, N F; Tereshchenko, S N; Baratashvili, V L; Abdurakhmanov, V R; Komissarenko, I A; Filippov, D V; Podkopaev, D V

2011-01-01

Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.

77 FR 2609 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to the Foreign...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-18

..., S.A. DE C.V. (a.k.a. MEDIC EXPRESS, S.A. DE C.V.; a.k.a. GRUPO LOMEDIC), Av. del Parque 489, Col. San Andres, Guadalajara, Jalisco 44810, Mexico; Calle Chicle 234, Colonia El Colli Industrial, Zapopan...

Repercussions of imprisonment for conjugal violence: discourses of men.

PubMed

Sousa, Anderson Reis de; Pereira, Álvaro; Paixão, Gilvânia Patrícia do Nascimento; Pereira, Nadirlene Gomes; Campos, Luana Moura; Couto, Telmara Menezes

2016-12-08

to know the consequences that men experience related to incarceration by conjugal violence. qualitative study on 20 men in jail and indicted in criminal processes related to conjugal violence in a Court specialized in Family and Domestic Violence against women. The interviews were classified based on Collective Subject Discourse method, using NVIVO(r) software. the collective discourse shows that the experience of preventive imprisonment starts a process of family dismantling, social stigma, financial hardship and psycho-emotional symptoms such as phobia, depression, hypertension, and headaches. due to the physical, mental and social consequences of the conjugal violence-related imprisonment experience, it is urgent to look carefully into the somatization process as well as to the prevention strategies regarding this process. conhecer as repercussões da prisão por violência conjugal para os homens. estudo qualitativo com 20 homens que foram presos e respondem a processo criminal por violência conjugal em uma Vara de Violência Doméstica e Familiar contra a Mulher. As entrevistas foram categorizadas com base no método do Discurso do Sujeito Coletivo, com auxílio do software NVIVO(r). o discurso coletivo revela que a vivência da prisão preventiva desencadeia desagregação familiar, estigma social, dificuldades financeiras e sintomatologia de caráter psicoemocional, como fobia, depressão, hipertensão e cefaleia. diante das repercussões físicas, mentais e sociais de experienciar a prisão em decorrência de violência conjugal, urge um olhar acerca do processo de somatização do vivido, da mesma maneira que estratégias de prevenção do fenômeno. conocer las repercusiones de prisión, por violencia conyugal, en los hombres. estudio cualitativo con 20 hombres que fueron presos y responden por caso criminal de violencia conyugal, en una Juzgado de Violencia Doméstica y Familiar contra la Mujer. Las entrevistas fueron categorizadas con base en el método del Discurso del Sujeto Colectivo, con auxilio del software NVIVO(r). el discurso colectivo revela que la vivencia de prisión preventiva desencadena desagregación familiar, estigma social, dificultades financieras y sintomatología de carácter psicoemocional, como fobia, depresión, hipertensión y cefalea. delante de las repercusiones físicas, mentales y sociales, de experimentar la prisión como consecuencia de violencia conyugal, es urgente examinar el proceso de somatización de esa experiencia, de la misma manera que encontrar estrategias de prevención de ese fenómeno.

Improving personalized link prediction by hybrid diffusion

NASA Astrophysics Data System (ADS)

Liu, Jin-Hu; Zhu, Yu-Xiao; Zhou, Tao

2016-04-01

Inspired by traditional link prediction and to solve the problem of recommending friends in social networks, we introduce the personalized link prediction in this paper, in which each individual will get equal number of diversiform predictions. While the performances of many classical algorithms are not satisfactory under this framework, thus new algorithms are in urgent need. Motivated by previous researches in other fields, we generalize heat conduction process to the framework of personalized link prediction and find that this method outperforms many classical similarity-based algorithms, especially in the performance of diversity. In addition, we demonstrate that adding one ground node that is supposed to connect all the nodes in the system will greatly benefit the performance of heat conduction. Finally, better hybrid algorithms composed of local random walk and heat conduction have been proposed. Numerical results show that the hybrid algorithms can outperform other algorithms simultaneously in all four adopted metrics: AUC, precision, recall and hamming distance. In a word, this work may shed some light on the in-depth understanding of the effect of physical processes in personalized link prediction.

Impact of hearing loss in the workplace: raising questions about partnerships with professionals.

PubMed

Jennings, Mary Beth; Shaw, Lynn

2008-01-01

The number of adults with hearing loss who continue to work later in life is growing. Persons with hearing loss are generally unaware of the role that audiologists, occupational therapists, and vocational rehabilitation counsellors might play in the assessment of the workplace environment and appropriate accommodations. Three narratives of adults with hearing loss are used to demonstrate the gaps in accessing information, technology and services needed to maintain optimal work performance and productivity. The lack of recognition of the multidimensional needs of older workers with hearing loss and the lack of timely coordination of services led to all three persons acting alone in trying to access services and supports. In two of the three cases the impact of the hearing loss resulted in further unexpected losses such as the loss of employment and the loss of a worker-identity. There is an urgent need for partnering with persons who are hard of hearing to develop new strategies for knowledge exchange, more thorough assessment of hearing demands and modifications in the workplace, and interdisciplinary approaches to service specific to the needs of hard of hearing persons.

Avian influenza and South Jakarta primary healthcare workers: a controlled mixed-method study.

PubMed

Koh, Gerald Choon-Huat; Abikusno, Nugroho; Kwing, Cheong Seng; Yee, Wong Teck; Kusumaratna, Rina; Sundram, Meena; Koh, Kelvin; Eng, Chia Sin; Koh, David

2009-07-01

To study the attitudes, concerns, perceived impact, coping strategies, knowledge on avian influenza (AI) and personal protection measures, and institutional and personal preparedness for AI among all Indonesian primary healthcare workers (PHW). Questionnaire survey of PHW from four public primary healthcare clinics in South Jakarta (n = 333), with Singaporean PHW from 18 such clinics as controls (n = 1321). Twelve focus group discussions with 51 South Jakarta PHW were also conducted. Quantitative and qualitative data were analysed separately with statistical and thematic analysis, respectively, then combined. South Jakarta PHW had positive attitudes but major concerns about contracting AI, difficulties in diagnosing human AI and inadequacy of personal protection provided. South Jakarta PHW are less knowledgeable about AI and use of personal protection equipment, and reported poorer awareness, availability and participation in AI preparation activities. Only 3% of South Jakarta PHW received influenza vaccination in the preceding 6 months and few felt prepared for AI. South Jakarta primary healthcare workers are not well prepared for avian influenza. There is an urgent need to build their primary healthcare capacity to protect them and contain this global health threat.

Aceptabilidad del diagnóstico rápido casero para HIV entre hombres gay y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires

PubMed Central

Balán, Iván C.; Carballo-Diéguez, Alex; Marone, Rubén O.; Pando, María A.; Barreda, Victoria; Ávila, María M.

2011-01-01

Resumen El uso del diagnóstico rápido para HIV en Argentina, así como otros países de Latinoamérica, ha sido limitado hasta el momento. Este trabajo reporta los resultados provenientes de un estudio cualitativo realizado entre hombres gays y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires, Argentina. El objetivo principal del mismo fue conocer las ventajas y desventajas que los hombres G&HSH perciben en relación al diagnóstico rápido casero para HIV. Se realizaron ocho grupos focales con 73 participantes en los cuales se discutió acerca de las ventajas y desventajas del uso de los diagnósticos rápidos. Las respuestas fueron codificadas utilizando un programa para análisis de datos cualitativos (NVivo) y analizadas temáticamente. Los participantes describieron numerosas ventajas sobre el uso del diagnóstico rápido casero, aunque algunos reportaron importantes preocupaciones dentro de las cuales se destaca la posibilidad de impulsos suicidas si alguien recibe un resultado positivo estando solo. En términos generales se observó una gran aceptabilidad para el uso del diagnóstico rápido si el mismo es realizado por personal de salud en lugares acondicionados para este fin. PMID:25284951

Aceptabilidad del diagnóstico rápido casero para HIV entre hombres gay y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires.

PubMed

Balán, Iván C; Carballo-Diéguez, Alex; Marone, Rubén O; Pando, María A; Barreda, Victoria; Avila, María M

2011-03-01

El uso del diagnóstico rápido para HIV en Argentina, así como otros países de Latinoamérica, ha sido limitado hasta el momento. Este trabajo reporta los resultados provenientes de un estudio cualitativo realizado entre hombres gays y otros hombres que tienen sexo con hombres (G&HSH) de la Ciudad de Buenos Aires, Argentina. El objetivo principal del mismo fue conocer las ventajas y desventajas que los hombres G&HSH perciben en relación al diagnóstico rápido casero para HIV. Se realizaron ocho grupos focales con 73 participantes en los cuales se discutió acerca de las ventajas y desventajas del uso de los diagnósticos rápidos. Las respuestas fueron codificadas utilizando un programa para análisis de datos cualitativos (NVivo) y analizadas temáticamente. Los participantes describieron numerosas ventajas sobre el uso del diagnóstico rápido casero, aunque algunos reportaron importantes preocupaciones dentro de las cuales se destaca la posibilidad de impulsos suicidas si alguien recibe un resultado positivo estando solo. En términos generales se observó una gran aceptabilidad para el uso del diagnóstico rápido si el mismo es realizado por personal de salud en lugares acondicionados para este fin.

The rights of persons with Disability Bill, 2014: How “enabling” is it for persons with mental illness?

PubMed Central

Rao, Gundugurti Prasad; Ramya, Vemulokonda Sri; Bada, Math Suresh

2016-01-01

India ratified the United Nations Convention on the Rights of Person with Disabilities (UNCRPD) in 2007. This is a welcome step towards realizing the rights of the persons with disability. The UNCRPD proclaims that disability results from interaction of impairments with attitudinal and environmental barriers which hinders full and active participation in society on an equal basis with others. Further, the convention also mandates the signatory governments to change their local laws, to identify and eliminate obstacles and barriers and to comply with the terms of the UNCRPD in order to protect the rights of the person with disabilities, hence the amendments of the national laws. Hence, the Government of India drafted two important bill the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) and Mental Health Care Bill, 2013 (MHC Bill, 2013). There is no doubt that persons with mental illness are stigmatized and discriminated across the civil societies, which hinders full and active participation in society. This situation becomes worse with regard to providing mental health care, rehabilitation and social welfare measures to persons with mental illness. There is an urgent need to address this issue of attitudinal barrier so that the rights of persons with mental illness is upheld. Hence, this article discusses shortcomings in the Right of Persons with Disabilities Bill, 2014 (RPWD Bill, 2014) from the perspective of persons with mental illness. Further, the article highlights the need to synchronize both the RPWD Bill, 2014 and Mental Health Care Bill, 2013 to provide justice for persons with mental illness. PMID:27385843

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention.

PubMed Central

Clements-Nolle, K; Marx, R; Guzman, R; Katz, M

2001-01-01

OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services. PMID:11392934

Measuring the performance of telephone-based disease surveillance systems in local health departments.

PubMed

Dausey, David J; Chandra, Anita; Schaefer, Agnes G; Bahney, Ben; Haviland, Amelia; Zakowski, Sarah; Lurie, Nicole

2008-09-01

We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times.

[Anaesthetic implications in a pregnant patient with an extreme thrombocytopenia due to a May-Hegglin anomaly: general o regional anaesthesia?].

PubMed

García Vallejo, G; Cabellos, M; Kabiri, M; Fraile, J R; Cuesta, J

2014-10-01

The May-Hegglin anomaly is an inherited disorder, so uncommon that the incidence is still unknown. It is characterized by macro-thrombocytopenia with normal platelet function and cytoplasmic inclusion bodies in granulocytes. The case is reported of a 28-year-old primiparous patient who had an urgent caesarean section due to failed induction of labour. The patient had no history of abnormal bleeding. Other causes of thrombocytopenia or platelet dysfunction, such as preeclampsia, HELLP syndrome, or placental abruption, were ruled out. The platelet count prior to surgery was 20,900/mm(3) with normal platelet function. General anaesthesia was performed. No excessive bleeding occurred and a platelet transfusion was not needed. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

77 FR 54949 - Unblocking of Specially Designated Nationals and Blocked Persons Pursuant to Executive Order 12978

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... (Colombia) (INDIVIDUAL) [SDNT]. 5. HACHITO SANCHEZ, Angel Alberto, c/o COPSERVIR LTDA., Bogota, Colombia.... GAMBA SANCHEZ, Fernando, c/o DISTRIBUIDORA DE DROGAS CONDOR S.A., Bogota, Colombia; DOB 03 Nov 1962...; Cedula No. 52492258 (Colombia) (INDIVIDUAL) [SDNT]. 17. MORENO GOMEZ, Ingrid Del Carmen, c/o CAJA...

75 FR 62568 - Meeting of the Compact Council for the National Crime Prevention and Privacy Compact

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

... exchange of criminal history records for licensing, employment, and similar purposes. The Compact also... records. The United States Attorney General appointed 15 persons from state and federal agencies to serve...-2868. Dated: August 11, 2010. Kimberly J. Del Greco, Section Chief, Biometric Services Section Criminal...

Forensic efficiency and genetic variation of 30 InDels in Vietnamese and Nigerian populations.

PubMed

Du, Weian; Peng, Zhiyong; Feng, Chunlei; Zhu, Bofeng; Wang, Bangchao; Wang, Yue; Liu, Chao; Chen, Ling

2017-10-24

Insertion/deletion polymorphisms (InDels) are ubiquitous diallelic genetic markers that have drawn increasing attention from forensic researchers. Here, we investigated 30 InDel loci in Vietnamese and Nigerian populations and evaluated their usefulness in forensic genetics. The polymorphic information content of these populations ranged, respectively, from 0.164 to 0.375 and from 0.090 to 0.375 across loci. After Bonferroni correction, no significant deviation from Hardy-Weinberg equilibrium was found, except for HLD97 in the Nigerian population. The cumulative power of exclusion for all 30 loci in the Vietnamese and Nigerian populations was 0.9870 and 0.9676, respectively, indicating that this InDel set is not suitable for paternity testing in these populations, but could be included as a supplement. For the Vietnamese and the Nigerian populations, the mean observed heterozygosity was 0.5917 and 0.6268, and the combined discrimination power of the 30 loci was 0.9999999999767 and 0.9999999999603, respectively. These findings indicated that these InDels may be suitable for personal forensic identification in the studied populations. The results of D A distance, phylogenetic tree, principal component, and cluster analyses were consistent and indicated a clear pattern of regional distribution. Moreover, the Vietnamese population was shown to have close genetic relationships with the Guangdong Han and Shanghai Han populations.

Forensic efficiency and genetic variation of 30 InDels in Vietnamese and Nigerian populations

PubMed Central

Du, Weian; Peng, Zhiyong; Feng, Chunlei; Zhu, Bofeng; Wang, Bangchao; Wang, Yue; Liu, Chao; Chen, Ling

2017-01-01

Insertion/deletion polymorphisms (InDels) are ubiquitous diallelic genetic markers that have drawn increasing attention from forensic researchers. Here, we investigated 30 InDel loci in Vietnamese and Nigerian populations and evaluated their usefulness in forensic genetics. The polymorphic information content of these populations ranged, respectively, from 0.164 to 0.375 and from 0.090 to 0.375 across loci. After Bonferroni correction, no significant deviation from Hardy-Weinberg equilibrium was found, except for HLD97 in the Nigerian population. The cumulative power of exclusion for all 30 loci in the Vietnamese and Nigerian populations was 0.9870 and 0.9676, respectively, indicating that this InDel set is not suitable for paternity testing in these populations, but could be included as a supplement. For the Vietnamese and the Nigerian populations, the mean observed heterozygosity was 0.5917 and 0.6268, and the combined discrimination power of the 30 loci was 0.9999999999767 and 0.9999999999603, respectively. These findings indicated that these InDels may be suitable for personal forensic identification in the studied populations. The results of DA distance, phylogenetic tree, principal component, and cluster analyses were consistent and indicated a clear pattern of regional distribution. Moreover, the Vietnamese population was shown to have close genetic relationships with the Guangdong Han and Shanghai Han populations. PMID:29179488

Present and future of personalized medicine in CLL.

PubMed

Montserrat, Emili; Bauman, Tycho; Delgado, Julio

2016-03-01

Medicine has been 'personalized' (i.e. centred in persons) since its foundation. Recently, however, the term 'personalized medicine' (or, better, 'precision medicine') has been introduced to define 'a form of medicine that uses information about a person's genes, proteins, and environment to prevent, diagnose, and treat disease'. This concept has gained momentum thanks to next-generation-sequencing (NGS) techniques that allow identification of molecular characteristics unique to the patient and to the tumour. It is hoped that NGS will not only contribute to a better understanding of chronic lymphocytic leukaemia (CLL), but will identify disease subsets that could benefit from specific treatment interventions. Recent advances in diagnosis (e.g. high-resolution immunophenotyping, markers of genetic abnormalities), prognosis (e.g. biomarkers), response predictors [e.g. del(17p)/TP53 mutations even at subclonal level], treatment (e.g. BCR signalling inhibitors, BCL2 antagonists, CAR-T cells) and methods to evaluate minimal residual disease constitute good examples of tools facilitating 'personalized' management of patients with CLL. Copyright © 2016. Published by Elsevier Ltd.

Molecular medicine - To be or not to be.

PubMed

Brunori, Maurizio; Gianni, Stefano

2016-01-01

Molecular medicine is founded on the synergy between Chemistry, Physics, Biology and Medicine, with the ambitious goal of tackling diseases from a molecular perspective. This Review aims at retracing a personal outlook of the birth and development of molecular medicine, as well as at highlighting some of the most urgent challenges linked to aging and represented by incurable neurodegenerative diseases caused by protein misfolding. Furthermore, we emphasize the emerging role of the retromer dysfunctions and improper protein sorting in Alzheimer's disease and other important neurological disordered. Copyright © 2016 Elsevier B.V. All rights reserved.

Suicide prevention for psychoanalytic institutes and societies.

PubMed

Kernberg, Otto F

2012-08-01

What follows are guidelines for rescue teams dedicated to suicide prevention for psychoanalytic institutes and societies. They provide a general orientation and presuppose intensive individual and organizational training by the rescue teams. Some general notes of caution: suicide prevention is a complex, delicate effort that requires specific training, experience, knowledge, patience, and courage. It is a well-known fact that drowning persons may resist rescue efforts, thereby posing the danger of drowning the rescuer along with themselves. Similarly, expect desperate, blind resistance to your efforts, particularly when the suicidal temptation is urgent and overwhelming.

Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

PubMed Central

Levitt, Naomi S.; Puoane, Thandi; Denman, Catalina A.; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A.

2015-01-01

Background We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Design Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Results Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. Conclusions The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. PMID:25854780

PubMed

Beas, Renato; Anduaga-Beramendi, Alexander; Maticorena-Quevedo, Jesus; Mayta-Tristán, Percy

2018-03-26

Objetivo: Identificar los factores asociados al Síndrome de Burnout (SB) en trabajadores de salud del Perú en el año 2014.Métodos: Estudio transversal analítico mediante un análisis secundario de la Encuesta Nacional de Usuarios de Salud del año 2014 en Perú. El SB fue medido mediante el Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Se realizó un análisis descriptivo, también un análisis bivariado y multivariado calculando los valores de p y los OR crudos y ajustados mediante Regresión Logística.Resultados: La prevalencia del SB en los profesionales de la salud fue 2,8%, encontrándose asociadas las variables: género, tiempo en el sector salud, horas de trabajo e ingreso mensual total.Conclusiones: Se encontró que los factores asociados al SB en el personal de Perú en el año 2014 fueron el género, el tiempo en el sector salud, las horas de trabajo y el ingreso mensual total.

Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making.

PubMed

Nydén, Kristoffer; Petersson, Martin; Nyström, Maria

2003-03-01

Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.

'Somebody there to watch over you': the role of the family in everyday and emergency diabetes care.

PubMed

Gunn, Kathleen L; Seers, Kate; Posner, Natasha; Coates, Vivien

2012-11-01

This paper reports on the role of family members in everyday diabetes self-care and in diabetic crises. It is based on qualitative data drawn from 45 semi-structured interviews with a wide range of people with an established diagnosis of Type 1 or Type 2 diabetes, who were admitted to hospital for urgent or emergency treatment in connection with their diabetes. The interviews were carried out in two contrasting sites in the United Kingdom in 2009-2010, transcribed and analysed thematically with particular reference to framework analysis methods. We found that family involvement in self-care was common, and the role of family and friends was especially important when the person with diabetes needed urgent help. We comment on the diversity of family members who assisted regularly or dealt with crises, the importance of taking account of the complexities of family life, including reciprocal care, and the particular problems faced by people without family support. Finally, we make recommendations for further research and for improvements in existing services. © 2012 Blackwell Publishing Ltd.

Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

PubMed Central

Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay

2015-01-01

Objective To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Methods Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Results Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). Conclusions In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. PMID:25564148

Sexual violence as a limiting factor on the perception and management of the risk of HIV in women married to migrants.

PubMed

Flores, Yesica Yolanda Rangel

2016-09-01

to analyze the influence of sexual violence on the perception and management of the risk of HIV in women married to migrants. study with an ethnographic approach carried out in urban and rural communities. Data were obtained by methodological triangulation, with participant and non-participant observation, as well as interviews. The informants were 21 women married to international migrants. The interviews were transcribed and discourse analysis was applied to them. three categories emerged from the speeches to problematize the influence of sexual violence in the perception and management of the risk of HIV: "Characterization of sexual practices in the context of migration", "Experiences of sexual violence" and "Construction of the risk of HIV-AIDS". women have difficulty to recognize the acts of sexual violence in their daily lives, and their perceptions of risk are not decisive in the management of the threat to which they are exposed. Therefore, it is becoming increasingly urgent that nursing problematizes the sexual violence within "steady couples", as a challenge to the promotion of healthy lifestyles. analisar a influência que a violência sexual tem na percepção e gestão do risco de HIV em mulheres casadas com migrantes. estudo com enfoque etnográfico, em comunidades urbanas e rurais. Os dados foram obtidos por triangulação metodológica, observação participativa e não participativa, bem como entrevistas. As informantes foram 21 mulheres casadas com migrantes internacionais. As entrevistas foram transcritas e análise de discurso foi aplicada a elas. três categorias emergiram dos discursos, para problematizar a influência da violência sexual na percepção e gestão do risco de HIV: "Caracterização das práticas sexuais no âmbito da migração", "Experiências de violência sexual" e "Construção do risco de HIV-AIDS". as mulheres têm dificuldade para reconhecer os atos de violência sexual em seus cotidianos e as suas percepções de risco não são decisivas na gestão da ameaça a qual estão expostas. Por isso, torna-se urgente que a enfermagem problematize a violência sexual nos "relacionamentos estáveis", como um desafio para a promoção de estilos de vida saudáveis. analizar la influencia que la violencia sexual tiene en la percepción y gestión del riesgo frente al VIH en mujeres parejas de migrantes. estudio con enfoque etnográfico, en comunidades urbanas y rurales. Los datos fueron obtenidos por triangulación de métodos, observación participante y no participante, así como entrevistas. Las informantes fueron 21 mujeres parejas de migrantes internacionales. Las entrevistas se transcribieron y se aplicó sobre ellas análisis de discurso. de los discursos emergieron tres categorías para problematizar la influencia de la violencia sexual en la percepción y la gestión del riesgo frente al VIH: "Caracterización de las prácticas sexuales en el marco de la migración", "Experiencias de violencia sexual" y "Construcción del riesgo de VIH-sida". las mujeres tienen dificultad para reconocer los actos de violencia sexual en sus cotidianeidades y sus percepciones respecto al riesgo no son determinantes en la gestión que respecto a la amenaza asumen. Resulta urgente que enfermería problematice la violencia sexual al interior de las "parejas estables", como desafío en la promoción de estilos de vida saludables.

Personal characteristics and job satisfaction among nurses in Lebanon.

PubMed

Yaktin, Umayma S; Azoury, Nuhad Bou-Raad; Doumit, Myrna A A

2003-01-01

This study investigates the level of satisfaction of Lebanese nurses in their job and the influence of their personal characteristics. Given the current difficulties experienced by Lebanese hospitals in recruiting and retaining a sufficient number of nurses, the need to understand the reasons of nurses' dissatisfaction became urgent. Moreover, satisfaction at work is essentially a personal experience also affected by cultural factors. Therefore, it was necessary to study the links between personal characteristics and nurses' dissatisfaction. The study included 421 registered nurses. A modified version of Measure of Job Satisfaction, developed by Taynor and Wade, was used to assess the effect of the personal characteristics, namely educational level, age, years of work experience, position, and marital and parental status, on 5 dimensions of satisfaction: personal satisfaction, workload, professional support, pay and prospect, and training. The findings suggest that personal characteristics have important influences on nurses' job perceptions. University graduate nurses reported more dissatisfaction with the quality of supervision and with respect and treatment they receive from their superiors. Nurses younger than 30 years and the technically trained were more dissatisfied with the available opportunities to attend continuing education courses. Results of staff nurses and unmarried nurses showed trends of more dissatisfaction than the married and nurses of higher positions. Moreover, the whole sample perceived that nursing provided a high level of personal satisfaction, but nurses were most dissatisfied with salary and lack of prospects for promotion. The results indicate the importance of personal characteristics on nurses' retention. Furthermore, intrinsic factors related to the nature and experience of nursing are more job satisfying than extrinsic factors.

Attitude of physiotherapy students in Nigeria toward persons with disability.

PubMed

Vincent-Onabajo, Grace O; Malgwi, Wasinda S

2015-01-01

Attitudes of students of health care professions, such as physiotherapy, toward persons with disability may influence their attitude and practice post-qualification. To examine attitudes toward persons with disability among undergraduate physiotherapy students in Universities in Nigeria. The 30-item Attitudes toward Disabled Persons--Form A (ATDP-A) scale was used to assess the attitudes of penultimate and final year physiotherapy students in 3 Nigerian universities. Overall and item-by-item analyzes of responses to the ATDP-A scale were carried out. Differences in attitude by sex, age, year and university of study were also examined using independent t-test and one-way ANOVA. One hundred and sixty-nine students with a male majority (56.2%) participated in the study. Mean score on the ATDP-A was 94.95 ± 17.50 with more students (60.4%) having a score >90 which depicts positive attitude. Item-by-item analysis of responses to the 30 items on the ATDP-A showed that negative attitudes were preponderant on items relating to the emotional component of the personality of persons with disability. Only age of students and their university of study however resulted in statistically significant differences in attitudes and older students reported better attitudes toward persons with disability. Although the overall attitude of the physiotherapy students was positive, negative stereotypes and discriminatory tendencies were observed in issues relating to the perceived emotional capacity of persons with disabilities. Educational strategies capable of effecting more positive attitudes in physiotherapy students in Nigeria toward persons with disability are urgently needed. Copyright © 2015 Elsevier Inc. All rights reserved.

Personal Docente del Nivel Primario. Series Estadisticas Basicas: Colombia (Teaching Personnel in Primary Schools. Basic Statistics Series: Colombia).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teacher personnel working in Colombian elementary schools between 1940 and 1968. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of teachers. (VM)

How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

PubMed

Cubbin, S; Llewellyn-Jones, S; Donnelly, P

2000-01-01

It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

Implementación de un modelo de capacitación multimedial para brindar orientación alimentaria a los beneficiarios de un programa de ayuda social en México.

PubMed

Amaya-Castellanos, Maritza Alejandra; Morales-Ruan, María Del Carmen; Uribe-Carvajal, Rebeca; Jiménez-Aguilar, Alejandra; Salazar-Coronel, Araceli Apolonia; Martínez-Tapia, Brenda; Shamah-Levy, Teresa

2018-03-01

Introducción: Se implementó un modelo de capacitación en orientación alimentaria para la población beneficiaria y el personal operativo del Programa de Abasto Rural (PAR) de Diconsa, el cual es una iniciativa social de ayuda alimentaria que abastece productos básicos y complementarios, además de brindar capacitación en localidades de alta marginación en México. Objetivo: Documentar la utilización de la Metodología de Capacitación Multimedial (MCM) en el desarrollo de un esquema de capacitación sobre orientación alimentaria y su implementación en la población beneficiaria del PAR, a través de la propia estructura operativa del PAR. Metodología: El modelo se fundamenta en la MCM, integrada por cuatro elementos didácticos e indivisibles que conforman el paquete pedagógico multimedial (PPM), compuesto a su vez por tres videos y rotafolios, material impreso, prácticas y las relaciones interpersonales. Los ejes temáticos fueron: alimentación correcta para una vida saludable, alimentación materno-infantil, elecciones saludables y gasto familiar. El modelo fue replicado en cascada en los tres niveles operativos del PAR (responsables de capacitación, supervisores operativos y beneficiarios del PAR), con un componente de multiplicación horizontal, e implementado como piloto en cuatro estados de México. Resultados: Se observó un cambio positivo sobre los conocimientos en alimentación correcta en todos los niveles de capacitación, principalmente en los beneficiarios del PAR. La evaluación del proceso mostró conocimientos previos de los responsables de capacitación en los temas, buen desempeño como facilitadores, y habilidades de presentación y manejo del grupo de los supervisores operativos. A partir de las evaluaciones y del acompañamiento en la prueba piloto, fueron modificados las actividades, las estrategias y los materiales educativos del PPM. Conclusiones: La capacitación multimedial y la educación nutricional promueven procesos de cambio y desarrollo comunitario, posibles a través de la toma de conciencia y la puesta en práctica de acciones que favorecen la salud.

Harnessing Omics Big Data in Nine Vertebrate Species by Genome-Wide Prioritization of Sequence Variants with the Highest Predicted Deleterious Effect on Protein Function.

PubMed

Rozman, Vita; Kunej, Tanja

2018-05-10

Harnessing the genomics big data requires innovation in how we extract and interpret biologically relevant variants. Currently, there is no established catalog of prioritized missense variants associated with deleterious protein function phenotypes. We report in this study, to the best of our knowledge, the first genome-wide prioritization of sequence variants with the most deleterious effect on protein function (potentially deleterious variants [pDelVars]) in nine vertebrate species: human, cattle, horse, sheep, pig, dog, rat, mouse, and zebrafish. The analysis was conducted using the Ensembl/BioMart tool. Genes comprising pDelVars in the highest number of examined species were identified using a Python script. Multiple genomic alignments of the selected genes were built to identify interspecies orthologous potentially deleterious variants, which we defined as the "ortho-pDelVars." Genome-wide prioritization revealed that in humans, 0.12% of the known variants are predicted to be deleterious. In seven out of nine examined vertebrate species, the genes encoding the multiple PDZ domain crumbs cell polarity complex component (MPDZ) and the transforming acidic coiled-coil containing protein 2 (TACC2) comprise pDelVars. Five interspecies ortho-pDelVars were identified in three genes. These findings offer new ways to harness genomics big data by facilitating the identification of functional polymorphisms in humans and animal models and thus provide a future basis for optimization of protocols for whole genome prioritization of pDelVars and screening of orthologous sequence variants. The approach presented here can inform various postgenomic applications such as personalized medicine and multiomics study of health interventions (iatromics).

Developmentally sensitive markers of personality functioning in adolescents: Age-specific and age-neutral expressions.

PubMed

Debast, Inge; Rossi, Gina; Feenstra, Dineke; Hutsebaut, Joost

2017-04-01

Criterion D of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5 ; American Psychiatric Association [APA], 2013) refers to a possible onset of personality disorders (PDs) in adolescence and in Section II the development/course in adolescence is described by some typical characteristics for several PDs. Yet, age-specific expressions of PDs are lacking in Section III. We urgently need a developmentally sensitive assessment instrument that differentiates developmental and contextual changes on the one hand from expressions of personality pathology on the other hand. Therefore we investigated which items of the Severity Indices for Personality Problems-118 (SIPP-118) were developmentally sensitive throughout adolescence and adulthood and which could be considered more age-specific markers requiring other content or thresholds over age groups. Applying item response theory (IRT) we detected differential item functioning (DIF) in 36% of the items in matched samples of 639 adolescents versus 639 adults. The DIF across age groups mainly reflected a different degree of symptom expressions for the same underlying level of functioning. The threshold for exhibiting symptoms given a certain degree of personality dysfunction was lower in adolescence for areas of personality functioning related to the Self and Interpersonal domains. Some items also measured a latent construct of personality functioning differently across adolescents and adults. This suggests that several facets of the SIPP-118 do not solely measure aspects of personality pathology in adolescents, but likely include more developmental issues. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Economic Evaluation of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Hemodialysis in the United States

PubMed Central

Liu, Frank Xiaoqing; Ghaffari, Arshia; Dhatt, Harman; Kumar, Vijay; Balsera, Cristina; Wallace, Eric; Khairullah, Quresh; Lesher, Beth; Gao, Xin; Henderson, Heather; LaFleur, Paula; Delgado, Edna M.; Alvarez, Melissa M.; Hartley, Janett; McClernon, Marilyn; Walton, Surrey; Guest, Steven

2014-01-01

Abstract Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization. However, there has been no assessment of the dialysis-related costs over the first 90 days of care. The objective of this study was to characterize the costs associated with urgent-start PD, urgent-start hemodialysis (HD), or a dual approach (urgent-start HD followed by urgent-start PD) over the first 90 days of treatment from a provider perspective. A survey of practitioners from 5 clinics known to use urgent-start PD was conducted to provide inputs for a cost model representing typical patients. Model inputs were obtained from the survey, literature review, and available cost data. Sensitivity analyses were also conducted. The estimated per patient cost over the first 90 days for urgent-start PD was $16,398. Dialysis access represented 15% of total costs, dialysis services 48%, and initial hospitalization 37%. For urgent-start HD, total per patient costs were $19,352, and dialysis access accounted for 27%, dialysis services 42%, and initial hospitalization 31%. The estimated cost for dual patients was $19,400. Urgent-start PD may offer a cost saving approach for the initiation of dialysis in eligible patients requiring an urgent-start to dialysis. PMID:25526471

Potential uses of pumped urban groundwater: a case study in Sant Adrià del Besòs (Spain)

NASA Astrophysics Data System (ADS)

Jurado, Anna; Vázquez-Suñé, Enric; Pujades, Estanislao

2017-09-01

Urban groundwater has often been over-exploited for industrial uses. Now, this usage tends to be reduced or the resource abandoned due to pollution and/or changes in land use. The use and the subsequent disuse of groundwater has resulted in rising water tables that damage underground structures (e.g., building basements and underground car parks and tunnels), leading to the need for additional pumping in urban areas. In the case of the underground parking lot of Sant Adrià del Besòs (Barcelona, NE Spain), large amounts of urban groundwater are pumped to avoid seepage problems. Can this pumped groundwater be used for other purposes (e.g., drinking water and urban irrigation) instead of wasting this valuable resource? To answer this question, it was necessary to quantify the groundwater recharge and to assess the evolution of groundwater quality. The limiting factor at this study site is the groundwater quality because ammonium and some metals (iron and manganese) are present at high concentrations. Hence, further treatment would be needed to meet drinking water requirements. The pumped groundwater could also be used for supplementing river flow for ecological benefit and/or for mitigating seawater intrusion problems. Currently, only a small amount of this urban groundwater is used for cleaning public areas and watering public gardens. This situation highlighted the urgent need to manage this resource in a responsible and more efficient manner, especially in moments of high water demand such as drought periods.

"Se Puede Conservar La Cultura y Tambien Se Puede Aspirar": Language and Cultural Identities among the Cora of Mexico

ERIC Educational Resources Information Center

Lopez, Jacqueline; Frawley, William; Peyton, Joy Kreeft

2010-01-01

This paper examines the connection between heritage language and culture and the construction and maintenance of social and personal identities of the Cora, an indigenous people of the Mexican Sierra del Nayar, in Northwestern Mexico. Using the frameworks of the socially and linguistically mediated mind (Dennet, 1991; Harre & Gillet, 1994;…

Cancer Phenotype Diagnosis and Drug Efficacy within Japanese Health Care

PubMed Central

Nishimura, Toshihide; Kato, Harubumi; Ikeda, Norihiko; Kihara, Makoto; Nomura, Masaharu; Kato, Yasufumi; Marko-Varga, György

2012-01-01

An overview on targeted personalized medicine is given describing the developments in Japan of lung cancer patients. These new targeted therapies with novel personalized medicine drugs require new implementations, in order to follow and monitor drug efficacy and outcome. Examples from IRESSA (Gefitinib) and TARCEVA (Erlotinib) treatments used in medication of lung cancer patients are presented. Lung cancer is one of the most common causes of cancer mortality in the world. The importance of both the quantification of disease progression, where diagnostic-related biomarkers are being implemented, in addition to the actual measurement of disease-specific mechanisms relating to pathway signalling activation of disease-progressive protein targets is summarised. An outline is also presented, describing changes and adaptations in Japan, meeting the rising costs and challenges. Today, urgent implementation of programs to address these needs has led to a rebuilding of the entire approach of medical evaluation and clinical care. PMID:22685658

Water filtration using plant xylem.

PubMed

Boutilier, Michael S H; Lee, Jongho; Chambers, Valerie; Venkatesh, Varsha; Karnik, Rohit

2014-01-01

Effective point-of-use devices for providing safe drinking water are urgently needed to reduce the global burden of waterborne disease. Here we show that plant xylem from the sapwood of coniferous trees--a readily available, inexpensive, biodegradable, and disposable material--can remove bacteria from water by simple pressure-driven filtration. Approximately 3 cm(3) of sapwood can filter water at the rate of several liters per day, sufficient to meet the clean drinking water needs of one person. The results demonstrate the potential of plant xylem to address the need for pathogen-free drinking water in developing countries and resource-limited settings.

Missed diagnosis: The emerging crisis of borderline personality disorder in older people.

PubMed

Beatson, Josephine; Broadbear, Jillian Helen; Sivakumaran, Hemalatha; George, Kuruvilla; Kotler, Eli; Moss, Francine; Rao, Sathya

2016-12-01

Clinical experience suggests a growing prevalence of borderline personality disorder in aged residential care and psychiatric facilities with attendant difficulties in their management. This paper reviews the literature concerning the prevalence, phenomenology and diagnosis of borderline personality disorder in old age. The aim is to elucidate the phenomenological differences in old age and thus improve identification of the disorder. A systematic search was conducted using MEDLINE, PubMed, EMBASE and PsycINFO databases, employing the search terms including 'personality disorder', 'borderline personality disorder', 'aged care', 'gerontology', 'geriatric psychiatry' and 'life span'. The search included articles in English involving participants 65+ years. Long-term prospective studies of borderline personality disorder, long-term follow-up studies and studies involving older adults from 50+ years were also examined. There is a paucity of literature on borderline personality disorder in the elderly. No diagnostic or rating instruments have been developed for borderline personality disorder in the elderly. The phenomenology of borderline personality disorder in the aged population differs in several respects from that seen in younger adults, causing some of the difficulties in reaching a diagnosis. Escalations of symptoms and maladaptive behaviours usually occur when the diagnosis of borderline personality disorder is either not made or delayed. Improved identification of borderline personality disorder in older patients, together with staff education concerning the phenomenology, aetiology and management of these patients, is urgently needed. Diagnostic instruments for borderline personality disorder in the elderly need to be developed. In the interim, suggestions are offered concerning patient symptoms and behaviours that could trigger psychiatric assessment and advice concerning management. A screening tool is proposed to assist in the timely diagnosis of borderline personality disorder in older people. Timely identification of these patients is needed so that they can receive the skilled help, understanding and treatment needed to alleviate suffering in the twilight of their lives. © The Royal Australian and New Zealand College of Psychiatrists 2016.

The Neotropical land snails (Mollusca, Gastropoda) collected by the ‘Comisión Científica del Pacífico’

PubMed Central

Araujo, Rafael

2017-01-01

The land snails collected by the ‘Comisión Científica del Pacifíco’ (CCP), a Spanish expedition to South and Central America from 1862–1866, are restudied and revised. The historical context of the expedition and the study of its collected material are described. Biographical data is given for the main persons involved. The land snails were previously studied by Joaquin Hidalgo between 1867 and 1893. A total of 3,470 specimens belonging to 211 species are treated in this paper. Of 34 species mentioned by Hidalgo is his catalogue, the corresponding material could not be located. Bulimus visendus Hidalgo, 1869 is now placed in the genus Synapterpes Pilsbry, 1896, a new combination. PMID:28316885

Towards Year 2009, a 25 000 person rehearsal

NASA Astrophysics Data System (ADS)

Fierro Gossman, Julieta; Espinosa, M.

2008-05-01

In this presentations we will talk about the way we planned and achieved successfully a 25 000 people observation in Mexico City downtown taking advantage of a lunar eclipse. We shall guide people so they think about their own activities. We shall mention the way we planned the event, carried out found raising and advertisement. We shall describe the way we handled people mainly during the observations with one hundred telescopes and parallel activities. These included: a public lecture enhanced with dance and hands-on demonstrations, workshops for children, workshops on the night sky, talking to an astronomer, how to handle a telescope and a picture exhibit as well as music till midnight. We shall also mentioned written materials for that particular event and for Year 2009, some of which were specially crafted for teachers. Hector Dominguez y Julieta Fierro Galileo y el telescopio, 400 anios de ciencia Uribe y Ferrari Editores, 2007 ISBN 970 756 238-2 Hector Dominguez y Julieta Fierro, Galileo para Maestros I Correo del Maestro, Núm. 133, p. 15-26, Anios 12, Junio 2007. Hector Dominguez y Julieta Fierro, Galileo para Maestros II Correo del Maestro, Núm. 134, p. 17-26, Anio 12, 2007. Hector Dominguez y Julieta Fierro, Galileo para Maestros III Correo del Maestro, Num. 135, p. 10-18, Anio 12, 2007. Hector Dominguez y Julieta Fierro Experimentos sobre la caida de los cuerpos El Correo del Maestro, anio 12 Numero 142, p. 5-18, 2008. Mariana Espinosa, Julieta Fierro y Silvia Torres Fiesta de estrellas El Correo del Maestro, aceptado para su publicacion.

Biological therapy targeting the IL-23/IL-17 axis in inflammatory bowel disease.

PubMed

Verstockt, Bram; Van Assche, Gert; Vermeire, Séverine; Ferrante, Marc

2017-01-01

As many inflammatory bowel disease (IBD) patients do not benefit from long-term anti-tumour necrosis factor treatment, new anti-inflammatories are urgently needed. After the discovery of the interleukin (IL) 23/17 axis being pivotal in IBD pathogenesis, many different compounds were developed, targeting different components within this pathway. Areas covered: A literature search to March 2016 was performed to identify the most relevant reports on the role of the IL-23/IL-17 axis in IBD and on the different molecules targeting this pathway. First, the authors briefly summarize the immunology of the IL-23/IL-17 pathway to elucidate the mode of action of all different agents. Second, they describe all different molecules targeting this pathway. Besides discussing efficacy and safety data, they also explore immunogenicity, exposure during pregnancy and pharmacokinetics. Expert opinion: A new era in IBD treatment has recently been initiated: besides immunomodulators and TNF-antagonists, anti-adhesion molecules and monoclonal antibodies targeting the IL-23/IL-17 pathway have been developed. Biomarkers for personalized medicine are urgently needed. This therapeutic (r)evolution will further improve disease-related and patient-reported outcome, though a lot of questions should still be addressed in future years.

A Personalized QoS Prediction Approach for CPS Service Recommendation Based on Reputation and Location-Aware Collaborative Filtering.

PubMed

Kuang, Li; Yu, Long; Huang, Lan; Wang, Yin; Ma, Pengju; Li, Chuanbin; Zhu, Yujia

2018-05-14

With the rapid development of cyber-physical systems (CPS), building cyber-physical systems with high quality of service (QoS) has become an urgent requirement in both academia and industry. During the procedure of building Cyber-physical systems, it has been found that a large number of functionally equivalent services exist, so it becomes an urgent task to recommend suitable services from the large number of services available in CPS. However, since it is time-consuming, and even impractical, for a single user to invoke all of the services in CPS to experience their QoS, a robust QoS prediction method is needed to predict unknown QoS values. A commonly used method in QoS prediction is collaborative filtering, however, it is hard to deal with the data sparsity and cold start problem, and meanwhile most of the existing methods ignore the data credibility issue. Thence, in order to solve both of these challenging problems, in this paper, we design a framework of QoS prediction for CPS services, and propose a personalized QoS prediction approach based on reputation and location-aware collaborative filtering. Our approach first calculates the reputation of users by using the Dirichlet probability distribution, so as to identify untrusted users and process their unreliable data, and then it digs out the geographic neighborhood in three levels to improve the similarity calculation of users and services. Finally, the data from geographical neighbors of users and services are fused to predict the unknown QoS values. The experiments using real datasets show that our proposed approach outperforms other existing methods in terms of accuracy, efficiency, and robustness.

A Personalized QoS Prediction Approach for CPS Service Recommendation Based on Reputation and Location-Aware Collaborative Filtering

PubMed Central

Huang, Lan; Wang, Yin; Ma, Pengju; Li, Chuanbin; Zhu, Yujia

2018-01-01

With the rapid development of cyber-physical systems (CPS), building cyber-physical systems with high quality of service (QoS) has become an urgent requirement in both academia and industry. During the procedure of building Cyber-physical systems, it has been found that a large number of functionally equivalent services exist, so it becomes an urgent task to recommend suitable services from the large number of services available in CPS. However, since it is time-consuming, and even impractical, for a single user to invoke all of the services in CPS to experience their QoS, a robust QoS prediction method is needed to predict unknown QoS values. A commonly used method in QoS prediction is collaborative filtering, however, it is hard to deal with the data sparsity and cold start problem, and meanwhile most of the existing methods ignore the data credibility issue. Thence, in order to solve both of these challenging problems, in this paper, we design a framework of QoS prediction for CPS services, and propose a personalized QoS prediction approach based on reputation and location-aware collaborative filtering. Our approach first calculates the reputation of users by using the Dirichlet probability distribution, so as to identify untrusted users and process their unreliable data, and then it digs out the geographic neighborhood in three levels to improve the similarity calculation of users and services. Finally, the data from geographical neighbors of users and services are fused to predict the unknown QoS values. The experiments using real datasets show that our proposed approach outperforms other existing methods in terms of accuracy, efficiency, and robustness. PMID:29757995

Patterns of Global Terrorism 2002

DTIC Science & Technology

2003-04-01

Lebanon. On 25 July, SEPRINTE raided the Ciudad del Este office and apartment of alleged money launderer Fajkumar Naraindas Sabnani, who is allegedly...Saint-Jean-De- Luz , unidentified persons threw gasoline bombs at a police headquarters, causing material damage to police barracks and three parked...sustaining. 121 Revolutionary Organization 17 November a.k.a. 17 November Revolutionary People’s Liberation Party/Front (DHKP/C) a.k.a. Devrimci Sol

Area Handbook Series: El Salvador: A Country Study

DTIC Science & Technology

1990-01-01

military attache, Carlos Ibiiez de Campo, who later became president of Chile , personally led a legendary charge of the Salvadoran cavalry in one of...Instituto Salvadorefio de Administraci6n Municipal. Primer Seminario de Coordinacidn Interinstitucional del Saneamiento Ambiental en El Salvador...Latina y Ei Caribe. La Participa- cidn Comunal en el Proceso de Construcciones Educativas. San Salvador: 1975. __ . Ministerio de Planificaci6n y

Human Trafficking: The Role of Medicine in Interrupting the Cycle of Abuse and Violence.

PubMed

Macias-Konstantopoulos, Wendy

2016-10-18

Human trafficking, a form of modern slavery, is an egregious violation of human rights with profound personal and public health implications. It includes forced labor and sexual exploitation of both U.S. and non-U.S. citizens and has been reported in all 50 states. Victims of human trafficking are currently among the most abused and disenfranchised persons in society, and they face a wide range of negative health outcomes resulting from their subjugation and exploitation. Medicine has an important role to play in mitigating the devastating effects of human trafficking on individuals and society. Victims are cared for in emergency departments, primary care offices, urgent care centers, community health clinics, and reproductive health clinics. In addition, they are unknowingly being treated in hospital inpatient units. Injuries and illnesses requiring medical attention thus represent unique windows of opportunity for trafficked persons to receive assistance from trusted health care professionals. With education and training, health care providers can recognize signs and symptoms of trafficking, provide trauma-informed care to this vulnerable population, and respond to exploited persons who are interested and ready to receive assistance. Multidisciplinary response protocols, research, and policy advocacy can enhance the impact of antitrafficking health care efforts to interrupt the cycle of abuse and violence for these victims.

Personal inhalation exposure to polycyclic aromatic hydrocarbons in urban and rural residents in a typical northern city in China.

PubMed

Duan, X; Wang, B; Zhao, X; Shen, G; Xia, Z; Huang, N; Jiang, Q; Lu, B; Xu, D; Fang, J; Tao, S

2014-10-01

Personal inhalation exposure samples were collected and analyzed for polycyclic aromatic hydrocarbons (PAHs) for 126 selected volunteers during heating and non-heating seasons in a typical northern Chinese city, Taiyuan. Measured personal PAH exposure levels for the urban residents in the heating and non-heating seasons were 690 (540-1051) and 404 (266-544) ng/m(3) , respectively, while, for the rural residents, they were 770 (504-1071) and 312 (201-412) ng/m(3) , respectively. Thus, rural residents are exposed to lower PAH contamination in comparison with the urban residents in the non-heating seasons. In the heating season, personal PAH inhalation exposure levels were comparable between the urban and rural residents, in part owing to the large rate of residential solid fuel consumption in the rural area for household cooking and heating. The estimated incremental lifetime cancer risks (ILCR) due to PAH exposure in Taiyuan were 3.36 × 10(-5) and 2.39 × 10(-5) for the rural and urban residents, respectively, significantly higher than the literature-reported national average level, suggesting an urgent need of PAH pollution control to protect human health. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Familiarity with, knowledge of, and attitudes toward epilepsy in residents of Seoul, South Korea.

PubMed

Choi-Kwon, S; Park, K A; Lee, H J; Park, M S; Lee, C H; Cheon, S E; Youn, M H; Lee, S K; Chung, C-K

2004-07-01

The aim of this study was to investigate the perceptions of epilepsy in Seoul, South Korea, a country where social stigma toward epilepsy is still pronounced. We randomly selected 1000 persons living in Seoul and performed telephone interviews regarding public awareness, knowledge, and attitudes toward epilepsy. Among 1000 respondents, the 92% who had read or heard about epilepsy became the subjects of the study. Word of mouth was most often referenced as a source of knowledge (78%). Forty-seven percentage believed that epilepsy is inheritable, whereas 5% thought that epilepsy is a mental illness. Marriage of their children to an epileptic person, childbearing by women with epilepsy, and employing a person with epilepsy were opposed by more than 50% of respondents. The reasons for the negative attitudes were that epilepsy was hereditary and untreatable (P < 0.05, respectively). Our study revealed that there still remains negative attitudes regarding the marriage, childbearing, and employment of persons with epilepsy, which may stem from misconceptions about the cause and treatability of epilepsy, possibly due in part to the influence of herbal medicine, and South Korea's ethnic homogeneity. Public health education either through media or school health education is urgently needed to improve knowledge about, and attitudes toward epilepsy.

76 FR 80907 - TRICARE Prime Urgent Care Demonstration Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-27

... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE Prime Urgent Care Demonstration Project....S. Code, section 1092, entitled Department Of Defense TRICARE Prime Urgent Care Demonstration Project. The demonstration project is intended to test whether allowing four visits to an urgent care...

[Barriers and Facilitators in the Recruitment and Retention of Heterosexual Couples for Preventive Interventions.

PubMed

Hernández-Hernández, Alberto L; Perez-Jimenez, David

2010-01-01

El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes.

[Health expenditure for prevention in Italy (2006-2013): descriptive analysis, regional trends and international comparisons].

PubMed

Signorelli, Carlo; Odone, Anna; Bianco, Daniela; Di Vivo, Natalia; Bevere, Francesco

2016-01-01

Il dato dell'Organizzazione per la cooperazione e lo sviluppo economico (OCSE) del 2012, che indicava l'Italia come il Paese con la più bassa spesa in prevenzione sanitaria, ha dato lo spunto per una raccolta sistematica e un'analisi critica dei flussi disponibili sulla spesa per le attività di prevenzione in Italia. Le statistiche correnti di spesa sanitaria sono raccolte centralmente dall'Agenzia nazionale per i servizi sanitari regionali (Agenas) attraverso i modelli di rilevazione dei costi dei livelli essenziali di assistenza (LEA) delle aziende USL. Le tre macroaree dei LEA sono: assistenza distrettuale, assistenza ospedaliera e assistenza sanitaria collettiva in ambiente di vita e di lavoro. Le spese per la prevenzione rientrano in quest'ultima e sono ripartite nelle seguenti voci: attività di prevenzione rivolte alle persone, igiene degli alimenti e della nutrizione, igiene e sanità pubblica, prevenzione e sicurezza negli ambienti di lavoro, sanità pubblica veterinaria, attività medico-legale per finalità pubblica. Tra il 2006 e il 2013, ultimo dato disponibile, la spesa per le attività di prevenzione del Servizio sanitario nazionale (SSN) è rimasta costante in rapporto alla spesa sanitaria totale (4,2%), pari a 4,9 miliardi nel 2013. Nel periodo di studio considerato (2006-2013) appaiono in aumento le spese per le attività rivolte alle persone (+8,7%), attribuibili soprattutto a vaccinazioni e screening, e in diminuzione le attività di igiene pubblica (-5,7%) e quelle della sanità pubblica veterinaria (-3,8%). I confronti internazionali indicano una spesa per la prevenzione del 2,9% rispetto alla spesa sanitaria totale, costante negli anni e nella media dei Paesi OCSE. Per la prevenzione, l'Italia spende tanto quanto i Paesi che non possiedono un servizio sanitario pubblico; il dato risulta inferiore del 5% rispetto alla programmazione nazionale, con poche eccezioni e molta variabilità regionale all'interno delle componenti delle voci di spesa. In questo contesto si sottolinea l'importanza di investire maggiori risorse nella pianificazione e nell'implementazione di interventi preventivi di provata efficacia e costo-efficacia.

Detection of epidermal growth factor receptor mutation in lung cancer by droplet digital polymerase chain reaction

PubMed Central

Xu, Qing; Zhu, Yazhen; Bai, Yali; Wei, Xiumin; Zheng, Xirun; Mao, Mao; Zheng, Guangjuan

2015-01-01

Background Two types of epidermal growth factor receptor (EGFR) mutations in exon 19 and exon 21 (ex19del and L858R) are prevalent in lung cancer patients and sensitive to targeted EGFR inhibition. A resistance mutation in exon 20 (T790M) has been found to accompany drug treatment when patients relapse. These three mutations are valuable companion diagnostic biomarkers for guiding personalized treatment. Quantitative polymerase chain reaction (qPCR)-based methods have been widely used in the clinic by physicians to guide treatment decisions. The aim of this study was to evaluate the technical and clinical sensitivity and specificity of the droplet digital polymerase chain reaction (ddPCR) method in detecting the three EGFR mutations in patients with lung cancer. Methods Genomic DNA from H1975 and PC-9 cells, as well as 92 normal human blood specimens, was used to determine the technical sensitivity and specificity of the ddPCR assays. Genomic DNA of formalin-fixed, paraffin-embedded specimens from 78 Chinese patients with lung adenocarcinoma were assayed using both qPCR and ddPCR. Results The three ddPCR assays had a limit of detection of 0.02% and a wide dynamic range from 1 to 20,000 copies measurement. The L858R and ex19del assays had a 0% background level in the technical and clinical settings. The T790M assay appeared to have a 0.03% technical background. The ddPCR assays were robust for correct determination of EGFR mutation status in patients, and the dynamic range appeared to be better than qPCR methods. The ddPCR assay for T790M could detect patient samples that the qPCR method failed to detect. About 49% of this patient cohort had EGFR mutations (L858R, 15.4%; ex19del, 29.5%; T790M, 6.4%). Two patients with the ex19del mutation also had a naïve T790M mutation. Conclusion These data suggest that the ddPCR method could be useful in the personalized treatment of patients with lung cancer. PMID:26124670

A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

PubMed

Yadav, Geeta; Goldberg, Hanna R; Barense, Morgan D; Bell, Chaim M

2016-01-01

Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

Water Filtration Using Plant Xylem

PubMed Central

Chambers, Valerie; Venkatesh, Varsha; Karnik, Rohit

2014-01-01

Effective point-of-use devices for providing safe drinking water are urgently needed to reduce the global burden of waterborne disease. Here we show that plant xylem from the sapwood of coniferous trees – a readily available, inexpensive, biodegradable, and disposable material – can remove bacteria from water by simple pressure-driven filtration. Approximately 3 cm3 of sapwood can filter water at the rate of several liters per day, sufficient to meet the clean drinking water needs of one person. The results demonstrate the potential of plant xylem to address the need for pathogen-free drinking water in developing countries and resource-limited settings. PMID:24587134

BEHAVIORAL CHARACTERISTICS OF DANGEROUS DRIVERS—Importance of Correction

PubMed Central

Friesen, Arnold R.; Schube, Purcell G.

1960-01-01

Studies of accident-prone drivers emphasize the frequency of unstable, aggressive or antisocial personalities expressing themselves through the automobile as a real and a symbolic weapon. Such expressions may be voluntary or unconscious and may also lead a driver to injure himself or seek injury from others. Because of the great public danger from such drivers, it is urgent that judges and enforcers of the law recognize the psychic motivation in habitual violation and withhold driving privileges from violators until a psychic adjustment has been made. Physicians can contribute in gaining acceptance for this attitude of enforcement, and in setting up adequate psychiatric procedures for correction of violators. PMID:13825207

Man of destiny: the life and work of Fritz Haber.

PubMed

Manchester, Keith L

2002-06-01

'The German physical chemist Fritz Haber was distinguished not only for his researches, but also for his services to industry and to his country. Haber and the research institutes he directed contributed to a wide range of advances in physical chemistry. His most outstanding scientific achievement was his synthesis of ammonia, which solved the urgent problem of meeting the world demand for nitrogen fertiliser'. So begins the entry to Haber in the 1972 Encyclopaedia Britannica. Haber was indeed a great and versatile scientist, but his was also a vigorous and complex personality that interacted in unexpected ways with the social and political circumstances of his time.

ESHRE Task Force on Ethics and Law 14: equity of access to assisted reproductive technology.

PubMed

Pennings, G; de Wert, G; Shenfield, F; Cohen, J; Tarlatzis, B; Devroey, P

2008-04-01

Justice and access are among the most urgent questions for medically assisted reproduction. This paper analyses this question not only for people suffering from infertility, but also for people who need assistance to prevent the birth of a child with a specific genetic disorder. Based on the impact of not being able to have a child on the quality of life of a person, the position is defended that infertility treatment should be at least partially reimbursed. Simultaneously, the medical professionals have an obligation towards their patients and the health care system to bring down the costs as far as reasonably possible.

Personal Docente del Nivel Primario. Series Estadisticas Basicas, Nivel Educativo: Cordoba (Teaching Personnel in Primary Schools. Basic Statistics Series , Level of Education: Cordoba).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teaching personnel working the elementary schools of Cordoba, Colombia, between 1958 and 1967. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of the teachers. For overall statistics in…

Personal Docente del Nivel Primario. Series Estadisticas Basicas, Nivel Educativo: Cauca (Teaching Personnel in Primary Schools. Basic Statistics Series, Level of Education: Cauca).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teaching personnel working in the elementary schools of Cauca, Colombia, between 1958 and 1967. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of the teachers. For overall statistics in…

Personal Docente del Nivel Primario. Series Estadisticas Basicas, Nivel Educativo: Caldas (Teaching Personnel in Primary Schools. Basic Statistics Series, Level of Education: Caldas).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teaching personnel working in the elementary schools of Caldas, Colombia, between 1958 and 1967. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of the teachers. For overall statistics in…

Personal Docente del Nivel Primario. Series Estadisticas Basicas, Nivel Educativo: Boyaca (Teaching Personnel in Primary Schools. Basic Statistics Series, Level of Education: Boyaca).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teaching personnel working in the elementary schools of Boyaca, Colombia, between 1958 and 1967. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of the teachers. For overall statistics in…

Personal Docente del Nivel Primario. Series Estadisticas Basicas, Nivel Educativo: Huila (Teaching Personnel in Primary Schools. Basic Statistics Series, Level of Education: Huila).

ERIC Educational Resources Information Center

Ministerio de Educacion Nacional, Bogota (Colombia). Instituto Colombiano de Pedagogia.

This document provides statistical data on the distribution and education of teaching personnel working in the elementary schools of Huila, Colombia, between 1958 and 1967. The statistics cover the number of men and women, public and private schools, urban and rural location, and the amount of education of the teachers. For overall statistics in…

78 FR 6173 - Diana Del Grosso, Ray Smith, Joseph Hatch, Cheryl Hatch, Kathleen Kelley, Andrew Wilklund, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

... submissions by the parties may be submitted via the Board's e-filing format or in the traditional paper format. Any person using e-filing should attach a document and otherwise comply with the instructions at the E... proceeding under 49 U.S.C. 721 and 5 U.S.C. 554(e). Petitioners request that the Board declare that specific...

Contribucion al estudio de la semantica de los verbos modales en espanol (con ejemplos del habla de Madrid). The Contribution of Spanish Modal Verbs to the Study of Semantics (with Evidence from Madrid Speech).

ERIC Educational Resources Information Center

Sirbu-Dumitrescu, Domnita

1988-01-01

Spanish modal verbs may express necessity, obligation, probability, and possibility, in either their personal or impersonal modes. Analysis is based on examples of contemporary Madrid speech. Four modals, "poder,""deber (de)," tener que," and "haber que," are placed within a tripartite structure defined by…

El Planetario Móvil de la Municipalidad de la ciudad de Córdoba

NASA Astrophysics Data System (ADS)

Suárez, F. E.; Campos, M.; Goldes, G. V.; Carranza, G. J.; Romero, R.; Juri, H. O.

Se describen las características y operatoria del nuevo Planetario Móvil. Se trata de un equipamiento de propiedad de la Municipalidad de la Ciudad de Córdoba que es operado por personal y en el predio de la Universidad, en virtud de un convenio suscripto entre ambas instituciones. El planetario consta de una cúpula inflable y de un proyector con programas alternativos que incluyen temas de astronomía, geografía, biología y medio ambiente, entre otros. En la actualidad opera en las instalaciones del Pabellón Argentina de la Ciudad Universitaria y recibe delegaciones escolares de todo el territorio provincial. El Planetario Móvil es parte de un proyecto más amplio de divulgación científica en el cual interactúan la Universidad y el Municipio.

A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

PubMed Central

Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

2016-01-01

Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4–3.4), followed by Urgent care (9.0 weeks; IQR = 2.1–12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4–16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Interpretation Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

Managing novel reproductive injuries in the law of tort: the curious case of destroyed sperm.

PubMed

Priaulx, Nicolette

2010-03-01

In view of developments in reproductive medicine, clinical mishaps in this domain are beginning to give rise to 'injuries' not easily accommodated within the English law of negligence. While 'personal injury' is typically understood as manifesting a deleterious 'physical' dimension, cases involving the negligent destruction of cryopreserved sperm, as recently litigated in Yearworth & Ors v Bristol NNN Trust (2009), and other media reported mishaps in fertility treatment do not straightforwardly possess this quality. Without modification, the traditional tortious conception of 'personal injury' in English law will not be able to address novel claims. Critically, however, nor do alternative modes of redress seem to offer ease of application. Focusing upon the controversial Yearworth case and exploring what is seen as an unpromising framing of loss, the note argues that there is now an urgent need to rethink what counts as 'personal injury'. Arguing for the formal recognition of'reproductive injury' as an independent head of damage in negligence, and illustrating the presence of judicial support for that approach, the comment suggests that in light of the difficult challenges that lie in the wake of Yearworth, such a development may be not only desirable but necessary.

Hepatitis C virus infection in HIV-infected patients.

PubMed

Sulkowski, Mark S

2007-10-01

The hepatitis C virus (HCV) is a spherical enveloped RNA virus of the Flaviviridae family, classified within the Hepacivirus genus. Since its discovery in 1989, HCV has been recognized as a major cause of chronic hepatitis and hepatic fibrosis that progresses in some patients to cirrhosis and hepatocellular carcinoma. In the United States, approximately 4 million people have been infected with HCV, and 10,000 HCVrelated deaths occur each year. Due to shared routes of transmission, HCV and HIV co-infection are common, affecting approximately one third of all HIV-infected persons in the United States. In addition, HIV co-infection is associated with higher HCV RNA viral load and a more rapid progression of HCV-related liver disease, leading to an increased risk of cirrhosis. HCV infection may also impact the course and management of HIV disease, particularly by increasing the risk of antiretroviral drug-induced hepatotoxicity. Thus, chronic HCV infection acts as an opportunistic disease in HIV-infected persons because the incidence of infection is increased and the natural history of HCV infection is accelerated in co-infected persons. Strategies to prevent primary HCV infection and to modify the progression of HCV-related liver disease are urgently needed among HIV/HCV co-infected individuals.

QuickCash: Secure Transfer Payment Systems

PubMed Central

Alhothaily, Abdulrahman; Alrawais, Arwa; Song, Tianyi; Lin, Bin; Cheng, Xiuzhen

2017-01-01

Payment systems play a significant role in our daily lives. They are an important driver of economic activities and a vital part of the banking infrastructure of any country. Several current payment systems focus on security and reliability but pay less attention to users’ needs and behaviors. For example, people may share their bankcards with friends or relatives to withdraw money for various reasons. This behavior can lead to a variety of privacy and security issues since the cardholder has to share a bankcard and other sensitive information such as a personal identification number (PIN). In addition, it is commonplace that cardholders may lose their cards, and may not be able to access their accounts due to various reasons. Furthermore, transferring money to an individual who has lost their bankcard and identification information is not a straightforward task. A user-friendly person-to-person payment system is urgently needed to perform secure and reliable transactions that benefit from current technological advancements. In this paper, we propose two secure fund transfer methods termed QuickCash Online and QuickCash Offline to transfer money from peer to peer using the existing banking infrastructure. Our methods provide a convenient way to transfer money quickly, and they do not require using bank cards or any identification card. Unlike other person-to-person payment systems, the proposed methods do not require the receiving entity to have a bank account, or to perform any registration procedure. We implement our QuickCash payment systems and analyze their security strengths and properties. PMID:28608846

QuickCash: Secure Transfer Payment Systems.

PubMed

Alhothaily, Abdulrahman; Alrawais, Arwa; Song, Tianyi; Lin, Bin; Cheng, Xiuzhen

2017-06-13

Payment systems play a significant role in our daily lives. They are an important driver of economic activities and a vital part of the banking infrastructure of any country. Several current payment systems focus on security and reliability but pay less attention to users' needs and behaviors. For example, people may share their bankcards with friends or relatives to withdraw money for various reasons. This behavior can lead to a variety of privacy and security issues since the cardholder has to share a bankcard and other sensitive information such as a personal identification number (PIN). In addition, it is commonplace that cardholders may lose their cards, and may not be able to access their accounts due to various reasons. Furthermore, transferring money to an individual who has lost their bankcard and identification information is not a straightforward task. A user-friendly person-to-person payment system is urgently needed to perform secure and reliable transactions that benefit from current technological advancements. In this paper, we propose two secure fund transfer methods termed QuickCash Online and QuickCash Offline to transfer money from peer to peer using the existing banking infrastructure. Our methods provide a convenient way to transfer money quickly, and they do not require using bank cards or any identification card. Unlike other person-to-person payment systems, the proposed methods do not require the receiving entity to have a bank account, or to perform any registration procedure. We implement our QuickCash payment systems and analyze their security strengths and properties.

Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient.

PubMed

Patterson, Christopher; Procter, Nicholas; Toffoli, Luisa

2016-09-01

This paper will explore the application of situation awareness in nursing to determine its suitability as a framework to study how the decision to admit or not admit a person as an involuntary patient is made. The decision by a specially qualified nurse to admit or not admit a person to a mental health facility against their will remains a central component of contemporary mental health legislation. The decision has an impact on a person's autonomy and human rights. Conversely, the decision to admit may facilitate urgent assessment and treatment and ensure the safety of the individual and others. Research highlights that decision-making in this context is challenging due to the multiple information sources and often incomplete information available to the clinician. Situation awareness is a concept used to explain how practitioners identify, use and make meaning of a multitude of factors and elements relevant to their practice. Discussion paper. A search of terms related to situation awareness and mental health nursing was conducted in the period 2000 - present. Exploring nurses decision-making using a situation awareness framework provides for a more nuanced understanding of nurses knowledge and skill when deciding to admit or not a person as an involuntary patient. The concept of situation awareness provides a framework to better understand the decision-making process associated with the involuntary admission decision. © 2016 John Wiley & Sons Ltd.

Education and personalized genomics: deciphering the public's genetic health report

PubMed Central

Lamb, Neil E; Myers, Richard M; Gunter, Chris

2010-01-01

Where do members of the public turn to understand what genetic tests mean in terms of their own health? Now that genome-wide association studies and complete genome sequencing are widely available, the importance of education in personalized genomics cannot be overstated. Although some media have introduced the concept of genetic testing to better understand health and disease, the public's understanding of the scope and impact of genetic variation has not kept up with the pace of the science or technology. Unfortunately, the likely sources to which the public turn to for guidance – their physician and the media – are often no better prepared. We examine several venues for information, including print and online guides for both lay and health-oriented audiences, and summarize selected resources in multiple formats. We also note on the roadblocks to progress and discuss ways to remove them, as urgent action is needed to connect people with their genomes in a meaningful way. PMID:20161675

Conservatorship: An Involuntary Legal Status for `Gravely Disabled' Mentally Disordered Persons

PubMed Central

Spensley, James; Werme, Paul H.

1979-01-01

Since 1969 in California, conservatorship has been the only form of civil, longterm involuntary psychiatric legal process. It does not require hospital-based treatment. This paper reports a preliminary study of this process through a retrospective analysis of conservatorship records in Sacramento County, California, from 1969 through 1976. There is a steady overall increase in the incidence of conservatorships each year. A dramatic decrease in state hospital admissions preceded this increase. Referrals were predominantly (69 percent) from the private sector. Once the first legal step was taken 87 percent of the patients completed the process and were placed on full conservatorship. Median age was 50; 52 percent were male and 90 percent were white. The relative proportion of single persons was high (45 percent). Diagnoses of schizophrenia and organic brain syndrome accounted for 86 percent of conservatees. About half (52 percent) terminate conservatorship after one year. No data were found which could be related to the character of treatment of conservatees. Future research in this area is urgently needed. PMID:160139

Invasive Group A Streptococcal Infection in Older Adults in Long-term Care Facilities and the Community, United States, 1998–20031

PubMed Central

Richards, Chesley L.; Lynfield, Ruth; Barrett, Nancy L.; Harrison, Lee H.; Arnold, Kathryn E.; Reingold, Arthur; Bennett, Nancy M.; Craig, Allen S.; Gershman, Ken; Cieslak, Paul R.; Lewis, Paige; Greene, Carolyn M.; Beall, Bernard; Van Beneden, Chris A.

2007-01-01

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons >65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons >65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed. PMID:18258035

Patterns and Correlates of Sexual Activity and Condom Use Behavior in Persons 50-Plus Years of Age Living with HIV/AIDS

PubMed Central

Heckman, Timothy G.; Sikkema, Kathleen J.; Hansen, Nathan B.; Kochman, Arlene; Suhr, Julie A.; Garske, John P.; Johnson, Christopher J.

2008-01-01

This study characterized rates of sexual activity and identified psychosocial and behavioral correlates of sexual activity and condom use in a metropolitan sample of 290 HIV-infected adults 50-plus years of age. Thirty-eight percent of participants were sexually active in the past three months, 33% of whom had at least one occasion of anal or vaginal intercourse that was not condom protected. Rates and correlates of sexual activity and condom use differed between gay/bisexual men, heterosexual men, and heterosexual women. In the past three months, 72% of heterosexual men were sexually active compared to only 36% of gay/bisexual men and 21% of heterosexual women. However, among sexually active persons, only 27% of heterosexual men reported inconsistent condom use compared to 37% of gay/bisexual men and 35% of heterosexual women. As the number of older adults living with HIV/AIDS in the U.S. continues to increase, age-appropriate secondary risk-reduction interventions are urgently needed. PMID:18389361

The applications of mobile telecommunications in new rural areas

NASA Astrophysics Data System (ADS)

Chen, Xia; Lu, Ting-jie

2009-07-01

With the current popularity of information and telecommunication technologies, more and more farmers recognize the important role of information. The urgent need for Chinese farmers is how to make use of information to get rich. Contrast in the newspapers, television, radio and other traditional media, mobile information services have unmatched advantages, such as wide spread in very low cost, spread source of widely dispersed, and diverse forms of communication, simple and easy to operate, with strong participatory and interactive, and so on. The paper proposes that Mobile operators can supply different information in accordance with personalized demands of farmers with various agencies, such as government departments, supply and marketing cooperatives, hospitals, banks, veterinary clinics, agricultural stations. They can unite to supply a number of convenience people, rich people, and love for the people's business through the message, voice, WAP and other forms to meet the needs of farmers. Besides, the paper points out that those farmers can order information on personalized service.

National policy on testing for HIV in South Africa: an urgent need.

PubMed

Oosthuizen, H

2001-01-01

No National Policy exists in South Africa for the testing of persons who may be infected by HIV/AIDS. A Draft National Policy on Testing for HIV was published in the Government Gazette by the Minister of Health for commentary in December 1999. The policy provides for the following: circumstances under which HIV testing may be conducted; informed consent, pre-test and post-test counselling; and the interpretation of the policy. This policy will apply to persons who are able to give consent as well as to those who are legally entitled to give proxy consent to HIV testing. Testing with informed consent means that the individual has been made aware of, and understands, the implications of the test. "The vision which fueled our struggle for freedom; the deployment of energies and resources; the unity and commitment to common goals--all these are needed if we are to bring AIDS under control. Future generations will judge us on the adequacy of our response." President Nelson Mandela. DAVOS, 1996.

Nursing Homes and their Spatial Contexts - Findings from Austria

NASA Astrophysics Data System (ADS)

Fischer, Tatjana

2017-10-01

Against the background of aging and the increasing number of persons in need of care on one hand and the decreasing potential of family support on the other hand, in-patient facilities both in rural areas as well as urban areas of Austria receive importance as final residence. The decision on a facility is challenging. That is why the Austrian Federal Ministry of Labour, Social Affairs and Consumer Protection edits a brochure in three volumes that provides interested persons with information on each residential and nursing home for elderly people. Basing on data from the year 2014, this contribution aims at analysing relevant spatial related information on 885 residential and nursing homes in urban and rural contexts in order to demonstrate how spatial related aspects are considered in the facilities’ presentations and how they illustrate the level of community integration of these in-patient offers, to understand facility-specific future plans as well as to reveal important questions and define urgent research demand and to stimulate the interdisciplinary and cross-cutting dialogue.

Barreras y Facilitadores en el Reclutamiento y la Retención de Parejas Heterosexuales en Intervenciones Preventivas en VIH/SIDA

PubMed Central

Hernández-Hernández, Alberto L.; Perez-Jimenez, David

2012-01-01

Compendio El Reclutamiento y la Retención (R&R) de participantes es fundamental para el éxito de estudios y para el desarrollo de intervenciones preventivas. El R&R de participantes determina la validez y efectividad de estos programas. En este trabajo examinamos algunos de los factores que facilitan y dificultan el R&R en los proyectos preventivos y ofrecemos algunas alternativas para mejorar los índices de R&R. Realizamos dos estudios, en el primero administramos el Instrumento de Informatión, Motivatión y Conductas-Español (IIMC-E) a un grupo de 26 parejas heterosexuales (52 participantes). En el segundo, entrevistamos a 5 parejas VIH discordantes (10 participantes). Encontramos que el 75% de los/las participantes indicó que su trabajo era una de las principales barreras que dificultan la asistencia a las actividades. Otras barreras son las responsabilidades laborales y familiares. Encontramos que la principal barrera fue el miedo a la revelación del estado serlógico. Los principales facilitadores del R&R son la coordinación adecuada y el seguimiento telefónico ofrecido por parte del personal del proyecto. Concluimos que en el desarrollo e implantación de programas de prevención el investigador/a debe tomar en cuenta la adaptación de aspectos logísticos como la disponibilidad y las necesidades particulares de los/las participantes. PMID:23264700

How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

PubMed

Pothier, D D; Repanos, C; Awad, Z

2006-08-01

The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category.

Mortality Caused by Chronic Liver Disease Among American Indians and Alaska Natives in the United States, 1999–2009

PubMed Central

Suryaprasad, Anil; Byrd, Kathy K.; Redd, John T.; Perdue, David G.; Manos, M. Michele; McMahon, Brian J.

2014-01-01

Objectives. We compared chronic liver disease (CLD) mortality from 1999 to 2009 between American Indians and Alaska Natives (AI/ANs) and Whites in the United States after improving CLD case ascertainment and AI/AN race classification. Methods. We defined CLD deaths and causes by comprehensive death certificate-based diagnostic codes. To improve race classification, we linked US mortality data to Indian Health Service enrollment records, and we restricted analyses to Contract Health Service Delivery Areas and to non-Hispanic populations. We calculated CLD death rates (per 100 000) in 6 geographic regions. We then described trends using linear modeling. Results. CLD mortality increased from 1999 to 2009 in AI/AN persons and Whites. Overall, the CLD death rate ratio (RR) of AI/AN individuals to Whites was 3.7 and varied by region. The RR was higher in women (4.7), those aged 25 to 44 years (7.4), persons residing in the Northern Plains (6.4), and persons dying of cirrhosis (4.0) versus hepatocellular carcinoma (2.5), particularly those aged 25 to 44 years (7.7). Conclusions. AI/AN persons had greater CLD mortality, particularly from premature cirrhosis, than Whites, with variable mortality by region. Comprehensive prevention and care strategies are urgently needed to stem the CLD epidemic among AI/AN individuals. PMID:24754616

Seroepidemiology of hepatitis A and B and vaccination status in staff at German schools for the handicapped.

PubMed

Claus, Matthias; Kimbel, Renate; Schöne, Klaus; Letzel, Stephan; Rose, Dirk-Matthias

2017-05-01

This study aims to assess serostatus and vaccination status of hepatitis A and B among staff at schools for the handicapped. We also wanted to investigate factors associated with serostatus, number of infections with hepatitis A/hepatitis B at work, and factors influencing being vaccinated or not. The cross-sectional study was carried out between August 2010 and August 2012 at 13 German schools for severely handicapped. Data were analyzed using blood samples, vaccination documents, and questionnaires. A total of 395 persons participated in our study (response: 59.7%), information on 367 could be used for analysis. Two respondents have been infected with HAV at work, 53.4% were anti-HAV seropositive. Vaccination against hepatitis A was influenced by information about infectious diseases before starting to work, level of education, and marital status. One person got infected with hepatitis B during work, 53.2% were anti-HBs-seropositive. Vaccination against hepatitis B depended on perceived burden by nursing activities, and vaccination costs being paid by employer. Immunity to hepatitis A and B in our sample is insufficient and does not correspond to the infectious risks. Two persons got infected with hepatitis A and one person with hepatitis B during work at school, indicating an urgent need for preventive actions. J. Med. Virol. 89:825-833, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

PubMed Central

2009-01-01

Background This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care. PMID:19968871

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program.

PubMed

Chiou, Shang-Jyh; Campbell, Claudia; Horswell, Ronald; Myers, Leann; Culbertson, Richard

2009-12-07

This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia.

PubMed

Tippett, Vivienne C; Toloo, Ghasem Sam; Eeles, David; Ting, Joseph Y S; Aitken, Peter J; Fitzgerald, Gerard J

2013-02-01

To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

[History of Instituto Nacional de Salud Ocupacional del Peru].

PubMed

Cossio-Brazzan, Juan M

2012-06-01

In Peru, the industry's development has made economic improvements but at the same time, it has had a major impact on the health of the workers; for that reason, it was necessary to generate control mechanisms. So, in 1940 it was created the Departmento de Higiene Industrial, which in 1956 was changed to Instituto de Salud Ocupacional, but it was deactivated in 1994. However, in 2001 it reappeared into the Ministerio de Salud organizational structure with the name of Instituto de Salud Ocupacional "Alberto Hurtado Abadía". Actually, it is the Centro Nacional de Salud Ocupacional y Protección del Ambiente para la Salud (CENSOPAS), organ of the Instituto Nacional de Salud which continues working in synergy with other institutions and sectors, making research to protect the health of exposed persons (workers and community) to contamination and risks associated with economic activities.

Examination of unmet treatment needs among persons with episodic migraine: results of the American Migraine Prevalence and Prevention (AMPP) Study.

PubMed

Lipton, Richard B; Buse, Dawn C; Serrano, Daniel; Holland, Starr; Reed, Michael L

2013-09-01

Despite the expanding therapeutic armamentarium, many people with episodic migraine (EM) have unmet acute treatment needs. To determine the relative frequency of prespecified types of "unmet treatment needs" in persons with EM in a US population-based sample. Eligible participants completed the 2009 American Migraine Prevalence and Prevention Study survey and met International Classification of Headache Disorders-2nd edition (ICHD-2) criteria for migraine with an average headache day frequency of <15 days per month (EM). We identified 5 domains of unmet treatment needs: (1) dissatisfaction with current acute treatment using 3 summary items from the Patient Perception of Migraine Questionnaire-revised edition (PPMQ-R); (2) moderate or severe headache-related disability defined by a Migraine Disability Assessment Scale score of ≥11; (3) excessive use of opioids or barbiturates defined as use on ≥4 days/month or by meeting Diagnostic and Statistical Manual for Mental Disorders-4th edition criteria for dependence; (4) recurrent use of the emergency department or urgent care clinic for headache defined by ≥2 visits in the preceding year for headache; and (5) history of cardiovascular events indicating a possible contraindication to triptan use. For each respondent, we identified their unmet treatment needs in each category and classified them as having no unmet needs or 1 or more unmet needs. Of 5591 respondents with EM, 2274 (40.7%) had 1 or more unmet needs; 1467 (26.2%) had exactly 1 unmet need, and 807 (14.4%) had 2 or more unmet needs. Among those with at least 1 unmet need, 1069 (47.0%) had moderate or severe headache-related disability, 851 (37.4%) were dissatisfied with their acute treatment regimen, 728 (32.0%) had excessive opioid or barbiturate use and/or probable dependence, 595 (26.2%) had a history of cardiovascular events, and 129 (5.7%) reported ≥2 visits in the preceding year to the emergency department/urgent care clinic for headache. Persons with more headache days, depression, or generalized anxiety were more likely to have unmet treatment needs. In a population sample of individuals with EM, more than 40% have at least 1 unmet need in the area of acute treatment. The leading reasons for unmet needs, which include headache-related disability and dissatisfaction with current acute treatment, suggest opportunities for improving outcomes for persons with EM. © 2013 American Headache Society.

The nursing department's view towards moroccan patients.

PubMed

Sánchez-Ojeda, María Angustias; Alemany Arrebola, Inmaculada; Gallardo Vigil, Miguel Ángel

2017-05-25

To determine the Melilla Hospital Nursing Department's attitude towards Moroccan patients. Descriptive ex post facto study. A questionnaire has been handed over to staff, on the Immigration Attitude Scale for Nursing. In general, nurses exhibit negative attitudes towards Moroccan patients, such as: the increase in crime is caused by the arrival of immigrants, those who commit offenses must be expelled from Spain, they take advantage of the Spanish health system and too many resources are devoted to immigration. The worst-rated immigrants are the Moroccans, considering that they do not pay much attention to their personal hygiene and do not adapt to their host countries. It is necessary to work with the nursing staff to change these attitudes. Future degree students must be trained in cultural skills and the care of immigrants will improve with a greater commitment towards cultural differences. Conocer la actitud de enfermería del Hospital de Melilla hacia los pacientes marroquíes. Estudio ex post facto descriptivo. Se ha pasado un cuestionario de Escala de Actitud ante la Inmigración para Enfermería. En general las enfermeras presentan actitudes negativas ante los pacientes marroquíes, como: el aumento de la delincuencia es provocado por la llegada de inmigrantes, los que delinquen deben ser expulsados de España, se aprovechan del sistema sanitario y se dedican demasiados recursos para la inmigración. Los inmigrantes peores valorados son los marroquíes, considerando que son pocos cuidadosos con su higiene personal y no se adaptan a los países de acogida. Es necesario trabajar con el personal de enfermería para que cambien estas actitudes. Las futuras promociones de Grado deben estar formadas en competencias culturales y mejorarán los cuidados a los inmigrantes como un mayor compromiso con la diferencia cultural.

[Spontaneous splenic rupture in the course of infectious mononucleosis].

PubMed

Irga, Ninela; Mierzejewska, Marta; Balcerska, Anna

2006-01-01

Spontaneous splenic rupture (SSR) in the course of infectious mononucleosis (IM) is a rare but potentially fatal complication. Mortality rate is relatively high, therefore emergency splenectomy is a life-saving intervention. In case of undergoing urgent operation there is no possibility to initiate proper prophylaxis of overwhelming infection. The humoral and cellular immunologic response impairment is a reason for life-threatening complications of splenectomised person. Asplenic children should receive infection prophylaxis immediately post splenectomy. We report two cases of splenic rupture inpatients with IM. The prevention of infection was initiated in both children. The mainstays of prophylaxis are: immunization, chemoprophylaxis and education. Complex information concerning asplenia-related subjects should be provided for patients and their parents.

A Framework for Latino Nursing Leadership.

PubMed

Villarruel, Antonia M

2017-10-01

There is an urgent need for Latino leaders in nursing, yet little has been written about Latino leaders and leadership. Leadership comes with challenges and opportunities in particular for Latino nurses who contend with specific cultural imperatives and obstacles. In this article, I review the current healthcare environment and propose a framework for Latino nursing leadership within the context of current challenges and opportunities and my personal experience in nursing. This framework is meant to serve as a guide for the development of Latino nurses who will improve the health and well-being of those in the most vulnerable communities by utilizing their cultural strengths and professional skills to deliver quality and compassionate care.

Mental Health Nursing Education: An Instructor's View.

PubMed

Loveland, Lynnetta

2016-09-01

If you knew no one with a mental illness, what would mold your perceptions of someone with a mental illness? A movie character, a television actor, a description from a friend? Each of these explanations has been given to me by nursing students beginning their mental health nursing clinical rotation. Reconsideration of the limited amount of mental health education in nursing school is urgent. As we become more engrossed as a society in television and movies, the result appears to be a deceptive idea of what true mental illness entails. This piece shares personal insight from a mental health nursing educator and the transformation she witnesses in her students after a mental health clinical rotation. © The Author(s) 2016.

Percepcion Del Crimen Cibernetico y la Confianza en la Asignacion de Recursos Para Combatirlo: Un Estudio Multisectorial en Puerto Rico

ERIC Educational Resources Information Center

Rivera Vazquez, Juan C.

2012-01-01

Cyber crime is a term used to describe the abuse and misuse of a computer system where it is at a loss for someone across the world. It also refers to crimes committed by, or with computers via the Internet or only accessing a computer, is to steal or manipulate information of a company or a person and to use as a means for traditional such as…

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

Rodriguez, E.P.

Due to the active demographic and industrial growth, the permanent incorporation of new lands to agricultural and cattle industries, the increasing heavy pressure on the renewable natural resources, the demand for new articles and products for human, conford, and the growing needs of water for human, agricultural, industrial and energetic uses, the present situation of Colombia as a developing country points out to the urgent need of a permanent and effective action by the state, that has been delegated to the National Institute of Natural Renewable Resources and the Environment (Instituto Nacional de los Recursos Naturales Renovables y del Ambiente-INDERENA).more » Accordingly a national environmental policy is being implemented by INDEPENA, based on primary fields of activity such as Environmental Education, a system of environmental information and environmental planning, coupled with the necessary actions for control and protection of natural renewable resources. A dynamic cooperation with the neighbowring Latin American countries would imply a meaningful diminution of possible duplicated efforts that usually are the result of efforts carried on when each country individually attempts to solve problems of a common nature.« less

Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.

PubMed

Reddel, Helen K; Ampon, Rosario D; Sawyer, Susan M; Peters, Matthew J

2017-09-25

Overuse of asthma relievers, particularly without anti-inflammatory preventers, increases asthma risks. This study aimed to identify how many reliever-only users have urgent healthcare, explore their attitudes and beliefs about asthma and its treatment, and investigate whether purchasing over-the-counter relievers was associated with worse asthma outcomes than by prescription. Cross-sectional population-based Internet survey in Australia. Of 2686 participants ≥16 years with current asthma randomly drawn from a web-based panel, 1038 (50.7% male) used only reliever medication. Urgent asthma-related healthcare; Asthma Control Test (ACT); patient attitudes about asthma and medications; reliever purchase (with/without prescription). Of 1038 reliever-only participants, 23.3% had required urgent healthcare for asthma in the previous year, and only 36.0% had a non-urgent asthma review. Those needing urgent healthcare were more likely than those without such events to be male (56.5% vs 49.0%, p=0.003) and current smokers (29.4% vs 23.3%, p=0.009). Only 30.6% had well-controlled asthma (ACT ≥20) compared with 71.0% of those with no urgent healthcare (p<0.0001), and 20.8% used relievers regularly to prevent asthma symptoms (vs 5.5% of those without urgent healthcare). Those with urgent healthcare were more frustrated by their asthma and less happy with how they managed it, and they were less confident about their ability to manage worsening asthma, but just as likely as those without urgent healthcare to manage worsening asthma themselves rather than visit a doctor. Reliever-only users purchasing over-the-counter relievers were no more likely than those purchasing relievers by prescription to have uncontrolled asthma (35.9% vs 40.6%, p=0.23) but were less likely to have had a non-urgent asthma review. One-quarter of the reliever-only population had needed urgent asthma healthcare in the previous year, demonstrating the importance of identifying such patients. Their attitudes and beliefs suggest opportunities for targeting this population in the community. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lived experiences of Iranian family member caregivers of persons with Alzheimer's disease: caring as 'captured in the whirlpool of time'.

PubMed

Navab, Elham; Negarandeh, Reza; Peyrovi, Hamid

2012-04-01

This study aimed to understand the experiences of Iranian family caregivers of persons with Alzheimer's disease. Increasing rate of Alzheimer's disease along with the ageing population has made this disease an urgent public health challenge worldwide. As non-professional caregivers, family members play a significant role in delivering care to elders, most of whom have one or more chronic diseases. Family-based caregiving has expanded with the encouragement of non-institutionalisation but at the same time creates challenges for caregivers. A qualitative study was conducted using Heideggerian hermeneutic phenomenology. Eight Iranian family caregivers of persons with Alzheimer's disease were interviewed. Interviews were audio-taped and transcribed; data were analysed by Van Manen's methodology. One of the most important themes that emerged was 'captured in the whirlpool of time', which also contained the subthemes of 'reminiscence of past' and 'being afraid of the future'. Family caregivers frequently remembered their common past experiences when interacting with their loved ones with Alzheimer's disease, as though travelling with him/her to the past. Furthermore, caregivers continually compared the past abilities of their relative with their present condition, which resulted in feelings of loss and regret. Further, the unpredictable nature of Alzheimer's disease created fear about the future deterioration of the condition and caregivers' future suffering. The findings demonstrated the necessity of providing continuous education and support for family caregivers of persons with Alzheimer's disease. Nurses are among front-line professionals who are in a position to support and provide information for family caregivers of persons with Alzheimer's disease. © 2012 Blackwell Publishing Ltd.

Using Rasch Analysis to Evaluate the Reliability and Validity of the Swallowing Quality of Life Questionnaire: An Item Response Theory Approach.

PubMed

Cordier, Reinie; Speyer, Renée; Schindler, Antonio; Michou, Emilia; Heijnen, Bas Joris; Baijens, Laura; Karaduman, Ayşe; Swan, Katina; Clavé, Pere; Joosten, Annette Veronica

2018-02-01

The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT; Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an individual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The item-person dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were 'category', 'threshold' or 'step' disordered; however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT.

[IMPLEMENTATION OF THE RIGHT FOR HEALTH CARE FOR CHILDREN - INTERNALLY DISPLACED PERSONS (CERTAIN ASPECTS)].

PubMed

Buletsa, S; Lazur, Y; Mendzhul, M; Pushkarenko, О

2017-12-01

The aim of the article is to do a research on selected issues related to realizing the right for health сare for the children - internally dislocated persons. In order to achieve the given aim statistical data of the quantity of involuntarily dislocated persons including children and also the quantity of children registered with the health-care authority as well as the quantity of their requests for medical care have been analized. It has been determined that in case of involuntary dislocation children are more often exposed to trauma than adults which leads to different emotional disorders. The concepts of «the right for health care» in international legal acts, national legislation of Ukraine and scientific works have been analized. There have been defined three levels of the provision of the right for health care of internally dislocated persons. It has been substantiated that the fact that a child has not been registered with the health-care authority as IRP can't be a ground for limitations in realization of his right on health care. During the research process it has been defined that children IRP need medical care more often than other internally dislocated persons and in realization of the right for health care they come across a number of problems that need urgent solution, including access to free of charge professional medical care, regardless of the fact of medical registration of a child IRP, insufficient funding for provision of the needs of children IRP with medications, absence of obligatory primary medical examination of children IRP, etc.

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

PubMed

Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

2016-05-01

This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Communicating science better through personal divestment from ideological strongholds

NASA Astrophysics Data System (ADS)

Myhre, S. E.

2017-12-01

There is an urgent need for the geoscience community to participate as trusted brokers of information in the partisan landscape of science communication. In the current moment of political engagement, academic-industry partnerships, and social justice organizing, the most immediate, inexpensive, and effective change to facilitate public trust-building is through changing the paradigm of professional science communication. Scientists must own the public trust of their intellectual station - and to do so effectively requires a concerted effort to professionally divest from personal ideological positions. Transparency and ideological divestment are hallmarks of public leadership, and yet these values often do not percolate into the existing cannon of communication best practices. However, it is likely that even seasoned communicators rely on a handful of values-based reframing messages to scaffold their science communication in public. Without clear examination of such values, these reframing messages often can function as communicative "tells" or ideological signals, and such signal will actively backfire by disenfranchising audiences with alternate or oppositional ideology. Therefore, it behooves science communicators to actively examine their personal and political ideology, and to build communicative strategies that do not include ideological tells. This practice, while potentially uncomfortable, will strengthen scientists' capacities to communicate evidence and scientific consensus across partisan and rhetorical chasms.

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review.

PubMed

Damm, K; Vogel, A; Prenzler, A

2014-11-01

Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods. © 2014 John Wiley & Sons Ltd.

The Contribution of the Spanish Guardia Civil to the Peace and Stability Operations Within the Human Security Framework

DTIC Science & Technology

2010-03-08

1999.- U.N. Civilian Police component in Kosovo (UNMIK.) 2000.- Oficina del Programa de Irak (no es especificamente una misi6n de paz) 2000.- Special...community security, and political security. Nevertheless, it is worth pointing out that the establishment and the inclusion of an agenda based on the human...model the pattern set in France by the Gendarmerie and in Catalonia by the existing Mossos de Escuadra. The Dulce of Ahumada personally shaped this new

Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases.

PubMed

Kubat, Eric; Hansen, Nathan; Nguyen, Huy; Wren, Sherry M; Eisenberg, Dan

2016-03-01

The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery. We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve. One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations. Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.

High heterogeneity and low reliability in the diagnosis of major depression will impair the development of new drugs.

PubMed

Lieblich, Samuel M; Castle, David J; Pantelis, Christos; Hopwood, Malcolm; Young, Allan Hunter; Everall, Ian P

2015-10-01

Major depressive disorder is a common diagnosis associated with a high burden of disease that has proven to be highly heterogeneous and unreliable. Treatments currently available demonstrate limited efficacy and effectiveness. New drug development is urgently required but is likely to be hindered by diagnostic limitations. D.J.C. has received grants and personal fees from Eli Lilly, Janssen-Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, AstraZeneca, Hospira, Organon, Sanofi-Aventis, and Wyeth during the writing of this review. C.P. has received grant support from Janssen-Cilag, Eli Lilly, Hospira (Mayne), AstraZeneca, and received honoraria for consultancy to Janssen-Cilag, Eli Lilly, Hospira (Mayne), AstraZeneca, Pfizer, Schering Plough, and Lundbeck. Over the past 2 years he has participated on advisory boards for Janssen-Cilag and Lundbeck, and received honoraria for talks presented at educational meetings organised by AstraZeneca, Janssen-Cilag and Lundbeck. M.H. has received personal fees or grants from Lundbeck, AstraZeneca and Servier during the writing of this review. A.H.Y. reports personal fees from Lundbeck, Sunovion, AstraZeneca and Janssen outside the submitted work. I.P.E. has received personal fees or grants from Lundbeck, AstraZeneca, and Abbvie during the writing of this review. © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Music and dementia.

PubMed

Baird, Amee; Samson, Séverine

2015-01-01

There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia. © 2015 Elsevier B.V. All rights reserved.

Predictive biomarkers for type 2 of diabetes mellitus: Bridging the gap between systems research and personalized medicine.

PubMed

Kraniotou, Christina; Karadima, Vasiliki; Bellos, George; Tsangaris, George Th

2018-03-05

The global incidence of metabolic disorders like type 2 diabetes mellitus (DM2) has assumed epidemic proportions, leading to adverse health and socio-economic impacts. It is therefore of critical importance the early diagnosis of DM2 patients and the detection of those at increased risk of disease. In this respect, Precision Medicine (PM) is an emerging approach that includes practices, tests, decisions and treatments adapted to the characteristics of each patient. With regard to DM2, PM manages a wealth of "omics" data (genomic, metabolic, proteomic, environmental, clinical and paraclinical) to increase the number of clinically validated biomarkers in order to identify patients in early stage even before the prediabetic phase. In this paper, we discuss the epidemic dimension of metabolic disorders like type 2 diabetes mellitus (DM2) and the urgent demand for novel biomarkers to reduce the incidence or even delay the onset of DM2. Recent research data produced by "multi-omics" technologies (genomics/epigenomics, transcriptomics, proteomics and metabolomics), suggest that many potential biomarkers might be helpful in the prediction and early diagnosis of DM2. Predictive, Preventive and Personalized Medicine (PPPM) manages and integrates these data to apply personalized, preventive, and therapeutic approaches. This is significant because there is an emerging need for establishing channels for communication and personalized consultation between systems research and precision medicine, as the medicine of the future. Copyright © 2018 Elsevier B.V. All rights reserved.

Pío del Río Hortega and the discovery of the oligodendrocytes

PubMed Central

Pérez-Cerdá, Fernando; Sánchez-Gómez, María Victoria; Matute, Carlos

2015-01-01

Pío del Río Hortega (1882–1945) discovered microglia and oligodendrocytes (OLGs), and after Ramón y Cajal, was the most prominent figure of the Spanish school of neurology. He began his scientific career with Nicolás Achúcarro from whom he learned the use of metallic impregnation techniques suitable to study non-neuronal cells. Later on, he joined Cajal’s laboratory. and Subsequently, he created his own group, where he continued to develop other innovative modifications of silver staining methods that revolutionized the study of glial cells a century ago. He was also interested in neuropathology and became a leading authority on Central Nervous System (CNS) tumors. In parallel to this clinical activity, del Río Hortega rendered the first systematic description of a major polymorphism present in a subtype of macroglial cells that he named as oligodendroglia and later OLGs. He established their ectodermal origin and suggested that they built the myelin sheath of CNS axons, just as Schwann cells did in the periphery. Notably, he also suggested the trophic role of OLGs for neuronal functionality, an idea that has been substantiated in the last few years. Del Río Hortega became internationally recognized and established an important neurohistological school with outstanding pupils from Spain and abroad, which nearly disappeared after his exile due to the Spanish civil war. Yet, the difficulty of metal impregnation methods and their variability in results, delayed for some decades the confirmation of his great insights into oligodendrocyte biology until the development of electron microscopy and immunohistochemistry. This review aims at summarizing the pioneer and essential contributions of del Río Hortega to the current knowledge of oligodendrocyte structure and function, and to provide a hint of the scientific personality of this extraordinary and insufficiently recognized man. PMID:26217196

[Video-assisted thoracoscopic surgery as an alternative to urgent thoracotomy following open chest trauma in selected cases].

PubMed

Samiatina, Diana; Rubikas, Romaldas

2004-01-01

To prove that video-assisted thoracoscopic surgery in selected cases is an alternative to urgent thoracotomy following open chest trauma. Retrospective analysis of case reports of patients operated for open chest trauma during 1997-2002. Comparison of two methods of surgical treatment: urgent video-assisted thoracoscopy and urgent thoracotomy. Duration of drain presence in the pleural cavity, duration of postoperative treatment, pain intensity and cosmetic effect were evaluated. Data analysis was performed using SPSS statistical software. Statistical evaluation of differences between groups was performed using Mann-Whitney U test. The differences between groups were considered to be statistically significant when the probability of deviation was p<0.05. During 1997-2002, 121 patients with open chest trauma were operated. Thirty three patients underwent urgent video-assisted thoracoscopy, 88 patients were operated through thoracotomy incision: 69 due to isolated open chest trauma, 17 due to thoracoabdominal injury and 2 due to abdominothoracic injury. Almost thirteen percent (12.5%) of patients after urgent thoracotomy underwent urgent laparotomy due to damaged diaphragm and other organs of peritoneal cavity. Duration of drain presence in the pleural cavity after video-assisted thoracoscopy was 4.57 days and after urgent thoracotomy - 6.88 days (p<0.05). Duration of post-operative treatment after video-assisted thoracoscopy was 8.21 days and after urgent thoracotomy - 14.89 days (p<0.05). Amount of consumed non-narcotic analgesics after video-assisted thoracoscopy was 1056.98 mg and after urgent thoracotomy - 1966.70 mg (p<0.05). Video-assisted thoracoscopy is minimally invasive method of thoracic surgery allowing for the evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes, and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. Compared to operations through thoracotomy incision, video assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma and stable hemodynamics and the respiration function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy.

Epidemiology and Molecular Biology of Head and Neck Cancer.

PubMed

Jou, Adriana; Hess, Jochen

2017-01-01

Head and neck cancer is a common and aggressive malignancy with a high morbidity and mortality profile. Although the large majority of cases resemble head and neck squamous cell carcinoma (HNSCC), the current classification based on anatomic site and tumor stage fails to capture the high level of biologic heterogeneity, and appropriate clinical management remains a major challenge. Hence, a better understanding of the molecular biology of HNSCC is urgently needed to support biomarker development and personalized care for patients. This review focuses on recent findings based on integrative genomics analysis and multi-scale modeling approaches and how they are beginning to provide more sophisticated clues as to the biological and clinical diversity of HNSCC. © 2017 S. Karger GmbH, Freiburg.

Recent advances in basic and clinical nanomedicine.

PubMed

Morrow, K John; Bawa, Raj; Wei, Chiming

2007-09-01

Nanomedicine is a global business enterprise. Industry and governments clearly are beginning to envision nanomedicine's enormous potential. A clear definition of nanotechnology is an issue that requires urgent attention. This problem exists because nanotechnology represents a cluster of technologies, each of which may have different characteristics and applications. Although numerous novel nanomedicine-related applications are under development or nearing commercialization, the process of converting basic research in nanomedicine into commercially viable products will be long and difficult. Although realization of the full potential of nanomedicine may be years or decades away, recent advances in nanotechnology-related drug delivery, diagnosis, and drug development are beginning to change the landscape of medicine. Site-specific targeted drug delivery and personalized medicine are just a few concepts that are on the horizon.

Security Protection on Trust Delegated Data in Public Mobile Networks

NASA Astrophysics Data System (ADS)

Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin

This paper provides detailed solutions for trust delegation and security protection for medical records in public mobile communication networks. The solutions presented in this paper enable the development of software for mobile devices that can be used by emergency medical units in urgent need of sensitive personal information about unconscious patients. In today's world, technical improvements in mobile communication systems mean that users can expect to have access to data at any time regardless of their location. This paper presents a token-based procedure for the data security at a mobile device and delegation of trust between a requesting mobile unit and secure medical data storage. The data security at the mobile device is enabled using identity based key generation methodology.

Selected risk factors associated with pulmonary tuberculosis among Saharia tribe of Madhya Pradesh, central India.

PubMed

Rao, Vikas G; Gopi, P G; Bhat, Jyothi; Yadav, Rajiv; Selvakumar, N; Wares, Douglas F

2012-04-01

Tuberculosis (TB) is a major public health problem among the Saharia, a marginalized tribal group in Madhya Pradesh state, central India. However, there is no information on the risk factors associated with the development of TB disease in this community. A cross-sectional TB prevalence survey was conducted among the Saharia residing in Sheopur district of Madhya Pradesh. Information on tobacco smoking and alcohol consumption was collected from all the individuals. Persons aged ≥45 years, males, smokers and alcohol consumers had higher risks of developing TB disease. There is an urgent need to develop and implement culturally appropriate awareness raising activities to target smoking and alcohol consumption to support the efforts to control TB in this community.

[Rehabilitation and algodystrophies].

PubMed

Simon, L; Blotman, F; Leroux, J L; Claustre, J; Azema, M J; Brun-Meyer, M

1982-12-01

Based on 20 years experience, and a personal series of 272 cases of reflex dystrophy (84 cases involving upper limbs, 188 cases involving lower limbs) admitted under a rheumatology unit equipped with all the available techniques of rehabilitative medicine, the authors stress the value of well conducted functional rehabilitation which, even alone, can obtain excellent results in the treatment of this disease, whatever the stage. The authors detail the modalities of this treatment. A local intra-articular or intra-canal injection of corticosteroids permits pain-free physiotherapy. The mobilisation of the lower limb is an urgent priority. Non-aggressive physiotherapeutic techniques should be adapted to the stage and the site of reflex dystrophy. Hydrokinesitherapy and the adaptation of craft techniques to occupational therapy also play an important part.

Pharmaceuticals and personal care products (PPCPs): a review on environmental contamination in China.

PubMed

Liu, Jin-Lin; Wong, Ming-Hung

2013-09-01

Pharmaceuticals and personal care products (PPCPs) which contain diverse organic groups, such as antibiotics, hormones, antimicrobial agents, synthetic musks, etc., have raised significant concerns in recently years for their persistent input and potential threat to ecological environment and human health. China is a large country with high production and consumption of PPCPs for its economic development and population growth in recent years. This may result in PPCP contamination in different environmental media of China. This review summarizes the current contamination status of different environment media, including sewage, surface water, sludge, sediments, soil, and wild animals, in China by PPCPs. The human body burden and adverse effects derived from PPCPs are also evaluated. Based on this review, it has been concluded that more contamination information of aquatic environment and wildlife as well as human body burden of PPCPs in different areas of China is urgent. Studies about their environmental behavior and control technologies need to be conducted, and acute and chronic toxicities of different PPCP groups should be investigated for assessing their potential ecological and health risks. © 2013.

Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.

PubMed

Schicktanz, Silke

2009-06-01

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

Preparing for Antibiotic Resistance Campaigns: A Person-centered Approach to Audience Segmentation

PubMed Central

Smith, Rachel A.; Quesnell, Madisen; Glick, Lydia; Hackman, Nicole; M’ikanatha, Nkuchia M.

2015-01-01

Antibiotic resistance is growing threat to public health threat that calls for urgent attention. However, creating campaigns to slow the emergence and spread of drug-resistant pathogens is challenging because the goal—antibiotic stewardship—encompasses multiple behaviors. This study provided a novel approach to audience segmentation for a multifaceted goal, by using a person-centered approach to identify profiles of US adults based on shared stewardship intentions. The latent class analysis identified three groups: Stewards, Stockers, and Demanders. The findings suggest campaigns with goals aimed at encouraging Stewards to follow through on their intentions, encouraging Stockers to dispose of their leftover antibiotics, and convincing Demanders to accept provider’s evidence-based judgment when a prescription for antibiotics is not indicated. Covariate analysis showed that people who held more inaccurate beliefs about what antibiotics can treat had higher odds of being Demanders and Stockers instead of Stewards. People with stronger health mavenism also had higher odds of being Stockers instead of Stewards. The covariate analysis provided theoretical insight into the strategies to pursue in campaigns targeting these three groups. PMID:26181623

Strategic aspects of higher education reform to cultivate specialists in diagnostic and biopharma industry as applicable to Predictive, Preventive and Personalized Medicine as the Medicine of the Future.

PubMed

Studneva, М; Mandrik, M; Song, Sh; Tretyak, E; Krasnyuk, I; Yamada, Y; Tukavin, A; Ansari, A; Kozlov, I; Reading, C; Ma, Y; Krapfenbauer, K; Svistunov, A; Suchkov, S

2015-01-01

Predictive, Preventive and Personalized Medicine as the Medicine of the Future represents an innovative model for advanced healthcare and robust platform for relevant industrial branches for diagnostics and pharmaceutics. However, rapid market penetration of new medicines and technologies demands the implementation of reforms not only in the spheres of biopharmaceutical industries and healthcare, but also in education. Therefore, the problem of the fundamental, modern preparation of specialists in bioengineering and affiliated fields is becoming particularly urgent, and it requires significant revision of training programs of higher education practice into current medical universities. Modernization and integration of widely accepted medical and teaching standards require consolidation of both the natural sciences and medical sciences that may become the conceptual basis for a university medical education. The main goal of this training is not simply to achieve advanced training and expansion of technological skills, but to provide development of novel multifaceted approaches to build academic schools for future generations.

Forget me not: dementia in prison.

PubMed

Maschi, Tina; Kwak, Jung; Ko, Eunjeong; Morrissey, Mary B

2012-08-01

The number of older adults with dementia in U.S. prisons is rapidly rising. Yet, the vast majority of this marginalized subgroup of the aging population is left neglected behind bars without access to adequate medical and mental health care services. We assert that proactive, interdisciplinary collaborative efforts to improve practice, policy, and research and to develop a high-quality evidence-based continuum of care for this aging population are urgently needed. The overarching goals of this paper are to raise awareness of the life and experiences of persons with dementia in prison and to stimulate discussion, research, and advocacy efforts for this forgotten subgroup of older Americans. We describe the growing number of older adults with dementia in U.S. prisons, high-risk factors for dementia present in the prison population, and the life and experience of persons with dementia in the culture and environment of prison that is primarily not designed for them. We review the current state of services and programs for dementia in prison. We conclude by proposing practice, policy, and research-related priority areas and strategies for interdisciplinary gerontological responses.

Measurement and evaluation of national family planning programs.

PubMed

Mauldin, W P

1967-03-01

RESUMEN: En los últimos quince años diez paises han inaugurado programas nacionales de planeamiento familiar: India, Pakistán, Corea del Sur, Taiwan, Turquía, Malasia, Ceilán, Túez, la República Arabe Unida, y Marruecos. Otros paises, incluyendo Tailandia, Hong Kong, Singapur, Kenya, Barbados, Trinidad y los Estados Unidos, apoyan y/o estimulan actividades de planeamiento familiar. En la mayor parte de los casos la razón fundamental del programa ha sido que si la tasa de crecimiento poblacional disminuyera, aumentaría la tasa de crecimiento económico.Las metas de largo alcance, expresadas típicamente en términos de reducir las tasa.de de natalidad o de crecimiento, tienen su ejemplo en el propósito de Pakistán de reducir su tasa de crecimiento a 26 para 1970; el de Corea de reducir su tasa de natalidad a 20 para 1971; y el de India de reducir su tasa de natalidad a 25 para 1973.Los objectivos intermedios, que cubren diversos aspectos del pro grama, incluyen metas específicas para un determinado mes a año, considerando personal, la adquisición de anticonceptivos, y el número de usarios por método. Las metas específicas anuales de aceptantes de dispositivos intrauterinos (IUD), para Taiwán, Corea, Túnez, Pakistán e India, son comunes, tanto por la naturaleza del artefacto, como por la facilidad de medición de los que continúan utilizándolos. El programa de evaluación en Taiwán, que trata de medir por diversos medios los efectos inmediatos, mediatos y de largo plazo del programa de planeamiento familiar sirve de modelo. El propósito de la evaiuación de un programa de planeamiento familiar es contribuir a la efectividad y eficiencia del programa, midiendo y analizando su progreso. Las áreas a medir pueden ser clasificadas como- (1) conocimiento acerca de; (2) actitudes hacia; (3) práctica de control de natalidad; y (4) nivel de fecundidad.Un buen sistema de evaluación debería incluir: A. Un buen conjunto de estadísticas de servicio presentadas en formularios estandarizados, en las siguienies formas: 1. Informes nensuales por áreas administrativas, sobre los actuales servicios de planeamiento familiar proporcionados en la actualidad, de carácter permanente o de larga duración (al presente, esterilización y IUD de acuerdo a las siguientes características del receptor: residencia, edad, paridad (número de hijos vivos por sexo), y donde se enteró del programa, si es posible "clase";(probablemente educación de la madre, pero posiblemente ocupación del esposo, ingreso, o equivalente); prácticas anticonceptivas anteriores; intervalo; y deseo de tener más hijos. En un programa grande estos datos pueden obtenerse en base a una muestra. 2. Informes mensuales sobre la distribución de suministros anticonceptivos (condones, píldoras, sustancias efervescentes, etc.), los primeros suministros deben ir acompañados de un registro de las características del recipiente, como anteriormente; los suministros subsecuentes se regietrarán sólo en volumen bruto. Esto también se aplicará al ritmo, donde éste método se enseñe a un número considerable de mujeres. 3. Informes regulares sobre las actividades de planeamiento familiar de médicos privados, como una estimación del efecto catalítico del programa del gobierno sobre ci sector privado. 4. Datos generates mensuales, ppr áreas admirtistrativas importantes, sabre: visitas domiciliarias, reuniones, cuñas radiates y televisadas, avisos en los periódicos y personal que trabaja. 5. Para propósitos de seguimiento una entrevi eta de campo cada 6 a 12 meses a cada N mujer de las listas para (1) y (2) arriba, en un total de 300 o 400, para conocer las tasas de continuación y las razones de abandono (ej: desea otro hijo, insatisfecha can ci método, otras). Las mue.stras podrían ser de 300 cada una, con una supuesta experiencia de 6, 12, 18 y 24 meses. B. Un buen conjunto de datos sobre costa (datos sobre cotos actulaes atribuíbles directamente al programa de planeamiento familiar) fraccionados par áreas principales y cinco a seis categorías de costos importantes tales coma: adminietración, personal de campo, publicidad, suministros, etc. C. Un buen conjunto de dates globales sobre la distribución de los suministros comerciales que puedan llegar tan cerca como sea posible del último consumidor, to cual significa probablemente obtener información de los mayoristas. D. Una encuesta de conocimientos, actitudes y prácticas (KAP) para una evaluación general cada dos años. Las preguntas básicas (además de las antes mencionadas y estatus marital y étnico cuando sea pertinente) son: actitud hacia e interés por la anticoncepción, número de niños por sexo, deseo de tener más hijos, prácticas anticonceptivas, experiencia sobre abortos, tal vez historia de embarazo (especialmente si esta producirá una tasa de fecundidad válida), aprobación del programa gubernamental (para uso politico), y si está actualmente embarazada (la única y mejor pregunta cuya respuesta habla del efecto sobre la tasa de natalidad). Administrativamente, la responsabilidad por la evalucion debe estar cerca al director, se debe tomar provisiones para obtener informes regulares (meneulaes) y especiales dirigidos a preguntar sobre política. El corolario es que el jefe de evaluación debe tener la confianza del director y debe estar al día en cuanto a las decisiones sabre la politics a seguir. Su trabajo consiste en extractar los aspectos principales que funcionan bien y los no operantes. En cuanto a costos, la evaluación debe hacerse sobre no más del 10 par ciento del costa del programa en paises pequeños (de menos de 30 milliones) y sabre no más del 5 per ciento en paises más grandes.Para medir en que forma el programa satisface el criterio final-la magnitud en que cambia la fecundidad-se debe realizar un trabajo más elaborado en el centro (Universidades, Consejos de población, etc.) para desarrollar una forma (a formas) segura de traducir las estadísticas de servicio en práticas y tal vez aún datos sobre suministro comercial en datos sabre tasas de natalidad. Esto incluye, par ejemplo, los esfuerzos para consolidar observaciones coma "cinco años-mujer de usa de IUD, a 400 condones equivalen a la prevención de un nacimiento," y esfuerzos como los de Pakistán de calcular tasas coma "años de protección de una pareja contra el embarazo."In the belief that a decrease in the rate of population growth will increase economic development, more than ten countries have inaugurated family planning programs in the past fifteen years. To provide a model for measuring the immediate, intermediate, and long-term effects of any such program, the authors use the Taiwan evaluation.The model suggests that a good system of evaluation should include monthly statistics on (1) participants, who are grouped by characteristics; (2) the distribution of supplies, reported at first by the characteristics of recipients, but after by gross volume only; (3) family planning activities of private physicians to measure the catalytic effect on the private sector; (4) new contacts and amount of advertising in mass media; (5) costs broken down by areas and by cost categories; and (6) distribution of commercial supplies. In addition, the program should conduct 300-400 interviews every 6-12 months to learn the rates of continuation and the rates and reasons for discontinuation. Finally, a KAP survey should be conducted every two years.The administration of the evaluation should be close to the director for policy decisions and for the ultimate work of evaluation-the finding of new ways to measure the main goal of change in fertility by the translation of statistics on Services provided and commercial supplies into birth rate data.

Patients' Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care.

PubMed

Bellier-Teichmann, Tanja; Golay, Philippe; Bonsack, Charles; Pomini, Valentino

2016-01-01

Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients' needs are organized. This study investigates both general and specific dimensions of patients' needs for care. Patients' needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients' perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients' personal motivations, needs, and wants. Four seventy-one patients' profiles were analyzed through exploratory factor analysis. A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) "finances" and "administrative tasks"; (b) "transports," "public places," "self-care," "housework," and "food"; and (c) "family," "children," "intimate relationships," and "friendship." As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions

PubMed Central

van Walraven, Carl; Jennings, Alison; Taljaard, Monica; Dhalla, Irfan; English, Shane; Mulpuru, Sunita; Blecker, Saul; Forster, Alan J.

2011-01-01

Background: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions. Methods: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%. Results: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%–14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%–19.1%; 2.2% of those discharged, 95% CI 1.8%–2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%–22.5%; χ2 = 92.9, p < 0.001); the proportion of readmissions deemed avoidable did not show significant variation by hospital (range 1.2%–3.7%; χ2 = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41). Interpretation: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission. PMID:21859870

Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP.

PubMed

Jang, Sang Eon; Park, Sang Wook; Lee, Ban Seok; Shin, Cheol Min; Lee, Sang Hyub; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho; Park, Joo Kyung; Hwang, Jin-Hyeok

2013-07-01

There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis. One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated. There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P < 0.001), and furthermore, intervention to discharge time was also significantly shorter by 1.1 days in the urgent group (P = 0.035). In terms of laboratory parameters, initial CRP level was the only factor correlated with hospital stay and intervention to discharge time. This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.

3 CFR - Unexpected Urgent Refugee and Migration Needs

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Unexpected Urgent Refugee and Migration Needs... Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the authority vested...) of the Migration and Refugee Assistance Act of 1962 (the “Act”), as amended, (22 U.S.C. 2601(c)(1...

77 FR 58404 - Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

...] Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children Program...) announces the award of two urgent single-source grants from the Unaccompanied Alien Children's Program to... providing services under the Unaccompanied Alien Children's program. Award Grantee organization Location...

76 FR 27250 - Drawbridge Operation Regulation; Atlantic Intracoastal Waterway, Albemarle and Chesapeake Canal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-11

... Chesapeake Canal, mile 15.2, at Chesapeake, VA. The deviation is necessary to facilitate urgent mechanical... operating regulations set out in 33 CFR 117.997(i), to facilitate urgent mechanical and structural repairs... will operate on a 4-hour opening schedule. This schedule is meant to facilitate urgent mechanical and...

3 CFR - Unexpected Urgent Refugee and Migration Needs

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Unexpected Urgent Refugee and Migration Needs Presidential Documents Other Presidential Documents Presidential Determination No. 2012-6 of April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the authority vested in me as President by the Constitution...

Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates.

PubMed

Cosgrove, J F; Gaughan, M; Snowden, C P; Lees, T

2008-06-01

National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p < 0.01). We conclude that auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.

Urgent consultations at the dermatology department of Basel University Hospital, Switzerland: characterisation of patients and setting - a 12-month study with 2,222 patients data and review of the literature.

PubMed

Ruzza, N; Itin, P H; Beltraminelli, H

2014-01-01

Urgent consultations for skin disorders are commonly done in different settings. Scarce data exist about the characteristics of these patients. The aim of this study was to analyse specific characteristics of patients receiving an urgent consultation at a dermatology department in a university hospital. We prospectively recorded the data of all patients having had an urgent consultation during a period of 12 months. We registered 2,222 urgent consultations. The most frequent diagnoses were eczemas (24.8%), dermatomycoses (5.1%) and dermatitis not otherwise specified (4.8%). The most frequent treatments were topical steroids, emollients, topical antibiotics, systemic antihistamines, antibiotics and virostatics. 2.2% of patients were hospitalized, 78.8% asked for a consultation for a disease lasting less than 4 weeks, and 6.9% presented the same day as the skin disease appeared. This study shows the characteristics of patients receiving an urgent dermatologic consultation. It underlines the need for collaboration between dermatologists, other physicians, general practitioners and nurses. © 2014 S. Karger AG, Basel.

Mental health literacy survey of non-mental health professionals in six general hospitals in Hunan Province of China

PubMed Central

Wu, Qiuxia

2017-01-01

Background Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals’ conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. Methods In 2014–2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Results Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. Conclusions The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals’ mental health knowledge in mainland China in order to provide better support for mental health service users. PMID:28678848

Mental health literacy survey of non-mental health professionals in six general hospitals in Hunan Province of China.

PubMed

Wu, Qiuxia; Luo, Xiaoyang; Chen, Shubao; Qi, Chang; Long, Jiang; Xiong, Yifan; Liao, Yanhui; Liu, Tieqiao

2017-01-01

Mental illness has brought great economic burden related to misdiagnosis by non-mental health professionals in general hospitals. The aim of this study was to explore non-mental health professionals' conceptions related to the identification of mental illness and perceived treatments, first aid and prognosis. In 2014-2015, we presented 1123 non-mental health professionals from six general hospitals in Hunan Province with one of three vignettes describing a person with schizophrenia, depression, or generalized anxiety disorder. Identification rates, beliefs about various interventions, best methods, and the prognosis with or without treatment were measured. Less than 60% of the non-mental health professionals could identify the mental disorders correctly. Psychiatrists and psychologists were considered to be the people who would be most helpful in all vignettes. Over 70% of participants identified the correct medication for each vignette. Participants gave higher ratings to lifestyle interventions than to psychological and medical interventions, especially in the depression and generalized anxiety disorder vignettes. For the question about how the person could best be helped, about half of the participants rated listening or talking with the person more highly than accompanying the person to professional help or encouraging the person to visit a psychiatrist or psychologist. Participants believed that, with professional help, the people in the vignettes would fully recover but that problems would probably reoccur and that, without professional help, the people described would get worse. The beliefs that non-mental health professionals hold about mental disorders are inadequate to provide appropriate help. There is an urgent need for mental health education campaigns to improve non-mental health professionals' mental health knowledge in mainland China in order to provide better support for mental health service users.

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers.

PubMed

Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R

2017-12-01

We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Quantitative comparison of measurements of urgent care service quality.

PubMed

Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Polycyclic aromatic hydrocarbons produced by electrocautery smoke and the use of personal protective equipment 1.

PubMed

Claudio, Caroline Vieira; Ribeiro, Renata Perfeito; Martins, Júlia Trevisan; Marziale, Maria Helena Palucci; Solci, Maria Cristina; Dalmas, José Carlos

2017-03-02

analyze the concentration of polycyclic aromatic hydrocarbons in electrocautery smoke in operating rooms and the use of personal protective equipment by the intraoperative team when exposed to hydrocarbons. exploratory and cross-sectional field research conducted in a surgery center. Gases were collected by a vacuum suction pump from a sample of 50 abdominal surgeries in which an electrocautery was used. A form was applied to identify the use of personal protective equipment. Gases were analyzed using chromatography. Descriptive statistics and Spearman's test were used to treat data. there were 17 (34%) cholecystectomies with an average duration of 136 minutes, while the average time of electrocautery usage was 3.6 minutes. Airborne hydrocarbons were detected in operating rooms in 100% of the surgeries. Naphthalene was detected in 48 (96.0%) surgeries and phenanthrene in 49 (98.0%). The average concentration of these compounds was 0.0061 mg/m3 and a strong correlation (0.761) was found between them. The intraoperative teams did not use respirator masks such as the N95. electrocautery smoke produces gases that are harmful to the health of the intraoperative team, which is a concern considering the low adherence to the use of personal protective equipment. analizar las concentraciones de hidrocarburos policíclicos aromáticos provenientes del humo del electrocauterio en salas quirúrgicas y el uso de equipamientos de protección individual por parte del equipo intraoperatorio, cuando expuestos a los hidrocarburos. investigación de campo, exploratoria y transversal realizada en un centro quirúrgico. En la muestra, compuesta por 50 cirugías abdominales con uso de electrocauterio, los gases fueron recolectados con una bomba de succión de vacío. Se aplicó un formulario para identificar el uso de los equipamientos de protección. Se realizó la lectura de los gases por medio de cromatografía. Los datos fueron analizados con la estadística descriptiva y el test de Spearman. 17 (34%) fueron colecistectomías con tiempo medio quirúrgico de 136 minutos y tiempo medio de uso del electrocauterio de 3,6 minutos. Fueron detectados hidrocarburos en el aire de las salas de operación en 100% de las cirugías. Se detectó el naftaleno en 48 (96,0%) cirugías y el fenantreno en 49 (98,0%). Las concentraciones promedio de esos compuestos fueron de 0,0061 mg/m3. Hubo correlación (0,761) fuerte entre estos compuestos. El equipo intraoperatorio no utilizó máscaras respiratorias, como la N95. el humo del electrocauterio produce gases perjudiciales para la salud del equipo intraoperatorio que se encuentra expuesto debido a la baja adhesión al uso de equipamientos de protección individual, tornando preocupante esta exposición. analisar as concentrações de hidrocarbonetos policíclicos aromáticos provenientes da fumaça do eletrocautério em salas cirúrgicas e o uso de equipamentos de proteção individual pela equipe intraoperatória quando expostos aos hidrocarbonetos. pesquisa de campo, exploratória e transversal realizada em um centro cirúrgico. Na amostra composta por 50 cirurgias abdominais com uso de eletrocautério, os gases foram coletados por bomba de sucção a vácuo. Um formulário foi aplicado para identificar o uso dos equipamentos de proteção. Realizou-se a leitura dos gases por cromatografia. Os dados foram analisados por estatística descritiva e teste de Spearman. 17 (34%) foram as colecistectomias com tempo médio cirúrgico de 136 minutos e tempo médio de uso do eletrocautério de 3,6 minutos. Hidrocarbonetos foram detectados no ar das salas operatórias em 100% dos atos cirúrgicos. Detectou-se o naftaleno em 48 (96,0%) cirurgias e o fenantreno em 49 (98,0%). As concentrações médias desses compostos foram de 0,0061 mg/m3. Houve correlação (0,761) forte entre estes compostos. A equipe intraoperatória não utilizou máscaras respiratórias, como a N95. a fumaça do eletrocautério produz gases prejudiciais à saúde da equipe intraoperatória exposta e diante da baixa adesão ao uso de equipamentos de proteção individual, tornando-se preocupante esta exposição.

Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data.

PubMed

O'Keeffe, Colin; Mason, Suzanne; Jacques, Richard; Nicholl, Jon

2018-01-01

The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E) data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014). Data was collected on all adult (>16 years) ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups. There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%). Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001). The odds of a non-urgent attendance were significantly higher for younger patients (aged 16-44) compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001) and the over 65's (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001). Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45-64's (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001) and the 65+'s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001). 110,605/554,564 (19.9%) of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2.12, 95% CI: 2.09 to 2.15, P<0.001). Younger adults are significantly more likely as older counterparts to use the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.

Cystic fibrosis gene modifier SLC26A9 modulates airway response to CFTR-directed therapeutics.

PubMed

Strug, Lisa J; Gonska, Tanja; He, Gengming; Keenan, Katherine; Ip, Wan; Boëlle, Pierre-Yves; Lin, Fan; Panjwani, Naim; Gong, Jiafen; Li, Weili; Soave, David; Xiao, Bowei; Tullis, Elizabeth; Rabin, Harvey; Parkins, Michael D; Price, April; Zuberbuhler, Peter C; Corvol, Harriet; Ratjen, Felix; Sun, Lei; Bear, Christine E; Rommens, Johanna M

2016-10-15

Cystic fibrosis is realizing the promise of personalized medicine. Recent advances in drug development that target the causal CFTR directly result in lung function improvement, but variability in response is demanding better prediction of outcomes to improve management decisions. The genetic modifier SLC26A9 contributes to disease severity in the CF pancreas and intestine at birth and here we assess its relationship with disease severity and therapeutic response in the airways. SLC26A9 association with lung disease was assessed in individuals from the Canadian and French CF Gene Modifier consortia with CFTR-gating mutations and in those homozygous for the common Phe508del mutation. Variability in response to a CFTR-directed therapy attributed to SLC26A9 genotype was assessed in Canadian patients with gating mutations. A primary airway model system determined if SLC26A9 shows modification of Phe508del CFTR function upon treatment with a CFTR corrector. In those with gating mutations that retain cell surface-localized CFTR we show that SLC26A9 modifies lung function while this is not the case in individuals homozygous for Phe508del where cell surface expression is lacking. Treatment response to ivacaftor, which aims to improve CFTR-channel opening probability in patients with gating mutations, shows substantial variability in response, 28% of which can be explained by rs7512462 in SLC26A9 (P = 0.0006). When homozygous Phe508del primary bronchial cells are treated to restore surface CFTR, SLC26A9 likewise modifies treatment response (P = 0.02). Our findings indicate that SLC26A9 airway modification requires CFTR at the cell surface, and that a common variant in SLC26A9 may predict response to CFTR-directed therapeutics.

Prevalence and Type of BRCA Mutations in Hispanics Undergoing Genetic Cancer Risk Assessment in the Southwestern United States: A Report From the Clinical Cancer Genetics Community Research Network

PubMed Central

Weitzel, Jeffrey N.; Clague, Jessica; Martir-Negron, Arelis; Ogaz, Raquel; Herzog, Josef; Ricker, Charité; Jungbluth, Chelsy; Cina, Cheryl; Duncan, Paul; Unzeitig, Gary; Saldivar, J. Salvador; Beattie, Mary; Feldman, Nancy; Sand, Sharon; Port, Danielle; Barragan, Deborah I.; John, Esther M.; Neuhausen, Susan L.; Larson, Garrett P.

2013-01-01

Purpose To determine the prevalence and type of BRCA1 and BRCA2 (BRCA) mutations among Hispanics in the Southwestern United States and their potential impact on genetic cancer risk assessment (GCRA). Patients and Methods Hispanics (n = 746) with a personal or family history of breast and/or ovarian cancer were enrolled in an institutional review board–approved registry and received GCRA and BRCA testing within a consortium of 14 clinics. Population-based Hispanic breast cancer cases (n = 492) enrolled in the Northern California Breast Cancer Family Registry, negative by sequencing for BRCA mutations, were analyzed for the presence of the BRCA1 ex9-12del large rearrangement. Results Deleterious BRCA mutations were detected in 189 (25%) of 746 familial clinic patients (124 BRCA1, 65 BRCA2); 21 (11%) of 189 were large rearrangement mutations, of which 62% (13 of 21) were BRCA1 ex9-12del. Nine recurrent mutations accounted for 53% of the total. Among these, BRCA1 ex9-12del seems to be a Mexican founder mutation and represents 10% to 12% of all BRCA1 mutations in clinic- and population-based cohorts in the United States. Conclusion BRCA mutations were prevalent in the largest study of Hispanic breast and/or ovarian cancer families in the United States to date, and a significant proportion were large rearrangement mutations. The high frequency of large rearrangement mutations warrants screening in every case. We document the first Mexican founder mutation (BRCA1 ex9-12del), which, along with other recurrent mutations, suggests the potential for a cost-effective panel approach to ancestry-informed GCRA. PMID:23233716

Neural mechanisms underlying urgent and evaluative behaviors: An fMRI study on the interaction of automatic and controlled processes.

PubMed

Megías, Alberto; Navas, Juan Francisco; Petrova, Dafina; Cándido, Antonio; Maldonado, Antonio; Garcia-Retamero, Rocio; Catena, Andrés

2015-08-01

Dual-process theories have dominated the study of risk perception and risk-taking over the last two decades. However, there is a lack of objective brain-level evidence supporting the two systems of processing in every-day risky behavior. To address this issue, we propose the dissociation between evaluative and urgent behaviors as evidence of dual processing in risky driving situations. Our findings show a dissociation of evaluative and urgent behavior both at the behavioral and neural level. fMRI data showed an increase of activation in areas implicated in motor programming, emotional processing, and visuomotor integration in urgent behavior compared to evaluative behavior. These results support a more automatic processing of risk in urgent tasks, relying mainly on heuristics and experiential appraisal. The urgent task, which is characterized by strong time pressure and the possibility for negative consequences among others factors, creates a suitable context for the experiential-affective system to guide the decision-making process. Moreover, we observed greater frontal activation in the urgent task, suggesting the participation of cognitive control in safe behaviors. The findings of this research are relevant for the study of the neural mechanisms underlying dual process models in risky perception and decision-making, especially because of their proximity to everyday activities. © 2015 Wiley Periodicals, Inc.

3 CFR - Unexpected Urgent Refugee and Migration Needs Relating to Syria

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Unexpected Urgent Refugee and Migration Needs Relating to Syria Presidential Documents Other Presidential Documents Presidential Determination No. 2013-4 of January 29, 2013 Unexpected Urgent Refugee and Migration Needs Relating to Syria Memorandum for the Secretary of State By the authority vested i...

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Libya

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Libya Presidential Documents Other Presidential Documents Presidential Determination No. 2011-8 of March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the Secretary of State By the authority vested in me...

3 CFR - Unexpected Urgent Refugee and Migration Needs Resulting from Flooding in Pakistan

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... Determination No. 2010-14 of September 3, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from... the Constitution and the laws of the United States, including section 2(c)(1) of the Migration and...

3 CFR - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... Determination No. 2010-12 of August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from... the Constitution and the laws of the United States, including section 2(c)(1) of the Migration and...

Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland - Appraisals by parents of children requiring medical attention.

PubMed

Kołłątaj, Barbara; Kołłątaj, Witold; Wrzołek, Katarzyna; Karwat, Irena Dorota; Klatka, Maria

2017-03-31

 Introduction. The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as 'the European Health Consumer Index', Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. The materials for this study consisted of 540 parents of children aged 6-16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved.

Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn's Disease Presenting to the Emergency Department.

PubMed

Jung, Yoon Suk; Park, Dong Il; Hong, Sung Noh; Kim, Eun Ran; Kim, Young Ho; Cheon, Jae Hee; Eun, Chang Soo; Han, Dong Soo; Lee, Chang Kyun; Kim, Jae Hak; Huh, Kyu Chan; Yoon, Soon Man; Song, Hyun Joo; Shin, Jeong Eun; Jeon, Seong Ran

2015-04-01

Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P < 0.1 in univariate analyses were included in a multivariable logistic regression model. Of the 266 APCTs performed, 103 (38.7 %) had OPAN and 113 (42.5 %) required changes in treatment plan. Stricturing or penetrating disease (odds ratio [OR] 2.72, 95 % confidence interval [CI] 1.21-6.13), heart rate >100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.

Association of over-the-counter pharmaceutical sales with influenza-like-illnesses to patient volume in an urgent care setting.

PubMed

Liu, Timothy Y; Sanders, Jason L; Tsui, Fu-Chiang; Espino, Jeremy U; Dato, Virginia M; Suyama, Joe

2013-01-01

We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round.

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire Presidential Documents Other Presidential Documents Presidential Determination No. 2011-7 of March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire Memorandum for the Secretary of State By the...

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa Presidential Documents Other Presidential Documents Presidential Determination No. 2011-12 of August 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa Memorandum for the Secretary of State By...

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks for...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... 8, 2010 Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks... section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the “Act”), as amended, (22 U.S.C...

The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography.

PubMed

Kaewlai, Rathachai; Greene, Reginald E; Asrani, Ashwin V; Abujudeh, Hani H

2010-09-01

The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients. The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier. During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift. Urgent findings requiring immediate communication were detected in 308 (4.8%) studies. The early-morning shift of radiologists, on average, communicated these findings 2 hours earlier compared with the historical control group (P < .001). Staggered radiologist work shifts that include an early-morning shift can improve the timeliness of reporting urgent findings on overnight portable chest radiography of hospitalized patients. Published by Elsevier Inc.

The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

PubMed

McClelland, Mark Stephen; Lazar, Danielle; Sears, Vickie; Wilson, Marcia; Siegel, Bruce; Pines, Jesse M

2011-12-01

Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters-a program funded by the Robert Wood Johnson Foundation (RWJF)-has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities. This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program. © 2011 by the Society for Academic Emergency Medicine.

Mental health literacy among caregivers of persons with mental illness: A descriptive survey.

PubMed

Poreddi, Vijayalakshmi; BIrudu, Raju; Thimmaiah, Rohini; Math, Suresh Bada

2015-01-01

Despite of growing evidence of mental disorders in developing countries, research on mental health literacy is limited from India. To examine mental health literacy among caregivers of persons with mental illness. A cross-sectional descriptive survey was carried out among 161 randomly selected caregivers of persons with mental illness at outpatient department of a tertiary care centre. Data was collected through face to face interview using a structured questionnaire. Regarding the causes of mental illness, a majority agreed that genetic inheritance (69%), substance abuse (64%) and brain disease (59.6%) are main factors for developing mental illness. Although more than two-thirds agreed that anyone could suffer from mental illness, 61.5% also agreed that people with mental health problems are largely to blame for their condition. The majority of the participants also agreed that mentally ill are not able to maintain friendships (45.9%), are dangerous (54%), and not capable to work (59.1%). Just over half (55.9%) of the participants would not want people to know if they had a mental illness and nearly half of them also expressed that they would feel ashamed if a family member had a mental illness. Based on the findings of the present study researchers suggest that there is an urgent need to educate and change the attitudes of caregivers through mental health literacy programs specifically designed for them.

View Points of an Ecologist on Practical Environmental Ethic: Socioecology, Common-Pool Resources and Conservation.

PubMed

Castilla, Juan Carlos

2016-01-01

The paper centers on environmental practical ethic point of views according to a professional ecologist. Ecology and the science of Socio-ecology are defined. The framework of the Millennium Ecosystem Assessment initiative (MA 2003), including the use of ecosystems as the environmental unit of analysis, ecosystem services and human well-being as the center for assessment are discussed. Common-pool resources (CPR) and the allegory of the tragedy of the commons are used to illustrate main scientific and ethical environmental approaches, and above all to highlight the case of climate change, considering ″air-atmosphere″ as a CPR. The need to adopt practical personal environmental ethical positions is highlighted. Furthermore, on climate change, a discussion on the need to develop environmental and socio-ecological polycentric approaches: top-down and bottom-up, is included. An updated discussion on the concept of conservation, including main scientific and ethic points of view, is presented. Pope Francis's Encyclical, Laudato Si', is used to highlight environmental, socio-ecological and ethical aspects behind the comprehensive concept of Integral Ecology. The paper ends with a short synthesis on Earth modern unseen and astonishing environmental and socio-ecological rates of changes, and identifying the main barriers for personal environmental engagement. A call is done regarding the urgent need for socio-environmental ethic personal engagement and collective actions.

The employment of elderly persons*

PubMed Central

Davies, T. A. Lloyd

1955-01-01

Not every old person is fit for employment, and consequently employment agencies must reserve the right of selection. Retirement at the customary age with, if desired, re-employment for defined periods seems to offer the best method of employing old people, avoiding damaging loss of dignity and the blocking of promotion of younger people. Under suitable conditions, old persons are capable of a high level of employment. The possibilities of employment, however, vary very much with different types of industries and industrial regions. The elderly usually have a higher sickness absenteeism than young people, but have fewer absences for other reasons than sickness. Elderly workers seem to be able to carry out manual labour with efficiency if they are put into jobs without time-stress. If retraining is necessary, the utmost possible use should be made of already established skills. Heavy work does not seem to be necessarily harmful for old people. Little knowledge is yet available on the health problems of professional workers or executives at increasing age. Lack of decisiveness, failure of critical judgement, and increasing irritability—resulting from difficulty in organizing new information—will call for transfer to less responsible positions. Many more studies of old age are needed before the circumstances under which they may best be employed in present-day industry can be determined. Full employment and the need for production make this problem still more urgent. PMID:13276813

Fluoroalkylsilane-Modified Textile-Based Personal Energy Management Device for Multifunctional Wearable Applications.

PubMed

Guo, Yinben; Li, Kerui; Hou, Chengyi; Li, Yaogang; Zhang, Qinghong; Wang, Hongzhi

2016-02-01

The rapid development of wearable electronics in recent years has brought increasing energy consumption, making it an urgent need to focus on personal energy harvesting, storage and management. Herein, a textile-based personal energy management device with multilayer-coating structure was fabricated by encapsulating commercial nylon cloth coated with silver nanowires into polydimethylsiloxane using continuous and facile dip-coating method. This multilayer-coating structure can not only harvest mechanical energy from human body motion to power wearable electronics but also save energy by keeping people warm without losing heat to surroundings and wasting energy to heat empty space and inanimate objects. Fluoroalkylsilanes (FAS) were grafted onto the surface of the film through one single dip-coating process to improve its energy harvesting performance, which has hardly adverse effect to heat insulation and Joule heating property. In the presence of FAS modification, the prepared film harvested mechanical energy to reach a maximum output power density of 2.8 W/m(2), charged commercial capacitors and lighted LEDs, showing its potential in powering wearable electronics. Furthermore, the film provided 8% more thermal insulation than normal cloth at 37 °C and efficiently heated to 40 °C within 4 min when applied the voltage of only 1.5 V due to Joule heating effect. The high flexibility and stability of the film ensures its wide and promising application in the wearable field.

Empowering Personalized Medicine with Big Data and Semantic Web Technology: Promises, Challenges, and Use Cases.

PubMed

Panahiazar, Maryam; Taslimitehrani, Vahid; Jadhav, Ashutosh; Pathak, Jyotishman

2014-10-01

In healthcare, big data tools and technologies have the potential to create significant value by improving outcomes while lowering costs for each individual patient. Diagnostic images, genetic test results and biometric information are increasingly generated and stored in electronic health records presenting us with challenges in data that is by nature high volume, variety and velocity, thereby necessitating novel ways to store, manage and process big data. This presents an urgent need to develop new, scalable and expandable big data infrastructure and analytical methods that can enable healthcare providers access knowledge for the individual patient, yielding better decisions and outcomes. In this paper, we briefly discuss the nature of big data and the role of semantic web and data analysis for generating "smart data" which offer actionable information that supports better decision for personalized medicine. In our view, the biggest challenge is to create a system that makes big data robust and smart for healthcare providers and patients that can lead to more effective clinical decision-making, improved health outcomes, and ultimately, managing the healthcare costs. We highlight some of the challenges in using big data and propose the need for a semantic data-driven environment to address them. We illustrate our vision with practical use cases, and discuss a path for empowering personalized medicine using big data and semantic web technology.

The Impact on Staff of Working with Personality Disordered Offenders: A Systematic Review

PubMed Central

Freestone, Mark C.; Wilson, Kim; Jones, Rose; Mikton, Chris; Milsom, Sophia; Sonigra, Ketan; Taylor, Celia; Campbell, Colin

2015-01-01

Background Personality disordered offenders (PDOs) are generally considered difficult to manage and to have a negative impact on staff working with them. Aims This study aimed to provide an overview of studies examining the impact on staff of working with PDOs, identify impact areas associated with working with PDOs, identify gaps in existing research,and direct future research efforts. Methods The authors conducted a systematic review of the English-language literature from 1964–2014 across 20 databases in the medical and social sciences. Results 27 papers were included in the review. Studies identified negative impacts upon staff including: negative attitudes, burnout, stress, negative counter-transferential experiences; two studies found positive impacts of job excitement and satisfaction, and the evidence related to perceived risk of violence from PDOs was equivocal. Studies demonstrated considerable heterogeneity and meta-analysis was not possible. The overall level of identified evidence was low: 23 studies (85%) were descriptive only, and only one adequately powered cohort study was found. Conclusions The review identified a significant amount of descriptive literature, but only one cohort study and no trials or previous systematic reviews of literatures. Clinicians and managers working with PDOs should be aware of the potential impacts identified, but there is an urgent need for further research focusing on the robust evaluation of interventions to minimise harm to staff working with offenders who suffer from personality disorder. PMID:26305891

Identity of the Teacher-Researcher in Collaborative Action Research: Concerns Reflected in a Research Journal (La identidad del docente investigador en la investigación acción colaborativa: preocupaciones reflejadas en un diario de investigación)

ERIC Educational Resources Information Center

Banegas, Darío Luis

2012-01-01

In this paper I report the insights of my personal research journal as part of a collaborative action research project I facilitated in a secondary school where I teach English as a foreign language. I kept a journal so as to offer the natural history of my research towards my doctoral degree. In this project I worked together with four…

Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause.

PubMed

Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C; Khoury, Nabil; Hadi, Christiane M; van der Ende, Arie; Wootton, Susan H; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

2013-08-01

We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193) and a retrospective validation (n = 567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high (≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95% CI 93.9-100.0%) in the validation cohort and 100.0% (95% CI 97.8-100.0%) in bacterial meningitis patients. The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

RISK SCORE FOR IDENTIFYING ADULTS WITH CSF PLEOCYTOSIS AND NEGATIVE CSF GRAM STAIN AT LOW RISK FOR AN URGENT TREATABLE CAUSE

PubMed Central

Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C; Khoury, Nabil; Hadi, Christiane M; van der Ende, Arie; Wootton, Susan H.; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

2013-01-01

Background We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Methods Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n=193) and a retrospective validation (n=567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high ( ≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. Findings A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95%CI 93.9-100.0%) in the validation cohort and 100.0% (95%CI 97.8-100.0%) in bacterial meningitis patients. Interpretation The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. PMID:23619080

Determination of TBT in water and sediment samples along the Argentine Atlantic coast.

PubMed

de Waisbaum, R G; Rodriguez, C; Nudelman, N Sbarbati

2010-11-01

Cases of imposex have been reported for some organisms living in areas of the Argentine Atlantic coast. Since this is one of the known effects of the anti-fouling agent tributyltin (TBT), quantitative determinations of organotins in samples of water and sediments collected from sites along the Argentine coast were carried out. Severe cases of imposex were first reported for two gastropod species living in the Mar del Plata area, and determinations of TBT in samples collected from this site gave extremely high values and showed a close correlation between the degree of imposex and TBT concentration. Recent investigations in the area have shown a significant decrease. Surveys were also conducted in sites that exhibit highly irregular coastal profiles to examine the relevance of physical environments. Alarming concentrations of TBT were determined in most of the sites where heavy boat traffic and/or marine activities occur, demonstrating the urgent need for regulations to avoid further input of TBT. Reports from other sites in South America reveal that this should be a subject of regional concern in order to avoid severe damage to the biodiversity of regional marine organisms.

Use of medicinal plants for the treatment of measles in Nigeria.

PubMed

Sonibare, M A; Moody, J O; Adesanya, E O

2009-03-18

The present study was an ethnobotanical survey of three Local Government areas of the Ijebu area of Ogun State in southwest Nigeria for plants used in the treatment of measles. Unstructured interviews were conducted among both urban and rural dwellers of three major groups of Ijebu people inhabiting the area (Ijebu North, Ijebu northeast and Ijebu Ode Local Governments). A total of 20 respondents constituted by herbalists, herbsellers and old people that have privileged information on the plants used in the treatment of measles among children were encountered during the survey. Twenty-three plant species belonging to 18 Angiosperm families were said to possess curative properties for the cure of measles among the local populace. Amongst the most frequently used plants are Elytraria marginata Vahl, Peperomia pellucida (L.) Humb., Bonpl. & Kunth, Vernonia amygdalina Del., Momordica charantia L., Newbouldia laevis (P. Beauv.) Seem. ex Bureau, and Ocimum gratissimum L. The most frequently mentioned family is Cucurbitaceae. The mode of preparation and recommended dosages are enumerated in this paper. The results of the study call for an urgent need of the introduction of a strategy for the conservation of indigenous medicinal plants in the area.

Chemical incidents: are we ready in the West Midlands? Testing the communication arrangements of on-call public health doctors.

PubMed

Pooransingh, S; Kibble, A; Saunders, P

2005-01-01

Primary care trusts are responsible for handling major chemical hazards. This includes the testing and exercising of plans in a regular and routine manner. The Chemical Hazards and Poisons Division (Birmingham), which provides a 24-h, 365-day resource for the West Midlands region in the UK, undertook an audit to test the out-of-hours communication arrangements of public health doctors. The audit revealed that there is an urgent need to: (1) review contact details within on-call packs; (2) ensure that doctors performing on-call duties know, at the very least, the names of the primary care trusts/local authorities, county councils/other trusts in the area; and (3) ensure a failsafe method for contacting the person on call for public health.

Making Astronomy and the Physical Sciences More Welcoming to LGBT+ Persons

NASA Astrophysics Data System (ADS)

Lawrence, Stephen; SGMA, LGBT+Physicists

2018-01-01

Want a department that is more welcoming to students, staff, and faculty across the spectrum of gender and sexual (LGBT+) identities? The AAS Committee for Sexual-Orientation and Gender Minorities in Astronomy (SGMA), together with LGBT+physicists, has produced a guide to help you: "Supporting LGBT+ Physicists and Astronomers: Best Practices for Academic Departments." This best practices guide provides simple, concrete suggestions to improve climate and increase LGBT+ visibility and acceptance within your department and across your institution. I will present a summary of these suggestions and discuss ways to implement them. In spite of rapid and remarkable advances in LGBT+ rights in the last decade, dramatic changes and policy reversals by the current administration make the need for these strategies very relevant and urgent once again.

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire Presidential Documents Other Presidential Documents Presidential Determination No. 2011-11 of June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire Memorandum for the Secretary of...

[Mental health as a front-line service for bewildered persons].

PubMed

Mulder, C L; van Weeghel, J; Wierdsma, A; Zoeteman, J; Schene, A

'Bewildered persons' have often been in the news over the last few years. There has been much discussion about the meaning of the term 'bewildered persons', the number of people involved, the way the problem should be tackled and the role of the mental health services.
AIM: To look critically at the term 'bewildered persons' and to discuss the suspected increase in numbers and the role of mental health services.
METHOD: Review and discussion of the relevant literature relating to 'bewildered persons' which has been published in the last 25 years.
RESULTS: The term 'bewildered persons' is a general label given by the Dutch police to several groups of people. Suicide rates are rising and more and more people are being compulsorily admitted to psychiatric clinics and hospitals. These factors indicate that increasing numbers of people may now be a danger to themselves and to their fellow-citizens. It is not clear whether the increase in numbers is real or simply reflects the extra attention given by the police. These people may in fact be a new group consisting of persons already known to the mental health services. A national team that aims to improve the care of 'bewildered persons' has made several recommendations to stop the increase: prevention and better cooperation between municipalities and mental health facilities. In our view the mental health services should operate at the front-line of the public mental health service, providing low-threshold diagnostics, assertive outreach and treatment for patients who have mental disorders but are unwilling to accept care or treatment. Such a service requires adequate finance, good cooperative agreements and removal of the bureaucratic and financial barriers that prevent patients from seeking care.
CONCLUSION: 'Bewildered persons' is an umbrella term used to denote people who urgently require care and are a public nuisance and who display disturbing behavior. 'Bewildered persons', who now form a part of the group of people targeted by the public health services, have been around for a long time but have been referred to by different names. They require the structured assistance of integrated care, access to social and medical services and timely diagnosis and treatment. People who have somehow slipped through the net of care facilities should not be left to fend for themselves.

Infrastructure Requirements for an Urgent-Start Peritoneal Dialysis Program

PubMed Central

Ghaffari, Arshia; Kumar, Vijay; Guest, Steven

2013-01-01

Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement. Urgent-start PD clinical pathways require a unique infrastructure and treatment approach. This article reviews the salient features required to establish an urgent-start PD program. PMID:24335123

Association of Over-The-Counter Pharmaceutical Sales with Influenza-Like-Illnesses to Patient Volume in an Urgent Care Setting

PubMed Central

Liu, Timothy Y.; Sanders, Jason L.; Tsui, Fu-Chiang; Espino, Jeremy U.; Dato, Virginia M.; Suyama, Joe

2013-01-01

We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round. PMID:23555647

Door to disposition times for obstetric triage visits: Is there a July phenomenon?

PubMed

Mehra, S; Gavard, J A; Gross, G; Myles, T; Nguyen, T; Amon, E

2016-01-01

The July phenomenon refers to a change in patient outcomes within teaching hospitals with the arrival of new and inexperienced house staff at the start of the academic year (July to June). In our obstetric triage unit we retrospectively evaluated the door to disposition time (DTDT) for 1817 patients who presented across July, December and May of academic years 2009-2010 and 2010-2011. DTDT was examined for three visit levels: non-urgent, urgent and emergent. No significant differences in disposition time were found for emergent visits. For urgent visits the median DTDT significantly decreased from 171 min in July to 155 min in December and 135 min in May (p < 0.001). Similarly for non-urgent visits, the median DTDT was greater during July than May (179 min vs. 133 min; p < 0.05). Electronic medical records (EMRs) were implemented in November 2010. Following the introduction of EMR shorter DTDT was seen in December 2010 versus December 2009 (median, 171 min vs. 150 min; p < 0.05), respectively. Our findings suggest a 'July Phenomenon' of greater disposition intervals for urgent and non-urgent obstetric triage visits across the academic year. Additionally the use of EMRs may facilitate patient flow through the OB triage unit.

The impact of an emergency fee increase on the composition of patients visiting emergency departments.

PubMed

Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

2014-11-01

This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

The impact of demand management strategies on parents’ decision-making for out-of-hours primary care: findings from a survey in The Netherlands

PubMed Central

Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

2017-01-01

Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. Results The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; 95% CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; 95% CI 0.08 to 0.32). Overview of medical cost (OR 0.59; 95% CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; 95% CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Conclusion Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. PMID:28487458

The impact of demand management strategies on parents' decision-making for out-of-hours primary care: findings from a survey in The Netherlands.

PubMed

Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

2017-05-09

To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices

PubMed Central

Lyratzopoulos, Georgios; Mendonca, Silvia C; Gildea, Carolynn; McPhail, Sean; Peake, Michael D; Rubin, Greg; Singh, Hardeep; Hamilton, William; Walter, Fiona M; Roland, Martin; Abel, Gary A

2018-01-01

Background Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use. Aim To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer. Design and setting Cross-sectional ecological analysis in English general practices. Method Data were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills. Results Taking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile). Conclusion Practices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice. PMID:29255108

[Trattamento della dipendenza da alcol. Alcol e persone senza fissa dimora: punto di vista sociale].

PubMed

Alessandrini, Giovanni; Ciccarelli, Rosaria; Battagliese, Gemma; Cereatti, Federica; Gencarelli, Simona; Messina, Marisa Patrizia; Vitali, Mario; De Rosa, Francesca; Ledda, Roberta; Mancini, Serena; Attilia, Maria Luisa

2018-01-01

RIASSUNTO. Il fenomeno delle persone senza fissa dimora sta assumendo in questi anni una rilevanza sociale devastante, con una prevalenza stimata in USA e in Europa compresa tra il 5,6% e il 13,9%. Queste persone hanno una scarsa qualità di vita, una limitata o assente vita sociale, sono spesso disoccupate o lavorano solo saltuariamente. Sono a rischio di problemi con la legge, sono spesso affette da dipendenza da droghe, da patologie psichiatriche e internistiche. L'alcol spesso non rappresenta la causa della loro condizione sociale, ma solo la conseguenza, contribuendo in questo modo al loro degrado bio-psico-sociale. Nel 2009 lo US Department of Housing and Urban Development's Homelessness Assistance Programs e nel 2010 la European Consensus Conference on Homelessness hanno segnato un grande passo avanti nella riabilitazione sociale di queste persone, utilizzando il concetto del "case management". In particolare lo Standard Case Management si è dimostrato in grado di migliorare la stabilità abitativa, di ridurre l'uso di droghe e di rimuovere le barriere lavorative. L'Assertive Community Treatment si è dimostrato, invece, in grado di migliorare la stabilità abitativa e ha un rapporto costo/beneficio migliore per i pazienti affetti da doppia diagnosi.

Awareness and attitude of the public toward personalized medicine in Korea

PubMed Central

Lee, Iyn-Hyang; Kang, Hye-Young; Suh, Hae Sun; Lee, Sukhyang; Oh, Eun Sil

2018-01-01

Objectives As personalized medicine (PM) is expected to greatly improve health outcomes, efforts have recently been made for its clinical implementation in Korea. We aimed to evaluate public awareness and attitude regarding PM. Methods We performed a self-administered questionnaire survey to 703 adults, who participated in the survey on a voluntary basis. The primary outcome measures included public knowledge, attitude, and acceptance of PM. We conducted multinomial multivariate logistic analysis for outcome variables with three response categories and performed multivariate logistic regression analyses for dichotomous outcome variables. Results Only 28% of participants had knowledge that genetic factors can contribute to inter-individual variations in drug response and the definition of PM (199 out of 702). Higher family income was correlated with greater knowledge concerning PM (OR = 3.76, p = 0.034). A majority of respondents preferred integrated pharmacogenomic testing over drug-specific testing and agreed to inclusion of pharmacogenomic testing in the national health examination (64% and 77%, respectively), but only 51% were willing to pay for it. Discussion Our results identify the urgent need for public education as well as the potential health disparities in access to PM. This study helps to frame policies for implementing PM in clinical practice. PMID:29451916

Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students.

PubMed

Vyas, Shaili; Sharma, Parul; Srivastava, Kajal; Nautiyal, Vipul; Shrotriya, Ved Prakash

2015-09-01

UTI is a well known entity amongst young girls, and the majority of girls have recurrent infections within one year. Anything that disturbs the usual vaginal environment would result in conditions favouring the production of unwanted microorganisms leading to infections of this very sensitive area. Studies have shown that, there is an evident relation of UTI's among students and practices of personal hygiene. To determine association between the behavioural risk factors and UTI among nursing girls. The present study was undertaken amongst unmarried nursing students of a Medical College Hospital. A predesigned pretested questionnaire was used to know the personal hygiene of students and to find out its association with UTI in the last three months. Chi-square test was used to analyse the data. A significant association was observed between perineal hygiene and UTI. The major risk factors of UTI identified were incorrect perineal washing technique, use of synthetic/silk innerwears, not sundrying the innerwears, improper menstrual hygiene. There are still major gaps in the knowledge regarding causation of UTI among the nursing students. This calls for an urgent need for educational talks periodically addressing these gaps.

Pitfalls in lung cancer molecular pathology: how to limit them in routine practice?

PubMed

Ilie, M; Hofman, P

2012-01-01

New treatment options in advanced non-small cell lung carcinoma (NSCLC) targeting activating epidermal growth factor receptor (EGFR) gene mutations and other genetic alterations demonstrated the clinical significance of the molecular features of specific subsets of tumors. Therefore, the development of personalized medicine has stimulated the routine integration into pathology departments of somatic mutation testing. However, clinical mutation testing must be optimized and standardized with regard to histological profile, type of samples, pre-analytical steps, methodology and result reporting. Routine molecular testing in NSCLC is currently moving beyond EGFR mutational analysis. Recent progress of targeted therapies will require molecular testing for a wide panel of mutations for a personalized molecular diagnosis. As a consequence, efficient testing of multiple molecular abnormalities is an urgent requirement in thoracic oncology. Moreover, increasingly limited tumor sample becomes a major challenge for molecular pathology. Continuous efforts should be made for safe, effective and specific molecular analyses. This must be based on close collaboration between the departments involved in the management of lung cancer. In this review we explored the practical issues and pitfalls surrounding the routine implementation of molecular testing in NSCLC in a pathology laboratory.

Screening the Toxicity of Selected Personal Care Products Using Embryo Bioassays: 4-MBC, Propylparaben and Triclocarban

PubMed Central

Torres, Tiago; Cunha, Isabel; Martins, Rosário; Santos, Miguel M.

2016-01-01

Recently, several emerging pollutants, including Personal Care Products (PCPs), have been detected in aquatic ecosystems, in the ng/L or µg/L range. Available toxicological data is limited, and, for certain PCPs, evidence indicates a potential risk for the environment. Hence, there is an urgent need to gather ecotoxicological data on PCPs as a proxy to improve risk assessment. Here, the toxicity of three different PCPs (4-Methylbenzylidene Camphor (4-MBC), propylparaben and triclocarban) was tested using embryo bioassays with Danio rerio (zebrafish) and Paracentrotus lividus (sea urchin). The No Observed Effect Concentration (NOEC) for triclocarban was 0.256 µg/L for sea urchin and 100 µg/L for zebrafish, whereas NOEC for 4-MBC was 0.32 µg/L for sea urchin and 50 µg/L for zebrafish. Both PCPs impacted embryo development at environmentally relevant concentrations. In comparison with triclocarban and 4-MBC, propylparaben was less toxic for both sea urchin (NOEC = 160 µg/L) and zebrafish (NOEC = 1000 µg/L). Overall, this study further demonstrates the sensitivity of embryo bioassays as a high-throughput approach for testing the toxicity of emerging pollutants. PMID:27775672

What else should we know about experiencing COPD? A narrative review in search of patients' psychological burden alleviation.

PubMed

Rzadkiewicz, Marta; Bråtas, Ola; Espnes, Geir Arild

2016-01-01

The present paper is a narrative review focusing on the psychological impact, identification of protective factors, and interventions minimizing the psychological burdens of chronic obstructive pulmonary disease (COPD). The research reviews studies on neurocognitive functions, personality, emotional problems, and health-related quality of life. This is done with regard to resources as well as activities enabling or enhancing a patient's adaptation. PubMed and PsychArticles databases were searched for relevant medical (eg, CODP, emphysema), psychopathology (eg, depression), and psychological (eg, personality) keywords, followed by hand search. After application of the inclusion and exclusion criteria, the search resulted in 82 articles and book chapters. The choice was based on evidence accepted by evidence-based medicine, although at different levels of strength. Psychological experiencing of COPD appears to be very unequally represented with scientific research on emotional problems and functioning decrease significantly outnumbering those addressing resources or effective interventions. As our initial literature search called for an urgent need for further exploration, we have carefully pointed out numerous areas where the knowledge on how to protect or restore psychological well-being among COPD patients should be broadened.

How Does Psychosocial Behavior Contribute to Cognitive Health in Old Age?

PubMed Central

Wilson, Robert S.; Bennett, David A.

2017-01-01

With the aging of the U.S. population, the number of cognitively disabled persons is expected to substantially increase in coming decades, underscoring the urgent need for effective interventions. Here, we review the current evidence linking psychosocial factors to late-life cognitive loss and consider the study design needed to illuminate the biologic bases of the associations. We then examine an ongoing study that includes several of the key design elements, the Rush Memory and Aging Project. In this longitudinal clinical-pathological cohort study, indicators of personality, social connectedness, and psychological well-being were shown to predict late-life cognitive outcomes. Participants who died underwent a uniform neuropathologic examination to quantify common dementia-related pathologies. Some psychosocial indicators were associated with cerebral infarction; some indicators modified the association of neurodegenerative pathologies with cognitive loss; and the association of some indicators with cognitive outcomes appears to be independent of the pathologies traditionally associated with late-life dementia. These findings suggest that psychosocial behavior influences late-life cognitive health through multiple neurobiologic mechanisms. A better understanding of these mechanisms may lead to novel strategies for preserving cognitive health in old age. PMID:28545247

[Reform of the guardianship and health care right--a contribution of government to the protection of the elderly].

PubMed

Schlüter, W; Liedmeier, N

1990-01-01

People over the age of majority who are in need of help because of age or sickness must be protected by a modern law of guardianship. Current law with its provisions for declarations of incapacity, guardians for non-minors and tutelage for the frail or infirm rests on outdated concepts of the nineteenth century. Science and practice agree that there is an urgent need for reform. It is not possible to be content with the constitutionally guaranteed principle of proportionality (the requirement that laws bear a reasonable relationship to the ends they are intended to effect); current law permits limitations on legal capacity but does not fully protect either the ward or the involved legal transactions. Current law also does not sufficiently assure that the ward receives personal attention from the guardian or tutor. The German Federal Government has now proposed a draft Guardianship Law. This draft is designed to limit intrusions into the rights of affected persons while also procedurally improving their legal position. The authors approve of this goal; they discuss the essential provisions of the proposed law and come to critical judgments about them.

Ultrasensitive Detection of Ricin Toxin in Multiple Sample Matrixes Using Single-Domain Antibodies.

PubMed

Gaylord, Shonda T; Dinh, Trinh L; Goldman, Ellen R; Anderson, George P; Ngan, Kevin C; Walt, David R

2015-07-07

Ricin is an extremely potent ribosomal inactivating protein listed as a Category B select agent. Although ricin intoxication is not transmittable from person to person, even a single ricin molecule can lead to cell necrosis because it inactivates 1500 ribosomes/min. Since there is currently no vaccine or therapeutic treatment for ricin intoxication, ultrasensitive analytical assays capable of detecting ricin in a variety of matrixes are urgently needed to limit exposure to individuals as well as communities. In this paper, we present the development and application of a single-molecule array (Simoa) for the detection of ricin toxin in human urine and serum. Single-domain antibodies (sdAbs), among the smallest engineered binding fragments, were chemically coupled to the surface of paramagnetic beads for the sensitive detection of ricin toxin. The Simoa was able to detect ricin at levels of 10 fg/mL, 100 fg/mL, and 1 pg/mL in buffer, urine and serum, respectively, in a fraction of the assay time need using immuno-polymerase chain reaction (IPCR). Using a fully automated state-of-the-art platform, the Simoa HD-1 analyzer, the assay time was reduced to 64 min.

An ecologically-controlled exoskeleton can improve balance recovery after slippage

NASA Astrophysics Data System (ADS)

Monaco, V.; Tropea, P.; Aprigliano, F.; Martelli, D.; Parri, A.; Cortese, M.; Molino-Lova, R.; Vitiello, N.; Micera, S.

2017-05-01

The evolution to bipedalism forced humans to develop suitable strategies for dynamically controlling their balance, ensuring stability, and preventing falling. The natural aging process and traumatic events such as lower-limb loss can alter the human ability to control stability significantly increasing the risk of fall and reducing the overall autonomy. Accordingly, there is an urgent need, from both end-users and society, for novel solutions that can counteract the lack of balance, thus preventing falls among older and fragile citizens. In this study, we show a novel ecological approach relying on a wearable robotic device (the Active Pelvis Orthosis, APO) aimed at facilitating balance recovery after unexpected slippages. Specifically, if the APO detects signs of balance loss, then it supplies counteracting torques at the hips to assist balance recovery. Experimental tests conducted on eight elderly persons and two transfemoral amputees revealed that stability against falls improved due to the “assisting when needed” behavior of the APO. Interestingly, our approach required a very limited personalization for each subject, and this makes it promising for real-life applications. Our findings demonstrate the potential of closed-loop controlled wearable robots to assist elderly and disabled subjects and to improve their quality of life.

Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students

PubMed Central

Sharma, Parul; Srivastava, Kajal; Nautiyal, Vipul; Shrotriya, Ved Prakash

2015-01-01

Introduction UTI is a well known entity amongst young girls, and the majority of girls have recurrent infections within one year. Anything that disturbs the usual vaginal environment would result in conditions favouring the production of unwanted microorganisms leading to infections of this very sensitive area. Studies have shown that, there is an evident relation of UTI’s among students and practices of personal hygiene. Aim To determine association between the behavioural risk factors and UTI among nursing girls. Materials and Methods The present study was undertaken amongst unmarried nursing students of a Medical College Hospital. A predesigned pretested questionnaire was used to know the personal hygiene of students and to find out its association with UTI in the last three months. Chi-square test was used to analyse the data. Results A significant association was observed between perineal hygiene and UTI. The major risk factors of UTI identified were incorrect perineal washing technique, use of synthetic/silk innerwears, not sundrying the innerwears, improper menstrual hygiene. Conclusion There are still major gaps in the knowledge regarding causation of UTI among the nursing students. This calls for an urgent need for educational talks periodically addressing these gaps. PMID:26500927

Screening the Toxicity of Selected Personal Care Products Using Embryo Bioassays: 4-MBC, Propylparaben and Triclocarban.

PubMed

Torres, Tiago; Cunha, Isabel; Martins, Rosário; Santos, Miguel M

2016-10-21

Recently, several emerging pollutants, including Personal Care Products (PCPs), have been detected in aquatic ecosystems, in the ng/L or µg/L range. Available toxicological data is limited, and, for certain PCPs, evidence indicates a potential risk for the environment. Hence, there is an urgent need to gather ecotoxicological data on PCPs as a proxy to improve risk assessment. Here, the toxicity of three different PCPs (4-Methylbenzylidene Camphor (4-MBC), propylparaben and triclocarban) was tested using embryo bioassays with Danio rerio (zebrafish) and Paracentrotus lividus (sea urchin). The No Observed Effect Concentration (NOEC) for triclocarban was 0.256 µg/L for sea urchin and 100 µg/L for zebrafish, whereas NOEC for 4-MBC was 0.32 µg/L for sea urchin and 50 µg/L for zebrafish. Both PCPs impacted embryo development at environmentally relevant concentrations. In comparison with triclocarban and 4-MBC, propylparaben was less toxic for both sea urchin (NOEC = 160 µg/L) and zebrafish (NOEC = 1000 µg/L). Overall, this study further demonstrates the sensitivity of embryo bioassays as a high-throughput approach for testing the toxicity of emerging pollutants.

Endocrine disrupting compounds (EDCs) and pharmaceuticals and personal care products (PPCPs) in the aquatic environment: implications for the drinking water industry and global environmental health.

PubMed

Rahman, M F; Yanful, E K; Jasim, S Y

2009-06-01

Endocrine disrupting compounds (EDCs) and pharmaceuticals and personal care products (PPCPs) are a group of chemical compounds with diverse physical and chemical properties. Recent studies have indicated undesired effects of EDCs and PPCPs at their reported trace concentrations (ng l(-1) to microg l(-1)). This paper reviews the current knowledge on the sources, properties, occurrence and health impacts of EDCs and PPCPs, and their removal from drinking water using ozonation and ozone/hydrogen peroxide-based advanced oxidation. The paper also examines the potential threats posed by these chemicals to drinking water and public health. While these compounds are known to have adverse effects on ecosystem health, notably in the fish population, a similar link is yet to be established between ingestion of these compounds through drinking water and human health. In addition, data on the effectiveness of existing methods for the removal of these compounds are not conclusive. Further studies are required to characterize risks, and also to evaluate and optimize existing removal processes. Also concerted international effort is urgent to cut down the risk of exposure and restrain the production and marketing of toxic chemicals.

Fault Tree Analysis: Investigation of Epidemic Hemorrhagic Fever Infection Acquired in Animal Laboratories in China.

PubMed

Liu, Xiao Yu; Xue, Kang Ning; Rong, Rong; Zhao, Chi Hong

2016-01-01

Epidemic hemorrhagic fever has been an ongoing threat to laboratory personnel involved in animal care and use. Laboratory transmissions and severe infections occurred over the past twenty years, even though the standards and regulations for laboratory biosafety have been issued, upgraded, and implemented in China. Therefore, there is an urgent need to identify risk factors and to seek effective preventive measures that can curb the incidences of epidemic hemorrhagic fever among laboratory personnel. In the present study, we reviewed literature that relevant to animals laboratory-acquired hemorrhagic fever infections reported from 1995 to 2015, and analyzed these incidences using fault tree analysis (FTA). The results of data analysis showed that purchasing of qualified animals and guarding against wild rats which could make sure the laboratory animals without hantaviruses, are the basic measures to prevent infections. During the process of daily management, the consciousness of personal protecting and the ability of personal protecting need to be further improved. Undoubtedly vaccination is the most direct and effective method, while it plays role after infection. So avoiding infections can't rely entirely on vaccination. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

The Challenges of Precision Medicine in COPD.

PubMed

Cazzola, Mario; Calzetta, Luigino; Rogliani, Paola; Matera, Maria Gabriella

2017-08-01

Pheno-/endotyping chronic obstructive pulmonary disease (COPD) is really important because it provides patients with precise and personalized medicine. The central concept of precision medicine is to take individual variability into account when making management decisions. Precision medicine should ensure that patients get the right treatment at the right dose at the right time, with minimum harmful consequences and maximum efficacy. Ideally, we should search for genetic and molecular biomarker-based profiles. Given the clinical complexity of COPD, it seems likely that a panel of several biomarkers will be required to characterize pathogenetic factors and their course over time. The need for biomarkers to guide the clinical care of individuals with COPD and to enhance the possibilities of success in drug development is clear and urgent, but biomarker development is tremendously challenging and expensive, and translation of research efforts to date has been largely ineffective. Furthermore, the development of personalized treatments will require a much more detailed understanding of the clinical and biological heterogeneity of COPD. Therefore, we are still far from being able to apply precision medicine in COPD and the treatable traits and FEV 1 -free approaches are attempts to precision medicine in COPD that must be considered still quite unsophisticated.

The potential of magneto-electric nanocarriers for drug delivery

PubMed Central

Kaushik, Ajeet; Jayant, Rahul Dev; Sagar, Vidya; Nair, Madhavan

2015-01-01

Introduction The development and design of personalized nanomedicine for better health quality is receiving great attention. In order to deliver and release a therapeutic concentration at the target site, novel nanocarriers (NCs) were designed, for example, magneto-electric (ME) which possess ideal properties of high drug loading, site-specificity and precise on-demand controlled drug delivery. Areas covered This review explores the potential of ME-NCs for on-demand and site-specific drug delivery and release for personalized therapeutics. The main features including effect of magnetism, improvement in drug loading, drug transport across blood-brain barriers and on-demand controlled release are also discussed. The future directions and possible impacts on upcoming nanomedicine are highlighted. Expert opinion Numerous reports suggest that there is an urgent need to explore novel NC formulations for safe and targeted drug delivery and release at specific disease sites. The challenges of formulation lie in the development of NCs that improve biocompatibility and surface modifications for optimum drug loading/preservation/transmigration and tailoring of electrical–magnetic properties for on-demand drug release. Thus, the development of novel NCs is anticipated to overcome the problems of targeted delivery of therapeutic agents with desired precision that may lead to better patient compliance. PMID:24986772

The potential of magneto-electric nanocarriers for drug delivery.

PubMed

Kaushik, Ajeet; Jayant, Rahul Dev; Sagar, Vidya; Nair, Madhavan

2014-10-01

The development and design of personalized nanomedicine for better health quality is receiving great attention. In order to deliver and release a therapeutic concentration at the target site, novel nanocarriers (NCs) were designed, for example, magneto-electric (ME) which possess ideal properties of high drug loading, site-specificity and precise on-demand controlled drug delivery. This review explores the potential of ME-NCs for on-demand and site-specific drug delivery and release for personalized therapeutics. The main features including effect of magnetism, improvement in drug loading, drug transport across blood-brain barriers and on-demand controlled release are also discussed. The future directions and possible impacts on upcoming nanomedicine are highlighted. Numerous reports suggest that there is an urgent need to explore novel NC formulations for safe and targeted drug delivery and release at specific disease sites. The challenges of formulation lie in the development of NCs that improve biocompatibility and surface modifications for optimum drug loading/preservation/transmigration and tailoring of electrical-magnetic properties for on-demand drug release. Thus, the development of novel NCs is anticipated to overcome the problems of targeted delivery of therapeutic agents with desired precision that may lead to better patient compliance.

A set of autosomal multiple InDel markers for forensic application and population genetic analysis in the Chinese Xinjiang Hui group.

PubMed

Xie, Tong; Guo, Yuxin; Chen, Ling; Fang, Yating; Tai, Yunchun; Zhou, Yongsong; Qiu, Pingming; Zhu, Bofeng

2018-07-01

In recent years, insertion/deletion (InDel) markers have become a promising and useful supporting tool in forensic identification cases and biogeographic research field. In this study, 30 InDel loci were explored to reveal the genetic diversities and genetic relationships between Chinese Xinjiang Hui group and the 25 previously reported populations using various biostatistics methods such as forensic statistical parameter analysis, phylogenetic reconstruction, multi-dimensional scaling, principal component analysis, and STRUCTURE analysis. No deviations from Hardy-Weinberg equilibrium tests were found at all 30 loci in the Chinese Xinjiang Hui group. The observed heterozygosity and expected heterozygosity ranged from 0.1971 (HLD118) to 0.5092 (HLD92), 0.2222 (HLD118) to 0.5000 (HLD6), respectively. The cumulative probability of exclusion and combined power of discrimination were 0.988849 and 0.99999999999378, respectively, which indicated that these 30 loci could be qualified for personal identification and used as complementary genetic markers for paternity tests in forensic cases. The results of present research based on the different methods of population genetic analysis revealed that the Chinese Xinjiang Hui group had close relationships with most Chinese groups, especially Han populations. In spite of this, for a better understanding of genetic background of the Chinese Xinjiang Hui group, more molecular genetic markers such as ancestry informative markers, single nucleotide polymorphisms (SNPs), and copy number variations will be conducted in future studies. Copyright © 2018 Elsevier B.V. All rights reserved.

Role of CYP1A2 polymorphisms on lung cancer risk in a prospective study.

PubMed

Pavanello, Sofia; Fedeli, Ugo; Mastrangelo, Giuseppe; Rota, Federica; Overvad, Kim; Raaschou-Nielsen, Ole; Tjønneland, Anne; Vogel, Ulla

2012-06-01

Cytochrome P4501A2 (CYP1A2) is a key enzyme for lung carcinogen activation and lung inflammation. We studied the interactions of the CYP1A2 functional variants -3860G/A(rs2069514),-2467T/delT(rs3569413),-163C/A(rs762551)] with occupational/environmental carcinogenic exposures in the development of lung cancer in a case-control study nested in the Danish prospective cohort "Diet, Cancer and Health." At enrollment (1993-1997), blood samples for genotype analyses and information on lifestyle were collected 5 (mean value) years before the onset of the disease. The study population included 425 lung cancer cases and 786 subcohort members, who were gender- and age-matched. We found that -163A carriers were at increased risk of lung cancer (P=0.035) in a multivariate COX regression model, which was adjusted for personal habits (i.e., cumulative smoking, passive smoke at home, alcohol intake, and fruit intake) and occupational exposure. Additionally, the interaction between -2467delT and smoking increases lung cancer risk in males, especially light smokers (<21.5 pack-years, P=0.004). The increased lung cancer risk found in -163C carriers, independent of smoking status, and in -2467delT male smokers, suggests that these variants could influence lung cancer development through different mechanisms (i.e. lung carcinogen activation and lung inflammation). Copyright © 2012 Elsevier Inc. All rights reserved.

Rapid Detection Method for the Four Most Common CHEK2 Mutations Based on Melting Profile Analysis.

PubMed

Borun, Pawel; Salanowski, Kacper; Godlewski, Dariusz; Walkowiak, Jaroslaw; Plawski, Andrzej

2015-12-01

CHEK2 is a tumor suppressor gene, and the mutations affecting the functionality of the protein product increase cancer risk in various organs. The elevated risk, in a significant percentage of cases, is determined by the occurrence of one of the four most common mutations in the CHEK2 gene, including c.470T>C (p.I157T), c.444+1G>A (IVS2+1G>A), c.1100delC, and c.1037+1538_1224+328del5395 (del5395). We have developed and validated a rapid and effective method for their detection based on high-resolution melting analysis and comparative-high-resolution melting, a novel approach enabling simultaneous detection of copy number variations. The analysis is performed in two polymerase chain reactions followed by melting analysis, without any additional reagents or handling other than that used in standard high-resolution melting. Validation of the method was conducted in a group of 103 patients with diagnosed breast cancer, a group of 240 unrelated patients with familial history of cancer associated with the CHEK2 gene mutations, and a 100-person control group. The results of the analyses for all three groups were fully consistent with the results from other methods. The method we have developed improves the identification of the CHEK2 mutation carriers, reduces the cost of such analyses, as well as facilitates their implementation. Along with the increased efficiency, the method maintains accuracy and reliability comparable to other more labor-consuming techniques.

[FISH analysis of meiotic segregation results of the spermatozoa from male pericentric inversion carriers].

PubMed

Pan, Cheng-Shuang; Qiu, Xiu-Fang; Huang, Xi-Xi; Weng, Zhi-Liang; Huang, Xue-Feng

2012-04-01

To analyze the meiotic segregation results of the spermatozoa from male pericentric inversion carriers by fluorescence in-situ hybridization (FISH). Using chemical depolymerization and multicolor FISH, we analyzed the meiotic segregation results of the spermatozoa from 4 male pericentric inversion carriers. Of the 4 males studied, 46,XY,inv(9) (p11q12) was found in 2, 46,XY,inv(9) (p11q13) in 1 and 46,XY,inv(6) (p22q24) in the other; the lengths of the inverted segments represented 16.0, 16.0, 21.0 and 76.0% of the size of the whole chromosome involved; and the frequencies of recombinant sperm were 0.2, 0.4, 0.3 and 43.9%, del(p)/dup(q) accounting for 22.4% and del(q)/dup(p) 21.5%, respectively. Males with pericentric inversion may produce spermatozoa with recombinant chromosomes and the rate of recombination varies principally according to the size proportion to the whole chromosome involved. The results of FISH analysis of chromosomal unbalanced spermatozoa can provide accurate personalized information on the genetic risk of fertility.

Cytogenetic Studies of Rwandan Pediatric Patients Presenting with Global Developmental Delay, Intellectual Disability and/or Multiple Congenital Anomalies

PubMed Central

Uwineza, Annette; Hitayezu, Janvier; Jamar, Mauricette; Caberg, Jean-Hubert; Murorunkwere, Seraphine; Janvier, Ndinkabandi; Bours, Vincent

2016-01-01

Global developmental delay (GDD) is defined as a significant delay in two or more developmental domains: gross or fine motor, speech/language, cognitive, social/personal and activities of daily living. Many of these children will go on to be diagnosed with intellectual disability (ID), which is most commonly defined as having an IQ <75 in addition to impairment in adaptive functioning. Cytogenetic studies have been performed in 664 Rwandan pediatric patients presenting GDD/ID and/or multiple congenital abnormalities (MCA). Karyotype analysis was performed in all patients and revealed 260 chromosomal abnormalities. The most frequent chromosomal abnormality was Down syndrome and then Edward syndrome and Patau syndrome. Other identified chromosomal abnormalities included 47,XX,+del(9)(q11), 46,XY,del(13)(q34) and 46,XX,der(22)t(10;22)(p10;p10)mat. In conclusion, our results highlight the high frequency of cytogenetically detectable abnormalities in this series, with implications for the burden on the healthcare. This study demonstrates the importance of cytogenetic analysis in patients with GDD/ID and MCA. PMID:26507407

Linking invasive exotic vertebrates and their ecosystem impacts in Tierra del Fuego to test theory and determine action

NASA Astrophysics Data System (ADS)

Valenzuela, Alejandro E. J.; Anderson, Christopher B.; Fasola, Laura; Cabello, José L.

2014-01-01

Understanding processes and impacts of biological invasions is fundamental for ecology and management. Recent reviews summarized the mechanisms by which invasive species alter entire ecosystems, but quantitative assessments of these mechanisms are lacking for actual assemblages to determine their relative importance, frequency and patterns. We updated information on introduced vertebrates in the Tierra del Fuego Archipelago (TDF) via an exhaustive literature review and new data to evaluate ecosystem impact mechanisms and provide management recommendations. To date, 24 exotic vertebrates have naturalized in TDF, outnumbering natives nearly 2:1, with the North American beaver (Castor canadensis) and muskrat (Ondatra zibethica) being the most widely distributed species and also impacting the ecosystem through the greatest number of mechanisms. Introduced vertebrates occupied most parts of the archipelago with human-inhabited islands having greater taxa richness. All exotics potentially altered ecosystems by one or more mechanisms: 100% food webs, 92% invasional meltdown, 42% habitat modification, 38% disease or parasite transmission, 21% soil property and disturbance regime changes. Impact to habitat structure was the main clustering criterion for this assemblage. Within the species that physically alter habitats, we found two sub-groups: 1) large herbivores and 2) "others" including beavers and muskrats. Species that did not alter habitat were divided further into those with predatory trophic effects (carnivorous mammals and trout, sub-group 4) and the rest with assorted impacts (sub-group 3). By establishing high quality information on archipelago-wide assemblage, distribution, impacts and mechanisms for exotic vertebrates, we recommend, based on ecological criteria, prioritizing the management of sub-group 2. A secondary priority might be given to the carnivores in sub-group 4, while species in sub-groups 1 and 3 are less urgent. As the first systematic survey of introduced fauna on an archipelago-scale, we identified knowledge gaps, such as population abundance and dynamics for specific species, which are needed to orient future work, but the notable progress made to date is highlighted.

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

PubMed

Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

2017-12-01

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials.

PubMed

Gupta, Ankur; Bajaj, Navkaranbir S; Arora, Pankaj; Arora, Garima; Qamar, Arman; Bhatt, Deepak L

2018-02-01

Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials. We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model. After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28). This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores

PubMed Central

Park, Sun Wook; Song, Young Wook; Tak, Dae Hyun; Ahn, Byung Moo; Kang, Sun Hyung; Moon, Hee Seok; Sung, Jae Kyu; Jeong, Hyun Yong

2015-01-01

Background/Aims: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores. Methods: This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (≥2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups. Results: A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05) Conclusions: AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods. PMID:26668799

Supplier-induced demand for urgent after-hours primary care services.

PubMed

Longden, Thomas; Hall, Jane; van Gool, Kees

2018-05-21

Australia is one of nine Organisation for Economic Co-operation and Development (OECD) countries that utilise deputising services to provide after-hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly advertising their services to consumers emphasising patient convenience and no copayments. The introduction of corporate entities has changed the way that deputising services operate. We use a difference-in-difference approach to estimate the amount of growth in urgent after-hours services that was not warranted by urgent medical need. These estimates are calculated by comparing the growth in urgent attendances that occurred during times of the day that are classified as "after-hours" (e.g., 6 pm-11 pm Monday to Friday) with those that are classified as "unsociable-hours" (e.g., 11 pm-7 am Monday to Friday). For the national level, we estimate that 593,141 unwarranted attendances were induced as urgent after-hours consultations in a single year. This corresponds to a national estimate of the total benefits paid for unwarranted demand of approximately $77 million. While deputising services have filled a short-fall in after-hours services, the overuse of urgent items has meant that that this has been achieved at a considerable cost to the Australian Government. Copyright © 2018 John Wiley & Sons, Ltd.

The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study.

PubMed

Kawai, Keisuke; Yamashita, Sakino; Yamanaka, Takeharu; Gondo, Motoharu; Morita, Chihiro; Nozaki, Takehiro; Takakura, Shu; Hata, Tomokazu; Yamada, Yu; Matsubayashi, Sunao; Takii, Masato; Kubo, Chiharu; Sudo, Nobuyuki

2011-12-05

The prevention of serious physical complications in anorexia nervosa (AN) patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17); planned admission (n = 96); and outpatient treatment only groups (n = 136). The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P < 0.01) and decreased more rapidly (P < 0.01). Urgent hospitalization was associated with the fat free mass (FFM) (P < 0.01). Between the groups, no considerable difference in social factors was found. The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.

77 FR 42947 - Unexpected Urgent Refugee and Migration Needs

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

Urgent-Start Peritoneal Dialysis: A Chance for a New Beginning

PubMed Central

Arramreddy, Rohini; Zheng, Sijie; Saxena, Anjali B.; Liebman, Scott E.; Wong, Leslie

2014-01-01

Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm. PMID:24246221

The Politics of Revolutionary Development: Civil-Military Relations in Cuba, 1959-1976,

DTIC Science & Technology

1976-01-01

for Cuban Studies Newsletter, 2, Nos. 5-6 (October-Decenber 1975); Estatutos del Partido Comrista de Cuba (La Habana: Departamento de Orientaci 6 n ...document in and to ali ’t, o" n Of the author. are Protcte by law. ’- Cnet reproducton. of ,s4C in-:~whole or in Part !3~t~unz T h i q n rI af lv -.-r...dominant force in the revolu- ti nary movement. It held a mmopoly of arm and, In the person of its am- mner- n -hief, a monopoly of popular support. WM

Community Care Workers, Poor Referral Networks and Consumption of Personal Resources in Rural South Africa

PubMed Central

Sips, Ilona; Haeri Mazanderani, Ahmad; Schneider, Helen; Greeff, Minrie; Barten, Francoise; Moshabela, Mosa

2014-01-01

Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data – CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers. PMID:24781696

Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey.

PubMed

Chuang, Yeu-Hui; Kuo, Li-Min

2018-05-24

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression. © 2018 Australian College of Mental Health Nurses Inc.

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Gaza

Code of Federal Regulations, 2010 CFR

2010-01-01

... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of Bureau of Population, Refugees, and...

Frequent or urgent urination

MedlinePlus

Urgent urination; Urinary frequency or urgency; Urgency-frequency syndrome; Overactive bladder (OAB) syndrome; Urge syndrome ... Medicines such as water pills (diuretics) Overactive bladder syndrome Radiation therapy to the pelvis, which is used ...

Caregiver burden of family members of persons living with HIV in Thailand

PubMed Central

Lee, Sung-Jae; Li, Li; Jiraphongsa, Chuleeporn; Rotheram-Borus, Mary J

2010-01-01

Caregivers of people living with HIV (PLH) in Thailand face tremendous caregiver burden. This study examines complex ways in which caregivers’ mental health affects their levels of caregiver burden. This study uses data from 409 caregivers of PLH in northern and north-eastern Thailand. Multiple regression models were used to examine the predictors of caregiver burden. Depression was significantly associated with caregiver burden (P < 0.0001) and being HIV positive (P = 0.015). Inverse associations were observed between depression and quality of life (P < 0.0001) and caregiver burden and quality of life (P = 0.004). Social support had direct positive association with caregiver’s quality of life (P < 0.0001). Our findings underscore the complex relationship between caregiver burden, depression and HIV-status. Interventions that address the caregiver burden are urgently needed. PMID:20158549

Domestic violence against children and adolescents: social support network perspectives.

PubMed

Carlos, Diene Monique; Pádua, Elisabete Matallo Marchesini De; Fernandes, Maria Isabel Domingues; Leitão, Maria Neto da Cruz; Ferriani, Maria das Graças Carvalho

2017-07-20

To identify and analyze the social support network of families involved in violence against children and adolescents, from the perspective of health professionals and families in a municipality of the state of São Paulo, Brazil. This was a qualitative strategic social study, anchored in the paradigm of complexity. Data were collected from 41 health professionals and 15 families using institutional or personal network maps, and semi-structured interviews. Analysis was conducted by organizing the data, constructing theoretical frameworks, and categorizing resulting information. The category "weaving the network" was unveiled, with family experiences and professionals focused on a logic of fragmentation of care. The creation and implementation of public policy are urgently needed to address the needs of this population, by empowering families and communities and developing research that respects the multidimensional nature of the phenomenon.

Forecasting generation of urban solid waste in developing countries--a case study in Mexico.

PubMed

Buenrostro, O; Bocco, G; Vence, J

2001-01-01

Based on a study of the composition of urban solid waste (USW) and of socioeconomic variables in Morelia, Mexico, generation rates were estimated. In addition, the generation of residential solid waste (RSW) and nonresidential solid waste (NRSW) was forecasted by means of a multiple linear regression (MLR) analysis. For residential sources, the independent variables analyzed were monthly wages, persons per dwelling, age, and educational level of the heads of the household. For nonresidential sources, variables analyzed were number of employees, area of facilities, number of working days, and working hours per day. The forecasted values for residential waste were similar to those observed. This approach may be applied to areas in which available data are scarce, and in which there is an urgent need for the planning of adequate management of USW.

[Tourism, imported parasitic diseases, and their prevention].

PubMed

Tumol'skaia, N I; Zavoĭkin, V D; Mazmanian, M V; Plakhotnaia, G A; Kurbatova, I V; Zelia, O P; Gutova, V P

2012-01-01

The paper gives the results of observations of 1558 patients before and after tourist travels to tropical countries and 368 individuals visiting the north areas of the Russian Federation. Different conditions (malaria, amebiasis, leishmaniasis, intestinal and tissue helminthiasis, insect bites, venomous fish pricks, medusa burn, tick bites, etc.) were found in 402 persons. Prophylactic immunization included vaccination against hepatitis A and B viruses, meningitis, typhus, yellow fever, tick-borne encephalitis in more than 2500 patients (not including influenza vaccination in the epidemic season). The performed observations reinforce the statement that imported pathology is urgent to Russia and suggest that it is necessary to develop this section of medicine and to set up a network of health care facilities with a necessary therapeutic and diagnostic base to render skilled care to tourists. It is essential to improve medical staff training in travel medicine.

["Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time].

PubMed

Lindner, Christina; Lindner, Gregor; Exadaktylos, Aristomenis K

2013-12-11

Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law.

Health co-benefits of climate change mitigation policies in the transport sector

NASA Astrophysics Data System (ADS)

Shaw, Caroline; Hales, Simon; Howden-Chapman, Philippa; Edwards, Richard

2014-06-01

Theory, common sense and modelling studies suggest that some interventions to mitigate carbon emissions in the transport sector can also have substantial short-term benefits for population health. Policies that encourage active modes of transportation such as cycling may, for example, increase population physical activity and decrease air pollution, thus reducing the burden of conditions such as some cancers, diabetes, heart disease and dementia. In this Perspective we systematically review the evidence from 'real life' transport policies and their impacts on health and CO2 emissions. We identified a few studies that mostly involved personalized travel planning and showed modest increases in active transport such as walking, and reductions in vehicle use and CO2 emissions. Given the poor quality of the studies identified, urgent action is needed to provide more robust evidence for policies.

[From Binet and Wundt to neuropsychological measurements and behavior scales].

PubMed

Lehmann, H E

1983-01-01

Experimental psychology was the first form of scientific psychology and saw its beginnings in Wundt's laboratory toward the end of the 19th century. Psychometric measures of cognitive functions were introduced, at about the same time, by Binet, while Galton was pioneering in studies of personality profiles. Most of the systematic work, both in the theory and practice of psychology, was focused on standardization of norms, or types and measures of normal mental functions. With the establishment of psychopharmacology as a new discipline with an important role in clinical psychiatry, there emerged an urgent need for scales that indicate the presence and measure the extent and severity of psychopathology. The AMDP scales, created in the context of the European tradition in psychopathology, are some of the most prominent and promising scales of this type.

HIV-related sexual risk behaviors among male-to-female transgender people in Nepal.

PubMed

Bhatta, Dharma Nand

2014-05-01

Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons. Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews. The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education. Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved.

Pilot study on use of home telephoning to identify and recruit high-risk individuals for lung cancer screening.

PubMed

Veronesi, Giulia; Colombo, Paolo; Novellis, Pierluigi; Crepaldi, Alessandro; Lutman, Romano Fabio; Dieci, Elisa; Profili, Manuel; Siracusano, Licia; Alloisio, Marco

2017-03-01

Widespread lung cancer screening with low-dose computed tomography is urgently needed in Europe to identify lung cancers early and reduce lung cancer deaths. The most effective method of identifying high-risk individuals and recruiting them for screening has not been determined. In the present pilot study we investigated direct telephoning to families as a way of identifying high risk individuals and recruiting them to a screening/smoking cessation program, that avoided the selection bias of voluntary screening. Families in the province of Milan, Italy, were contacted by telephone at their homes and asked about family members over 50 years who were heavy smokers (30 or more pack-years). Persons meeting these criteria were contacted and asked to participate in the program. Those who agreed were given an appointment to undergo screening and receive smoking cessation counseling. Among the 1000 contacted families, involving 2300 persons, 44 (1.9%) were eligible for LDCT screening, and 12 (27%) of these participated in the program. The cost of this recruitment strategy pilot study was around 150 euro per screened subject. We obtained useful information on the proportion of the general population eligible for lung cancer screening and the proportion of those who responded. However the cost of home telephone calling is probably too high to be practicable as a method of recruiting high risk persons for screening. Alternative recruitment methods, possibly involving family physicians practitioners, need to be investigated. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Risk of kidney stones with surgical intervention in living kidney donors.

PubMed

Thomas, S M; Lam, N N; Welk, B K; Nguan, C; Huang, A; Nash, D M; Prasad, G V R; Knoll, G A; Koval, J J; Lentine, K L; Kim, S J; Lok, C E; Garg, A X

2013-11-01

A kidney stone in a person with a solitary kidney requires urgent attention, which may result in surgical and/or hospital attention. We conducted a matched retrospective cohort study to determine if living kidney donors compared to healthy nondonors have a higher risk of: (i) kidney stones with surgical intervention, and (ii) hospital encounters for kidney stones. We reviewed all predonation charts for living kidney donations from 1992 to 2009 at five major transplant centers in Ontario, Canada, and linked this information to healthcare databases. We selected nondonors from the healthiest segment of the general population and matched 10 nondonors to every donor. Of the 2019 donors and 20 190 nondonors, none had evidence of kidney stones prior to cohort entry. Median follow-up time was 8.4 years (maximum 19.7 years; loss to follow-up <7%). There was no difference in the rate of kidney stones with surgical intervention in donors compared to nondonors (8.3 vs. 9.7 events/10 000 person-years; rate ratio 0.85; 95% confidence interval [CI] 0.47-1.53). Similarly there was no difference in the rate of hospital encounters for kidney stones (12.1 vs. 16.1 events/10 000 person-years; rate ratio 0.75; 95% CI 0.45-1.24). These interim results are reassuring for the safety of living kidney donation. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Treatment of gastric and duodenum ulcers by means of copper laser irradiation

NASA Astrophysics Data System (ADS)

Averbush, G. I.; Beliy, K. P.; Berezin, J. D.; Gidkov, B. N.; Solovjov, A. F.

1996-04-01

One of the leading problems of gastroenterology of our country is the task of ulcerative disease of the stomach treatment, duodenum treatment and diseases of large intestinal treatment. In spite of introduction of clinical practice the new anti-ulcerous preparations, the process of ulcerative disease of the stomach treatment remains a long process and makes in average about 2 - 4 weeks for acute ulcers and 2 - 3 months for chronic ulcers. In accordance with a world statistics an ulcerative disease of the stomach remains a very spread sickness (on the average 5 cases on 1 thousand persons), and even in the majority of countries at the last decade an increase of number of illness, stipulated by breach of ecology, stress, general worsening of human living conditions took place. Notice that the growth of exposure of morbidity in the area of alimentary tract to a certain extent is connected with introduction into diagnostics practice the endoscopical methods during a checkup of patients. Within Russia the statistics data give the following picture: (1) 500 - 700 persons per 100 thousand of inhabitants have an ulcerative disease and 15 - 20 persons from them have a steady resistance to an anti- ulcerative medicamental therapy. (2) At complex and electoral treatment of ulcerative disease patients with various preparations an epithelization have 60 - 94% of patients in the time of 20 - 48 days. (3) Insufficient efficiency of means of a conservative treatment results in that 50% of the sicks need urgent operations, sometimes at complicated for them conditions.

78 FR 9569 - Unexpected Urgent Refugee and Migration Needs Relating to Syria

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-08

... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population, Refugees, and...

Does Urgent Colonoscopy Improve Outcomes in the Management of Lower Gastrointestinal Bleeding?

PubMed

Seth, Ankur; Khan, Muhammad Ali; Nollan, Richard; Gupta, Deepansh; Kamal, Sehrish; Singh, Utkarsh; Kamal, Faisal; Howden, Colin W

2017-03-01

Colonoscopy continues to be an essential diagnostic and therapeutic tool in the management of lower gastrointestinal bleeding (LGIB). Studies that have evaluated the role of urgent colonoscopy for treating LGIB have reached conflicting conclusions. We conducted a systematic review and meta-analysis to evaluate the role of urgent colonoscopy in several outcomes in patients with LGIB. We searched Medline, Embase, Scopus and Cochrane databases from inception to July 10, 2016 for comparative studies evaluating the role of urgent versus elective colonoscopy in the management of LGIB. We evaluated mortality, rate of rebleeding, length of stay in hospital, identification of bleeding source, stigmata of recent hemorrhage and need for surgery. Pooled odds ratios (OR) were calculated for dichotomous variables whereas standard mean differences were calculated for continuous variables. We assessed quality using the Cochrane tool and Newcastle Ottawa Scale for randomized controlled trials and observational studies, respectively. We used the GRADE framework to interpret our findings. A total of 6 studies (2 randomized controlled trials and 4 observational studies) with 23,419 patients (9,498 urgent colonoscopy and 13,921 elective colonoscopy) were included in this meta-analysis. Pooled ORs with 95% CI for mortality, rebleeding and identification of bleeding source were 0.84 (0.46-1.53), 1.18 (0.64-2.16) and 1.49 (0.86-2.59), respectively. Stigmata of recent hemorrhage were more readily identified with urgent colonoscopy OR 2.85 (1.90-4.28). There were no differences in requirement for surgery, length of hospital stay or rate of endoscopic intervention. However, these effect sizes were limited by considerable heterogeneity, which was probably due to studies being conducted in different countries having different criteria for discharge and on variations in the type of endoscopic therapy for stigmata of recent hemorrhage. In conclusion, among patients with acute LGIB, there is no evidence that urgent colonoscopy reduces mortality, rebleeding or requirement for surgery or that it improves the rate of identification of the bleeding source. However, urgent colonoscopy does increase the rate of detection of stigmata of recent hemorrhage. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Analisis de Alteraciones EN la Imagen Debidas a Descolimacion de un Telescopio

NASA Astrophysics Data System (ADS)

Cobos, F. J.; Galan, M. J.

1987-05-01

Podemos considerar, en términos generales, que los espejos de un telescopio tienen una calidad óptica intrínseca, entendiendo por ésta la que se ha obtenido como resultado, fundamentalmente, de la destreza del personal del Taller Optico, que considerará terminadas las superficies ópticas cuando éstas satisfagan los requisitos de diseño y las pruebas de evaluación pertinentes. Debemos esperar que, una vez instalados los espejos en el telescopio, no se altere esta calidad de la óptica por un funcionamiento inadecuado de partes mecánicas del mismo. En los últimos años, en la medida que los problemas de infraestructuratura de nuestros Observatorios se han ido resolviendo, se ha hecho más patente la necesidad de llevar a la instrumentación existente al máximo de su potencial y parte esencial de ésta la conforman los mismos te lescopios. Mejorar la calidad óptica de las imágenes obtenidas con ellos ha hecho que sea prioritario el realizar una investigación más sistemática de sus características. Este trabajo ha tenido como objetivo primordial el usar un programa de diseño óptico, en el caso particular del telescopio UNAM212, con el fin de calcular y obtener gráficamente los diagramas de manchas de imagenes en foco y extrafocales, tanto con la óptica perfectamente alineada como descolimándola (mediante pequenos giros y descentramientos de los espejos). De esta manera, se hizo una evaluación de los efectos que estas alteraciones simuladas producirían en las imágenes focales y extra focales para así poder compararlas con las que realmente se han observado. Asimismo, se ha buscado información bibliográfica, en particular sobre los efectos de giros y descentramientos en las imágenes extrafocales, en lo que se ref iere a la falta de concentricidad de los círculos que forman la "dona" y a la distribución de intensidad luminosa en la misma. De ésta, l futuro un proceso que, haciendo uso de los detectores bidimensionales, nos permita Ilevar a cabo una alineación más rigurosa de la óptica del telescopio y evaluar con precisión Si variaciones en el posicionado del misesperamos desarrollar en emo producen efectos de descolimación.

Critical region within 22q11.2 linked to higher rate of autism spectrum disorder.

PubMed

Clements, Caitlin C; Wenger, Tara L; Zoltowski, Alisa R; Bertollo, Jennifer R; Miller, Judith S; de Marchena, Ashley B; Mitteer, Lauren M; Carey, John C; Yerys, Benjamin E; Zackai, Elaine H; Emanuel, Beverly S; McDonald-McGinn, Donna M; Schultz, Robert T

2017-01-01

Previous studies have reported no clear critical region for medical comorbidities in children with deletions or duplications of 22q11.2. The purpose of this study was to evaluate whether individuals with small nested deletions or duplications of the LCR-A to B region of 22q11.2 show an elevated rate of autism spectrum disorder (ASD) compared to individuals with deletions or duplications that do not include this region. We recruited 46 patients with nested deletions ( n  = 33) or duplications ( n  = 13) of 22q11.2, including LCR-A to B ( n del  = 11), LCR-A to C ( n del  = 4), LCR-B to D ( n del  = 14; n dup  = 8), LCR-C to D ( n del  = 4; n dup  = 2), and smaller nested regions ( n  = 3). Parent questionnaire, record review, and, for a subset, in-person evaluation were used for ASD diagnostic classification. Rates of ASD in individuals with involvement of LCR-B to LCR-D were compared with Fisher's exact test to LCR-A to LCR-B for deletions, and to a previously published sample of LCR-A to LCR-D for duplications. The rates of medical comorbidities and psychiatric diagnoses were determined from questionnaires and chart review. We also report group mean differences on psychiatric questionnaires. Individuals with deletions involving LCR-A to B showed a 39-44% rate of ASD compared to 0% in individuals whose deletions did not involve LCR-A to B. We observed similar rates of medical comorbidities in individuals with involvement of LCR-A to B and LCR-B to D for both duplications and deletions, consistent with prior studies. Children with nested deletions of 22q11.2 may be at greater risk for autism spectrum disorder if the region includes LCR-A to LCR-B. Replication is needed.

Earthquake Protection Measures for People with Disabilities

NASA Astrophysics Data System (ADS)

Gountromichou, C.; Kourou, A.; Kerpelis, P.

2009-04-01

The problem of seismic safety for people with disabilities not only exists but is also urgent and of primary importance. Working towards disability equality, Earthquake Planning and Protection Organization of Greece (E.P.P.O.) has developed an educational scheme for people with disabilities in order to guide them to develop skills to protect themselves as well as to take the appropriate safety measures before, during and after an earthquake. The framework of this initiative includes a number of actions have been already undertaken, including the following: a. Recently, the main guidelines have been published to help people who have physical, cognitive, visual, or auditory disabilities to cope with a destructive earthquake. Of great importance, in case of people with disabilities, is to be prepared for the disaster, with several measures that must be taken starting today. In the pre-earthquake period, it is important that these people, in addition to other measures, do the following: - Create a Personal Support Network The Personal Support Network should be a group of at least three trustful people that can assist the disabled person to prepare for a disastrous event and to recover after it. - Complete a Personal Assessment The environment may change after a destructive earthquake. People with disabilities are encouraged to make a list of their personal needs and their resources for meeting them in a disaster environment. b. Lectures and training seminars on earthquake protection are given for students, teachers and educators in Special Schools for disabled people, mainly for informing and familiarizing them with earthquakes and with safety measures. c. Many earthquake drills have already taken place, for each disability, in order to share good practices and lessons learned to further disaster reduction and to identify gaps and challenges. The final aim of this action is all people with disabilities to be well informed and motivated towards a culture of earthquake resilience, since Greece is one of the most seismically active countries of the world.

[Prevalence of mental disorder and related treatments in a local jail: a 20-month consecutive case study].

PubMed

Carrà, Giuseppe; Giacobone, Caterina; Pozzi, Florinda; Alecci, Pasquale; Barale, Francesco

2004-01-01

To define the prevalence of mental disorder within an Italian local jail and to describe main psychiatric treatments provided. Cross-sectional study of consecutive male prisoners referred, over a twenty-month period, for a clinical psychiatric assessment, among population (N = 990) of Casa circondariale "Torre del Gallo", Pavia (I); clinical DSM-IV diagnostic assessment and retrospective analysis of provided psychiatric treatments (i.e. psychiatric visits and pharmacological prescriptions). 191 men (19.3%) had one or more current mental disorders (excluding substance misuse), including 13 (1.3%) psychosis; 53 (5.4%) mood disorder; 24 (2.4%) anxiety disorder; 26 (2.6%) adjustment disorder; 40 (4.1%) personality disorder; 32 (3.2%) personality disorder plus mood disorder; 3 (0.3%) mental retardation. Substance- (N = 89, 47%) and HIV-related (N = 19, 10%) disorders comorbidity is recognised. Psychiatric visits are mainly provided to psychosis and personality disorder plus mood disorder subgroups. Off-label antipsychotics prescriptions are frequent. The prevalence of mental disorder in this population is higher than US and EU averages, and for particular diagnostic subgroups it could be underestimated. Psychiatric management in prison should be reorganized according to national and European health guidelines.

Stroke awareness and knowledge in an urban New Zealand population.

PubMed

Bay, Jacquie L; Spiroski, Ana-Mishel; Fogg-Rogers, Laura; McCann, Clare M; Faull, Richard L M; Barber, Peter A

2015-06-01

Stroke is the third most common cause of death and a major cause of chronic disability in New Zealand. Linked to risk factors that develop across the life-course, stroke is considered to be largely preventable. This study assessed the awareness of stroke risk, symptoms, detection, and prevention behaviors in an urban New Zealand population. Demographics, stroke risk factors awareness, symptoms, responsiveness, and prevention behaviors were evaluated using a structured oral questionnaire. Binomial logistic regression analyses were used to identify predictors of stroke literacy. Although personal experience of stroke increased awareness of symptoms and their likeliness to indicate the need for urgent medical attention, only 42.7% of the respondents (n = 850) identified stroke as involving both blood and the brain. Educational attainment at or above a trade certificate, apprenticeship, or diploma increased the awareness of stroke symptoms compared with those with no formal educational attainment. Pacific Island respondents were less likely than New Zealand Europeans to identify a number of stroke risk factors. Māori, Pacific Island, and Asian respondents were less likely to identify symptoms of stroke and indicate the need for urgent medical attention. The variability in stroke awareness and knowledge may suggest the need to enhance stroke-related health literacy that facilitates understanding of risk and of factors that reduce morbidity and mortality after stroke in people of Māori and Pacific Island descent and in those with lower educational attainment or socioeconomic status. It is therefore important that stroke awareness campaigns include tailored components for target audiences. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Parental satisfaction with paediatric care, triage and waiting times.

PubMed

Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

2014-04-01

The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

75 FR 67015 - Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-01

... September 3, 2010 Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan... humanitarian needs resulting from recent devastating flooding in Pakistan. You are authorized and directed to...

75 FR 34617 - Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-18

... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

75 FR 67013 - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-01

... August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan... humanitarian needs resulting from recent violence in Kyrgyzstan. You are authorized and directed to publish...

The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach.

PubMed

Dibble, Elizabeth H; Swenson, David W; Cobb, Cynthia; Paul, Timothy J; Karn, Andrew E; Portelli, David C; Movson, Jonathan S

2017-04-01

The goal of this project was to create a system that was easy for radiologists to use and that could reliably identify, communicate, and track communication of important but non-urgent radiology findings to providers and patients. Prior to 2012, our workflow for communicating important non-urgent diagnostic imaging results was cumbersome, rarely used by our radiologists, and resulted in delays in report turnaround time. In 2012, we developed a new system to communicate important non-urgent findings (the RADiology CATegorization 3 (RADCAT-3) system) that was easy for radiologists to use and documented communication of results in the electronic medical record. To evaluate the performance of the new system, we reviewed our radiology reports before (June 2011-June 2012) and after (June 2012-June 2014) the implementation of the new system to compare utilization by the radiologists and success in communicating these findings. During the 12 months prior to implementation, 250 radiology reports (0.06 % of all reports) entered our workflow for communicating important non-urgent findings. One-hundred percent were successfully communicated. During the 24 months after implementation, 13,158 radiology reports (1.4 % of all reports) entered our new RADCAT-3 workflow (3995 (0.8 % of all reports) during year 1 and 9163 (1.9 % of all reports) during year 2). 99.7 % of those reports were successfully communicated. We created a reliable system to ensure communication of important but non-urgent findings with providers and/or patients and to document that communication in the electronic medical record. The rapid adoption of the new system by radiologists suggests that they found it easy to use and had confidence in its integrity. This system has the potential to improve patient care by improving the likelihood of appropriate follow-up for important non-urgent findings that could become life threatening.

Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program

PubMed Central

Alkatheeri, Ali M.A.; Blake, Peter G.; Gray, Daryl; Jain, Arsh K.

2016-01-01

♦ Background: Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ Methods: In this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting. ♦ Results: Thirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7 %) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0 – 13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3 %) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch. ♦ Conclusions: Our results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access. PMID:26374834

Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program.

PubMed

Alkatheeri, Ali M A; Blake, Peter G; Gray, Daryl; Jain, Arsh K

2016-01-01

♦ Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ In this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting. ♦ Thirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7%) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0-13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3%) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch. ♦ Our results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access. Copyright © 2016 International Society for Peritoneal Dialysis.

Effectiveness of personalized face-to-face and telephone nursing counseling interventions for cardiovascular risk factors: a controlled clinical trial.

PubMed

Vílchez Barboza, Vivian; Klijn, Tatiana Paravic; Salazar Molina, Alide; Sáez Carrillo, Katia Lorena

2016-08-08

to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life. evaluar efecto y diferencias por sexo de una intervención innovadora "Consejería de Enfermería Personalizada y Telefónica", dirigida al control de factores de riesgo cardiovascular (hipertensión arterial, dislipidemia y sobrepeso) y al mejoramiento de la calidad de vida relacionada con la salud, fortaleciendo la autoeficacia y el apoyo social en personas usuarias del programa de salud cardiovascular de los Centros de Salud Municipales de Concepción. ensayo clínico controlado aleatoriamente y selección aleatoria de participantes; grupo intervención con consulta tradicional más consejería de enfermería personalizada y telefónica durante 7 meses (n=53); y grupo control (n=56); siguiendo la declaración del Consolidated Standards of Reporting Trials. mujeres del grupo intervención, presentaron aumento significativo con respecto al grupo control, en componentes de salud física y mental; disminución de: peso, circunferencia abdominal, colesterol total, colesterol lipoproteínas de baja densidad e índice de aterogenicidad. En hombres del grupo intervención se reflejó como efectos atribuibles a la intervención: 1) aumento en dimensiones del rol físico y emocional; 2) disminución: presión sistólica y diastólica, circunferencia abdominal, colesterol total, colesterol lipoproteínas de baja densidad, índice de aterogenicidad, factor de riesgo cardiovascular y riesgo coronario a 10 años. esta intervención es una estrategia efectiva para el control de tres factores de riesgo cardiovascular y mejoría de calidad de vida relacionada con la salud. avaliar o efeito e as diferenças por sexo de uma intervenção inovadora: o aconselhamento personalizado e por telefone em enfermagem, visando o controle de fatores de risco cardiovascular (hipertensão arterial, dislipidemia e sobrepeso) e a melhora na qualidade de vida relacionada à saúde, fortalecendo a autoeficácia e o apoio social a pessoas que usam o programa de saúde cardiovascular de Centros Municipais de Saúde. ensaio clínico controlado e randomizado, participantes randomizados, grupo de intervenção: consulta tradicional mais aconselhamento personalizado e por telefone em enfermagem por 7 meses (n = 53); e grupo de controle (n = 56); seguindo a declaração Consolidated Standards of Reporting Trials Statement. mulheres do grupo intervenção apresentaram um aumento significativo, em relação ao grupo controle, nos componentes de saúde mental e física, com diminuição do peso, circunferência abdominal, colesterol total, colesterol de lipoproteínas de baixa densidade e índice aterogênico. Em homens do grupo intervenção, os efeitos atribuíveis à intervenção foram: aumentos nos papeis físicos e emocionais, com diminuições na pressão sistólica e diastólica, circunferência abdominal, colesterol total, colesterol de lipoproteínas de baixa densidade, índice aterogênico, fator de risco cardiovascular e risco coronariano em 10 anos. essa intervenção é uma estratégia eficaz para o controle dos três fatores de risco cardiovascular e a melhora da qualidade de vida relacionada à saúde.

[Emergency Surgery and Treatments for Pneumothorax].

PubMed

Kurihara, Masatoshi

2015-07-01

The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

Impact of continuing medical education in cancer diagnosis on GP knowledge, attitude and readiness to investigate - a before-after study.

PubMed

Toftegaard, Berit Skjødeberg; Bro, Flemming; Falborg, Alina Zalounina; Vedsted, Peter

2016-07-26

Continuing medical education (CME) in earlier cancer diagnosis was launched in Denmark in 2012 as part of the Danish National Cancer Plan. The CME programme was introduced to improve the recognition among general practitioners (GPs) of symptoms suggestive of cancer and improve the selection of patients requiring urgent investigation. This study aims to explore the effect of CME on GP knowledge about cancer diagnosis, attitude towards own role in cancer detection, self-assessed readiness to investigate and cancer risk assessment of urgently referred patients. We conducted a before-after study in the Central Denmark Region including 831 GPs assigned to one of eight geographical clusters. All GPs were invited to participate in the CME at three-week intervals between clusters. A questionnaire focusing on knowledge, attitude and clinical vignettes was sent to each GP one month before and seven months after the CME. The GPs were also asked to assess the risk of cancer in patients urgently referred to a fast-track cancer pathway during an eight-month period. CME-participating GPs were compared with reference (non-participating) GPs by analysing before-after differences. One quarter of all GPs participated in the CME. 202 GPs (24.3 %) completed both the baseline and the follow-up questionnaires. 532 GPs (64.0 %) assessed the risk of cancer before the CME and 524 GPs (63.1 %) assessed the risk of cancer after the CME in urgently referred consecutive patients. Compared to the reference group, CME-participating GPs statistically significantly improved their understanding of a rational probability of diagnosing cancer among patients urgently referred for suspected cancer, increased their knowledge of cancer likelihood in a 50-year-old referred patient and lowered the assessed risk of cancer in urgently referred patients. The standardised CME lowered the GP-assessed cancer risk of urgently referred patients, whereas the effect on knowledge about cancer diagnosis and attitude towards own role in cancer detection was limited. No effect was found on the GPs' readiness to investigate. CME may be effective for optimising the interpretation of cancer symptoms and thereby improve the selection of patients for urgent cancer referral. NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.

[Right to life vs right to a determined quality of life. Reflections on human cloning].

PubMed

Maris Martínez, Stella

2003-01-01

This article studies the bioethic divergences appeared as a consequence of the use and therapeutic obtaining of stem cells. It also chronicles the development of the cloning techniques and then, following the parameters of Bioethics, it distinguishes a categorization of the cloning with reproductive aims and cloning with therapeutic aims. It emphasizes how this problematic takes us to the beginning of human life and to the determination of the moment where this one deserves ethic recognition and legal protection. It also marks that the impact that would have the development of the therapeutic-cloning over the quality of life of sick persons and old men changes the traditional points of view. It is necessary a urgent normative with intenational validity, nevertheless the real safeguard against abuses would only be possible by the respect to human dignity by all the people who are involve in the investigation of these techniques.

An intelligent artificial throat with sound-sensing ability based on laser induced graphene

PubMed Central

Tao, Lu-Qi; Tian, He; Liu, Ying; Ju, Zhen-Yi; Pang, Yu; Chen, Yuan-Quan; Wang, Dan-Yang; Tian, Xiang-Guang; Yan, Jun-Chao; Deng, Ning-Qin; Yang, Yi; Ren, Tian-Ling

2017-01-01

Traditional sound sources and sound detectors are usually independent and discrete in the human hearing range. To minimize the device size and integrate it with wearable electronics, there is an urgent requirement of realizing the functional integration of generating and detecting sound in a single device. Here we show an intelligent laser-induced graphene artificial throat, which can not only generate sound but also detect sound in a single device. More importantly, the intelligent artificial throat will significantly assist for the disabled, because the simple throat vibrations such as hum, cough and scream with different intensity or frequency from a mute person can be detected and converted into controllable sounds. Furthermore, the laser-induced graphene artificial throat has the advantage of one-step fabrication, high efficiency, excellent flexibility and low cost, and it will open practical applications in voice control, wearable electronics and many other areas. PMID:28232739

An intelligent artificial throat with sound-sensing ability based on laser induced graphene.

PubMed

Tao, Lu-Qi; Tian, He; Liu, Ying; Ju, Zhen-Yi; Pang, Yu; Chen, Yuan-Quan; Wang, Dan-Yang; Tian, Xiang-Guang; Yan, Jun-Chao; Deng, Ning-Qin; Yang, Yi; Ren, Tian-Ling

2017-02-24

Traditional sound sources and sound detectors are usually independent and discrete in the human hearing range. To minimize the device size and integrate it with wearable electronics, there is an urgent requirement of realizing the functional integration of generating and detecting sound in a single device. Here we show an intelligent laser-induced graphene artificial throat, which can not only generate sound but also detect sound in a single device. More importantly, the intelligent artificial throat will significantly assist for the disabled, because the simple throat vibrations such as hum, cough and scream with different intensity or frequency from a mute person can be detected and converted into controllable sounds. Furthermore, the laser-induced graphene artificial throat has the advantage of one-step fabrication, high efficiency, excellent flexibility and low cost, and it will open practical applications in voice control, wearable electronics and many other areas.

Towards human behavior recognition based on spatio temporal features and support vector machines

NASA Astrophysics Data System (ADS)

Ghabri, Sawsen; Ouarda, Wael; Alimi, Adel M.

2017-03-01

Security and surveillance are vital issues in today's world. The recent acts of terrorism have highlighted the urgent need for efficient surveillance. There is indeed a need for an automated system for video surveillance which can detect identity and activity of person. In this article, we propose a new paradigm to recognize an aggressive human behavior such as boxing action. Our proposed system for human activity detection includes the use of a fusion between Spatio Temporal Interest Point (STIP) and Histogram of Oriented Gradient (HoG) features. The novel feature called Spatio Temporal Histogram Oriented Gradient (STHOG). To evaluate the robustness of our proposed paradigm with a local application of HoG technique on STIP points, we made experiments on KTH human action dataset based on Multi Class Support Vector Machines classification. The proposed scheme outperforms basic descriptors like HoG and STIP to achieve 82.26% us an accuracy value of classification rate.

Quantitative imaging of disease signatures through radioactive decay signal conversion

PubMed Central

Thorek, Daniel LJ; Ogirala, Anuja; Beattie, Bradley J; Grimm, Jan

2013-01-01

In the era of personalized medicine there is an urgent need for in vivo techniques able to sensitively detect and quantify molecular activities. Sensitive imaging of gamma rays is widely used, but radioactive decay is a physical constant and signal is independent of biological interactions. Here we introduce a framework of novel targeted and activatable probes excited by a nuclear decay-derived signal to identify and measure molecular signatures of disease. This was accomplished utilizing Cerenkov luminescence (CL), the light produced by β-emitting radionuclides such as clinical positron emission tomography (PET) tracers. Disease markers were detected using nanoparticles to produce secondary Cerenkov-induced fluorescence. This approach reduces background signal compared to conventional fluorescence imaging. In addition to information from a PET scan, we demonstrate novel medical utility by quantitatively determining prognostically relevant enzymatic activity. This technique can be applied to monitor other markers and facilitates a shift towards activatable nuclear medicine agents. PMID:24013701

Research on the optimization strategy of web search engine based on data mining

NASA Astrophysics Data System (ADS)

Chen, Ronghua

2018-04-01

With the wide application of search engines, web site information has become an important way for people to obtain information. People have found that they are growing in an increasingly explosive manner. Web site information is verydifficult to find the information they need, and now the search engine can not meet the need, so there is an urgent need for the network to provide website personalized information service, data mining technology for this new challenge is to find a breakthrough. In order to improve people's accuracy of finding information from websites, a website search engine optimization strategy based on data mining is proposed, and verified by website search engine optimization experiment. The results show that the proposed strategy improves the accuracy of the people to find information, and reduces the time for people to find information. It has an important practical value.

Childhood emotional abuse, negative emotion-driven impulsivity, and alcohol use in young adulthood☆

PubMed Central

Shin, Sunny H.; Lee, Sungkyu; Jeon, Sae-Mi; Wills, Thomas A.

2015-01-01

Childhood emotional abuse has been linked to problematic alcohol use in later life but there is a paucity of empirically based knowledge about the developmental pathways linking emotional abuse and alcohol use in young adulthood. Using a community sample of young individuals aged 18–25 (N = 268; female 52%), we performed structural equation modeling to investigate whether emotional abuse influences alcohol use through urgent personality trait and to determine pathways for these effects in a multivariate context. We also examined variations in these pathways by four different alcohol use outcomes including frequency of alcohol use, binge drinking, alcohol-related problems, and alcohol use disorders (AUD). The present study found that emotional abuse was related to urgency, which in turn influenced four types of alcohol use. Urgency may play a significant role in linking childhood maltreatment to alcohol use in young adulthood. PMID:25743371

Childhood emotional abuse, negative emotion-driven impulsivity, and alcohol use in young adulthood.

PubMed

Shin, Sunny H; Lee, Sungkyu; Jeon, Sae-Mi; Wills, Thomas A

2015-12-01

Childhood emotional abuse has been linked to problematic alcohol use in later life but there is a paucity of empirically based knowledge about the developmental pathways linking emotional abuse and alcohol use in young adulthood. Using a community sample of young individuals aged 18-25 (N=268; female 52%), we performed structural equation modeling to investigate whether emotional abuse influences alcohol use through urgent personality trait and to determine pathways for these effects in a multivariate context. We also examined variations in these pathways by four different alcohol use outcomes including frequency of alcohol use, binge drinking, alcohol-related problems, and alcohol use disorders (AUD). The present study found that emotional abuse was related to urgency, which in turn influenced four types of alcohol use. Urgency may play a significant role in linking childhood maltreatment to alcohol use in young adulthood. Copyright © 2015. Published by Elsevier Ltd.

An intelligent artificial throat with sound-sensing ability based on laser induced graphene

NASA Astrophysics Data System (ADS)

Tao, Lu-Qi; Tian, He; Liu, Ying; Ju, Zhen-Yi; Pang, Yu; Chen, Yuan-Quan; Wang, Dan-Yang; Tian, Xiang-Guang; Yan, Jun-Chao; Deng, Ning-Qin; Yang, Yi; Ren, Tian-Ling

2017-02-01

Traditional sound sources and sound detectors are usually independent and discrete in the human hearing range. To minimize the device size and integrate it with wearable electronics, there is an urgent requirement of realizing the functional integration of generating and detecting sound in a single device. Here we show an intelligent laser-induced graphene artificial throat, which can not only generate sound but also detect sound in a single device. More importantly, the intelligent artificial throat will significantly assist for the disabled, because the simple throat vibrations such as hum, cough and scream with different intensity or frequency from a mute person can be detected and converted into controllable sounds. Furthermore, the laser-induced graphene artificial throat has the advantage of one-step fabrication, high efficiency, excellent flexibility and low cost, and it will open practical applications in voice control, wearable electronics and many other areas.

Data-protection standards and confidentiality of HIV/AIDS status in the workplace - a South African case study.

PubMed

Muskat-Gorska, Zuzanna

2008-11-01

The article contextualises an emerging new regime for information privacy in South Africa (i.e. the draft Protection of Personal Information Bill). Subsequently, it discusses the possibility of successful implementation of international data-protection standards in an environment where there is an urgent need to balance HIV/AIDS confidentiality rights with public health requirements. Also, the article presents a preliminary assessment of the possible impact of professionalisation (and outsourcing) of workplace HIV/AIDS management on workplace data-protection practices, and it identifies some spaces for social dialogue on HIV/AIDS-data treatment in South Africa. The study methods comprise an analysis of legal documents (concerning international data-protection standards and the development of law governing data protection and HIV/AIDS confidentiality in South Africa) and interviews conducted with workplace health managers and trade union representatives, in Johannesburg, in 2007.

Dietary guidelines in type 2 diabetes: the Nordic diet or the ketogenic diet?

PubMed

Magnusdottir, Ola K; Gunnarsdottir, Ingibjorg; Birgisdóttir, Bryndís E

2017-10-01

To highlight recent developments in research regarding nutrition therapies for type 2 diabetes mellitus (T2DM) with a focus on the different approaches of the Nordic diet and the ketogenic diet. Recent short-term studies have revealed that similar beneficial outcomes are seen after different dietary treatments for T2DM, with different approaches resulting in comparable weight loss and impacts on metabolic factors. More individualized approaches in nutrition therapy should be considered for T2DM patients and clinical guidelines should reflect this. More studies, especially long-term studies, are urgently needed on the impacts of the diets on different health parameters. Such studies should be prioritized because of the high and increasing prevalence of T2DM and because dietary changes may have greater benefits than previously thought. Furthermore, studies that focus on patient compliance to different types of diets, and personal and environmental factors that may affect compliance, are needed.

The 'medical body' as philosophy's arena.

PubMed

Evans, M

2001-01-01

Medicine, as Byron Good argues, reconstitutes the human body of our daily experience as a "medical body," unfamiliar outside medicine. This reconstitution can be seen in two ways: (i) as a salutary reminder of the extent to which the reality even of the human body is constructed; and (ii) as an arena for what Stephen Toulmin distinguishes as the "intersection" of natural science and history, in which many of philosophy's traditional (and traditionally abstract) questions are given concrete and urgent form. This paper begins by examining a number of dualities between the medical body and the body familiar in daily experience. Toulmin's epistemological analysis of clinical medicine as combining both universal and existential knowledge is then considered. Their expression, in terms of attention, respectively, to natural science and to personal history, is explored through the epistemological contrasts between the medical body and the familiar body, noting the traditional philosophical questions which they in turn illustrate.

[Energy saving and LED lamp lighting and human health].

PubMed

Deĭnego, V N; Kaptsov, V A

2013-01-01

The appearance of new sources of high-intensity with large proportion of blue light in the spectrum revealed new risks of their influence on the function of the eye and human health, especially for children and teenagers. There is an urgent need to reconsider the research methods of vision hygiene in conditions of energy-saving and LED bulbs lighting. On the basis of a systematic approach and knowledge of the newly discovered photosensitive receptors there was built hierarchical model of the interaction of "light environment - the eye - the system of formation of visual images - the hormonal system of the person - his psycho-physiological state." This approach allowed us to develop a range of risk for the negative impact of spectrum on the functions of the eye and human health, as well as to formulate the hygiene requirements for energy-efficient high-intensity light sources.

Exposure to cats: update on risks for sensitization and allergic diseases.

PubMed

Dharmage, Shyamali C; Lodge, Caroline L; Matheson, Melanie C; Campbell, Brittany; Lowe, Adrian J

2012-10-01

Cats are the pets most commonly implicated in the etiology of asthma and allergic disease. However, systematic reviews have concluded that there is a lack of evidence to support the idea that cat exposure in early life increases the risk of allergic disease. Indeed, it appears most likely that cat exposure is protective against allergic diseases. Recent large prospective studies have shown that living with a cat during childhood, especially during the first year of a child's life, could be protective. However, any advice given to the parents should also incorporate how new acquisition of cats can affect other family members, especially those who are already sensitized. Research is urgently needed to determine whether the suggested impact of acquisition of cats in adult life is modified by the person's childhood pet ownership, to help parents who seek advice on whether or not to get a cat.

[Medical ethics as professional ethics].

PubMed

Kwon, Ivo

2012-09-25

Contemporary medical ethics is far from the traditional concept of "In-Sul (benevolent art)" or "Yul-Li (倫, ethics), which emphasizes so much the personality or the character of a doctor. Nowadays, medical ethics should be considered as "professional ethics" which regulates the acts and medical practices of ordinary doctors in their daily practice. The key concepts of the professional ethics are "autonomy", "integrity", and "professional standard" established by medical organizations such as medical societies or associations. Most of Korean doctors have not been familiar with the concept of professional ethics or professionalism, which is due to the modern history of Korea. However, the concept of professional ethics is really critical to Korean doctors from the perspective of professional dignity and social respect to this profession. The current healthcare system of Korea is suffering from many problems of both private and public sector. Nonetheless, the professional ethics is urgently demanded for that very reason.

Theranostics in nuclear medicine practice.

PubMed

Yordanova, Anna; Eppard, Elisabeth; Kürpig, Stefan; Bundschuh, Ralph A; Schönberger, Stefan; Gonzalez-Carmona, Maria; Feldmann, Georg; Ahmadzadehfar, Hojjat; Essler, Markus

2017-01-01

The importance of personalized medicine has been growing, mainly due to a more urgent need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets can help predict if a patient will benefit from a particular treatment. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents has been continually increasing. In this article, important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with a well-known radioiodine therapy in patients with thyroid cancer and then progresses through various approaches for the treatment of advanced cancer with targeted therapies. The aim of this review was to provide a summary of background knowledge and current applications, and to identify the advantages of targeted therapies and imaging in nuclear medicine practices.

Theranostics in nuclear medicine practice

PubMed Central

Yordanova, Anna; Eppard, Elisabeth; Kürpig, Stefan; Bundschuh, Ralph A; Schönberger, Stefan; Gonzalez-Carmona, Maria; Feldmann, Georg; Ahmadzadehfar, Hojjat; Essler, Markus

2017-01-01

The importance of personalized medicine has been growing, mainly due to a more urgent need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets can help predict if a patient will benefit from a particular treatment. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents has been continually increasing. In this article, important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with a well-known radioiodine therapy in patients with thyroid cancer and then progresses through various approaches for the treatment of advanced cancer with targeted therapies. The aim of this review was to provide a summary of background knowledge and current applications, and to identify the advantages of targeted therapies and imaging in nuclear medicine practices. PMID:29042793

Oral drug delivery in personalized medicine: unmet needs and novel approaches.

PubMed

Wening, Klaus; Breitkreutz, Jörg

2011-02-14

Increasing knowledge into personalized medicine has demonstrated the need for individual dosing. Drug dosage forms are urgently needed enabling an individual therapy, especially for oral drug delivery. This review is focusing on approaches for solid and liquid oral dosage forms for individual dosing. The proposed dosage forms and devices may be distinguished into assembling and partition concepts and have been categorized regarding their applicability, costs, dose flexibility and potential benefits. Opportunities, challenges and further unmet needs are elaborated and critically discussed. Liquid dosage forms can be accurately dosed by novel dropping tubes or oral syringes, but less precisely by dosing spoons and cups. Breaking scored tablets into fragments show major risks such as inaccurate dosing, formation of potent dust and stability issues of the residual segments. Novel approaches are proposed for solid dosage forms enabling a flexible and appropriate therapy such as various dispensers for multiparticulate drug formulations. However, most of the proposals still have to prove their applicability in practice. Promising concepts are the solid dosage pen and drug-loaded oral films which can be cut in individual sections enabling freely selectable doses. Further research and development are required for novel dosage forms and medical devices appropriate for individualized therapy. Copyright © 2010 Elsevier B.V. All rights reserved.

Application of in vitro cell transformation assays in regulatory toxicology for pharmaceuticals, chemicals, food products and cosmetics.

PubMed

Vanparys, Philippe; Corvi, Raffaella; Aardema, Marilyn J; Gribaldo, Laura; Hayashi, Makoto; Hoffmann, Sebastian; Schechtman, Leonard

2012-04-11

Two year rodent bioassays play a key role in the assessment of carcinogenic potential of chemicals to humans. The seventh amendment to the European Cosmetics Directive will ban in 2013 the marketing of cosmetic and personal care products that contain ingredients that have been tested in animal models. Thus 2-year rodent bioassays will not be available for cosmetics/personal care products. Furthermore, for large testing programs like REACH, in vivo carcinogenicity testing is impractical. Alternative ways to carcinogenicity assessment are urgently required. In terms of standardization and validation, the most advanced in vitro tests for carcinogenicity are the cell transformation assays (CTAs). Although CTAs do not mimic the whole carcinogenesis process in vivo, they represent a valuable support in identifying transforming potential of chemicals. CTAs have been shown to detect genotoxic as well as non-genotoxic carcinogens and are helpful in the determination of thresholds for genotoxic and non-genotoxic carcinogens. The extensive review on CTAs by the OECD (OECD (2007) Environmental Health and Safety Publications, Series on Testing and Assessment, No. 31) and the proven within- and between-laboratories reproducibility of the SHE CTAs justifies broader use of these methods to assess carcinogenic potential of chemicals. Copyright © 2012 Elsevier B.V. All rights reserved.

Massive outbreak of poliomyelitis caused by type-3 wild poliovirus in Angola in 1999.

PubMed Central

Valente, F.; Otten, M.; Balbina, F.; Van de Weerdt, R.; Chezzi, C.; Eriki, P.; Van-Dúnnen, J.; Bele, J. M.

2000-01-01

The largest outbreak of poliomyelitis ever recorded in Africa (1093 cases) occurred from 1 March to 28 May 1999 in Luanda, Angola, and in surrounding areas. The outbreak was caused primarily by a type-3 wild poliovirus, although type-1 wild poliovirus was circulating in the outbreak area at the same time. Infected individuals ranged in age from 2 months to 22 years; 788 individuals (72%) were younger than 3 years. Of the 590 individuals whose vaccination status was known, 23% had received no vaccine and 54% had received fewer than three doses of oral poliovirus vaccine (OPV). The major factors that contributed to this outbreak were as follows: massive displacement of unvaccinated persons to urban settings; low routine OPV coverage; inaccessible populations during the previous three national immunization days (NIDs); and inadequate sanitation. This outbreak indicates the urgent need to improve accessibility to all children during NIDs and the dramatic impact that war can have by displacing persons and impeding access to routine immunizations. The period immediately after an outbreak provides an enhanced opportunity to eradicate poliomyelitis. If continuous access in all districts for acute flaccid paralysis surveillance and supplemental immunizations cannot be assured, the current war in Angola may threaten global poliomyelitis eradication. PMID:10812730

Correlates of Smoke-Free Home Policies in Shanghai, China

PubMed Central

Kegler, Michelle C.; Berg, Carla J.; Wang, Jing; Zhou, Xilan; Liu, Dong

2014-01-01

Background. Approximately 63.7% of nonsmokers in China are exposed to secondhand smoke (SHS) in their homes. The current study documents the prevalence and correlates of smoke-free home policies in Shanghai, as well as reasons for implementing such a policy and places where smoking is most commonly allowed. Methods. We conducted in-person surveys of 500 participants using a multistage proportional random sampling design in an urban and suburban district. Results. Overall, 35.3% had a smoke-free home policy. In the logistic regression, having higher income, not having smokers in the home, having children in the home, having fewer friends/relatives who permit smoking at home, and not being a current smoker were correlates of having a smoke-free home policy (P < 0.05). Concern about the health impact of SHS was reportedly the most important reason for establishing a smoke-free home. Among participants with no or partial bans, the most common places where smoking was allowed included the living room (64.2%), kitchen (46.1%), and bathroom (33.8%). Conclusions. Smoke-free home policies were in place for a minority of households surveyed. Establishing such a policy was influenced by personal smoking behavior and social factors. These findings suggest an urgent need to promote smoke-free home policies through tobacco control programs. PMID:25061606

Correlates of smoke-free home policies in Shanghai, China.

PubMed

Zheng, Pinpin; Kegler, Michelle C; Berg, Carla J; Fu, Wenjie; Wang, Jing; Zhou, Xilan; Liu, Dong; Fu, Hua

2014-01-01

Approximately 63.7% of nonsmokers in China are exposed to secondhand smoke (SHS) in their homes. The current study documents the prevalence and correlates of smoke-free home policies in Shanghai, as well as reasons for implementing such a policy and places where smoking is most commonly allowed. We conducted in-person surveys of 500 participants using a multistage proportional random sampling design in an urban and suburban district. Overall, 35.3% had a smoke-free home policy. In the logistic regression, having higher income, not having smokers in the home, having children in the home, having fewer friends/relatives who permit smoking at home, and not being a current smoker were correlates of having a smoke-free home policy (P < 0.05). Concern about the health impact of SHS was reportedly the most important reason for establishing a smoke-free home. Among participants with no or partial bans, the most common places where smoking was allowed included the living room (64.2%), kitchen (46.1%), and bathroom (33.8%). Smoke-free home policies were in place for a minority of households surveyed. Establishing such a policy was influenced by personal smoking behavior and social factors. These findings suggest an urgent need to promote smoke-free home policies through tobacco control programs.

The Cost and Threshold Analysis of Retention in Care (RiC): A Multi-Site National HIV Care Program.

PubMed

Maulsby, Catherine; Jain, Kriti M; Weir, Brian W; Enobun, Blessing; Riordan, Maura; Charles, Vignetta E; Holtgrave, David R

2017-03-01

Persons diagnosed with HIV but not retained in HIV medical care accounted for the majority of HIV transmissions in 2009 in the United States (US). There is an urgent need to implement and disseminate HIV retention in care programs; however little is known about the costs associated with implementing retention in care programs. We assessed the costs and cost-saving thresholds for seven Retention in Care (RiC) programs implemented in the US using standard methods recommended by the US Panel on Cost-effectiveness in Health and Medicine. Data were gathered from accounting and program implementation records, entered into a standardized RiC economic analysis spreadsheet, and standardized to a 12 month time frame. Total program costs for from the societal perspective ranged from $47,919 to $423,913 per year or $146 to $2,752 per participant. Cost-saving thresholds ranged from 0.13 HIV transmissions averted to 1.18 HIV transmission averted per year. We estimated that these cost-saving thresholds could be achieved through 1 to 16 additional person-years of viral suppression. Across a range of program models, retention in care interventions had highly achievable cost-saving thresholds, suggesting that retention in care programs are a judicious use of resources.

Accountability for Community-Based Programs for the Seriously Ill.

PubMed

Teno, Joan M; Montgomery, Russ; Valuck, Tom; Corrigan, Janet; Meier, Diane E; Kelley, Amy; Curtis, J Randall; Engelberg, Ruth

2018-03-01

Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system. A series of articles written by experts provided the basis for debate and guidance in formulating a path forward to develop an accountability system for community-based programs for the seriously ill, outlined in this article. As we innovate in existing population-based payment programs such as Medicare Advantage and develop new alternative payment models, it is important and urgent that we develop the foundation for accountability along with actionable measures so that the healthcare system ensures high-quality person- and family-centered care for persons who are seriously ill.

A Systematic Review of Risk Factors Prospectively Associated with Borderline Personality Disorder: Taking Stock and Moving Forward

PubMed Central

Stepp, Stephanie D.; Lazarus, Sophie A.; Byrd, Amy L.

2016-01-01

There is an urgent need to identify signs that harbinger onset of borderline personality disorder (BPD). Advancement in this area is required to refine developmental theories, discover etiological mechanisms, improve early detection, and achieve our ultimate goal of prevention. Though many studies have supported a wide range of factors that increase subsequent risk for BPD, this literature has yet to be critically evaluated, and there are no comprehensive reviews that examine and integrate these findings. To address this limitation, we conducted a systematic review to summarize and synthesize the current literature. Electronic databases were systematically searched for prospective, longitudinal studies that examined risk factors of subsequent BPD outcomes (features, symptoms, diagnosis) resulting in a total of 39 studies, reflecting 24 unique samples. Though increased risk for BPD was reliably attributed to multiple factors within social, family, maltreatment, and child domains, the most striking limitation of this research is its lack of disorder-specific findings Additional limitations, including notable heterogeneity in sampling methodology, symptom assessment methodology, and developmental timing of assessments, are discussed in terms of how close are we to pinpointing who is most at risk and why in an attempt to provide a roadmap for future research. PMID:27709988

Accountability for Community-Based Programs for the Seriously Ill

PubMed Central

Montgomery, Russ; Valuck, Tom; Corrigan, Janet; Meier, Diane E.; Kelley, Amy; Curtis, J. Randall; Engelberg, Ruth

2018-01-01

Abstract Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system. A series of articles written by experts provided the basis for debate and guidance in formulating a path forward to develop an accountability system for community-based programs for the seriously ill, outlined in this article. As we innovate in existing population-based payment programs such as Medicare Advantage and develop new alternative payment models, it is important and urgent that we develop the foundation for accountability along with actionable measures so that the healthcare system ensures high-quality person- and family-centered care for persons who are seriously ill. PMID:29195052

A systematic review of risk factors prospectively associated with borderline personality disorder: Taking stock and moving forward.

PubMed

Stepp, Stephanie D; Lazarus, Sophie A; Byrd, Amy L

2016-10-01

There is an urgent need to identify signs that harbinger onset of borderline personality disorder (BPD). Advancement in this area is required to refine developmental theories, discover etiological mechanisms, improve early detection, and achieve our ultimate goal of prevention. Though many studies have supported a wide range of factors that increase subsequent risk for BPD, this literature has yet to be critically evaluated, and there are no comprehensive reviews that examine and integrate these findings. To address this limitation, we conducted a systematic review to summarize and synthesize the current literature. Electronic databases were systematically searched for prospective, longitudinal studies that examined risk factors of subsequent BPD outcomes (features, symptoms, diagnosis), resulting in a total of 39 studies, reflecting 24 unique samples. Though increased risk for BPD was reliably attributed to multiple factors within social, family, maltreatment, and child domains, the most striking limitation of this research is its lack of disorder-specific findings. Additional limitations, including notable heterogeneity in sampling methodology, symptom assessment methodology, and developmental timing of assessments, are discussed in terms of how close we are to pinpointing who is most at risk and why in an attempt to provide a roadmap for future research. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Hereditary breast and ovarian cancer: successful systematic implementation of a group approach to genetic counselling.

PubMed

Benusiglio, Patrick R; Di Maria, Marina; Dorling, Leila; Jouinot, Anne; Poli, Antoine; Villebasse, Sophie; Le Mentec, Marine; Claret, Béatrice; Boinon, Diane; Caron, Olivier

2017-01-01

The increase in referrals to cancer genetics clinics, partially associated with the "Angelina Jolie effect", presents a challenge to existing services, many are already running at full capacity. More efficient ways to deliver genetic counselling are therefore urgently needed. We now systematically offer group instead of standard individual counselling to patients with suspected Hereditary Breast and Ovarian Cancer. Group sessions last 30 min. The first twenty consist of a presentation by the genetic counsellor, the next ten of a discussion involving a cancer geneticist and a psychologist. A short individual consultation ensues, where personal and family issues are addressed and consent obtained. Blood is drawn afterwards. Satisfaction and knowledge are evaluated. We report data for the Oct-2014-Aug-2015 period. 210 patients attended group counselling, up to eight simultaneously. We always fitted them within a 4-h time frame. Mean satisfaction score was 41/43. Knowledge scores increased from 3.1/6 to 4.9/6 post-counselling (p value < 2.2 × 10 -16 ). Thanks to group counselling, we have withstood increases in referrals without compromising care. The "Angelina Jolie effect" and rapid developments in personalized medicine threaten to overwhelm cancer genetics clinics. In this context, our innovative approach should ensure that all patients have access to approved services.

Managing, Analysing, and Integrating Big Data in Medical Bioinformatics: Open Problems and Future Perspectives

PubMed Central

Merelli, Ivan; Pérez-Sánchez, Horacio; Gesing, Sandra; D'Agostino, Daniele

2014-01-01

The explosion of the data both in the biomedical research and in the healthcare systems demands urgent solutions. In particular, the research in omics sciences is moving from a hypothesis-driven to a data-driven approach. Healthcare is additionally always asking for a tighter integration with biomedical data in order to promote personalized medicine and to provide better treatments. Efficient analysis and interpretation of Big Data opens new avenues to explore molecular biology, new questions to ask about physiological and pathological states, and new ways to answer these open issues. Such analyses lead to better understanding of diseases and development of better and personalized diagnostics and therapeutics. However, such progresses are directly related to the availability of new solutions to deal with this huge amount of information. New paradigms are needed to store and access data, for its annotation and integration and finally for inferring knowledge and making it available to researchers. Bioinformatics can be viewed as the “glue” for all these processes. A clear awareness of present high performance computing (HPC) solutions in bioinformatics, Big Data analysis paradigms for computational biology, and the issues that are still open in the biomedical and healthcare fields represent the starting point to win this challenge. PMID:25254202

Falls and Hospitalizations Among Persons With Dementia and Associated Caregiver Emotional Difficulties.

PubMed

Leggett, Amanda N; Polenick, Courtney A; Maust, Donovan T; Kales, Helen C

2018-03-19

Falls and hospitalizations are adverse health events commonly experienced by persons with dementia (PWDs). These events often require urgent care from a family caregiver and may increase caregiver stress. We examine falls and hospitalizations among PWDs as predictors of caregivers' reported care-related emotional difficulty, in addition to care-related stressors. Cross-sectional telephone survey of 652 informal caregivers for PWDs. A multinomial logistic regression examined falls (last month) and hospitalizations (prior year) experienced by PWDs as predictors of caregivers' care-related emotional difficulty, accounting for demographic characteristics and primary and secondary caregiving stressors. Over 20% of caregivers reported high levels of care-related emotional difficulty. Controlling for demographic characteristics and primary and secondary caregiving stressors, the PWD's prior month fall was significantly associated with greater care-related emotional difficulty; the PWD's hospitalizations were not associated with care-related emotional difficulty. Approximately 30% of PWDs had experienced a past year hospitalization and prior month fall, and one in five caregivers reported high emotional difficulty related to care. Although secondary strains and resources of caregiving were strong predictors of care-related emotional difficulty, PWDs' falls represent a significant stressor that increases odds of caregiver emotional difficulty over and above other strains. Consequently, a fall experienced by a PWD may represent a key time for clinicians to assess caregiver well-being.

Effects of Social Needs Screening and In-Person Service Navigation on Child Health: A Randomized Clinical Trial.

PubMed

Gottlieb, Laura M; Hessler, Danielle; Long, Dayna; Laves, Ellen; Burns, Abigail R; Amaya, Anais; Sweeney, Patricia; Schudel, Christine; Adler, Nancy E

2016-11-07

Social determinants of health shape both children's immediate health and their lifetime risk for disease. Increasingly, pediatric health care organizations are intervening to address family social adversity. However, little evidence is available on the effectiveness of related interventions. To evaluate the effects of social needs screening and in-person resource navigation services on social needs and child health. Patients were randomized to intervention or active control conditions by the day of the week. Primary outcomes observed at 4 months after enrollment included caregivers' reports of social needs and child health status. Recruitment occurred between October 13, 2013, and August 27, 2015, in pediatric primary and urgent care clinics in 2 safety-net hospitals. Participants were English-speaking or Spanish-speaking caregivers accompanying minor children to nonacute medical visits. After standardized screening, caregivers either received written information on relevant community services (active control) or received in-person help to access services with follow-up telephone calls for further assistance if needed (navigation intervention). Change in reported social needs and in caregiver assessment of child's overall health reported 4 months later. Among 1809 patients enrolled in the study, evenly split between the 2 sites, 31.6% (n = 572) were enrolled in a primary care clinic and 68.4% (n = 1237) were enrolled in an urgent care setting. The children were primarily Hispanic white individuals (50.9% [n = 921]) and non-Hispanic black individuals (26.2% [n = 473]) and had a mean (SD) age of 5.1 (4.8) years; 50.5% (n = 913) were female. The reported number of social needs at baseline ranged from 0 to 11 of 14 total possible items, with a mean (SD) of 2.7 (2.2). At 4 months after enrollment, the number of social needs reported by the intervention arm decreased more than that reported by the control arm, with a mean (SE) change of -0.39 (0.13) vs 0.22 (0.13) (P < .001). In addition, caregivers in the intervention arm reported significantly greater improvement in their child's health, with a mean (SE) change of -0.36 (0.05) vs -0.12 (0.05) (P < .001). To our knowledge, this investigation is the first randomized clinical trial to evaluate health outcomes of a pediatric social needs navigation program. Compared with an active control at 4 months after enrollment, the intervention significantly decreased families' reports of social needs and significantly improved children's overall health status as reported by caregivers. These findings support the feasibility and potential effect of addressing social needs in pediatric health care settings. clinicaltrials.gov Identifier: NCT01939704.

Cytogenetic Studies of Rwandan Pediatric Patients Presenting with Global Developmental Delay, Intellectual Disability and/or Multiple Congenital Anomalies.

PubMed

Uwineza, Annette; Hitayezu, Janvier; Jamar, Mauricette; Caberg, Jean-Hubert; Murorunkwere, Seraphine; Janvier, Ndinkabandi; Bours, Vincent; Mutesa, Leon

2016-02-01

Global developmental delay (GDD) is defined as a significant delay in two or more developmental domains: gross or fine motor, speech/language, cognitive, social/personal and activities of daily living. Many of these children will go on to be diagnosed with intellectual disability (ID), which is most commonly defined as having an IQ <75 in addition to impairment in adaptive functioning. Cytogenetic studies have been performed in 664 Rwandan pediatric patients presenting GDD/ID and/or multiple congenital abnormalities (MCA). Karyotype analysis was performed in all patients and revealed 260 chromosomal abnormalities. The most frequent chromosomal abnormality was Down syndrome and then Edward syndrome and Patau syndrome. Other identified chromosomal abnormalities included 47,XX,+del(9)(q11), 46,XY,del(13)(q34) and 46,XX,der(22)t(10;22)(p10;p10)mat. In conclusion, our results highlight the high frequency of cytogenetically detectable abnormalities in this series, with implications for the burden on the healthcare. This study demonstrates the importance of cytogenetic analysis in patients with GDD/ID and MCA. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study

PubMed Central

Keizer Beache, Simone; Guell, Cornelia

2016-01-01

Objective We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. Methods In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. Results In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. Conclusions We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. PMID:25841166

Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana

PubMed Central

Mash, Robert; Phaladze, Nthabiseng

2015-01-01

Background Botswana has a shortage of health care workers, especially in primary health care. Retention and high performance of employees are closely linked to job satisfaction and motivation, which are both highest where employees’ personal values and goals are realised. Aim The aim of the study was to evaluate employees’ personal values, and the current and desired organisational culture of the district health services as experienced by the primary health care workers. Setting The study was conducted in the Ngamiland and Mahalapye health districts. Method This was a cross sectional survey. The participants were asked to select 10 values that best described their personal, current organisational and desired organisational values from a predetermined list. Results Sixty and 67 health care workers completed the survey in Mahalapye and Ngamiland districts, respectively. The top 10 prevalent organisational values experienced in both districts were: teamwork, patient satisfaction, blame, confusion, job insecurity, not sharing information and manipulation. When all the current values were assessed, 32% (Mahalapye) and 36% (Ngamiland) selected by health care workers were potentially limiting organisational effectiveness. The organisational values desired by health care workers in both districts were: transparency, professional growth, staff recognition, shared decision-making, accountability, productivity, leadership development and teamwork. Conclusions The experience of the primary health care workers in the two health districts were overwhelmingly negative, which is likely to contribute to low levels of motivation, job satisfaction, productivity and high attrition rates. There is therefore urgent need for organisational transformation with a focus on staff experience and leadership development. PMID:26842516

The Influence of Beliefs About Health and Illness on Foot Care in Ugandan Persons with Diabetic Foot Ulcers

PubMed Central

Hjelm, Katarina; Beebwa, Esther

2013-01-01

Diabetes mellitus is becoming pandemic, particularly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of morbidity and disability. Delay in the health care process due to patients’ beliefs may have deleterious consequences for limb and life in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been found. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect self-care and care seeking behaviour. In an explorative study with consecutive sample semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcer. Knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful sores, perceived to heal or improve, and led to stress and social isolation due to smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health and related it to contact with nurses in the professional sector from whom they sought information, blood tests and wound dressings and desired better organised diabetes clinics offering health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised diabetes clinics working to raise awareness of the threat and prevent foot ulcers. PMID:24039644

The status of occupational blood and infectious body fluids exposures in five blood centres in China: a 5-year review.

PubMed

Wang, Y J; Meng, Z H; Zheng, X F; Tang, X X; Sang, L Y; Du, X-M; Cheng, Y-Z

2015-12-01

Little information about the occupational exposures to blood and body fluid (BBF) among blood service workers (BSWs) in blood stations in China is available currently. To assess current status of occupational exposure to BBF and assess the knowledge about occupational blood-borne pathogen exposures and universal precaution among BSWs in blood donations in China. To understand the incidence of occupational exposure in five blood centres in China. A cross-sectional study was conducted from January 2008 to December 2013. There were a total of 99 BBF exposures reported during the study period. The total incidence of BBF exposures was 4.4 per 100 person-years. Higher rates were observed for persons employed less than five years and persons less than 45 years old. Nurses have the highest percentage (49.5%) of BBF exposures. BBF exposures occurred most commonly during the afternoon (62.7%). Percutaneous injuries were the most common BBF exposures. Most incidents occurred during sharps use (73.4%). The major cause of occupational exposure was that there was no continuous training (48.4%) and improper use of equipment (23.2%). Only 56.6% of BBF exposures had appropriate first aid measures. During this research work, one staff member was reported to have seroconverted to syphilis after BBF exposure. To reduce BBF exposures, it is urgent to take several effective actions in China, including improved occupational health systems, adequate education, administrative support, increased use of standard precautions, better safety devices/products and work practices. © 2015 British Blood Transfusion Society.

Organ donation consanguinity or universality.

PubMed

Kishore, R R

1996-01-01

1. Neither the "Diseased Persons" nor the "Genetic Relations" provide an answer to "trading" in human body parts. 2. Live human body constitutes a vital source of supply of organs and tissues and the possibilities of optimum utilisation should be explored. 3. There is no scope for dogmatic postures and open-mindedness should be the approach while dealing with the issue of Organ Transplantation. 4. Society owes a duty to save the file of a dying man and in the event of failure to do so, it is absolutely immoral to interfere with his own arrangements by making unrealistic laws. No immorality is involved if an individual disposes of his spare body parts for a valid consideration to a needy person. 5. The scarcity needs to be urgently overcome otherwise unwarranted trade and crime are liable to thrive. 6. Families are not unconnected or antagonistic fragments of humanity. After thousands of years of continuous efforts the individuals on this earth have attained the stage of organic and functional integration. Atomisation of society on the basis of consanguineous proximities amounts to reversing this holistic trend. Organ transplantation is a functional expression of a highly evolved pursuit with inherent and intimate interaction in the form of organic exchange at the individual level, independent of consanguineous inducements or motivations. As such there is absolutely no scope for restricting organ donations by strangers. 7. Commercialisation should be curbed by making the enforcement agencies more efficient and not by depriving a needy person of his genuine requirements. Legislative craftsmanship lies in providing an answer without curtailing the freedom of the people.

Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis

PubMed Central

Bader, Pearl; Boisclair, David; Ferrence, Roberta

2011-01-01

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success. PMID:22163198

Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives.

PubMed

Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio; Agostoni, Carlo; Astrup, Arne; Brighenti, Furio; Cook, Robert; Folco, Emanuela; Fontana, Luigi; Gibson, Robert A; Guerra, Ranieri; Guyatt, Gordon H; Ioannidis, John Pa; Jackson, Ann S; Klurfeld, David M; Makrides, Maria; Mathioudakis, Basil; Monaco, Alessandro; Patel, Chirag J; Racagni, Giorgio; Schünemann, Holger J; Shamir, Raanan; Zmora, Niv; Peracino, Andrea

2017-07-01

A large body of evidence supports the notion that incorrect or insufficient nutrition contributes to disease development. A pivotal goal is thus to understand what exactly is appropriate and what is inappropriate in food ingestion and the consequent nutritional status and health. The effective application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline recommendations, properly grading the quality of the available evidence, promoting adherence to the well-established evidence hierarchy in nutrition, and enhancing strategies for appropriate vetting and transparent reporting that will solidify the recommendations for health promotion. The final goal is to build a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic biomarkers, food quality and intake frequency, lifestyle variables such as physical activity, and environmental variables including one's microbiome profile. There is a strong and urgent need to develop a successful commitment among all the stakeholders to define novel and sustainable approaches toward the management of the health value of nutrition at individual and population levels. Moving forward requires adherence to well-established principles of evidence evaluation as well as identification of effective tools to obtain better quality evidence. Much remains to be done in the near future. © 2017 American Society for Nutrition.

Recognising and responding to suicidal crisis within family and social networks: qualitative study.

PubMed

Owens, Christabel; Owen, Gareth; Belam, Judith; Lloyd, Keith; Rapport, Frances; Donovan, Jenny; Lambert, Helen

2011-10-18

To shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene. Qualitative study of completed suicides, based on in-depth interviews with multiple informants. London, southwest England, and south Wales. 31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services. Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks. As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.

Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis.

PubMed

Bader, Pearl; Boisclair, David; Ferrence, Roberta

2011-11-01

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success.

[Urgent retinal detachment management by the National Health System of Spain. Project Retina 2].

PubMed

Rojas, J; Fernández, I; Pastor, J C; Gómez-Ulla, F; Piñero, A

2007-05-01

To identify problems in the urgent management of retinal detachments (RD) in hospitals of the Spanish National Health System (NHS). A questionnaire was submitted confidentially to the heads of Ophthalmic Departments of 217 hospitals of the NHS to obtain information on the management of urgent RD during the last year. Data was stored in a Microsoft Access database and statistically analyzed by Excel and Statgraphics. Qualitative variables were analyzed by Chi-Square and Fisher exact tests and quantitative variables by the Kruskall-Wallis test. A global response rate of 54.8% was achieved with higher participation of the Teaching Hospitals (TH). District Hospital and non-Teaching Hospital responses were similar and grouped as non-TH. Eighteen percent of centers, mostly non-TH, had no ophthalmologist on duty. Thirty-six percent had a vitreoretinal specialist on call. Eighty percent of centres admitted to have problems handling urgent RD during weekends. Twenty-four had no ophthalmic surgical theatre available. Fifty percent referred to have problems having an anaesthesiologist available and only 22% had ophthalmic trained personnel (nurses) available. Sixty-four percent of centres performed pars plana vitrectomy (PPV) and 77% of those were able to perform an urgent PPV. Ninety percent admitted that a patient with a macula-threatening RD occurring at the beginning of the week-end would not be treated until at least 24 hours had elapsed, although 84% considered this to be inadequate. Despite the methodological problems and bias of this questionnaire, we did identify several important problems in the management of urgent RD by NHS hospitals. The data obtained provides useful information to enable the quality of the NHS care of RD to be improved, particularly that available at the week-end.

Upper Gastrointestinal Hemorrhage: Development of the Severity Score.

PubMed

Chaikitamnuaychok, Rangson; Patumanond, Jayanton

2012-12-01

Emergency endoscopy for every patient with upper gastrointestinal hemorrhage is not possible in many medical centers. Simple guidelines to select patients for emergency endoscopy are lacking. The aim of the present report is to develop a simple scoring system to classify upper gastrointestinal hemorrhage (UGIH) severity based on patient clinical profiles at the emergency departments. Retrospective data of patients with UGIH in a university affiliated hospital were analyzed. Patients were criterion-classified into 3 severity levels: mild, moderate and severe. Clinical and laboratory information were compared among the 3 groups. Significant parameters were selected as indicators of severity. Coefficients of significant multivariable parameters were transformed into item scores, which added up as individual severity scores. The scores were used to classify patients into 3 urgency levels: non-urgent, urgent and emergent groups. Score-classification and criterion-classification were compared. Significant parameters in the model were age ≥ 60 years, pulse rate ≥ 100/min, systolic blood pressure < 100 mmHg, hemoglobin < 10 g/dL, blood urea nitrogen ≥ 35 mg/dL, presence of cirrhosis and hepatic failure. The score ranged from 0 to 27, and classifying patients into 3 urgency groups: non-urgent (score < 4, n = 215, 21.2%), urgent (score 4 - 16, n = 677, 66.9%) and emergent (score > 16, n = 121, 11.9%). The score correctly classified 81.4% of the patients into their original (criterion-classified) severity groups. Under-estimation (7.5%) and over-estimation (11.1%) were clinically acceptable. Our UGIH severity scoring system classified patients into 3 urgency groups: non-urgent, urgent and emergent, with clinically acceptable small number of under- and over-estimations. Its discriminative ability and precision should be validated before adopting into clinical practice.

The experience of bedaquiline implementation at a decentralised clinic in South Africa.

PubMed

Cariem, R; Cox, V; de Azevedo, V; Hughes, J; Mohr, E; Durán, L Triviño; Ndjeka, N; Furin, J

2016-09-01

Multidrug-resistant tuberculosis (MDR-TB) is a serious public health problem, but the new drugs bedaquiline (BDQ) and delamanid offer hope to improve outcomes and minimise toxicity. In Khayelitsha, South Africa, patients are routinely started on BDQ in the out-patient setting. This report from the field describes BDQ use in the out-patient setting at the Nolungile Clinic. The clinic staff overall report a positive experience using the drug. Challenges have been based largely on the logistics of drug supply and delivery. BDQ can be started successfully in the out-patient setting, and can be a positive experience for both patients and providers. La tuberculose multirésistante (TB-MDR) est un problème de santé publique grave, mais les nouveaux médicaments que sont la bédaquiline (BDQ) et le délamanide apportent un espoir d'améliorer les résultats tout en réduisant la toxicité. A Khayelitsha, Afrique du Sud, les patients démarrent leur traitement par BDQ en consultation externe en routine. Ce rapport du terrain décrit l'utilisation de la BDQ à la consultation externe du dispensaire Nolungile. Dans l'ensemble, le personnel du centre de santé exprime une expérience positive du médicament. Les défis ont surtout été liés à la logistique de l'approvisionnement et de la distribution du médicament. La BDQ peut être mise en route avec succès dans le cadre d'une consultation externe et peut constituer une expérience positive pour les patients et les prestataires de soins. La tuberculosis multirresistente (TB-MDR) representa un grave problema de salud pública, pero la utilización de nuevos medicamentos como la bedaquilina (BDQ) y el delamanid ofrece perspectivas de mejores desenlaces terapéuticos y disminución de la toxicidad asociada. En Khayelitsha, Suráfrica, se inicia de manera sistemática el tratamiento ambulatorio con BDQ. En el presente informe del terreno, se describe la utilización de BDQ en tratamiento antituberculoso ambulatorio en el centro de atención Nolungile. En general, los miembros del personal del centro refirieron una experiencia positiva con la administración del medicamento. Las dificultades surgieron en gran parte con respecto a aspectos logísticos del suministro y la administración del medicamento. Es posible iniciar un tratamiento eficaz con BDQ en condiciones ambulatorias, y represente una experiencia positiva para los pacientes y los profesionales de salud.

Anesthetic Implications of Ebola Patient Management: A Review of the Literature and Policies.

PubMed

Missair, Andres; Marino, Michael J; Vu, Catherine N; Gutierrez, Juan; Missair, Alfredo; Osman, Brian; Gebhard, Ralf E

2015-09-01

As of mid-October 2014, the ongoing Ebola epidemic in Western Africa has affected approximately 10,000 patients, approached a 50% mortality rate, and crossed political and geographic borders without precedent. The disease has spread throughout Liberia, Guinea, and Sierra Leone. Isolated cases have arrived in urban centers in Europe and North America. The exponential growth, currently unabated, highlights the urgent need for effective and immediate management protocols for the various health care subspecialties that may care for Ebola virus disease patients. We conducted a comprehensive review of the literature to identify key areas of anesthetic care affected by this disease. The serious potential for "high-risk exposure" and "direct contact" (as defined by the Centers for Disease Control and Prevention) of anesthesiologists caring for Ebola patients prompted this urgent investigation. A search was conducted using MEDLINE/PubMed, MeSH, Cochrane Review, and Google Scholar. Key words included "anesthesia" and/or "ebola" combined with "surgery," "intubation," "laryngoscopy," "bronchoscopy," "stethoscope," "ventilation," "ventilator," "phlebotomy," "venous cannulation," "operating room," "personal protection," "equipment," "aerosol," "respiratory failure," or "needle stick." No language or date limits were applied. We also included secondary-source data from government organizations and scientific societies such as the Centers for Disease Control and Prevention, World Health Organization, American Society of Anesthesiologists, and American College of Surgeons. Articles were reviewed for primary-source data related to inpatient management of Ebola cases as well as evidence-based management guidelines and protocols for the care of Ebola patients in the operative room, infection control, and health care worker personal protection. Two hundred thirty-six articles were identified using the aforementioned terminology in the scientific database search engines. Twenty articles met search criteria for information related to inpatient Ebola virus disease management or animal virology studies as primary or secondary sources. In addition, 9 articles met search criteria as tertiary sources, representing published guidelines. The recommendations developed in this article are based on these 29 source documents. Anesthesia-specific literature regarding the care of Ebola patients is very limited. Secondary-source guidelines and policies represent the majority of available information. Data from controlled animal experiments and tuberculosis patient research provide some evidence for the existing recommendations and identify future guideline considerations.

Uncovering factors affecting use of the emergency department for less urgent health problems in urban and rural areas.

PubMed

Hodgins, Marilyn J; Wuest, Judith

2007-09-01

People who access the emergency department for less urgent health problems have been described as inappropriate users of the health-care system.Yet little is known about the factors precipitating such use and how these differ based on location of the emergency department. In this descriptive-correlational study guided by Andersen's Model of Health Services Use, 1612 people who presented to an emergency department with a less urgent health problem were interviewed. Analysis revealed rural/urban differences in the characteristics of patients, nature of the problems, actions taken, and factors precipitating the visit. Despite its popularity, the predictive capabilities of Andersen's model were limited in explaining use of self-treatment or willingness to wait for treatment. The findings show that an emergency department's roles and functions vary according to its location. Such insights provide direction for developing services that respond to the needs of people with less urgent health problems that are cognizant of geographic location.

Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: an observational study.

PubMed

Chen, Brian K; Hibbert, James; Cheng, Xi; Bennett, Kevin

2015-03-21

Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access. A random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients. We find that relative to the reference group of adults aged 35-64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent. These patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.

Derivation and validation of a diagnostic score based on case-mix groups to predict 30-day death or urgent readmission.

PubMed

van Walraven, Carl; Wong, Jenna; Forster, Alan J

2012-01-01

Between 5% and 10% of patients die or are urgently readmitted within 30 days of discharge from hospital. Readmission risk indexes have either excluded acute diagnoses or modelled them as multiple distinct variables. In this study, we derived and validated a score summarizing the influence of acute hospital diagnoses and procedures on death or urgent readmission within 30 days. From population-based hospital abstracts in Ontario, we randomly sampled 200 000 discharges between April 2003 and March 2009 and determined who had been readmitted urgently or died within 30 days of discharge. We used generalized estimating equation modelling, with a sample of 100 000 patients, to measure the adjusted association of various case-mix groups (CMGs-homogenous groups of acute care inpatients with similar clinical and resource-utilization characteristics) with 30-day death or urgent readmission. This final model was transformed into a scoring system that was validated in the remaining 100 000 patients. Patients in the derivation set belonged to 1 of 506 CMGs and had a 6.8% risk of 30-day death or urgent readmission. Forty-seven CMG codes (more than half of which were directly related to chronic diseases) were independently associated with this outcome, which led to a CMG score that ranged from -6 to 7 points. The CMG score was significantly associated with 30-day death or urgent readmission (unadjusted odds ratio for a 1-point increase in CMG score 1.52, 95% confidence interval [CI] 1.49-1.56). Alone, the CMG score was only moderately discriminative (C statistic 0.650, 95% CI 0.644-0.656). However, when the CMG score was added to a validated risk index for death or readmission, the C statistic increased to 0.759 (95% CI 0.753-0.765). The CMG score was well calibrated for 30-day death or readmission. In this study, we developed a scoring system for acute hospital diagnoses and procedures that could be used as part of a risk-adjustment methodology for analyses of postdischarge outcomes.

Decreased fetal hemoglobin over time among youth with sickle cell disease on hydroxyurea is associated with higher urgent hospital use.

PubMed

Green, Nancy S; Manwani, Deepa; Qureshi, Mahvish; Ireland, Karen; Sinha, Arpan; Smaldone, Arlene M

2016-12-01

Hydroxyurea (HU) induces dose-dependent increased fetal hemoglobin (HbF) for sickle cell disease (SCD). Large deviation from historical personal best (PBest) HbF, a clinic-based version of maximum dose, may identify a subset with suboptimal HU adherence over time. Retrospective clinical data from youth ages 10-18 years prescribed HU at two centers were extracted from medical records at three time points: pre-HU initiation, PBest and a recent assessment. Decrease from PBest HbF of 20% or more at recent assessment despite stable dosing was designated as high deviation from PBest. Acute hospital use was compared between 1-year periods, pre-HU and ±6 months for PBest and recent assessment. Groups were compared using descriptive and bivariate nonparametric statistics. Seventy-five youth, mean HU duration 5.9 years, met eligibility criteria. Mean ages of HU initiation, PBest and recent assessment were 8.0, 10.9 and 13.9 years, respectively. Despite stable dosing, average HbF of 19.5% at PBest overall declined by 31.8% at recent assessment. PBest HbF declined by 11.7 and 40.1% in two groups, the latter comprised 70.7% of the sample, had lower pre-HU and recent HbF and higher dosing. They experienced more urgent hospital use during the year framing recent assessment than during PBest; these findings were supported by sensitivity analysis. Decline from PBest HbF is a novel approach to assess HU effectiveness, is common among youth and may represent suboptimal adherence. Larger prospective studies using additional adherence measures are needed to confirm our approach of tracking HbF deviation over time and to define an appropriate cutoff. © 2016 Wiley Periodicals, Inc.

The novel complex allele [A238V;F508del] of the CFTR gene: clinical phenotype and possible implications for cystic fibrosis etiological therapies.

PubMed

Diana, Anna; Polizzi, Angela Maria; Santostasi, Teresa; Ratclif, Luigi; Pantaleo, Maria Giuseppina; Leonetti, Giuseppina; Iusco, Danila Rosa; Gallo, Crescenzio; Conese, Massimo; Manca, Antonio

2016-06-01

Few mutations in cis have been annotated for F508del homozygous patients. Southern Italy patients who at a first analysis appeared homozygous for the F508del mutation (n=63) or compound heterozygous for the F508del and another mutation in the cystic fibrosis transmembrane conductance regulator gene (n=155) were searched for the A238V mutation in exon 6. The allelic frequency of the complex allele [A238V;F508del] was 0.04. When the whole data set was used (comprised also of 56 F508del/F508del and 34 F508del/other mutation controls), no differences reached the statistical significance in the clinical parameters, except chloride concentrations which were lower in [A238V;F508del]/other mutation compared with F508del/other mutation (P=0.03). The two study groups presented less complications than the control groups. Within the minimal data set (34 F508del/F508del, 27 F508del/other mutation, 4 [A238V;F508del]/F508del cases and 5 [A238V;F508del]/other mutation cases); that is, presenting all the variables in each patient, forced expiratory volume in 1 s and forced vital capacity presented a trend to lower levels in the study groups in comparison with the F508del/F508del group, and C-reactive protein approximated statistically significant higher levels in the [A238V;F508del]/other mutation as compared with F508del/F508del patients (P=0.09). The analysis of statistical dependence among the variables showed a significant anticorrelation between chloride and body mass index in the [A238V;F508del]/other mutation group. In conclusion, the complex allele [A238V;F508del] seems to be associated with less general complications than in the control groups, on the other hand possibly giving a worse pulmonary phenotype and higher systemic/local inflammatory response. These findings have implications for the correct recruitment and clinical response of F508del patients in the clinical trials testing the new etiological drugs for cystic fibrosis.

The CF Canada-Sick Kids Program in individual CF therapy: A resource for the advancement of personalized medicine in CF.

PubMed

Eckford, Paul D W; McCormack, Jacqueline; Munsie, Lise; He, Gengming; Stanojevic, Sanja; Pereira, Sergio L; Ho, Karen; Avolio, Julie; Bartlett, Claire; Yang, Jin Ye; Wong, Amy P; Wellhauser, Leigh; Huan, Ling Jun; Jiang, Jia Xin; Ouyang, Hong; Du, Kai; Klingel, Michelle; Kyriakopoulou, Lianna; Gonska, Tanja; Moraes, Theo J; Strug, Lisa J; Rossant, Janet; Ratjen, Felix; Bear, Christine E

2018-04-20

Therapies targeting certain CFTR mutants have been approved, yet variations in clinical response highlight the need for in-vitro and genetic tools that predict patient-specific clinical outcomes. Toward this goal, the CF Canada-Sick Kids Program in Individual CF Therapy (CFIT) is generating a "first of its kind", comprehensive resource containing patient-specific cell cultures and data from 100 CF individuals that will enable modeling of therapeutic responses. The CFIT program is generating: 1) nasal cells from drug naïve patients suitable for culture and the study of drug responses in vitro, 2) matched gene expression data obtained by sequencing the RNA from the primary nasal tissue, 3) whole genome sequencing of blood derived DNA from each of the 100 participants, 4) induced pluripotent stem cells (iPSCs) generated from each participant's blood sample, 5) CRISPR-edited isogenic control iPSC lines and 6) prospective clinical data from patients treated with CF modulators. To date, we have recruited 57 of 100 individuals to CFIT, most of whom are homozygous for F508del (to assess in-vitro: in-vivo correlations with respect to ORKAMBI response) or heterozygous for F508del and a minimal function mutation. In addition, several donors are homozygous for rare nonsense and missense mutations. Nasal epithelial cell cultures and matched iPSC lines are available for many of these donors. This accessible resource will enable development of tools that predict individual outcomes to current and emerging modulators targeting F508del-CFTR and facilitate therapy discovery for rare CF causing mutations. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Urgent Aeromedical Evacuation Network Capacity Planning

DTIC Science & Technology

2013-03-01

What if AMC had one strategically positioned AC for the Urgent / Priority AE mission and the redistribution needs they encounter? This idea stems ...KtMI~rAFB _~...,_ Po~AFB ;------------~ Service Tirr~e Estimates I CO\\" CLl "SIO\\" • C-378 performs bestfrom a cost perspective • Contracted

42 CFR 405.440 - Emergency and urgent care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section 405.440 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.440...

Urgent Medical Assessment after Child Sexual Abuse

ERIC Educational Resources Information Center

Palusci, Vincent J.; Cox, Edward O.; Shatz, Eugene M.; Schultze, Joel M.

2006-01-01

Background: Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or…

Improving Education and Training for Educational Administrators and Managers: Urgent Needs.

ERIC Educational Resources Information Center

Hughes, M. G.

This paper advocates giving urgent attention to improving the education and training of educational administrators and managers, realizing the need to respond to rapid and far-reaching political and social change worldwide, and to consequent change within national educational systems. The improvement of administrative structures and the…

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... means of transportation would endanger the beneficiary's health. (b) Emergency and urgently needed... temporarily absent from the MA plan's service (or, if applicable, continuation) area (or, under unusual and... organization's provider network is temporarily unavailable or inaccessible) when the services are medically...

Health Needs of Urban Blacks.

ERIC Educational Resources Information Center

Blackwell, James E.; And Others

Interviews were conducted with 237 adult blacks in the Boston area to determine their most urgent needs and the most urgent needs of blacks in general, to characterize the information flow from health services agencies, and to characterize access to and utilization of health services. The respondents ranked better economic conditions, family and…

Traditional alcoholic beverages and their value in the local culture of the Alta Valle del Reno, a mountain borderland between Tuscany and Emilia-Romagna (Italy).

PubMed

Egea, Teresa; Signorini, Maria Adele; Ongaro, Luca; Rivera, Diego; Obón de Castro, Concepción; Bruschi, Piero

2016-06-22

Traditional alcoholic beverages (TABs) have only received marginal attention from researchers and ethnobotanists so far, especially in Italy. This work is focused on plant-based TABs in the Alta Valle del Reno, a mountainous area on the border between Tuscany and Emilia-Romagna regions. The aims of our study were to document local knowledge about TABs and to analyze and discuss the distribution of related knowledge within the investigated communities. Field data were collected through semi-structured interviews. The relative importance of each plant species used to prepare TABs was assessed by calculating a general Use Value Index (UV general), a current UV (UV current) and a past UV (UV past). We also assessed personal experience of use by calculating effective and potential UV (UV effective, UV potential). A multivariate analysis was performed to compare ingredients in recipes recorded in the Alta Valle del Reno with those reported for neighboring areas. Forty-six plant species, belonging to 20 families, were recorded. Rosaceae was the most significant family (98 citations, 19 species), followed by Rutaceae (15, 3) and Lamiaceae (12, 4). The most important species was Prunus cerasus L. (UV general = 0.44), followed by Juglans regia L. (0.38), Rubus idaeus L. (0.27) and Prunus spinosa L. (0.22). Species with the highest UV current were Juglans regia (0.254), Prunus cerasus (0.238) and Citrus limon L. (0.159). The highest UV effective values were obtained by Prunus cerasus (0.413), Juglans regia (0.254), Rubus idaeus (0.222) and Citrus limon (0.206). We also discuss the results of the multivariate analysis. TABs proved to occupy an important place in the traditional culture and social life of the studied communities. Moreover, data highlight the local specificity and richness of this kind of tradition in the Alta Valle del Reno, compared to other Italian areas. Some plant ingredients used for TABs have potential nutraceutical and even therapeutic properties that are well known by local people. These properties could constitute an additional economic value for TABs' commercialization, which in turn could promote the local rural economy.

Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China

PubMed Central

Li, Li; Liang, Li-Jung; Wu, Zunyou; Lin, Chunqing; Wen, Yi

2009-01-01

This study examined HIV/AIDS-related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor-nurse ratio of each hospital or clinic. Lab technicians were over-sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV-related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs. Cette étude a examiné le VIH/SIDA lié à stigmatisation parmi les agences chinoises fournissant des soins en comparant leurs attitudes personnelles envers les personnes atteintes du VIH/SIDA avec leur perception des normes sociales liées aux personnes atteintes du VIH/SIDA. Nous avons sélectionné au hasard trois hôpitaux provinciaux, quatre hôpitaux de villelpréfecture, dix hôpitaux ruraux, 18 centres hospitaliers de cantons et 54 cliniques de village au Yunnan en Chine. Les médecins et les infirmiéres étaient échantillonés au hasard de maniére proportionnelle au ratio médecin-infirmiére de chaque hôpital ou clinique. Les techniciens de laboratoire ont été suréchantillionnés afin d’inclure une représentation adéquate dans l’analyse. Un total de 1, 101 fournisseurs de soins ont participé à un sondage volontaire et anonyme oú les caractéristiques démographiques, l’attítude individuelle et les normes sociales perçues envers les personnes atteintes du VIH/SIDA, l’intention de discrimination au travail, l’attitude générale de préjugé et les connaissances sur le VIH/SIDA ont été mesurées. Une majorité de l’échantillon a démontré une similarité entre leurs opinions personnelles et qu’ils pensaient que la plupart des gens dans la société croyaient. Des régressions logistiques multiples ont indiqué que les participants qui étaient plus jeunes ou ceux qui ont rapporté un contact personnel avec les personnes atteintes du VIH/SIDA ont été significativement plus enclines á rapporter des attitudes personnelles envers la population qui étaient plus libérales que leurs normes sociales perçues. Avoir une attitude personnelle plus libérale envers les personnes atteintes du VIH/SID A que les normes sociales perçues était significativement et négativement lié au niveau de l’intention de discrimination au travail, à la discrimination perçue au niveau interpersonnel et au niveau de l’attitude générale de préjugé envers les personnes atteintes du VIH/SIDA. Les résultats soulignent l’importance de comprendre les normes sociales et les attitudes personnelles dans l’étude de la stigmatisation lié au VIH et prōnent l’incorporation de l’existence du capital humain dans les futurs programmes de réduction de la stigmatisation du VIH. En este estudio se examinó el estigma hacia el VIH/SIDA entre proveedores de servicios chinos mediante la comparación de sus actitudes hacia las personas que viven con el VIH/SIDA con su precepción de las normas sociales relacionadas a personas que viven con el VIH/SIDA. Se seleccionaron al azar tres hospitales provinciales, cuatro de la ciudadlhospitales de la prefectura, diez hospitales del condado, 18 clinicas de salud municipales, y 54 clinicas de la aldea de Yunnan, China. Los médicos y las enfermeras fueron incluidos en la muestra de manera aleatoria y considerando la relación enfermera-médico de cada hospital o clínica. Una muestra grande de técnicos de laboratorio fue incluida en el estudio con el fin de garantizar su adecuada representación en los análisis. Un total de 1,101 proveedores de servicios participaron de manera voluntaria en una encuesta anónima, en la cual se evaluaron las caracteristicas demográficas, las actitudes individuales, asi como la percepción de las normas sociales hacia personas que viven con el VIH/SIDA, la intención de discriminación laboral, las actitudes globales de prejuicio y los conocimientos sobre el VIH/SIDA. La mayor parte de la muestra presentó similitudes entre sus opiniones personales y lo que ellos pensaban, eran las creencias de la mayoria de las personas de su sociedad. En una regresión logistica multiple se pudo observar que los participantes más jóvenes o que indicaron un contacto personal con personas que viven con el VIH/SIDA, mostraron de manera más significativa respecto de esta población actitudes personales mucho más liberales que las normas sociales percibidas. El presentar una actitud personal más liberal que las normas sociales percibidas, hacia personas que viven con el VIH/SIDA, estaba significativa y negativamente relacionado con el nivel de intención de discriminación laboral, la percepción de discriminación a nivel interpersonal y el nivel general del actitudes prejuiciosas hacia estas personas. Los resultados remarcan la importancia de la comprensión de las normas sociales y de las actítudes personales en el estudio del estigma relacionado con el VIH y propone la incorporación del capital humano existente en programas futuros de reducciôn del estigma hacia el VIH. PMID:20090857

The relationship between occupational sun exposure and non-melanoma skin cancer: clinical basics, epidemiology, occupational disease evaluation, and prevention.

PubMed

Fartasch, Manigé; Diepgen, Thomas Ludwig; Schmitt, Jochen; Drexler, Hans

2012-10-01

The cumulative effect of solar ultraviolet (UV) radiation is responsible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occupational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer. On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV exposure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current recommendations for prevention and for medicolegal assessment. Recent meta-analyses have consistently documented a significantly higher risk of squamous cell carcinoma of the skin among persons who work outdoors (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.40-2.22, p<0.001). There is also evidence for an elevated risk of basal-cell carcinoma (OR 1.43, 95% CI 1.23-1.66, p = 0.0001), but the effect is of lesser magnitude and the study findings are not as uniform. The association of occupational exposure to solar UV radiation with squamous cell carcinoma, including actinic keratosis, has been conclusively demonstrated. It follows that, in Germany, suspected non-melanoma skin cancer in persons with high occupational exposure to UV radiation should be reported as an occupational disease under § 9, paragraph 2 of the Seventh Book of the German Social Code (Sozialgesetzbuch, SGB VII). Preventive measures are urgently needed for persons with high occupational exposure to UV radiation.

A questionnaire to measure melanoma risk, knowledge and protective behaviour: assessing content validity in a convenience sample of Scots and Australians.

PubMed

Gillespie, Helen S; Watson, Tony; Emery, Jon D; Lee, Amanda J; Murchie, Peter

2011-08-25

The aim of this study was to assess the content validity of a questionnaire to measure melanoma risk, knowledge and protective behaviour in a convenience sample of Scots and Australians. Australia has the highest melanoma incidence worldwide but has developed a culture of skin cancer avoidance with a long history of skin cancer primary prevention campaigns of proven effectiveness. Scotland has lower incidence, but has shown a greater rate of increase between 1985 and 2007. There is an urgent need in Scotland, therefore, to identify those groups at greatest risk and provide them with effective preventative advice. A self-administered postal survey was completed by four groups formed from convenience samples in two geographical locations (Northeast Scotland and Western Australia). In univariate analysis scores on personal risk, level of concern, protective behaviour, and knowledge were compared by nationality, previous skin cancer diagnosis and personally knowing someone with melanoma. Multivariate linear regression analysis modelled the influence of potential predictor variables upon each of the scores. 540 people completed the questionnaire, 273 Scots (50.6%). 133 (24.6%) Scots and 83 (15.4%) Australians previously had melanoma or non-melanoma skin cancer, whilst 120 (22.2%) Scots and 190 (35.2%) Australians personally knew someone with melanoma. Australians had higher knowledge (p < 0.001), level of concern (p < 0.001) and protective behaviour (p < 0.001) scores than the Scottish. Australian nationality was the strongest independent predictor of a higher knowledge score (p < 0.001), followed by a previous skin cancer diagnosis (p = 0.003), personal knowledge of someone with melanoma (p = 0.011), female gender (p = 0.005) and higher education status (p < 0.001) (R(2) = 0.163). The questionnaire detected higher levels of knowledge and skin cancer protective behaviours in Australians than in Scottish people. This was expected and supports the content validity of the questionnaire and its value as a future research tool in the Scottish population.

Community health professionals' dementia knowledge, attitudes and care approach: a cross-sectional survey in Changsha, China.

PubMed

Wang, Yao; Xiao, Lily Dongxia; Luo, Yang; Xiao, Shui-Yuan; Whitehead, Craig; Davies, Owen

2018-05-25

Community health professionals play a significant role in dementia care. However, little is known about community health professionals' capacity in dementia care, especially in low and middle-income countries. The aim of the present study was to assess community health professionals' dementia knowledge, attitudes and care approach in China, a country with the largest population of people with dementia in the world and where community based dementia care services are much needed. A cross-sectional survey was conducted. 450 health professionals were recruited into the study using random sampling from community health service centres in Changsha, China. Their knowledge, attitudes and care approach were assessed utilising the Chinese version of the Alzheimer's Disease Knowledge Scale, Dementia Care Attitude Scale and Approach to Advanced Dementia Care Questionnaire respectively. A total of 390 participants returned the questionnaire (response rate 87%). Age, education, professional group and care experience were associated with knowledge scores, and overall dementia knowledge was poor. Attitudes were generally positive and influenced by age, professional group, gender and care experience. The experience of caring for people with dementia was positively associated with a person-centred care approach, although the participants tended not to use a person-centred care approach. A statistically significant association was found between knowledge and attitudes (r = 0.379, P < 0.001), and between attitudes and care approach (r = 0.143, P < 0.001). However, dementia knowledge has no relationship with a person-centred approach. Community health professionals showed generally positive attitudes towards people with dementia. However, they demonstrated poor dementia knowledge and tended not to use a person-centred care approach. The results suggest that a multifaceted approach consisting of educational interventions for community health professionals, and policy and resource development to meet the demand for community dementia care services, is urgently needed in China.

Profile and birthing practices of Maranao traditional birth attendants.

PubMed

Maghuyop-Butalid, Roselyn; Mayo, Norhanifa A; Polangi, Hania T

2015-01-01

This study determined the profile and birthing practices in both modern and traditional ways among Maranao traditional birth attendants (TBAs) in Lanao del Norte, Philippines. It employed a descriptive research design. The respondents were 50 Maranao TBAs selected through the snowball sampling technique. A questionnaire was developed by the researchers to identify the respondents' modern birthing practices utilizing the Essential Intrapartum and Newborn Care (EINC) Protocol. To determine their profile and traditional birthing practices, items from a previous study and the respondents' personal claims were adapted. This study shows that Maranao TBAs have less compliance to the EINC Protocol and they often practice the traditional birthing interventions, thus increasing the risk of complications to both mother and newborn.

How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care

PubMed Central

Berntsen, G K R; Gammon, D; Steinsbekk, A; Salamonsen, A; Foss, N; Ruland, C; Fønnebø, V

2015-01-01

Objectives Patients with complex long-term needs experience multiple parallel care processes, which may have conflicting or competing goals, within their individual patient trajectory (iPT). The alignment of multiple goals is often implicit or non-existent, and has received little attention in the literature. Research questions: (1) What goals for care relevant for the iPT can be identified from the literature? (2) What goal typology can be proposed based on goal characteristics? (3) How can professionals negotiate a consistent set of goals for the iPT? Design Document content analysis of health service research papers, on the topic of ‘goals for care’. Setting With the increasing prevalence of multimorbidity, guidance regarding the identification and alignment of goals for care across organisations and disciplines is urgently needed. Participants 70 papers that describe ‘goals for care’, ‘health’ or ‘the good healthcare process’ relevant to a general iPT, identified in a step-wise structured search of MEDLINE, Web of Science and Google Scholar. Results We developed a goal typology with four categories. Three categories are professionally defined: (1) Functional, (2) Biological/Disease and (3) Adaptive goals. The fourth category is the patient's personally defined goals. Professional and personal goals may conflict, in which case goal prioritisation by creation of a goal hierarchy can be useful. We argue that the patient has the moral and legal right to determine the goals at the top of such a goal hierarchy. Professionals can then translate personal goals into realistic professional goals such as standardised health outcomes linked to evidence-based guidelines. Thereby, when goals are aligned with one another, the iPT will be truly patient centred, while care follows professional guidelines. Conclusions Personal goals direct professional goals and define the success criteria of the iPT. However, making personal goals count requires brave and wide-sweeping attitudinal, organisational and regulatory transformation of care delivery. PMID:26656243

3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan Presidential Documents Other Presidential Documents... to the Continuing Conflict in Pakistan Memorandum for the Secretary of State By the authority vested...

76 FR 35000 - Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL AGENCY: Office of Refugee Resettlement, ACF, HHS. ACTION... technical assistance on incoming Lesbian, Gay, Bi- Sexual and Transgender (LGBT) refugee cases to Heartland...

78 FR 25455 - Announcement of the Award of Three Urgent Single-Source Grants To Support Shelter Care for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... Unaccompanied Alien Children AGENCY: Office of Refugee Resettlement, Administration for Children and Families... of three urgent single-source grants from the Unaccompanied Alien Children's Program to KidsPeace in... capacity and supportive services to meet the number of unaccompanied alien children referrals from the...

29 CFR 570.52 - Occupations of motor-vehicle driver and outside helper (Order 2).

Code of Federal Regulations, 2010 CFR

2010-07-01

... urgent, time-sensitive deliveries means trips which, because of such factors as customer satisfaction... for the purpose of delivering goods of the minor's employer to a customer (except urgent, time... delivery of pizzas and prepared foods to the customer; the delivery of materials under a deadline (such as...

Forum: Communication Activism Pedagogy. A Call for an Ethic of Transformation in Communication Activism Education

ERIC Educational Resources Information Center

Artz, Lee

2017-01-01

Lawrence Frey and David Palmer present a provocative call for communication education and research that is urgent and opportune in this forum's stimulus essay, "Communication Activism Pedagogy and Research: Communication Education Scholarship to Promote Social Justice." The call is urgent because the global human condition--including…

77 FR 21389 - Unexpected Urgent Refugee and Migration Needs

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the... 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C... United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting unexpected and...

76 FR 14271 - Unexpected Urgent Refugee and Migration Needs Related to Libya

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-16

... March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the... States, including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as... million from the United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting...

Prognostic impact of terminal T wave inversions on presentation in patients with ST-elevation myocardial infarction undergoing urgent percutaneous coronary intervention.

PubMed

Shimada, Yuichi J; Po, Jose Ricardo F; Kanei, Yumiko; Schweitzer, Paul

2013-01-01

Terminal T wave inversions (TTWI) indicate advanced stages of ST-elevation myocardial infarction (STEMI). The present study investigated whether TTWI predict unfavorable in-hospital outcomes in STEMI patients treated with urgent percutaneous coronary intervention (PCI). A retrospective cohort study was performed with consecutive 188 STEMI cases undergoing urgent PCI. The primary endpoint was in-hospital major adverse cardiac event (MACE), and the secondary endpoints were ST resolution (STR) after PCI and length of stay (LOS). TTWI on presentation were independently associated with higher incidence of in-hospital MACE (adjusted OR 2.8; 95% CI 1.1-7.0; p=0.03), inadequate STR (adjusted OR 5.5; 95% CI 2.1-14.3; p=0.01), and longer LOS (adjusted mean increase 4.1 days; 95% CI 0.3-7.9; p=0.03). TTWI predicted these outcomes better than patient-reported ischemic time or pathologic Q waves. TTWI on presentation are an independent risk factor for poor inpatient prognosis among patients presenting with STEMI undergoing urgent PCI. Copyright © 2013 Elsevier Inc. All rights reserved.

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study.

PubMed

Keizer Beache, Simone; Guell, Cornelia

2016-01-01

We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. 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/

Analysis of the availability of the resources necessary for urgent and emergency healthcare in São Paulo between 2009-2013.

PubMed

Coimbra, Silvana Hebe; Camanho, Eliete Dominguez Lopez; Heringer, Lindolfo Carlos; Botelho, Ricardo Vieira; Vasconcellos, Cidia

2017-06-01

The Regulatory Complex is the structure that operationalizes actions for making resources available to meet the needs of urgent and emergency care in the municipality of São Paulo. In the case of urgent care, needs are immediate and associated with high morbidity and mortality. To identify the most frequently requested resources, the resolution capacity and the mortality rate associated with the unavailability of a certain resource. Our study was based on data from medical bulletins issued by the Urgent and Emergency Regulation Center (CRUE) in the city of São Paulo from 2009 to 2013. 91,823 requests were made over the five years of the study (2009 to 2013). Neurosurgery requests were the most frequent in all years (4,828, 5,159, 4,251, 5,008 and 4,394, respectively), followed by computed tomography (CT) scans, adult intensive care unit (ICU) beds, cardiac catheterization, and pediatric ICU beds. On average, requests for neurosurgery, adult ICU, pediatric ICU, CT scans, catheterization and vascular surgery were answered in 70%, 27%, 39%, 97%, 87% and 77% of cases. The total number of deaths relating to requests for neurosurgery, CT scans, adult ICU, pediatric ICU, catheterization and vascular surgeon assessment were 182, 9, 1,536, 1,536, 135, 49 and 24 cases, respectively. There is a lack of resources to meet urgent and emergency needs in the city of São Paulo.

Towards personal health care with model-guided medicine: long-term PPPM-related strategies and realisation opportunities within 'Horizon 2020'.

PubMed

Lemke, Heinz U; Golubnitschaja, Olga

2014-01-01

At the international EPMA Summit carried out in the EU Parliament (September 2013), the main challenges in Predictive, Preventive and Personalised Medicine have been discussed and strategies outlined in order to implement scientific and technological innovation in medicine and healthcare utilising new strategic programmes such as 'Horizon 2020'. The joint EPMA (European Association for Predictive, Preventive and Personalised Medicine) / IFCARS (International Foundation for Computer Assisted Radiology and Surgery) paper emphasises the consolidate position of the leading experts who are aware of the great responsibility of being on a forefront of predictive, preventive and personalised medicine. Both societies consider long-term international partnerships and multidisciplinary projects to create PPPM relevant innovation in science, technological tools and practical implementation in healthcare. Personalisation in healthcare urgently needs innovation in design of PPPM-related medical services, new products, research, education, didactic materials, propagation of targeted prevention in the society and treatments tailored to the person. For the paradigm shift from delayed reactive to predictive, preventive and personalised medicine, a new culture should be created in communication between individual professional domains, between doctor and patient, as well as in communication with individual social (sub)groups and patient cohorts. This is a long-term mission in personalised healthcare with the whole spectrum of instruments available and to be created in the field.

How psychiatric patients perceive the public's stereotype of mental illness.

PubMed

Freidl, M; Lang, T; Scherer, M

2003-05-01

It is well established that the general public has devaluating attitudes towards psychiatric patients. In order to avoid rejection, many of these patients develop coping strategies, such as withdrawal and concealing their treatment history. These efforts are in themselves stressing, which might have negative consequences for the course of the disorder. It is not clear, however, how many and which patients do actually perceive the public's stereotype as threatening and, therefore, expect rejection. Ninety psychiatric patients and a sample of 1042 persons of the Austrian general population were asked whether they agreed with five devaluating statements about mental patients contained in a questionnaire developed by Link et al. Matched pairs comparisons and multiple logistic regression were employed in order to find out whether patients agreed with these statements to the same extent as the general population did. For the statements that most people believe that psychiatric patients are "less intelligent", "less trustworthy" and "taken less seriously", patients thought significantly less often than the general population that most people devalue mental patients. For two statements ("personal failure", "think less of") no difference was found. It seems that some psychiatric patients are less convinced than the general population that most people devalue psychiatric patients in specific respects; these patients might fear rejection less than other patients do. Those who actually fear rejection might need antistigma assistance more urgently than the first group.

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

PubMed Central

Nidzvetska, Svitlana; Rodriguez-Llanes, Jose M.; Aujoulat, Isabelle; Gil Cuesta, Julita; Tappis, Hannah; van Loenhout, Joris A. F.; Guha-Sapir, Debarati

2017-01-01

Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine’s proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended. PMID:28075363

Exploring women's personal experiences of giving birth in Gonabad city: a qualitative study.

PubMed

Askari, Fariba; Atarodi, Alireza; Torabi, Shirin; Moshki, Mahdi

2014-05-08

Women's health is an important task in society. The aim of this qualitative study that used a phenomenological approach was to explain women's personal experiences of giving birth in Gonabad city that had positive experiences of giving birth in order to establish quality cares and the related factors of midwifery cares for this physiological phenomenon. The participants were 21 primiparae women who gave a normal and or uncomplicated giving birth in the hospital of Gonabad University of medical sciences. Based on a purposeful approach in-depth interviews were continued to reach data saturation. The data were collected through open and semi-structured interactional in-depth interviews with all the participants. All the interviews were taped, transcribed and then analyzed through a qualitative content analysis method to identify the concepts and themes. Some categories were emerged. A quiet and safe environment was the most urgent need of the most women giving birth. Unnecessary routine interventions that are performed on all women regardless of their needs and should be avoided were considered such as: "absolute rest, establishing vein, frequent vaginal examinations, fasting and early Amniotomy". All the women wanted to take part actively in their giving birth, because they believed it could affect their giving birth. We hope that the women's experiences of giving birth will be a pleasant and enjoyable experience for all the mothers giving birth.

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study.

PubMed

Nidzvetska, Svitlana; Rodriguez-Llanes, Jose M; Aujoulat, Isabelle; Gil Cuesta, Julita; Tappis, Hannah; van Loenhout, Joris A F; Guha-Sapir, Debarati

2017-01-09

Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine's proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.

Development of a triage engine enabling behavior recognition and lethal arrhythmia detection for remote health care system.

PubMed

Sugano, Hiroto; Hara, Shinsuke; Tsujioka, Tetsuo; Inoue, Tadayuki; Nakajima, Shigeyoshi; Kozaki, Takaaki; Namkamura, Hajime; Takeuchi, Kazuhide

2011-01-01

For ubiquitous health care systems which continuously monitor a person's vital signs such as electrocardiogram (ECG), body surface temperature and three-dimensional (3D) acceleration by wireless, it is important to accurately detect the occurrence of an abnormal event in the data and immediately inform a medical doctor of its detail. In this paper, we introduce a remote health care system, which is composed of a wireless vital sensor, multiple receivers and a triage engine installed in a desktop personal computer (PC). The middleware installed in the receiver, which was developed in C++, supports reliable data handling of vital data to the ethernet port. On the other hand, the human interface of the triage engine, which was developed in JAVA, shows graphics on his/her ECG data, 3D acceleration data, body surface temperature data and behavior status in the display of the desktop PC and sends an urgent e-mail containing the display data to a pre-registered medical doctor when it detects the occurrence of an abnormal event. In the triage engine, the lethal arrhythmia detection algorithm based on short time Fourier transform (STFT) analysis can achieve 100 % sensitivity and 99.99 % specificity, and the behavior recognition algorithm based on the combination of the nearest neighbor method and the Naive Bayes method can achieve more than 71 % classification accuracy.

Brazilians have different views on when abortion should be legal, but most do not agree with imprisoning women for abortion.

PubMed

Faúndes, Aníbal; Duarte, Graciana Alves; de Sousa, Maria Helena; Soares Camargo, Rodrigo Paupério; Pacagnella, Rodolfo Carvalho

2013-11-01

Unsafe abortions remain a major public health problem in countries with very restrictive abortion laws. In Brazil, parliamentarians - who have the power to change the law - are influenced by "public opinion", often obtained through surveys and opinion polls. This paper presents the findings from two studies. One was carried out in February-December 2010 among 1,660 public servants and the other in February-July 2011 with 874 medical students from three medical schools, both in São Paulo State, Brazil. Both groups of respondents were asked two sets of questions to obtain their opinion about abortion: 1) under which circumstances abortion should be permitted by law, and 2) whether or not women in general and women they knew who had had an abortion should be punished with prison, as Brazilian law mandates. The differences in their answers were enormous: the majority of respondents were against putting women who have had abortions in prison. Almost 60% of civil servants and 25% of medical students knew at least one woman who had had an illegal abortion; 85% of medical students and 83% of civil servants thought this person(s) should not be jailed. Brazilian parliamentarians who are currently reviewing a reform in the Penal Code need to have this information urgently. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

NGO action on refugees and displaced people.

PubMed

1998-06-01

This article summarizes some issues that emerged from a 1997 seminar on reproductive health among refugees. 90 delegates from 16 countries shared ideas about how to better lend support in emergencies and discussed the prevention and control of AIDS. The role was not clear for nongovernmental organizations (NGOs) that preferred constructing community-based institutions instead of satisfying the basic, urgent needs of displaced persons. The NGO sector recognizes its reliance on UN funding, but desires better UNHCR and UNAIDS guidelines and more positive support. NGOs were very reluctant to integrate HIV testing and counseling in already mistrustful settings, while ignoring the violence against women, which is closely tied to their vulnerability to AIDS. UNHCR solutions appeared to prolong the conflict and offer opportunities to channel energies into negative sexuality. Most refugees are women and children. There is wide inconsistency in beliefs and government responses to basic human rights issues. It was proposed that a deterrent to the spread of AIDS is an emphasis on self-respect and a concept of belonging. Management issues in resettled populations vary with essential needs and different phases of an emergency. Common HIV and refugee concerns include a balance between the needs of host and displaced persons; a balance between long- and short-term HIV emergency needs; and a reduction of violence among militarized refugees. Pressing concerns were advocacy, vulnerability, and research on gender and effects of militarization.

[The Jardé law, a real simplification of research in France?

PubMed

Levy, C; Rybak, A; Cohen, R; Jung, C

2017-06-01

The Jardé law was voted in 2012 and its implementing decrees were published in November 2016. The delay between the vote and the decrees highlights the difficulties encountered. This law concerns all research, interventional and otherwise, involving the human person. Each research study must receive the approval of a randomly assigned ethics committee or Committee for the Protection of Persons. The approach here is based on risk in three types of study: interventional studies, studies with minimal risk and intervention, and non-interventional studies (observational studies). The main changes are: simplified informed consent for pediatric studies and possible enrolment for people not affiliated with a social health care system in non-interventional research. The law provides clarification for changes in the purpose of biological collections. For vigilance, the notions of "new facts" and "urgent security measures" have emerged. Although this law appears to be an advancement, some concerns still need to be clarified. The main problem arises from the foreseeable extension of the delay to implement research. Medical research is a competition where time is valuable. Colleagues working on cosmetics research have already anticipated these difficulties. On February 8, 2017, the decrees of the Jardé law were suspended for cosmetics studies. Will the Jardé law be suspended for all French clinical research? Copyright © 2017 Elsevier Masson SAS. All rights reserved.

[Combined use of contrast media containing iodine and gadolinium for imaging and intervention : A hitherto widely ignored topic in radiological practice].

PubMed

Golder, W

2012-02-01

The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several organs or organ systems. Unlike other topics of contrast-enhanced imaging procedures, the difficulties encountered with double contrast injections have been widely ignored in the literature. In the absence of reliable data from experimental and clinical studies the radiologist is dependent on case reports, information provided by the contrast media manufacturers, personal communications, mostly scanty personal experiences and a skilful time management, in order to overcome the situation. Only the combination of X-ray, computed tomography and magnetic resonance arthrography can be performed without another thought. However, the more or less synchronous vascular application of contrast media containing iodine and gadolinium requires vigilance. The more seriously ill the patient is, the more caution is advised even if the decision on the combined administration has to be reached urgently. The following overview gives a description of the properties of contrast media containing iodine and gadolinium as far as interactions following simultaneous administration are concerned. Subsequently, the clinically relevant situations and constellations are outlined and analyzed.

Towards personal health care with model-guided medicine: long-term PPPM-related strategies and realisation opportunities within ‘Horizon 2020’

PubMed Central

2014-01-01

At the international EPMA Summit carried out in the EU Parliament (September 2013), the main challenges in Predictive, Preventive and Personalised Medicine have been discussed and strategies outlined in order to implement scientific and technological innovation in medicine and healthcare utilising new strategic programmes such as ‘Horizon 2020’. The joint EPMA (European Association for Predictive, Preventive and Personalised Medicine) / IFCARS (International Foundation for Computer Assisted Radiology and Surgery) paper emphasises the consolidate position of the leading experts who are aware of the great responsibility of being on a forefront of predictive, preventive and personalised medicine. Both societies consider long-term international partnerships and multidisciplinary projects to create PPPM relevant innovation in science, technological tools and practical implementation in healthcare. Personalisation in healthcare urgently needs innovation in design of PPPM-related medical services, new products, research, education, didactic materials, propagation of targeted prevention in the society and treatments tailored to the person. For the paradigm shift from delayed reactive to predictive, preventive and personalised medicine, a new culture should be created in communication between individual professional domains, between doctor and patient, as well as in communication with individual social (sub)groups and patient cohorts. This is a long-term mission in personalised healthcare with the whole spectrum of instruments available and to be created in the field. PMID:24883142

Medical students’ attitude toward suicide attempters

PubMed Central

Nebhinani, Naresh; Chahal, Savita; Jagtiani, Amit; Nebhinani, Mamta; Gupta, Rajiv

2016-01-01

Background: Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes. Objectives: This study was aimed to assess the medical students' attitudes toward suicide attempters. Materials and Methods: A cross-sectional study was conducted in a tertiary care medical institute of Haryana, a Northern state of India. Two hundred and five final year medical students were recruited through total enumeration method. “Suicide Opinion Questionnaire” was administered to assess their attitudes toward suicide attempters. Results: Only minority had previous exposure of managing any suicidal patient and attended suicide prevention programs. Majority agreed for suicide attempters being lonely and depressed. Nearly half of the students reported small family, disturbed interpersonal relationship, weak personality, self-punishment approach, cultural inhibitions in emotional expression, national instability, and disbelief in afterlife, as a major push to attempt suicide. Compared to boys, girls reported the greater contribution of weak personality and self-destructive behaviors and lesser contribution of family disturbances and religious convictions as suicide triggers. They held favorable attitude for only one-third of the attitudinal statement, and they were uncertain for two-third of the attitudinal statements. Conclusions: Such a high proportion of uncertain responses imply toward lack of awareness and clinical expertise for managing suicide attempters. It also signifies the urgent need for enhancing their educational and clinical exposure, to improve their attitudes toward patients presenting with self-harm. PMID:28163403

[Physician and freedom of conscience].

PubMed

Munzarová, Marta

2012-01-01

In the arena of bioethics we can find the ideas trying to deny the right to freedom of conscience to physicians. This is an attack upon morality itself. It is therefore urgent to outline the basic knowledge dealing with conscience and to be aware of the fact that violation of conscience leads to breakdown of conscience. The present article deals with Socrates daimonion and his conviction of objective truth as well as with other similar thoughts of great philosophers and theologians in this context: everybody is able to recognize good and evil, some basic knowledge of the common truth exists in the heart of everyone. The feeling of guilt and the capacity to recognize guilt should not be suppressed: the silence of conscience is the greatest tragedy of man. It is quite clear, that the doctor should not agree with the patients every wish, no matter how destructive it is. His own conscience and personal integrity as well as the fact, that the doctor should be the person of integrity, is a more fundamental notion than the respect to autonomy of the patient. Being engaged in killing [euthanasia] serves as an example of bewildering and silencing of conscience. The right to and the importance of physicians freedom of conscience are emphasized in many international documents; the relevant quotations are presented in the text. Key words: conscience, truth, euthanasia, autonomy, conscientious objection.

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise.

PubMed

Wischmeyer, Paul E; Puthucheary, Zudin; San Millán, Iñigo; Butz, Daniel; Grocott, Michael P W

2017-08-01

We have significantly improved hospital mortality from sepsis and critical illness in last 10 years; however, over this same period we have tripled the number of 'ICU survivors' going to rehabilitation. Furthermore, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life. For those who do survive, recent data reveals many 'ICU survivors' will suffer significant functional impairment or post-ICU syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anticatabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care. New data for novel LBM analysis technique such as computerized tomography scan and ultrasound analysis of LBM are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-Breath testing is a novel technique under study to predict infection earlier and predict over-feeding and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing to target preoperative exercise optimization and post-ICU recovery are becoming reality. New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more 'survivors' and fewer victim's post-ICU care.

Cataract Blindness in Osun State, Nigeria: Results of a Survey

PubMed Central

Kolawole, Olubayo U.; Ashaye, Adeyinka O.; Mahmoud, Abdulraheem O.; Adeoti, Caroline O.

2012-01-01

Purpose: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. Materials and Methods: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. Results: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6–2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3–3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. “Lack of awareness” (30.4%), “no need for surgery” (17.6%), cost (14.6%), fear (10.2%), “waiting for cataract to mature” (8.8%), AND “surgical services not available” (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. Conclusions: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free. PMID:23248537

Initiating Maintenance Dialysis Before Living Kidney Donor Transplantation When a Donor Candidate Evaluation Is Well Underway.

PubMed

Habbous, Steven; McArthur, Eric; Dixon, Stephanie N; McKenzie, Susan; Garcia-Ochoa, Carlos; Lam, Ngan N; Lentine, Krista L; Dipchand, Christine; Litchfield, Kenneth; Begen, Mehmet A; Sarma, Sisira; Garg, Amit X

2018-07-01

Preemptive kidney transplants result in better outcomes and patient experiences than transplantation after dialysis onset. It is unknown how often a person initiates maintenance dialysis before living kidney donor transplantation when their donor candidate evaluation is well underway. Using healthcare databases, we retrospectively studied 478 living donor kidney transplants from 2004 to 2014 across 5 transplant centers in Ontario, Canada, where the recipients were not receiving dialysis when their donor's evaluation was well underway. We also explored some factors associated with a higher likelihood of dialysis initiation before transplant. A total of 167 (35%) of 478 persons with kidney failure initiated dialysis in a median of 9.7 months (25th-75th percentile, 5.4-18.7 months) after their donor candidate began their evaluation and received dialysis for a median of 8.8 months (3.6-16.9 months) before kidney transplantation. The total cohort's dialysis cost was CAD $8.1 million, and 44 (26%) of 167 recipients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 months (6.4-21.6 months) for preemptive transplants and 22.4 months (13.1-38.7 months) for donors whose recipients started dialysis before transplant. Recipients were more likely to start dialysis if their donor was female, nonwhite, lived in a lower-income neighborhood, and if the transplant center received the recipient referral later. One third of persons initiated dialysis before receiving their living kidney donor transplant, despite their donor's evaluation being well underway. Future studies should consider whether some of these events can be prevented by addressing inappropriate delays to improve patient outcomes and reduce healthcare costs.

The Grand Challenge of Scale in Scientific Hydrology: Some Personal Reflections

NASA Astrophysics Data System (ADS)

Gupta, V. K.

2009-12-01

Scale issues in hydrology have shaped my entire scientific career. I first recognized the challenge of scale during the 1970s in linking multi-scale hydrologic processes through collaborative work on solute transport in saturated porous media. Linking geometry, dynamics and statistics, and the role of diagnostics in testing theoretical predictions against experimental observations, played a foundational role. This foundation has guided the rest of my multi-scale research on larger space-time scales of river basins, regional, and global. After the blue book was published in 1991, NSF needed a futuristic implementation plan for the blue book, but did not communicate it to Pete. I came to know of it in 1998 after six years of pursuing an ‘open-ended agenda’ in which Doug played a key role. The upper management of the Geosciences Directorate first mentioned to me in 1998 that the blue book needed a broad and futuristic implementation plan. It led to the Water, Earth, and Biota (WEB) report in 2000 following an NSF-funded workshop in 1999. The multi-scale nature of hydrology served as the central organizing theme for the WEB report. The history from 1984 to 2001 is summarized on the CUAHSI web page under “history”, so I will only share a few personal reflections from this period. Where do we go from here? My perspective is that an urgent need exists to modernize hydrology curriculum that should include the progress that has been made in addressing multi-scale challenges. I will share some personal reflections, both intellectual and administrative, from my experiences in implementing a graduate hydrology science program at the University of Colorado after joining it in 1989.

Personalized Herbal Medicine? A Roadmap for Convergence of Herbal and Precision Medicine Biomarker Innovations.

PubMed

Thomford, Nicholas Ekow; Dzobo, Kevin; Chimusa, Emile; Andrae-Marobela, Kerstin; Chirikure, Shadreck; Wonkam, Ambroise; Dandara, Collet

2018-06-01

While drugs remain the cornerstone of medicine, herbal medicine is an important comedication worldwide. Thus, precision medicine ought to face this clinical reality and develop "companion diagnostics" for drugs as well as herbal medicines. Yet, many are in denial with respect to the extent of use of traditional/herbal medicines, overlooking that a considerable number of contemporary therapeutic drugs trace their discovery from herbal medicines. This expert review underscores that absent such appropriate attention on both classical drug therapy and herbal medicines, precision medicine biomarkers will likely not stand the full test of clinical practice while patients continue to use both drugs and herbal medicines and, yet the biomarker research and applications focus only (or mostly) on drug therapy. This asymmetry in biomarker innovation strategy needs urgent attention from a wide range of innovation actors worldwide, including governments, research funders, scientists, community leaders, civil society organizations, herbal, pharmaceutical, and insurance industries, policymakers, and social/political scientists. We discuss the various dimensions of a future convergence map between herbal and conventional medicine, and conclude with a set of concrete strategies on how best to integrate biomarker research in a realm of both herbal and drug treatment. Africa, by virtue of its vast experience and exposure in herbal medicine and a "pregnant" life sciences innovation ecosystem, could play a game-changing role for the "birth" of biomarker-informed personalized herbal medicine in the near future. At this critical juncture when precision medicine initiatives are being rolled out worldwide, precision/personalized herbal medicine is both timely and essential for modern therapeutics, not to mention biomarker innovations that stand the test of real-life practices and implementation in the clinic and society.

Use of unsolicited first-person written illness narratives in research: systematic review.

PubMed

O'Brien, Mary R; Clark, David

2010-08-01

This paper is a report of a methodological systematic review conducted to critically analyze the use of unsolicited first-person written illness narratives for research purposes. Documenting illness experiences through written narratives enables individuals to record the impact of illness on themselves and those closest to them. In health research, unsolicited first-person written illness narratives are recognized increasingly as legitimate data sources. To date there has been no critical evaluation of the method. The ISI Web of Knowledge; CINAHL; PubMed; MEDLINE; PsycINFO; Science Direct; Cochrane Library databases and the internet metasearch engine 'Dogpile' were searched for the period up to 2009. The search terms were: 'patient experience', 'narratives', 'autobiography', 'pathography', 'written narratives', 'illness narratives', 'internet', 'published', 'unsolicited'. Recommendations within the Centre for Reviews and Dissemination guidance informed the review. Eligible studies were evaluated according to inclusion/exclusion criteria. The data were extracted by one reviewer and monitored by the second reviewer. Eighteen papers met the inclusion criteria, 12 from the original search in 2008 and six from the updated search in October 2009. Nine used unpublished (internet) narratives, eight used published (print) accounts and one drew on both genres. The method has been used to explore a wide range of illness experiences. There was lack of agreement on key terminology. Methodological issues were often poorly-described, and confused ethical stances were reported. The lack of methodological detail in published papers requires attention if this method is to be used effectively in healthcare research. The confused ethical stance adopted needs to be addressed and clarified. A theoretical conceptual framework to define and describe the method accurately is urgently required.

Coverage of hospital-based cataract surgery and barriers to the uptake of surgery among cataract blind persons in nigeria: the Nigeria National Blindness and Visual Impairment Survey.

PubMed

Abubakar, Tafida; Gudlavalleti, Murthy V S; Sivasubramaniam, Selvaraj; Gilbert, Clare E; Abdull, Mohammed M; Imam, Abdullahi U

2012-04-01

To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria. Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery. A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4-1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%). Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.

The microbiome in urogenital schistosomiasis and induced bladder pathologies

PubMed Central

Adebayo, Adewale S.; Survayanshi, Mangesh; Bhute, Shrikanth; Agunloye, Atinuke M.; Isokpehi, Raphael D.; Shouche, Yogesh S.

2017-01-01

Background Human schistosomiasis is a highly prevalent neglected tropical disease (NTD) caused by Schistosoma species. Research on the molecular mechanisms influencing the outcomes of bladder infection by Schistosoma haematobium is urgently needed to develop new diagnostics, therapeutics and infection prevention strategies. The objective of the research study was to determine the microbiome features and changes in urine during urogenital schistosomiasis and induced bladder pathologies. Methodology Seventy participants from Eggua, southwestern Nigeria provided morning urine samples and were screened for urogenital schistosomiasis infection and bladder pathologies in a cross-sectional study. Highthroughput NGS sequencing was carried out, targeting the 16S V3 region. Filtered reads were processed and analyzed in a bioinformatics pipeline. Principal findings The study participants (36 males and 34 females, between ages 15 and 65) were categorized into four groups according to status of schistosomiasis infection and bladder pathology. Data analytics of the next-generation sequencing reads revealed that Proteobacteria and Firmicutes dominated and had influence on microbiome structure of both non-infected persons and persons with urogenital schistosomiasis. Furthermore, gender and age influenced taxa abundance independent of infection or bladder pathology. Several taxa distinguished urogenital schistosomiasis induced bladder pathologies from urogenital schistosomiasis infection alone and from healthy persons, including known immune-stimulatory taxa such as Fusobacterium, Sphingobacterium and Enterococcus. Some of these significant taxa, especially Sphingobacterium were projected as markers of infection, while several genera including potentially beneficial taxa such as Trabulsiella and Weissella, were markers of the non-infected. Finally, expected changes in protein functional categories were observed to relate to cellular maintenance and lipid metabolism. Conclusion The urinary microbiome is a factor to be considered in developing biomarkers, diagnostic tools, and new treatment for urogenital schistosomiasis and induced bladder pathologies. PMID:28793309

Credit use: psychological perspectives on a multifaceted phenomenon.

PubMed

Kamleitner, Bernadette; Hoelzl, Erik; Kirchler, Erich

2012-01-01

Consumer borrowing is a highly topical and multifaceted phenomenon as well as a popular subject for study. We focus on consumer credit use and review the existing literature. To categorize what is known we identify four main psychological perspectives on the phenomenon: credit use as (1) a reflection of the situation, (2) a reflection of the person, (3) a cognitive process, and (4) a social process. On top of these perspectives we view credit use as a process that entails three distinct phases: (1) processes before credit acquisition, (2) processes at credit acquisition, and (3) processes after credit acquisition. We review the international literature along a two-tier structure that aligns the psychological perspectives with a process view of credit. This structure allows us to identify systematic concentrations as well as gaps in the existing research. We consolidate what is known within each perspective and identify what seems to be most urgently missing. Some of the most important gaps relate to research studying credit acquisition from the perspective of credit use as a reflection of the person or as a social process. In particular, research on credit use as a reflection of the person appears to focus exclusively on the first stage of the credit process. We conclude with a discussion that reaches across perspectives and identifies overarching gaps, trends, and open questions. We highlight a series of implicit linkages between perspectives and the geographical regions in which studies related to the perspectives were conducted. Beyond diagnosing a geographical imbalance of research, we argue for future research that systematically addresses interrelations between perspectives. We conclude with a set of global implications and research recommendations.

New opportunities for quality enhancing of images captured by passive THz camera

NASA Astrophysics Data System (ADS)

Trofimov, Vyacheslav A.; Trofimov, Vladislav V.

2014-10-01

As it is well-known, the passive THz camera allows seeing concealed object without contact with a person and this camera is non-dangerous for a person. Obviously, efficiency of using the passive THz camera depends on its temperature resolution. This characteristic specifies possibilities of the detection for concealed object: minimal size of the object; maximal distance of the detection; image quality. Computer processing of the THz image may lead to many times improving of the image quality without any additional engineering efforts. Therefore, developing of modern computer code for its application to THz images is urgent problem. Using appropriate new methods one may expect such temperature resolution which will allow to see banknote in pocket of a person without any real contact. Modern algorithms for computer processing of THz images allow also to see object inside the human body using a temperature trace on the human skin. This circumstance enhances essentially opportunity of passive THz camera applications for counterterrorism problems. We demonstrate opportunities, achieved at present time, for the detection both of concealed objects and of clothes components due to using of computer processing of images captured by passive THz cameras, manufactured by various companies. Another important result discussed in the paper consists in observation of both THz radiation emitted by incandescent lamp and image reflected from ceramic floorplate. We consider images produced by THz passive cameras manufactured by Microsemi Corp., and ThruVision Corp., and Capital Normal University (Beijing, China). All algorithms for computer processing of the THz images under consideration in this paper were developed by Russian part of author list. Keywords: THz wave, passive imaging camera, computer processing, security screening, concealed and forbidden objects, reflected image, hand seeing, banknote seeing, ceramic floorplate, incandescent lamp.

Early cannulation prosthetic graft (Acuseal) for arteriovenous access: a useful option to provide a personal vascular access solution.

PubMed

Aitken, Emma L; Jackson, Andrew J; Kingsmore, David B

2014-01-01

Early cannulation arteriovenous grafts (ecAVGs), such as the GORE Acuseal, have "low bleed" properties permitting cannulation within 24 hours of insertion. They may provide an alternative to tunneled central venous catheters (and associated line complications) in patients requiring urgent vascular access. We present our early experience of 37 patients treated with the GORE Acuseal ecAVG. A total of 11 upper limb, 24 lower limb and 2 complex graft procedures were performed. Indications for ecAVG were as follows: bridge to transplantation (21.6%); bridge to arteriovenous fistula (AVF) maturation (8.1%); AVF salvage (8.1%); no native options (67.6%, including 17 patients with bilateral central vein stenosis); 36 AVGs (97.3%) were successfully cannulated. Mean time to first cannulation: 30.4±23.4 hours (range: 2-192). Primary and secondary patency rates at 3, 6 and 12 months were 64.9%, 48.6%, 32.4% and 70.2%, 59.4%, 40.5% respectively. The systemic bacteremia rate was 0.2 per 1,000 access days. There was one perioperative death. Other complications included hematoma at cannulation sites (n=9), pseudoaneurysm (n=3) and local infection at graft site (n=6). A total of 26 of 37 patients (70.6%) achieved a "personal vascular access solution": bridge to transplantation (n=8), bridge to functioning AVF/interposition AVG (n=5), maintenance hemodialysis via ecAVG (n=13); death with functioning AVG (n=1). Early experience with the GORE Acuseal is encouraging. Patency and bacteremia rates are at least comparable to standard polytetrafluoroethylene grafts. ecAVGs have permitted cannulation within 24 hours of insertion and line avoidance in the majority of patients. Nearly three-quarters of patients achieved a definitive "personal vascular access solution" from their ecAVG.

Creation of Integrated System of Cosmonauts Sanitary-Hygienic Supply: Researches, Problems and Prospects

NASA Astrophysics Data System (ADS)

Shumilina, I.; Krivobok, S.; Shumilina, G.

The necessity of Integrated System creation for cosmonauts Sanitary - Hygienic Supply has appeared at realization of joint flights on the International Space Station (ISS). Russian hygiene means manufactured and tested in the long space flights conditions and personal hygiene means of foreign manufacture, which were developed without chamber experiments conditions, are mean to use for Integrated System. The realization of Sanitary - Hygienic Water (SHW) regeneration is supposed for water circulation. The researches directed on equipment creation for clothing washing and clothing drying were carried out for the purposes of goods turnover optimization on ISS The variants of possible realization of water procedures (shower-bath, face washing) are studied. New and essentially date are received for an estimation of efficiency of various ways of cosmonauts Sanitary - Hygienic Supply, including results of tests for new generation regeneration SHW systems with Nanofiltration unit on various kinds real SHW. The improvement of washing-up liquids, individual selection of a complex of personal hygiene means with the man skin condition registration allows to raise of preventive measures use efficiency directed on prevention of adverse skin changes and skin diseases. The analysis of the equipment and methods for clothing washing and clothing drying for conditions of long space flight are carried out. The experimental data on textile materials drying are received. The investigations covered a wide range of issues associated with Sanitary - Hygienic Supply Integrated System including Personal Hygiene complex (items and techniques), ways of Sanitary - Hygienic Supply realization, methods of wastewater regeneration. The results of researches are especially urgent for cosmonauts Sanitary - Hygienic Supply System creation for long space flights, in particular, "Mars" flights at impossibility of updating of water stock, clothing stock etc.

Determining the Number of Ischemic Strokes Potentially Eligible for Endovascular Thrombectomy: A Population-Based Study.

PubMed

Chia, Nicholas H; Leyden, James M; Newbury, Jonathan; Jannes, Jim; Kleinig, Timothy J

2016-05-01

Endovascular thrombectomy (ET) is standard-of-care for ischemic stroke patients with large vessel occlusion, but estimates of potentially eligible patients from population-based studies have not been published. Such data are urgently needed to rationally plan hyperacute services. Retrospective analysis determined the incidence of ET-eligible ischemic strokes in a comprehensive population-based stroke study (Adelaide, Australia 2009-2010). Stroke patients were stratified via a prespecified eligibility algorithm derived from recent ET trials comprising stroke subtype, pathogenesis, severity, premorbid modified Rankin Score, presentation delay, large vessel occlusion, and target mismatch penumbra. Recognizing centers may interpret recent ET trials either loosely or rigidly; 2 eligibility algorithms were applied: restrictive (key criteria modified Rankin Scale score 0-1, presentation delay <3.5 hours, and target mismatch penumbra) and permissive (modified Rankin Scale score 0-3 and presentation delay <5 hours). In a population of 148 027 people, 318 strokes occurred in the 1-year study period (crude attack rate 215 [192-240] per 100 000 person-years). The number of ischemic strokes eligible by restrictive criteria was 17/258 (7%; 95% confidence intervals 4%-10%) and by permissive criteria, an additional 16 were identified, total 33/258 (13%; 95% confidence intervals 9%-18%). Two of 17 patients (and 6/33 permissive patients) had thrombolysis contraindications. Using the restrictive algorithm, there were 11 (95% confidence intervals 4-18) potential ET cases per 100 000 person-years or 22 (95% confidence intervals 13-31) using the permissive algorithm. In this cohort, ≈7% of ischemic strokes were potentially eligible for ET (13% with permissive criteria). In similar populations, the permissive criteria predict that ≤22 strokes per 100 000 person-years may be eligible for ET. © 2016 American Heart Association, Inc.

Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department

PubMed Central

Neeki, Michael M.; Dong, Fanglong; Avera, Leigh; Than, Tan; Borger, Rodney; Powell, Joe; Vaezazizi, Reza; Pitts, Richard

2016-01-01

Introduction Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient’s acuity level to determine the need to transport to an ED. Methods We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients’ acuity level in a large Level II trauma center between April 2015 and November 2015. Under-triage was defined as lower acuity assessed by paramedics but higher acuity by EPs. Over-triage was defined as higher acuity assessed by paramedics but lower acuity by EPs. The degree of agreement between the paramedics and EPs’ evaluations of patient’s acuity level was compared using Chi-square test. Results We included a total of 503 patients in the final analysis. For paramedics, 2 51 (49.9%) patients were assessed to be emergent, 178 (35.4%) assessed as urgent, and 74 (14.7%) assessed as non-emergent/non-urgent. In comparison, the EPs assessed 296 (58.9%) patients as emergent, 148 (29.4%) assessed as urgent, and 59 (11.7%) assessed as non-emergent/non-urgent. Paramedics agreed with EPs regarding the acuity level assessment on 71.8% of the cases. The overall under- and over-triage were 19.3% and 8.9%, respectively. A moderate Kappa=0.5174 indicated moderate inter-rater agreement between paramedics’ and EPs’ assessment on the same cohort of patients. Conclusion There is a significant difference in paramedic and physician assessment of patients into emergent, urgent, or non-emergent/non-urgent categories. The field triage of a patient to an alternative destination by paramedics under their current scope of practice and training cannot be supported. PMID:27833674

[Non elective cesarean section: use of a color code to optimize management of obstetric emergencies].

PubMed

Rudigoz, René-Charles; Huissoud, Cyril; Delecour, Lisa; Thevenet, Simone; Dupont, Corinne

2014-06-01

The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour.

C-Reactive Protein and White Blood Cell Count as Triage Test Between Urgent and Nonurgent Conditions in 2961 Patients With Acute Abdominal Pain

PubMed Central

Gans, Sarah L.; Atema, Jasper J.; Stoker, Jaap; Toorenvliet, Boudewijn R.; Laurell, Helena; Boermeester, Marja A.

2015-01-01

Abstract The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging. Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. Parameters of diagnostic accuracy were calculated for clinically applicable cutoff values of CRP levels and WBC count, and for combinations. A total of 2961 patients were included of which 1352 patients (45.6%) had an urgent final diagnosis. The median WBC count and CRP levels were significantly higher in the urgent group than in the nonurgent group (12.8 ×109/L; interquartile range [IQR] 9.9–16) versus (9.3 ×109/L; IQR 7.2–12.1) and (46 mg/L; IQR 12–100 versus 10 mg/L; IQR 7–26) (P < 0.001). The highest positive predictive value (PPV) (85.5%) and lowest false positives (14.5%) were reached when cutoff values of CRP level >50 mg/L and WBC count >15 ×109/L were combined; however, 85.3% of urgent cases was missed. A high CRP level (>50 mg/L) combined with a high WBC count (>15 ×109/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48 hours). PMID:25738473

An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

PubMed

McDevitt, Joe; Melby, Vidar

2015-02-01

To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. This descriptive study used a case-note review and a survey design with one open-ended exploratory question. Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. This study provides some evidence to support the continued expansion of the emergency nurse practitioner service in rural settings in the UK. © 2014 John Wiley & Sons Ltd.

Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes.

PubMed

Jin, Haijiao; Fang, Wei; Zhu, Mingli; Yu, Zanzhe; Fang, Yan; Yan, Hao; Zhang, Minfang; Wang, Qin; Che, Xiajing; Xie, Yuanyuan; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Mou, Shan; Ni, Zhaohui

2016-01-01

Several studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients. In this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups. Our study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate. In an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need for dialysis.

Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study.

PubMed

Sobolev, Boris G; Kuramoto, Lisa; Levy, Adrian R; Hayden, Robert

2006-08-24

In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02-2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54-1.04) vs. 0.58 (95% CI 0.42-0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01-2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.

33 CFR 80.1118 - Marina Del Rey, CA.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NAVIGATION RULES COLREGS DEMARCATION LINES Pacific Coast § 80.1118 Marina Del Rey, CA. (a) A line drawn from Marina Del Rey Breakwater South Light 1 to Marina Del Rey Light 4. (b) A line drawn from Marina Del Rey... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Marina Del Rey, CA. 80.1118...

33 CFR 80.1118 - Marina Del Rey, CA.

Code of Federal Regulations, 2012 CFR

2012-07-01

... NAVIGATION RULES COLREGS DEMARCATION LINES Pacific Coast § 80.1118 Marina Del Rey, CA. (a) A line drawn from Marina Del Rey Breakwater South Light 1 to Marina Del Rey Light 4. (b) A line drawn from Marina Del Rey... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Marina Del Rey, CA. 80.1118...

33 CFR 80.1118 - Marina Del Rey, CA.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NAVIGATION RULES COLREGS DEMARCATION LINES Pacific Coast § 80.1118 Marina Del Rey, CA. (a) A line drawn from Marina Del Rey Breakwater South Light 1 to Marina Del Rey Light 4. (b) A line drawn from Marina Del Rey... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Marina Del Rey, CA. 80.1118...

33 CFR 80.1118 - Marina Del Rey, CA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NAVIGATION RULES COLREGS DEMARCATION LINES Pacific Coast § 80.1118 Marina Del Rey, CA. (a) A line drawn from Marina Del Rey Breakwater South Light 1 to Marina Del Rey Light 4. (b) A line drawn from Marina Del Rey... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Marina Del Rey, CA. 80.1118...

33 CFR 80.1118 - Marina Del Rey, CA.

Code of Federal Regulations, 2014 CFR

2014-07-01

... NAVIGATION RULES COLREGS DEMARCATION LINES Pacific Coast § 80.1118 Marina Del Rey, CA. (a) A line drawn from Marina Del Rey Breakwater South Light 1 to Marina Del Rey Light 4. (b) A line drawn from Marina Del Rey... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Marina Del Rey, CA. 80.1118...

Atlas de aves: Un metodo para documentar distribucion y seguir poblaciones

USGS Publications Warehouse

Robbins, C.S.; Dowell, B.A.; Dawson, D.K.; Alvarez-Lopez, Humberto; Kattan, Gustavo; Murcia, Carolina

1988-01-01

Los Atlas de Aves son proyectos nacionales o regionalies para trazar en mapas la distribucion en reproduccion de cada especie de ave. Ese procedimiento se esta usando en Europa, Australia, Nueva Zelanda, Norteamerica, y partes de Africa. El tama?o de los cuadrados varia de medio grado de latitud y Iongitud hasta 5 x 5 km. El trabajo de campo de cada proyecto exige aproxlmadamente cinco a?os, pero los aficionados pueden llevar a cabo la mayor parte del trabajo. Es posible almacenar los resultados en un computador personal. Hay muchos beneficios: (I) se presenta la distribucion corriente de las aves de la nacion, del estado, o de la Iocalidad; (2) se desarrolla nueva informacion especialmente sobre especies raras o en peligro; (3) se descubren areas que tienen una avlfauna sobresaliente o habitats raros y ayuda a su proteccion, (4) se documentan cambios de dlstribucion; (5) se pueden usar para documentar cambios de poblacion, especialmente en los tropicos donde otros metodos son mas dificiles de usar porque hay muchas especies y no hay muchos observadores calificados en la identificacion de sonidos de las aves; (6) son proyectos buenos de investigacion para estudiantes graduados; (7) los turistas y los jefes de excursiones de historia natural pueden contribuir con muchas informaciones

[Yesterdays and happenings at hospitals of Tehuacán, Puebla, México].

PubMed

Fajardo-Ortiz, Guillermo

2004-01-01

The history of the hospital of Tehuacán, the second city importance in Puebla State, began in 1744, when the Hospital de San Juan de Dios (Hospital of St. John) was founded; in 1820, it was converted into the Municipal of Civil Hospital. The medical establishement continues to provide services to the poor to this day annual also covers health public workers of services for the municipality. The Hospital de la Cruz Roja Mexicana (The Mexican Red Cross Hospital) was created in 1934 provide medical services for accident victims: The hospital services of the Mexican Institute of Social Security (IMSS) began in 1953; an earthquake destroyed the building in 1973, and a new hospital was inaugurated in 1979; at present, it readers services to 98,000 persons. The Sanatorio del Sagrado Corazón (Sacred Heart Sanatorium) is a private religious institution founded at the beginning of the second half the 20th century. In 1996, the Hospital General (General Hospital) began to provide services, takes care of the poor of the geographical region, and is financed with federal funds. The Instituto de Seguridad y Servicios Sociales para Trabajadores del Estado (Institute of Securtiy and Social Services for the Workers of the State, ISSSTE) has a small hospital with 10 beds, it was founded in 1995.

8th Argentinean Bioengineering Society Conference (SABI 2011) and 7th Clinical Engineering Meeting

NASA Astrophysics Data System (ADS)

Meschino, Gustavo Javier; Ballarin, Virginia L.

2011-12-01

In September 2011, the Eighteenth Edition of the Argentinean Bioengineering Society Conference (SABI 2011) and Seventh Clinical Engineering Meeting were held in Mar del Plata, Argetina. The Mar del Plata SABI Regional and the School of Engineering of the Universidad Nacional de Mar del Plata invited All bioengineers, engineers, physicists, mathematicians, biologists, physicians and health professionals working in the field of Bioengineering to participate in this event. The overall objectives of the Conference were: To provide discussion of scientific research results in Bioengineering and Clinical Engineering. To promote technological development experiences. To strengthen the institutional and scientific communication links in the area of Bioengineering, mainly between Universities of Latin America. To encourage students, teachers, researchers and professionals to establish exchanges of experiences and knowledge. To provide biomedical engineering technology solutions to the society and contributing ideas for low cost care. Conference photograph Conference photograph Conference photograph Conference photograph EXECUTIVE COMMITTEE SABI 2011 Chair Dra Virginia L Ballarin Universidad Nacional de Mar del Plata Co-Chair Dra Teresita R Cuadrado Universidad Nacional de Mar del Plata - CONICET Local Comittee Dr Gustavo Abraham Universidad Nacional de Mar del Plata - CONICET Dra Josefina Ballarre Universidad Nacional de Mar del Plata - CONICET Dr Eduardo Blotta Universidad Nacional de Mar del Plata Dra Agustina Bouchet Universidad Nacional de Mar del Plata Dr Marcel Brun Universidad Nacional de Mar del Plata Dra Silvia Ceré Universidad Nacional de Mar del Plata - CONICET Dra Mariela Azul Gonzalez Universidad Nacional de Mar del Plata - CONICET Dra Lucia Isabel Passoni Universidad Nacional de Mar del Plata Dr Juan Ignacio Pastore Universidad Nacional de Mar del Plata - CONICET Dra Adriana Scandurra Universidad Nacional de Mar del Plata SCIENTIFIC ADVISORY COMMITTEE President Dr Gustavo Meschino Universidad Nacional de Mar del Plata Comittee Dr Gustavo Abraham Universidad Nacional de Mar del Plata - CONICET Mg Rubén Acevedo Universidad Nacional de Entre Ríos Ing Pablo Agüero Universidad Nacional de Mar del Plata Ing Mariela Ambrustolo Universidad Nacional de Mar del Plata Dr Ricardo Armentano Universidad Favaloro Dra Virginia L Ballarin Universidad Nacional de Mar del Plata Dra Josefina Ballarre Universidad Nacional de Mar del Plata - CONICET Dr Eduardo Blotta Universidad Nacional de Mar del Plata Ing Marco Benalcázar Universidad Nacional de Mar del Plata Mg Freddy Geovanny Benalcázar Palacios Escuela Superior Politécnica de Chimborazo, Ecuador Dr Roberto Boeri Universidad Nacional de Mar del Plata - CONICET - INTEMA Dra Agustina Bouchet Universidad Nacional de Mar del Plata Dr Ariel Braidot Universidad Nacional de Entre Ríos Dr Marcel Brun Universidad Nacional de Mar del Plata Dra Silvia Ceré Universidad Nacional de Mar del Plata - CONICET Ing Fernando Clara Universidad Nacional de Mar del Plata Dr Raúl Correa Prado Universidad Nacional de San Juan Bioing Pablo Cortez Universidad Nacional de Mar del Plata Dra Teresita R Cuadrado Universidad Nacional de Mar del Plata - CONICET Ing Eduardo De Forteza Universidad Favaloro Dra Mariana Del Fresno Universidad Nacional del Centro de la Provincia de Buenos Aires Dr Martín Diaz Informática Médica Hospital Aleman de Buenos Aires - GIBBA Ing Julio César Doumecq Universidad Nacional de Mar del Plata Mg Ana María Echenique Universidad Nacional de San Juan Bioing Pedro Escobar Universidad Nacional del Centro, Olavarría, Pcia de Buenos Aires Dr Fernando Daniel Farfán Universidad Nacional de Tucumán Dr Carmelo Felice Universidad Nacional de Tucumán - CONICET Dr Elmer Fernández Universidad Católica de Córdoba - CONICET Ing José Flores Universidad Nacional de Entre Ríos Dr Arturo Gayoso Universidad Nacional de Mar del Plata Dra Bioing Agustina Garcés Universidad Nacional de San Juan ¬- CONICET Bioing Luciano Gentile Universidad Favaloro Mg María Eugenia Gómez Universidad Nacional de San Juan Dr Claudio González Universidad Nacional de Mar del Plata Mg Esteban González Universidad Nacional de Mar del Plata Dra Mariela A Gonzalez Universidad Nacional de Mar del Plata - CONICET Dr Juan Pablo Graffigna Universidad Nacional de San Juan Dra Myriam Herrera Universidad Nacional de Tucumán - CONICET Dr Roberto Hidalgo Universidad Nacional de Mar del Plata Dr Roberto Isoardi Fundación Escuela de Medicina Nuclear de Mendoza - CNEA Dra Susana Jerez Universidad Nacional de Tucumán Dr Eric Laciar Universidad Nacional de San Juan - CONICET Bioing Roberto Leonarduzzi Universidad Nacional de Entre Ríos Mg Norberto Lerendegui Instituto Tecnológico de Buenos Aires Dra Natalia López Universidad Nacional de San Juan - CONICET Dra Rossana Madrid Universidad Nacional de Tucuman - CONICET Ing Florencia Montini Ballarin Universidad Nacional de Mar del Plata - CONICET Dra Emilce Moler Universidad Nacional de Mar del Plata Dr Jorge Castiñieira Moreira Universidad Nacional de Mar del Plata Dr Silvia Murialdo Universidad Nacional de Mar del Plata - CIC Dr Juan Manuel Olivera Universidad Nacional de Tucumán Dra Lucia Isabel Passoni Universidad Nacional de Mar del Plata Dr Juan Ignacio Pastore Universidad Nacional de Mar del Plata - CONICET Dra María Elisa Pérez Universidad Nacional de San Juan Mg Franco M Pessana Universidad Favaloro Dr Julio Politti Universidad Nacional de Tucumán Dr Marcelo Risk Universidad Nacional de Buenos Aires - CONICET Ing Raúl Rivera Universidad Nacional de Mar del Plata Mg Luis Rocha Universidad Nacional de Tucumán - SIPROSA Dra Silvia Rodrigo Universidad Nacional de San Juan Dra Viviana Rotger Universidad Nacional de Tucumán Dr Leonardo Rufiner Universidad Nacional de Entre Rios - CONICET Dra Estela Ruiz Universidad Nacional de Tucumán Dr Martín Santiago Universidad Nacional del Centro de la Provincia de Buenos Aires Dra Adriana Scandurra Universidad Nacional de Mar del Plata Ing Graciela Secreto Universidad Favaloro Mg Pablo Solarz Universidad Nacional de Tucumán Mg Carolina Tabernig Universidad Nacional de Entre Ríos Ing Ricardo Taborda Universidad Nacional de Córdoba Dra María Eugenia Torres Universidad Nacional de Entre Ríos - CONICET Ing Juan Carlos Tulli Universidad Nacional de Mar del Plata Dr Gerardo Tusman Hospital Privado de Comunidad, Mar del Plata Dr Santiago Urquiza Universidad Nacional de Mar del Plata Mg Andrés Valdez Universidad Nacional de San Juan Dr Máximo Valentinuzzi INSIBIO - CONICET - Universidad Nacional de Tucumán

Exome Sequencing Identifies Biallelic MSH3 Germline Mutations as a Recessive Subtype of Colorectal Adenomatous Polyposis.

PubMed

Adam, Ronja; Spier, Isabel; Zhao, Bixiao; Kloth, Michael; Marquez, Jonathan; Hinrichsen, Inga; Kirfel, Jutta; Tafazzoli, Aylar; Horpaopan, Sukanya; Uhlhaas, Siegfried; Stienen, Dietlinde; Friedrichs, Nicolaus; Altmüller, Janine; Laner, Andreas; Holzapfel, Stefanie; Peters, Sophia; Kayser, Katrin; Thiele, Holger; Holinski-Feder, Elke; Marra, Giancarlo; Kristiansen, Glen; Nöthen, Markus M; Büttner, Reinhard; Möslein, Gabriela; Betz, Regina C; Brieger, Angela; Lifton, Richard P; Aretz, Stefan

2016-08-04

In ∼30% of families affected by colorectal adenomatous polyposis, no germline mutations have been identified in the previously implicated genes APC, MUTYH, POLE, POLD1, and NTHL1, although a hereditary etiology is likely. To uncover further genes with high-penetrance causative mutations, we performed exome sequencing of leukocyte DNA from 102 unrelated individuals with unexplained adenomatous polyposis. We identified two unrelated individuals with differing compound-heterozygous loss-of-function (LoF) germline mutations in the mismatch-repair gene MSH3. The impact of the MSH3 mutations (c.1148delA, c.2319-1G>A, c.2760delC, and c.3001-2A>C) was indicated at the RNA and protein levels. Analysis of the diseased individuals' tumor tissue demonstrated high microsatellite instability of di- and tetranucleotides (EMAST), and immunohistochemical staining illustrated a complete loss of nuclear MSH3 in normal and tumor tissue, confirming the LoF effect and causal relevance of the mutations. The pedigrees, genotypes, and frequency of MSH3 mutations in the general population are consistent with an autosomal-recessive mode of inheritance. Both index persons have an affected sibling carrying the same mutations. The tumor spectrum in these four persons comprised colorectal and duodenal adenomas, colorectal cancer, gastric cancer, and an early-onset astrocytoma. Additionally, we detected one unrelated individual with biallelic PMS2 germline mutations, representing constitutional mismatch-repair deficiency. Potentially causative variants in 14 more candidate genes identified in 26 other individuals require further workup. In the present study, we identified biallelic germline MSH3 mutations in individuals with a suspected hereditary tumor syndrome. Our data suggest that MSH3 mutations represent an additional recessive subtype of colorectal adenomatous polyposis. Copyright © 2016 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

[Psychohygienic problems of development in early childhood (author's transl)].

PubMed

Pechstein, J

1976-01-01

For a "social environmental protection" as one of the most urgent problems in infantile psychohygiene, the following conclusions should be taken into consideration: 1. In particular during the first years of life the development of the child is, within certain limits, sensitive to influences from the environment and therefore it can be fostered or disturbed from the outside. Congenital, prenatal, perinatal and postnatal injuries to the brain and sensory organs must be given great attention psychohygienically. 2. The social influences exercised on the child by persons of his environment, their availability, their emotional relationships and the development of a durable link predominate psychohygienically. In addition, the material security of young families and their type of accommodation (e.g. granting of loans to help set up a home) must be considered. 3. The possibilities of exercising a positive educational influence on a mentally and psychically sound development of the child as a person and member of society are greatest at the beginning of life and diminish during childhood. The effectiveness of negative educational and social interference factors is also subject to this rule from which again the necessity of adopting psychohygienic measures for the young child is derived. 4. The phenomenon of increasingly imbalanced behaviour of older children and juveniles which cause concern today, are as a rule symptoms of a chiefly environmentally determined disturbance upsetting the personality, which often originates in early childhood. Psychohygienic measures must be concentrated on this. 5. The inadequate care of young children accounting for one third of the population, a phenomenon which can be read in the statistical records and which has risen sharply during the last few years, makes it possible to forecast a further increase in developmental and behavioral disturbances of both an intellectual and psychological nature as well as in infantile and juvenile criminality in the coming years to an at present unimaginable extent. 6. In contrast to general opinion, the situation calls for an urgent fundamental revaluation of the importance of intrafamiliar social conditions of development and of the parental educational work on the small child, which to date, have been underestimated and neglected. At the same time many of the presently overrated extrafamiliar institutions of education and training for the older child need to be relativised. 7. The advances in developmental biology which allow us to realize the basic dependence of the future social fate of the individual - and thus the extent of disturbed social relationships in society - on the intrafamily conditions must become a political issue, if psychohygiene as ameans to prevent avoidable disturbances is to be taken seriously. Thus the securement of adequate intrafamily conditions with respect to development and upbringing, in particular of the young child, must head the list of social political priorities, also in times when money is in short supply. 8...

The Human 343delT HSPB5 Chaperone Associated with Early-onset Skeletal Myopathy Causes Defects in Protein Solubility*

PubMed Central

Mitzelfelt, Katie A.; Limphong, Pattraranee; Choi, Melinda J.; Kondrat, Frances D. L.; Lai, Shuping; Kolander, Kurt D.; Kwok, Wai-Meng; Dai, Qiang; Grzybowski, Michael N.; Zhang, Huali; Taylor, Graydon M.; Lui, Qiang; Thao, Mai T.; Hudson, Judith A.; Barresi, Rita; Bushby, Kate; Jungbluth, Heinz; Wraige, Elizabeth; Geurts, Aron M.; Benesch, Justin L. P.; Riedel, Michael; Christians, Elisabeth S.; Minella, Alex C.; Benjamin, Ivor J.

2016-01-01

Mutations of HSPB5 (also known as CRYAB or αB-crystallin), a bona fide heat shock protein and molecular chaperone encoded by the HSPB5 (crystallin, alpha B) gene, are linked to multisystem disorders featuring variable combinations of cataracts, cardiomyopathy, and skeletal myopathy. This study aimed to investigate the pathological mechanisms involved in an early-onset myofibrillar myopathy manifesting in a child harboring a homozygous recessive mutation in HSPB5, 343delT. To study HSPB5 343delT protein dynamics, we utilize model cell culture systems including induced pluripotent stem cells derived from the 343delT patient (343delT/343delT) along with isogenic, heterozygous, gene-corrected control cells (WT KI/343delT) and BHK21 cells, a cell line lacking endogenous HSPB5 expression. 343delT/343delT and WT KI/343delT-induced pluripotent stem cell-derived skeletal myotubes and cardiomyocytes did not express detectable levels of 343delT protein, contributable to the extreme insolubility of the mutant protein. Overexpression of HSPB5 343delT resulted in insoluble mutant protein aggregates and induction of a cellular stress response. Co-expression of 343delT with WT prevented visible aggregation of 343delT and improved its solubility. Additionally, in vitro refolding of 343delT in the presence of WT rescued its solubility. We demonstrate an interaction between WT and 343delT both in vitro and within cells. These data support a loss-of-function model for the myopathy observed in the patient because the insoluble mutant would be unavailable to perform normal functions of HSPB5, although additional gain-of-function effects of the mutant protein cannot be excluded. Additionally, our data highlight the solubilization of 343delT by WT, concordant with the recessive inheritance of the disease and absence of symptoms in carrier individuals. PMID:27226619

Survivability on the Island of Spice: The Development of the UH-60 Blackhawk and Its Baptism of Fire in Operation Urgent Fury

DTIC Science & Technology

2015-06-12

SURVIVABILITY ON THE ISLAND OF SPICE : THE DEVELOPMENT OF THE UH-60 BLACKHAWK AND ITS BAPTISM OF FIRE IN OPERATION URGENT FURY......THESIS APPROVAL PAGE Name of Candidate: Major Matthew G. Easley Thesis Title: Survivability on the Island of Spice : The Development of the UH

Visions Lost and Dreams Forgotten: Environmental Education, Systems Thinking, and Possible Futures in American Public Schools

ERIC Educational Resources Information Center

Cassell, John A.; Nelson, Thomas

2010-01-01

This article discusses the contributions to this special issue of "Teacher Education Quarterly." At the core of all the contributions is the compellingly urgent realization that humanity is facing, and must deal with, enormous ecological and social problems and challenges. This situation has created an urgent and compelling need centered…

39 CFR 320.6 - Suspension for extremely urgent letters.

Code of Federal Regulations, 2013 CFR

2013-07-01

... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

39 CFR 320.6 - Suspension for extremely urgent letters.

Code of Federal Regulations, 2010 CFR

2010-07-01

... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

39 CFR 320.6 - Suspension for extremely urgent letters.

Code of Federal Regulations, 2014 CFR

2014-07-01

... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

39 CFR 320.6 - Suspension for extremely urgent letters.

Code of Federal Regulations, 2011 CFR

2011-07-01

... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

39 CFR 320.6 - Suspension for extremely urgent letters.

Code of Federal Regulations, 2012 CFR

2012-07-01

... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

Breathing Life into New Speakers: Nsyilxcn and Tlingit Sequenced Curriculum, Direct Acquisition, and Assessments

ERIC Educational Resources Information Center

Johnson, S?ímla?w Michele K.

2017-01-01

Many Indigenous languages are critically endangered and faced with the urgent need to create parent-aged advanced speakers. This goal requires sequenced curriculum, effective teaching methods, students being supported to spend more than 2,000 hours on task, and regular assessments. In response to this urgent need the author followed a proven…

76 FR 53913 - Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego, CA; Correction AGENCY: Office of... (SOTI), San Diego, CA. The document contained incorrect information in citing the statutory authority...

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

Education Through Aerospace Components. (Spanish Title: Educación Através de Elementos Aeroespaciales.) Educação Através de Elementos Aeroespaciais

NASA Astrophysics Data System (ADS)

Barbosa Loureda, Oswaldo; Sobral de Araújo, Jéssyca B.

2008-12-01

Education is a field that needs development. For such purposes, there are various methods and tools that suggest ideas in favor of the improvement of the Brazilian people in the pedagogical, psychological and cultural aspects. Teaching is an act that demands a lot of care and responsibility; the behavior and performance of an individual in the society is the result of way that people was educated. However, the area of hard sciences demands a special attention, because the acquired knowledge is essential for the personal development of the individual and the technological future of the country. As an alternative or complementary tool for education it is suggested the use of aerospace element, since they show a vast amount of subjects qualitatively dealing with abilities of great importance for the future professional life of the students. A new Race happens, however this time the goal is not the Moon, but knowledge. El área educacional es un campo que necesita desarrollo. Para esto se dispone de diversos métodos y medios que pueden implantar ideas en pro del avance del pueblo brasilero en los aspectos pedagógicos, psicológicos y culturales. Alfabetizar es un acto que exige mucho cuidado y responsabilidad; el comportamento y desempeño de un individuo en la sociedad es el resultado de la manera en que fue educado. En particular, el área de ciencias exactas exige especial atención, pues los conocimientos adquiridos son imprescindibles para el desarrollo personal del individuo y también para el futuro tecnológico del País. Como medio alternativo o complementar de enseñanza se sugiere el uso de elementos aeroespaciales, debido a que compreende una vasta cantidad de disciplinas cualitativamente involucradas en la adquisición de habilidades de gran importancia para su vida profesional futura. Una nueva Carrera está em marcha, sin embargo esta vez la meta no es la Luna, sino el conocimiento. A área educacional é um campo que necessita de desenvolvimento. Para tal, dispõe-se de diversos métodos e meios que vêm implantar idéias em prol do avanço do povo brasileiro nos aspectos pedagógicos, psicológicos e culturais. Alfabetizar é um ato que exige muito cuidado e responsabilidade; o comportamento e desempenho de um indivíduo na sociedade é resultado da maneira com que ele foi instruído. Contudo, a área de exatas exige especial atenção, pois os conhecimentos adquiridos são imprescindíveis para o desenvolvimento pessoal do individuo, assim como para o futuro tecnológico do País. Como meio alternativo ou complementar de ensino é sugerido o uso de elementos aeroespaciais, devido ao fato de comportar uma vasta quantidade e qualidade de disciplinas envolvidas respectivamente com competências de grande importância para sua vida profissional futura. Uma nova Corrida acontece, porém dessa vez a meta não é a Lua e sim o conhecimento.

Corporate use of information regarding natural resources and environmental quality

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

Train, R.E.

1984-01-01

This report presents findings and recommendations from a one-year study of the corporate use of information regarding natural resources and environmental quality. Personal interviews were conducted with 229 information users at 45 of America's largest corporations, trade associations, and private information companies. In addition, 110 information users participated in a written survey. Our principal findings are: (1) US corporations urgently need more international data; (2) US corporations feel that the government's natural resource forecasts are not credible; (3) US corporations need upgraded and expanded data on environmental quality; (4) US corporations believe that government information is not timely; (5) informationmore » on natural resources and environmental quality is vital to the success of US corporations; (6) US corporations depend on a large body of this information in making decisions regarding capacity, siting, marketing, production, and strategic planning among others; and (7) the US government is the principal source of information on natural resources and environmental quality.« less

Diagnostics for Lassa Fever: Detecting Host Antibody Responses.

PubMed

Salvato, Maria S; Lukashevich, Igor S; Medina-Moreno, Sandra; Zapata, Juan Carlos

2018-01-01

There are two types of viral diagnostics: (1) those that detect components of the pathogen (like viral RNA or proteins) and (2) those that detect host molecules that rise or fall as a consequence of pathogen infection (like anti-viral antibodies or virus-induced inflammatory cytokines). Quantitative PCR to detect Lassa RNA, and clinical chemistry to detect high liver enzymes (AST/ALT) are commonly used to diagnose Lassa fever. Here, we discuss the various types of diagnostics for Lassa fever and the urgent need for early diagnosis. We also describe a protocol for using the attenuated Lassa vaccine candidate, ML29 , as an antigen for detecting Lassa-specific antibodies. Since antibodies are developed late in the progression of Lassa fever disease, this is not an early diagnostic, but is more useful in surveillance of the population to determine the sero-prevalence of antibodies to Lassa virus (LASV ), and to define treatment options for people in close contact with a Lassa-infected person.

The Asilomar Survey: Stakeholders' Opinions on Ethical Issues Related to Brain-Computer Interfacing.

PubMed

Nijboer, Femke; Clausen, Jens; Allison, Brendan Z; Haselager, Pim

2013-01-01

Brain-Computer Interface (BCI) research and (future) applications raise important ethical issues that need to be addressed to promote societal acceptance and adequate policies. Here we report on a survey we conducted among 145 BCI researchers at the 4 th International BCI conference, which took place in May-June 2010 in Asilomar, California. We assessed respondents' opinions about a number of topics. First, we investigated preferences for terminology and definitions relating to BCIs. Second, we assessed respondents' expectations on the marketability of different BCI applications (BCIs for healthy people, BCIs for assistive technology, BCIs-controlled neuroprostheses and BCIs as therapy tools). Third, we investigated opinions about ethical issues related to BCI research for the development of assistive technology: informed consent process with locked-in patients, risk-benefit analyses, team responsibility, consequences of BCI on patients' and families' lives, liability and personal identity and interaction with the media. Finally, we asked respondents which issues are urgent in BCI research.

The DNA Bank: High-Security Bank Accounts to Protect and Share Your Genetic Identity.

PubMed

den Dunnen, Johan T

2015-07-01

With the cost of genome sequencing decreasing every day, DNA information has the potential of affecting the lives of everyone. Surprisingly, an individual has little knowledge about his own DNA information, can rarely access it, and has hardly any control over its use. This may result in preventable, life-threatening situations, and also significantly inhibits scientific progress. What we urgently need is a "DNA bank," a resource providing a secure personal account where, similar to a financial institution, you can store your DNA sequence. Using this private and secure DNA bank account, you govern your sequence-related business. For any genetic study performed, the data generated must be transferred (paid) to your DNA account. Using your account, you regulate access, knowing for what purpose (informed consent) and only for the genetic data you are willing to share. The DNA account ensures you are in the driver's seat, know what is known, and control what is happening with it. © 2015 WILEY PERIODICALS, INC.

Molecular mechanisms and therapeutic targets in neuroblastoma.

PubMed

Johnsen, John Inge; Dyberg, Cecilia; Fransson, Susanne; Wickström, Malin

2018-05-01

Neuroblastoma is the most common extracranical tumor of childhood and the most deadly tumor of infancy. It is characterized by early age onset and high frequencies of metastatic disease but also the capacity to spontaneously regress. Despite intensive therapy, the survival for patients with high-risk neuroblastoma and those with recurrent or relapsed disease is low. Hence, there is an urgent need to develop new therapies for these patient groups. The molecular pathogenesis based on high-throughput omics technologies of neuroblastoma is beginning to be resolved which have given the opportunity to develop personalized therapies for high-risk patients. Here we discuss the potential of developing targeted therapies against aberrantly expressed molecules detected in sub-populations of neuroblastoma patients and how these selected targets can be drugged in order to overcome treatment resistance, improve survival and quality of life for these patients and also the possibilities to transfer preclinical research into clinical testing. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Adolescent knowledge, values, and coping strategies: implications for health in sub-Saharan Africa.

PubMed

Balmer, D H; Gikundi, E; Billingsley, M C; Kihuho, F G; Kimani, M; Wang'ondu, J; Njoroge, H

1997-07-01

The purposes of this study were to investigate the experiences and knowledge of adolescents living in an urban center in Kenya and to understand how the decisions they make affect their physical and psychological health. A sample of 216 adolescents was drawn and they met weekly in small groups with trained facilitators for a period of 6 months. A research team monitored the developments of the groups and the topics they discussed. The findings were corroborated by the adolescents. It was found that adolescents were primarily concerned with developing a coherent and consistent set of personal values which would govern their behavior. Unfortunately, they could not always achieve those values and they resorted to dysfunctional coping strategies which were injurious to their health. The role of the adolescent in developing countries is complex and poorly defined. In a period of unprecedented change, an urgent and comprehensive review is necessary by all sections of society if the health of this group is to improve.

[Proxy decision in health questions and advance designations by patients. A practice-oriented review of the legal and ethical problems in treating the incompetent patient].

PubMed

Strätling, M; Scharf, V E; Wulf, H; Eisenbart, B; Simon, A

2000-07-01

Except in emergencies, the medical treatment of incompetent patients also has to be based upon an informed consent between the physician and a legitimate legal representative (durable power of attorney). Consequently, the German 'Betreuungsrecht' advices persons to designate in advance such a proxy or surrogate. However, an additional court-decision is demanded, if a medical measure poses significant risks for the future health or the life of the incompetent patient. On the base of the available epidemiologic data we illustrate that neither our medical nor our legal system could realistically cope with the practical consequences of this legislation: The vast majority of our present decisions in such cases is not covered by a legally valid informed consent, which implies possible forensic consequences. This article provides relevant clinical and legal advice on how to protect the legitimate interests of all concerned within the present framework, which should urgently be revised.

[Reduction and control of school bullying is urgently needed].

PubMed

Zhao, Y J; Wang, S Y

2017-03-10

School bullying and campus violence is a widespread social problem in the world. School bullying is characterized by its repeatability and suddenness, which could make the victims suffering from both psychological and health damage, and even affect their personality growth. Government should pay close attention to the reduction and control of school bullying and campus violence by establishing school bullying emergency response system and preparedness plan. The school and teacher's role and legal responsibility in the service and management in schools should be cleared and defined. It is necessary to help teachers conduct early detection and intervention for school bullying, conduct morality, mental health and legal educations in students to teach them to act according to the law and protect themselves according to the law and help them identify and avoid risks, encourage the establishment of rescue facility and web of anti-school bullying by non-government organizations, and set hotline for school bullying incident to reduce the incidence of school bullying.

Rural families caring for a relative with dementia: barriers to use of formal services.

PubMed

Morgan, Debra G; Semchuk, Karen M; Stewart, Norma J; D'Arcy, Carl

2002-10-01

Planning for the care of increasing numbers of elderly persons with dementia has become an urgent health services concern in Canada and elsewhere, yet little is known about the challenges of providing appropriate dementia care in rural areas. A community-based approach was used to obtain input from decision-makers and others to develop the objectives and design for a study of rural dementia care in the province of Saskatchewan, Canada. The resulting study design, which used both qualitative and quantitative methods, was then pilot tested in one rural health district (16,000 km2, population 20,000). This paper describes the study development process and reports selected findings from focus groups conducted with home care staff and family members, focussing on the theme of low use of formal supportive services such as home care and support groups by family caregivers. Participants identified eight barriers to the use of formal services, described consequences of low service use, and suggested strategies for addressing this concern.

Trypanosoma cruzi: analysis of two different strains after piplartine treatment.

PubMed

Vieira, Gabriela Alves Licursi; Silva, Marco Túlio Alves da; Regasini, Luis Octávio; Cotinguiba, Fernando; Laure, Helen Julie; Rosa, José César; Furlan, Maysa; Cicarelli, Regina Maria Barretto

2018-06-04

The hemoflagellate protozoan, Trypanosoma cruzi, mainly transmitted by triatomine insects through blood transfusion or from mother-to-child, causes Chagas' disease. This is a serious parasitic disease that occurs in Latin America, with considerable social and economic impact. Nifurtimox and benznidazole, drugs indicated for treating infected persons, are effective in the acute phase, but poorly effective during the chronic phase. Therefore, it is extremely urgent to find innovative chemotherapeutic agents and/or effective vaccines. Since piplartine has several biological activities, including trypanocidal activity, the present study aimed to evaluate it on two T. cruzi strains proteome. Considerable changes in the expression of some important enzymes involved in parasite protection against oxidative stress, such as tryparedoxin peroxidase (TXNPx) and methionine sulfoxide reductase (MSR) was observed in both strains. These findings suggest that blocking the expression of the two enzymes could be potential targets for therapeutic studies. Copyright © 2018 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

Feeding difficulties, a key feature of the Drosophila NDUFS4 mitochondrial disease model

PubMed Central

Foriel, Sarah; Eidhof, Ilse

2018-01-01

ABSTRACT Mitochondrial diseases are associated with a wide variety of clinical symptoms and variable degrees of severity. Patients with such diseases generally have a poor prognosis and often an early fatal disease outcome. With an incidence of 1 in 5000 live births and no curative treatments available, relevant animal models to evaluate new therapeutic regimes for mitochondrial diseases are urgently needed. By knocking down ND-18, the unique Drosophila ortholog of NDUFS4, an accessory subunit of the NADH:ubiquinone oxidoreductase (Complex I), we developed and characterized several dNDUFS4 models that recapitulate key features of mitochondrial disease. Like in humans, the dNDUFS4 KD flies display severe feeding difficulties, an aspect of mitochondrial disorders that has so far been largely ignored in animal models. The impact of this finding, and an approach to overcome it, will be discussed in the context of interpreting disease model characterization and intervention studies. This article has an associated First Person interview with the first author of the paper. PMID:29590638

HIV, Hepatitis C, TB, Harm Reduction, and Persons Deprived of Liberty

PubMed Central

Lines, Rick

2016-01-01

Abstract HIV, hepatitis C virus (HCV), and TB in prisons and other places of detention are serious public health concerns, with prevalence and incidence considerably higher than in the general community because of the overrepresentation of risky behavior, substandard conditions, overcrowding, people who inject drugs, and the wholly inadequate prevention, care, and treatment of these conditions, including the denial of harm reduction services. This is not only a severe public health crisis but also a serious human rights concern. This article works to clarify the standards established by human rights law with regards to HIV, HCV, TB, and harm reduction in prisons by examining international and regional case law, minimum standards on the treatment of prisoners and public health, as well as the work of UN treaty bodies, Special Rapporteurs, and prison monitoring bodies. It is imperative that urgent steps are taken to close the gap between human rights and public health standards on the one hand, and effective implementation in prison settings on the other. PMID:28559684

Chronic traumatic encephalopathy and other neurodegenerative proteinopathies

PubMed Central

Tartaglia, Maria Carmela; Hazrati, Lili-Naz; Davis, Karen D.; Green, Robin E. A.; Wennberg, Richard; Mikulis, David; Ezerins, Leo J.; Keightley, Michelle; Tator, Charles

2014-01-01

“Chronic traumatic encephalopathy” (CTE) is described as a slowly progressive neurodegenerative disease believed to result from multiple concussions. Traditionally, concussions were considered benign events and although most people recover fully, about 10% develop a post-concussive syndrome with persisting neurological, cognitive and neuropsychiatric symptoms. CTE was once thought to be unique to boxers, but it has now been observed in many different athletes having suffered multiple concussions as well as in military personal after repeated blast injuries. Much remains unknown about the development of CTE but its pathological substrate is usually tau, similar to that seen in Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD). The aim of this “perspective” is to compare and contrast clinical and pathological CTE with the other neurodegenerative proteinopathies and highlight that there is an urgent need for understanding the relationship between concussion and the development of CTE as it may provide a window into the development of a proteinopathy and thus new avenues for treatment. PMID:24550810

Personal experience with the procurement of 132 liver allografts

PubMed Central

Yanaga, K.; Tzakis, A.G.; Starzl, T.E.

2010-01-01

A single donor surgeon's experience procuring the livers from 132 donors is described. Thirty-seven grafts (28.9%) had hepatic arterial anomalies, 19 (14.4%) of which required arterial reconstruction prior to transplantation. Of the 121 grafts evaluated for early function, 103 grafts (85.2%) functioned well, whereas 14 grafts (11.6%) functioned poorly and 4 grafts (3.3%) failed to function at all. The variables associated with less than optimal function of the graft consisted of donor age (P < 0.05), duration of donor's stay in the intensive care unit (P < 0.005), abnormal graft appearance (P < 0.05), and such recipient problems as vascular thromboses during or immediately following transplantation (P < 0.005). A new preservation fluid, University of Wisconsin solution, allowed safe and longer cold storage of the liver allograft than did Euro-Collins' solution (P < 0.0001). A parameter of liver allograft viability, which is simple and predictive of allograft function prior to the actual transplant procedure, is urgently needed. PMID:2803485

Toward ubiquitous healthcare services with a novel efficient cloud platform.

PubMed

He, Chenguang; Fan, Xiaomao; Li, Ye

2013-01-01

Ubiquitous healthcare services are becoming more and more popular, especially under the urgent demand of the global aging issue. Cloud computing owns the pervasive and on-demand service-oriented natures, which can fit the characteristics of healthcare services very well. However, the abilities in dealing with multimodal, heterogeneous, and nonstationary physiological signals to provide persistent personalized services, meanwhile keeping high concurrent online analysis for public, are challenges to the general cloud. In this paper, we proposed a private cloud platform architecture which includes six layers according to the specific requirements. This platform utilizes message queue as a cloud engine, and each layer thereby achieves relative independence by this loosely coupled means of communications with publish/subscribe mechanism. Furthermore, a plug-in algorithm framework is also presented, and massive semistructure or unstructured medical data are accessed adaptively by this cloud architecture. As the testing results showing, this proposed cloud platform, with robust, stable, and efficient features, can satisfy high concurrent requests from ubiquitous healthcare services.

The role of professional education in building capacity for health promotion in the global South: a case study from Norway.

PubMed

Mittelmark, Maurice B

2003-01-01

The capacity to train public health professionals is far from sufficient to meet urgent global needs. Foreign aid programs hold much promise to deal with this challenge. A case study from Norway illustrates the possibilities. Since the early 1960s, Norwegian universities have offered English-taught masters and doctoral degree programs, with sufficient financial support that all Third World students have the resources to complete training, regardless of their personal financial circumstances. This facet of the program is its main distinguishing factor, compared to many educational opportunities that are available in other countries. Since the first visiting students were awarded degrees in 1968, almost 10,000 students have participated at more than 25 Norwegian institutions, including many offering public health training. Many eligible applicants have been turned away due to lack of resources, indicating a level of interest that cannot be met with existing resources. Similar programs in more countries could help alleviate the need.

Gabor filter based fingerprint image enhancement

NASA Astrophysics Data System (ADS)

Wang, Jin-Xiang

2013-03-01

Fingerprint recognition technology has become the most reliable biometric technology due to its uniqueness and invariance, which has been most convenient and most reliable technique for personal authentication. The development of Automated Fingerprint Identification System is an urgent need for modern information security. Meanwhile, fingerprint preprocessing algorithm of fingerprint recognition technology has played an important part in Automatic Fingerprint Identification System. This article introduces the general steps in the fingerprint recognition technology, namely the image input, preprocessing, feature recognition, and fingerprint image enhancement. As the key to fingerprint identification technology, fingerprint image enhancement affects the accuracy of the system. It focuses on the characteristics of the fingerprint image, Gabor filters algorithm for fingerprint image enhancement, the theoretical basis of Gabor filters, and demonstration of the filter. The enhancement algorithm for fingerprint image is in the windows XP platform with matlab.65 as a development tool for the demonstration. The result shows that the Gabor filter is effective in fingerprint image enhancement technology.

"Right Here is the Gateway": Mobility, Sex Work Entry and HIV Risk Along the Mexico-U.S. Border.

PubMed

Goldenberg, Sm; Silverman, Js; Engstrom, D; Bojorquez-Chapela, I; Strathdee, Sa

2014-08-01

Women comprise an increasing proportion of migrants. Many voluntarily migrate for sex work or practice survival sex, while others may be trafficked for sexual exploitation. To investigate how the context of mobility shapes sex work entry and HIV risk, we conducted in-depth interviews with formerly trafficked women currently engaged in sex work (n=31) in Tijuana, Mexico and their service providers (n=7) in Tijuana and San Diego, USA from 2010-2011. Women's experiences of coerced and deceptive migration, deportation as forced migration, voluntary mobility, and migration to a risk environment illustrate that circumstances driving and resulting from migration shape vulnerability to sex trafficking, voluntary sex work entry, and HIV risk. Findings suggest an urgent need for public health and immigration policies that provide integrated support for deported and/or recently arrived female migrants. Policies to prevent sex trafficking and assist trafficked females must also consider the varying levels of personal agency involved in migration and sex work entry.

“Right Here is the Gateway”: Mobility, Sex Work Entry and HIV Risk Along the Mexico-U.S. Border

PubMed Central

Goldenberg, SM; Silverman, JS; Engstrom, D; Bojorquez-Chapela, I; Strathdee, SA

2013-01-01

Women comprise an increasing proportion of migrants. Many voluntarily migrate for sex work or practice survival sex, while others may be trafficked for sexual exploitation. To investigate how the context of mobility shapes sex work entry and HIV risk, we conducted in-depth interviews with formerly trafficked women currently engaged in sex work (n=31) in Tijuana, Mexico and their service providers (n=7) in Tijuana and San Diego, USA from 2010–2011. Women’s experiences of coerced and deceptive migration, deportation as forced migration, voluntary mobility, and migration to a risk environment illustrate that circumstances driving and resulting from migration shape vulnerability to sex trafficking, voluntary sex work entry, and HIV risk. Findings suggest an urgent need for public health and immigration policies that provide integrated support for deported and/or recently arrived female migrants. Policies to prevent sex trafficking and assist trafficked females must also consider the varying levels of personal agency involved in migration and sex work entry. PMID:25346548

Proyecto para la medición sistemática de seeing en CASLEO

NASA Astrophysics Data System (ADS)

Fernández Lajus, E.; Forte, J. C.

La calidad del seeing astronómico es ciertamente uno de los parámetros mas importantes que caracterizan el sitio de un observatorio. Por tanto se desea determinar si el alto valor de seeing observado con el telescopio de 2.15 m se debe a efectos internos y/o del entorno a la cupula o si se debe simplemente al seeing propio del lugar. El actual mecanismo de refrigeración del espejo primario del 2.15, parece haber mejorado notablemente la calidad del seeing. Sin embargo se hace necesario saber hasta que punto el valor del seeing puede ser mejorado. La primera etapa del proyecto consistió en la puesta a punto del telescopio emplazado para este propósito y la adquisición de las primeras medidas tentativas de seeing.

Intertextual Sexual Politics: Illness and Desire in Enrique Gomez Carrillo's "Del amor", "del dolor y del vicio" and Aurora Caceres's "La rosa muerta"

ERIC Educational Resources Information Center

LaGreca, Nancy

2012-01-01

This study explores the intertextuality between Aurora Caceres's "La rosa muerta" (1914) and the novel "Del amor, del dolor y del vicio" (1898) by her ex-husband, Enrique Gomez Carrillo. Caceres strategically mentions Gomez Carrillo's novel in "La rosa muerta" to invite a reading of her work in dialogue with his. Both narratives follow the sexual…

Associations between uncoupling protein 2, body composition, and resting energy expenditure in lean and obese African American, white, and Asian children.

PubMed

Yanovski, J A; Diament, A L; Sovik, K N; Nguyen, T T; Li, H; Sebring, N G; Warden, C H

2000-06-01

Little is known about genes that affect childhood body weight. The objective of this study was to examine the association between alleles of the mitochondrial uncoupling protein 2 (UCP2) gene and obesity because UCP2 may influence energy expenditure. We related UCP2 genotype to body composition and resting energy expenditure in 105 children aged 6-10 y. Overweight children and nonoverweight children of overweight parents were genotyped for a 45-base pair deletion/insertion (del/ins) in 3'-untranslated region of exon 8 and for an exon 4 C to T transition. Eighty-nine children were genotyped for the exon 8 allele: 50 children had del/del, 33 had del/ins, and 6 had ins/ins. Mean (+/-SD) body mass index (BMI; in kg/m(2)) was greater for children with del/ins (24.1 +/- 5.9) than for children with del/del (20.4 +/- 4.8; P < 0.001). BMI of ins/ins children (23.7 +/- 7.8) was not significantly different from that of del/ins children. A greater BMI in del/ins children was independent of race and sex. Body composition was also different according to UCP2 genotype. All body circumferences and skinfold thicknesses examined were significantly greater in del/ins than in del/del children. Body fat mass as determined by dual-energy X-ray absorptiometry was also greater in del/ins than in del/del children (P < 0.005). For 104 children genotyped at exon 4, no significant differences in BMI or body composition were found among the 3 exon 4 genotypes. Neither resting energy expenditure nor respiratory quotient were different according to UCP2 exon 4 or exon 8 genotype. The exon 8 ins/del polymorphism of UCP2 appears to be associated with childhood-onset obesity. The UCP2/UCP3 genetic locus may play a role in childhood body weight.

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

PubMed Central

Hunskaar, Steinar

2011-01-01

Background The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n=18, response rate 90%) as a test–retest assessment. Results Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage. PMID:21262792

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios.

PubMed

Hansen, Elisabeth Holm; Hunskaar, Steinar

2011-05-01

The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n = 18, response rate 90%) as a test-retest assessment. Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage.

CLARIPED: a new tool for risk classification in pediatric emergencies.

PubMed

Magalhães-Barbosa, Maria Clara de; Prata-Barbosa, Arnaldo; Alves da Cunha, Antonio José Ledo; Lopes, Cláudia de Souza

2016-09-01

To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

Low Caregiver Health Literacy is Associated with Higher Pediatric Emergency Department Use and Non-urgent Visits

PubMed Central

Morrison, Andrea K.; Schapira, Marilyn M.; Gorelick, Marc H.; Hoffmann, Raymond G.; Brousseau, David C.

2014-01-01

Objective We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. Methods This year long cross-sectional study utilized the Newest Vital Sign to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model the outcomes: 1) prior ED visits and 2) ED visit urgency, stratified by chronic illness. Analyses were weighted by triage level. Results Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (aIRR 1.5; 95% C.I.1.2, 1.8) and increased odds of a non-urgent index ED visit (AOR 2.4; 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of non-urgent index ED visits (48% vs 22%; AOR 3.2; 1.8, 5.7). Conclusions Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for non-urgent conditions. In children without a chronic illness, low health literate caregivers had more than three times great odds of presenting for a non-urgent condition than those with adequate health literacy. PMID:24767784

76 FR 35719 - Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $15 million from the United States Emergency Refugee and Migration Assistance Fund...

76 FR 53295 - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-25

...-12 of August 8, 2011--Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa... Migration Needs Related to the Horn of Africa Memorandum for the Secretary of State By the authority vested...) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C. 2601(c)(1...

Antagonistic effects of IL-17 and D-resolvins on endothelial Del-1 expression through a GSK-3β-C/EBPβ pathway.

PubMed

Maekawa, Tomoki; Hosur, Kavita; Abe, Toshiharu; Kantarci, Alpdogan; Ziogas, Athanasios; Wang, Baomei; Van Dyke, Thomas E; Chavakis, Triantafyllos; Hajishengallis, George

2015-09-16

Del-1 is an endothelial cell-secreted anti-inflammatory protein. In humans and mice, Del-1 expression is inversely related to that of IL-17, which inhibits Del-1 through hitherto unidentified mechanism(s). Here we show that IL-17 downregulates human endothelial cell expression of Del-1 by targeting a critical transcription factor, C/EBPβ. Specifically, IL-17 causes GSK-3β-dependent phosphorylation of C/EBPβ, which is associated with diminished C/EBPβ binding to the Del-1 promoter and suppressed Del-1 expression. This inhibitory action of IL-17 can be reversed at the GSK-3β level by PI3K/Akt signalling induced by D-resolvins. The biological relevance of this regulatory network is confirmed in a mouse model of inflammatory periodontitis. Intriguingly, resolvin-D1 (RvD1) confers protection against IL-17-driven periodontal bone loss in a Del-1-dependent manner, indicating an RvD1-Del-1 axis against IL-17-induced pathological inflammation. The dissection of signalling pathways regulating Del-1 expression provides potential targets to treat inflammatory diseases associated with diminished Del-1 expression, such as periodontitis and multiple sclerosis.

OSHA's renewed mandate for regulatory flexibility review: in support of the 1984 ethylene oxide standard.

PubMed

LaMontagne, A D; Kelsey, K T

1998-08-01

The Regulatory Flexibility Act of 1980 requires that all federal agencies consider the impact of regulations on small entities. One of the provisions of the Act requires review of regulations ever 10 years to determine whether such regulations should be continued without changes, rescinded, or amended to make them more effective or less burdensome on businesses. The Small Business Regulatory Enforcement Fairness Act (SBREFA) of 1996 amended and expanded the Regulatory Flexibility Act. Most significantly, SBREFA entitles aggrieved small entities or their representative (e.g., trade associations) to sue OSHA for failure to fulfill Regulatory Flexibility Act requirements. In response to this new political reality, OSHA held the first public meeting of their kind in June of 1997 to gather information on the ethylene oxide and lock-out/tag-out standards for the purposes of Regulatory Flexibility review. This paper presents the development of the Regulatory Flexibility review process and details our analysis of the ethylene oxide standard using OSHA's eight Regulatory Flexibility review criteria. Great progress in ethylene oxide health and safety has been made since the promulgation of the standard in 1984, including a considerable decrease in average workshift exposures. Yet, important concerns remain, such as the lack of safer substitutes for EtO's most common uses, the widespread occurrence of accidental exposures to EtO that are not captured by personal monitoring, and the recent increase in the occurrence of catastrophic EtO explosions. Because of the considerable study that has been devoted to EtO and to the EtO standard, there is a very strong cases for either making the EtO standard more worker protective, or continuing the standard without change while improving outreach and enforcement efforts to address shortcomings. Other valuable standards for which fewer data exist may be inappropriately threatened by the Regulatory Flexibility review process. Importantly, Regulatory Flexibility review could be constructive if accompanied by appropriations to fund sound evaluation studies. Instead, it will likely divert OSHA's limited resources from the numerous urgent health hazard that await initial rule-making. As signified by the designation of "intervention effectiveness research" as one of the 21 priorities on the National Occupational Research Agenda, evaluation studies of OSHA standards and other interventions are urgently needed. The occupational health community's response to this need will play a crucial role in preserving hard-won protections, as well as in developing other urgently needed protections in the future.

An audit of urgent referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service.

PubMed

White, T; Rutherford, H

2005-10-01

This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).

A data management system to enable urgent natural disaster computing

NASA Astrophysics Data System (ADS)

Leong, Siew Hoon; Kranzlmüller, Dieter; Frank, Anton

2014-05-01

Civil protection, in particular natural disaster management, is very important to most nations and civilians in the world. When disasters like flash floods, earthquakes and tsunamis are expected or have taken place, it is of utmost importance to make timely decisions for managing the affected areas and reduce casualties. Computer simulations can generate information and provide predictions to facilitate this decision making process. Getting the data to the required resources is a critical requirement to enable the timely computation of the predictions. An urgent data management system to support natural disaster computing is thus necessary to effectively carry out data activities within a stipulated deadline. Since the trigger of a natural disaster is usually unpredictable, it is not always possible to prepare required resources well in advance. As such, an urgent data management system for natural disaster computing has to be able to work with any type of resources. Additional requirements include the need to manage deadlines and huge volume of data, fault tolerance, reliable, flexibility to changes, ease of usage, etc. The proposed data management platform includes a service manager to provide a uniform and extensible interface for the supported data protocols, a configuration manager to check and retrieve configurations of available resources, a scheduler manager to ensure that the deadlines can be met, a fault tolerance manager to increase the reliability of the platform and a data manager to initiate and perform the data activities. These managers will enable the selection of the most appropriate resource, transfer protocol, etc. such that the hard deadline of an urgent computation can be met for a particular urgent activity, e.g. data staging or computation. We associated 2 types of deadlines [2] with an urgent computing system. Soft-hard deadline: Missing a soft-firm deadline will render the computation less useful resulting in a cost that can have severe consequences Hard deadline: Missing a hard deadline renders the computation useless and results in full catastrophic consequences. A prototype of this system has a REST-based service manager. The REST-based implementation provides a uniform interface that is easy to use. New and upcoming file transfer protocols can easily be extended and accessed via the service manager. The service manager interacts with the other four managers to coordinate the data activities so that the fundamental natural disaster urgent computing requirement, i.e. deadline, can be fulfilled in a reliable manner. A data activity can include data storing, data archiving and data storing. Reliability is ensured by the choice of a network of managers organisation model[1] the configuration manager and the fault tolerance manager. With this proposed design, an easy to use, resource-independent data management system that can support and fulfill the computation of a natural disaster prediction within stipulated deadlines can thus be realised. References [1] H. G. Hegering, S. Abeck, and B. Neumair, Integrated management of networked systems - concepts, architectures, and their operational application, Morgan Kaufmann Publishers, 340 Pine Stret, Sixth Floor, San Francisco, CA 94104-3205, USA, 1999. [2] H. Kopetz, Real-time systems design principles for distributed embedded applications, second edition, Springer, LLC, 233 Spring Street, New York, NY 10013, USA, 2011. [3] S. H. Leong, A. Frank, and D. Kranzlmu¨ ller, Leveraging e-infrastructures for urgent computing, Procedia Computer Science 18 (2013), no. 0, 2177 - 2186, 2013 International Conference on Computational Science. [4] N. Trebon, Enabling urgent computing within the existing distributed computing infrastructure, Ph.D. thesis, University of Chicago, August 2011, http://people.cs.uchicago.edu/~ntrebon/docs/dissertation.pdf.

ASSOCIATIONS BETWEEN UNCOUPLING PROTEIN 2, BODY COMPOSITION, AND RESTING ENERGY EXPENDITURE IN LEAN AND OBESE AFRICAN AMERICAN, CAUCASIAN, AND ASIAN CHILDREN

PubMed Central

Yanovski, J.A.; Diament, A.L.; Sovik, K.N.; Nguyen, T.T.; Li, H.; Sebring, N.G.; Warden, C.H.

2015-01-01

Background Little is known about genes affecting childhood body weight. Objective To examine alleles of the mitochondrial uncoupling protein-2 (UCP2) gene for association with obesity, since UCP2 may influence energy expenditure. Design We related UCP2 genotype to body composition, and to resting energy expenditure, in 105 children aged 6–10y. Overweight children and non-overweight children of overweight parents were genotyped for a 45 bp deletion/insertion (del/ins) in 3’ UTR of exon 8 and for an exon 4 C to T transition. Results 89 children were genotyped for the exon 8 allele: 50 children had del/del, 33 del/ins, and 6 ins/ins. Body mass index (BMI) was greater for del/ins (24.1 ± 5.9 kg/m2) than for del/del (20.4 ± 4.8 kg/m2, p<0.001). BMI of ins/ins (23.7 ± 7.8 kg/m2) was not different from del/ins. This effect was independent of race and gender (ANOVAs, p< 0.05). Body composition was also different according to UCP2 genotype. All body circumferences and skin fold thicknesses examined were significantly greater in del/ins than in del/del. DXA body fat mass (p<0.005) was also greater in del/ins than del/del. For 104 children genotyped at exon 4, no significant differences in BMI or body composition were found among the three exon 4 genotypes. Neither resting energy expenditure nor respiratory quotient were different according to UCP2 exon 4 or exon 8 genotype. Conclusion The exon 8 ins/del polymorphism of UCP2 appears to be associated with childhood-onset obesity. The UCP2/UCP3 genetic locus may play a role in childhood body weight. PMID:10837279

Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy)

PubMed Central

2013-01-01

Background The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother’s educational level in the relationship between citizenship and ER utilisation. Methods The cohort study included all healthy singleton live births in the years 2008–2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother’s citizenship. Other covariates were mother’s educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. Results There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59). The risk of ER visits is higher in the first two months of life (RR1stvs 3rd-12th 2.08; 95% CI 1.93-2.24 and RR 2ndvs 3rd-12th 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). Conclusions Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions. PMID:24176109

Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy).

PubMed

Ballotari, Paola; D'Angelo, Stefania; Bonvicini, Laura; Broccoli, Serena; Caranci, Nicola; Candela, Silvia; Giorgi Rossi, Paolo

2013-11-01

The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.

Vigilando la Calidad del Agua de los Grandes Rios de la Nacion: El Programa NASQAN del Rio Grande (Rio Bravo del Norte)

USGS Publications Warehouse

Lurry, Dee L.; Reutter, David C.; Wells, Frank C.; Rivera, M.C.; Munoz, A.

1998-01-01

La Oficina del Estudio Geologico de los Estados Unidos (U.S. Geological Survey, 0 USGS) ha monitoreado la calidad del agua de la cuenca del Rio Grande (Rio Bravo del Norte) desde 1995 como parte de la rediseiiada Red Nacional para Contabilizar la Calidad del Agua de los Rios (National Stream Quality Accounting Network, o NASOAN) (Hooper and others, 1997). EI programa NASOAN fue diseiiado para caracterizar las concentraciones y el transporte de sedimento y constituyentes quimicos seleccionados, encontrados en los grandes rios de los Estados Unidos - incluyendo el Misisipi, el Colorado y el Columbia, ademas del Rio Grande. En estas cuatro cuencas, el USGS opera actualmente (1998) una red de 40 puntos de muestreo pertenecientes a NASOAN, con un enfasis en cuantificar el flujo en masa (la cantidad de material que pasa por la estacion, expresado en toneladas por dial para cada constituyente. Aplicacando un enfoque consistente, basado en la cuantificacion de flujos en la cuenca del Rio Grande, el programa NASOAN esta generando la informacion necesaria para identificar fuentes regionales de diversos contaminantes, incluyendo sustancias qui micas agricolas y trazas elementos en la cuenca. EI efecto de las grandes reservas en el Rio Grande se puede observar segun los flujos de constituyentes discurren a 10 largo del rio. EI analisis de los flujos de constituyentes a escala de la cuenca proveera los medios para evaluar la influencia de la actividad humana sobre las condiciones de calidad del agua del Rio Grande.

[Emergencies and urgent consultation in non-urban Swiss general practices].

PubMed

Meyer, R L; Marty, F

2007-03-07

The upcoming shortage of general practitioners in Switzerland will be a big challenge for medical out-of-hours services. Regionally ver different exists only few datas about organisational matters of and problems seen in "out-of-hours" care and "urgent consultations". Our Pilot present the prevalence of "out-of-hours care" in a general practitioner setting describes and classifies the problems seen using ICPC-2.

Operation Urgent Fury - Grenada

DTIC Science & Technology

1983-11-01

Urgent Fury : the planning and execution of joint operations in Grenada, 12 October-2 November 1983 / Ronald H. Cole. p . cm...meeting, Secretary of State George P . Shultz and the Chairman of the Joint Chiefs of Staff, General John W. Vessey, Jr., USA, warned the Special Situation...Group (RIG) of the National Security Council (NSC), on 12 October, Langhorne A. Motley, Assistant Secretary of State for Inter-American Affairs

A cost-minimisation study of 1,001 NHS Direct users.

PubMed

Lambert, Rod; Fordham, Richard; Large, Shirley; Gaffney, Brian

2013-08-08

To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points). The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study.

PubMed

Sikdar, Khokan C; Dickinson, James; Winget, Marcy

2017-01-05

Although it is well-known that early detection of colorectal cancer (CRC) is important for optimal patient survival, the relationship of patient and health system factors with delayed diagnosis are unclear. The purpose of this study was to identify the demographic, clinical and healthcare factors related to mode of CRC detection and length of the diagnostic interval. All residents of Alberta, Canada diagnosed with first-ever incident CRC in years 2004-2010 were identified from the Alberta Cancer Registry. Population-based administrative health datasets, including hospital discharge abstract, ambulatory care classification system and physician billing data, were used to identify healthcare services related to CRC diagnosis. The time to diagnosis was defined as the time from the first CRC-related healthcare visit to the date of CRC diagnosis. Mode of CRC detection was classified into three groups: urgent, screen-detected and symptomatic. Quantile regression was performed to assess factors associated with time to diagnosis. 9626 patients were included in the study; 25% of patients presented as urgent, 32% were screen-detected and 43% were symptomatic. The median time to diagnosis for urgent, screen-detected and symptomatic patients were 6 days (interquartile range (IQR) 2-14 days), 74 days (IQR 36-183 days), 84 days (IQR 39-223 days), respectively. Time to diagnosis was greater than 6 months for 27% of non-urgent patients. Healthcare factors had the largest impact on time to diagnosis: 3 or more visits to a GP increased the median by 140 days whereas 2 or more visits to a GI-specialist increased it by 108 days compared to 0-1 visits to a GP or GI-specialist, respectively. A large proportion of CRC patients required urgent work-up or had to wait more than 6 months for diagnosis. Actions are needed to reduce the frequency of urgent presentation as well as improve the timeliness of diagnosis. Findings suggest a need to improve coordination of care across multiple providers.

LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data

PubMed Central

van Walraven, Carl; Wong, Jenna; Forster, Alan J

2012-01-01

Background Death or urgent readmission after hospital discharge is a common adverse event that can be used to compare outcomes of care between institutions. To accurately adjust for risk and to allow for interhospital comparisons of readmission rates, we used administrative data to derive and internally validate an extension of the LACE index, a previously validated index for 30-day death or urgent readmission. Methods We randomly selected 500 000 medical and surgical patients discharged to the community from any Ontario hospital between 1 April 2003 and 31 March 2009. We derived a logistic regression model on 250 000 randomly selected patients from this group and modified the final model into an index scoring system, the LACE+ index. We internally validated the LACE+ index using data from the remaining 250 000 patients and compared its performance with that of the original LACE index. Results Within 30 days of discharge to the community, 33 825 (6.8%) of the patients had died or had been urgently readmitted. In addition to the variables included in the LACE index (length of stay in hospital [L], acuity of admission [A], comorbidity [C] and emergency department utilization in the 6 months before admission [E]), the LACE+ index incorporated patient age and sex, teaching status of the discharge hospital, acute diagnoses and procedures performed during the index admission, number of days on alternative level of care during the index admission, and number of elective and urgent admissions to hospital in the year before the index admission. The LACE+ index was highly discriminative (C statistic 0.771, 95% confidence interval 0.767–0.775), was well calibrated across most of its range of scores and had a model performance that exceeded that of the LACE index. Interpretation The LACE+ index can be used to predict the risk of postdischarge death or urgent readmission on the basis of administrative data for the Ontario population. Its performance exceeds that of the LACE index, and it allows analysts to accurately estimate the risk of important postdischarge outcomes. PMID:23696773

The novel c.247_249delTTC (p.F83del) GJB2 mutation in a family with prelingual sensorineural deafness.

PubMed

Petersen, Michael B; Grigoriadou, Maria; Koutroumpe, Maria; Kokotas, Haris

2012-07-01

Non-syndromic hearing loss is one of the most common hereditary determined diseases in human, and the disease is a genetically heterogeneous disorder. Mutations in the GJB2 gene, encoding connexin 26 (Cx26), are a major cause of non-syndromic recessive hearing impairment in many countries and are largely dependent on ethnic groups. Due to the high frequency of the c.35delG GJB2 mutation in the Greek population, we have previously suggested that Greek patients with sensorineural, non-syndromic deafness should be tested for the c.35delG mutation and the coding region of the GJB2 gene should be sequenced in c.35delG heterozygotes. Here we present on the clinical and molecular genetic evaluation of a family suffering from prelingual, sensorineural, non-syndromic deafness. A novel c.247_249delTTC (p.F83del) GJB2 mutation was detected in compound heterozygosity with the c.35delG GJB2 mutation in the proband and was later confirmed in the father, while the mother was homozygous for the c.35delG GJB2 mutation. We conclude that compound heterozygosity of the novel c.247_249delTTC (p.F83del) and the c.35delG mutations in the GJB2 gene was the cause of deafness in the proband and his father. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Comparison of the efficacy of intravenous tranexamic acid with and without topical administration versus placebo in urgent endoscopy rate for acute gastrointestinal bleeding: A double-blind randomized controlled trial

PubMed Central

Tavakoli, Nader; Agah, Shahram; Azizi, Ali; Masoodi, Mohsen; Amiri, Hassan; Sheikhvatan, Mehrdad; Syedsalehi, Bahare; Behnam, Behdad; Arabahmadi, Mehran; Mehrazi, Maryam

2017-01-01

Background Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. Method This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. Results The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p < 0.001). A need for urgent endoscopy was seen in 14.49%, 10.52%, and 30.21% of patients in groups A, B, and C, respectively (p < 0.001). No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates. No thromboembolic event was documented during the 1-week follow up. Conclusions Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients. PMID:29435313

Evacuation Priorities in Mass Casualty Terror-Related Events

PubMed Central

Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

2004-01-01

Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

[Scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit].

PubMed

Sumano-Ziga, Erika; Veloz-Martínez, María Guadalupe; Vázquez-Rodríguez, Juan Gustavo; Becerra-Alcántara, Geomar; Jimenez Vieyra, Carlos Ramón

2015-01-01

Patients with placenta accreta have a high frequency of complications and death risk. The aim of this study was to compare the results of scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit. An observational, comparative, cross-sectional study was conducted by reviewing patient records with confirmed diagnostic of placenta accreta, who attended in a one year period. They were divided into 2 groups based on the type of surgery, scheduled or urgent. Descriptive statistics were applied, with comparisons using Student t-test and chi squared tests. A value of P<.05 was considered significant. There were 4,592 births in the period of study, and 125 obstetric hysterectomies were performed, with 40 confirmed cases of accreta (8.7 per thousand births) with 20 in scheduled and 20 in urgent surgeries, with the most frequent type being placenta accreta. The mean maternal age was 32 years, with a mean of 5 hours operating time, total bleeding 3135 ml, and 3.5 units of packed cells transfused. There was no statistical difference when comparing these variables with re-interventions, hypovolaemic shock, and intensive care unit admission. Caesarean-hysterectomy with hypogastric artery ligation was the most frequent surgery performed. In this hospital, scheduled and urgent surgical treatment of patients with placenta accreta show similar results, probably because the constant availability of resources and the experience obtained by the multidisciplinary team in all shifts. Nevertheless, make absolutely sure to perform elective surgery while having all the necessary resources. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients.

PubMed

Beynon, Christopher; Jakobs, Martin; Rizos, Timolaos; Unterberg, Andreas W; Sakowitz, Oliver W

2014-01-01

With the increased use of oral anticoagulation with vitamin K antagonists, emergency physicians encounter a growing number of patients requiring a rapid reversal of anticoagulant effects in order to perform urgent surgical procedures. Initiation of these procedures can be delayed because the coagulation status has to be assessed through examination of blood samples in central laboratories (CL). This delay may lead to negative effects, especially in potentially life-threatening conditions such as intracranial haemorrhage. Point-of-care (POC) devices for assessment of international normalized ratio (POC INR) have improved the management of anticoagulation therapy in the outpatient setting. The use of these devices may also have beneficial effects in the treatment of anticoagulated patients requiring urgent neurosurgical procedures. The primary aim of this study was to analyse the potential of POC-guided assessment of INR to reduce time to potentially life-saving neurosurgery in this setting. Feasibility and accuracy as well as the gain of time through the use of this device were analysed. The POC coagulometer CoaguChek XS(®) was used in 17 patients with a history of anticoagulant use and a condition requiring urgent anticoagulant reversal prior to neurosurgical procedures (burr-hole trepanation: n = 8, craniotomy: n = 7, laminectomy: n = 2). No technical difficulties occurred and rapid assessment of INR was achieved in all cases within 2 min. POC INR values correlated well with CL INR assessment with a mean INR deviation of 0.036 ± 0.12. The mean gain of time through the use of the POC INR device compared with CL assessment of INR was 47 ± 6 min (range: 37-61 min). Our initial experiences with a POC INR device in anticoagulated patients undergoing urgent neurosurgical procedures demonstrate that its use may contribute to an improved management of these patients.

Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

PubMed

Roberts, Nasreen; Nesdole, Robert; Hu, Tina

2018-01-01

a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p < 0.01), a higher proportion in special educational placement (X2 (1) = 6.82, p < 0.01), a higher proportion with a family history of anxiety disorders (X2 (1) = 10.62, p = 0.01) and substance use disorder (X2 (1) = 18.99, p < 0.01). Conditional logistic regression results suggested that repeat-presentation group had higher odds of past hospital admission (OR: 3.50, p < 0.01) higher odds of family history of mood disorders (OR: 4.86, p < 0.01) and of antisocial disorders (OR: 4.97, p = 0.02), and lower odds of recommendation compliance (OR: 0.10, p < 0.01). Repeat-presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

Patient Satisfaction With Care for Urgent Health Problems: A Survey of Family Practice Patients

PubMed Central

Howard, Michelle; Goertzen, James; Hutchison, Brian; Kaczorowski, Janusz; Morris, Kelly

2007-01-01

PURPOSE Patient satisfaction is an important health care outcome. This study compared patients’ satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services. METHODS We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied). RESULTS The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8–6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2–6.0). CONCLUSIONS Satisfaction was highest for patients receiving care from their own family physician or their physician’s after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians. PMID:17893383

Risk stratification of patients with severe heart failure awaiting heart transplantation-prospective national registry POLKARD HF.

PubMed

Zieliński, T; Browarek, A; Zembala, M; Sadowski, J; Zakliczyński, M; Przybylowski, P; Roguski, K; Kosakowska, A B; Korewicki, J

2009-10-01

Most methods used in the risk assessment of heart transplant candidates do not include new biomarkers. The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for heart transplantation. Data of 658 patients enlisted for heart transplantation in all active transplantation centers were stored in a prospective registry. The composite end point-death or urgent transplantation was recorded during the follow-up. Death or urgent transplantation was recorded in 161 (24%) of pts. 102 (15%) patients died and 59 (9%) were transplanted urgently. Kaplan-Meier curves for risk of death or urgent transplantation where highly significant when pts were stratified by the quartiles of NT proBNP (P < .000001) or quartiles according to the hsCRP level on admission (P < .002). In the multivariate Cox proportional hazard model, the significance was observed for NTproBNP (P < .01) and HFSS (P < .02), and borderline significance for hsCRP (P = .057). When ROC analyses of the area under the curve (AUC) values were considered, AUC area was for HFSS - 0.645, for NTproBNP - 0.653 and for hsCRP - 0.566. When all those variables were included together in the model, the AUC value rose to 0.6943. Based on those results a weighted risk model with all three parameters was proposed. HFSS, NTproBNP and hsCRP levels are independent stratification variables of survival or need for urgent heart transplantation. Their predictive value is moderately increased when they are analyzed together.

Weekend Hospitalizations and Post-operative Complications following urgent surgery for Ulcerative Colitis and Crohn’s Disease

PubMed Central

Ananthakrishnan, Ashwin N; McGinley, Emily L

2013-01-01

Background There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) with frequent requirement for urgent surgery. Aim To determine whether a weekend effect exists for IBD care in the United States. Methods We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer hospitalization database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalization were identified using the appropriate ICD-9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders. Results Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post-operative complications were more common following weekend than weekday hospitalizations in UC (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01–2.90). The most common post-operative complication was post-operative infections (Weekend 30% vs. weekday 20%, p=0.04). The most striking difference between weekend and weekday hospitalizations was for need for repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post-operative complication in CD was similar between weekday and weekend admissions. Conclusion Patients with UC hospitalized on a weekend undergoing urgent surgery within 2 days have an increased risk for post-operative complications, in particular mechanical wound complications, need for repeat laparotomy, and post-operative infections. PMID:23451882

Modelo semi-empírico de protuberancia solar a partir del diagnóstico de densidades

NASA Astrophysics Data System (ADS)

Cirigliano, D.; Vial, J. C.; Rovira, M.

A partir de la observación del espectro del quintuplete de C III alrededor de 1175 Å, se ha realizado el diagnóstico de la densidad y presión electrónica, basado en el cálculo del cociente de las intensidades observadas. Una vez establecida la densidad electrónica, y con el cálculo de las velocidades Doppler, hemos investigado el flujo de masa en la protuberancia en función de la temperatura. Estableciendo como hipótesis la conservación del número de partículas que ingresan y salen del cuerpo de la protuberancia, se investiga la variación del área de un tubo de flujo semi-empírico en función de la temperatura. A partir de dicho diagnóstico, se examina el comportamiento del radio del tubo magnético en función de la temperatura, los que dan cuenta de la abertura de las líneas de campo magnético que confinan el plasma y de la divergencia del campo magnético en diferentes alturas de la atmósfera solar.

Del(20q) in patients with chronic lymphocytic leukemia: a therapy-related abnormality involving lymphoid or myeloid cells.

PubMed

Yin, C Cameron; Tang, Guilin; Lu, Gary; Feng, Xiaoli; Keating, Michael J; Medeiros, L Jeffrey; Abruzzo, Lynne V

2015-08-01

Deletion 20q (Del(20q)), a common cytogenetic abnormality in myeloid neoplasms, is rare in chronic lymphocytic leukemia. We report 64 patients with chronic lymphocytic leukemia and del(20q), as the sole abnormality in 40, a stemline abnormality in 21, and a secondary abnormality in 3 cases. Fluorescence in situ hybridization (FISH) analysis revealed an additional high-risk abnormality, del(11q) or del(17p), in 25/64 (39%) cases. In most cases, the leukemic cells showed atypical cytologic features, unmutated IGHV (immunoglobulin heavy-chain variable region) genes, and ZAP70 positivity. The del(20q) was detected only after chemotherapy in all 27 cases with initial karyotypes available. With a median follow-up of 90 months, 30 patients (47%) died, most as a direct consequence of chronic lymphocytic leukemia. Eight patients developed a therapy-related myeloid neoplasm, seven with a complex karyotype. Combined morphologic and FISH analysis for del(20q) performed in 12 cases without morphologic evidence of a myeloid neoplasm localized the del(20q) to the chronic lymphocytic leukemia cells in 5 (42%) cases, and to myeloid/erythroid cells in 7 (58)% cases. The del(20q) was detected in myeloid cells in all 4 cases of myelodysplastic syndrome. In aggregate, these data indicate that chronic lymphocytic leukemia with del(20q) acquired after therapy is heterogeneous. In cases with morphologic evidence of dysplasia, the del(20q) likely resides in the myeloid lineage. However, in cases without morphologic evidence of dysplasia, the del(20q) may represent clonal evolution and disease progression. Combining morphologic analysis with FISH for del(20q) or performing FISH on immunomagnetically selected sub-populations to localize the cell population with this abnormality may help guide patient management.

Del(20q) in patients with chronic lymphocytic leukemia: A therapy-related abnormality involving lymphoid or myeloid cells

PubMed Central

Yin, C. Cameron; Tang, Guilin; Lu, Gary; Feng, Xiaoli; Keating, Michael J.; Medeiros, L. Jeffrey; Abruzzo, Lynne V.

2015-01-01

Del(20q), a common cytogenetic abnormality in myeloid neoplasms, is rare in chronic lymphocytic leukemia. We report 64 patients with chronic lymphocytic leukemia and del(20q), as the sole abnormality in 40, a stemline abnormality in 21, and a secondary abnormality in 3 cases. FISH analysis revealed an additional high-risk abnormality, del(11q) or del(17p), in 27/64 (42%) cases. In most cases, the leukemic cells showed atypical cytologic features, unmutated IGHV genes and ZAP70 positivity. The del(20q) was detected only after chemotherapy in all 27 cases with initial karyotypes available. With a median follow-up of 90 months, 30 patients (47%) died, most as a direct consequence of chronic lymphocytic leukemia. Eight patients developed a therapy-related myeloid neoplasm, seven with a complex karyotype. Combined morphologic and FISH analysis for del(20q) performed in 12 cases without morphologic evidence of a myeloid neoplasm localized the del(20q) to the chronic lymphocytic leukemia cells in 5 (42%) cases, and to myeloid/erythroid cells in 7 (58)% cases. The del(20q) was detected in myeloid cells in all 4 cases of myelodysplastic syndrome. In aggregate, these data indicate that chronic lymphocytic leukemia with del(20q) acquired after therapy is heterogeneous. In cases with morphologic evidence of dysplasia, the del(20q) likely resides in the myeloid lineage. However, in cases without morphologic evidence of dysplasia, the del(20q) may represent clonal evolution and disease progression. Combining morphologic analysis with FISH for del(20q) or performing FISH on immunomagnetically-selected subpopulations to localize the cell population with this abnormality may help guide patient management. PMID:25953391

Increasing Naval Security Cooperation between the U.S., Chile and Peru

DTIC Science & Technology

2009-03-01

del Mar: La Marina de Guerra en la historia del Perú (Lima: Marina de Guerra del Perú, 1994), 184. 108 Ibid., 188. 109 Ibid., 191-193. 42 “the...La Marina de Guerra en la historia del Perú, 205. 111 Ibid. 112 Ibid., 210. 113 Ibid., 229. 114 Ibid., 230. 115 Ibid., 246. 43 contributed to...la Puente Brunke, Los Hombres del Mar: La Marina de Guerra en la historia del Perú, 252. 117 Ibid., 264. 118 Ibid., 302. 119 Ibid., 342. 44