Proteomic Characterization of Plasmid pLA1 for Biodegradation of Polycyclic Aromatic Hydrocarbons in the Marine Bacterium, Novosphingobium pentaromativorans US6-1

PubMed Central

Yun, Sung Ho; Choi, Chi-Won; Lee, Sang-Yeop; Lee, Yeol Gyun; Kwon, Joseph; Leem, Sun Hee; Chung, Young Ho; Kahng, Hyung-Yeel; Kim, Sang Jin; Kwon, Kae Kyoung; Kim, Seung Il

2014-01-01

Novosphingobium pentaromativorans US6-1 is a halophilic marine bacterium able to degrade polycyclic aromatic hydrocarbons (PAHs). Genome sequence analysis revealed that the large plasmid pLA1 present in N. pentaromativorans US6-1 consists of 199 ORFs and possess putative biodegradation genes that may be involved in PAH degradation. 1-DE/LC-MS/MS analysis of N. pentaromativorans US6-1 cultured in the presence of different PAHs and monocyclic aromatic hydrocarbons (MAHs) identified approximately 1,000 and 1,400 proteins, respectively. Up-regulated biodegradation enzymes, including those belonging to pLA1, were quantitatively compared. Among the PAHs, phenanthrene induced the strongest up-regulation of extradiol cleavage pathway enzymes such as ring-hydroxylating dioxygenase, putative biphenyl-2,3-diol 1,2-dioxygenase, and catechol 2,3-dioxygenase in pLA1. These enzymes lead the initial step of the lower catabolic pathway of aromatic hydrocarbons through the extradiol cleavage pathway and participate in the attack of PAH ring cleavage, respectively. However, N. pentaromativorans US6-1 cultured with p-hydroxybenzoate induced activation of another extradiol cleavage pathway, the protocatechuate 4,5-dioxygenase pathway, that originated from chromosomal genes. These results suggest that N. pentaromativorans US6-1 utilizes two different extradiol pathways and plasmid pLA1 might play a key role in the biodegradation of PAH in N. pentaromativorans US6-1. PMID:24608660

Welfare analysis of a zero-smoking policy - A case study in Japan.

PubMed

Nakamura, Yuuki; Takahashi, Kenzo; Nomura, Marika; Kamei, Miwako

2018-03-19

Smoking cessation efforts in Japan reduce smoking rates. A future zero-smoking policy would completely prohibit smoking (0% rate). We therefore analyzed the social welfare of smokers and non-smokers under a hypothetical zero-smoking policy. The demand curve for smoking from 1990 to 2014 was estimated by defining quantity as the number of cigarettes smoked and price as total tobacco sales/total cigarettes smoked by the two-stage least squares method using the tax on tobacco as the instrumental variable. In the estimation equation (calculated using the ordinary least squares method), the price of tobacco was the dependent variable and tobacco quantity the explanatory variable. The estimated constant was 31.90, the estimated coefficient of quantity was - 0.0061 (both, p < 0.0004), and the determinant coefficient was 0.9187. Thus, the 2015 consumer surplus was 1.08 trillion yen (US$ 9.82 billion) (95% confidence interval (CI), 889 billion yen (US$ 8.08 billion) - 1.27 trillion yen (US$ 11.6 billion)). Because tax revenue from tobacco in 2011 was 2.38 trillion yen (US$ 21.6 billion), the estimated deadweight loss if smoking were prohibited in 2014 was 3.31 trillion yen (US$ 30.2 billion) (95% CI, 3.13 trillion yen (US$ 28.5 billion) - 3.50 trillion yen (US$ 31.8 billion)), representing a deadweight loss about 0.6 trillion yen (US$ 5.45 billion) below the 2014 disease burden (4.10-4.12 trillion yen (US$ 37.3-37.5 billion)). We conclude that a zero-smoking policy would improve social welfare in Japan.

The cost of diabetes in Latin America and the Caribbean in 2015: Evidence for decision and policy makers.

PubMed

Barcelo, Alberto; Arredondo, Armando; Gordillo-Tobar, Amparo; Segovia, Johanna; Qiang, Anthony

2017-12-01

The financial implications of the increase in the prevalence of diabetes in middle-income countries represents one of the main challenges to health system financing and to the society as a whole. The objective of this study was to estimate the economic cost of diabetes in Latin America and the Caribbean (LAC) in 2015. The study used a prevalence-based approach to estimate the direct and indirect costs related to diabetes in 29 LAC countries in 2015. Direct costs included health care expenditures such as medications (insulin and oral hypoglycemic agents), tests, consultations, hospitalizations, emergency visits and treating complications. Two different scenarios (S1 and S2) were used to analyze direct cost. S1 assumed conservative estimates while S2 assumed broader coverage of medication and services. Indirect costs included lost resources due to premature mortality, temporary and permanent disabilities. In 2015 over 41 million adults (20 years of age and more) were estimated to have Diabetes Mellitus in LAC. The total indirect cost attributed to Diabetes was US$ 57.1 billion, of which US$ 27.5 billion was due to premature mortality, US$16.2 billion to permanent disability, and US$ 13.3 billion to temporary disability. The total direct cost was estimated between US$ 45 and US$ 66 billion, of which the highest estimated cost was due to treatment of complications (US$ 1 616 to US$ 26 billion). Other estimates indicated the cost of insulin between US$ 6 and US$ 11 billion; oral medication US$ 4 to US$ 6 billion; consultations between US$ 5 and US$ 6 billion; hospitalization US$ 10 billion; emergency visits US$ 1 billion; test and laboratory exams between US$ 1 and US$ 3 million. The total cost of diabetes in 2015 in LAC was estimated to be between US$ 102 and US$ 123 billion. On average, the annual cost of treating one case of diabetes mellitus (DM) in LAC was estimated between US$ 1088 and US$ 1818. Per capita National Health Expenditures averaged US$ 1061 in LAC. Diabetes represented a major economic burden to the countries of Latin America and the Caribbean in 2015. The estimates presented here are key information for decision-making that can be used in the formulation of policies and programs to achieve greater efficiency and effectiveness in the use of resources for diabetes prevention in the 29 countries of LAC.

The cost of diabetes in Latin America and the Caribbean in 2015: Evidence for decision and policy makers

PubMed Central

Barcelo, Alberto; Arredondo, Armando; Gordillo–Tobar, Amparo; Segovia, Johanna; Qiang, Anthony

2017-01-01

BACKGROUND The financial implications of the increase in the prevalence of diabetes in middle–income countries represents one of the main challenges to health system financing and to the society as a whole. The objective of this study was to estimate the economic cost of diabetes in Latin America and the Caribbean (LAC) in 2015. METHODS The study used a prevalence–based approach to estimate the direct and indirect costs related to diabetes in 29 LAC countries in 2015. Direct costs included health care expenditures such as medications (insulin and oral hypoglycemic agents), tests, consultations, hospitalizations, emergency visits and treating complications. Two different scenarios (S1 and S2) were used to analyze direct cost. S1 assumed conservative estimates while S2 assumed broader coverage of medication and services. Indirect costs included lost resources due to premature mortality, temporary and permanent disabilities. RESULTS In 2015 over 41 million adults (20 years of age and more) were estimated to have Diabetes Mellitus in LAC. The total indirect cost attributed to Diabetes was US$ 57.1 billion, of which US$ 27.5 billion was due to premature mortality, US$16.2 billion to permanent disability, and US$ 13.3 billion to temporary disability. The total direct cost was estimated between US$ 45 and US$ 66 billion, of which the highest estimated cost was due to treatment of complications (US$ 1 616 to US$ 26 billion). Other estimates indicated the cost of insulin between US$ 6 and US$ 11 billion; oral medication US$ 4 to US$ 6 billion; consultations between US$ 5 and US$ 6 billion; hospitalization US$ 10 billion; emergency visits US$ 1 billion; test and laboratory exams between US$ 1 and US$ 3 million. The total cost of diabetes in 2015 in LAC was estimated to be between US$ 102 and US$ 123 billion. On average, the annual cost of treating one case of diabetes mellitus (DM) in LAC was estimated between US$ 1088 and US$ 1818. Per capita National Health Expenditures averaged US$ 1061 in LAC. CONCLUSIONS Diabetes represented a major economic burden to the countries of Latin America and the Caribbean in 2015. The estimates presented here are key information for decision–making that can be used in the formulation of policies and programs to achieve greater efficiency and effectiveness in the use of resources for diabetes prevention in the 29 countries of LAC. PMID:29163935

Financial analysis of brucellosis control for small-scale goat farming in the Bajío region, Mexico.

PubMed

Oseguera Montiel, David; Bruce, Mieghan; Frankena, Klaas; Udo, Henk; van der Zijpp, Akke; Rushton, Jonathan

2015-03-01

Brucellosis is an endemic disease in small-scale goat husbandry systems in Mexico. It is a zoonosis and the economic consequences can be large, although estimates are not available for the Mexican goat sector. Our objective was to conduct a financial analysis of brucellosis control in a prominent dairy goat production area of the Bajío region, Mexico. We used three models: (1) a brucellosis transmission model at village flock level (n=1000 head), (2) a flock growth model at smallholder flock level (n=23 head) using output of model 1 and (3) cost-benefit analysis of several brucellosis control scenarios based on output of model 2. Scenarios consisted of test-and-slaughter or vaccination or a combination of both compared to the base situation (no control). The average net present values (NPV) of using vaccination over a 5-year period was 3.8 US$ (90% CI: 1.3-6.6) and 20 US$ (90% CI: 11.3-28.6) over a 10-year period per goat. The average benefit-cost ratios over a 5-year period and 10-year period were 4.3 US$ (90% CI: 2.2-6.9) and 12.3 US$ (90% CI: 7.5-17.3) per goat, respectively. For the total dairy goat population (38,462 head) of the study area (the Bajío of Jalisco and Michoacán) the NPV's over a 5-year and 10-year period were 0.15 million US$ and 0.8 million US$. However, brucellosis prevalence was predicted to remain relatively high at about 12%. Control scenarios with test-and-slaughter predicted to reduce brucellosis prevalence to less than 3%, but this produced a negative NPV over a 5-year period ranging from -31.6 to -11.1 US$ and from -31.1 to 7.5 US$ over a 10-year period. A brucellosis control campaign based on vaccination with full coverage is economically profitable for the goat dairy sector of the region although smallholders would need financial support in case test-and-slaughter is applied to reduce the prevalence more quickly. Copyright © 2014 Elsevier B.V. All rights reserved.

The US7 score is sensitive to change in a large cohort of patients with rheumatoid arthritis over 12 months of therapy

PubMed Central

Backhaus, Tina M; Ohrndorf, Sarah; Kellner, Herbert; Strunk, Johannes; Hartung, Wolfgang; Sattler, Horst; Iking-Konert, Christof; Burmester, Gerd R; Schmidt, Wolfgang A; Backhaus, Marina

2013-01-01

Purpose To determine the sensitivity to change of the US7 score among RA patients under various therapies and to analyze the effect of each therapeutic option over 1 year. To estimate predictors for development of destructive bone changes. Methods Musculoskeletal ultrasound (US7 score), DAS28, CRP and ESR were performed in 432 RA patients at baseline and after 3, 6 and 12 months. The cohort was divided into four sub-groups: first-line DMARDs (Group 1; 27.3%), therapy switch: DMARDs to second DMARDs (Group 2; 25.0%), first-line biologic after DMARDs therapy (Group 3; 35.4%) and therapy change from biologic to second biologic (Group 4; 12.3%). Results The US7 synovitis and tenosynovitis sum scores in grey-scale (GSUS) and power Doppler ultrasound (PDUS) as well as ESR, CRP decreased significantly (p<0.05) after 12 months in group 1 to 3. Group 1+2 also illustrated a significant change of DAS28 after 1 year (p<0.001). Only in Group 4, the US7 erosion sum score decreased significantly from 4.3 to 3.6 (p=0.008) after 1 year. Predictors capable of forecasting US erosions after one year were: higher score of US7 synovitis (p<0.001), of US7 erosions in GSUS (p<0.001), as well as of DAS28 (p<0.001) at baseline. Conclusions The comparable developments of the US7 score with clinical and laboratory data illustrates its potential to reflect therapeutic response. Therefore, the novel US7 score is sensitive to change. Patients who switched from one biologic to another exhibited a significant decline in erosions after 12 months, while the erosions scores in the other groups were stable. PMID:22956596

Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates.

PubMed

Kim, Do Hyun; Jeon, Jihyun; Park, Chang Gi; Sriram, Sudhir; Lee, Kwang Sun

2016-09-01

Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions.

Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates

PubMed Central

2016-01-01

Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions. PMID:27510390

U.S. Crude Oil and Natural Gas Proved Reserves

EIA Publications

2016-01-01

U.S. oil and natural gas proved reserves declined in 2015 due to lower prices. U.S. crude oil and lease condensate proved reserves declined 4.7 billion barrels (11.8%) from their year-end 2014 level to 35.2 billion barrels at year-end 2015, according to U.S. Crude Oil and Natural Gas Proved Reserves, Year-end 2015, released today by the U.S. Energy Information Administration. U.S natural gas proved reserves decreased 64.5 trillion cubic feet, a 16.6% decline, reducing the U.S. total to 324.3 Tcf at year-end 2015.

Ultrasound Detection of Soft Tissue Abscesses Performed by Non-Physician U.S. Army Medical Providers Naïve to Diagnostic Sonography.

PubMed

LaDuke, Mike; Monti, Jon; Cronin, Aaron; Gillum, Bart

2017-03-01

Patients commonly present to emergency rooms and primary care clinics with cellulitic skin infections with or without abscess formation. In military operational units, non-physician medical personnel provide most primary and initial emergency medical care. The objective of this study was to determine if, after minimal training, Army physician assistants and medics could use portable ultrasound (US) machines to detect superficial soft tissue abscesses. This was a single-blinded, randomized, prospective observational study conducted over the course of 2 days at a military installation. Active duty military physician assistants and medics with little or no US experience were recruited as participants. They received a short block of training on abscess detection using both clinical examination skills (inspection/palpation) and US examination. The participants were then asked to provide a yes/no answer regarding abscess presence in a chicken tissue model. Results were analyzed to assess the participants' abilities to detect abscesses, compare the diagnostic accuracy of their clinical examinations with their US examinations, and assess how often US results changed treatment plans initially on the basis of clinical examination findings alone. 22 participants performed a total of 220 clinical examinations and 220 US scans on 10 chicken tissue abscess models. Clinical examination for abscess detection yielded a sensitivity of 73.5% (95% confidence interval [CI], 65.3-80.3%) and a specificity of 77.2% (95% CI, 67.4-84.9%), although US examination for abscess detection yielded a sensitivity of 99.2% (95% CI, 95.4-99.9%) and a specificity of 95.5% (95% CI, 88.5-98.6%). Clinical examination yielded a diagnostic accuracy of 75.0% (95% CI, 68.9-80.3) although US examination yielded a diagnostic accuracy of 97.7% (95% CI, 94.6-99.2%), a difference in accuracy of 22.7% favoring US (p < 0.01). US changed the diagnosis in 56 of 220 cases (25.4% of all cases, p = 0.02). Of these 56 cases, US led to the correct diagnosis 53 of 56 times (94.6%). Non-physician military medical providers can be trained in a very brief period to use US to detect superficial soft tissue abscesses with excellent accuracy. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Monte Carlo modeling of ultrasound probes for image guided radiotherapy

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

Bazalova-Carter, Magdalena, E-mail: bazalova@uvic.ca; Schlosser, Jeffrey; Chen, Josephine

2015-10-15

Purpose: To build Monte Carlo (MC) models of two ultrasound (US) probes and to quantify the effect of beam attenuation due to the US probes for radiation therapy delivered under real-time US image guidance. Methods: MC models of two Philips US probes, an X6-1 matrix-array transducer and a C5-2 curved-array transducer, were built based on their megavoltage (MV) CT images acquired in a Tomotherapy machine with a 3.5 MV beam in the EGSnrc, BEAMnrc, and DOSXYZnrc codes. Mass densities in the probes were assigned based on an electron density calibration phantom consisting of cylinders with mass densities between 0.2 andmore » 8.0 g/cm{sup 3}. Beam attenuation due to the US probes in horizontal (for both probes) and vertical (for the X6-1 probe) orientation was measured in a solid water phantom for 6 and 15 MV (15 × 15) cm{sup 2} beams with a 2D ionization chamber array and radiographic films at 5 cm depth. The MC models of the US probes were validated by comparison of the measured dose distributions and dose distributions predicted by MC. Attenuation of depth dose in the (15 × 15) cm{sup 2} beams and small circular beams due to the presence of the probes was assessed by means of MC simulations. Results: The 3.5 MV CT number to mass density calibration curve was found to be linear with R{sup 2} > 0.99. The maximum mass densities in the X6-1 and C5-2 probes were found to be 4.8 and 5.2 g/cm{sup 3}, respectively. Dose profile differences between MC simulations and measurements of less than 3% for US probes in horizontal orientation were found, with the exception of the penumbra region. The largest 6% dose difference was observed in dose profiles of the X6-1 probe placed in vertical orientation, which was attributed to inadequate modeling of the probe cable. Gamma analysis of the simulated and measured doses showed that over 96% of measurement points passed the 3%/3 mm criteria for both probes placed in horizontal orientation and for the X6-1 probe in vertical orientation. The X6-1 probe in vertical orientation caused the highest attenuation of the 6 and 15 MV beams, which at 10 cm depth accounted for 33% and 43% decrease compared to the respective (15 × 15) cm{sup 2} open fields. The C5-2 probe in horizontal orientation, on the other hand, caused a dose increase of 10% and 53% for the 6 and 15 MV beams, respectively, in the buildup region at 0.5 cm depth. For the X6-1 probe in vertical orientation, the dose at 5 cm depth for the 3-cm diameter 6 MV and 5-cm diameter 15 MV beams was attenuated compared to the corresponding open fields to a greater degree by 65% and 43%, respectively. Conclusions: MC models of two US probes used for real-time image guidance during radiotherapy have been built. Due to the high beam attenuation of the US probes, the authors generally recommend avoiding delivery of treatment beams that intersect the probe. However, the presented MC models can be effectively integrated into US-guided radiotherapy treatment planning in cases for which beam avoidance is not practical due to anatomy geometry.« less

7 CFR 51.2832 - U.S. Commercial.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false U.S. Commercial. 51.2832 Section 51.2832 Agriculture... Standards for Grades of Onions (Other Than Bermuda-Granex-Grano and Creole Types) Grades § 51.2832 U.S...) Free from damage caused by: (1) Seedstems; (2) Tops; (3) Roots; (4) Dry sunken areas; (5) Sunburn; (6...

7 CFR 51.2832 - U.S. Commercial.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false U.S. Commercial. 51.2832 Section 51.2832 Agriculture... Standards for Grades of Onions (Other Than Bermuda-Granex-Grano and Creole Types) Grades § 51.2832 U.S...) Free from damage caused by: (1) Seedstems; (2) Tops; (3) Roots; (4) Dry sunken areas; (5) Sunburn; (6...

Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots.

PubMed

Meunier, Jason M; Holland, Christy K; Pancioli, Arthur M; Lindsell, Christopher J; Shaw, George J

2009-01-01

Fibrinolytics such as recombinant tissue plasminogen activator (rt-PA) are used to treat thrombotic disease such as acute myocardial infarction (AMI) and ischemic stroke. Interest in increasing efficacy and reducing side effects has led to the study of adjuncts such as GP IIb-IIIa inhibitors and ultrasound (US) enhanced thrombolysis. Currently, GP IIb-IIIa inhibitor and fibrinolytic treatment are often used in AMI, and are under investigation for stroke treatment. However, little is known of the efficacy of combined GP IIb-IIIa inhibitor, fibrinolytic and ultrasound treatment. We measure the lytic efficacy of rt-PA, eptifibatide (Epf) and 120 kHz ultrasound treatment in an in-vitro human clot model. Blood was drawn from 15 subjects after IRB approval. Clots were made in 20 microL pipettes, and placed in a water tank for microscopic visualization during lytic treatment. Clots were exposed to control, rt-PA (rt-PA), eptifibatide (Epf), or rt-PA+eptifibatide (rt-PA + Epf), with (+US) or without (-US) ultrasound for 30 minutes at 37 degrees C in human plasma. Clot lysis was measured over time, using a microscopic imaging technique. The fractional clot loss (FCL) and initial lytic rate (LR) were used to quantify lytic efficacy. LR values for (- US) treated clots were 0.8+/-0.1(control), 1.8+/-0.3 (Epf), 1.5+/-0.2 (rt-PA), and 1.3+/-0.4 (rt-PA + Epf) (% clot width/minute) respectively. In comparison, the (+ US) group exhibited LR values of 1.6+/-0.2 (control), 4.3+/-0.4 (Epf), 6.3+/-0.4 (rt-PA), and 4.6+/-0.6 (rt-PA + Epf). For (- US) treated clots, FCL was 6.0+/-0.8 (control), 9.2+/-2.5 (Epf), 15.6+/-1.7 (rt-PA), and 28.0+/-2.2% (rt-PA + Epf) respectively. FCL for (+ US) clots was 13.5+/-2.4 (control), 20.7+/-6.4 (Epf), 44.4+/-3.6 (rt-PA) and 30.3+/-3.6% (rt-PA + Epf) respectively. Although the addition of eptifibatide enhances the in-vitro lytic efficacy of rt-PA in the absence of ultrasound, the efficacy of ultrasound and rt-PA is greater than that of combined ultrasound, rt-PA and eptifibatide exposure.

Evaluation of a Non-Nuclear Soil Density Gauge on Fine-Grained Soils

DTIC Science & Technology

2013-05-01

U.S. STANDARD SIEVE NUMBERS HYDROMETER fY, in o/. in. 318 in #140 6 in. 3 in. 2 in. 1 in. ’A in #4 ’" #20 #30 #40 ឬ #100 #200 100 J I ’ I I I I I...1 3-20 31 C L-2 U.S. SIEVE OPENING IN INCHES U.S. STANDARD SIEVE NUMBERS HYDROMETER 1Y,in. ’/.in Un~/8 in #140 6 in 3 in. 2 in. 1in. " #4...Particle Size Distribution Reoort Fine PL 14 HYDROMETER %Fines Silt -------,---- PI Project Non-Nuclear Gau_ge Proiect 27 Area Boring No. 3 Date

Efficacy of low-intensity pulsed ultrasound in the prevention of osteoporosis following spinal cord injury.

PubMed

Warden, S J; Bennell, K L; Matthews, B; Brown, D J; McMeeken, J M; Wark, J D

2001-11-01

Ultrasound (US), a high-frequency acoustic energy traveling in the form of a mechanical wave, represents a potential site-specific intervention for osteoporosis. Bone is a dynamic tissue that remodels in response to applied mechanical stimuli. As a form of mechanical stimulation, US is anticipated to produce a similar remodeling response. This theory is supported by growing in vitro and in vivo evidence demonstrating an osteogenic effect of pulsed-wave US at low spatial-averaged temporal-averaged intensities. The aim of this study was to investigate whether low-intensity pulsed US could prevent calcaneal osteoporosis in individuals following spinal cord injury (SCI). Fifteen patients with a 1-6 month history of SCI were recruited. Active US was introduced to one heel for 20 min/day, 5 days/week, over 6 weeks. The contralateral heel was simultaneously treated with inactive US. Patients were blind to which heel was being actively treated. Active US pulsed with a 10 microsec burst of 1.0 MHz sine waves repeating at 3.3 kHz. The spatial-averaged temporal-averaged intensity was set at 30 mW/cm(2). Bone status was assessed at baseline and following the intervention period by dual-energy X-ray absorptiometry and quantitative US. SCI resulted in significant bone loss. Bone mineral content decreased by 7.5 +/- 3.0% in inactive US-treated calcanei (p < 0.001). Broadband US attenuation and speed of sound decreased by 8.5 +/- 6.9% (p < 0.001) and 1.5 +/- 1.3% (p < 0.001), respectively. There were no differences between active and inactive US-treated calcanei for any skeletal measure (p > 0.05). These findings confirm the negative skeletal impact of SCI, and demonstrate that US at the dose and mode administered was not a beneficial intervention for SCI-induced osteoporosis. This latter finding may primarily relate to the inability of US to effectively penetrate the outer cortex of bone due to its acoustic properties.

Prediction of cervical intraepithelial neoplasia grade 2+ (CIN2+) using HPV DNA testing after a diagnosis of atypical squamous cell of undetermined significance (ASC-US) in Catalonia, Spain.

PubMed

Ibáñez, Raquel; Moreno-Crespi, Judit; Sardà, Montserrat; Autonell, Josefina; Fibla, Montserrat; Gutiérrez, Cristina; Lloveras, Belen; Alejo, María; Català, Isabel; Alameda, Francesc; Casas, Miquel; Bosch, F Xavier; de Sanjosé, Silvia

2012-01-26

A protocol for cervical cancer screening among sexually active women 25 to 65 years of age was introduced in 2006 in Catalonia, Spain to increase coverage and to recommend a 3-year-interval between screening cytology. In addition, Human Papillomavirus (HPV) was offered as a triage test for women with a diagnosis of atypical squamous cells of undetermined significance (ASC-US). HPV testing was recommended within 3 months of ASC-US diagnosis. According to protocol, HPV negative women were referred to regular screening including a cytological exam every 3 years while HPV positive women were referred to colposcopy and closer follow-up. We evaluated the implementation of the protocol and the prediction of HPV testing as a triage tool for cervical intraepithelial lesions grade two or worse (CIN2+) in women with a cytological diagnosis of ASC-US. During 2007-08 a total of 611 women from five reference laboratories in Catalonia with a novel diagnosis of ASC-US were referred for high risk HPV (hrHPV) triage using high risk Hybrid Capture version 2. Using routine record linkage data, women were followed for 3 years to evaluate hrHPV testing efficacy for predicting CIN2+ cases. Logistic regression analysis was used to estimate the odds ratio for CIN2 +. Among the 611 women diagnosed with ASC-US, 493 (80.7%) had at least one follow-up visit during the study period. hrHPV was detected in 48.3% of the women at study entry (mean age 35.2 years). hrHPV positivity decreased with increasing age from 72.6% among women younger than 25 years to 31.6% in women older than 54 years (p < 0.01). At the end of the 3 years follow-up period, 37 women with a diagnosis of CIN2+ (18 CIN2, 16 CIN3, 2 cancers, and 1 with high squamous intraepithelial lesions--HSIL) were identified and all but one had a hrHPV positive test at study entry. Sensitivity to detect CIN2+ of hrHPV was 97.2% (95%confidence interval (CI) = 85.5-99.9) and specificity was 68.3% (95%CI = 63.1-73.2). The odds ratio for CIN2+ was 45.3 (95% CI: 6.2-333.0), when among ASC-US hrHPV positive women were compared to ASC-US hrHPV negative women. Triage of ASC-US with hrHPV testing showed a high sensitivity for the detection of CIN2+ and a high negative predictive value after 3 years of follow-up. The results of this study are in line with the current guidelines for triage of women with ASC-US in the target age range of 25-65. Non adherence to guidelines will lead to unnecessary medical interventions. Further investigation is needed to improve specificity of ASC-US triage.

Secondary Signs May Improve the Diagnostic Accuracy of Equivocal Ultrasounds for Suspected Appendicitis in Children

PubMed Central

Partain, Kristin N.; Patel, Adarsh; Travers, Curtis; McCracken, Courtney; Loewen, Jonathan; Braithwaite, Kiery; Heiss, Kurt F.; Raval, Mehul V.

2016-01-01

Introduction Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improves diagnostic accuracy in equivocal US studies. Methods Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated. Results 530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, p<0.001). Of 172 (32%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis (61.0% vs 33.6%, p<0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% Confidence Interval (CI) 2.1–82.8), hyperemia (OR=2.0, 95%CI 1.5–95.5), free fluid (OR=9.8, 95%CI 3.8–25.4), and appendicolith (OR=7.9, 95%CI 1.7–37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy. Conclusion Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions. PMID:27039121

Major depression in China-to-US immigrants and US-born Chinese Americans: testing a hypothesis from culture-gene co-evolutionary theory of mental disorders.

PubMed

Tan, Tony Xing

2014-01-01

In this study, the culture-gene co-evolutionary theory of mental disorders was used to test the hypothesis that major depression was less prevalent in China-to-US immigrants who migrated to the US as adults than in US-born adult Chinese Americans. Data from the Collaborative Psychiatric Epidemiology Surveys (CPES) were extracted for secondary data analyses on the rates of major depression disorder (MDD) and major depressive episode (MDE) in the two groups. Findings showed that for life time MDD, the rates for China-to-US immigrant and US-born Chinese were 5.3% and 7.9% for men and 8.5% and 33.1% for women. For 12-month MDD, the corresponding rates were 2.2% and 3.4% for men, and 4.7% and 12.6% for women. For life time MDE, the corresponding rates were 6.8% and 8.8% for men; for women the rates were 8.5% and 33.1%. For 12-month MDE, the rates were 2.2% and 4.4% for men; the rates were 4.7% and 12.6% for women. Controlling for age, education level, income, BMI, marital status, and income-to-needs ratio, China-to-US immigrant women remained less likely to have life time major depression than US-born Chinese American women. While the study has the strength of utilizing nationally representative datasets, the approach is limited as the data sources lack the capacity to investigate how the strength of connection with the collectivist culture might be related to major depression in the immigrant group. Copyright © 2014 Elsevier B.V. All rights reserved.

Combined Screening with Ultrasound and Mammography Compared to Mammography Alone in Women at Elevated Risk of Breast Cancer: Results of the First-Year Screen in ACRIN 6666

PubMed Central

Berg, Wendie A.; Blume, Jeffrey D.; Cormack, Jean B.; Mendelson, Ellen B.; Lehrer, Daniel; Böhm-Vélez, Marcela; Pisano, Etta D.; Jong, Roberta A.; Evans, W. Phil; Morton, Marilyn J.; Mahoney, Mary C.; Larsen, Linda Hovanessian; Barr, Richard G.; Farria, Dione M.; Marques, Helga S.; Boparai, Karan

2008-01-01

Context Screening ultrasound (US) may depict small, node-negative breast cancers not seen on mammography (M). Objective To compare the diagnostic yield (proportion of women with a positive screen test and positive reference standard) and performance of screening with US+M compared to M alone in women at elevated risk of breast cancer. Design, Setting, and Participants From April 2004 to February 2006, 2809 women at elevated risk for breast cancer, with at least heterogeneously dense breast tissue in at least one quadrant, were recruited from 21 IRB-approved sites to undergo mammography (M) and physician-performed ultrasound (US) exams in randomized order by a radiologist masked to the results of the other exam. Reference standard was defined as a combination of pathology and 12 month follow-up, and was available for 2637 out of the 2725 eligible participants. Main Outcome Measure Diagnostic yield, sensitivity, specificity, and AUC of combined M+US compared to M alone; PPV of biopsy recommendations for M+US compared to M alone. Results Forty participants (41 breasts) were diagnosed with cancer: 8 suspicious on both US and M, 12 on US alone, 12 on M alone, and 8 participants (9 breasts) on neither (interval cancers). The diagnostic yield for M was 7.6 per 1000 women screened (20/2637) and increased to 11.8 per 1000 (31/2637) for combined US+M; the supplemental yield was 4.2 per 1000 women screened (95% CI 1.1 to 7.2 per 1000; p = 0.003 that the supplemental yield is zero). The diagnostic accuracy (AUC) for M was 0.78 (95% CI 0.67 to 0.87) and increased to 0.91 (95% CI 0.84 to 0.96) for US+M (p = 0.003 that difference is zero). Of 12 supplemental cancers seen only by US, 11 (92%) were invasive with median size 10 mm (range 5 to 40 mm; mean 12.6, SE 3.0) and 8/9 (89%) reported had negative nodes. PPV of biopsy recommendation after full diagnostic workup (PPV2) was 84/276 for M (22.6%, 95% CI 14.2 to 33%), 21/235 for US (8.9%, 95% CI 5.6 to 13.3%), and 31/276 for combined US+M (11.2%, 95% CI 7.8 to 15.6%). Conclusions Adding a single screening US to M will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but will also substantially increase the number of false positives. Evaluation of the role of annual screening US is ongoing in this patient population. [Clinicaltrials.gov registry # NCT00072501] PMID:18477782

Clinical characteristics of patients with spinocerebellar ataxias 1, 2, 3 and 6 in the US; a prospective observational study

PubMed Central

2013-01-01

Background All spinocerebellar ataxias (SCAs) are rare diseases. SCA1, 2, 3 and 6 are the four most common SCAs, all caused by expanded polyglutamine-coding CAG repeats. Their pathomechanisms are becoming increasingly clear and well-designed clinical trials will be needed. Methods To characterize the clinical manifestations of spinocerebellar ataxia (SCA) 1, 2, 3 and 6 and their natural histories in the United States (US), we conducted a prospective multicenter study utilized a protocol identical to the European consortium study, using the Scale for the Assessment and Rating of Ataxia (SARA) score as the primary outcome, with follow-ups every 6 months up to 2 years. Results We enrolled 345 patients (60 SCA1, 75 SCA2, 138 SCA3 and 72 SCA6) at 12 US centers. SCA6 patients had a significantly later onset, and SCA2 patients showed greater upper-body ataxia than patients with the remaining SCAs. The annual increase of SARA score was greater in SCA1 patients (mean ± SE: 1.61 ± 0.41) than in SCA2 (0.71 ± 0.31), SCA3 (0.65 ± 0.24) and SCA6 (0.87 ± 0.28) patients (p = 0.049). The functional stage also worsened faster in SCA1 than in SCA2, 3 and 6 (p = 0.002). Conclusions The proportions of different SCA patients in US differ from those in the European consortium study, but as in the European patients, SCA1 progress faster than those with SCA2, 3 and 6. Later onset in SCA6 and greater upper body ataxia in SCA2 were noted. We conclude that progression rates of these SCAs were comparable between US and Europe cohorts, suggesting the feasibility of international collaborative clinical studies. PMID:24225362

Site Area Boundaries

EPA Pesticide Factsheets

This dataset consists of site boundaries from multiple Superfund sites in U.S. EPA Region 8. These data were acquired from multiple sources at different times and were combined into one region-wide layer. Thus far the sources include:1. California Gulch (Irrigated Meadows) - ESAT Contractor.2. Manning Canyon - U.S. EPA Region 8; ESAT Contractor.3. Rapid City Small Arms Range - U.S. EPA Region 8; ESAT Contractor.4. Animas River/Cement Creek - U.S. EPA Region 8; ESAT Contractor.5. Monticello Mill Tailings (USDOE) - USDOE; ESAT Contractor.6. Pinon Canyon - USDOD.7. Rock Flats Industrial Park - U.S. EPA Region 8.8. Bountiful/Woods Cross - U.S. EPA Region 8.9. Lincoln Park - U.S. EPA Region 8.10. Marshall Landfill - U.S. EPA Region 8.11. U.S. Magnesium - Pacific Western Technologies Inc.

Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation.

PubMed

Celi, Ann C; Rich-Edwards, Janet W; Richardson, Marcie K; Kleinman, Ken P; Gillman, Matthew W

2005-03-01

To determine the impact of immigration status as well as race/ethnicity and social and economic factors on breastfeeding initiation. Cohort. Multisite group practice in eastern Massachusetts. One thousand eight hundred twenty-nine pregnant women prospectively followed up in Project Viva. Whether the participant breastfed her infant. The overall breastfeeding initiation rate was 83%. In multivariate models that included race/ethnicity and social, economic, and demographic factors, foreign-born women were more likely to initiate breastfeeding than US-born women (odds ratio [OR], 3.2 [95% confidence interval (CI), 2.0-5.2]). In models stratified by both race/ethnicity and immigration status, and further adjusted for whether the mother herself was breastfed as an infant and the mother's parents' immigration status, US-born and foreign-born black and Hispanic women initiated breastfeeding at rates at least as high as US-born white women (US-born black vs US-born white women, OR, 1.2 [95% CI, 0.8-1.9], US-born Hispanic vs US-born white women, OR, 1.1 [95% CI, 0.6-1.9], foreign-born black vs US-born white women, OR, 2.6 [95% CI, 1.1-6.0], and foreign-born Hispanic vs US-born white women, OR, 1.8 [95% CI, 0.7-4.8]). Calculations of predicted prevalences showed that, for example, the 2.6-fold increase in odds for the foreign-born black vs US-born white women translated to an increase in probability of approximately 1.4. Higher maternal education and household income also predicted higher initiation rates. Immigration status was strongly associated with increased breastfeeding initiation in this cohort, implying that cultural factors are important in the decision to breastfeed. Immigrants of all races/ethnicities initiated breastfeeding more often than their US-born counterparts. In addition, US-born minority groups initiated breastfeeding at rates at least as high as their white counterparts, likely due in part to high levels of education and income as well as to access to a medical care system that explicitly supports breastfeeding.

Comparison of 2- and 3-dimensional shoulder ultrasound to magnetic resonance imaging in a community hospital for the detection of supraspinatus rotator cuff tears with improved worktime room efficiency.

PubMed

Co, Steven; Bhalla, Sonny; Rowan, Kevin; Aippersbach, Sven; Bicknell, Simon

2012-08-01

The purpose of this study was to evaluate whether 3-dimensional (3D) volumetric acquisition of shoulder ultrasound (US) data for supraspinatus rotator cuff tears is as sensitive when compared with conventional 2-dimensional (2D) US and routine magnetic resonance imaging (MRI), and whether there is improved workroom time efficiency when using the 3D technique compared with the 2D technique. In this prospective study, 39 shoulders underwent US and MRI examination of their rotator cuff to confirm the accuracy of both the 2D and 3D techniques. The difference in sensitivities was compared by using confidence interval analysis. The mean times required to obtain the 2D and 3D US data and to review the scans were compared by using a 1-tailed Wilcoxon test. Sensitivity and specificity of 2D US in detecting supraspinatus full- and partial-thickness tears was 100% and 96%, and 80% and 100%, respectively, and similar values were obtained with 3D US at 100% and 100%, and 90% and 96.6%, respectively. Analysis of the confidence limits of the sensitivities showed no significant difference. The mean time (± SD) of the overall 2D examination of the shoulder, including interpretation was 10.02 ± 3.28 minutes, whereas, for the 3D examination, it was 7.08 ± 0.35 minutes. Comparison between the 2 cohorts when using a 1-tailed Wilcoxon test showed a statistically significant difference (P < .05). 3D US of the shoulder is as accurate as 2D US when compared with MRI for the diagnosis of full- and partial-thickness supraspinatus rotator cuff tears, and 3D US examination significantly reduced the time between the initial scan and the radiologist interpretation, ultimately improving workplace efficiency. Copyright © 2012 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

23 CFR Appendix A to Part 658 - National Network-Federally-Designated Routes

Code of Federal Regulations, 2011 CFR

2011-04-01

... Anchorage AK 3 Palmer. AK 2 AK 3 Fairbanks Milepost 1412 Delta Junction. AK 3 AK 1 Palmer AK 2 Fairbanks... Harbors. US 63 I-90 Rochester US 52 Rochester. US 63 MN 58 Red Wing WI State Line. US 71 IA State Line MN... State Line Red Wing MN US 2 W. of Ashland. US 141 US 41 Abrams US 8 Pembine. US 151 IA State Line...

23 CFR Appendix A to Part 658 - National Network-Federally-Designated Routes

Code of Federal Regulations, 2010 CFR

2010-04-01

... Anchorage AK 3 Palmer. AK 2 AK 3 Fairbanks Milepost 1412 Delta Junction. AK 3 AK 1 Palmer AK 2 Fairbanks... Harbors. US 63 I-90 Rochester US 52 Rochester. US 63 MN 58 Red Wing WI State Line. US 71 IA State Line MN... State Line Red Wing MN US 2 W. of Ashland. US 141 US 41 Abrams US 8 Pembine. US 151 IA State Line...

32 CFR 855.6 - Aircraft exempt from the requirement for a civil aircraft landing permit.

Code of Federal Regulations, 2012 CFR

2012-07-01

... individuals but leased by an Air Force aero club. (3) Aero clubs of other US military services. Note: This... aircraft owned by: (1) Any other US Government agency. (2) US Air Force aero clubs established as prescribed in AFI 34-117, Air Force Aero Club Program, and AFMAN 3-132, Air Force Aero Club Operations 1 . 1...

32 CFR 855.6 - Aircraft exempt from the requirement for a civil aircraft landing permit.

Code of Federal Regulations, 2013 CFR

2013-07-01

... individuals but leased by an Air Force aero club. (3) Aero clubs of other US military services. Note: This... aircraft owned by: (1) Any other US Government agency. (2) US Air Force aero clubs established as prescribed in AFI 34-117, Air Force Aero Club Program, and AFMAN 3-132, Air Force Aero Club Operations 1 . 1...

32 CFR 855.6 - Aircraft exempt from the requirement for a civil aircraft landing permit.

Code of Federal Regulations, 2014 CFR

2014-07-01

... individuals but leased by an Air Force aero club. (3) Aero clubs of other US military services. Note: This... aircraft owned by: (1) Any other US Government agency. (2) US Air Force aero clubs established as prescribed in AFI 34-117, Air Force Aero Club Program, and AFMAN 3-132, Air Force Aero Club Operations 1 . 1...

Compared to Canadians, U.S. physicians spend nearly four times as much money interacting with payers.

PubMed

Zimmerman, Christina

2011-11-01

(1) In Canadian office practices, physi­cians spent 2.2 hours per week interacting with payers, nurses spent 2.5 hours, and clerical staff spent 15.9 hours. In U.S. practices, physicians spent 3.4 hours per week interacting with payers, nurses spent 20.6 hours, and clerical staff spent 53.1 hours. (2) Canadian physician practices spent $22,205 per physician per year on interactions with health plans. U.S. physician practices spent $82,975 per physician per year. (3) U.S. physician practices spend $60,770 per physician per year more (approximately four times as much) than their Canadian counterparts.

Characterizing tuberculosis genotype clusters along the United States-Mexico border.

PubMed

Baker, B J; Moonan, P K

2014-03-01

We examined the growth of tuberculosis (TB) genotype clusters during 2005-2010 in the United States, categorized by country of origin and ethnicity of the index case and geographic proximity to the US-Mexico border at the time of TB diagnosis. Nationwide, 38.9% of cases subsequent to Mexico-born index cases were US-born. Among clusters following US-born Hispanic and US-born non-Hispanic index cases, respectively 29.2% and 5.3% of subsequent cluster members were Mexico-born. In border areas, the majority of subsequent cases were Mexico-born following US-born Hispanic (56.4%) and US-born non-Hispanic (55.6%) index cases. These findings suggest that TB transmission commonly occurs between US-born and Mexico-born persons. Along the US-Mexico border, prioritizing TB genotype clusters following US-born index cases for investigation may prevent subsequent cases among both US-born and Mexico-born persons.

Patients' with type 2 diabetes willingness to pay for insulin therapy and clinical outcomes

PubMed Central

Feher, Michael D; Brazier, John; Schaper, Nicolaas; Vega-Hernandez, Gabriela; Bøgelund, Mette

2016-01-01

Objectives This study assessed patient preferences, using willingness to pay as a method to measure different treatment characteristics or attributes associated with injectable insulin therapy in patients with type 2 diabetes. Research design and methods Adults with type 2 diabetes in 12 countries, diagnosed >6 months prior and receiving insulin for >3 months, were recruited through a representative online panel. Data were collected via online questionnaire and analyzed using a standard choice model for discrete choice experiment. Results A total of 3758 patients from North America (n=646), South America (n=1537), and Europe (n=1575) completed the study. Mean glycated hemoglobin (HbA1c) levels in North America, South America, and Europe were 63 mmol/mol (7.9%), 75 mmol/mol (9.0%), and 64 mmol/mol (8.0%), respectively. In the three regions, monthly willingness to pay was US$116, US$74, and US$92, respectively, for a 1%-point decrease in HbA1c; US$99, US$80, and US$104 for one less major hypoglycemic event per year; and US$64, US$37 and US$60 for a 3 kg weight decrease. To avoid preinjection preparation of insulin, the respective values were US$47, US$18, and US$37, and US$25, US$25, and US$24 for one less injection per day. Among respondents on basal-only insulin who had previously tried a more intensive regimen, reasons for switching back included difficulty in handling multiple injections and risk of hypoglycemic events. Conclusions Reducing HbA1c, frequency of major hypoglycemic events and weight decrease were the highest valued outcomes in each region. The administrative burden of injections was also considered important. PMID:27158518

Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans.

PubMed

Argirò, Renato; Diacinti, Daniele; Sacconi, Beatrice; Iannarelli, Angelo; Diacinti, Davide; Cipriani, Cristiana; Pisani, Daniela; Romagnoli, Elisabetta; Biffoni, Marco; Di Gioia, Cira; Pepe, Jessica; Bezzi, Mario; Letizia, Claudio; Minisola, Salvatore; Catalano, Carlo

2018-05-07

To evaluate the diagnostic performance of 3TMRI in comparison with ultrasound (US) and 99mTc-sestamibi scan for presurgical localisation of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT). Fifty-seven patients affected by PHPT were prospectively enrolled and underwent US, 99mTc-sestamibi and 3TMRI. T2-weighted and post-contrast T1-weighted Iterative decomposition of water and fat with Echo Asymmetry and Least squares estimation (IDEAL) sequences were acquired. Diagnostic performance of US, 99mTc-sestamibi and MRI in localising PTAs to correct quadrant were compared according to surgical and pathological findings. According to surgical findings, US correctly localised 41/46 PTAs (sensitivity of 89.1%; specificity 97.5%; PPV 93.1% and NPV 95.6%); 99mTc-sestamibi correctly localised 38/46 PTAs (sensitivity 83.6%, specificity 98.3%, PPV 95% and NPV 93.7%). US and 99mTc-sestamibi combined had a sensitivity of 93.4% (43/46 PTAs), specificity of 98.3%, PPV 95% and NPV 98.3%. MRI correctly localised 45/46 PTAs (sensitivity 97.8%; specificity 97.5%; PPV 93.7% and NPV 99.2%). MRI was able to detect six adenomas missed by 99mTc-sestamibi and two adenomas missed by US. MRI and US were able to detect all enlarged parathyroid glands in patients with multiglandular disease. MRI identified six of seven ectopic adenomas. Our study demonstrated high diagnostic performance of 3T MRI in the preoperative PTAs quadrant localisation, as well as in patients with multiglandular disease and ectopic PTAs. MRI may be preferred to adequately select patient candidates for minimally invasive parathyroidectomy (MIP). • PTA(s) quadrant localisation by 3TMRI was more accurate than US+99mTc-sestamibi. • MRI identified all enlarged glands in multiglandular disease similarly to US. • MRI identified 6/7 ectopic PTAs similarly to 99mTc-sestamibi. • Presurgical PTA(s) localisation by 3TMRI select the optimal candidates for MIP.

Spectacle dispensing in Timor-Leste: tiered-pricing, cross-subsidization and financial viability.

PubMed

Ramke, Jacqueline; Brian, Garry; Palagyi, Anna

2012-08-01

To examine the financial viability of the Timor-Leste National Spectacle Program as it increases spectacle availability, affordability and uptake, particularly for Timor's poor. In rural areas, three models of ready-made spectacles were dispensed according to a tiered pricing structure of US$3.00, 1.00, 0.10 and 0.00. In addition, custom-made spectacles were available in the capital, Dili. Spectacle costs, dispensing data and income for the National Spectacle Program for 18 months from March 2007 were analyzed. Rural services dispensed 3415 readymade spectacles: 47.1% to women, and 51.4% at subsidized prices, being 39.8% at US$0.10 and 11.6% free. A profit of US$1,529 was generated, mainly from the sale of US$3.00 spectacles. Women (odds ratio, OR, 1.3, 95% confidence interval, CI, 1.1-1.4) and consumers aged ≥65 years (OR 2.1; 95% CI 1.7-2.6) were more likely to receive subsidized spectacles. Urban services dispensed 2768 spectacles; mostly US$3.00 readymade (52.8%) and custom-made single vision (29.6%) units. Custom-made spectacles accounted for 36.7% of dispensing, but 73.1% of the US$12,264 urban profit. The combined rural and urban profit covered all rural costs, leaving US$2,200 to meet administration and other urban expenses. It is instructive and encouraging that a national spectacle dispensing program in one of the ten poorest countries of the world can use tiered-pricing based on willingness-to-pay information to cover spectacle stock replacement costs and produce profit, while using cross-subsidization to provide spectacles to the poor.

Comparison of mega-voltage cone-beam computed tomography prostate localization with online ultrasound and fiducial markers methods

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

Gayou, Olivier; Miften, Moyed

2008-02-15

The online image-guided localization data from 696 ultrasound (United States), 598 mega-voltage cone-beam computed tomography (MV-CBCT), and 393 seed markers (SMs) couch alignments for patients undergoing intensity modulation radiotherapy of the prostate were analyzed. Daily US, MV-CBCT and SM images were acquired for 19, 17 and 12 patients, respectively, after each patient was immobilized in a vacuum cradle and setup to skin markers as the center of mass. The couch shifts applied in the lateral (left-right/LR), vertical (anterior-posterior/AP), and longitudinal (superior-inferior/SI) directions, along with the magnitude of the three-dimensional (3D) shift vector, were analyzed and compared for all three methods.more » The percentage of shifts larger than 5 mm in all directions was also compared. Clinical target volume-planning target volume (CTV-to-PTV) expansion margins were estimated based on the localization data with US, CB, and SM image guidance. Results show the US data have greater variability. Systematic and random shifts were -1.2{+-}6.8 mm (LR), -2.8{+-}5.1 mm (SI) and -1.0{+-}5.9 mm (AP) for US, 1.0{+-}3.9 mm (LR), -1.3{+-}2.5 mm (SI) and -0.3{+-}3.9 mm (AP) for CB, and -1.0{+-}3.4 mm (LR), 0.0{+-}3.4 mm (SI) and 0.5{+-}4.1 mm (AP) for SM. The mean 3D shift distance was larger using US (8.8{+-}6.2 mm) compared to CB and SM (5.3{+-}3.4 mm and 5.2{+-}3.7 mm, respectively). The percentage of US shifts larger than 5 mm were 34%, 31%, and 38% in the LR, SI, and AP directions, respectively, compared to 18%, 6%, and 16% for CB and 14%, 10%, and 20% for SM. MV-CBCT and SM localization data suggest a different distribution of prostate center-of-mass shifts with smaller variability, compared to US. The online MV-CBCT and SM image-guidance data show that for treatments that do not include daily prostate localization, one can use a CTV-to-PTV margin that is 4 mm smaller than the one suggested by US data, hence allowing more rectum and bladder sparing and potentially improving the therapeutic ratio.« less

Integrated Field-Screening for Rapid Sediment Characterization

DTIC Science & Technology

2000-09-30

Station Naval Submarine Naval Shipyard Hickam Air Force Base Pearl Harbor Naval Base Ford Island (US Navy) Waipio Peninsula (US Navy) McGrew Point...December 1941, the Japanese Imperial Navy launched a surprise air attack on the U.S. Fleet in Pearl Harbor from a task force of 32 vessels, including 6...18 3.2.1 Naval Air Station Alameda

Sonocatalytic activity of a heterostructured β-Bi2O3/Bi2O2CO3 nanoplate in degradation of bisphenol A.

PubMed

Lee, Gooyong; Ibrahim, Shaliza; Kittappa, Shanmuga; Park, Heekyung; Park, Chang Min

2018-06-01

Novel heterostructured β-Bi 2 O 3 /Bi 2 O 2 CO 3 nanoplates (hBN) were synthesized to observe the sonocatalytic degradation of bisphenol A (BPA) (widely used as a model pollutant) under ultrasonic (US) irradiation. Prior to obtaining the hBN, the Bi 2 O 2 CO 3 micropowder precursor was prepared under hydrothermal conditions and then converted to hBN by increasing the calcination temperature to 300 °C. The synthesized hBN samples were characterized by field emission scanning electron microscope with energy dispersive X-ray analysis (FESEM/EDX), transmission electron microscopy (TEM), X-ray diffraction (XRD), ultraviolet-visible spectrophotometer diffuse reflection spectroscopy (UV-vis DRS), and X-ray photoelectron spectroscopy (XPS). The hBN/US system exhibited greater sonocatalytic activity for the degradation of BPA than the US treatment with the single element bismuth oxide, β-Bi 2 O 3 prepared by annealing the Bi 2 O 2 CO 3 precursor at 400 °C for 1 h. The US frequency and US power intensity in the hBN/US system were the key operating parameters, which were responsible for the complete degradation of BPA during 6 h of reactions. The degradation efficiency of BPA under the US irradiation was positively correlated with the dose of hBN. Our findings indicate that heterostructured hBN can be used as an efficient sonocatalyst for the catalytic degradation of BPA in water and wastewater treatment. Copyright © 2018 Elsevier B.V. All rights reserved.

The value of power Doppler ultrasound in patients with rheumatoid arthritis in clinical remission: Reclassifying disease activity?

PubMed

Vergara, Facundo; Ruta, Santiago; Rosa, Javier; Marín, Josefina; García-Mónaco, Ricardo; Soriano, Enrique R

2017-03-18

The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients. We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS28<2.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively. Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28. Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Mobile Robot Localization Using Sonar.

DTIC Science & Technology

1985-01-01

beam, called ’, is greater than Driilihelier: Rohot Localizatiou Us1 iig Sonai c.ON. OF PkIE.FI-EC.TION GiMowG I.O NO R..H O k.:N1 PROA "tr"S -rHts...null wall. Drumhii~eller Robot, Localizatlioni Us’ing Sonai ((Si IW)(S2 WW~S3 W3)(S4 W2)(S5 W4)(96 IJI)S7 US)]; x = -7.4 ft. y =6.9 ft. 99 deg. Actual

76 FR 40745 - In the Matter of Certain Light-Emitting Diodes and Products Containing the Same; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

...Notice is hereby given that two complaints were filed with the U.S. International Trade Commission on June 3, 2011, under section 337 of the Tariff Act of 1930, as amended, 19 U.S.C. 1337, on behalf of OSRAM GmbH of Germany. Both complaints allege violations of section 337 based upon the importation into the United States, the sale for importation, and the sale within the United States after importation of certain lighting-emitting diodes and products containing same by reason of infringement of certain claims of U.S. Patents. The first complaint asserts U.S. Patent No. 6,812,500 (``the `500 patent''); U.S. Patent No. 7,078,732 (``the `732 patent''); U.S. Patent No. 7,126,162 (``the `162 patent''); U.S. Patent No. 7,345,317 (``the `317 patent''); U.S. Patent No. 7,629,621 (``the `621 patent''); U.S. Patent No. 6,459,130 (``the `130 patent''); U.S. Patent No. 6,927,469 (``the `469 patent''); U.S. Patent No. 7,199,454 (``the `454 patent''); and U.S. Patent No. 7,427,806 (``the `806 patent''). The second complaint asserts U.S. Patent No. 6,849,881 (``the `881 patent''); U.S. Patent No. 6,975,011 (``the `011 patent''); U.S. Patent No. 7,106,090 (``the `090 patent''); U.S. Patent No. 7,151,283 (``the `283 patent''); and U.S. Patent No. 7,271,425 (``the `425 patent'') as well as the `500 patent, `732 patent, `162 patent, `621 patent, `130 patent, `469 patent, and `454 patent. Each complaint further alleges that an industry in the United States exists as required by subsection (a)(2) of section 337. The complainant requests that the Commission institute the two investigations and, after the investigation, issue an exclusion order and cease and desist orders. Letters regarding the possible consolidation of investigations stemming from these complaints were received on June 21, June 22, and June 29, 2011.

76 FR 40746 - In the Matter of Certain Light-Emitting Diodes and Products Containing Same; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

...Notice is hereby given that two complaints were filed with the U.S. International Trade Commission on June 3, 2011, under section 337 of the Tariff Act of 1930, as amended, 19 U.S.C. 1337, on behalf of OSRAM GmbH of Germany. Both complaints allege violations of section 337 based upon the importation into the United States, the sale for importation, and the sale within the United States after importation of certain light-emitting diodes and products containing same by reason of infringement of certain claims of U.S. Patents. The first complaint asserts U.S. Patent No. 6,812,500 (``the `500 patent''); U.S. Patent No. 7,078,732 (``the `732 patent''); U.S. Patent No. 7,126,162 (``the `162 patent''); U.S. Patent No. 7,345,317 (``the `317 patent''); U.S. Patent No. 7,629,621 (``the `621 patent''); U.S. Patent No. 6,459,130 (``the `130 patent''); U.S. Patent No. 6,927,469 (``the `469 patent''); U.S. Patent No. 7,199,454 (``the `454 patent''); and U.S. Patent No. 7,427,806 (``the `806 patent''). The second complaint asserts U.S. Patent No. 6,849,881 (``the `881 patent''); U.S. Patent No. 6,975,011 (``the `011 patent''); U.S. Patent No. 7,106,090 (``the `090 patent''); U.S. Patent No. 7,151,283 (``the `283 patent''); and U.S. Patent No. 7,271,425 (``the `425 patent'') as well as the `500 patent, `732 patent, `162 patent, `621 patent, `130 patent, `469 patent, and `454 patent. Each complaint further alleges that an industry in the United States exists as required by subsection (a)(2) of section 337. The complainant requests that the Commission institute the two investigations and, after the investigation, issue an exclusion order and cease and desist orders. Letters regarding the possible consolidation of investigations stemming from these complaints were received on June 21, June 22, and June 29, 2011.

[Unit cost variation in a social security company in Querétaro, México].

PubMed

Villarreal-Ríos, Enrique; Campos-Esparza, Maribel; Garza-Elizondo, María E; Martínez-González, Lidia; Núñez-Rocha, Georgina M; Romero-Islas, Nestor R

2006-01-01

Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. Unit cost variation was more important in the emergency room and the dental service.

Military Review: The Professional Journal of the U.S. Army, Volume 90, Number 1, January-February 2000

DTIC Science & Technology

2000-02-01

Bulletin 100-99-5/6 Now available in Adobe Acrobat ( pdf ) format CONTENTS Editorial PDF 2 Korean Conflict: A 50-Year Perspective 3 Task Force Smith...Revisited PDF by Lieutenant Colonel Joseph G.D. Babb, US Army, Retired 14 Harnessing Thunderbolts PDF by Major Kelly C. Jordan, US Army 20 North Korea...and the Bomb PDF by Stanley Weintraub 28 Busting Through PDF by Colonel John F. Antal, US Army 40 Planning for Major Theater Wars: Examining the

Risk Factors for Injury Associated with Low, Moderate, and High Mileage Road Marching in a U.S. Army Infantry Brigade

DTIC Science & Technology

2017-03-24

Injuries in the previous 6 months were identified by survey from 831 U.S Army infantry soldiers. Road marching-related injuries were reported as those...2 2 References 2 3 Authority 3 4 Background 3 5 Methods 5 5.1 Survey Design and Administration...the 6 months prior to survey administration. Most respondents (89 percent, n=736) reported participation in road marching with their unit during

Fact Sheets - The National Guard

Science.gov Websites

National Guard About Us By the Numbers Contact Us FAQ Federal Mission History Join Us Leaders Director of March Today in Guard History Leadership CNGB VCNGB SEA DANG DARNG Joint Staff J-1 J-2 J-3 J-4 J-5 J-6 J ARNG Readiness Home : Resources : Fact Sheets General Information Air Guard History Army National Guard

China’s Exchange Rate Peg: Economic Issues and Options for U.S. Trade Policy

DTIC Science & Technology

2005-05-10

in 2004) and has hurt U.S. production and employment in several U.S. manufacturing sectors (such as textiles and apparel and furniture) that are forced...countries is mixed. From 1980 to 1997, Korea, Malaysia , Philippines, Indonesia, and Thailand typically ran current account deficits, while Hong Kong...64.0 73.9 7.9 China 8.3 8.2 12.0 18.7 29.5 255.4 Malaysia 4.9 5/0 7.1 8.0 8.7 77.6 Mexico 6.9 8.5 7.9 7.0 7.4 7.2 Singapore 8.7 7.1 7.1 6.9 6.6 -24.1

NASA/DOD Aerospace Knowledge Diffusion Research Project. Report 13: Source selection and information use by US aerospace engineers and scientists: Results of a telephone survey

NASA Technical Reports Server (NTRS)

Pinelli, Thomas E.; Glassman, Nanci A.

1992-01-01

A telephone survey of U.S. aerospace engineers and scientists belonging to the Society of Automotive Engineers (SAE) was conducted between December 4, 1991 and January 5, 1992. The survey was undertaken to (1) validate the telephone survey as an appropriate technique for collecting data from U.S. aerospace engineers and scientists; (2) collect information about how the results of NASA/DoD aerospace research are used in the R&D process; (3) identify those selection criteria which affect the use of federally-funded aerospace R&D; and (4) obtain information that could be used to develop a self-administered mail questionnaire for use with the same population. The average rating of importance of U.S. government technical reports was 2.5 (on a 4-point scale); The mean/median number of times U.S. government technical reports were used per 6 months was 8/2. Factors scoring highest for U.S. government technical reports were technical accuracy (2.9), reliable data and technical information (2.8), and contains comprehensive data and information (2.7) on a 4-point system. The factors scoring highest for influencing the use of U.S. government technical reports were relevance (3.1), technical accuracy (3.06), and reliable data/information (3.02). Ease of use, familiarity, technical accuracy, and relevance correlated with use of U.S. government technical reports. Survey demographics, survey questionnaire, and the NASA/DoD Aerospace Knowledge Diffusion Research Project publications list are included.

Insulin Pump and CGM Usage in the United States and Germany

PubMed Central

Walsh, John; Roberts, Ruth; Weber, Dietmar; Faber-Heinemann, Gabriele; Heinemann, Lutz

2015-01-01

Background: This survey collected and evaluated user responses about routine tasks and preferences regarding insulin pumps and infusion sets (IIS) with comparison of intercountry differences between the United States (US) and Germany (GER), chosen for their large insulin pump populations. Methods: A total of 985 subjects (534 US, 451 GER; 60% female) with type 1 diabetes on pump therapy anonymously answered 20 pump-related questions. US subjects also answered 11 questions about continuous glucose monitoring (CGM) usage. Results: Length of use of insulin cartridges is shorter in US than in GER, mean (SD) 4.3 (5.0) versus 5.3 (3.2) days (P < .001), while the IIS is used longer: 3.3 (1.0) versus 2.7 (1.1) days (P < .001). Lower self-reported HbA1c levels were associated with longer use of insulin cartridges (7.3% for >3 days vs 7.7% for <3 days; P < .01), and with use of an auto-insertion device (vs manual IIS insertion) in the US (7.2% vs 6.9%), but not in GER (7.7% vs 7.9%). Only 47% of pump wearers stated that they were “very satisfied” with their pump (49% US vs 45% GER, ns). However, 98% would recommend the pump to others (95% vs 93%, ns). Analysis of CGM questions showed that 297 (60%) of 496 US responders currently wore one. Of these, 84% said they would recommend CGM to others. CGM wearers who stated they were “very satisfied” with their CGM had lower HbA1c than those who said they were “partly satisfied” (6.9% vs 7.2%). Conclusions: This survey shows interesting differences in real-world use of insulin pumps in 2 large markets, and suggests areas where insulin pumps and CGMs might be improved. PMID:26071425

Metabolic responses to a traditional Mexican diet compared with a commonly consumed US diet in women of Mexican descent: a randomized crossover feeding trial12

PubMed Central

Santiago-Torres, Margarita; Kratz, Mario; Lampe, Johanna W; Tapsoba, Jean De Dieu; Breymeyer, Kara L; Levy, Lisa; Villaseñor, Adriana; Wang, Ching-Yun; Song, Xiaoling; Neuhouser, Marian L

2016-01-01

Background: Mexican immigrants are disproportionally affected by diet-related risk of metabolic dysfunction. Whether adhering to a traditional Mexican diet or adopting a US diet contributes to metabolic changes associated with future risk of type 2 diabetes and other chronic diseases has not been investigated. Objective: The purpose of this study was to test in a randomized crossover feeding trial the metabolic responses to a Mexican diet compared with a commonly consumed US diet. Design: First- and second-generation healthy women of Mexican descent (n = 53) were randomly assigned in a crossover design to consume a Mexican or US diet for 24 d each, separated by a 28-d washout period. Diets were eucaloric and similar in macronutrient composition. The metabolic responses to diets were assessed by measuring fasting serum concentrations of glucose, insulin, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), adiponectin, C-reactive protein (CRP), and interleukin 6 (IL-6), as well as the homeostasis model assessment of insulin resistance (HOMA-IR) at the beginning and end of each period. Linear mixed models tested the intervention effect on the biomarkers, while adjusting for diet sequence, feeding period, baseline and washout biomarker concentrations, age, acculturation, and BMI. Results: Compared with the US diet, the Mexican diet reduced insulin by 14% [geometric means (95% CIs): 9.3 (8.3, 10.3) compared with 8.0 (7.2, 8.9) μU/mL; P = 0.02], HOMA-IR by 15% [2.0 (1.8, 2.3) compared with 1.7 (1.6, 2.0); P = 0.02], and IGFBP-3 by 6% (mean ± SEM: 2420 ± 29 compared with 2299 ± 29 ng/mL; P < 0.01) and tended to reduce circulating concentrations of IGF-1 by 4% (149 ± 2.6 compared with 144 ± 2.5 ng/mL; P = 0.06). There was no significant intervention effect on serum concentrations of glucose, adiponectin, CRP, or IL-6 in the US compared with the Mexican diet. Conclusion: Compared with the commonly consumed US diet, the traditional Mexican diet modestly improved insulin sensitivity under conditions of weight stability in healthy women of Mexican descent, while having no impact on biomarkers of inflammation. This trial was registered at clinicaltrials.gov as NCT01369173. PMID:26718418

Theoretical Analysis of Microwave Propagation.

DTIC Science & Technology

1984-04-01

effects of the turbulent atmosphere on wave propagation, US Department of Commerce, NTIS, Springfield, VA. * VanVleck, J.H. (1947), "The absorption of... turbulent atmosphere on wave propagation, US Department of Commerce, NTIS, Sprinifield, VA. -. A. Vigants (1975), "Space diversity engineering," BSTJ, Vol... Turbulence ., ...... 2-26 2.5 ATMOSPHERIC ABSORPTION. 2-26 2 .6 RAIN ATTENUATION ....... 2-29 3 TROPOSCATTER PROPAGATION .................... 3-1 3.1

Benign Solid Thyroid Nodules: US-guided High-Intensity Focused Ultrasound Ablation-Initial Clinical Outcomes.

PubMed

Kovatcheva, Roussanka D; Vlahov, Jordan D; Stoinov, Julian I; Zaletel, Katja

2015-08-01

To assess the short-term efficacy and safety of ultrasonographically (US)-guided high-intensity focused ultrasound (HIFU) ablation for treatment of benign solid thyroid nodules. This prospective study was approved by the institutional ethics committee, and written informed consent was acquired. HIFU ablation was performed in one session with US guidance and conscious sedation in 20 euthyroid patients (mean age, 44.5 years) with a benign solitary or dominant thyroid nodule. Thyroid nodule volume, US structure, and Doppler pattern were assessed at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Adverse events associated with HIFU were evaluated. Statistical analysis was conducted by using repeated measures analysis of variance, the Student t test, χ(2) test, and correlation analysis. The mean ± standard deviation nodule volume was 4.96 mL ± 2.79 at the start of the study. Nodule volume had decreased to 3.05 mL ± 1.96 at the 3-month follow-up examination (n = 20, P < .001), and reached 2.91 mL ± 2.43 by the 6-month follow-up examination (n = 16, P < .001). By then, the mean volume reduction was 48.7% ± 24.3 (P < .001). Isoechoic nodules showed greater reduction at 1 month than did hypoechoic nodules (31.6% ± 18.1 vs 16.4% ± 8.6, P = .053). Nodules with markedly increased blood flow showed smaller volume reduction at 3 months than did less-vascularized nodules (10.9% ± 14.5 vs 41.5% ± 20.3, P = .054). Minor transient complications (eg, subcutaneous edema, mild skin redness) were observed in two patients. Early data suggest that US-guided HIFU ablation is an effective and safe procedure for treatment of benign solid thyroid nodules. Initial US echogenicity and vascularization influence the ablation outcome. (©) RSNA, 2015.

76 FR 31320 - Commission Information Collection Activities (FERC-725B); Comment Request; Submitted for OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... respondent response \\7\\ hours (1) (2) (3) (1) x (2) x (3) FERC-725B: Category 1--Estimate of U.S. 345 1 1,920... 138,720 Entities that have not identified Critical Cyber Assets. Category 3--New U.S. Entities 6 1 3... longer required Category 1: -2...... 1 Category 1 (2 -3,840 to comply with CIP Standards respondents...

Religious characteristics of US women physicians.

PubMed

Frank, E; Dell, M L; Chopp, R

1999-12-01

Physicians' religious attributes are unknown, and may affect patient care. The Women Physicians' Health Study (WPHS) is a random sample (n = 4501 respondents, 59% response rate) of US women physicians aged 30-70; the first large, national study of US women physicians. In this study US women physicians were less likely to be Christian than were other Americans (61.2% of women physicians versus 85.1% of the general population), but were more likely to be Jewish (13.2% vs 2.0%), Buddhist (1.4% vs 0.3%), Hindu (3.9% vs 0.4%), or atheist/agnostic (5.9% vs 0.6%). Protestantism (29.3% of the population) and Catholicism (24.9%) were the most commonly reported religious identities. The strongest religious identity was claimed by Mormons and Seventh Day Adventists. Thus, women physicians' religious beliefs differ from those of the general population in the US. This may be particularly important for physicians practicing with patient populations with different religious affiliations, and in addressing clinical questions with ethical or religious dimensions.

Tankers in US waters

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

Stewart, R.J.

About 200 US flag tankers operate between US ports; the import trade consists of 30-40 more US tankers and 600-700 foreign tankers. US ships have 50% as many spills per port call as Liberian tankers and 20-33% as many as foreign tankers as a whole. There is mounting evidence that ships are prone to have a rather constant number of spills per year irrespective of variations in port call exposure. When spill incidence is measured per ship time, the US tanker margin over foreign fleets is only 2-3 instead of 3-6. For 1973-1975, 76% of all US tanker spills weremore » <100 gal, compared with 65% of all flag of convenience spills. The probability of no tanker losses in a one-year period in US waters is only 0.22. One-half the losses can be expected to occur in conditions favorable to a spill in coastal waters. In any given year, the US tanker fleet of 235 vessels >1000 gross registered tonnage can be expected to have about 100 spills in US waters, while foreign flag ships contribute another 250 spills. The largest US tanker spill in a one-year period is <5000 gal; the median value for the largest spill from foreign tankers is closer to 50,000-100,000 gal.« less

Polybrominated diphenyl ethers (PBDEs) in U.S. computers and domestic carpet vacuuming: possible sources of human exposure.

PubMed

Schecter, Arnold; Päpke, Olaf; Joseph, Jean Elizabeth; Tung, Kuang-Chi

2005-04-09

Polybrominated diphenyl ethers (PBDEs), a type of brominated flame retardant chemically and toxicologically similar to polychlorinated biphenyls (PCBs), are a class of emerging environmental and human contaminants. They have recently been detected in U.S. milk, blood, and food at the highest levels in the world. This pilot study was undertaken with the aim of determining levels of PBDE in the U.S. indoor environment, to assess the potential exposure to PBDEs from computer surfaces and carpets. Food of animal origin is the usual source of polychlorinated dibenzo-p-dioxin (PCDD), polychlorinated dibenzofurans (PCDF), and PCBs in humans, but there may also be environmental sources for intake of PBDEs. It was also our aim to characterize the PBDE congener profile in these indoor environmental samples. Four computer wipe samples and 9 domestic vacuum-sweeping samples were analyzed for 13 PBDE congeners, PBDEs 17 (2,2',4), 28 (2,4,4'?), 47 (2,2',4,4'?), 66 (2,3',4,4'?), 77 (3,3',4,4'?), 85 (2,2',3,4,4'?), 99 (2,2'4,4',5), 100 (2,2',4,4',6), 138 (2,2',3,4,4',5'?), 153 (2,2',4,4',5,5'?), 154 (2,2',4,4',5,6'?), 183 (2,2',3,4,4',5',6), and 209 (2,2',3,3',4,4',5,5',6,6'?). All samples tested positive for PBDEs. PBDE 209 was the dominant congener in all 4 computer wipe samples and in 7 out of the 9 vacuum dust samples. The congener profiles observed in this study varied considerably, a finding that has been observed previously. However these congener profiles differ from the pattern seen in U.S. human milk, human blood and in food, where PBDEs 47 and 99 predominate.

Philippines: Population: USAID loan.

PubMed

The Philippines and the United States Agency for International Development signed an agreement on Christmas Day for a US $5.7 million loan and a US $6 million grant for the country's population program. The loan, which matures in 40 years, carries a 2% interest per year for the first 10 years, and 3% thereafter. A 10-year grace period is provided. The US $11.7 million loan and grant package is the first part of USAID's pledge of US $26.9 million in loan and US $29.8 million in grants for the population project. The agreement was signed by Finance Minister Cesar Virata and USAID director Anthony Schwarzwalder. The total loan package of US $57.7 million will be given in the next 5 years.

Usefulness of real-time three-dimensional ultrasonography in percutaneous nephrostomy: an animal study.

PubMed

Hongzhang, Hong; Xiaojuan, Qin; Shengwei, Zhang; Feixiang, Xiang; Yujie, Xu; Haibing, Xiao; Gallina, Kazobinka; Wen, Ju; Fuqing, Zeng; Xiaoping, Zhang; Mingyue, Ding; Huageng, Liang; Xuming, Zhang

2018-05-17

To evaluate the effect of real-time three-dimensional (3D) ultrasonography (US) in guiding percutaneous nephrostomy (PCN). A hydronephrosis model was devised in which the ureters of 16 beagles were obstructed. The beagles were divided equally into groups 1 and 2. In group 1, the PCN was performed using real-time 3D US guidance, while in group 2 the PCN was guided using two-dimensional (2D) US. Visualization of the needle tract, length of puncture time and number of puncture times were recorded for the two groups. In group 1, score for visualization of the needle tract, length of puncture time and number of puncture times were 3, 7.3 ± 3.1 s and one time, respectively. In group 2, the respective results were 1.4 ± 0.5, 21.4 ± 5.8 s and 2.1 ± 0.6 times. The visualization of needle tract in group 1 was superior to that in group 2, and length of puncture time and number of puncture times were both lower in group 1 than in group 2. Real-time 3D US-guided PCN is superior to 2D US-guided PCN in terms of visualization of needle tract and the targeted pelvicalyceal system, leading to quick puncture. Real-time 3D US-guided puncture of the kidney holds great promise for clinical implementation in PCN. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Single-Use Devices in Argentina: Cost Comparison Analysis of a "Re-Use" versus a "Single-Use" Policy for Trocars, Endocutters, Linear Cutters, and Harmonic Scalpels.

PubMed

Garay, Osvaldo Ulises; Elorrio, Ezequiel Garcia; Rodríguez, Viviana; Spira, Cintia; Augustovski, Federico; Pichon-Riviere, Andrés

2017-12-01

Re-use of medical devices labeled and marketed for single use only is a current practice around the world. To estimate the average difference per surgery in device-related costs (DRCs) when performed with single-use devices under a single-use policy (SUP) instead of a re-use policy (RP) from the perspective of the private health sector of Argentina. An analytical model was developed in Microsoft Excel and populated with data from a literature review, a Delphi-like panel, and local cost estimations. Four single-use devices were selected for analysis: plastic trocars, endocutters, linear cutters, and harmonic scalpels. DRCs were expressed in 2012 US dollars and divided into four cost categories: devices, adverse events, device failure, and surgical time extension. Outputs were expressed as DRCs per surgery under a SUP, under a RP, the difference between them expressed in US dollars (Diff_$), and the difference between them expressed as a percentage of surgery costs (Diff_%S). Deterministic and probabilistic sensitivity analyses were performed to analyze the impact of uncertainty on results. Expected DRCs per surgery were as follows: for trocars: SUP, US $424.6; RP, US $244.2; Diff_$, US $-180.4; and Diff_%S, -3.8%; for endocutters: SUP, US $1667.4; RP, US $1102.3; Diff_$, US $-565.1; and Diff_%S, -11.1%; for linear cutters: SUP, US $1228.1; RP, US $1045.9; Diff_$, US $-182.2; and Diff_%S, -3.4%; and for harmonic scalpels: SUP, US $1040.9; RP, US $292.4; Diff_$, US $-748.5; and Diff_%S, -14.8%. Sensitivity analyses showed results to be robust. RP was shown to be less costly in all devices and scenarios considered. Nevertheless, the real frequency of adverse events and their cost implications are still uncertain. More research is needed to assess the effectiveness and safety of these off-label policies. Copyright © 2017. Published by Elsevier Inc.

Energy Use and Energy Intensity of U.S. Manufacturing—Data from the 2014 Manufacturing Energy Consumption Survey (MECS)

EIA Publications

2017-01-01

Energy intensity in manufacturing in the United States decreased from 2010 to 2014. U.S. manufacturing overall fuel intensity decreased by 4.4% from 3.016 thousand British thermal units (Btu) per dollar of output in 2010 to 2.882 thousand Btu in 2014.[1] U.S. manufacturing fuel consumption rose 4.7% from 2010 to 2014, although real gross output[2] increased more rapidly at 9.6%.

Development and evaluation of ultra-small nanostructured lipid carriers: novel topical delivery system for athlete's foot.

PubMed

Singh, Samipta; Singh, Mahendra; Tripathi, Chandra Bhushan; Arya, Malti; Saraf, Shubhini A

2016-02-01

Athlete's foot is a fungal infection of the foot which causes dry, itchy, flaky condition of the skin caused by Trichophyton species. In this study, the potential of ultra-small nanostructured lipid carrier (usNLC)-based topical gel of miconazole nitrate for the treatment of athlete's foot was evaluated. Nanostructure lipid carriers (NLCs) prepared by melt emulsification and sonication technique were characterized for particle size, drug entrapment, zeta potential and drug release. The optimized usNLC revealed particle size 53.79 nm, entrapment efficiency 86.77%, zeta potential -12.9 mV and polydispersity index (PDI) of 0.27. The drug release studies of usNLC showed initial fast release followed by sustained release with 91.99% drug released in 24 h. Optimized usNLCs were incorporated into carbopol-934 gel and evaluated for pH (6.8), viscosity (36,400 mPa s) and texture analysis. Antifungal activity against Trichophyton mentagrophytes exhibited wider zone of inhibition, 6.6 ± 1.5 mm for optimized usNLC3 gel viz-à-viz marketed gel formulation (3.7 ± 1.2 mm). Hen's egg test-chorioallantoic membrane (HET-CAM) irritation test confirmed optimized usNLC gel to be non-irritant to chorioallantoic membrane. Improved dermal delivery of miconazole by usNLC gel could be achieved for treatment of athlete's foot.

The environmental and economic impact of removing growth-enhancing technologies from U.S. beef production.

PubMed

Capper, J L; Hayes, D J

2012-10-01

The objective of this study was to quantify the environmental and economic impact of withdrawing growth-enhancing technologies (GET) from the U.S. beef production system. A deterministic model based on the metabolism and nutrient requirements of the beef population was used to quantify resource inputs and waste outputs per 454 × 10(6) kg of beef. Two production systems were compared: one using GET (steroid implants, in-feed ionophores, in-feed hormones, and beta-adrenergic agonists) where approved by FDA at current adoption rates and the other without GET use. Both systems were modeled using characteristic management practices, population dynamics, and production data from U.S. beef systems. The economic impact and global trade and carbon implications of GET withdrawal were calculated based on feed savings. Withdrawing GET from U.S. beef production reduced productivity (growth rate and slaughter weight) and increased the population size required to produce 454 × 10(6) kg beef by 385 × 10(3) animals. Feedstuff and land use were increased by 2,830 × 10(3) t and 265 × 10(3) ha, respectively, by GET withdrawal, with 20,139 × 10(6) more liters of water being required to maintain beef production. Manure output increased by 1,799 × 10(3) t as a result of GET withdrawal, with an increase in carbon emissions of 714,515 t/454 × 10(6) kg beef. The projected increased costs of U.S. beef produced without GET resulted in the effective implementation of an 8.2% tax on beef production, leading to reduced global trade and competitiveness. To compensate for the increase in U.S. beef prices and maintain beef supply, it would be necessary to increase beef production in other global regions, with a projected increase in carbon emissions from deforestation, particularly in Brazil. Withdrawing GET from U.S. beef production would reduce both the economic and environmental sustainability of the industry.

A Pivotal Study of Optoacoustic Imaging to Diagnose Benign and Malignant Breast Masses: A New Evaluation Tool for Radiologists.

PubMed

Neuschler, Erin I; Butler, Reni; Young, Catherine A; Barke, Lora D; Bertrand, Margaret L; Böhm-Vélez, Marcela; Destounis, Stamatia; Donlan, Pamela; Grobmyer, Stephen R; Katzen, Janine; Kist, Kenneth A; Lavin, Philip T; Makariou, Erini V; Parris, Tchaiko M; Schilling, Kathy J; Tucker, F Lee; Dogan, Basak E

2018-05-01

Purpose To compare the diagnostic utility of an investigational optoacoustic imaging device that fuses laser optical imaging (OA) with grayscale ultrasonography (US) to grayscale US alone in differentiating benign and malignant breast masses. Materials and Methods This prospective, 16-site study of 2105 women (study period: 12/21/2012 to 9/9/2015) compared Breast Imaging Reporting and Data System (BI-RADS) categories assigned by seven blinded independent readers to benign and malignant breast masses using OA/US versus US alone. BI-RADS 3, 4, or 5 masses assessed at diagnostic US with biopsy-proven histologic findings and BI-RADS 3 masses stable at 12 months were eligible. Independent readers reviewed US images obtained with the OA/US device, assigned a probability of malignancy (POM) and BI-RADS category, and locked results. The same independent readers then reviewed OA/US images, scored OA features, and assigned OA/US POM and a BI-RADS category. Specificity and sensitivity were calculated for US and OA/US. Benign and malignant mass upgrade and downgrade rates, positive and negative predictive values, and positive and negative likelihood ratios were compared. Results Of 2105 consented subjects with 2191 masses, 100 subjects (103 masses) were analyzed separately as a training population and excluded. An additional 202 subjects (210 masses) were excluded due to technical failures or incomplete imaging, 72 subjects (78 masses) due to protocol deviations, and 41 subjects (43 masses) due to high-risk histologic results. Of 1690 subjects with 1757 masses (1079 [61.4%] benign and 678 [38.6%] malignant masses), OA/US downgraded 40.8% (3078/7535) of benign mass reads, with a specificity of 43.0% (3242/7538, 99% confidence interval [CI]: 40.4%, 45.7%) for OA/US versus 28.1% (2120/7543, 99% CI: 25.8%, 30.5%) for the internal US of the OA/US device. OA/US exceeded US in specificity by 14.9% (P < .0001; 99% CI: 12.9, 16.9%). Sensitivity for biopsied malignant masses was 96.0% (4553/4745, 99% CI: 94.5%, 97.0%) for OA/US and 98.6% (4680/4746, 99% CI: 97.8%, 99.1%) for US (P < .0001). The negative likelihood ratio of 0.094 for OA/US indicates a negative examination can reduce a maximum US-assigned pretest probability of 17.8% (low BI-RADS 4B) to a posttest probability of 2% (BI-RADS 3). Conclusion OA/US increases the specificity of breast mass assessment compared with the device internal grayscale US alone. Online supplemental material is available for this article. © RSNA, 2017.

Racial Discrimination, Psychological Distress, and Self-Rated Health Among US-Born and Foreign-Born Black Americans

PubMed Central

Kosheleva, Anna; Waterman, Pamela D.; Chen, Jarvis T.; Koenen, Karestan

2011-01-01

Objectives. We investigated associations among racial discrimination, psychological distress, and self-rated health among US-born and immigrant Black Americans. Methods. We conducted a cross-sectional analysis of a cohort of employed working-class Black Americans (193 US-born, 275 foreign-born). Results. Both US-born and foreign-born Black participants had high levels of exposure to poverty (51% and 57%, respectively) and racial discrimination (76% and 60%) and reported high levels of severe psychological distress (14% and 16% had a Kessler 6 [K6] score of 13 or greater); 17% and 7% reported fair or poor health. After controlling for relevant covariates, their risk parameters for racial discrimination (high vs no exposure) were 4.0 (95% confidence interval [CI] = 2.3, 5.6) and 3.3 (95% CI = 2.1, 4.5), respectively, for continuous K6 score; corresponding odds ratios for severe psychological distress were 6.9 (95% CI = 1.4, 35.7) and 6.8 (95% CI = 2.5, 18.3). No associations existed between racial discrimination and self-reported health, suggesting that an underlying propensity to report adversity does not account for our psychological distress findings. Conclusions. Our results attest to the salience of racial discrimination, nativity, and socioeconomic position in understanding the experiences and psychological health of Black Americans. PMID:21778504

Prevalence of Hepatitis B and C in US Air Force Basic Military Trainees

DTIC Science & Technology

2017-08-29

REPORT TYPE 08/29/2017 Journal -4. TITLE AND SUBTITLE Prevalence ofliepatitis B and C in US Air Force Basic Military Trainees 6. AUTHOR(S) Capt...unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER a. REPORT b.ABSTRACT c ...Prescnbed by ANSI Sld, Z3B.16 Adobe Prnfeodohal 7.0 Prevalence of Hepatitis Band C in US Air Force Basic Military Trainees from Blood Donations 2 3

Laboratory Evaluation of Multiviscosity-Grade Engine Oils in U.S. Army Diesel Engines

DTIC Science & Technology

1981-05-01

0.001 0.007 - 0.007 A-14 C L U 0i L zw 0 200 Lu 0 0- 0 ~~ U.’ L L u, C𔃾 H~~~( I - --- d z r- 8 0 0 0 r n CD 00 c z ’Uz 2 C3 ,’U tD z~ *C( 0% UJZ us...fl- ~ r %0 IT It r H- c c.0I I IHq * cI n CV 00r)0C) (n C ’OC4 C’JC.4 c 1-1 Ln 100 M0 0o 130 U 000 00 -- 13.6 30 L-6 TEST 3 9.1 ~ 20 LUBRICANT: AL...ARMOR SCHOOL ATTN ATSB- TD FORT KNOX KY 40121 Page 3 of 5 CDR DEPARTMENT OF THE NAVY US ARMY LOGISTICS CTR HQ, US HARINE CORPS ATTN ATCL-MS (MR A MARSHALL

[Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy].

PubMed

Li, J; Guo, X J; Ding, X L; Lyu, B M; Xiao, J; Sun, Q L; Li, D S; Zhang, W F; Zhou, J C; Li, C P; Yang, R C

2018-02-14

Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median ( P 25 , P 75 ) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance ( P <0.001). The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% (95% CI 59.7%-65.9%), 59.5% (95% CI 56.5%-62.4%) and 56.6% (95% CI 53.6%-59.6%) respectively, and the difference was statistically significant ( P <0.001). Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95% CI 20.6%-29.6%), 17.0% (95% CI 12.6%-21.1%) and 11.9% (95% CI 8.4%-15.7%) respectively, and the difference was statistically significant ( P <0.001). There were significant changes ( P <0.05) in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant ( P <0.001). Conclusion: Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system.

Comparison of ultrasound versus computed tomography for the detection of kidney stones in the pediatric population: a clinical effectiveness study.

PubMed

Roberson, Nathaniel P; Dillman, Jonathan R; O'Hara, Sara M; DeFoor, William R; Reddy, Pramod P; Giordano, Richard M; Trout, Andrew T

2018-07-01

The incidence of pediatric nephrolithiasis in the United States is increasing. There is a paucity of literature comparing the diagnostic performance of computed ultrasound (US) to tomography (CT) in the pediatric population. To determine the diagnostic performance of renal US for nephrolithiasis in children using a clinical effectiveness approach. Institutional review board approval with a waiver of informed consent was obtained for this retrospective, HIPAA-complaint investigation. Billing records and imaging reports were used to identify children (≤18 years old) evaluated for nephrolithiasis by both US and unenhanced CT within 24 h between March 2012 and March 2017. Imaging reports were reviewed for presence, number, size and location of kidney stones. Diagnostic performance of US (reference standard=CT) was calculated per renal unit (left/right kidney) and per renal sector (four sectors per kidney). For sector analysis, US was considered truly positive if a stone was identified at CT in the same or an adjacent sector. There were 68 renal stones identified by CT in 30/69 patients (43%). Mean patient age was 14.7±3.6 years, and 35 were boys. For detecting nephrolithiasis in any kidney, US was 66.7% (48.8-80.8%) sensitive and 97.4% (86.8-99.9%) specific (positive predictive value=95.2% [77.3-99.8%], negative predictive value=79.2% [65.7-88.3%], positive likelihood ratio=26.0). Per renal sector, US was 59.7% (46.7-71.4%) sensitive and 97.4% (95.5-98.5%) specific (positive predictive value=72.3% [58.2-83.1%], negative predictive value=95.4% [93.2-96.9%], positive likelihood ratio=22.5). Of the 30 stones not detected by US, only 3 were >3 mm at CT. In clinical practice, US has high specificity for detecting nephrolithiasis in children but only moderate sensitivity and false negatives are common.

Internationalization of general surgical journals: origin and content of articles published in North America and Great Britain from 1983 to 1998.

PubMed

Tompkins, R K; Ko, C Y; Donovan, A J

2001-12-01

The origin and characteristics of articles published in the 6 highest rated (Institute for Scientific Information classification) English-language general surgical journals have changed significantly during the past 15 years. All articles published in 1983, 1988, 1993, and 1998 in 5 US surgical journals and 1 British surgical journal were reviewed and characterized. Absolute numbers and proportions of national and international articles published in each journal. Articles reviewed included 4868 in US journals and 1380 in the British journal. The total number of US journal articles decreased by 15.1%. The total number of British journal articles increased by 58.9%. The percentage of national articles decreased from 87.5% to 68.8% in US journals (P<.001) and constituted the minority of freely submitted articles in 1998 in 3 of 5 US journals. The percentage of national articles also decreased from 74.8% to 47.1% in the British journal (P<.001). Articles by European and Asian authors showed the most striking increases in all journals. The percentage of basic research articles declined in US journals from 23.3% to 17.9% (P =.001) owing to a 14.9% decline in national basic research articles. The percentage of clinical randomized studies increased from 2.2% to 4.1% (P<.008), but the increase was attributable to international articles. Government funding alone decreased from 13.6% to 11.2%, and government plus another source of funding decreased from 19.2% to 16.7% for national articles in US journals. Internationalization of the highly rated British and the 5 highest rated US general surgical journals has occurred. The decrease in the number of national articles in the US journals has been accompanied by significant decreases in government funding and basic research articles and a static output of clinical randomized studies from North America.

3D ultrasound system to investigate intraventricular hemorrhage in preterm neonates

NASA Astrophysics Data System (ADS)

Kishimoto, J.; de Ribaupierre, S.; Lee, D. S. C.; Mehta, R.; St. Lawrence, K.; Fenster, A.

2013-11-01

Intraventricular hemorrhage (IVH) is a common disorder among preterm neonates that is routinely diagnosed and monitored by 2D cranial ultrasound (US). The cerebral ventricles of patients with IVH often have a period of ventricular dilation (ventriculomegaly). This initial increase in ventricle size can either spontaneously resolve, which often shows clinically as a period of stabilization in ventricle size and eventual decline back towards a more normal size, or progressive ventricular dilation that does not stabilize and which may require interventional therapy to reduce symptoms relating to increased intracranial pressure. To improve the characterization of ventricle dilation, we developed a 3D US imaging system that can be used with a conventional clinical US scanner to image the ventricular system of preterm neonates at risk of ventriculomegaly. A motorized transducer housing was designed specifically for hand-held use inside an incubator using a transducer commonly used for cranial 2D US scans. This system was validated using geometric phantoms, US/MRI compatible ventricle volume phantoms, and patient images to determine 3D reconstruction accuracy and inter- and intra-observer volume estimation variability. 3D US geometric reconstruction was found to be accurate with an error of <0.2%. Measured volumes of a US/MRI compatible ventricle-like phantom were within 5% of gold standard water displacement measurements. Intra-class correlation for the three observers was 0.97, showing very high agreement between observers. The coefficient of variation was between 1.8-6.3% for repeated segmentations of the same patient. The minimum detectable difference was calculated to be 0.63 cm3 for a single observer. Results from ANOVA for three observers segmenting three patients of IVH grade II did not show any significant differences (p > 0.05) for the measured ventricle volumes between observers. This 3D US system can reliably produce 3D US images of the neonatal ventricular system. There is the potential to use this system to monitor the progression of ventriculomegaly over time in patients with IVH.

Trends in awareness and use of electronic cigarettes among US adults, 2010-2013.

PubMed

King, Brian A; Patel, Roshni; Nguyen, Kimberly H; Dube, Shanta R

2015-02-01

Electronic cigarette (e-cigarette) marketing has increased considerably since the product entered the US market in 2007, thereby warranting additional surveillance to monitor recent trends in population-level awareness and utilization. We assessed the prevalence, characteristics, and trends in e-cigarette awareness and use among nationally representative samples of US adults during 2010-2013. Data came from the 2010-2013 HealthStyles survey, an annual consumer-based web survey of US adults aged ≥ 18 years. Sample sizes ranged from 2,505 (2010) to 4,170 (2012). Descriptive statistics were used to assess e-cigarette awareness, ever use, and current use (use within the past 30 days) overall and by sex, age, race/ethnicity, education, income, US region, and cigarette smoking status. Trends were assessed using logistic regression. During 2010-2013, increases (p < .05) were observed for e-cigarette awareness (40.9%-79.7%), ever use (3.3%-8.5%), and current use (1.0%-2.6%). Awareness increased among all socio demographic subpopulations during 2010-2013 (p < .05); an increase in ever use of e-cigarettes occurred among all sociodemographic groups except those aged 18-24 years, Hispanics, and those living in the Midwest (p < .05). During 2010-2013, ever use increased among current (9.8%-36.5%) and former (2.5%-9.6%) cigarette smokers (p < .05), but it remained unchanged among never smokers (1.3%-1.2%). Awareness and use of e-cigarettes increased considerably among US adults during 2010-2013. In 2013, more than one-third of current cigarette smokers reported having ever used e-cigarettes. Given the uncertain public health impact of e-cigarettes, continued surveillance of emerging use patterns is critical for public health planning. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Ultrasonic degradation of acetaminophen and naproxen in the presence of single-walled carbon nanotubes.

PubMed

Im, Jong-Kwon; Heo, Jiyong; Boateng, Linkel K; Her, Namguk; Flora, Joseph R V; Yoon, Jaekyung; Zoh, Kyung-Duk; Yoon, Yeomin

2013-06-15

Ultrasonic (US) and single-walled carbon nanotube (SWNT)-catalyzed ultrasonic (US/SWNT) degradation of a pharmaceutical (PhAC) mixture of acetaminophen (AAP) and naproxen (NPX) used as analgesics was carried out in water. In the absence of SWNTs, maximum degradations of AAP and NPX occurred at a high frequency (1000 kHz) and under acidic conditions (pH 3) and different solution temperatures (25 °C at 28 kHz and 35 °C at 1000 kHz) during US reactions. Rapid degradation of PhACs occurred within 10 min at 28 kHz (44.5% for AAP; 90.3% for NPX) and 1000 kHz (39.2% for AAP; 74.8% for NPX) at a SWNT concentration of 45 mgL(-1) under US/SWNT process, compared with 28 kHz (5.2% for AAP; 10.6% for NPX) and 1000 kHz (29.1% for AAP; 46.2% for NPX) under US process. Degradation was associated with the dispersion of SWNTs; small particles acted as nuclei during US reactions, enhancing the H2O2 production yield. NPX removal was greater than AAP removal under all US-induced reaction and SWNT adsorption conditions, which is governed by the chemical properties of PhACs. Based on the results, the optimal treatment performance was observed at 28 kHz with 45 mgL(-1) SWNTs (US/SWNT) within 10 min. Copyright © 2013 Elsevier B.V. All rights reserved.

Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.

PubMed

Muntner, Paul; Carey, Robert M; Gidding, Samuel; Jones, Daniel W; Taler, Sandra J; Wright, Jackson T; Whelton, Paul K

2018-01-16

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals. This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates. According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication. Copyright © 2018 American College of Cardiology Foundation and American Heart Association. Published by Elsevier Inc. All rights reserved.

Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline.

PubMed

Muntner, Paul; Carey, Robert M; Gidding, Samuel; Jones, Daniel W; Taler, Sandra J; Wright, Jackson T; Whelton, Paul K

2018-01-09

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals. This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among US adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9 623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce US population estimates. According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among US adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of US adults, respectively. Nonpharmacological intervention is advised for the 9.4% of US adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among US adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively. Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of US adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication. © 2017 jointly by American College of Cardiology Foundation and American Heart Association. Published by Wolters Kluwer Health, Inc. All rights reserved.

Ultrafest: a novel approach to ultrasound in medical education leads to improvement in written and clinical examinations.

PubMed

Connolly, Kiah; Beier, Lancelot; Langdorf, Mark I; Anderson, Craig L; Fox, John C

2015-01-01

Our objective was to evaluate the effectiveness of hands-on training at a bedside ultrasound (US) symposium ("Ultrafest") to improve both clinical knowledge and image acquisition skills of medical students. Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma (FAST) US knowledge. Secondary outcome was improvement in image acquisition for either pulmonary or FAST. Prospective cohort study of 48 volunteers at "Ultrafest," a free symposium where students received five contact training hours. Students were evaluated before and after training for proficiency in either pulmonary US or FAST. Proficiency was assessed by clinical knowledge through written multiple-choice exam, and clinical skills through accuracy of image acquisition. We used paired sample t-tests with students as their own controls. Pulmonary knowledge scores increased by a mean of 10.1 points (95% CI [8.9-11.3], p<0.00005), from 8.4 to a posttest average of 18.5/21 possible points. The FAST knowledge scores increased by a mean of 7.5 points (95% CI [6.3-8.7] p<0.00005), from 8.1 to a posttest average of 15.6/21. We analyzed clinical skills data on 32 students. The mean score was 1.7 pretest and 4.7 posttest of 12 possible points. Mean improvement was 3.0 points (p<0.00005) overall, 3.3 (p=0.0001) for FAST, and 2.6 (p=0.003) for the pulmonary US exam. This study suggests that a symposium on US can improve clinical knowledge, but is limited in achieving image acquisition for pulmonary and FAST US assessments. US training external to official medical school curriculum may augment students' education.

Inventory of U.S. 2012 dioxin emissions to atmosphere.

PubMed

Dwyer, Henri; Themelis, Nickolas J

2015-12-01

In 2006, the U.S. EPA published an inventory of dioxin emissions for the U.S. covering the period from 1987-2000. This paper is an updated inventory of all U.S. dioxin emissions to the atmosphere in the year 2012. The sources of emissions of polychlorinated dibenzodioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs), collectively referred to in this paper as "dioxins", were separated into two classes: controlled industrial and open burning sources. Controlled source emissions decreased 95.5% from 14.0 kg TEQ in 1987 to 0.6 kg in 2012. Open burning source emissions increased from 2.3 kg TEQ in 1987 to 2.9 kg in 2012. The 2012 dioxin emissions from 53 U.S. waste-to-energy (WTE) power plants were compiled on the basis of detailed data obtained from the two major U.S. WTE companies, representing 84% of the total MSW combusted (27.4 million metric tons). The dioxin emissions of all U.S. WTE plants in 2012 were 3.4 g TEQ and represented 0.54% of the controlled industrial dioxin emissions, and 0.09% of all dioxin emissions from controlled and open burning sources. Copyright © 2015. Published by Elsevier Ltd.

Publications - GMC 226 | Alaska Division of Geological & Geophysical

Science.gov Websites

Alaskan Barrow Arch oil and gas wells: U.S. Navy Avak Test #1 (3,571-3,792'), U.S. Navy South Barrow Test the following Alaskan Barrow Arch oil and gas wells: U.S. Navy Avak Test #1 (3,571-3,792'), U.S. Navy South Barrow Test #3 (602-2,799'); and North Slope Borough (U.S. Navy) South Barrow #12 (2,220-2,250

Engineering study comparing injection force and dose accuracy between two prefilled insulin injection pens.

PubMed

Ignaut, Debra A; Opincar, Michael R; Clark, Paula E; Palaisa, Melanie K; Lenox, Sheila M

2009-12-01

This study compared injection force (measured by glide force [GF] and glide force variability [GFV]) and dosing accuracy of the Humalog KwikPen * (prefilled insulin lispro [Humalog dagger] pen, Eli Lilly and Company, Indianapolis, IN) and the Next Generation FlexPen double dagger (prefilled insulin aspart [NovoRapid section sign] pen, Novo Nordisk A/S, Bagsvaerd, Denmark). * Humalog KwikPen is a registered trademark of Eli Lilly and Company, Indianapolis, IN, USA. dagger Humalog is a registered trademark of Eli Lilly and Company, Indianapolis, IN, USA. double dagger FlexPen is a registered trademark of Novo Nordisk A/S, Bagsvaerd, Denmark. section sign NovoRapid is a registered trademark of Novo Nordisk A/S, Bagsvaerd, Denmark. A total of 100 prefilled insulin pens (50 insulin lispro pens, 50 insulin aspart pens) were tested using two dose sizes (30 U and 60 U). In all, 50 devices (25 of each type) were tested at 10 U/s dosing speed and 50 were tested at 6.6 U/s. Devices were used per manufacturer instructions. Dose accuracy (represented as absolute dose error %), maximum and average GF, and GFV data were automatically collected by the test system for all datasets (dose size/dosing speed/device type). The test system controlled for potential dosing errors. The insulin lispro pen demonstrated a significantly lower median maximum GF at both dosing speeds: (2.83 vs. 3.92 lbs [30 U] and 3.00 vs. 4.14 lbs [60 U]) at 10 U/s; (1.85 vs. 2.93 lbs [30 U] and 2.14 vs. 3.02 lbs [60 U]) at 6.6 U/s, all p < 0.0001. For all datasets, the median GFV was significantly lower for the insulin lispro pen, p < 0.0001. Median dose error was comparable between device types when tested at 10 U/s dosing speed; however, at 6.6 U/s, the median dose error was significantly lower for insulin lispro pen compared to insulin aspart pen (0.47 vs. 0.67% [30 U] and 0.50 vs. 0.78% [60 U], both p < 0.05). The insulin lispro pen had significantly lower median GF and GFV compared with insulin aspart pen when tested at two dose sizes and two dosing speeds. Median dose error was similar between the device types at the 10 U/s dosing speed, but median dose error was significantly lower for the insulin lispro pen at the 6.6 U/s dosing speed. A limitation of this study was that it was executed as an open label study.

A cost comparison of more and less nutritious food choices in US supermarkets.

PubMed

Katz, David L; Doughty, Kim; Njike, Valentine; Treu, Judith A; Reynolds, Jesse; Walker, Jennifer; Smith, Erica; Katz, Catherine

2011-09-01

The present study directly compared prices of more and less nutritious foods within given categories in US supermarkets. Foods selected from six supermarkets in Jackson County were categorized using the five criteria of the Nutrition Detectives™ (ND) programme and an item-to-item cost comparison was made using posted prices. The nutritional quality of foods was distinguished using the clues of the ND nutrition education programme for elementary-school children and validated using the Overall Nutritional Quality Index. Supermarkets in Jackson County, MO, USA. Not applicable. The average price of the item for more nutritious foods did not differ significantly from that of less nutritious foods overall ($US 2·89 (sd $US 0·74) v. $US 2·85 (sd $0·68), P = 0·76). More nutritious breads cost more than less nutritious breads ($US 3·36 (sd $ US 0·28) v. $US 2·56 (sd $US 0·80, P = 0·03), whereas more nutritious cereals ($US 2·46 (sd $US 0·69) v. $US 3·50 (sd $US 0·30), P < 0·01) and cookies ($US 2·76 (sd $US 0·50) v. $US 3·40 (sd $US0·28), P < 0·01) cost less. Our findings indicate that it is possible to choose more nutritious foods within many common categories without spending more money and suggest that making small improvements in dietary choices does not invariably cost more.

Measuring the volume of uterine fibroids using 2- and 3-dimensional ultrasound and comparison with histopathology.

PubMed

Zivković, Nikica; Zivković, Kreiimir; Despot, Albert; Paić, Josip; Zelić, Ana

2012-12-01

The aim of this study was clinical testing of the reliability and usability of three-dimensional (3D) and two-dimensional (2D) ultrasound (US) technology. The ultimate aim and purpose of this study was to establish ultrasound methods, standards and protocols for determining the volume of any gynecologic organ or tumor. The study included 31 women in reproductive age and postmenopause. All patients were examined with a RIC 5-9 3D-endovaginal probe (4.3-7.5 MHz) on a Voluson 730 Pro ultrasound device. The volume of myomas was measured by using the existing 2D and 3D ultrasound methods on the above mentioned device. All patients underwent myomectomy or hysterectomy due to clinically and ultrasonographically diagnosed uterine myomas indicating operative intervention. After the operation, the pathologist determined the volume of removed myomas by measuring them in a gauge bowl containing water, i.e. using Archimedes' principle (lift), serving as the control group with histopathologic diagnosis. A total of 155 myoma volumes were processed on 2D display, 31 myoma volumes were preoperatively measured on 3D display and 31 myoma volumes were measured by the pathologist. The values of US measurements for each US method were expressed as mean value of all measurements of myoma volumes. Statistical processing of the results and Student's t-test for independent samples revealed that the 2nd examined US method (measuring of myoma by using an ellipse and the longer tumor diameter) and 4th examined US method (measuring of myoma by using the longer and shorter tumor diameters together with establishing their mean values) in 2D US technique, as well as the 6th examined US method in 3D US technique showed no significant measurement differences in comparison with control measurement in a gauge bowl containing water (p < 0.05), indicating acceptability of the US methods for verifying tumor volumes. The standard error in determining the volume of myomas by the above US methods varied between 15% and 25%, so it is concluded that these three methods can be used in clinical practice to determine tumor volumes, in this case uterine myomas. The 3D MultiPlane method proved to be the most reliable method of determining the volume of uterine myomas.

The Role of Contrast-Enhanced Ultrasound in Selection Indication and Improveing Diagnosis for Transthoracic Biopsy in Peripheral Pulmonary and Mediastinal Lesions

PubMed Central

Wang, Song; Yang, Wei; Zhang, Hui; Xu, Qian; Yan, Kun

2015-01-01

Objective. To investigate the value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of peripheral lung and mediastinal lesions. Methods. Of 142 patients, 82 patients received CEUS before biopsy and were defined as CEUS group. The remaining 60 patients only underwent conventional ultrasound (US) before biopsy and were served as US group. The information of CEUS was used for selecting indication and instructing biopsy. The imaging features, number of punctures, diagnostic successful rate, and complication rate between the two groups were compared. Results. Necrosis was demonstrated in 43.9% of the lesions in CEUS group and in 6.7% of US group (P < 0.001). Detection rate of lesion hidden in pulmonary atelectasis in CEUS group was 13.4%, which was statistically higher than 1.7% of US group (P = 0.013). The diagnostic success rate was 96.3% for CEUS group and 80% for US group, respectively (P = 0.002). The average number of punctures was 2.5 ± 0.7 and 2.6 ± 0.6, respectively. There was no significant difference in complications between CEUS group and US group. Conclusions. CEUS could play an important role in selecting proper indication and improving diagnostic accuracy rate of lung biopsy. PMID:26090391

Potential for change in US diagnosis of hip dysplasia solely caused by changes in probe orientation: patterns of alpha-angle variation revealed by using three-dimensional US.

PubMed

Jaremko, Jacob L; Mabee, Myles; Swami, Vimarsha G; Jamieson, Lucy; Chow, Kelvin; Thompson, Richard B

2014-12-01

To use three-dimensional ( 3D three-dimensional ) ultrasonography (US) to quantify the alpha-angle variability due to changing probe orientation during two-dimensional ( 2D two-dimensional ) US of the infant hip and its effect on the diagnostic classification of developmental dysplasia of the hip ( DDH developmental dysplasia of the hip ). In this institutional research ethics board-approved prospective study, with parental written informed consent, 13-MHz 3D three-dimensional US was added to initial 2D two-dimensional US for 56 hips in 35 infants (mean age, 41.7 days; range, 4-112 days), 26 of whom were female (mean age, 38.7 days; range, 6-112 days) and nine of whom were male (mean age, 50.2 days; range, 4-111 days). Findings in 20 hips were normal at the initial visit and were initially inconclusive but normalized spontaneously at follow-up in 23 hips; 13 hips were treated for dysplasia. With the computer algorithm, 3D three-dimensional US data were resectioned in planes tilted in 5° increments away from a central plane, as if slowly rotating a 2D two-dimensional US probe, until resulting images no longer met Graf quality criteria. On each acceptable 2D two-dimensional image, two observers measured alpha angles, and descriptive statistics, including mean, standard deviation, and limits of agreement, were computed. Acceptable 2D two-dimensional images were produced over a range of probe orientations averaging 24° (maximum, 45°) from the central plane. Over this range, alpha-angle variation was 19° (upper limit of agreement), leading to alteration of the diagnostic category of hip dysplasia in 54% of hips scanned. Use of 3D three-dimensional US showed that alpha angles measured at routine 2D two-dimensional US of the hip can vary substantially between 2D two-dimensional scans solely because of changes in probe positioning. Not only could normal hips appear dysplastic, but dysplastic hips also could have normal alpha angles. Three-dimensional US can display the full acetabular shape, which might improve DDH developmental dysplasia of the hip assessment accuracy. © RSNA, 2014.

Cost Per Additional Responder Associated With Ixekizumab and Etanercept in the Treatment of Moderate-to-Severe Psoriasis.

PubMed

Feldman, Steven R; Foster, Shonda A; Zhu, Baojin; Burge, Russel; Al Sawah, Sarah; Goldblum, Orin M

2017-12-01

BACKGROUND: Newer psoriasis treatments can achieve greater levels of efficacy than older systemic therapies; however, current psoriasis costs are substantial. We sought to estimate costs per additional responder associated with ixekizumab and etanercept, versus placebo, using efficacy data from phase 3 clinical trials (UNCOVER-2 and UNCOVER-3). METHODS: In UNCOVER-2/UNCOVER-3, patients received subcutaneous placebo, etanercept 50 mg twice weekly (BIW), or ixekizumab one 80 mg injection every 2 weeks (Q2W) after a 160-mg starting dose. Twelve-week induction-phase Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 response rates for ixekizumab, etanercept, and placebo were obtained from pooled data from the overall and United States (US) subgroup intention-to-treat (ITT) populations, and used to calculate numbers needed to treat (NNTs) to achieve one additional PASI 75, PASI 90, or PASI 100 response for ixekizumab Q2W and etanercept BIW versus placebo. Twelve-week drug costs per patient were calculated based on the UNCOVER-2/UNCOVER-3 dosing schedule and wholesale acquisition costs. Mean costs per additional responder for PASI 75, PASI 90, and PASI 100 for each treatment versus placebo were calculated for pooled UN-COVER-2/UNCOVER-3 overall and US subgroup ITT populations. RESULTS: Pooled overall ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $37,540, US $46,299, or US $80,710 for ixekizumab Q2W and US $57,533, US $120,720, or US $404,695 for etanercept BIW, respectively. US subgroup ITT population: costs per additional PASI 75, PASI 90, or PASI 100 responder were US $38,165, US $49,740, or US $93,536 for ixekizumab Q2W and US $69,580, US $140,881, or US $631,875 for etanercept BIW, respectively. CONCLUSIONS: Twelve-week costs per additional responder were lower for ixekizumab Q2W than for etanercept BIW across all levels of clearance (PASI 75, PASI 90, and PASI 100) in the pooled UNCOVER-2/UNCOVER-3 overall and US subgroup ITT populations.

Cardiovascular Risk Factor Management Performance in Canada and the United States: A Systematic Review.

PubMed

Alabousi, Mostafa; Abdullah, Peri; Alter, David A; Booth, Gillian L; Hogg, William; Ko, Dennis T; Manuel, Douglas G; Farkouh, Michael E; Tu, Jack V; Udell, Jacob A

2017-03-01

Comparative cardiovascular risk factor care across North America is unknown. We aimed to determine current performance in Canada and the United States (US). A systematic review was conducted of Medline and EMBASE (to June 1, 2014). Eligible studies reported on screening, awareness, treatment, or control rates for hypertension, dyslipidemia, diabetes, and smoking. Categorical performance 'ratings' on the basis of the most successful US health plans were used to classify rates as suboptimal (< 50%), below target (50%-70%), above target (70%-90%), or optimal (> 90%). A total of 127 studies reporting on 10,510,324 individuals across North America were included. Hypertension awareness (84.3%) and treatment (82.0%) rates in Canada and the US (82.7% and 75.6%, respectively) were above target, whereas control in both nations was below target (68.1% vs 51.8%, respectively). Canadian awareness, treatment, and control rates for dyslipidemia (42.7%, 40.9%, and 41.5%, respectively) were suboptimal, and American indicators were generally below target (61.5%, 43.0%, and 63.6%, respectively). Canada and the US showed diabetes awareness (88.2% vs 86.8%) and treatment rates (82.3% vs 82.5%) above target. However, glucose control was suboptimal in Canada (35.3%), and below target in the US (58.8%). There was a modest decline in absolute smoking prevalence rates in Canada from 1999 to 2013 (25.2% to 14.6%). Screening for tobacco use (72.2%) and counselling rates (73.8%) in the US were above target. Substantial variation exists in cardiovascular risk factor care across North America. Standardized reporting, dissemination of practice guidelines, and setting explicit goal-directed targets for performance might facilitate improvement. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Fourth Annual International Acquisitions Workshop: Access to Multiple Media Worldwide

NASA Technical Reports Server (NTRS)

1994-01-01

Topics discussed during the workshop include: (1) Multinational-Multiple media collections and activities spanning many countries; (2) Multiple media in North American trade and commerce; (3) African spotlight; (4) Europe-Multiple media in national libraries and services; (5) Scandinavian spotlight; (6) Internet update; (7) Multiple media in US federal agencies; (8) Open-source multiple media in US federal agencies; and (9) Multiple media at US federal technical agencies-NIST and NOAA.

National Guard > About the Guard > Today in Guard History

Science.gov Websites

National Guard About Us By the Numbers Contact Us FAQ Federal Mission History Join Us Leaders Director of March Today in Guard History Leadership CNGB VCNGB SEA DANG DARNG Joint Staff J-1 J-2 J-3 J-4 J-5 J-6 J ARNG Readiness Home : About the Guard : Today in Guard History Today in Guard History Browse history by

A Study of HPV Typing for the Management of HPV-Positive ASC-US Cervical Cytologic Results

PubMed Central

Schiffman, Mark; Vaughan, Laurence; Raine-Bennett, Tina R.; Castle, Philip E.; Katki, Hormuzd A.; Gage, Julia C.; Fetterman, Barbara; Befano, Brian; Wentzensen, Nicolas

2015-01-01

Background In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US (equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. Methods The NCI-Kaiser Permanente Northern California Persistence and Progression Cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0 years. Using stratified random sampling, we typed 2,079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1,187 with

[Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico].

PubMed

Martínez Carranza, Edith Olimpia; Villarreal Ríos, Enrique; Vargas Daza, Emma Rosa; Galicia Rodríguez, Liliana; Martínez González, Lidia

2010-12-01

To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro. A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions. The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24. Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care.

Short-term sensory and cutaneous vascular responses to therapeutic ultrasound in the forearms of healthy volunteers.

PubMed

Shaik, Shaguftha Sultana; MacDermid, Joy C; Birmingham, Trevor; Grewal, Ruby; Farooq, Baseer

2014-01-01

Therapeutic ultrasound (US) is used for a variety of clinical pathologies and is thought to accelerate tissue repair and help with pain reduction via its thermal and nonthermal effects. The evidence on physiological effects of US on both sensory and vascular functions in humans is incomplete. Hence, the purpose of this study was to determine the short-term impact of two doses of US (3 MHz, 1:4, 0.25 W/cm(2), 5 min; 1 MHz, continuous, 0.8 W/cm(2), 3 min), on sensory and vascular responses in the healthy forearms. Twenty healthy subjects were recruited (mean age, 29.6 ± 8.8 years) for the study. Superficial blood flow (SBF) in the distal forearms was determined using the tissue viability imaging system. Sensory perception thresholds (SPT) were determined from ring finger (C7, C8) to assess A-beta (at 2,000 Hz) and C fiber function (at 5 Hz), using a Neurometer CPT/C device. Subject's two hands were randomly allocated to group order (AB/BA). Scores were obtained before and immediately after the application of US and control. Differences in these were analyzed using repeated measures. Both 3 MHz pulsed US and 1 MHz continuous US showed small to moderate (effect size = 0.12 to 0.68), statistically significant reductions in SBF (3 MHz, mean change = 2.8 AU and 1 MHz, mean change = 3.9 AU, p < 0.05 respectively), skin temperature (2.5°C and 1.1°C, p < 0.05), and SPT at 5 Hz (1.3 and 1 mA, p < 0.05) across time. SPT at 2,000 Hz remained unaltered by all three conditions (p > 0.05). Age and gender also had no effect on all outcome measures (p > 0.05). This study demonstrated minor reductions in skin blood flow, skin temperatures, and C fiber perception thresholds immediately after 3 MHz, and 1 MHz US. The responses observed may have been due to a thermo-cooling effect of the gel or due to the direct effect of US on C fibers of median and ulnar nerves. US had a negligible effect on A-beta fibres. This would suggest that future studies looking at physiological effects of US should move towards investigating larger dosages and study the effects in patient populations.

Economic analysis for evidence-based policy-making on a national immunization program: a case of rotavirus vaccine in Thailand.

PubMed

Muangchana, Charung; Riewpaiboon, Arthorn; Jiamsiri, Suchada; Thamapornpilas, Piyanit; Warinsatian, Porpit

2012-04-16

Severe diarrhea caused by rotavirus is a health problem worldwide, including Thailand. The World Health Organization has recommended incorporating rotavirus vaccination into national immunization programs. This policy has been implemented in several countries, but not in Thailand where the mortality rate is not high. This leads to the question of whether it would be cost-effective to implement such a policy. The Thai National Vaccine Committee, through the Immunization Practice Subcommittee, has conducted an economic analysis. Their study aimed to estimate the costs of rotavirus diarrhea and of a rotavirus vaccination program, and the cost-effectiveness of such a program including budget impact analysis. The study was designed as an economic evaluation, employing modeling technique in both provider and societal perspectives. A birth cohort of Thai children in 2009 was used in the analysis, with a 5-year time horizon. Costs were composed of cost of the illness and the vaccination program. Outcomes were measured in the form of lives saved and DALYs averted. Both costs and outcomes were discounted at 3%. The study found the discounted number of deaths to be 7.02 and 20.52 for vaccinated and unvaccinated cohorts, respectively (13.5 deaths averted). Discounted DALYs were 263.33 and 826.57 for vaccinated and unvaccinated cohorts, respectively (563.24 DALYs averted). Costs of rotavirus diarrhea in a societal perspective were US$6.6 million and US$21.0 million for vaccinated and unvaccinated cohorts, respectively. At base case, the costs per additional death averted were US$5.1 million and US$5.7 for 2-dose and 3-dose vaccines, respectively, in a societal perspective. Costs per additional DALYs averted were US$128,063 and US$142,144, respectively. In a societal perspective, with a cost-effectiveness threshold at 1 GDP per capita per DALYs averted, vaccine prices per dose were US$4.98 and US$3.32 for 2-dose and 3-dose vaccines, respectively; in a provider perspective, they were US$2.90 and US$1.93. One-way and probabilistic sensitivity analyses were included. The budget required for vaccine purchase was calculated for all scenarios. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessing environmental impacts embodied in manufacturing and labor input for the China-U.S. trade.

PubMed

Xu, Ming; Williams, Eric; Allenby, Braden

2010-01-15

Previous studies on environmental impacts embodied in trade have paid little attention to the impacts of labor input, or environmental overhead of labor input (EOLI). EOLI occurs to support lifestyles both in the purchase of goods and services and in the consumption of fuels and electricity by workers. This research investigates both supply chain manufacturing and EOLI energy use and carbon dioxide (CO(2)) emissions embodied in the 2002 China-U.S. trade. EOLI is substantial in scale: 24% of manufacturing energy in the U.S. and 6% for China. The higher share of EOLI in the U.S. is the result of higher energy use to support worker lifestyles. Analysis shows China's EOLI is dominated by the manufacturing of products consumed by workers, while EOLI on the U.S. side is primarily from workers' direct consumption. The total manufacturing and EOLI energy and CO(2) embodied in the eastbound trade from China to the U.S. are 6.5 exajoules (EJ) of energy (6% EOLI) and 440 million tons (Mt) of CO(2) (8% EOLI). The total manufacturing and EOLI energy and CO(2) embodied in the westbound trade from the U.S. to China are 424 petajoules (PJ) of energy (19% EOLI) and 25.3 Mt of CO(2) (21% EOLI).

Evaluation of reproductive tract infection during early post-partum period and its relationship with subsequent reproductive performance in high milk producing dairy cows.

PubMed

Senosy, W; Uchiza, M; Tameoka, N; Izaike, Y; Osawa, T

2012-04-01

Clinically normal Holstein-Friesian cows (n = 43) were used to establish a relationship between the evaluations of the uterine condition by vaginoscopy, Metricheck, endometrial cytology (EC) and ultrasonography (US) during post-partum period (pp), and subsequent reproductive performance. The uterine status of the selected cows was evaluated by EC, Metricheck, US and vaginoscopy on a weekly basis from the third week (W3) to the seventh week (W7) pp. The animals were bred after a voluntary waiting period of 45-60 days pp and diagnosed for pregnancy status at 45 days after breeding by US. First service conception rate (FSCR) of bred animals was 32.6% (14/43). There was no significant difference in polymorphonuclear leucocyte percentage between conceived and non-conceived cows during different weeks post-partum. First service conception rate in animals with normal vaginal discharge as detected by Metricheck was significantly low when compared to those of abnormal discharge during W3 (2.3% vs 30.3%; p < 0.001) and W4 (4.7% vs 29.7%; p < 0.01) post-partum. Using US, the number of pregnant cows having fluid in uterus (FIU) during W6 (p < 0.01) and W7 (p < 0.001) post-partum was significantly lower (2/34, 4.7% and 1/43, 2.3%, respectively) than those that had no FIU (12/43, 27.9% and 13/43, 30.3%, respectively). Using vaginoscopy, FSCR in animals having abnormal discharge was significantly (p < 0.01) low when compared to that of normal discharge (2.4% vs 30.2%) during W5 and W6 post-partum. In conclusion, Metricheck during W3 and W4 and detection of FIU by US and vaginoscopy during W6 and W7 pp can be used as good predictive tools to anticipate the future reproductive performance of dairy cattle. © 2011 Blackwell Verlag GmbH.

A study of HPV typing for the management of HPV-positive ASC-US cervical cytologic results.

PubMed

Schiffman, Mark; Vaughan, Laurence M; Raine-Bennett, Tina R; Castle, Philip E; Katki, Hormuzd A; Gage, Julia C; Fetterman, Barbara; Befano, Brian; Wentzensen, Nicolas

2015-09-01

In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US (equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. The NCI-Kaiser Permanente Northern California Persistence and Progression cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0years. Using stratified random sampling, we typed 2079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1187 with

75 FR 29358 - Maritime Security Directive 104-6 (Rev 2 and 3); Guidelines for U.S. Vessels Operating in High...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-25

... developed piracy-related Port Security Advisories (PSAs)to provide further guidance and direction to U.S. flagged vessels operating in high risk waters to help facilitate compliance with this directive. The PSAs...

Cross-national comparison of screening mammography accuracy measures in U.S., Norway, and Spain.

PubMed

Domingo, Laia; Hofvind, Solveig; Hubbard, Rebecca A; Román, Marta; Benkeser, David; Sala, Maria; Castells, Xavier

2016-08-01

To compare accuracy measures for mammographic screening in Norway, Spain, and the US. Information from women aged 50-69 years who underwent mammographic screening 1996-2009 in the US (898,418 women), Norway (527,464), and Spain (517,317) was included. Screen-detected cancer, interval cancer, and the false-positive rates, sensitivity, specificity, positive predictive value (PPV) for recalls (PPV-1), PPV for biopsies (PPV-2), 1/PPV-1 and 1/PPV-2 were computed for each country. Analyses were stratified by age, screening history, time since last screening, calendar year, and mammography modality. The rate of screen-detected cancers was 4.5, 5.5, and 4.0 per 1000 screening exams in the US, Norway, and Spain respectively. The highest sensitivity and lowest specificity were reported in the US (83.1 % and 91.3 %, respectively), followed by Spain (79.0 % and 96.2 %) and Norway (75.5 % and 97.1 %). In Norway, Spain and the US, PPV-1 was 16.4 %, 9.8 %, and 4.9 %, and PPV-2 was 39.4 %, 38.9 %, and 25.9 %, respectively. The number of women needed to recall to detect one cancer was 20.3, 6.1, and 10.2 in the US, Norway, and Spain, respectively. Differences were found across countries, suggesting that opportunistic screening may translate into higher sensitivity at the cost of lower specificity and PPV. • Positive predictive value is higher in population-based screening programmes in Spain and Norway. • Opportunistic mammography screening in the US has lower positive predictive value. • Screening settings in the US translate into higher sensitivity and lower specificity. • The clinical burden may be higher for women screened opportunistically.

Direct costs associated with the appropriateness of hospital stay in elderly population

PubMed Central

Mould-Quevedo, Joaquín F; García-Peña, Carmen; Contreras-Hernández, Iris; Juárez-Cedillo, Teresa; Espinel-Bermúdez, Claudia; Morales-Cisneros, Gabriela; Sánchez-García, Sergio

2009-01-01

Background Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. Methods Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. Results The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3), (p < 0.001). Conclusion Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management. PMID:19698130

CFS Forecast Verification

Science.gov Websites

history of Nino3.4 SST anomalies of individual forecasts Forecast anomalies Target season Nino SST Global SST Global Prec Global T2m US Prec US T2m US SM z200 NDJ 2004/2005 Nino SST Global SST Global Prec Global T2m US Prec US T2m US SM z200 DJF 2005 Nino SST Global SST Global Prec Global T2m US Prec US T2m

NASA/DoD Aerospace Knowledge Diffusion Research Project. Report Number 20. The Use of Selected Information Products and Services by U.S. Aerospace Engineers and Scientists: Results of Two Surveys.

DTIC Science & Technology

1994-02-01

within and between organizations. The technical report has been defined etymologically , according to report content and method (U.S. Department of...number) I AERONAUTICS 6 MATHEMATICAL & COMPUTER SCIENCES 2 ASTRONAUTICS 7 MATERIALS & CHEMISTRY 3 ENGINEERING 8 PHYSICS 4 GEOSCIENCES 9 SPACE SCIENCES 5...the application of your work? (Circle ONLY one number) 1 AERONAUTICS 6 MATHEMATICAL & COMPUTER SCIENCES 2 ASTRONAUTICS 7 MATERIALS & CHEMISTRY 3

Preference-based comparative effectiveness and cost–effectiveness: a review and relevance of value-based medicine for vitreoretinal interventions.

PubMed

Brown, Melissa M; Brown, Gary C; Lieske, Heidi B; Lieske, P Alexander

2012-05-01

This analysis discusses the comparative effectiveness and cost-effectiveness of vitreoretinal interventions, measured in quality-adjusted life years (QALYs) and percentage patient value (PPV gain, or improvement in quality of life and/or length of life). The material is relevant since the Patient Protection and Affordable Care Act enacted by Congress with the support of the President has emphasized the critical importance of patient-based preferences. The majority of preference-based, comparative effectiveness and cost-effectiveness vitreoretinal interventions assessed in the US healthcare literature are Value-Based Medicine analyses, thus comparable. These interventions confer a mean patient (human) value gain (improvement in quality of life) of 8.3% [SD 6.3%, 95% confidence interval (CI) + 2.6%]. The average cost-utility of these vitreoretinal interventions is US$23 026/QALY (SD US$24 508, 95% CI + US$8770). Most vitreoretinal interventions are very cost effective using a conventional US standard of US$50 000/QALY as the upper anchor for a very cost-effective intervention, and the World Health Organization of approximately US$142 200/QALY as the upper anchor for a cost-effective intervention. Most vitreoretinal interventions confer considerable patient value and are very cost effective. Further standardization across healthcare is needed in the preference-based, comparative and cost-utility (cost-effectiveness) arena. The metrics of PPV (percentage patient value) gain and US$/PPV (dollars expended per percentage patient value gain) or financial value gain may be more user-friendly than the QALY.

Accuracy of volume measurement using 3D ultrasound and development of CT-3D US image fusion algorithm for prostate cancer radiotherapy.

PubMed

Baek, Jihye; Huh, Jangyoung; Kim, Myungsoo; Hyun An, So; Oh, Yoonjin; Kim, DongYoung; Chung, Kwangzoo; Cho, Sungho; Lee, Rena

2013-02-01

To evaluate the accuracy of measuring volumes using three-dimensional ultrasound (3D US), and to verify the feasibility of the replacement of CT-MR fusion images with CT-3D US in radiotherapy treatment planning. Phantoms, consisting of water, contrast agent, and agarose, were manufactured. The volume was measured using 3D US, CT, and MR devices. A CT-3D US and MR-3D US image fusion software was developed using the Insight Toolkit library in order to acquire three-dimensional fusion images. The quality of the image fusion was evaluated using metric value and fusion images. Volume measurement, using 3D US, shows a 2.8 ± 1.5% error, 4.4 ± 3.0% error for CT, and 3.1 ± 2.0% error for MR. The results imply that volume measurement using the 3D US devices has a similar accuracy level to that of CT and MR. Three-dimensional image fusion of CT-3D US and MR-3D US was successfully performed using phantom images. Moreover, MR-3D US image fusion was performed using human bladder images. 3D US could be used in the volume measurement of human bladders and prostates. CT-3D US image fusion could be used in monitoring the target position in each fraction of external beam radiation therapy. Moreover, the feasibility of replacing the CT-MR image fusion to the CT-3D US in radiotherapy treatment planning was verified.

Ultrasonography screening for hepatocellular carcinoma in Japanese patients with diabetes mellitus.

PubMed

Hiraoka, Atsushi; Ochi, Marie; Matsuda, Rie; Aibiki, Toshihiko; Okudaira, Tomonari; Kawamura, Tomoe; Yamago, Hiroka; Nakahara, Hiromasa; Suga, Yoshifumi; Azemoto, Nobuaki; Miyata, Hideki; Miyamoto, Yasunao; Ninomiya, Tomoyuki; Hirooka, Masashi; Abe, Masanori; Matsuura, Bunzo; Hiasa, Yoichi; Michitaka, Kojiro

2016-09-01

Effective surveillance for hepatocellular carcinoma (HCC) in diabetes mellitus (DM) has not been established. We elucidated the risk factors for HCC in DM patients. From 2000 to 2014, 80 patients diagnosed with HCC for the first time who had concomittant DM but no other etiology of liver disease were enrolled as the DM-HCC group. From 2005 October to 2014, after introduction of the abdominal ultrasonography (US) report database, 2083 DM patients with no viral hepatitis, no known autoimmune hepatic diseases, and/or no evidence of alcohol abuse (>60 g/day) were enrolled as the DM-US group. Findings from the first US screening were evaluated. "Elderly" patients were defined as those aged >65 years. Clinical features of DM-HCC patients were evaluated and compared with those of DM-US patients. In the DM-HCC group (54 men, 26 women), the mean (± SD age was 74.1 ± 8.5 years, and mean HbA1c and fibrosis-4 (FIB-4) index were 7.3 ± 1.3% and 4.50 ± 3.42, respectively. Mean tumor diameter was 5.7 ± 3.5 cm, there were 63/13/2/2 patients classified as Child-Pugh A/B/C/unknown, and 56/24 were single/multiple lesions. In the DM-US group, HCC was detected in three patients (0.14%; 0.3% of those classified as elderly). The mean age and FIB-4 index of these three patients (one man, two women) were 75.6 years (range 67-92 years) and 4.84 (range 2.87-6.98), respectively. Mean tumor diamter was 7.6 cm and there were one and two single and multiple lesions, respectively. In elderly DM-US patients with a high FIB-4 index (≥4), the rate of HCC detection was 5.0%. Being elderly and having a high FIB-4 index are characteristic features of DM-HCC. Similar characteristics were noted for patients with HCC in the DM-US group. HCC surveillance with US is recommended for DM patients, especially those who are elderly (≥65 years) and have a high FIB-4 index. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Drinking-Water Standards and Regulations. Volume 2. Manual for 1982-88

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

Wang, L.K.; Wang, M.H.S.

1988-04-10

The following 11 important documents are compiled for Drinking Water Standards and Regulations: (1) U.S. Environmental Agency Water Programs, National Interim Primary Drinking Water Regulations; (2) New Jersey Safe Drinking Water Act; (3) Summary of New Jersey Drinking Water Standards; (4) U.S. Environmental Protection Agency Safe Drinking Water Act of 1986 Amendments; (5) U.S. Environmental Protection Agency National Primary Drinking Water Standards; (6) Canadian National Health and Welfare Drinking Water Quality Guidelines--Maximum Acceptable Concentrations; (7) U.S. Environmental Protection Agency, National Primary Drinking Water Regulations, Filtration and Disinfection Turbidity, Giardia Lamblia, Viruses, Legionella, and Heterotrophic Bacteria; (8) Public Water Supply Manual--Guidemore » to the Safe Drinking Water Program; (9) Public Water Supply Manual--Emergency Response; (10) U.S. EPA Approved Krofta Chemicals; (11) NY-DOH Approved Krofta Chemicals.« less

Effect of Low Frequency Ultrasound on Combined rt-PA and Eptifibatide Thrombolysis in Human Clots

PubMed Central

Meunier, Jason M.; Holland, Christy K.; Pancioli, Arthur M.; Lindsell, Christopher J.; Shaw, George J.

2009-01-01

Introduction Fibrinolytics such as recombinant tissue plasminogen activator (rt-PA) are used to treat thrombotic disease such as acute myocardial infarction (AMI) and ischemic stroke. Interest in increasing efficacy and reducing side effects has led to the study of adjuncts such as GP IIb-IIIa inhibitors and ultrasound (US) enhanced thrombolysis. Currently, GP IIb-IIIa inhibitor and fibrinolytic treatment are often used in AMI, and are under investigation for stroke treatment. However, little is known of the efficacy of combined GP IIb-IIIa inhibitor, fibrinolytic and ultrasound treatment. We measure the lytic efficacy of rt-PA, eptifibatide (Epf) and 120 kHz ultrasound treatment in an in-vitro human clot model. Materials and Methods Blood was drawn from 15 subjects after IRB approval. Clots were made in 20 μL pipettes, and placed in a water tank for microscopic visualization during lytic treatment. Clots were exposed to control, rt-PA (rt-PA), eptifibatide (Epf), or rt-PA+eptifibatide (rt-PA+Epf), with or without ultrasound for 30 minutes at 37°C in human plasma. Clot lysis was measured over time, using a microscopic imaging technique. The fractional clot loss (FCL) and initial lytic rate (LR) were used to quantify lytic efficacy. Results and Conclusions LR values for (−US) treated clots were 0.8±0.1(control), 1.8±0.3 (Epf), 1.5±0.2 (rt-PA), and 1.3±0.4 (rt-PA+Epf) (% clot width/minute) respectively. In comparison, the (+US) group exhibited LR values of 1.6±0.2 (control), 4.3±0.4 (Epf), 6.3±0.4 (rt-PA), and 4.6±0.6 (rt-PA+Epf). For (−US) treated clots, FCL was 6.0±0.8 (control), 9.2±2.5 (Epf), 15.6±1.7 (rt-PA), and 28.0±2.2% (rt-PA+Epf) respectively. FCL for (+US) clots was 13.5±2.4 (control), 20.7±6.4 (Epf), 44.4±3.6 (rt-PA) and 30.3±3.6% (rt-PA+Epf) respectively. Although the addition of eptifibatide enhances the in-vitro lytic efficacy of rt-PA in the absence of ultrasound, the efficacy of ultrasound and rt-PA is greater than that of combined ultrasound, rt-PA and eptifibatide exposure. PMID:18619651

Ultrasound guidance for central venous catheter placement in Australasian emergency departments: potential barriers to more widespread use.

PubMed

Matera, Jakub T; Egerton-Warburton, Diana; Meek, Robert

2010-12-01

To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not. Descriptive and analytical cross-sectional electronic survey of all FACEMs. Baseline variables including hospital type, US availability, frequency of CVC insertion, US usage and technique are presented descriptively. US practice and opinions on usage are compared between routine and non-routine users. Responses were obtained from 486 (42.4%) of 1146 FACEMs emailed. Whereas 88.5% of respondents had US available and 70% had done an US course, only 37% routinely used US for CVC placement. Completion of an US course and performance of >11 CVC per year were strongly associated with routine US use (odds ratio 10.0 [5.5-18.4] and 2.6 [1.7-3.9], respectively). Common barriers to more frequent US use were not having completed an US course (20%) and US-guided CVC placement taking too long (18%). Eighty-five per cent of FACEMs agreed that there should be ED access to US and US training but only 34% thought its use should be mandatory. We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Incidence of High Grade Squamous Intraepithelial Lesions in Patients with Atypical Squamous Cells of Undetermined Significance Papanicolaou Smears at Naresuan University Hospital.

PubMed

Heng, Suttichai; Sirichaisutdhikorn, Daranee

2016-01-01

To determine the incidence of high-grade cervical intraepithelial neoplasia (CIN2-3) among patients with atypical squamous cells of undetermined significance (ASC-US) Papanicolaou (Pap) smears. One-hundred and eighty-seven patients with ASC-US Pap smears who underwent colposcopy with histological study were enrolled between September 2007 and August 2015. Patient factors (including age, parity, current pills used, HIV status, age at first sexual intercourse and number of sexual partners) were obtained. Logistic regression analysis was used to evaluate clinical factors associated with CIN2-3. CIN was diagnosed in 92 of 187 women (49.2%). Sixty-one of these (32.6%) had CIN1 and 31 (16.6%) had CIN2-3. There was no woman who had invasive cancer. There was no correlation of high-grade CIN with factors in this study including age, parity, current pills used, HIV status, age at first sexual intercourse and number of sexual partners. Data from this study showed no invasive cervical cancer was found in patients with ASC-US. There was no patient factor associated with high grade intraepithelial neoplasia in patients with ASC-US Pap smears.

The Rise and Decline of U.S. Private Sector Investments in Energy R&D since the Arab Oil Embargo of 1973

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

Dooley, James J.

2010-11-01

This paper presents two distinct datasets that describe investments in energy research and development (R&D) by the US private sector since the mid1970s, which is when the US government began to systematically collect these data. The first dataset is based upon a broad survey of more than 20,000 firms’ industrial R&D activities. This broad survey of US industry is coordinated by the US National Science Foundation. The second dataset discussed here is a much narrower accounting of the energy R&D activities of the approximately two dozen largest US oil and gas companies conducted by the US Department of Energy’s Energymore » Information Agency. Even given the large disparity in the breadth and scope of these two surveys of the private sector’s support for energy R&D, both datasets tell the same story in terms of the broad outlines of the private sector’s investments in energy R&D since the mid 1970s. The broad outlines of the US private sector’s support for energy R&D since the mid 1970s is: (1) In the immediate aftermath of the Arab Oil Embargo of 1973, there is a large surge in US private sector investments in energy R&D that peaked in the period between 1980 and 1982 at approximately $3.7 billion to $6.7 billion per year (in inflation adjusted 2010 US dollars) depending upon which survey is used (2) Private sector investments in energy R&D declined from this peak until bottoming out at approximately $1.8 billion to $1 billion per year in 1999; (3) US private sector support for energy R&D has recovered somewhat over the past decade and stands at $2.2 billion to $3.4 billion. Both data sets indicate that the US private sector’s support for energy R&D has been and remains dominated by fossil energy R&D and in particular R&D related to the needs of the oil and gas industry.« less

International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?

PubMed

Shiroiwa, Takeru; Sung, Yoon-Kyoung; Fukuda, Takashi; Lang, Hui-Chu; Bae, Sang-Cheol; Tsutani, Kiichiro

2010-04-01

Although the threshold of cost effectiveness of medical interventions is thought to be 20 000- 30 000 UK pounds in the UK, and $50 000-$100 000 in the US, it is well known that these values are unjustified, due to lack of explicit scientific evidence. We measured willingness-to-pay (WTP) for one additional quality-adjusted life-year gained to determine the threshold of the incremental cost-effectiveness ratio. Our study used the Internet to compare WTP for the additional year of survival in a perfect status of health in Japan, the Republic of Korea (ROK), Taiwan, Australia, the UK, and the US. The research utilized a double-bound dichotomous choice, and analysis by the nonparametric Turnbull method. WTP values were JPY 5 million (Japan), KWN 68 million (ROK), NT$ 2.1 million (Taiwan), 23 000 UK pounds (UK), AU$ 64 000 (Australia), and US$ 62 000 (US). The discount rates of outcome were estimated at 6.8% (Japan), 3.7% (ROK), 1.6% (Taiwan), 2.8% (UK), 1.9% (Australia), and 3.2% (US). Based on the current study, we suggest new classification of cost-effectiveness plane and methodology for decision making. Copyright (c) 2009 John Wiley & Sons, Ltd.

Ultrasound guidance system for prostate biopsy

NASA Astrophysics Data System (ADS)

Hummel, Johann; Kerschner, Reinhard; Kaar, Marcus; Birkfellner, Wolfgang; Figl, Michael

2017-03-01

We designed a guidance system for prostate biopsy based on PET/MR images and 3D ultrasound (US). With our proposed method common inter-modal MR-US (or CT-US in case of PET/CTs) registration can be replaced by an intra-modal 3D/3D-US/US registration and an optical tracking system (OTS). On the pre-operative site, a PET/MR calibration allows to link both hybrid modalities with an abdominal 3D-US. On the interventional site, another abdominal 3D US is taken to merge the pre-operative images with the real-time 3D-US via 3D/3D-US/US registration. Finally, the images of a tracked trans-rectal US probe can be displayed with the pre-operative images by overlay. For PET/MR image fusion we applied a point-to-point registration between PET and OTS and MR and OTS, respectively. 3D/3D-US/US registration was evaluated for images taken in supine and lateral patient position. To enable table shifts between PET/MR and US image acquisition a table calibration procedure is presented. We found fiducial registration errors of 0.9 mm and 2.8 mm, respectively, with respect to the MR and PET calibration. A target registration error between MR and 3D US amounted to 1.4 mm. The registration error for the 3D/3D-US/US registration was found to be 3.7 mm. Furthermore, we have shown that ultrasound is applicable in an MR environment.

Ultrasound follow-up for gallbladder polyps less than 6 mm may not be necessary.

PubMed

Pedersen, Malene Roland V; Dam, Claus; Rafaelsen, Søren Rafael

2012-10-01

The management of ultrasound (US) detected gallbladder (GB) polyps remains a dilemma. The aim of this study was to assess the size distribution and the outcome of US follow-up of GB polyps. The study was approved by the Danish Data Protection Agency. US reports from patients examined with abdominal US in our department from January 2008 to the end of December 2009 were reviewed with a view to including all patients with GB polyps. Patients with GB polyps are routinely recommended a 2-year follow-up with US every six months. The GB polyp size was recorded at baseline and at subsequent US reports. Pathology reports were finally reviewed for all patients with GB polyps to check who underwent cholecystectomy and to register the histological diagnosis. A total of 203 patients (median age 54 years; range 19-95 years) with GB polyps were included; 89 (44%) men and 114 (56%) women. The mean polyp size was 5 mm (range 2-40 mm). In 143 patients (70%) the GB polyp diameter was less than 6 mm. The first US follow-up was performed in 120 patients (59%), and only 31 (15%) completed the full 2-year US follow-up programme. Polyp size was stable in 100 patients, decreased in five patients, increased in eight and resolved in 15 patients. A total of 13 patients (6%) underwent cholecystectomy. Of the 203 patients, none showed neoplastic or malignant GB polyps. We recommend that follow-up US of patients with GB polyps < 6 mm is avoided. Alternatively, the intervals between US follow-up of GB polyps < 6 mm may be extended. not relevant. not relevant.

Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan.

PubMed

Vento, Todd J; Calvano, Tatjana P; Cole, David W; Mende, Katrin; Rini, Elizabeth A; Tully, Charla C; Landrum, Michael L; Zera, Wendy; Guymon, Charles H; Yu, Xin; Beckius, Miriam L; Cheatle, Kristelle A; Murray, Clinton K

2013-07-16

Staphylococcus aureus [methicillin-resistant and methicillin-susceptible (MRSA/MSSA)] is a leading cause of infections in military personnel, but there are limited data regarding baseline colonization of individuals while deployed. We conducted a pilot study to screen non-deployed and deployed healthy military service members for MRSA/MSSA colonization at various anatomic sites and assessed isolates for molecular differences. Colonization point-prevalence of 101 military personnel in the US and 100 in Afghanistan was determined by swabbing 7 anatomic sites. US-based individuals had received no antibiotics within 30 days, and Afghanistan-deployed personnel were taking doxycycline for malaria prophylaxis. Isolates underwent identification and testing for antimicrobial resistance, virulence factors, and pulsed-field type (PFT). 4 individuals in the US (4 isolates- 3 oropharynx, 1 perirectal) and 4 in Afghanistan (6 isolates- 2 oropharynx, 2 nare, 1 hand, 1 foot) were colonized with MRSA. Among US-based personnel, 3 had USA300 (1 PVL+) and 1 USA700. Among Afghanistan-based personnel, 1 had USA300 (PVL+), 1 USA800 and 2 USA1000. MSSA was present in 40 (71 isolates-25 oropharynx, 15 nare) of the US-based and 32 (65 isolates- 16 oropharynx, 24 nare) of the Afghanistan-based individuals. 56 (79%) US and 41(63%) Afghanistan-based individuals had MSSA isolates recovered from extra-nare sites. The most common MSSA PFTs were USA200 (9 isolates) in the US and USA800 (7 isolates) in Afghanistan. MRSA/MSSA isolates were susceptible to doxycycline in all but 3 personnel (1 US, 2 Afghanistan; all were MSSA isolates that carried tetM). MRSA and MSSA colonization of military personnel was not associated with deployment status or doxycycline exposure. Higher S. aureus oropharynx colonization rates were observed and may warrant changes in decolonization practices.

Kinetics of transcription of infectious laryngotracheitis virus genes.

PubMed

Mahmoudian, Alireza; Markham, Philip F; Noormohammadi, Amir H; Browning, Glenn F

2012-03-01

The kinetics of expression of only a few genes of infectious laryngotracheitis virus (ILTV) have been determined, using northern blot analysis. We used quantitative reverse transcriptase PCR to examine the kinetics of expression of 74 ILTV genes in LMH cells. ICP4 was the only gene fully expressed in the presence of cycloheximide, and thus classified as immediate-early. The genes most highly expressed early in infection, and thus classified as early, included UL1 (gL), UL2, UL3, UL4, UL5, UL6, UL7, UL8, UL13, UL14, UL19, UL20, UL23 (TK), UL25, UL28, UL29, UL31, UL33, UL34, UL38, UL39, UL40, UL42, UL43, UL44 (gC), UL47, UL48 (α-TIF), UL49, UL54 (ICP27), US3 and US10. ORF A, ORF B, ORF C, ORF E, sORF 4/3, UL[-1], UL0, UL3.5, UL9, UL10 (gM), UL11, UL15a, UL15b, UL18, UL22 (gH), UL24, UL26, UL30, UL32, UL36, UL45, UL49.5 (gN), UL52, US2, US4 (gG), US5 (gJ) and US9 were most highly expressed late in infection and were thus considered late genes. Several genes, including ORF D, UL12, UL17, UL21, UL27 (gB), UL35, UL37, UL41, UL46, UL50, UL51, UL53 (gK), US8 (gE), US6 (gD) and US7 (gI), had features of both early and late genes and were classified as early/late. Our findings suggest transcription from most of ILTV genes is leaky or subject to more complex patterns of regulation than those classically described for herpesviruses. This is the first study examining global expression of ILTV genes and the data provide a basis for future investigations of the pathogenesis of infection with ILTV. Copyright © 2011 Elsevier Ltd. All rights reserved.

Source apportionments of aerosols and their direct radiative forcing and long-term trends over continental United States

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

Yang, Yang; Wang, Hailong; Smith, Steven J.

Due to US air pollution regulations, aerosol and precursor emissions have decreased during recent decades, while changes in emissions in other regions of the world also influence US aerosol trends through long-range transport. We examine here the relative roles of these domestic and foreign emission changes on aerosol concentrations and direct radiative forcing (DRF) at the top of the atmosphere over the continental US. Long-term (1980-2014) trends and aerosol source apportionment are quantified in this study using a global aerosol-climate model equipped with an explicit aerosol source tagging technique. Due to US emission control policies, the annual mean near-surface concentrationmore » of particles, consisting of sulfate, black carbon, and primary organic aerosol, decreases by about –1.1 (±0.1) / –1.4 (±0.1) μg m -3 in western US and –3.3 (±0.2) / –2.9 (±0.2) μg m -3 in eastern US during 2010–2014, as compared to those in 1980–1984. Meanwhile, decreases in US emissions lead to a warming of +0.48 (±0.03) / –0.46 (±0.03) W m -2 in western US and +1.41 (±0.07) /+1.32 (±0.09) W m -2 in eastern US through changes in aerosol DRF. Increases in emissions from East Asia generally have a modest impact on US air quality, but mitigated the warming effect induced by reductions in US emissions by 25% in western US and 7% in eastern US. Thus, as US domestic aerosol and precursor emissions continue to decrease, foreign emissions may become increasingly important to radiative forcing over the US.« less

Source apportionments of aerosols and their direct radiative forcing and long-term trends over continental United States

DOE PAGES

Yang, Yang; Wang, Hailong; Smith, Steven J.; ...

2018-05-23

Due to US air pollution regulations, aerosol and precursor emissions have decreased during recent decades, while changes in emissions in other regions of the world also influence US aerosol trends through long-range transport. We examine here the relative roles of these domestic and foreign emission changes on aerosol concentrations and direct radiative forcing (DRF) at the top of the atmosphere over the continental US. Long-term (1980-2014) trends and aerosol source apportionment are quantified in this study using a global aerosol-climate model equipped with an explicit aerosol source tagging technique. Due to US emission control policies, the annual mean near-surface concentrationmore » of particles, consisting of sulfate, black carbon, and primary organic aerosol, decreases by about –1.1 (±0.1) / –1.4 (±0.1) μg m -3 in western US and –3.3 (±0.2) / –2.9 (±0.2) μg m -3 in eastern US during 2010–2014, as compared to those in 1980–1984. Meanwhile, decreases in US emissions lead to a warming of +0.48 (±0.03) / –0.46 (±0.03) W m -2 in western US and +1.41 (±0.07) /+1.32 (±0.09) W m -2 in eastern US through changes in aerosol DRF. Increases in emissions from East Asia generally have a modest impact on US air quality, but mitigated the warming effect induced by reductions in US emissions by 25% in western US and 7% in eastern US. Thus, as US domestic aerosol and precursor emissions continue to decrease, foreign emissions may become increasingly important to radiative forcing over the US.« less

Three-dimensional transvaginal sonographic assessment of uterine volume as preoperative predictor of need to morcellate in women undergoing laparoscopic hysterectomy.

PubMed

Gerges, B; Mongelli, M; Casikar, I; Bignardi, T; Condous, G

2017-08-01

In light of recent statements from the United States Food and Drug Administration warning against the use of power morcellation of uterine leiomyomas during laparoscopy, we sought to evaluate the use of preoperative two- (2D) and three- (3D) dimensional transvaginal ultrasound (US) assessment of uterine volume to predict the need for morcellation in women undergoing laparoscopic hysterectomy (LH). This was a prospective observational study performed between October 2008 and November 2011 in a tertiary referral laparoscopic unit. All women scheduled to undergo LH were included and underwent detailed preoperative transvaginal US. Uterine volumes were calculated using 2D-US measurements (ellipsoid formula), and using Virtual Organ Computer-aided AnaLysis (VOCAL™) having acquired 3D-US volumes of the uterus. Age, parity, need to morcellate and final uterine dry weight at histology were recorded. The estimated uterine volumes were then incorporated into a previously published logistic regression model to predict the need to morcellate for both nulliparous and parous women. The probability threshold cut-off of 0.14 (95% sensitivity) was evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratios (LRs). The performance of the models incorporating 2D- and 3D-US calculations were compared with 2D- and 3D-US-generated volumes alone, using receiver-operating characteristics (ROC) curves. Of 76 women who underwent LH during the study period, 79% (n = 60) had complete background and 3D-US data. Their mean age was 43.7 years, 91.7% were parous and 35% underwent morcellation. The greatest uterine volume that did not require morcellation was 404 mL estimated using 3D-US, which corresponded to a uterine volume of 688.8 mL using 2D-US. The smallest uterine volume that required morcellation was 118.9 mL using 3D-US, which corresponded to a uterine volume of 123.4 mL using 2D-US. The 3D-US uterine volume for parous women with a sensitivity of 95% based on ROC-curve analysis was approximately 120 mL, which equated to a predicted probability of morcellation cut-off of 0.14. For this cut-off, specificity was 55.00%, PPV was 51.35%, NPV was 95.65%, LR+ was 2.11 and LR- was 0.09. Areas under the ROC curves for the morcellation logistic regression model were 0.769 (95% CI, 0.653-0.886) and 0.586 (95% CI, 0.419-0.753) using uterine volumes obtained by 3D-US and by 2D-US, respectively, and they were 0.938 (95% CI, 0.879-0.996) and 0.815 (95% CI, 0.681-0.948) using 3D-US and 2D-US volumes alone. The need to morcellate can be predicted preoperatively using 3D-US uterine volumes obtained by transvaginal US with a fair degree of accuracy. Uteri with volumes smaller than 120 mL at 3D-US are very unlikely to require morcellation. The incorporation of 3D-US-estimated uterine volume into the previously published logistic regression model does not seem to confer any significant improvement when compared with 3D-US uterine volume alone to predict the need to morcellate in women undergoing total LH. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Promoting Sun Safety Among US Postal Service Letter Carriers: Impact of a 2-Year Intervention

PubMed Central

Mayer, Joni A.; Slymen, Donald J.; Clapp, Elizabeth J.; Pichon, Latrice C.; Eckhardt, Laura; Eichenfield, Lawrence F.; Elder, John P.; Sallis, James F.; Weinstock, Martin A.; Achter, April; Balderrama, Cynthia; Galindo, Gabriel R.; Oh, Sam S.

2007-01-01

Objectives. We examined whether US Postal Service letter carriers who received a sun safety intervention would wear wide-brim hats and sunscreen significantly more often than those who did not receive the intervention. Methods. We used a 2-group randomized design with 2662 evaluation cohort participants from 70 US postal stations. Evaluations were conducted at baseline, 3 months, 1 year, and 2 years. Questionnaire items assessed occupational use of sun-screen and wide-brim hats. The 2-year sun safety intervention included the provision of wide-brim hats, accessible sunscreen, reminders, and 6 educational sessions. Results. At the 3-month follow-up evaluations, the odds ratio (OR) for regular sun-screen use was 2.8 times higher among the intervention group than among the control group (95% confidence interval [CI]=2.2, 3.5); at the 2-year follow-up evaluations, the rate was still significantly higher (OR=2.0; 95% CI=1.6, 2.6). Intervention group participants also had significantly higher rates of hat use, with the differences remaining consistent across all follow-ups (OR=2.9; 95% CI=2.3, 3.6). Conclusions. The intervention should be disseminated to postal stations nationwide and possibly to other occupational groups that work outdoors. PMID:17267715

Effects of breastfeeding on postpartum weight loss among U.S. women

PubMed Central

Jarlenski, Marian P.; Bennett, Wendy L.; Bleich, Sara N.; Barry, Colleen L.; Stuart, Elizabeth A.

2014-01-01

Objective To evaluate the effects of breastfeeding on maternal weight loss in the 12 months postpartum among U.S. women. Methods Using data from a national cohort of U.S. women conducted in 2005-2007 (N=2,102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12 months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. Results Compared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3 months resulted in 3.2 pounds (95% CI: 1.4,4.7) greater weight loss at 12 months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. Conclusion Our study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women. PMID:25284261

Profiles of the Caribbean Basin in 1960/1980: Changing Geopolitical and Geostrategic Dimensions.

DTIC Science & Technology

1983-12-01

8.816.000 (SI = I quetzal ) ARM1Y: 8,400 regs 2 bns 18 60mm (US). 99 80mm (Ger), 8 81mm (US), 2 lnchr (flare) mor; 17 3. 5 -in rkt lnchr (US), 8 57mm rclss...service: conscription; 2 years Total armed forces: 15,050 Estimated GNP 1979: S6.9 bn Defense excpenditure 1980: 76.8 m quetzal ’S69.S m) S51 1.1 quetzal ...1980), 1.0 quetzal (1979) ARMY: 14,000 4 bde H{Q 1 Presidential Guard bde 9 jnf bps 1 Para bn 1 engr bn I armd car co 13 arty btys 7 M-3 Sruart It tks

Missile Defense Certification: Examination of the U.S. Navy Aegis Warship and U.S. Army Patriot Crew Certification Process

DTIC Science & Technology

2008-09-01

C. Ensure FP Status indicators posted IAW SSTO : ___ (1) WCS ___ (2) DEFCON ___ (3) MOC ___ (4) Alert State ___ (5) ADW... SSTO . ___ 6. Denial and destruction plans. ___ 7. Missile hazard/misfire procedures. ___ 8. General Knowledge of TABS, Switch/Indicator

3D ultrasonography is as accurate as low-dose CT in thyroid volumetry.

PubMed

Licht, K; Darr, A; Opfermann, T; Winkens, T; Freesmeyer, M

2014-01-01

The purpose of this study was to compare thyroid volumetry by three-dimensional mechanically swept ultrasonography (3DmsUS) and low-dose computed tomography (ldCT). 30 subjects referred for radioiodine therapy of benign thyroid diseases were subjected to 3DmsUS and ldCT. A prerequisite of 3DmsUS analyses was that the scans had to capture the entire thyroid, excluding therefore cases with a very large volume or retrosternal portions. The 3DmsUS data were transformed into a DICOM format, and volumetry calculations were performed via a multimodal workstation equipped with standard software for cross-sectional imaging. Volume was calculated applying both the ellipsoid model and a manually tracing method. Statistical analyses included 95% confidence intervals (CI) of the means and limits of agreement according to Bland and Altman, the latter including 95% of all expected values. Volumetric measurements by 3DmsUS and ldCT resulted in very high, significant correlation coefficients, r = 0.997 using the ellipsoid model and r = 0.993 with the manually tracing method. The mean relative differences of the two imaging modalities proved very small (-1.2±4.0% [95% CI -2.62; 0.28] using the ellipsoid model; -1.1±5.2% [95% CI -2.93; 0.80] using the manually tracing method) and the limits of agreement sufficiently narrow (-9.1% to 6.8%; -11.3% to 9.2%, respectively). For moderately enlarged thyroids, volumetry with 3DmsUS proved comparable to that of ldCT, irrespective of whether the ellipsoid model or the manually tracing method was applied. Thus, 3DmsUS qualifies as a potential alternative to ldCT, provided that the organ is completely accessible. The use of a standard workstation for cross-sectional imaging with routine software did not prove problematic.

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

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

PubMed

Tsai, Timothy L; Marine, Megan B; Wanner, Matthew R; Cooper, Matthew L; Steiner, Steven J; Ouyang, Fangqian; Gregory Jennings, S; Karmazyn, Boaz

2017-07-01

There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure. The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease. A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6< kappa <0.8). In screening for Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

Australian and U.S. news media portrayal of sharks and their conservation.

PubMed

Muter, Bret A; Gore, Meredith L; Gledhill, Katie S; Lamont, Christopher; Huveneers, Charlie

2013-02-01

Investigation of the social framing of human-shark interactions may provide useful strategies for integrating social, biological, and ecological knowledge into national and international policy discussions about shark conservation. One way to investigate social opinion and forces related to sharks and their conservation is through the media's coverage of sharks. We conducted a content analysis of 300 shark-related articles published in 20 major Australian and U.S. newspapers from 2000 to 2010. Shark attacks were the emphasis of over half the articles analyzed, and shark conservation was the primary topic of 11% of articles. Significantly more Australian articles than U.S. articles treated shark attacks (χ(2) = 3.862; Australian 58% vs. U.S. 47%) and shark conservation issues (χ(2) = 6.856; Australian 15% vs. U.S. 11%) as the primary article topic and used politicians as the primary risk messenger (i.e., primary person or authority sourced in the article) (χ(2) = 7.493; Australian 8% vs. U.S. 1%). However, significantly more U.S. articles than Australian articles discussed sharks as entertainment (e.g., subjects in movies, books, and television; χ(2) = 15.130; U.S. 6% vs. Australian 1%) and used scientists as the primary risk messenger (χ(2) = 5.333; U.S. 25% vs. Australian 15%). Despite evidence that many shark species are at risk of extinction, we found that most media coverage emphasized the risks sharks pose to people. To the extent that media reflects social opinion, our results highlight problems for shark conservation. We suggest that conservation professionals purposefully and frequently engage with the media to highlight the rarity of shark attacks, discuss preventative measures water users can take to reduce their vulnerability to shark encounters, and discuss conservation issues related to local and threatened species of sharks. When integrated with biological and ecological data, social-science data may help generate a more comprehensive perspective and inform conservation practice. © 2012 Society for Conservation Biology.

The influence of foreign vs. North American emissions on surface ozone in the US

NASA Astrophysics Data System (ADS)

Reidmiller, D. R.; Fiore, A. M.; Jaffe, D. A.; Bergmann, D.; Cuvelier, C.; Dentener, F. J.; Duncan, B. N.; Folberth, G.; Gauss, M.; Gong, S.; Hess, P.; Jonson, J. E.; Keating, T.; Lupu, A.; Marmer, E.; Park, R.; Schultz, M. G.; Shindell, D. T.; Szopa, S.; Vivanco, M. G.; Wild, O.; Zuber, A.

2009-03-01

As part of the Hemispheric Transport of Air Pollution (HTAP; http://www.htap.org/) project, we analyze results from 16 global and hemispheric chemical transport models and compare these to Clean Air Status and Trends Network (CASTNet) observations in the United States (US) for 2001. Using the policy-relevant maximum daily 8-h ozone (MDA8 O3) statistic, the multi-model ensemble represents the observations well (mean r2=0.57, ensemble bias=+4.1 ppbv for all regions and all seasons) despite a wide range in the individual model results. Correlations are strongest in the NorthEastern US during spring and fall (r2=0.68); and weakest in the Midwestern US in summer (r2=0.46). However, large positive mean biases exist during summer for all Eastern US regions, ranging from 10-20 ppbv, and a smaller negative bias is present in the Western US during spring (~3 ppbv). In most all other regions and seasons, the biases of the model ensemble simulations are ≤5 ppbv. Sensitivity simulations in which anthropogenic O3-precursor emissions (NOx+NMVOC+CO+aerosols) were decreased by 20% in each of four source regions: East Asia (EA), South Asia (SA), Europe (EU) and North America (NA) show that the greatest response of MDA8 O3 to the summed foreign emissions reductions occurs during spring in the West (0.9 ppbv reduction due to 20% reductions from EA+SA+EU). East Asia is the largest contributor to MDA8 O3 at all ranges of the O3 distribution for most regions (typically ~0.45 ppbv). The exception is in the NorthEastern US where European emissions reductions had the greatest impact on MDA8 O3, particularly in the middle of the MDA8 O3 distribution (response of ~0.35 ppbv between 35-55 ppbv). In all regions and seasons, however, O3-precursor emissions reductions of 20% in the NA source region decrease MDA8 O3 the most - by a factor of 2 to nearly 10 relative to foreign emissions reductions. The O3 response to anthropogenic NA emissions is greatest in the Eastern US during summer at the high end of the O3 distribution (5-6 ppbv for 20% reductions). While the impact of foreign emissions on surface O3 in the US is not negligible - and is of increasing concern given the growth in emissions upwind of the US - domestic emissions reductions remain a far more effective means of decreasing MDA8 O3 values, particularly those above 75 ppb (the current US standard).

Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation.

PubMed

Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

2013-06-25

Little is known about how U.S. physicians' political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians' impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S. physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6-46.2]; OR 5.0 [95 % CI, 3.7-6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2-2.5]) or salary plus bonus (OR 1.4 [95 % CI, 1.1-1.9) compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0-2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI, 1.3-2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8-3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4-0.7], OR 0.6 [95 % CI, 0.5-0.9], respectively). Significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.

Blood-Brain Barrier Closure Time After Controlled Ultrasound-Induced Opening Is Independent of Opening Volume.

PubMed

O'Reilly, Meaghan A; Hough, Olivia; Hynynen, Kullervo

2017-03-01

Microbubble-mediated focused ultrasound (US) opening of the blood-brain barrier (BBB) has shown promising results for the treatment of brain tumors and conditions such as Alzheimer disease. Practical clinical implementation of focused US treatments would aim to treat a substantial portion of the brain; thus, the safety of opening large volumes must be investigated. This study investigated whether the opened volume affects the time for the BBB to be restored after treatment. Sprague Dawley rats (n = 5) received bilateral focused US treatments. One hemisphere received a single sonication, and the contralateral hemisphere was targeted with 4 overlapping foci. Contrast-enhanced T1-weighted magnetic resonance imaging was used to assess the integrity of the BBB at 0, 6, and 24 hours after focused US. At time 0, there was no significant difference in the mean enhancement between the single- and multi-point sonications (mean ± SD, 29.7% ± 18.4% versus 29.7% ± 24.1%; P = .9975). The mean cross-sectional area of the BBB opening resulting from the multi-point sonication was approximately 3.5-fold larger than that of the single-point case (14.2 ± 4.7 versus 4.1 ± 3.3 mm 2 ; P < .0001). The opened volumes in 9 of 10 hemispheres were closed by 6 hours after focused US. The remaining treatment location had substantially reduced enhancement at 6 hours and was closed by 24 hours. Histologic analysis revealed small morphologic changes associated with this location. T2-weighted images at 6 and 24 hours showed no signs of edema. T2*-weighted images obtained at 6 hours also showed no signs hemorrhage in any animal. The time for the BBB to close after focused US was independent of the opening volume on the time scale investigated. No differences in treatment effects were observable by magnetic resonance imaging follow-up between larger- and smaller-volume sonications, suggesting that larger-volume BBB opening can be performed safely. © 2017 by the American Institute of Ultrasound in Medicine.

Utility of CT after sonography for suspected appendicitis in children: integration of a clinical scoring system with a staged imaging protocol.

PubMed

Srinivasan, Abhay; Servaes, Sabah; Peña, Andrès; Darge, Kassa

2015-02-01

To improve diagnosis of pediatric appendicitis, many institutions have implemented a staged imaging protocol utilizing ultrasonography (US) first and then computed tomography (CT). A substantial number of children with suspected appendicitis undergo CT after US, and the efficient and accurate diagnosis of pediatric appendicitis continues to be challenging. The objective of the study is to characterize the utility of CT following US for diagnosis of pediatric appendicitis, in conjunction with a clinical appendicitis score (AS). Imaging studies of children with suspected appendicitis who underwent CT after US in an imaging protocol were retrospectively reviewed by three radiologists in consensus. Chart review derived the AS (range 0-10) and obtained the patient diagnosis and disposition, and an AS was applied to each patient. Clinical and radiologic data were analyzed to assess the yield of CT after US. Studies of 211 children (mean age 11.3 years) were included. The positive threshold for AS was determined to be 6 out of 10. When AS and US were concordant (N = 140), the sensitivity and specificity of US were similar to CT. When AS and US were discordant (N = 71) and also when AS ≥ 6 (N = 84), subsequent CT showed superior sensitivity and specificity to US alone. In the subset where US showed neither the appendix nor inflammatory change in the right lower quadrant (126/211, 60 % of scans), when AS < 6 (N = 83), the negative predictive value (NPV) of US was 0.98. However, when AS ≥ 6 (N = 43), NPV of US was 0.58, and the positive predictive value of subsequent CT was 1. There was a significant decrease in depiction of the appendix on US with patient weight-to-age ratio of >6 (kg/year, P < 0.001) and after-hours (1700 -0730 hours) performance of US (P < 0.001). Results suggest that the appendicitis score has utility in guiding an imaging protocol and support the contention that non-visualization of the appendix on US is not intrinsically non-diagnostic. There was little benefit to additional CT when AS < 6 and US did not show the appendix or evidence of inflammation; this would have avoided CT in 140/211 (66 %) patients. CT demonstrated benefit when AS ≥ 6, suggesting that cases with AS ≥ 6 and features that limit depiction of the appendix on US may be triaged to CT.

Prognostic value of nerve ultrasound and electrophysiological findings in traumatic sural neuropathy.

PubMed

Kerasnoudis, A; Ntasiou, P; Barmpalios, G

2018-06-13

We report on the prognostic role of cross sectional area (CSA) enlargement and axonal damage in traumatic sural neuropathy (TSN). Reference values were defined in 23 healthy subjects. 13patients with TSN underwent evaluation (Thessaloniki Hypesthesia Score (THS), ultrasound, electrophysiology). All patients were followed up with THS 6 months after initial evaluation. During initial evaluation, the 13 patients showed a mean THS of 2.6 (SD ± 0.9). 7 patients showed pathological (pUS) and 6 normal CSA (nUS). 8 patients showed axonal affection (pCS) and 5 no axonal affection (nCS). During follow up, mean THS was 3.1 (SD ± 0.9) in pUS, and 1.8 (SD ± 0.7) in the nUS group (p < 0.001). Mean THS was 2.8 (SD ± 0.7) in pCS, and 2.1 (SD ± 0.9) in nCS group (p = 0.035). CSA enlargement, but not axonal loss, seems to have a negative prognostic role in patients with TSN. Copyright © 2018. Published by Elsevier Ltd.

Eastern U.S. Infrared, Enhancement 4 - NOAA GOES Geostationary Satellite

Science.gov Websites

Enhancement 4 Eastern U.S. Infrared Enhancements IR Enhancement 1 Eastern U.S. Infrared Enhancement 1 IR Enhancement 2 Eastern U.S. Infrared Enhancement 2 IR Enhancement 3 Eastern U.S. Infrared Enhancement 3 IR large amount of water vapor. » Enhancement types In an infrared (IR) image cold clouds are high clouds

Combination of doxorubicin and low-intensity ultrasound causes a synergistic enhancement in cell killing and an additive enhancement in apoptosis induction in human lymphoma U937 cells.

PubMed

Yoshida, Toru; Kondo, Takashi; Ogawa, Ryohei; Feril, Loreto B; Zhao, Qing-Li; Watanabe, Akihiko; Tsukada, Kazuhiro

2008-04-01

Potential clinical use of ultrasound (US) in enhancing the effects of anticancer drugs in the treatment of cancers has been highlighted in previous reports. Increased uptake of drugs by the cancer cells due to US has been suggested as a mechanism. However, the precise mechanism of the enhancement has not yet been elucidated. Here, the combined effects of low-intensity pulsed US and doxorubicin (DOX) on cell killing and apoptosis induction of U937 cells, and mechanisms involved were investigated. Human myelomonocytic lymphoma U937 cells were used for the experiments. Experiments were conducted in 4 groups: (1) non-treated, (2) DOX treated (DOX), (3) US treated (US), and (4) combined (DOX + US). In DOX +US, cells were exposed to 5 microM DOX for 30 min and sonicated by 1 MHz pulsed US (PRF 100 Hz, DF 10%) at intensities of 0.2-0.5 W/cm(2) for 60 s. The cells were washed and incubated for 6 h. The viability was evaluated by Trypan blue dye exclusion test and apoptosis and incorporation of DOX was assessed by flow cytometry. Involvement of sonoporation in molecular incorporation was evaluated using FITC-dextran, hydroxyl radical formation was measured by electron paramagnetic resonance-spin trapping, membrane alteration including lipid peroxidation and membrane fluidity by DOX was evaluated using cis-parinaric acid and perylene fluorescence polarization method, respectively. Synergistic enhancement in cell killing and additive enhancement in induction of apoptosis were observed at and above 0.3 W/cm(2). No enhancement was observed at 0.2 W/cm(2) in cell killing and induction of apoptosis. Hydroxyl radicals formation was detected at and above 0.3 W/cm(2). The radicals were produced more in the DOX + US than US alone. Incorporation of DOX was increased 13% in DOX + US (vs. DOX) at 0.5 W/cm(2). Involvement of sonoporation for increase of drug uptake was suggested by experiment using FITC-labeled dextran. We made the hypothesis that DOX treatment made the cells weaken against the mechanical effect of the US. Although treatment of DOX at 5 microM for 30 min did not affect lipid peroxidation and fluidity of cell membrane significantly, higher concentration and longer treatment of DOX induced the significant alteration of cell membrane. Mechanisms of enhancements could be (1) increase in incorporation of the DOX by US involved with sonoporation, (2) enhancement of the cavitation by DOX. Cavitation is required for the enhancement of the effect of DOX. Although the precise involvement of the membrane modifications by DOX in the enhancement remains to be elucidated, they could be involved in the latent effects.

Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18–39 Years

PubMed Central

Bucholz, Emily M.; Gooding, Holly C.; de Ferranti, Sarah D.

2018-01-01

Introduction Young adults with hyperlipidemia, hypertension, and diabetes are at increased risk of developing heart disease later in life. Despite emphasis on early screening, little is known about awareness of these risk factors in young adulthood. Methods Data from the nationally representative cross-sectional survey National Health and Nutrition Examination Survey 2011–2014 were analyzed in 2017 to estimate the prevalence of self-reported awareness of hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18–39 years (n=11,083). Prevalence estimates were weighted to population estimates using survey procedures, and predictors of awareness were identified using weighted logistic regression. Results Among U.S. young adults, the prevalence of hypercholesterolemia, hypertension, and diabetes was 8.8% (SE=0.4%), 7.3% (SE=0.3%), and 2.6% (SE=0.2%), respectively. The prevalence of borderline high cholesterol, blood pressure, and blood glucose were substantially higher (21.6% [SE= 0.6%], 26.9% [SE=0.7%], and 18.9% [SE=0.6%], respectively). Awareness was low for hypercholesterolemia (56.9% [SE=2.4%]) and moderate for hypertension and diabetes (62.7% [SE=2.4%] and 70.0% [SE=2.7%]); <25% of young adults with borderline levels of these risk factors were aware of their risk. Correlates of risk factor awareness included older age, insurance status, family income above the poverty line, U.S. origin, having a usual source of health care, and the presence of comorbid conditions. Conclusions Despite the high prevalence of cardiovascular risk factors in U.S. young adults, awareness remains less than ideal. Interventions that target access may increase awareness and facilitate achieving treatment goals in young adults. PMID:29433955

Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011.

PubMed

Ong, Paulina; Lovasi, Gina S; Madsen, Ann; Van Wye, Gretchen; Demmer, Ryan T

2017-09-01

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection.

PubMed

Capretti, Maria Grazia; Lanari, Marcello; Tani, Giovanni; Ancora, Gina; Sciutti, Rita; Marsico, Concetta; Lazzarotto, Tiziana; Gabrielli, Liliana; Guerra, Brunella; Corvaglia, Luigi; Faldella, Giacomo

2014-03-01

To assess the diagnostic and prognostic value of cerebral magnetic resonance imaging (cMRI) in comparison with that of cerebral ultrasound (cUS) in predicting neurodevelopmental outcome in newborns with congenital cytomegalovirus (CMV) infection. Forty CMV-congenitally infected newborns underwent cUS and cMRI within the first month of life. Clinical course, laboratory findings, visual/hearing function and neurodevelopmental outcome were documented. Thirty newborns showed normal cMRI, cUS and hearing/visual function in the first month of life; none showed CMV-related abnormalities at follow-up. Six newborns showed pathological cMRI and cUS findings (pseudocystis, ventriculomegaly, calcifications, cerebellar hypoplasia) but cMRI provided additional information (white matter abnormalities in three cases, lissencephaly/polymicrogyria in one and a cyst of the temporal lobe in another one); cerebral calcifications were detected in 3/6 infants by cUS but only in 2/6 by cMRI. Four of these 6 infants showed severe neurodevelopmental impairment and five showed deafness during follow-up. Three newborns had a normal cUS, but cMRI documented white matter abnormalities and in one case also cerebellar hypoplasia; all showed neurodevelopmental impairment and two were deaf at follow-up. One more newborn showed normal cUS and cMRI, but brainstem auditory evoked responses were abnormal; psychomotor development was normal at follow-up. Compared with cUS, cMRI disclosed additional pathological findings in CMV-congenitally infected newborns. cUS is a readily available screening tool useful in the identification of infected newborns with major cerebral involvement. Further studies with a larger sample size are needed to determine the prognostic role of MRI, particularly regarding isolated white matter lesions. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Specialty, political affiliation, and perceived social responsibility are associated with U.S. physician reactions to health care reform legislation.

PubMed

Antiel, Ryan M; James, Katherine M; Egginton, Jason S; Sheeler, Robert D; Liebow, Mark; Goold, Susan Dorr; Tilburt, Jon C

2014-02-01

Little is known about how U.S. physicians’ political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation. To assess U.S. physicians’ impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility. A cross-sectional, mailed, self-reported survey. Simple random sample of 3,897 U.S.physicians. Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility. Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6–46.2]; OR 5.0 [95 % CI, 3.7–6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2–2.5])or salary plus bonus (OR 1.4 [95 % CI, 1.1–1.9)compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0–2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI,1.3–2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8–3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4–0.7], OR 0.6 [95 %CI, 0.5–0.9], respectively). Significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation,type of medical specialty, as well as perceived social responsibility.

Provider management of equivocal cervical cancer screening results among underserved women, 2009–2011: follow-up of atypical squamous cells of undetermined significance

PubMed Central

Watson, Meg; Benard, Vicki; Lin, Lavinia; Rockwell, Tanner; Royalty, Janet

2015-01-01

Purpose Reflex human papillomavirus (HPV) testing is the preferred triage option for most women diagnosed with atypical squamous cells of undetermined significance (ASC-US). This study was conducted to describe follow-up results of women with ASC-US Pap test results in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), focusing on HPV test use. Methods We examined the follow-up of 45,049 women in the NBCCEDP with ASC-US Pap tests during 2009–2011. Data on demographic characteristics, diagnostic procedures, and clinical outcomes were analyzed. Results NBCCEDP providers diagnosed 45,049 women (4.5 % of all Pap tests) with an ASC-US result. Of those, 28,271 (62.8 %) were followed with an HPV test, 3,883 (8.6 %) with a repeat Pap test, 6,592 (14.6 %) with colposcopy, and 6,303 were lost to follow-up (14.0 %). Women aged 40 and older were followed more often with an HPV test. White, black, and Asian/Pacific Islander women were followed more often with an HPV test after an ASC-US Pap compared to Hispanic and American Indian/Alaska Native (AI/AN) women. Among women with a positive HPV test on follow-up, almost 90 % continued with colposcopy as recommended. AI/AN women had the highest rates of HPV positivity (55.2 %) and of no follow-up (25.0 %). Conclusion This is the first analysis describing follow-up of ASC-US Pap test results in the NBCCEDP, providing a window into current management of ASC-US results. Findings raise concerns about persistent disparities among AI/AN women. During 2009–2011, nearly two-thirds of women with an ASC-US Pap test result were followed with an HPV reflex test. PMID:25794897

Disparities between black and white children in hospitalizations associated with acute respiratory illness and laboratory-confirmed influenza and respiratory syncytial virus in 3 US counties--2002-2009.

PubMed

Iwane, Marika K; Chaves, Sandra S; Szilagyi, Peter G; Edwards, Kathryn M; Hall, Caroline B; Staat, Mary A; Brown, Cedric J; Griffin, Marie R; Weinberg, Geoffrey A; Poehling, Katherine A; Prill, Mila M; Williams, John V; Bridges, Carolyn B

2013-04-01

Few US studies have assessed racial disparities in viral respiratory hospitalizations among children. This study enrolled black and white children under 5 years of age who were hospitalized for acute respiratory illness (ARI) in 3 US counties during October-May 2002-2009. Population-based rates of hospitalization were calculated by race for ARI and laboratory-confirmed influenza and respiratory syncytial virus (RSV), using US Census denominators. Relative rates of hospitalization between racial groups were estimated. Of 1,415 hospitalized black children and 1,824 hospitalized white children with ARI enrolled in the study, 108 (8%) black children and 111 (6%) white children had influenza and 230 (19%) black children and 441 (29%) white children had RSV. Hospitalization rates were higher among black children than among white children for ARI (relative rate (RR) = 1.7, 95% confidence interval (CI): 1.6, 1.8) and influenza (RR = 2.1, 95% CI: 1.6, 2.9). For RSV, rates were similar among black and white children under age 12 months but higher for black children aged 12 months or more (for ages 12-23 months, RR = 1.7, 95% CI: 1.1, 2.5; for ages 24-59 months, RR = 2.2, 95% CI: 1.3, 3.6). Black children versus white children were significantly more likely to have public insurance or no insurance (85% vs. 43%) and a history of asthma/wheezing (28% vs. 18%) but not more severe illness. The observed racial disparities require further study.

Effects of Low-Intensity Pulsed Ultrasound on Implant Osseointegration in Ovariectomized Rats.

PubMed

Zhou, Hongbo; Hou, Yongfu; Zhu, Zhimin; Xiao, Weixiong; Xu, Qian; Li, Lei; Li, Xin; Chen, Wenchuan

2016-04-01

To investigate the effect of low-intensity pulsed ultrasound (US) on periimplant bone healing and osseointegration under osteoporotic conditions. Seventy-two 12-week-old female Sprague Dawley rats received bilateral ovariectomies. Twelve weeks later, titanium implants were bilaterally placed in the proximal tibial metaphysis. The right tibia was exposed to low-intensity pulsed US (40 mW/cm2, spatial and temporal average) for 20 min/d starting the 2nd day after implantation, and the left tibia served as a control without stimulation. The rats were randomly assigned to 6 groups of 12 each according to the US duration (group 1: weeks 0–2, 280 minutes; group 2: weeks 0–4, 560 minutes; group 3: weeks 0–6, 840 minutes; group 4: weeks 0–8, 1120 minutes; group 5: weeks 0–10, 1400 minutes; group 6: weeks 0–12, 1680 minutes). At the end of the 2nd, 4th, 6th, 8th, 10th, and 12th weeks, the rats were euthanized, and bilateral tibias were harvested. Peri-implant bone volume and bone-implant contact were assessed by micro–computed tomography; the implantbone interface was assessed histologically; and implant fixation strength was determined by a removal torque test. Low-intensity pulsed US increased bone-implant contact at the 4th, 6th, 8th, 10th, and 12th weeks (P = .019, .017, <.001, <.001, and <.001, respectively) and periimplant bone volume at all times (P = <.001, .002, .012, .007, .005, and .010). Removal torque on the US side was improved at the 6th, 8th, 10th, and 12th weeks (P= .012, <.001, .006, and .009). Ultrasound evoked a favorable bone response in the histologic study. Low-intensity pulsed US might enhance new bone formation, especially at an early stage, and improve osseointegration in osteoporotic bone as an auxiliary method. However, further studies are needed to elucidate the mechanisms underlying its action.

Effects of Low-Intensity Pulsed Ultrasound on Implant Osseointegration in Ovariectomized Rats.

PubMed

Zhou, Hongbo; Hou, Yongfu; Zhu, Zhimin; Xiao, Weixiong; Xu, Qian; Li, Lei; Li, Xin; Chen, Wenchuan

2016-04-01

To investigate the effect of low-intensity pulsed ultrasound (US) on peri-implant bone healing and osseointegration under osteoporotic conditions. Seventy-two 12-week-old female Sprague Dawley rats received bilateral ovariectomies. Twelve weeks later, titanium implants were bilaterally placed in the proximal tibial metaphysis. The right tibia was exposed to low-intensity pulsed US (40 mW/cm 2 , spatial and temporal average) for 20 min/d starting the 2nd day after implantation, and the left tibia served as a control without stimulation. The rats were randomly assigned to 6 groups of 12 each according to the US duration (group 1: weeks 0-2, 280 minutes; group 2: weeks 0-4, 560 minutes; group 3: weeks 0-6, 840 minutes; group 4: weeks 0-8, 1120 minutes; group 5: weeks 0-10, 1400 minutes; group 6: weeks 0-12, 1680 minutes). At the end of the 2nd, 4th, 6th, 8th, 10th, and 12th weeks, the rats were euthanized, and bilateral tibias were harvested. Peri-implant bone volume and bone-implant contact were assessed by micro-computed tomography; the implant-bone interface was assessed histologically; and implant fixation strength was determined by a removal torque test. Low-intensity pulsed US increased bone-implant contact at the 4th, 6th, 8th, 10th, and 12th weeks (P = .019, .017, <.001, <.001, and <.001, respectively) and peri-implant bone volume at all times (P = <.001, .002, .012, .007, .005, and .010). Removal torque on the US side was improved at the 6th, 8th, 10th, and 12th weeks (P= .012, <.001, .006, and .009). Ultrasound evoked a favorable bone response in the histologic study. Low-intensity pulsed US might enhance new bone formation, especially at an early stage, and improve osseointegration in osteoporotic bone as an auxiliary method. However, further studies are needed to elucidate the mechanisms underlying its action. © 2016 by the American Institute of Ultrasound in Medicine.

Variation in Patient Profiles and Outcomes in US and Non-US Subgroups of the Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION) PHOENIX Trial

PubMed Central

Vaduganathan, Muthiah; Harrington, Robert A.; Stone, Gregg W.; Steg, Ph. Gabriel; Gibson, C. Michael; Hamm, Christian W.; Price, Matthew J.; Prats, Jayne; Deliargyris, Efthymios N.; Mahaffey, Kenneth W.; White, Harvey D.

2016-01-01

Background— The Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION) PHOENIX trial demonstrated superiority of cangrelor in reducing ischemic events at 48 hours in patients undergoing percutaneous coronary intervention compared with clopidogrel. Methods and Results— We analyzed all patients included in the modified intention-to-treat analysis in US (n=4097; 37.4%) and non-US subgroups (n=6845; 62.6%). The US cohort was older, had a higher burden of cardiovascular risk factors, and had more frequently undergone prior cardiovascular procedures. US patients more frequently underwent percutaneous coronary intervention for stable angina (77.9% versus 46.2%). Almost all US patients (99.1%) received clopidogrel loading doses of 600 mg, whereas 40.5% of non-US patients received 300 mg. Bivalirudin was more frequently used in US patients (56.7% versus 2.9%). At 48 hours, rates of the primary composite end point were comparable in the US and non-US cohorts (5.5% versus 5.2%; P=0.53). Cangrelor reduced rates of the primary composite end point compared with clopidogrel in US (4.5% versus 6.4%; odds ratio 0.70 [95% confidence interval 0.53–0.92]) and in non-US patients (4.8% versus 5.6%; odds ratio 0.85 [95% confidence interval 0.69–1.05]; interaction P=0.26). Similarly, rates of the key secondary end point, stent thrombosis, were reduced by cangrelor in both regions. Rates of Global Use of Strategies to Open Occluded Arteries (GUSTO)–defined severe bleeding were low and not significantly increased by cangrelor in either region. Conclusions— Despite broad differences in clinical profiles and indications for percutaneous coronary intervention by region in a large global cardiovascular clinical trial, cangrelor consistently reduced rates of ischemic end points compared with clopidogrel without an excess in severe bleeding in both the US and non-US subgroups. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01156571. PMID:27313282

[Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile].

PubMed

Alarcón, Álvaro; Lagos, Isabel; Fica, Alberto

2016-08-01

Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.

Comparing Global Influence: China’s and U.S. Diplomacy, Foreign Aid, Trade, and Investment in the Developing World

DTIC Science & Technology

2008-08-15

from 2006-2010 and about 7.4% for Source: United Nations, COMTRADE Database . 95 96 97 98 99 2000 1 2 3 4 5 6 7 Year 0 500 1000 1500 2000 2500 3000...49 Source: United Nations, COMTRADE Database . 95 96 97 98 99 2000 1 2 3 4 5 6 7 Year 0 200 400 600 800 1000 1200 1400 $Billion China Exports 149 151...U.S. and China’s Exports of Goods to the World Source: United Nations, COMTRADE Database . 95 96 97 98 99 2000 1 2 3 4 5 6 7 Year 0 500 1000 1500

The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

PubMed

Hyle, Emily P; Jani, Ilesh V; Lehe, Jonathan; Su, Amanda E; Wood, Robin; Quevedo, Jorge; Losina, Elena; Bassett, Ingrid V; Pei, Pamela P; Paltiel, A David; Resch, Stephen; Freedberg, Kenneth A; Peter, Trevor; Walensky, Rochelle P

2014-09-01

Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique. We use a validated model of HIV testing, linkage, and treatment (CEPAC-International) to examine two strategies of immunological staging in Mozambique: (1) laboratory-based CD4 testing (LAB-CD4) and (2) point-of-care CD4 testing (POC-CD4). Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%), probability of correctly detecting antiretroviral therapy (ART) eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90%) or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%), and test cost (LAB-CD4, US$10; POC-CD4, US$24). In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570) to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%), increasing to 65.0% (95% CI, 64.9%-65.1%) with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y) and US$2,440 (95% CI, US$2,440-US$2,450) and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y) and US$2,800 (95% CI, US$2,790-US$2,800); the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS) (95% CI, US$480-US$520/YLS). POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published values. In other resource-limited settings with fewer opportunities to access care, POC-CD4 has a greater impact on clinical outcomes and remains cost-effective compared to LAB-CD4. Limitations of the analysis include the uncertainty around input parameters, which is examined in sensitivity analyses. The potential added benefits due to decreased transmission are excluded; their inclusion would likely further increase the value of POC-CD4 compared to LAB-CD4. POC-CD4 at the time of HIV diagnosis could improve survival and be cost-effective compared to LAB-CD4 in Mozambique, if it improves linkage to care. POC-CD4 could have the greatest impact on mortality in settings where resources for HIV testing and linkage are most limited. Please see later in the article for the Editors' Summary.

Point-of-sale cigarette purchase patterns among U.S. adult smokers-National Adult Tobacco Survey, 2012-2014.

PubMed

Kruger, Judy; Jama, Amal; Lee, Joseph G L; Kennedy, Sara; Banks, Asha; Sharapova, Saida; Agaku, Israel

2017-08-01

Tobacco products are ubiquitous in most U.S. retail environments. Given that data on preferred point-of-sale purchase locations among U.S. adult tobacco users are limited, an enhanced understanding of tobacco purchase locations can help inform tobacco control policy, planning, and practice. We investigated prevalence and sociodemographic characteristics associated with cigarette purchase location among U.S. adult smokers. Pooled data came from the 2012-2013 (N=60,192) and 2013-2014 (N=75,233) National Adult Tobacco Surveys. Current cigarette smokers (n=18,005) aged ≥18 were asked if they purchased cigarettes within the previous 30days (n=15,182) and, if so, where they last purchased cigarettes. In 2016, logistic regression adjusted for sex, age, race/ethnicity, education level and annual household income was used to assess characteristics associated with purchase location. Among current smokers, 90.2% reported purchasing cigarettes in the past 30days. The most common purchase locations were convenience stores/gas stations (69.1%), tobacco discount stores (9.9%), drug stores (5.0%), supermarkets (4.9%), and liquor stores (3.6%). The odds of purchasing cigarettes at convenience stores/gas stations were higher among men (adjusted odds ratio (AOR)=1.4; 95% confidence interval (CI)=1.2-1.5) than women; and among adults aged 18-24 (AOR=3.1; 95% CI=2.4-3.9), 25-44 (AOR=3.1; 95% CI=2.7-3.7), and 45-64years (AOR=1.8 95% CI=1.6-2.1) than adults aged ≥65years. Over two-thirds of U.S. smokers last purchased cigarettes from convenience stores/gas stations. Understanding the relationship between purchase location and smoker characteristics may inform tobacco control strategies in the retail environment. Published by Elsevier Inc.

USE OF PHARMACOKINETIC MODEL TO ASSESS CHLORPYRIFOS EXPOSURE AND DOSE IN CHILDREN BASED ON URINARY BIOMARKER MEASUREMENTS

EPA Science Inventory

Chlorpyrifos is a common agricultural insecticide and has been used residentially in the United States until 2000 when this use was restricted by the U.S. Environmental Protection Agency (U.S. EPA). A chlorpyrifos metabolite, 3,5,6-trichloro-2-pyridinol (TCPy) has been found i...

CONTROL TECHNOLOGY: SUMMARY OF THE 1991 EPRI/EPA/DOE S02 CONTROL SYMPOSIUM

EPA Science Inventory

The 1991 SO₂ Control Symposium was held December 3–6, 1991, in Washington, D.C. The symposium, jointly sponsored by the Electric Power Research Institute (EPRI), the U.S. Environmental Protection Agency (EPA), and the U.S. Department of Energy (DOE), focused attention...

U.S. Foreign Aid to East and South Asia: Selected Recipients

DTIC Science & Technology

2006-08-27

Levels and Restrictions — South Asia . . . . . . . . . . . . . . . . . . . . . . 28 Bangladesh ...24 Table 14. U.S. Assistance to Bangladesh , 2003-2007 . . . . . . . . . . . . . . . . . . . . 28 Table 15. U.S...and Appendix. 2001 2002 2003 2004 2005 2006 est. 0 200 400 600 800 1000 1200 1 - Bangladesh 2 - Cambodia 3 - India 4 - Indonesia 5 - Pakistan 6

Visual screening for malignant melanoma: a cost-effectiveness analysis.

PubMed

Losina, Elena; Walensky, Rochelle P; Geller, Alan; Beddingfield, Frederick C; Wolf, Lindsey L; Gilchrest, Barbara A; Freedberg, Kenneth A

2007-01-01

To evaluate the cost-effectiveness of various melanoma screening strategies proposed in the United States. We developed a computer simulation Markov model to evaluate alternative melanoma screening strategies. Hypothetical cohort of the general population and siblings of patients with melanoma. Intervention We considered the following 4 strategies: background screening only, and screening 1 time, every 2 years, and annually, all beginning at age 50 years. Prevalence, incidence, and mortality data were taken from the Surveillance, Epidemiology, and End Results Program. Sibling risk, recurrence rates, and treatment costs were taken from the literature. Outcomes included life expectancy, quality-adjusted life expectancy, and lifetime costs. Cost-effectiveness ratios were in dollars per quality-adjusted life year (US dollars/QALY) gained. In the general population, screening 1 time, every 2 years, and annually saved 1.6, 4.4, and 5.2 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 10,100/QALY, US dollars 80,700/QALY, and US dollars 586,800/QALY, respectively. In siblings of patients with melanoma (relative risk, 2.24 compared with the general population), 1-time, every-2-years, and annual screenings saved 3.6, 9.8, and 11.4 QALYs per 1000 persons screened, with incremental cost-effectiveness ratios of US dollars 4000/QALY, US dollars 35,500/QALY, and US dollars 257,800/QALY, respectively. In higher risk siblings of patients with melanoma (relative risk, 5.56), screening was more cost-effective. Results were most sensitive to screening cost, melanoma progression rate, and specificity of visual screening. One-time melanoma screening of the general population older than 50 years is very cost-effective compared with other cancer screening programs in the United States. Screening every 2 years in siblings of patients with melanoma is also cost-effective.

Epidemiology of Usher syndrome in Valencia and Spain.

PubMed

Espinós, C; Millán, J M; Beneyto, M; Nájera, C

1998-01-01

To obtain epidemiological data on the prevalence of the different types of Usher syndrome (US) in Spain, since these data were missing; to estimate the proportion of sporadic cases among simplex families, and calculate the prevalence of the Usher syndrome in a homogeneous population from Eastern Spain (3,875,234 inhabitants) that is representative of the Spanish population. Otological, ophthalmological and genetic studies were performed in 89 US patients from 46 families and subjected to statistical and segregation analysis. 41.6% of them suffered US type I, 46.1% type II, and in 12.3% the classification remains unclear. The estimated prevalence for the Province of Valencia was 4.2/100,000. There was a notable excess of male-only affected multiplex sibships in our sample that could be attributable to an X-linked inheritance. The number of families with USI type was similar to that of families with USII type. The estimated prevalence for the Province of Valencia is in agreement with other reports in which the estimate for the prevalence of US ranges from 1.8 to 6.2/100,000.

Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses

PubMed Central

Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

2013-01-01

Objective: Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. Patients and Methods: A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). Results: EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). Conclusion: EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate. PMID:24949394

Assessing fundamental motor skills in Belgian children aged 3-8 years highlights differences to US reference sample.

PubMed

Bardid, Farid; Huyben, Floris; Lenoir, Matthieu; Seghers, Jan; De Martelaer, Kristine; Goodway, Jacqueline D; Deconinck, Frederik J A

2016-06-01

This study aimed to understand the fundamental motor skills (FMS) of Belgian children using the process-oriented Test of Gross Motor Development, Second Edition (TGMD-2) and to investigate the suitability of using the United States (USA) test norms in Belgium. FMS were assessed using the TGMD-2. Gender, age and motor performance were examined in 1614 Belgian children aged 3-8 years (52.1% boys) and compared with the US reference sample. More proficient FMS performance was found with increasing age, from 3 to 6 years for locomotor skills and 3 to 7 years for object control skills. Gender differences were observed in object control skills, with boys performing better than girls. In general, Belgian children had lower levels of motor competence than the US reference sample, specifically for object control skills. The score distribution of the Belgian sample was skewed, with 37.4% scoring below average and only 6.9% scoring above average. This study supported the usefulness of the TGMD-2 as a process-oriented instrument to measure gross motor development in early childhood in Belgium. However, it also demonstrated that caution is warranted when using the US reference norms. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Risk factors associated with higher body fat in US Army female soldiers.

PubMed

Anderson, Morgan K; Grier, Tyson; Canham-Chervak, Michelle; Bushman, Timothy T; Jones, Bruce H

2014-01-01

Increased body fat among US Soldiers is a continuing challenge that contributes to increased health risks and decreased combat readiness. Factors contributing to higher body fat among US Army female Soldiers have been minimally investigated. To investigate the risk factors associated with exceeding US Army body fat standards among active duty women in a light infantry brigade. Investigated risk factors include personal characteristics, physical training, physical fitness, and injury history. Data were obtained by survey from women in 3 US Army infantry brigades. Body fat percentage was calculated, and the women were categorized as either meeting or exceeding the maximum Army body fat standard of 30% for ages 17-20, 32% for ages 21-27, 34% for ages 28-39, and 36% for age 40 years or more. Army Physical Fitness Test (APFT) results were converted into tertiles (T), where T1=lowest 1/3 of performance and T3=highest 1/3 of performance. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from a multivariate analysis assessing risk associated with exceeding the Army body fat standards. Among the women surveyed (n=629), 22% exceeded Army body fat standards. Higher risk of being above the Army standard was associated with older age (≥29 years / ≤23 years) (OR=47, 95% CI, 1.24-4.92), and poor aerobic fitness (APFT 2-mile run) (T1/T3) OR=6.11, 95% CI, 2.62-14.24), (T1/T2) OR=2.66, 95% CI, 1.12-6.33). A marginal association was found for poor muscular strength (APFT sit-ups) (T1/T3). The results suggest that women who are older, and/or have poor aerobic fitness are more likely to exceed the maximum Army body fat standards.

Feasibility of Using Volumetric Contrast-Enhanced Ultrasound with a 3-D Transducer to Evaluate Therapeutic Response after Targeted Therapy in Rabbit Hepatic VX2 Carcinoma.

PubMed

Kim, Jeehyun; Kim, Jung Hoon; Yoon, Soon Ho; Choi, Won Seok; Kim, Young Jae; Han, Joon Koo; Choi, Byung-Ihn

2015-12-01

The aim of this study was to assess the feasibility of using dynamic contrast-enhanced ultrasound (DCE-US) with a 3-D transducer to evaluate therapeutic responses to targeted therapy. Rabbits with hepatic VX2 carcinomas, divided into a treatment group (n = 22, 30 mg/kg/d sorafenib) and a control group (n = 13), were evaluated with DCE-US using 2-D and 3-D transducers and computed tomography (CT) perfusion imaging at baseline and 1 d after the first treatment. Perfusion parameters were collected, and correlations between parameters were analyzed. In the treatment group, both volumetric and 2-D DCE-US perfusion parameters, including peak intensity (33.2 ± 19.9 vs. 16.6 ± 10.7, 63.7 ± 20.0 vs. 30.1 ± 19.8), slope (15.3 ± 12.4 vs. 5.7 ± 4.5, 37.3 ± 20.4 vs. 15.7 ± 13.0) and area under the curve (AUC; 1004.1 ± 560.3 vs. 611.4 ± 421.1, 1332.2 ± 708.3 vs. 670.4 ± 388.3), had significantly decreased 1 d after the first treatment (p = 0.00). In the control group, 2-D DCE-US revealed that peak intensity, time to peak and slope had significantly changed (p < 0.05); however, volumetric DCE-US revealed that peak intensity, time-intensity AUC, AUC during wash-in and AUC during wash-out had significantly changed (p = 0.00). CT perfusion imaging parameters, including blood flow, blood volume and permeability of the capillary vessel surface, had significantly decreased in the treatment group (p = 0.00); however, in the control group, peak intensity and blood volume had significantly increased (p = 0.00). It is feasible to use DCE-US with a 3-D transducer to predict early therapeutic response after targeted therapy because perfusion parameters, including peak intensity, slope and AUC, significantly decreased, which is similar to the trend observed for 2-D DCE-US and CT perfusion imaging parameters. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Effectiveness of a Layer-by-Layer Microbubbles-Based Delivery System for Applying Minoxidil to Enhance Hair Growth.

PubMed

Liao, Ai-Ho; Lu, Ying-Jui; Lin, Yi-Chun; Chen, Hang-Kang; Sytwu, Huey-Kang; Wang, Chih-Hung

2016-01-01

Minoxidil (Mx) is a conventional drug for treating androgenetic alopecia, preventing hair loss, and promoting hair growth. The solubility of Mx has been improved using chemical enhancement methods to increase its skin permeability over the long term. This study created a new ultrasound (US) contrast agent-albumin-shelled microbubbles (MBs) that absorb chitosan oligosaccharide lactate (COL) and Mx-and combined it with sonication by US energy in the water phase to enhance hair growth while shortening the treatment period. COL and Mx grafted with MBs (mean diameter of 1480 nm) were synthesized into self-assembled complexes of COL-MBs and Mx-COL-MBs that had mean diameters of 4150 and 4500 nm, respectively. The US was applied at 3 W/cm(2) for 1 min, and combined with Mx-COL-MBs containing 0.3% Mx. The diffusion of Mx through the dialysis membrane from Mx-COL-MB during US (US+Mx-COL-MB) was more rapid at pH 4 than at pH 7.4, which is favorable given that the environment of the scalp is mildly acidic (pH=4.5-5.5). In Franz diffusion experiments performed in vitro, the release rates at 18 hours in the US+Mx-COL-MBs and US+MBs+Mx groups resulted in 2.3 and 1.7 times the penetration and deposition, respectively, of Mx relative to the group with Mx alone. During 21 days treatment in animal experiments, the growth rates at days 10 and 14 in the US+Mx-COL-MBs group increased by 22.6% and 64.7%, respectively, and there were clear significant differences (p<0.05) between the US+Mx-COL-MBs group and the other four groups. The use of US+Mx-COL-MB in the water phase can increased the effects of Mx so as to shorten the telogen phase, and also increase both the diameter of keratinized hair shafts and the size of hair follicles without causing skin damage.

Effects of breastfeeding on postpartum weight loss among U.S. women.

PubMed

Jarlenski, Marian P; Bennett, Wendy L; Bleich, Sara N; Barry, Colleen L; Stuart, Elizabeth A

2014-12-01

The aim of this study is to evaluate the effects of breastfeeding on maternal weight loss in the 12months postpartum among U.S. women. Using data from a national cohort of U.S. women conducted in 2005-2007 (N=2102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. Compared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3months resulted in 3.2 pound (95% CI: 1.4,4.7) greater weight loss at 12months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. Our study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women. Copyright © 2014 Elsevier Inc. All rights reserved.

Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012.

PubMed

Booth, John N; Li, Jiexiang; Zhang, Lu; Chen, Liwei; Muntner, Paul; Egan, Brent

2017-08-01

Prehypertension is associated with increased risk for hypertension and cardiovascular disease. Data are limited on the temporal changes in the prevalence of prehypertension and risk factors for hypertension and cardiovascular disease among US adults with prehypertension. We analyzed data from 30 958 US adults ≥20 years of age who participated in the National Health and Nutrition Examination Surveys between 1999 and 2012. Using the mean of 3 blood pressure (BP) measurements from a study examination, prehypertension was defined as systolic BP of 120 to 139 mm Hg and diastolic BP <90 mm Hg or diastolic BP of 80 to 89 mm Hg and systolic BP <140 mm Hg among participants not taking antihypertensive medication. Between 1999-2000 and 2011-2012, the percentage of US adults with prehypertension decreased from 31.2% to 28.2% ( P trend=0.007). During this time period, the prevalence of several risk factors for cardiovascular disease and incident hypertension increased among US adults with prehypertension, including prediabetes (9.6% to 21.6%), diabetes mellitus (6.0% to 8.5%), overweight (33.5% to 37.3%), and obesity (30.6% to 35.2%). There was a nonstatistically significant increase in no weekly leisure-time physical activity (40.0% to 43.9%). Also, the prevalence of adhering to the Dietary Approaches to Stop Hypertension eating pattern decreased (18.4% to 11.9%). In contrast, there was a nonstatistically significant decline in current smoking (25.9% to 23.2%). In conclusion, the prevalence of prehypertension has decreased modestly since 1999-2000. Population-level approaches directed at adults with prehypertension are needed to improve risk factors to prevent hypertension and cardiovascular disease. © 2017 American Heart Association, Inc.

SU-E-J-205: Monte Carlo Modeling of Ultrasound Probes for Real-Time Ultrasound Image-Guided Radiotherapy

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

Hristov, D; Schlosser, J; Bazalova, M

2014-06-01

Purpose: To quantify the effect of ultrasound (US) probe beam attenuation for radiation therapy delivered under real-time US image guidance by means of Monte Carlo (MC) simulations. Methods: MC models of two Philips US probes, an X6-1 matrix-array transducer and a C5-2 curved-array transducer, were built based on their CT images in the EGSnrc BEAMnrc and DOSXYZnrc codes. Due to the metal parts, the probes were scanned in a Tomotherapy machine with a 3.5 MV beam. Mass densities in the probes were assigned based on an electron density calibration phantom consisting of cylinders with mass densities between 0.2–8.0 g/cm{sup 3}.more » Beam attenuation due to the probes was measured in a solid water phantom for a 6 MV and 15 MV 15x15 cm{sup 2} beam delivered on a Varian Trilogy linear accelerator. The dose was measured with the PTW-729 ionization chamber array at two depths and compared to MC simulations. The extreme case beam attenuation expected in robotic US image guided radiotherapy for probes in upright position was quantified by means of MC simulations. Results: The 3.5 MV CT number to mass density calibration curve was found to be linear with R{sup 2} > 0.99. The maximum mass densities were 4.6 and 4.2 g/cm{sup 3} in the C5-2 and X6-1 probe, respectively. Gamma analysis of the simulated and measured doses revealed that over 98% of measurement points passed the 3%/3mm criteria for both probes and measurement depths. The extreme attenuation for probes in upright position was found to be 25% and 31% for the C5-2 and X6-1 probe, respectively, for both 6 and 15 MV beams at 10 cm depth. Conclusion: MC models of two US probes used for real-time image guidance during radiotherapy have been built. As a Result, radiotherapy treatment planning with the imaging probes in place can now be performed. J Schlosser is an employee of SoniTrack Systems, Inc. D Hristov has financial interest in SoniTrack Systems, Inc.« less

Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012

PubMed Central

Ford, Earl S.; Cunningham, Timothy J.; Croft, Janet B.

2015-01-01

Study Objective: The trend in sleep duration in the United States population remains uncertain. Our objective was to examine changes in sleep duration from 1985 to 2012 among US adults. Design: Trend analysis. Setting: Civilian noninstitutional population of the United States. Participants: 324,242 US adults aged ≥ 18 y of the National Health Interview Survey (1985, 1990, and 2004–2012). Measurements and Results: Sleep duration was defined on the basis of the question “On average, how many hours of sleep do you get in a 24-h period?” The age-adjusted mean sleep duration was 7.40 h (standard error [SE] 0.01) in 1985, 7.29 h (SE 0.01) in 1990, 7.18 h (SE 0.01) in 2004, and 7.18 h (SE 0.01) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004–2012 = 0.982). The age-adjusted percentage of adults sleeping ≤ 6 h was 22.3% (SE 0.3) in 1985, 24.4% (SE 0.3) in 1990, 28.6% (SE 0.3) in 2004, and 29.2% (SE 0.3) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004–2012 = 0.050). In 2012, approximately 70.1 million US adults reported sleeping ≤ 6 h. Conclusions: Since 1985, age-adjusted mean sleep duration has decreased slightly and the percentage of adults sleeping ≤ 6 h increased by 31%. Since 2004, however, mean sleep duration and the percentage of adults sleeping ≤ 6 h have changed little. Citation: Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. SLEEP 2015;38(5):829–832. PMID:25669182

Terrorism as a Perceived Threat to US Armed Forces Serving OCONUS and the Army’s Program of Addressing That Threat.

DTIC Science & Technology

1986-03-27

many terrorist groups with plastique and other explosives to build bombs. 6 Using these explosives they have produced vehicle bombs which are totally...US Army War College Study, 19 April 1982. 3. TRADOC Pam 525-37, Military Operations, US Army Operational Concept For Terrorism Counteraction, 19...Army (U). Counterintelligence Special Report. (Overall Report (S)), 1981. 30. US Army. TRADOC Pam 525-37. "Military Operations." US Army Concept For

Do Anesthetic Techniques Influence the Threshold for Glomerular Capillary Hemorrhage Induced in Rats by Contrast-Enhanced Diagnostic Ultrasound?

PubMed

Miller, Douglas L; Lu, Xiaofang; Fabiilli, Mario; Dou, Chunyan

2016-02-01

Glomerular capillary hemorrhage can be induced by ultrasonic cavitation during contrast-enhanced diagnostic ultrasound (US) exposure, an important nonthermal US bioeffect. Recent studies of pulmonary US exposure have shown that thresholds for another nonthermal bioeffect of US, pulmonary capillary hemorrhage, is strongly influenced by whether xylazine is included in the specific anesthetic technique. The objective of this study was to determine the influence of xylazine on contrast-enhanced diagnostic US-induced glomerular capillary hemorrhage. In this study, anesthesia with ketamine only was compared to ketamine plus xylazine for induction of glomerular capillary hemorrhage in rats by 1.6-MHz intermittent diagnostic US with a microsphere contrast agent (similar to Definity; Lantheus Medical Imaging, Inc, North Billerica, MA). Glomerular capillary hemorrhage was measured as a percentage of glomeruli with hemorrhage found in histologic sections for groups of rats scanned at different peak rarefactional pressure amplitudes. There was a significant difference between the magnitude of the glomerular capillary hemorrhage between the anesthetics at 2.3 MPa, with 45.6% hemorrhage for ketamine only, increasing to 63.2% hemorrhage for ketamine plus xylazine (P < .001). However, the thresholds for the two anesthetic methods were virtually identical at 1.0 MPa, based on linear regression of the exposure response data. Thresholds for contrast-enhanced diagnostic US-induced injury of the microvasculature appear to be minimally affected by anesthetic methods. © 2016 by the American Institute of Ultrasound in Medicine.

Cost effectiveness of facility-based care, home-based care and mobile clinics for provision of antiretroviral therapy in Uganda.

PubMed

Babigumira, Joseph B; Sethi, Ajay K; Smyth, Kathleen A; Singer, Mendel E

2009-01-01

Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years. Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses. FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost.

Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

PubMed Central

Babigumira, Joseph B.; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

2012-01-01

Background Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical Stage 3 and 4 from the perspective of the Ugandan healthcare system. The main outcome measures were cost (year 2008 values), life expectancy in life-years (LY) and the incremental cost-effectiveness ratio (ICER) measured as cost per QALY or LY gained over 10 years. Results Ten-year mean undiscounted life expectancy was lowest for FBC (3.6 LY), followed by MCC (4.3 LY) and highest for HBC (5.3 LY), while the mean discounted QALYs were also lowest for FBC (2.3), followed by MCC (2.9) and highest for HBC (3.7). The 10-year mean costs per patient were lowest for FBC ($US3212), followed by MCC ($US4782) and highest for HBC ($US7033). The ICER was lower for MCC versus FBC ($US2241 per LY and $US2615 per QALY) than for HBC versus MCC ($US2251 per LY and $US2814 per QALY). FBC remained cost effective in univariate and probabilistic sensitivity analyses. Conclusions FBC appears to be the most cost-effective programme for provision of ART in Uganda. This analysis supports the implementation of FBC for scale-up and sustainability of ART in Uganda. HBC and MCC would be competitive only if there is increased access, increased adherence or reduced cost. PMID:19888795

7 CFR 51.2832 - U.S. Commercial.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false U.S. Commercial. 51.2832 Section 51.2832 Agriculture... Creole Types) Grades § 51.2832 U.S. Commercial. U.S. Commercial consists of onions which meet the...) Roots; (4) Dry sunken areas; (5) Sunburn; (6) Sprouts; (7) Freezing; (8) Cracked fleshy scales; (9...

Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography.

PubMed

Vlahiotis, Anna; Griffin, Brian; Stavros, A Thomas; Margolis, Jay

2018-01-01

Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures. Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes. The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion. The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.

Renal Sympathetic Denervation System via Intraluminal Ultrasonic Ablation: Therapeutic Intravascular Ultrasound Design and Preclinical Evaluation.

PubMed

Chernin, Gil; Szwarcfiter, Iris; Bausback, Yvonne; Jonas, Michael

2017-05-01

To assess the safety and performance of a nonfocused and nonballooned ultrasonic (US) catheter-based renal sympathetic denervation (RDN) system in normotensive swine. RDN with the therapeutic intravascular US catheter was evaluated in 3 experiments: (i) therapeutic intravascular US RDN vs a control group of untreated animals with follow-up of 30, 45, and 90 days (n = 6; n = 12 renal arteries for each group); (ii) therapeutic intravascular US RDN vs radiofrequency (RF) RDN in the contralateral artery in the same animal (n = 2; n = 4 renal arteries); and (iii) therapeutic intravascular US RDN in a recently stent-implanted renal artery (n = 2; n = 4 renal arteries). In the first experiment, therapeutic intravascular US RDN was safe, without angiographic evidence of dissection or renal artery stenosis. Neuronal tissue vacuolization, nuclei pyknosis, and perineuronal inflammation were evident after RDN, without renal artery wall damage. Norepinephrine levels were significantly lower after therapeutic intravascular US RDN after 30, 45, and 90 days compared with the control group (200.17 pg/mg ± 63.35, 184.75 pg/mg ± 44.51, and 203.43 pg/mg ± 58.54, respectively, vs 342.42 pg/mg ± 79.97). In the second experiment, deeper neuronal ablation penetrance was found with therapeutic intravascular US RDN vs RF RDN (maximal penetrance from endothelium of 7.0 mm vs 3.5 mm, respectively). There was less damage to the artery wall after therapeutic intravascular US RDN than with RF RDN, after which edema and injured endothelium were seen. In the third experiment, denervation inside the stent-implanted segments was feasible without damage to the renal artery wall or stent. The therapeutic intravascular US system performed safely and reduced norepinephrine levels. Deeper penetrance and better preservation of vessel wall were observed with therapeutic intravascular US RDN vs RF RDN. Neuronal ablations were observed in stent-implanted renal arteries. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Shock and Static Compression of Nitrobenzene

NASA Astrophysics Data System (ADS)

Kozu, Naoshi; Arai, Mitsuru; Tamura, Masamitsu; Fujihisa, Hiroshi; Aoki, Katsutoshi; Yoshida, Masatake

2000-08-01

The Hugoniot and static compression curve (isotherm) were investigated using explosive plane wave generators and diamond anvil cells, respectively. The obtained Hugoniot from the shock experiments is represented by two linear lines: Us=2.52+1.23 up (0.8

The Economic Burden of Violence against Children in South Africa.

PubMed

Fang, Xiangming; Zheng, Xiaodong; Fry, Deborah A; Ganz, Gary; Casey, Tabitha; Hsiao, Celia; Ward, Catherine L

2017-11-22

The purpose of this study was to estimate the economic burden of violence against children in South Africa. We assembled summative estimates of lifetime prevalence, calculated the magnitude of associations with negative outcomes, and thereby estimated the economic burden of violence against children. According to our calculations, 2.3 million and 84,287 disability-adjusted life-years (DALYs) lost in South Africa in 2015 were attributable to nonfatal and fatal violence against children, respectively. The estimated economic value of DALYs lost to violence against children (including both fatal and nonfatal) in South Africa in 2015 totalled ZAR173 billion (US $13.5 billion)-or 4.3% of South Africa's gross domestic product (GDP) in 2015. In addition, the reduced earnings attributable to childhood physical violence and emotional violence in South Africa in 2015 were ZAR25.2 billion (US $2.0 billion) and ZAR9.6 billion (US $750 million), respectively. In addition, South Africa spent ZAR1.6 billion (US $124 million) on child care and protection in fiscal year 2015/2016, many of which costs are directly related to violence against children. This study confirms the importance of prioritising violence against children as a key social and economic concern for South Africa's future.

Segmentation of the common carotid artery with active shape models from 3D ultrasound images

NASA Astrophysics Data System (ADS)

Yang, Xin; Jin, Jiaoying; He, Wanji; Yuchi, Ming; Ding, Mingyue

2012-03-01

Carotid atherosclerosis is a major cause of stroke, a leading cause of death and disability. In this paper, we develop and evaluate a new segmentation method for outlining both lumen and adventitia (inner and outer walls) of common carotid artery (CCA) from three-dimensional ultrasound (3D US) images for carotid atherosclerosis diagnosis and evaluation. The data set consists of sixty-eight, 17× 2× 2, 3D US volume data acquired from the left and right carotid arteries of seventeen patients (eight treated with 80mg atorvastain and nine with placebo), who had carotid stenosis of 60% or more, at baseline and after three months of treatment. We investigate the use of Active Shape Models (ASMs) to segment CCA inner and outer walls after statin therapy. The proposed method was evaluated with respect to expert manually outlined boundaries as a surrogate for ground truth. For the lumen and adventitia segmentations, respectively, the algorithm yielded Dice Similarity Coefficient (DSC) of 93.6%+/- 2.6%, 91.8%+/- 3.5%, mean absolute distances (MAD) of 0.28+/- 0.17mm and 0.34 +/- 0.19mm, maximum absolute distances (MAXD) of 0.87 +/- 0.37mm and 0.74 +/- 0.49mm. The proposed algorithm took 4.4 +/- 0.6min to segment a single 3D US images, compared to 11.7+/-1.2min for manual segmentation. Therefore, the method would promote the translation of carotid 3D US to clinical care for the fast, safety and economical monitoring of the atherosclerotic disease progression and regression during therapy.

Site Investigation Report Groups 3,5, and 6 Fort Devens, Massachusetts. Volume 2 of 2: Appendices

DTIC Science & Technology

1996-01-01

Invertebrates: A Synoptic Review" U.S. Fish and Wildlife Service Biological Report 85 (1.6), 60 pp. Eisler , R., 1987 . "Mercury Hazards to Fish, Wildlife, and...Invertebrates: A Synoptic Review" U.S. Fish and Wildlife Service Biological Report 85 (1.10), 90 pp. Eisler , R., 1987 . "Polycyclic Aromatic...1983). [f] From Eisler ( 1987 ). [g] Value from Hansch and Leo (1979). [h] Plant value from Eisler (1988). [i] Mammal value from USEPA (1985). [j

United States Geological Survey Alaska Program, 1975

USGS Publications Warehouse

Yount, M.E.

1975-01-01

This report on the Alaskan activities of the U.S. Geological Survey contains up-to-date accounts of recent results and summaries of plans for the summer of 1975. It is organized in six parts: (1} responsibilities and services of the Geological Survey; (2} organization of the U.S. Geological Survey; (3) U.S. Geological Survey Alaskan field activities for 1975; (4) cooperative projects with State and Federal agencies; (5) summary of important results of geological, hydrological, and geophysical research in 1974; and (6) reports published by Survey authors in 1974.

Placental Extravillous Cytotrophoblasts Persistently Express Class I Major Histocompatibility Complex Molecules after Human Cytomegalovirus Infection

PubMed Central

Terauchi, Masakazu; Koi, Hideki; Hayano, Chikako; Toyama-Sorimachi, Noriko; Karasuyama, Hajime; Yamanashi, Yuji; Aso, Takeshi; Shirakata, Masaki

2003-01-01

Human cytomegalovirus (HCMV) downregulates the class I major histocompatibility complexes (MHCs), HLA-A and -B, in infected fibroblasts to escape from antigen-specific cytotoxic T lymphocytes. The HCMV genes responsible for the downregulation of MHCs are US2, US3, US6, and US11, which encode type I membrane proteins working at the endoplasmic reticulum (ER). However, it is largely unknown whether HCMV downregulates the class I MHC molecules in placental extravillous cytotrophoblasts (EVT), which express HLA-C, -E, and -G to protect a semiallogenic fetus from maternal natural killer (NK) cells at the fetomaternal interface. Here, we report that differentiated EVT prepared from human first-trimester chorionic villi persistently express class I MHC molecules upon HCMV infection. When these US proteins were expressed in uninfected EVT, they were localized at the ER in the entire cytoplasm. However, subsequent HCMV infection resulted in dissociation of these US proteins from the ER, which relocated toward the cell membrane. In fibroblasts, these US proteins were localized at the ER before and after HCMV infection. These results suggest that the US gene products are not integrated into ER of HCMV-infected EVT and fail to downregulate class I MHC molecules. PMID:12857887

International energy indicators

NASA Astrophysics Data System (ADS)

Bauer, E. K.

1980-03-01

For the international sector, a table of data is first presented followed by corresponding graphs of the data for the following: (1) Iran: crude oil capacity, production, and shut in, 1974 to February 1980; (2) Saudi Arabia (same as Iran); (3) OPEC (ex-Iran and Saudi Arabia); capacity, production, and shutin, 1974 to January 1980; (4) non-OPEC Free World and US production of crude oil, 1973 to January 1980; (5) oil stocks: Free World, US, Japan, and Europe (landed), 1973 to 1979; (6) petroleum consumption by industrial countries, 1973 to October 1979; (7) USSR crude oil production, 1974 to February 1980; (8) Free World and US nuclear generation capacity, 1973 to January 1980. For the United States, the same data format is used for the following: US imports of crude oil and products 1973 to January 1980; landed cost of Saudi Arabia crude oil in current and 1974 dollars, 1974 to October 1979; US trade in coal, 1973 to 1979; summary of US merchandise trade, 1976 to January 1980; and US energy/GNP ratio (in 1972 dollars), 1947 to 1979.

Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images.

PubMed

Dai, Jessica C; Dunmire, Barbrina; Sternberg, Kevan M; Liu, Ziyue; Larson, Troy; Thiel, Jeff; Chang, Helena C; Harper, Jonathan D; Bailey, Michael R; Sorensen, Mathew D

2018-05-01

Posterior acoustic shadow width has been proposed as a more accurate measure of kidney stone size compared to direct measurement of stone width on ultrasound (US). Published data in humans to date have been based on a research using US system. Herein, we compared these two measurements in clinical US images. Thirty patient image sets where computed tomography (CT) and US images were captured less than 1 day apart were retrospectively reviewed. Five blinded reviewers independently assessed the largest stone in each image set for shadow presence and size. Shadow size was compared to US and CT stone sizes. Eighty percent of included stones demonstrated an acoustic shadow; 83% of stones without a shadow were ≤ 5 mm on CT. Average stone size was 6.5 ± 4.0 mm on CT, 10.3 ± 4.1 mm on US, and 7.5 ± 4.2 mm by shadow width. On average, US overestimated stone size by 3.8 ± 2.4 mm based on stone width (p < 0.001) and 1.0 ± 1.4 mm based on shadow width (p < 0.0098). Shadow measurements decreased misclassification of stones by 25% among three clinically relevant size categories (≤ 5, 5.1-10, > 10 mm), and by 50% for stones ≤ 5 mm. US overestimates stone size compared to CT. Retrospective measurement of the acoustic shadow from the same clinical US images is a more accurate reflection of true stone size than direct stone measurement. Most stones without a posterior shadow are ≤ 5 mm.

Effect of packaging during storage time on retail display microbial population of beef strip loins from two different production systems.

PubMed

Luzardo, S; Woerner, D R; Geornaras, I; Hess, A M; Belk, K E

2016-06-01

Two studies were conducted to evaluate the influence of packaging during storage of strip loins (to simulate export shipment) from steers fattened on intensive grazing systems (Uruguay; UR) or on a high-concentrate diet (United States; US) on retail display life microbial growth. Four or 3 different packaging treatments were applied to UR and US strip loin roasts or steaks during 35 d of storage; treatments were applied 7 d following slaughter. After 35 d of storage, the samples were evaluated during simulated retail display for up to 6 d. In Exp. 1, the treatments were vacuum packaging (VP), low-oxygen modified atmosphere packaging (MAP) with N and CO (MAP/CO), low-oxygen MAP with N plus CO and CO, and VP plus an application of peroxyacetic acid (VP/PAA). In Exp. 2, block 1, the treatments were VP, MAP/CO, and VP with ethyl--lauroyl--arginate HCl incorporated into the film as an antimicrobial agent (VP/AM). In Exp. 2, block 2, the treatments were VP, MAP/CO, MAP/CO, and VP/AM. For retail display, VP treatments were sliced and repackaged in PVC overwrap, and MAP treatments were actually PVC overwrap trays that were removed from a master bag with the prescribed gas treatment. Regardless of production system and packaging treatment, mesophilic and psychrotrophic counts of 6.9 to 7.8 and 6.7 to 7.7 log10 CFU/cm, respectively, were obtained at the end of retail display, except for US samples in Exp. 2 (5.5 to 6.3 log CFU/cm). No differences ( > 0.05) were detected for spp. counts among packaging treatments in US steaks at the end of the display time in Exp.1, whereas, for UR steaks, both MAP treatments had lower ( < 0.05) spp. counts than VP treatments. spp. counts were lower ( < 0.05) in the MAP/CO treatment than in the other 3 treatments in US samples on d 6 of retail display for Exp. 2. At the end of display time and for Exp. 1, US steaks under MAP/CO had greater ( < 0.05) lactic acid bacteria (LAB) counts than samples in both VP treatments; no differences ( > 0.05) among packaging were detected for UR steaks. Both MAP and VP/AM treatments in the US samples for Exp. 2 had lower ( < 0.05) LAB counts on d 6 of display than the VP treatment, but no differences ( > 0.05) were found among packaging treatments for the UR samples. To maximize shelf life (storage and display life) of exported fresh beef, it is critical to minimize bacterial populations during processing and storage.

Dual-targeted and pH-sensitive Doxorubicin Prodrug-Microbubble Complex with Ultrasound for Tumor Treatment

PubMed Central

Luo, Wanxian; Wen, Ge; Yang, Li; Tang, Jiao; Wang, Jianguo; Wang, Jihui; Zhang, Shiyu; Zhang, Li; Ma, Fei; Xiao, Liling; Wang, Ying; Li, Yingjia

2017-01-01

In this study, we investigated the potential of a dual-targeted pH-sensitive doxorubicin prodrug-microbubble complex (DPMC) in ultrasound (US)-assisted antitumor therapy. The doxorubicin prodrug (DP) consists of a succinylated-heparin carrier conjugated with doxorubicin (DOX) via hydrazone linkage and decorated with dual targeting ligands, folate and cRGD peptide. Combination of microbubble (MB) and DP, generated via avidin-biotin binding, promoted intracellular accumulation and improved therapeutic efficiency assisted by US cavitation and sonoporation. Aggregates of prepared DP were observed with an inhomogeneous size distribution (average diameters: 149.6±29.8 nm and 1036.2±38.8 nm, PDI: 1.0) while DPMC exhibited a uniform distribution (average diameter: 5.804±2.1 μm), facilitating its usage for drug delivery. Notably, upon US exposure, DPMC was disrupted and aggregated DP dispersed into homogeneous small-sized nanoparticles (average diameter: 128.6±42.3 nm, PDI: 0.21). DPMC could target to angiogenic endothelial cells in tumor region via αvβ3-mediated recognition and subsequently facilitate its specific binding to tumor cells mediated via recognition of folate receptor (FR) after US exposure. In vitro experiments showed higher tumor specificity and killing ability of DPMC with US than free DOX and DP for breast cancer MCF-7 cells. Furthermore, significant accumulation and specificity for tumor tissues of DPMC with US were detected using in vivo fluorescence and ultrasound molecular imaging, indicating its potential to integrate tumor imaging and therapy. In particular, through inducing apoptosis, inhibiting cell proliferation and antagonizing angiogenesis, DPMC with US produced higher tumor inhibition rates than DOX or DPMC without US in MCF-7 xenograft tumor-bearing mice while inducing no obvious body weight loss. Our strategy provides an effective platform for the delivery of large-sized or aggregated particles to tumor sites, thereby extending their therapeutic applications in vivo. PMID:28255342

Ultrasound to Detect Pressure-related Deep Tissue Injuries in Adults Admitted via the Emergency Department: A Prospective, Descriptive, Pilot Study.

PubMed

Scheiner, Jonathan; Farid, Karen; Raden, Mark; Demisse, Seleshi

2017-03-01

Stage 4 pressure ulcers (PUs) start with tissue death at the level of the bone, also known as deep tissue injury (DTI). Studies have shown the appearance of DTI on the skin is delayed for several days after the original pressure-related injury to the deep soft tissues. Studies also suggest DTI can be seen using ultrasound (US) technology. A prospective, descriptive, correlational pilot study was conducted to evaluate the use of US technology to detect DTI in the soft tissues that are not visible on the skin upon hospital admission. Study participants included a convenience sample of 33 persons at risk for PUs (ie, Braden score <18) admitted through the emergency department. Each participant had US scans of 13 common PU body sites. All scans were documented in the radiologist report in the electronic medical record. Creatinine phosphokinase, calcium levels, and urine myoglobin levels also were assessed upon enrollment. Skin failure risk factors (SFRFs), including fever, hypotension, weight loss, coagulopathy, and acidosis/respiratory failure, also were documented. Patients were examined for skin PUs every day for 7 days after US scan. Twenty-three (23) patients completed the study. US scans identified pressure necrosis at 2 levels: bone (54 positive [US+]) and subcutaneous (SC); 79 US+, respectively). US+ bone sites resulted in 5 PUs appearing 6 to 7 days post-admission (sensitivity = 100%, specificity 84.7%, positive predictive value 10%, and negative predictive value 100%), indicating all DTI that later became purple skin DTI were detected by the US. US+ SC sites, located immediately under the skin, yielded 5 PUs appearing on day 2 after admission (sensitivity 100%, specificity 74.8%, positive predictive value 6.3%, and negative predictive value 100%). The participants with PU occurrence in both bone and SC groups had low Braden scores (bone group mean = 13.25, SC group mean = 11.2). Study patients who were positive for PU also had >4 SFRFs. Creatinine phosphokinase, calcium, and myoglobin levels were inconsistent and did not correlate with US+ scans. These observations warrant larger studies to confirm findings and optimize the validity of US screening for DTI in select populations, which may help improve protocols of care and PU admission documentation. The preliminary results suggest inclusion of the Braden Scale score and known PU risk factors may improve the positive predictive value of this test.

Looking at History: A Review of Major U.S. History Textbooks.

ERIC Educational Resources Information Center

Davis, O. L., Jr.; And Others

Fifteen grade 8 and 16 grade 10 U.S. history textbooks, all published in 1986, are reviewed. Eight criteria were used in evaluating the texts: (1) authority; (2) interpretation; (3) significance; (4) context; (5) representativeness; (6) perspective; (7) engagement; and (8) appropriateness. The results of the review show that most of the texts are…

The Impact of Globalization on the U.S. Defense Industrial Base

DTIC Science & Technology

2013-10-01

national security and technology. 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% U.S. Greece U.k. France Turkey Poland Denmark Germany Italy Netherlands Belgium...Master of Public Policy degree from the University of Maryland, College Park, in 2011, and holds a Bachelor of Arts degree in anthropology from the

Census U.S. Civil Aircraft Calendar Year 1991

DTIC Science & Technology

1991-12-31

2 2 - - 2 - - - - - - Basler Flight Service ......................... 3 - - - - - - - 3 - - 3 - Britt Airways /Rocky Mountain dba Continental...60 - - 60 - 60 - Aviation Associates dba Sunaire . 12 - - 12 - 12 - Baker Aviation ................................... 3 - - - - 3 3- Bemidji...2 . .- 2 - - Big Sky Transportation ..................... 8 - 2 - 2 6 6 - Britt Airways /Rocky Mountain dba Continental

Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan

PubMed Central

2013-01-01

Background Staphylococcus aureus [methicillin-resistant and methicillin-susceptible (MRSA/MSSA)] is a leading cause of infections in military personnel, but there are limited data regarding baseline colonization of individuals while deployed. We conducted a pilot study to screen non-deployed and deployed healthy military service members for MRSA/MSSA colonization at various anatomic sites and assessed isolates for molecular differences. Methods Colonization point-prevalence of 101 military personnel in the US and 100 in Afghanistan was determined by swabbing 7 anatomic sites. US-based individuals had received no antibiotics within 30 days, and Afghanistan-deployed personnel were taking doxycycline for malaria prophylaxis. Isolates underwent identification and testing for antimicrobial resistance, virulence factors, and pulsed-field type (PFT). Results 4 individuals in the US (4 isolates- 3 oropharynx, 1 perirectal) and 4 in Afghanistan (6 isolates- 2 oropharynx, 2 nare, 1 hand, 1 foot) were colonized with MRSA. Among US-based personnel, 3 had USA300 (1 PVL+) and 1 USA700. Among Afghanistan-based personnel, 1 had USA300 (PVL+), 1 USA800 and 2 USA1000. MSSA was present in 40 (71 isolates-25 oropharynx, 15 nare) of the US-based and 32 (65 isolates- 16 oropharynx, 24 nare) of the Afghanistan-based individuals. 56 (79%) US and 41(63%) Afghanistan-based individuals had MSSA isolates recovered from extra-nare sites. The most common MSSA PFTs were USA200 (9 isolates) in the US and USA800 (7 isolates) in Afghanistan. MRSA/MSSA isolates were susceptible to doxycycline in all but 3 personnel (1 US, 2 Afghanistan; all were MSSA isolates that carried tetM). Conclusion MRSA and MSSA colonization of military personnel was not associated with deployment status or doxycycline exposure. Higher S. aureus oropharynx colonization rates were observed and may warrant changes in decolonization practices. PMID:24060181

The influence of foreign vs. North American emissions on surface ozone in the US

NASA Astrophysics Data System (ADS)

Reidmiller, D. R.; Fiore, A. M.; Jaffe, D. A.; Bergmann, D.; Cuvelier, C.; Dentener, F. J.; Duncan, B. N.; Folberth, G.; Gauss, M.; Gong, S.; Hess, P.; Jonson, J. E.; Keating, T.; Lupu, A.; Marmer, E.; Park, R.; Schultz, M. G.; Shindell, D. T.; Szopa, S.; Vivanco, M. G.; Wild, O.; Zuber, A.

2009-07-01

As part of the Hemispheric Transport of Air Pollution (HTAP; http:// www.htap.org) project, we analyze results from 15 global and 1 hemispheric chemical transport models and compare these to Clean Air Status and Trends Network (CASTNet) observations in the United States (US) for 2001. Using the policy-relevant maximum daily 8-h average ozone (MDA8 O3) statistic, the multi-model ensemble represents the observations well (mean r2=0.57, ensemble bias = +4.1 ppbv for all US regions and all seasons) despite a wide range in the individual model results. Correlations are strongest in the northeastern US during spring and fall (r2=0.68); and weakest in the midwestern US in summer (r2=0.46). However, large positive mean biases exist during summer for all eastern US regions, ranging from 10-20 ppbv, and a smaller negative bias is present in the western US during spring (~3 ppbv). In nearly all other regions and seasons, the biases of the model ensemble simulations are ≤5 ppbv. Sensitivity simulations in which anthropogenic O3-precursor emissions (NOx + NMVOC + CO + aerosols) were decreased by 20% in four source regions: East Asia (EA), South Asia (SA), Europe (EU) and North America (NA) show that the greatest response of MDA8 O3 to the summed foreign emissions reductions occurs during spring in the West (0.9 ppbv reduction due to 20% emissions reductions from EA + SA + EU). East Asia is the largest contributor to MDA8 O3 at all ranges of the O3 distribution for most regions (typically ~0.45 ppbv) followed closely by Europe. The exception is in the northeastern US where emissions reductions in EU had a slightly greater influence than EA emissions, particularly in the middle of the MDA8 O3 distribution (response of ~0.35 ppbv between 35-55 ppbv). EA and EU influences are both far greater (about 4x) than that from SA in all regions and seasons. In all regions and seasons O3-precursor emissions reductions of 20% in the NA source region decrease MDA8 O3 the most - by a factor of 2 to nearly 10 relative to foreign emissions reductions. The O3 response to anthropogenic NA emissions is greatest in the eastern US during summer at the high end of the O3 distribution (5-6 ppbv for 20% reductions). While the impact of foreign emissions on surface O3 in the US is not negligible - and is of increasing concern given the recent growth in Asian emissions - domestic emissions reductions remain a far more effective means of decreasing MDA8 O3 values, particularly those above 75 ppb (the current US standard).

Comparison of prescribing patterns between United States and Dominican Republic prescribers on short-term medical mission trips.

PubMed

Prescott, Gina M; Patzke, Ciera L; Brody, Peter M; Prescott, William A

2018-01-01

Short-term medical missions (STMMs) have increased and are viewed as a way to extend care in low- and middle-income countries (LMICs). Although benefits may exist, visiting teams may lack insight into using medications safely and effectively. The primary objective was to assess prescribing differences between US-based and Dominican Republic (DR) healthcare providers on STMMs in the DR. A retrospective database review between January 2013 and 2015 was conducted. Data from US and DR groups were compared for differences in diagnoses, medication classes prescribed and prescriptions per patient. The mean number of medical conditions diagnosed per patient in the DR (n=423) and US groups (n=1585) were 1.4±0.9 and 1.0±0.8, respectively. The diagnosis of infectious diseases was the same as non-communicable diseases. The DR group prescribed more medications at each patient encounter (mean 2.6 vs 2.2, respectively; p<0.001). The US group prescribed more antibiotics for respiratory infections (US 46.2% vs DR 25.0%; p=0.0001), used more metronidazole than albendazole alone for parasite infections (p=0.0022) and used more oral fluconazole for vaginal candidiasis (p<0.0001) and tinea infections (US 44.6%, DR 14.3%, respectively; p=0.0020). Although some significant prescribing differences exist between US and DR providers, many similarities were present. Visiting providers should understand the medication use system and disease burden before providing care in an LMIC. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

PubMed

Hwang, Eun Gu; Lee, Yunjung

2016-12-01

Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography ( P =0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

Are Free Maternity Services Completely Free of Costs?

PubMed

Acharya, Jeevan

2016-02-01

The Government of Nepal revised free maternity health services, "Aama Surakshya Karyakram", beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2-19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during the hospital stay and at discharge time. Similarly, arrangements for liquid, food, and hot water, as well as clothes for mothers and newborns, should be made by the hospital in order to enhance hospital attendance.

Financial Impact of Foot-and-mouth disease outbreaks on pig farms in the Republic of Korea, 2014/2015.

PubMed

Yoon, Hachung; Jeong, Wooseog; Han, Jun-Hee; Choi, Jida; Kang, Yong-Myung; Kim, Yong-Sang; Park, Hong-Sig; Carpenter, Tim E

2018-01-01

The financial impact of foot-and-mouth disease (FMD) that occurred in 180 piggeries (100 farrow-to-finish and 80 fattening farms) confirmed infected during the 2014/2015 epidemic in the Republic of Korea was estimated at the farm level. The median loss due to slaughtering of pigs prior to their expected market weights was US$ 71.8 (uncovered compensation-compensation loss) plus US$ 57.3 (foregone net gain) per pig. Median loss per farm was US$ 27,487 (55.6% of total loss) for compensation and US$ 15,925 (44.4%) for foregone net gain. The total loss per farm (median, 25th-75th percentile) was US$ 43,822 (9,767-115,893), which represented 49.4% (11.5-112.8) of the annual net gain of pig farms. The total financial loss in 180 FMD outbreak pig farms was US$ 25.2 million, which was nearly one-half of the control cost (US$ 58.3 million) spent by the Korean government on this epidemic. The findings in this study should help planning to help reduce the impact at the farm level in the Republic of Korea in the future. Copyright © 2017 Elsevier B.V. All rights reserved.

Penetration depth, concentration and efficiency of transdermal α-arbutin delivery after ultrasound treatment with albumin-shelled microbubbles in mice.

PubMed

Liao, Ai-Ho; Ma, Wan-Chun; Wang, Chih-Hung; Yeh, Ming-Kung

2016-09-01

Recently, the feasibility and effects of using microbubbles (MBs) as an ultrasound (US) contrast agent for enhancing the penetration in transdermal delivery in vivo have been demonstrated, but the mechanism and efficiency are unclear. This study demonstrates the penetration depth, concentration and efficiency of transdermal α-arbutin delivery during 4 weeks after US treatment with MBs in mice. Experimental animals were randomly divided into the following four groups (n = 5 animals per group): (1) penetrating α-arbutin alone (C), (2) US combined with penetrating α-arbutin, (3) US combined with MBs and penetrating α-arbutin, and (4) US combined with diluted MBs and penetrating α-arbutin (UBD). The penetration depths in agarose phantoms and pigskin were 47 and 84% greater for group UBD, respectively, than for group C. The in vitro skin penetration by 2% α-arbutin after 3 h was 83% greater in group UBD than in group C. The degree of in vivo skin whitening (quantified as the luminosity index) in group UBD significantly increased by 25% after 1 week, 34% after 2 weeks, and then stabilized after 3 weeks at 37% in C57BL/6J mice over a 4-week experimental period. Our results indicate that combined treatment with optimal US and MBs can increase skin permeability so as to enhance α-arbutin delivery to inhibit melanogenesis without damaging the skin in mice.

US Urban Forest Statistics, Values, and Projections

Treesearch

David J Nowak; Eric J. Greenfield

2018-01-01

U.S. urban land increased from 2.6% (57.9 million acres) in 2000 to 3.0% (68.0 million acres) in 2010. States with the greatest amount of urban growth were in the South/Southeast (TX, FL, NC, GA and SC). Between 2010 and 2060, urban land is projected to increase another 95.5 million acres to 163.1 million acres (8.6%) with 18 states projected to have an increase of...

Emergency Department Visits by Nursing Home Residents in the United States

PubMed Central

Wang, Henry E.; Shah, Manish N.; Allman, Richard M.; Kilgore, Meredith

2012-01-01

BACKGROUND/OBJECTIVES The Emergency Department (ED) is an important source of health care for nursing home residents. The objective of this study was to characterize ED use by nursing home residents in the United States (US). DESIGN Analysis of the National Hospital Ambulatory Medical Care Survey SETTING US Emergency Departments, 2005-2008 PARTICIPANTS Individuals visiting US EDs, stratified by nursing home and non-nursing home residents. INTERVENTIONS None MEASUREMENTS We identified all ED visits by nursing home residents. We contrasted the demographic and clinical characteristics between nursing home residents and non-nursing home residents. We also compared ED resource utilization, length of stay and outcomes. RESULTS During 2005-2008, nursing home residents accounted for 9,104,735 of 475,077,828 US ED visits (1.9%; 95% CI: 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were elderly (mean 76.7 years, 95% CI: 75.8-77.5), female (63.3%), and non-Hispanic White (74.8%). Compared with non-nursing home residents, nursing home residents were more likely have been discharged from the hospital in the prior seven days (adjusted OR 1.4, 95% CI: 1.1-1.9). Nursing home residents were more likely to present with fever (adjusted OR 1.9; 95% CI: 1.5-2.4) or hypotension (systolic blood pressure ≤90 mm Hg, OR 1.8; 95% CI: 1.5-2.2). Nursing home patients were more likely to receive diagnostic test, imaging and procedures in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Compared with non-nursing home residents, nursing home residents were more likely to be admitted to the hospital (adjusted OR 1.8; 95% CI 1.6-2.1) and to die (adjusted OR 2.3; 95% CI 1.6-3.3). CONCLUSIONS Nursing home residents account for over 2.2 million ED visits annually in the US. Compared with other ED patients, nursing home residents have higher medical acuity and complexity. These observations highlight the national challenges of organizing and delivering ED care to nursing home residents in the US. PMID:22091500

Culture and ethnicity influence outcomes of the Scoliosis Research Society Instrument in adolescent idiopathic scoliosis.

PubMed

Morse, Lee Jae; Kawakami, Noriaki; Lenke, Lawrence G; Sucato, Daniel J; Sanders, James O; Diab, Mohammad

2012-05-20

Retrospective comparative study. To report preoperative differences in the Scoliosis Research Society Outcomes Instrument (SRS-30) between multiple US ethnicities and native Japanese and Korean children with adolescent idiopathic scoliosis (AIS). The SRS-24 was developed in a US cohort with AIS. Comparative studies using the SRS-24 between US and Japanese patients showed differences, suggesting that culture might affect functional outcome. Preoperative SRS-30 outcomes were collected from 1853 children with AIS from 6 different ethnic groups: US white (1234), black (213), Hispanic (78), and Asian (29), as well as native Japanese (192) and Koreans (107). Analysis of covariance of 4 SRS-30 domains (pain, appearance, activity, and mental) was compared between groups adjusting for differences in age, sex, major curve magnitude, and body mass index. Pairwise comparisons of the 4 SRS-30 domains were adjusted for multiple comparisons, using Bonferroni correction. A P value of less than 0.05 was considered significant. Significant differences between ethnicities were found in all domains (P < 0.001). Whites reported more pain than Japanese or Koreans (Japanese = 4.52, Korean = 4.47, white = 4.04). Korean and Japanese patients had the lowest appearance scores (Japanese = 2.89, Korean = 2.73, US Asian = 3.55, Hispanic = 3.11, black = 3.47, white = 3.29). Koreans also had the lowest activity (Korean = 3.64, Japanese = 4.24, US Asian = 4.07, Hispanic = 4.02, black = 4.06, white = 4.16), mental (Korean = 3.70, Japanese = 4.23, US Asian = 4.05, Hispanic = 3.75, black = 4.03, white = 3.94), and total scores (Korean = 3.63, Japanese = 3.92, US Asian = 4.02, Hispanic = 3.75, black = 3.92, and white = 3.84). Culture and ethnicity influence SRS-30 outcomes in AIS. Whites reported more pain than Japanese and Koreans. Japanese and Koreans had the lowest appearance scores. Koreans additionally were distinguished by the lowest activity, mental, and total scores. These cultural and ethnic differences must be taken into account when counseling patients with AIS and studying functional outcomes.

US surveillance of regional lymph node recurrence after breast cancer surgery.

PubMed

Moon, Hee Jung; Kim, Min Jung; Kim, Eun-Kyung; Park, Byeong-Woo; Youk, Ji Hyun; Kwak, Jin Young; Sohn, Joohyuk; Kim, Seung-Il

2009-09-01

To determine the diagnostic indexes of lymph node ultrasonography (US) of the axillary and supraclavicular regions for detecting lymph node recurrence (LNR) after breast cancer surgery and assess the effect of lymph node evaluation on prognosis during bilateral breast US. Institutional review board approved this retrospective study and waived informed consent. Between January 2003 and December 2004, 3982 lymph node US examinations, including bilateral axillary and supraclavicular areas, were performed in 1817 women (mean age, 49.9 years; range, 22-86 years) after breast cancer surgery, nine of whom had palpable lesions. Final diagnosis was based on cytopathologic results, clinical follow-up, and imaging studies for at least 12 months after breast US. Diagnostic indexes of US for detecting LNR were assessed. The frequency of distant metastases between patients with ipsilateral LNR and those without was compared. Three-year mortality rates of patients with ipsilateral LNR only and those with distant metastases were evaluated. Of 1817 patients, 54 had suspicious LNR at US (28 at first, 20 at second, five at third, and one at fourth US examination). Thirty-nine of 1817 patients (2.1%), including nine with palpable lesions, had LNR, 11 of whom had ipsilateral LNR only. At first lymph node US, LNR was detected in 17 patients; at second, in 10; at third, in two; and at fourth, in one. Nine had false-negative results. The respective sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of lymph node US for detecting LNR per woman was 76.9% (30 of 39), 98.7% (1754 of 1778), 98.2% (1784 of 1817), 55.6% (30 of 54), and 99.5% (1754 of 1763); those of first lymph node US were 85.0% (17 of 20), 99.4% (1786 of 1797), 99.2% (1803 of 1817), 60.7% (17 of 28), and 99.8% (1786 of 1789); and those of total US examinations were 78.0% (32 of 41), 99.4% (3917 of 3941), 99.2% (3949 of 3982), 57.1% (32 of 56), and 99.8% (3917 of 3926). Distant metastases were found more frequently in patients with ipsilateral LNR (62%) than in those without (2.3%) (P < .0001). The 3-year mortality rate of patients with ipsilateral LNR only was significantly lower than that in patients with distant metastases (P = .03). Ipsilateral LNR is a predictor of distant metastasis, and lymph node evaluation during breast US is useful for early detection of LNR in asymptomatic patients.

Assessment of ultrafine particles in Portuguese preschools: levels and exposure doses.

PubMed

Fonseca, J; Slezakova, K; Morais, S; Pereira, M C

2014-12-01

The aim of this work was to assess ultrafine particles (UFP) number concentrations in different microenvironments of Portuguese preschools and to estimate the respective exposure doses of UFP for 3-5-year-old children (in comparison with adults). UFP were sampled both indoors and outdoors in two urban (US1, US2) and one rural (RS1) preschool located in north of Portugal for 31 days. Total levels of indoor UFP were significantly higher at the urban preschools (mean of 1.82 × 10(4) and 1.32 × 10(4) particles/cm(3) at US1 an US2, respectively) than at the rural one (1.15 × 10(4) particles/cm(3) ). Canteens were the indoor microenvironment with the highest UFP (mean of 5.17 × 10(4) , 3.28 × 10(4) , and 4.09 × 10(4) particles/cm(3) at US1, US2, and RS1), whereas the lowest concentrations were observed in classrooms (9.31 × 10(3) , 11.3 × 10(3) , and 7.14 × 10(3) particles/cm(3) at US1, US2, and RS1). Mean indoor/outdoor ratios (I/O) of UFP at three preschools were lower than 1 (0.54-0.93), indicating that outdoor emissions significantly contributed to UFP indoors. Significant correlations were obtained between temperature, wind speed, relative humidity, solar radiation, and ambient UFP number concentrations. The estimated exposure doses were higher in children attending urban preschools; 3-5-year-old children were exposed to 4-6 times higher UFP doses than adults with similar daily schedules. This study reports information on ultrafine particles (UFPs) in various indoor and outdoor microenvironments (canteens, classrooms, gymnasiums, and outdoor) of urban and rural preschools. It identifies the potential sources and origins, characterizes the influence of meteorological parameters on UFP levels, and performs a comparison with other existing international studies. To this date, relatively few studies have investigated UFP in preschools (none in Portugal) and none assessed exposure dose for different age-groups. The obtained findings showed that levels of UFP in various microenvironments of schools differed significantly. Therefore, to obtain an accurate representation of child’s overall preschool exposure profiles, the exposures occurring in these different microenvironments should be always accounted for. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

How Might Recharge Change Under Projected Climate Change in the Western U.S.?

NASA Astrophysics Data System (ADS)

Niraula, R.; Meixner, T.; Dominguez, F.; Bhattarai, N.; Rodell, M.; Ajami, H.; Gochis, D.; Castro, C.

2017-10-01

Although groundwater is a major water resource in the western U.S., little research has been done on the impacts of climate change on groundwater storage and recharge in the West. Here we assess the impact of projected changes in climate on groundwater recharge in the near (2021-2050) and far (2071-2100) future across the western U.S. Variable Infiltration Capacity model was run with RCP 6.0 forcing from 11 global climate models and "subsurface runoff" output was considered as recharge. Recharge is expected to decrease in the West (-5.8 ± 14.3%) and Southwest (-4.0 ± 6.7%) regions in the near future and in the South region (-9.5 ± 24.3%) in the far future. The Northern Rockies region is expected to get more recharge in the near (+5.3 ± 9.2%) and far (+11.8 ± 12.3%) future. Overall, southern portions of the western U.S. are expected to get less recharge in the future and northern portions will get more. Climate change interacts with land surface properties to affect the amount of recharge that occurs in the future. Effects on recharge due to change in vegetation response from projected changes in climate and CO2 concentration, though important, are not considered in this study.

Human Macrophages Escape Inhibition of Major Histocompatibility Complex-Dependent Antigen Presentation by Cytomegalovirus and Drive Proliferation and Activation of Memory CD4+ and CD8+ T Cells.

PubMed

Frascaroli, Giada; Lecher, Carina; Varani, Stefania; Setz, Corinna; van der Merwe, Johannes; Brune, Wolfram; Mertens, Thomas

2018-01-01

Human cytomegalovirus (HCMV) persistently infects 40-90% of the human population but in the face of a normal immune system, viral spread and dissemination are efficiently controlled thus preventing clinically signs and disease. HCMV-infected hosts produce a remarkably large amount of HCMV-specific CD4 + and CD8 + T cells that can even reach 20-50% of total T memory cells in the elderly. How HCMV may elicit such large and long-lasting T-cell responses in the absence of detectable viremia has not been elucidated yet. Additionally, HCMV is known to encode several gene products that potently inhibit T-cell recognition of infected cells. The best characterized are the four immune evasive US2, US3, US6, and US11 genes that by different mechanisms account for major histocompatibility complex (MHC) class I and class II degradation and intracellular retention in infected cells. By infecting M1 and M2 human macrophages (Mφ) with the wild-type HCMV strain TB40E or a mutant virus deleted of the four immune evasive genes US2, US3, US6, and US11, we demonstrated that human Mφ counteract the inhibitory potential of the US2-11 genes and remain capable to present peptides via MHC class I and class II molecules. Moreover, by sorting the infected and bystander cells, we provide evidence that both infected and bystander Mφ contribute to antigen presentation to CD4 + and CD8 + T cells. The T cells responding to TB40E-infected Mφ show markers of the T effector memory compartment, produce interferon-γ, and express the lytic granule marker CD107a on the cell surface, thus mirroring the HCMV-specific T cells present in healthy seropositive individuals. All together, our findings reveal that human Mφ escape inhibition of MHC-dependent antigen presentation by HCMV and continue to support T cell proliferation and activation after HCMV infection. Taking into account that Mφ are natural targets of HCMV infection and a site of viral reactivation from latency, our findings support the hypothesis that Mφ play crucial roles for the lifelong maintenance and expansion of HCMV-committed T cells in the human host.

Country of Birth of Children With Diagnosed HIV Infection in the United States, 2008-2014.

PubMed

Nesheim, Steven R; Linley, Laurie; Gray, Kristen M; Zhang, Tianchi; Shi, Jing; Lampe, Margaret A; FitzHarris, Lauren F

2018-01-01

Diagnoses of HIV infection among children in the United States have been declining; however, a notable percentage of diagnoses are among those born outside the United States. The impact of foreign birth among children with diagnosed infections has not been examined in the United States. Using the Centers for Disease Control and Prevention National HIV Surveillance System, we analyzed data for children aged <13 years with diagnosed HIV infection ("children") in the United States (reported from 50 states and the District of Columbia) during 2008-2014, by place of birth and selected characteristics. There were 1516 children [726 US born (47.9%) and 676 foreign born (44.6%)]. US-born children accounted for 70.0% in 2008, declining to 32.3% in 2013, and 40.9% in 2014. Foreign-born children have exceeded US-born children in number since 2011. Age at diagnosis was younger for US-born than foreign-born children (0-18 months: 72.6% vs. 9.8%; 5-12 years: 16.9% vs. 60.3%). HIV diagnoses in mothers of US-born children were made more often before pregnancy (49.7% vs. 21.4%), or during pregnancy (16.6% vs. 13.9%), and less often after birth (23.7% vs. 41%). Custodians of US-born children were more often biological parents (71.9% vs. 43.2%) and less likely to be foster or nonrelated adoptive parents (10.4% vs. 55.1%). Of 676 foreign-born children with known place of birth, 65.5% were born in sub-Saharan Africa and 14.3% in Eastern Europe. The top countries of birth were Ethiopia, Ukraine, Uganda, Haiti, and Russia. The increasing number of foreign-born children with diagnosed HIV infection in the United States requires specific considerations for care and treatment.

Atmospheric Implications of Light Alkane Emissions From the U.S. Oil and Natural Gas Sector

NASA Astrophysics Data System (ADS)

Fischer, E. V.; Tzompa Sosa, Z. A.; Henderson, B.; Travis, K.; Keller, C.; Sive, B. C.; Helmig, D.; Fried, A.; Herndon, S. C.; Yacovitch, T. I.; Mahieu, E.; Franco, B.

2017-12-01

New efficient drilling techniques triggered a massive growth of unconventional oil and natural gas production in North America starting in 2005. Emissions of a variety of volatile organic compounds (VOCs) from the oil and gas sector occur during well development and production phases, and emissions to the atmosphere also continue when wells are abandoned. Determining VOC emission fluxes in the context of rapid growth of the oil and natural gas industry presents a big challenge for emission inventories. In the U.S., the latest version of the 2011 National Emission Inventory (NEI2011v6.3) includes updates over important oil and natural gas basins and speciation profiles based on the Western Regional Air Partnership. We incorporated the NEI2011v6.3 into the GEOS-Chem chemical transport model to simulate the atmospheric abundances of C2-C5 alkanes over the U.S. attributed to emissions from the oil and gas sector. We present results from a nested high-resolution (0.5 degree x 0.667 degree) simulation over North America. C2-C5 alkane emissions from NEI 2011v6.3 increase across the U.S. compared to the previous NEI 2011 v2 incorporated as default in GEOS-Chem. Ethane (C2H6) and propane (C3H8) emission fluxes increased over important oil and natural gas basins. We compare our simulation to a suite of surface observations, column measurements, and aircraft profiles. Finally, we estimate the contribution that C2-C5 alkanes make to the abundance and production of important secondary species including ozone, peroxy acetyl nitrate, and several ketones.

Amino acid sequences of peptides from a tryptic digest of a urea-soluble protein fraction (U.S.3) from oxidized wool

PubMed Central

Corfield, M. C.; Fletcher, J. C.; Robson, A.

1967-01-01

1. A tryptic digest of the protein fraction U.S.3 from oxidized wool has been separated into 32 peptide fractions by cation-exchange resin chromatography. 2. Most of these fractions have been resolved into their component peptides by a combination of the techniques of cation-exchange resin chromatography, paper chromatography and paper electrophoresis. 3. The amino acid compositions of 58 of the peptides in the digest present in the largest amounts have been determined. 4. The amino acid sequences of 38 of these have been completely elucidated and those of six others partially derived. 5. These findings indicate that the parent protein in wool from which the protein fraction U.S.3 is derived has a minimum molecular weight of 74000. 6. The structures of wool proteins are discussed in the light of the peptide sequences determined, and, in particular, of those sequences in fraction U.S.3 that could not be elucidated. PMID:16742497

Extensor tendinopathy of the elbow assessed with sonoelastography: histologic correlation.

PubMed

Klauser, Andrea S; Pamminger, Mathias; Halpern, Ethan J; Abd Ellah, Mohamed M H; Moriggl, Bernhard; Taljanovic, Mihra S; Deml, Christian; Sztankay, Judit; Klima, Guenther; Jaschke, Werner R

2017-08-01

To compare agreement between conventional B-mode ultrasound (US) and compression sonoelastography (SEL) of the common extensor tendons of the elbow with histological evaluation. Twenty-six common extensor tendons were evaluated in 17 cadavers (11 females, median age 85 years and 6 males, median age 80 years). B-mode US was graded into: Grade 1, homogeneous fibrillar pattern; grade 2, hypoechoic areas and/or calcifications <30%; and grade 3 > 30%. SEL was graded into: Grade 1 indicated blue (hardest) to green (hard); grade 2 yellow (soft); and grade 3 red (softest). B-mode US, SEL, and a combined grading score incorporating both were compared to histological findings in 76 biopsies. Histological alterations were detected in 55/76 biopsies. Both modalities showed similar results (sensitivity, specificity, and accuracy 84%, 81%, and 83% for B-mode US versus 85%, 86%, and 86% for SEL, respectively, P > 0.3). However, a combination of both resulted in significant improvement in sensitivity (96%, P < 0.02) without significant change in specificity (81%, P < 0.3), yielding an improved overall accuracy (92%). Combined imaging of the extensor tendons with both modalities is superior to either modality alone for predicting the presence of pathologic findings on histology. • Combination of B-mode US and SEL proved efficiency in diagnosing lateral epicondylitis. • Combination of B-mode US and SEL in lateral epicondylitis correlates to histology. • Combination of both modalities provides improved sensitivity without loss of specificity.

7 CFR 51.3197 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false U.S. No. 2. 51.3197 Section 51.3197 Agriculture... Standards for Grades of Bermuda-Granex-Grano Type Onions Grades § 51.3197 U.S. No. 2. U.S. No. 2 consists of...) Free from serious damage caused by: (1) Seedstems; (2) Dry sunken areas; (3) Sprouting; (4) Staining...

7 CFR 51.3197 - U.S. No. 2.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false U.S. No. 2. 51.3197 Section 51.3197 Agriculture... Standards for Grades of Bermuda-Granex-Grano Type Onions Grades § 51.3197 U.S. No. 2. U.S. No. 2 consists of...) Free from serious damage caused by: (1) Seedstems; (2) Dry sunken areas; (3) Sprouting; (4) Staining...

7 CFR 51.3197 - U.S. No. 2.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false U.S. No. 2. 51.3197 Section 51.3197 Agriculture... Standards for Grades of Bermuda-Granex-Grano Type Onions Grades § 51.3197 U.S. No. 2. U.S. No. 2 consists of...) Free from serious damage caused by: (1) Seedstems; (2) Dry sunken areas; (3) Sprouting; (4) Staining...

Use of Fibrates in the United States and Canada

PubMed Central

Jackevicius, Cynthia A.; Tu, Jack V.; Ross, Joseph S.; Ko, Dennis T.; Carreon, Daniel; Krumholz, Harlan M.

2012-01-01

Context Interest in the role of fibrates has intensified with the publication of the negative ACCORD trial with fenofibrate, especially since the evidence for clinical outcomes benefit for fibrates is heavily weighted on older fibrates, gemfibrozil and clofibrate. Objective This study seeks to examine trends in the current use of fibrates, and for fenofibrate, to illuminate the relationship between differences in the availability of proprietary versus generic formulations and use and economic implications in the United States (US) compared with Canada. Design/Setting/Patients Population-level, cohort study using IMS Health data in the United States and Canada of patients prescribed fibrates between 2002 and 2009. Main Outcome Measure(s) Fibrate prescribing and expenditures. Results From 2002–2009, fibrate prescriptions increased 117.1% in the US, by 12,000/month to 2.1 million prescriptions/month, yet only increased by 18.1% in Canada. (p<0.001) Fenofibrate use was relatively constant in Canada, while in the US, it increased by 159.3%, comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. The annual ratio of generic:brand fenofibrate use in the US from 2002 to 2008 ranged from 0:1 to 0.09:1, while the ratio in Canada steadily increased from 2005 to 2008 from 0.51:1 to 1.89:1. In the US, crude fenofibrate expenditures rose from $33.2 million/month in 2002 to $129.6 million/month in 2009, while those in Canada declined from $5.6 million/month to $5.1 million/month. Fibrate expenditures per 100,000 population were 3-fold higher in the US compared with Canada in 2009. Conclusions During the past decade, prescriptions for fibrates, particularly, fenofibrate, increased in the United States, while prescriptions for fibrates in Canada remained stable. PMID:21427374

The costs of fluid overload in the adult intensive care unit: is a small-volume infusion model a proactive solution?

PubMed Central

Child, Debra L; Cao, Zhun; Seiberlich, Laura E; Brown, Harold; Greenberg, Jordan; Swanson, Anne; Sewall, Martha R; Robinson, Scott B

2015-01-01

Purpose Fluid overload (FO) in critically ill patients remains a challenging clinical dilemma, and many continuous intravenous (IV) medications in the US are being delivered as a dilute solution, adding significantly to a patient’s daily intake. This study describes the costs and outcomes of FO in patients receiving multiple continuous infusions. Materials and methods A retrospective study was conducted using a hospital administrative database covering >500 US hospitals. An FO cohort included adult intensive care unit (ICU) patients with a central line receiving IV loop diuretics and 2+ continuous IV infusions on 50%+ of their ICU days; a directly matched non-FO cohort included patients without IV diuretic use. The primary outcome of the study was total hospitalization costs per visit. Additional outcomes were ICU costs, mortality, total and ICU length of stay (LOS), 30-day readmission rates, and ventilator use. Unadjusted descriptive analysis was performed using chi-squared or paired t-tests to compare outcomes between the two cohorts. Results A total of 63,974 patients were identified in each cohort. The total hospitalization cost per visit for the FO cohort was US$15,344 higher than the non-FO cohort (US$42,386 vs US$27,042), and the ICU cost for the FO cohort was US$5,243 higher than the non-FO cohort (US$10,902 vs US$5,659). FO patients had higher mortality (20% vs 16.8%), prolonged LOS (11.5 vs 8.0 days), longer ICU LOS (6.2 vs 3.6 days), higher risk of 30-day readmission (21.8% vs 21.3%), and ventilator usage (47.7% vs 28.3%) than the non-FO cohort (all P<0.05). Conclusion In patients receiving multiple continuous infusions, FO is associated with increased health care resources and costs. Maximally concentrating medications and proactively providing continuous medications in small-volume infusions (SVI) could be a potential solution to prevent iatrogenic FO in critically ill patients. Further prospective research is warranted to assess the impact of the SVI dispensing model on patient outcomes and health care costs. PMID:25548524

Detection of prostate cancer using magnetic resonance imaging/ultrasonography image-fusion targeted biopsy in African-American men.

PubMed

Shin, Toshitaka; Smyth, Thomas B; Ukimura, Osamu; Ahmadi, Nariman; de Castro Abreu, Andre Luis; Oishi, Masakatsu; Mimata, Hiromitsu; Gill, Inderbir S

2017-08-01

To assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US). We retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7. After controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4-5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4 mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively. Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Afghanistan: Post-Taliban Governance, Security, and U.S. Policy

DTIC Science & Technology

2010-08-17

3%; Baluch 2%. Size of Religious Minorities Religions: Sunni (Hanafi school) 80%; Shiite (Hazaras, Qizilbash, and Isma’ilis) 19%; other 1...Pakistan 38.6%; U.S. 9.5%; Germany 5.5%; India 5.2%.. Main imports are food, petroleum, capital goods, textiles, autos Cellphones/ Tourism About 12...million cellphones, up from several hundred used by Taliban government officials. Tourism : National park opened June 2009. Increasing tourist visits

76 FR 18194 - Notice of Patent Application Deadline for Advanced Battery Technology Related Patents for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

...,524,579 B1). 5. ARL 04-29--Safer, Less Expensive Lithium Ion Batteries (US 7,629,080). 6. ARL 05-18... Performance by Reducing Resistance in Lithium Ion Batteries. Filed with USPTO on 2/3/2010 (S/N 12/699,182). 11.... ARL 01-37--Choosing Electrolytes for Lithium/Air Batteries (US 7,585,579). 2. ARL 02-06--Solvent...

76 FR 3118 - Notice of Availability of Advanced Battery Technology Related Patents for Exclusive, Partially...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

..., Less Expensive Lithium Ion Batteries (US 7,629,080). 6. ARL 05-18--High Capacity Metal/Air Battery... Resistance in Lithium Ion Batteries. Filed with USPTO on 2/3/2010 (S/N 12/699,182). 11. ARL 09-33--Pure LiBOB... Electrolytes for Lithium/Air Batteries (US 7,585,579). 2. ARL 02-06--Solvent Systems Comprising a Mixture of...

Economic Costs of Chikungunya Virus in Colombia.

PubMed

Alvis-Zakzuk, Nelson J; Díaz-Jiménez, Diana; Castillo-Rodríguez, Liliana; Castañeda-Orjuela, Carlos; Paternina-Caicedo, Ángel; Pinzón-Redondo, Hernando; Carrasquilla-Sotomayor, María; Alvis-Guzmán, Nelson; De La Hoz-Restrepo, Fernando

2018-04-05

The aim of the present study was to estimate the economic impact of chikungunya virus (CHIKV) infection in Colombia from a societal perspective. We conducted a retrospective, bottom-up cost-of-illness study in clinically confirmed cases during the first chikungunya (CHIK) outbreak in Colombia in 2014. Direct and indirect costs were estimated per patient. Economic costs were calculated by the addition of direct costs (direct medical costs and out-of-pocket heath expenditures) and indirect cost as a result of loss of productivity. A total of 126 patients (67 children and 59 adults) with CHIK were included. The median of the direct medical cost in children was US$257.9 (interquartile range [IQR] 121.7-563.8), and US$66.6 (IQR 26.5-317.3) for adults. The productivity loss median expenditures reached US$81.3 (IQR 72.2-203.2) per adult patient. The median economic cost in adults as a result of CHIK was US$152.9 (IQR 101.0-539.6), of which 53.2% was a result of indirect costs. Out-of-pocket expenditures comprised 3.3% of all economic costs. Our study can help health decision makers to properly assess the burden of disease caused by CHIK in Colombia, an endemic tropical country. We recommend to strength the health information systems and to continue investing in public health measures to prevent CHIK. Copyright © 2018. Published by Elsevier Inc.

Medical Surveillance Monthly Report (MSMR). Volume 9, Number 6, September/October 2003

DTIC Science & Technology

2003-10-01

October 2003Vol. 9 No. 6 Contents Incidence, severity, and trends of pneumonia/influenza and acute respiratory failure/pulmonary insufficiency, US...high risk of acute respiratory illnesses.1-3 In the US military, acute respiratory illnesses continue to be leading causes of hospitalizations and...ambulatory visits of servicemembers.4,5 The most frequent acute respiratory illnesses of US servicemembers are upper respiratory infections (URIs) that

United States Commercial Shipbuilding Productivity: An International View

DTIC Science & Technology

1990-12-01

produced, U.S. shipbuilders would have ranked 36th. The U.S. output is just above Malaysia (2758 GT), Peru (3136 GT) and Chile (3372 GT), but below...2 6,172 0.05 35 GREECE 4 5,219 0.04 36 UNITED STATES 10 4,078 0.03 37 CHILE 8 3,372 0.03 38 PERU 7 3,136 0.02 39 MALAYSIA 2 2,758 0.02 40 THAILAND 2...Korean shipbuilders’ rank second behind Japan in total GT produced. Collectively, the three major yards, Hyundai Heavy Industries (HH I), Samsung , and

Sex Differences in Academic Rank in US Medical Schools in 2014.

PubMed

Jena, Anupam B; Khullar, Dhruv; Ho, Oliver; Olenski, Andrew R; Blumenthal, Daniel M

2015-09-15

The proportion of women at the rank of full professor in US medical schools has not increased since 1980 and remains below that of men. Whether differences in age, experience, specialty, and research productivity between sexes explain persistent disparities in faculty rank has not been studied. To analyze sex differences in faculty rank among US academic physicians. We analyzed sex differences in faculty rank using a cross-sectional comprehensive database of US physicians with medical school faculty appointments in 2014 (91,073 physicians; 9.1% of all US physicians), linked to information on physician sex, age, years since residency, specialty, authored publications, National Institutes of Health (NIH) funding, and clinical trial investigation. We estimated sex differences in full professorship, as well as a combined outcome of associate or full professorship, adjusting for these factors in a multilevel (hierarchical) model. We also analyzed how sex differences varied with specialty and whether differences were more prevalent at schools ranked highly in research. Physician sex. Academic faculty rank. In all, there were 30,464 women who were medical faculty vs 60,609 men. Of those, 3623 women (11.9%) vs 17,354 men (28.6%) had full-professor appointments, for an absolute difference of -16.7% (95% CI, -17.3% to -16.2%). Women faculty were younger and disproportionately represented in internal medicine and pediatrics. The mean total number of publications for women was 11.6 vs 24.8 for men, for a difference of -13.2 (95% CI, -13.6 to -12.7); the mean first- or last-author publications for women was 5.9 vs 13.7 for men, for a difference of -7.8 (95% CI, -8.1 to -7.5). Among 9.1% of medical faculty with an NIH grant, 6.8% (2059 of 30,464) were women and 10.3% (6237 of 60,609) were men, for a difference of -3.5% (95% CI, -3.9% to -3.1%). In all, 6.4% of women vs 8.8% of men had a trial registered on ClinicalTrials.gov, for a difference of -2.4% (95% CI, -2.8% to -2.0%). After multivariable adjustment, women were less likely than men to have achieved full-professor status (absolute adjusted difference in proportion, -3.8%; 95% CI, -4.4% to -3.3%). Sex-differences in full professorship were present across all specialties and did not vary according to whether a physician's medical school was ranked highly in terms of research funding. Among physicians with faculty appointments at US medical schools, there were sex differences in academic faculty rank, with women substantially less likely than men to be full professors, after accounting for age, experience, specialty, and measures of research productivity.

Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012.

PubMed

Ford, Earl S; Cunningham, Timothy J; Croft, Janet B

2015-05-01

The trend in sleep duration in the United States population remains uncertain. Our objective was to examine changes in sleep duration from 1985 to 2012 among US adults. Trend analysis. Civilian noninstitutional population of the United States. 324,242 US adults aged ≥ 18 y of the National Health Interview Survey (1985, 1990, and 2004-2012). Sleep duration was defined on the basis of the question "On average, how many hours of sleep do you get in a 24-h period?" The age-adjusted mean sleep duration was 7.40 h (standard error [SE] 0.01) in 1985, 7.29 h (SE 0.01) in 1990, 7.18 h (SE 0.01) in 2004, and 7.18 h (SE 0.01) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004-2012 = 0.982). The age-adjusted percentage of adults sleeping ≤ 6 h was 22.3% (SE 0.3) in 1985, 24.4% (SE 0.3) in 1990, 28.6% (SE 0.3) in 2004, and 29.2% (SE 0.3) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004-2012 = 0.050). In 2012, approximately 70.1 million US adults reported sleeping ≤ 6 h. Since 1985, age-adjusted mean sleep duration has decreased slightly and the percentage of adults sleeping ≤ 6 h increased by 31%. Since 2004, however, mean sleep duration and the percentage of adults sleeping ≤ 6 h have changed little. © 2015 Associated Professional Sleep Societies, LLC.

Asia-Pacific Economic Update, 2012. Volume 3

DTIC Science & Technology

2012-09-01

merchandise trade with the Asia-Pacific region in 2012, will impact the region?s growth. This paper considers how US economic slowness and the European...sail again will affect the pace of growth in Asia. In addition, the US’s capacity to expand its 2011 $1.2 trillion in merchandise trade with the Asia...story is somewhat more balanced. China and US total bilateral merchandise trade stood at $3.6 and $3.7 trillion, respectively, for 2011.26,27

Controlled release of basic fibroblast growth factor for angiogenesis using acoustically-responsive scaffolds.

PubMed

Moncion, Alexander; Lin, Melissa; O'Neill, Eric G; Franceschi, Renny T; Kripfgans, Oliver D; Putnam, Andrew J; Fabiilli, Mario L

2017-09-01

The clinical translation of pro-angiogenic growth factors for treatment of vascular disease has remained a challenge due to safety and efficacy concerns. Various approaches have been used to design spatiotemporally-controlled delivery systems for growth factors in order to recapitulate aspects of endogenous signaling and thus assist in translation. We have developed acoustically-responsive scaffolds (ARSs), which are fibrin scaffolds doped with a payload-containing, sonosensitive emulsion. Payload release can be controlled non-invasively and in an on-demand manner using focused, megahertz-range ultrasound (US). In this study, we investigate the in vitro and in vivo release from ARSs containing basic fibroblast growth factor (bFGF) encapsulated in monodispersed emulsions. Emulsions were generated in a two-step process utilizing a microfluidic device with a flow focusing geometry. At 2.5 MHz, controlled release of bFGF was observed for US pressures above 2.2 ± 0.2 MPa peak rarefactional pressure. Superthreshold US yielded a 12.6-fold increase in bFGF release in vitro. The bioactivity of the released bFGF was also characterized. When implanted subcutaneously in mice, ARSs exposed to superthreshold US displayed up to 3.3-fold and 1.7-fold greater perfusion and blood vessel density, respectively, than ARSs without US exposure. Scaffold degradation was not impacted by US. These results highlight the utility of ARSs in both basic and applied studies of therapeutic angiogenesis. Copyright © 2017 Elsevier Ltd. All rights reserved.

Technoeconomic Assessment of an Advanced Aqueous Ammonia-Based Postcombustion Capture Process Integrated with a 650-MW Coal-Fired Power Station.

PubMed

Li, Kangkang; Yu, Hai; Yan, Shuiping; Feron, Paul; Wardhaugh, Leigh; Tade, Moses

2016-10-04

Using a rigorous, rate-based model and a validated economic model, we investigated the technoeconomic performance of an aqueous NH 3 -based CO 2 capture process integrated with a 650-MW coal-fired power station. First, the baseline NH 3 process was explored with the process design of simultaneous capture of CO 2 and SO 2 to replace the conventional FGD unit. This reduced capital investment of the power station by US$425/kW (a 13.1% reduction). Integration of this NH 3 baseline process with the power station takes the CO 2 -avoided cost advantage over the MEA process (US$67.3/tonne vs US$86.4/tonne). We then investigated process modifications of a two-stage absorption, rich-split configuration and interheating stripping to further advance the NH 3 process. The modified process reduced energy consumption by 31.7 MW/h (20.2% reduction) and capital costs by US$55.4 million (6.7% reduction). As a result, the CO 2 -avoided cost fell to $53.2/tonne: a savings of $14.1 and $21.9/tonne CO 2 compared with the NH 3 baseline and advanced MEA process, respectively. The analysis of energy breakdown and cost distribution indicates that the technoeconomic performance of the NH 3 process still has great potential to be improved.

7 CFR 51.2835 - U.S. No. 2.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false U.S. No. 2. 51.2835 Section 51.2835 Agriculture... Standards for Grades of Onions (Other Than Bermuda-Granex-Grano and Creole Types) Grades § 51.2835 U.S. No... Matter; (4) Seedstems; (5) Sprouts; (6) Mechanical; (7) Dry sunken areas; (8) Disease; (9) Freezing; (10...

7 CFR 51.2835 - U.S. No. 2.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false U.S. No. 2. 51.2835 Section 51.2835 Agriculture... Standards for Grades of Onions (Other Than Bermuda-Granex-Grano and Creole Types) Grades § 51.2835 U.S. No... Matter; (4) Seedstems; (5) Sprouts; (6) Mechanical; (7) Dry sunken areas; (8) Disease; (9) Freezing; (10...

Studying cross-cultural differences in the development of infant temperament: People's Republic of China, the United States of America, and Spain.

PubMed

Gartstein, Maria A; Gonzalez, Carmen; Carranza, Jose A; Ahadi, Stephan A; Ye, Renmin; Rothbart, Mary K; Yang, Suh Wen

2006-01-01

Investigated early development of temperament across three cultures: People's Republic of China (PRC), United States of America (US), and Spain, utilizing a longitudinal design (assessments at 3, 6, and 9 months of age). Selection of these countries presented an opportunity to conduct Eastern-Western/Individualistic-Collectivistic comparisons. The greatest number of significant differences (i.e., involving more temperament dimensions) was anticipated for the US (Western/Individualistic) and PRC (Eastern/Collectivistic) comparisons. The US sample included 66, the PRC group 69, and the Spanish sample, 60 mothers, all of whom completed the Infant Behavior Questionnaire (IBQ) 3 times, when their infants were 3, 6, and 9 months of age. Results related to mean group differences were generally consistent with our hypotheses, demonstrating a greater number of significant differences for US versus PRC, with fewer differences observed for US and Spain. Analyses addressing developmental changes in temperament indicated patterns consistent with a priori expectations and cross-cultural differences.

Probabilistic determination of the ecological risk from OTNE in aquatic and terrestrial compartments based on US-wide monitoring data.

PubMed

McDonough, Kathleen; Casteel, Kenneth; Zoller, Ann; Wehmeyer, Kenneth; Hulzebos, Etje; Rila, Jean-Paul; Salvito, Daniel; Federle, Thomas

2017-01-01

OTNE [1-(1,2,3,4,5,6,7,8-octahydro-2,3,8,8-tetramethyl-2-naphthyl)ethan-1-one; trade name Iso E Super] is a fragrance ingredient commonly used in consumer products which are disposed down the drain. This research measured effluent and sludge concentrations of OTNE at 44 US wastewater treatment plants (WWTP). The mean effluent and sludge concentrations were 0.69 ± 0.65 μg/L and 20.6 ± 33.8 mg/kg dw respectively. Distribution of OTNE effluent concentrations and dilution factors were used to predict surface water and sediment concentrations and distributions of OTNE sludge concentrations and loading rates were used to predict terrestrial concentrations. The 90th percentile concentration of OTNE in US WWTP mixing zones was predicted to be 0.04 and 0.85 μg/L under mean and 7Q10 low flow (lowest river flow occurring over a 7 day period every 10 years) conditions respectively. The 90th percentile sediment concentrations under mean and 7Q10 low flow conditions were predicted to be 0.081 and 1.6 mg/kg dw respectively. Based on current US sludge application practices, the 90th percentile OTNE terrestrial concentration was 1.38 mg/kg dw. The probability of OTNE concentrations being below the predicted no effect concentration (PNEC) for the aquatic and sediment compartments was greater than 99%. For the terrestrial compartment, the probability of OTNE concentrations being lower than the PNEC was 97% for current US sludge application practices. Based on the results of this study, OTNE concentrations in US WWTP effluent and sludge do not pose an ecological risk to aquatic, sediment and terrestrial organisms. Copyright © 2016 Elsevier Ltd. All rights reserved.

Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

PubMed Central

Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

2014-01-01

Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

International labor migration and external debt.

PubMed

Bustamante, J A

1987-01-01

The prevailing Mexican and US definitions of undocumented migration are poles apart. The US views it as a criminal problem. Mexicans view the undocumented migrants as actors in an economic game in which the rules are extremely disadvantageous to these migrants. Migrants themselves and their communities view the undocumented as a positive element. It is necessary to move toward a bilateral focus and bilateral negotiation on the issue of migratory workers. This proposal derives from several assumptions: 1) the external debt is a bilateral or multilateral issue, 2) it is important to avoid forcing debtor countries to choose between stimulating economic growth or making payment on their foreign debt, 3) prevailing public opinion in the US favors halting undocumented migration, 4) the US views the migration of undocumented Mexicans as the result of forces endogenous to Mexico and exogenous to the US, 5) the US views both Mexico's ability to make payment on its external debt and to halt emigration as tied to the Mexican government's ability or inability to reconcile political stability with scarce monetary resources, and 6) political instability in Mexico could augment emigration to the US and undermine Mexico's ability to address its foreign debt. The following proposal suggests means to link negotiation on the external debt to that of undocumented migration: 1) The Mexican government could reach an accord with the US to channel a portion of the actual interest on the external debt as a fund to be invested in Mexico to construct a system of labor intensive agroindustrial productive units designed to attract former or potential migratory workers; 2) the total amount of these funds would be deducted from interest payments on the principal of the actual external debt and redefined as an ad hoc loan to Mexico to finance these production units; 3) part of the production from these units would be incorporated into ongoing US food relief and food assistance programs; 4) the program by which the US would import the production of these agroindustrial units in Mexico would retain previously migratory workers in Mexico; 5) a feasibility study would precede implementing an accord on the amount of financing and the terms of operation; and 6) the time during the binational study would be a grace period, during which payment of a portion of the interest of Mexico's foreign debt would be temporarily suspended.

Efficacy of Combined Ultrasound-and-Microbubbles-Mediated Diclofenac Gel Delivery to Enhance Transdermal Permeation in Adjuvant-Induced Rheumatoid Arthritis in the Rat.

PubMed

Liao, Ai-Ho; Chung, Huan-Yu; Chen, Wen-Shiang; Yeh, Ming-Kung

2016-08-01

A previous study that investigated the effect of ultrasound (US) on the transdermal permeation of the non-steroidal anti-inflammatory drug diclofenac found that therapeutic US can increase circulation in an inflamed joint and decrease arthritic pain. Transdermal drug delivery has recently been demonstrated by US combined with microbubbles (MB) contrast agent (henceforth referred to as "US-MB"). The present study evaluated the efficacy of US-MB-mediated diclofenac delivery for treating adjuvant-induced rheumatoid arthritis (RA) in rats. RA was induced by injecting 100 μL of complete Freund's adjuvant into the ankle joint of male Sprague-Dawley rats (250-300 g) that were randomly divided into five treatment groups: (i) carbopol gel alone (the control [group C]), (ii) diclofenac-carbopol gel (group D), (iii) US plus carbopol gel (group U), (iv) US plus diclofenac-carbopol gel (group DU) and (v) US-MB plus diclofenac-carbopol gel (group DUB). The ankle width was measured over 10 d using high-frequency (40-MHz) US B-mode and color Doppler-mode imaging, covering the period before and after treatment. Longitudinal US images of the induced RA showed synovitis and neovascularity. Only a small amount of neovascularity was observed after treatment. The recovery rate on day 10 was significantly higher in group DUB (97.7% ± 2.7%, mean ± standard deviation [SD]) than in groups C (1.0% ± 2.7%), D (37.5% ± 4.6%), U (75.5% ± 4.2%) and DU (87.3% ± 5.2%) (p < 0.05). The results obtained indicate that combining US and MB can increase the skin permeability and thereby enhance the delivery of diclofenac sodium gel and thereby inhibit inflammation of the tissues surrounding the arthritic ankle. Color Doppler-mode imaging revealed that US-MB treatment induced a rapid reduction in synovial neoangiogenesis in the arthritic area. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Participation in Genetic Research: Amazon's Mechanical Turk Workforce in the United States and India.

PubMed

Groth, Susan W; Dozier, Ann; Demment, Margaret; Li, Dongmei; Fernandez, I Diana; Chang, Jack; Dye, Timothy

2016-01-01

Genomic research has innumerable benefits. However, if people are unwilling to participate in genomic research, application of knowledge will be limited. This study examined the likelihood of respondents from a high- and a low- to middle-income country to participate in genetic research. Cross-sectional data were collected using Amazon's Mechanical Turk workforce to ascertain attitudes toward participation in genetic research. Registered country of residence was either the US (n = 505) or India (n = 505). Multiple logistic regression models were used to assess adjusted effects of demographic characteristics, health, social status, beliefs and concerns on 4 genetic research outcomes. Participants from India who believed chance and powerful others influenced their health were more likely to participate in genetic research (OR = 1.0, 95% CI 1.0-1.1) and to agree with sharing of DNA data (OR = 1.1, 95% CI 1.1-1.2). US participants were more likely to be concerned about protection of family history, which they indicated would affect participation (OR = 3.6, 95% CI 2.1-6.0). Commonalities for the likelihood of participation were beliefs that genetic research could help find new treatments (India OR = 2.3, 95% CI 1.0-5.4; US OR = 4.7, 95% CI 2.0-11.2) and descendants would benefit (India OR = 2.6, 95% CI 1.2-5.5; US OR = 3.0, 95% CI 1.3-7.1). Concurrence of beliefs on benefits and concerns about genetic research suggest they may be common across countries. Consideration of commonalities may be important to increase global participation in genetic research. © 2016 S. Karger AG, Basel.

Participation in Genetic Research: Amazon's Mechanical Turk Workforce in the United States and India Weigh In

PubMed Central

Groth, Susan W; Dozier, Ann; Demment, Margaret; Li, Dongmei; Fernandez, I Diana; Chang, Jack; Dye, Timothy

2016-01-01

Background Genomic research has innumerable benefits. However, if people are unwilling to participate in genomic research application of knowledge will be limited. This study examined the likelihood of respondents from a high and a low-middle income country to participate in genetic research. Methods Cross-sectional data were collected using Amazon's Mechanical Turk workforce to ascertain attitudes toward participation in genetic research. Registered country of residence was either the US (n = 505) or India (n = 505). Multiple logistic regression models were used to assess adjusted effects of demographic characteristics, health, social status, beliefs and concerns on four genetic research outcomes. Results India participants who believed chance and powerful others influenced their health were more likely to participate in genetic research (OR = 1.0: 95% CI [1.0, 1.1]) and to agree with sharing of DNA data (OR = 1.1: 95% CI [1.1, 1.2]). US participants were more likely to be concerned about protection of family history, which they indicated would affect participation (OR = 3.6: 95% CIs [2.1, 6.0]). Commonalities for likelihood of participation were beliefs that genetic research could help find new treatments (India OR = 2.3: 95% CIs [1.0, 5.4]: US OR = 4.7: 95% CI [2.0, 11.2]) and descendants would benefit (India OR = 2.6: 95% CIs [1.2, 5.5]: US OR = 3.0: 95% CIs [1.3, 7.1]). Conclusions Concurrence of beliefs on benefits and concerns about genetic research suggest they may be common across countries. Consideration of commonalities may be important to increase global participation in genetic research. PMID:27811475

Brain ultrasound findings in neonates treated with intrauterine transfusion for fetal anaemia.

PubMed

Leijser, Lara M; Vos, Nikki; Walther, Frans J; van Wezel-Meijler, Gerda

2012-09-01

The main causes of severe fetal anaemia are red-cell allo-immunization, parvo B19 virus infection and feto-maternal haemorrhage. Treatment consists of intrauterine transfusion (IUT). Neuro-imaging studies in surviving neonates treated with IUT are scarce. To assess if neonates treated with IUT for fetal anaemia are at risk for cerebral injury, report the incidence and severity of brain ultrasound (US) abnormalities and explore the relation between brain US findings and perinatal parameters and neurological outcome. Brain US scans of neonates born alive between 2001 and 2008 with at least one IUT were retrospectively reviewed and classified as normal, mildly or moderately/severely abnormal. Incidences of abnormalities were calculated for full-term and preterm neonates. Presence and severity of abnormalities were related to clinical and IUT related parameters and to neurological outcome around 2 years of age (adverse: moderate or severe disability; favourable: normal or mild disability). A total of 127 neonates (82 born preterm) were included. Median number of IUTs was 3 (range 1-6) and of brain US 2 (1-6). Median gestational age and weight at birth were 36.6 (26.0-41.1) weeks and 2870 (1040-3950)g. In 72/127 (57%) neonates ≥1 abnormality was seen on brain US, classified as moderate/severe in 30/127 (24%). Neurological outcome was adverse in 5 infants. Presence of brain US abnormalities was not significantly related to any of the perinatal parameters or to neurological outcome. Neonates undergoing IUT for fetal anaemia are at high risk of brain injury. Copyright © 2012 Elsevier Ltd. All rights reserved.

Physical Function After Total Knee Replacement: An Observational Study Describing Outcomes in a Small Group of Women From China and the United States.

PubMed

White, Daniel K; Li, Zhichang; Zhang, Yuqing; Marmon, Adam R; Master, Hiral; Zeni, Joseph; Niu, Jingbo; Jiang, Long; Zhang, Shu; Lin, Jianhao

2018-01-01

To describe physical function before and six months after Total Knee Replacement (TKR) in a small sample of women from China and the United States. Observational. Community environment. Both groups adhered to the Osteoarthritis Research Society International (OARSI) protocols for the 6-minute walk and 30-second chair stand. We compared physical function prior to TKR and 6 months after using linear regression adjusted for covariates. Women (N=60) after TKR. Not applicable. Age and body mass index in the China group (n=30; 66y and 27.0kg/m 2 ) were similar to those in the U.S. group (n=30; 65y and 29.6kg/m 2 ). Before surgery, the China group walked 263 (95% confidence interval [CI], -309 to -219) less meters and had 10.2 (95% CI, -11.8 to -8.5) fewer chair stands than the U.S. group. At 6 months when compared with the U.S. group, the China group walked 38 more meters, but this difference did not reach statistical significance (95% CI, -1.6 to 77.4), and had 3.1 (95% CI, -4.4 to -1.7) fewer chair stands. The China group had greater improvement in the 6-minute walk test than did the U.S. group (P<.001). Despite having worse physical function before TKR, the China group had greater gains in walking endurance and similar gains in repeated chair stands than did the U.S. group after surgery. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of heat sink on the recurrence of small malignant hepatic tumors after radiofrequency ablation.

PubMed

Lin, Zheng-Yu; Li, Guo-Lin; Chen, Jin; Chen, Zhong-Wu; Chen, Yi-Ping; Lin, Sun-Zhi

2016-12-01

The aim of this study was to investigate the effect of heat sink on the recurrence of hepatic malignant tumors <3 cm after percutaneous radiofrequency ablation (RFA). This study included 564 hepatic malignant tumors <3 cm in 381 patients. Preoperative images were used to determine whether these tumors were adjacent to vessels, and the diameter of adjacent vessels was measured. RFA was performed computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) guidance, and postoperative imaging follow-up was then conducted. SPSS software version 17.0 was used for data processing, and the χ2 test was used for comparative analysis. Two-sided P < 0.05 indicated statistical significance. A total of 33 recurrences were found: 15 in the MR group (15/468), 12 in the US group (12/53), and 6 in the CT group (6/43). Of the 101 lesions adjacent to blood vessels larger than 3 mm, 20 showed recurrence: 10 in the MR group (10/77), 7 in the US group (7/17), and 3 in the CT group (3/7). The recurrence rate of perivascular lesions was higher than that of nonperivascular lesions, and the rate in the MR group was lower those in the US and CT groups. The curative effect of MRI-guided RFA is better than those of US- and CT-guided ablation. The heat sink effect is an important factor affecting recurrence of hepatic malignant tumors after RFA.

The Dorsal 4-finger Technique: A Novel Method to Examine Metacarpophalangeal Joints in Patients with Rheumatoid Arthritis.

PubMed

Omair, Mohammed A; Akhavan, Pooneh; Naraghi, Ali; Mittoo, Shikha; Xiong, Juan; Weber, Deborah; Lin, Daming; Weber, Melissa; Keystone, Edward C

2018-03-01

To describe the dorsal 4-finger technique (DFFT) in examining metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) and compare it to the traditional 2-finger technique (TFT) using ultrasound (US) as a gold standard. Four rheumatologists evaluated 180 MCP joints of 18 patients with RA. All patients underwent US for greyscale (GSUS) and power Doppler US (PDUS). Agreements between rheumatologists, the 2 techniques, and US were evaluated using Cohen κ and the first-order agreement coefficient (AC1) κ methods. The population comprised 17 females (94.4%) with a mean (SD) age and disease duration of 56.8 (14.4) and 21.8 (12.9) years, respectively. Eight patients (44.4%) were taking methotrexate monotherapy, while 10 patients (55.6%) were receiving biologics. US evaluation revealed 69 (38.3%) and 30 (16.7%) joints exhibited synovitis grade 2-3 by GSUS and PDUS, respectively. Effusion was documented in 30 joints (16.7%). The mean intraobserver agreement using the DFFT and TFT were 80.5% and 86%, respectively. The mean interobserver agreements using the DFFT and TFT were 84% and 74%, respectively. κ agreement with US findings was similar for both techniques in tender joints but was higher for the DFFT in nontender joints (0.33 vs 0.07, p = 0.015 for GSUS) and (0.48 vs 0.11, p = 0.002 for PDUS). The DFFT had a higher sensitivity in detecting ballottement by GSUS (0.47 vs 0.2, p < 0.001) and PDUS (0.60 vs 0.27, p < 0.001). The DFFT is a novel, reproducible, and reliable method to examine MCP joints, and it has a better correlation with US than the traditional TFT.

Influence of body condition score on live and carcass value of cull beef cows.

PubMed

Apple, J K

1999-10-01

Mature beef cows (n = 88) were slaughtered to determine the influence of body condition score (BCS) on carcass and live animal value. Cows were weighed and assigned a BCS (9-point scale), 24 h before slaughter. Hide and by-products weights were recorded during harvest. After a 48-h chill period, the right side of each carcass was fabricated into boneless subprimal cuts, minor cuts, lean trim, fat, and bone. Weights were recorded at all stages of fabrication. Carcass values (U.S.$/100 kg of hot carcass weight) were calculated for U.S. Utility and U.S. Cutter grades, as well as for the Utility/Cutter mix for each BCS. Gross value included the carcass value and the value of the hide and byproducts, whereas net value was calculated after harvest and fabrication costs and by-product value were considered. Live value (U.S.$/100 kg of live weight) was computed by dividing the net value by the animal's live weight 24 h before harvest. The value of the hide and by-products for BCS-2 cows was greater (P<.05) than for cows assigned a BCS of 3 through 8. Even though U.S. Utility carcasses from BCS-8 cows produced the least (P<.05) valuable subprimal cuts from the chuck, loin, and round, the gross and net values of BCS-8 cows were greater (P<.05) than those of BCS-3, 4, 5, and 6. Within the grade of U.S. Cutter, carcasses from BCS-6 cows had the highest (P<.05), and BCS-2 cows had the lowest (P<.05), gross and net values. Across the U.S. Utility/Cutter mix, cows designated with a BCS of 7 and 8 had greater (P<.05) gross and net values than cows assigned a BCS of 6, or lower. Live value increased linearly (P = .0002) from a low of $76.10/100 kg for BCS-2 cows to a high of $90.84/100 kg for BCS-7 cows. Carcasses from BCS-6 cows were relatively lean (8.4 mm of fat opposite of the longissimus muscle), and approximately 73% of the carcasses achieved a quality grade of U.S. Utility. Moreover, carcasses from BCS-6 cows had the highest total carcass values and live values comparable (P>.05) to BCS-7 cows. Information from this study can be used by the non-fed beef industry to establish a value-based marketing system. Data from this study would indicate that marketing cull beef cows at a BCS of 6 could optimize economic returns to both cow-calf producers and non-fed beef packers.

37 CFR 6.2 - Prior U.S. schedule of classes of goods and services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... classes of goods and services. 6.2 Section 6.2 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE CLASSIFICATION OF GOODS AND SERVICES UNDER THE TRADEMARK ACT § 6.2 Prior U.S. schedule of classes of goods and services. Class Title Goods 1 Raw or partly...

Effectiveness of a Layer-by-Layer Microbubbles-Based Delivery System for Applying Minoxidil to Enhance Hair Growth

PubMed Central

Liao, Ai-Ho; Lu, Ying-Jui; Lin, Yi-Chun; Chen, Hang-Kang; Sytwu, Huey-Kang; Wang, Chih-Hung

2016-01-01

Minoxidil (Mx) is a conventional drug for treating androgenetic alopecia, preventing hair loss, and promoting hair growth. The solubility of Mx has been improved using chemical enhancement methods to increase its skin permeability over the long term. This study created a new ultrasound (US) contrast agent—albumin-shelled microbubbles (MBs) that absorb chitosan oligosaccharide lactate (COL) and Mx—and combined it with sonication by US energy in the water phase to enhance hair growth while shortening the treatment period. COL and Mx grafted with MBs (mean diameter of 1480 nm) were synthesized into self-assembled complexes of COL-MBs and Mx-COL-MBs that had mean diameters of 4150 and 4500 nm, respectively. The US was applied at 3 W/cm2 for 1 min, and combined with Mx-COL-MBs containing 0.3% Mx. The diffusion of Mx through the dialysis membrane from Mx-COL-MB during US (US+Mx-COL-MB) was more rapid at pH 4 than at pH 7.4, which is favorable given that the environment of the scalp is mildly acidic (pH=4.5-5.5). In Franz diffusion experiments performed in vitro, the release rates at 18 hours in the US+Mx-COL-MBs and US+MBs+Mx groups resulted in 2.3 and 1.7 times the penetration and deposition, respectively, of Mx relative to the group with Mx alone. During 21 days treatment in animal experiments, the growth rates at days 10 and 14 in the US+Mx-COL-MBs group increased by 22.6% and 64.7%, respectively, and there were clear significant differences (p<0.05) between the US+Mx-COL-MBs group and the other four groups. The use of US+Mx-COL-MB in the water phase can increased the effects of Mx so as to shorten the telogen phase, and also increase both the diameter of keratinized hair shafts and the size of hair follicles without causing skin damage. PMID:27162552

Measurement of testicular volume in smaller testes: how accurate is the conventional orchidometer?

PubMed

Lin, Chih-Chieh; Huang, William J S; Chen, Kuang-Kuo

2009-01-01

The aim of this study was to evaluate the accuracy of different methods, including the Seager orchidometer (SO) and ultrasonography (US), for assessing testicular volume of smaller testes (testes volume less than 18 mL). Moreover, the equations used for the calculations--the Hansen formula (length [L] x width [W](2) x 0.52, equation A), the prolate ellipsoid formula (L x W x height [H] x 0.52, equation B), and the Lambert equation (L x W x H x 0.71, equation C)--were also examined and compared with the gold standard testicular volume obtained by water displacement (Archimedes principle). In this study, 30 testes from 15 men, mean age 75.3 (+/-8.3) years, were included. They all had advanced prostate cancer and were admitted for orchiectomy. Before the procedure, all the testes were assessed using SO and US. The dimensions were then input into each equation to obtain the volume estimates. The testicular volume by water displacement was 8.1 +/- 3.5 mL. Correlation coefficients (R(2)) of the 2 different methods (SO, US) to the gold standard were 0.70 and 0.85, respectively. The calculated testicular volumes were 9.2 +/- 3.9 mL (measured by SO, equation A), 11.9 +/- 5.2 mL (measured by SO, equation C), 7.3 +/- 4.2 mL (measured by US, equation A), 6.5 +/- 3.3 mL (measured by US, equation B) and 8.9 +/- 4.5 mL (measured by US, equation C). Only the mean size measured by US and volume calculated with the Hansen equation (equation A) and the mean size measured by US and volume calculated with the Lambert equation (equation C) showed no significant differences when compared with the volumes estimated by water displacement (mean difference 0.81 mL, P = .053, and 0.81 mL, P = .056, respectively). Based on our measurements, we categorized testicular volume by different cutoff values (7.0 mL, 7.5 mL, 8.0 mL, and 8.5 mL) to calculate a new constant for use in the Hansen equation. The new constant was 0.59. We then reexamined the equations using the new 0.59 constant, and found that the equation Volume (V) = L x W(2) x 0.59 was the best for describing testicular volume among our subjects (difference between the new equation and the gold standard of water displacement = 0.19 mL, P = .726). We also found that US was more precise in measuring testicular dimensions. We propose a new formula, V = L x W(2) x 0.59, to assess the volumes of smaller testes.

Carbon dioxide from coal combustion: Variation with rank of US coal

USGS Publications Warehouse

Quick, J.C.; Glick, D.C.

2000-01-01

Carbon dioxide from combustion of US coal systematically varies with ASTM rank indices, allowing the amount of CO2 produced per net unit of energy to be predicted for individual coals. No single predictive equation is applicable to all coals. Accordingly, we provide one equation for coals above high volatile bituminous rank and another for lower rank coals. When applied to public data for commercial coals from western US mines these equations show a 15% variation of kg CO2 (net GJ)-1. This range of variation suggests reduction of US CO2 emissions is possible by prudent selection of coal for combustion. Maceral and mineral content are shown to slightly affect CO2 emissions from US coal. We also suggest that CO2 emissions increased between 6 and 8% in instances where Midwestern US power plants stopped burning local, high-sulfur bituminous coal and started burning low-sulfur, subbituminous C rank coal from the western US.

Testicular Cancer in U.S. Navy Personnel.

DTIC Science & Technology

1985-09-01

34 FO6i L MEuN 44 L.0. 1 1.2 11111h.6 111WII*Z MIIIII-; S0irIO TSTCHR &L. TESTICULAR CANCER IN U.S. NAVY PERSONNEL (o ’- F. C. GARLAND SE.0. GORIHAM o...CALIFORNIA 92138-9174 * ~NAVAL MEDICAL RESEARCH AND DEVELOPMENT COMMAND L, BETHESDA, MARYLAND Mir’ I, Testicular Cancer in U.S. Navy Personnel Frank...development of testicular cancer is greatest in white men aged 20-29. The U.S. Navy is one of the largest defined populations available of men in this

Epidemiological research on parent-child conflict in the United States: subgroup variations by place of birth and ethnicity, 2002-2013.

PubMed

Parra-Cardona, Jose Ruben; Yeh, Hsueh-Han; Anthony, James C

2017-01-01

Chronically escalated parent-child conflict has been observed to elicit maladaptive behavior and reduced psychological well-being in children and youth. In this epidemiological study, we sought to estimate the occurrence of escalated parent-child conflict for United States (US) adolescent subgroups defined by (a) ethnic self-identification, and (b) nativity (US-born versus foreign-born). US study populations of 12-to-17-year-olds were sampled, recruited, and assessed for the National Surveys on Drug Use and Health (NSDUH), 2002-2013 ( n  = 111, 129). Analysis-weighted contingency table analyses contrasted US-born versus foreign-born who self-identified as: (a) Hispanic, (b) non-Hispanic African-American, (c) non-Hispanic Asian, and (c) non-Hispanic White. Frequently escalated parent-child conflict was most prevalent among US-born non-Hispanic White adolescents, from 18% at age 12 (95% CI [17.6%, 18.9%]) to 29% at age 17 (95% CI [28.3%, 29.7%]), followed by US-born Hispanic and non-Hispanic Asian children. Estimated prevalence proportions were markedly lower for African-American children, from 8% at age 12 (95% CI [6.8, 8.5]) to 16% at age 17 (95% CI [14.3, 16.7]). Broad and sometimes overlapping CI indicate that larger sample sizes are needed for complete evaluation of an apparent excess occurrence of frequent parent-child conflict among US-born versus foreign-born. Nonetheless, in the larger subgroups, the US-born show a clear excess occurrence of frequent parent-child conflict. For example, US-born Mexican children have 1.7 times higher odds of experiencing frequent parent-child conflict than foreign-born Mexican children (OR = 1.7, 95% CI [1.5, 2.0], p -value < 0.001). The main discovery from this multi-ethnic sample investigation is a rank-ordering of parent-child conflict prevalence estimates from high (non-Hispanic White) to low (non-Hispanic African-American). The pattern also suggests a possibly generalizable excess associated with US-born sub-groups. The epidemiological estimates presented here merit attention in future cross-cultural research focused on parent-child conflict.

Epidemiological research on parent–child conflict in the United States: subgroup variations by place of birth and ethnicity, 2002–2013

PubMed Central

Yeh, Hsueh-Han; Anthony, James C.

2017-01-01

Background Chronically escalated parent–child conflict has been observed to elicit maladaptive behavior and reduced psychological well-being in children and youth. In this epidemiological study, we sought to estimate the occurrence of escalated parent–child conflict for United States (US) adolescent subgroups defined by (a) ethnic self-identification, and (b) nativity (US-born versus foreign-born). Methods US study populations of 12-to-17-year-olds were sampled, recruited, and assessed for the National Surveys on Drug Use and Health (NSDUH), 2002–2013 (n = 111, 129). Analysis-weighted contingency table analyses contrasted US-born versus foreign-born who self-identified as: (a) Hispanic, (b) non-Hispanic African-American, (c) non-Hispanic Asian, and (c) non-Hispanic White. Results Frequently escalated parent–child conflict was most prevalent among US-born non-Hispanic White adolescents, from 18% at age 12 (95% CI [17.6%, 18.9%]) to 29% at age 17 (95% CI [28.3%, 29.7%]), followed by US-born Hispanic and non-Hispanic Asian children. Estimated prevalence proportions were markedly lower for African-American children, from 8% at age 12 (95% CI [6.8, 8.5]) to 16% at age 17 (95% CI [14.3, 16.7]). Broad and sometimes overlapping CI indicate that larger sample sizes are needed for complete evaluation of an apparent excess occurrence of frequent parent-child conflict among US-born versus foreign-born. Nonetheless, in the larger subgroups, the US-born show a clear excess occurrence of frequent parent-child conflict. For example, US-born Mexican children have 1.7 times higher odds of experiencing frequent parent-child conflict than foreign-born Mexican children (OR = 1.7, 95% CI [1.5, 2.0], p-value < 0.001). Discussion The main discovery from this multi-ethnic sample investigation is a rank-ordering of parent-child conflict prevalence estimates from high (non-Hispanic White) to low (non-Hispanic African-American). The pattern also suggests a possibly generalizable excess associated with US-born sub-groups. The epidemiological estimates presented here merit attention in future cross-cultural research focused on parent-child conflict. PMID:28149684

Outcomes of Multiple Listing for Adult Heart Transplantation in the United States: Analysis of OPTN Data From 2000 to 2013.

PubMed

Givens, Raymond C; Dardas, Todd; Clerkin, Kevin J; Restaino, Susan; Schulze, P Christian; Mancini, Donna M

2015-12-01

This study sought to assess the association of multiple listing with waitlist outcomes and post-heart transplant (HT) survival. HT candidates in the United States may register at multiple centers. Not all candidates have the resources and mobility needed for multiple listing; thus this policy may advantage wealthier and less sick patients. We identified 33,928 adult candidates for a first single-organ HT between January 1, 2000 and December 31, 2013 in the Organ Procurement and Transplantation Network database. We identified 679 multiple-listed (ML) candidates (2.0%) who were younger (median age, 53 years [interquartile range (IQR): 43 to 60 years] vs. 55 years [IQR: 45 to 61 years]; p < 0.0001), more often white (76.4% vs. 70.7%; p = 0.0010) and privately insured (65.5% vs. 56.3%; p < 0.0001), and lived in zip codes with higher median incomes (US$90,153 [IQR: US$25,471 to US$253,831] vs. US$68,986 [IQR: US$19,471 to US$219,702]; p = 0.0015). Likelihood of ML increased with the primary center's median waiting time. ML candidates had lower initial priority (39.0% 1A or 1B vs. 55.1%; p < 0.0001) and predicted 90-day waitlist mortality (2.9% [IQR: 2.3% to 4.7%] vs. 3.6% [IQR: 2.3% to 6.0]%; p < 0.0001), but were frequently upgraded at secondary centers (58.2% 1A/1B; p < 0.0001 vs. ML primary listing). ML candidates had a higher HT rate (74.4% vs. 70.2%; p = 0.0196) and lower waitlist mortality (8.1% vs. 12.2%; p = 0.0011). Compared with a propensity-matched cohort, the relative ML HT rate was 3.02 (95% confidence interval: 2.59 to 3.52; p < 0.0001). There were no post-HT survival differences. Multiple listing is a rational response to organ shortage but may advantage patients with the means to participate rather than the most medically needy. The multiple-listing policy should be overturned. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan.

PubMed

Chopra, Teena; Marchaim, Dror; Awali, Reda A; Levine, Miriam; Sathyaprakash, Smitha; Chalana, Indu K; Ahmed, Farah; Martin, Emily T; Sieggreen, Mary; Sobel, Jack D; Kaye, Keith S

2016-03-01

Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners. A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs. Mean adjusted in-hospital costs per patient and per hospitalization were calculated and compared between infected and noninfected PrUs. The study cohort included 201 gunshot-SCI patients with PrUs contributing to 395 admissions, including readmissions, between 2004 and 2008. Seventy-six patients (38%) had infected PrUs at time of the index admission. Independent predictors of infected PrUs on index admission included Charlson Comorbidity Index ≥2 (odds ratio, 2.18, P = .026) and stage III/IV PrU (odds ratio, 4.82; P <.0001). During the study period, the cumulative median duration of hospitalization per patient was 12 days (interquartile range, 6-24 days), resulting in a mean adjusted cost of $19,969 ± $6639 per patient. The mean adjusted cost per hospitalization for patients with infected PrUs was significantly higher than that for patients with noninfected PrUs ($16,735 ± $8310 vs $12,356 ± $7007; P <.001). A multidisciplinary approach including home-based rehabilitation programs and SCI wound clinics might help prevent PrUs and their complications and reduce associated costs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Tumor size measured by preoperative ultrasonography and postoperative pathologic examination in papillary thyroid carcinoma: relative differences according to size, calcification and coexisting thyroiditis.

PubMed

Yoon, Young Hoon; Kwon, Ki Ryun; Kwak, Seo Young; Ryu, Kyeung A; Choi, Bobae; Kim, Jin-Man; Koo, Bon Seok

2014-05-01

Ultrasonography (US) is a useful diagnostic modality for evaluation of the size and features of thyroid nodules. Tumor size is a key indicator of the surgical extent of thyroid cancer. We evaluated the difference in tumor sizes measured by preoperative US and postoperative pathologic examination in papillary thyroid carcinoma (PTC). We reviewed the medical records of 172 consecutive patients, who underwent thyroidectomy for PTC treatment. We compared tumor size, as measured by preoperative US, with that in postoperative specimens. And we analyzed a number of factors potentially influencing the size measurement, including cancer size, calcification and coexisting thyroiditis. The mean size of the tumor measured by preoperative US was 11.4, and 10.2 mm by postoperative pathologic examination. The mean percentage difference (US-pathology/US) of tumor sizes measured by preoperative US and postoperative pathologic examination was 9.9 ± 19.3%, which was statistically significant (p < 0.001). When the effect of tumor size (≤10.0 vs. 10.1-20.0 vs. >20.0 mm) and the presence of calcification or coexisting thyroiditis on the tumor size discrepancy between the two measurements was analyzed, the mean percentage differences according to tumor size (9.1 vs. 11.2% vs. 9.8%, p = 0.842), calcification (9.2 vs. 10.2%, p = 0.756) and coexisting thyroiditis (17.6 vs. 9.5%, p = 0.223) did not show statistical significance. Tumor sizes measured in postoperative pathology were ~90% of those measured by preoperative US in PTC; this was not affected by tumor size, the presence of calcification or coexisting thyroiditis. When the surgical extent of PTC treatment according to tumor size measured by US is determined, the relative difference between tumor sizes measured by preoperative US and postoperative pathologic examination should be considered.

Household expenditures on pneumonia and diarrhoea treatment in Ethiopia: a facility-based study.

PubMed

Memirie, Solomon Tessema; Metaferia, Zewdu Sisay; Norheim, Ole F; Levin, Carol E; Verguet, Stéphane; Johansson, Kjell Arne

2017-01-01

Out-of-pocket (OOP) medical payments can lead to catastrophic health expenditure and impoverishment. We quantified household OOP expenditure for treatment of childhood pneumonia and diarrhoea and its impact on poverty for different socioeconomic groups in Ethiopia. This study employs a mix of retrospective and prospective primary household data collection for direct medical and non-medical costs (2013 US$). Data from 345 pneumonia and 341 diarrhoea cases (0-59 months of age) were collected retrospectively through exit interviews from 35 purposively sampled health facilities in Ethiopia. Prospective 2-week follow-up interviews were conducted at the household level using a structured questionnaire. The mean total medical expenditures per outpatient visit were US$8 for pneumonia and US$6 for diarrhoea, while the mean for inpatient visits was US$64 for severe pneumonia and US$79 for severe diarrhoea. The mean associated direct non-medical costs (mainly transport costs) were US$2, US$2, US$13 and US$20 respectively. 7% and 6% of the households with a case of severe pneumonia and severe diarrhoea, respectively, were pushed below the extreme poverty threshold of purchasing power parity (PPP) US$1.25 per day. Wealthier and urban households had higher OOP payments, but poorer and rural households were more likely to be impoverished due to medical payments. Households in Ethiopia incur considerable costs for the treatment of childhood diarrhoea and pneumonia with catastrophic consequences and impoverishment. The present circumstances call for revisiting the existing health financing strategy for high-priority services that places a substantial burden of payment on households at the point of care.

U.S. hardwood product exports, hardwood exports to Korea, hardwood resource situation, and the future of U.S. exports to Korea

Treesearch

Philip A. Araman

1991-01-01

The exerpts from this seminar are intended to give an overview of U.S. hardwood exports, hardwood exports to Korea, the hardwood resource situation, and the future of U.S. hardwood exports to Korea. It includes 1) some basic information about total U.S. hardwood exports and products, 2) information on hardwood exports to Korea from the U.S., 3) U.S. hardwood resources...

Relevance of Global Health Security to the US Export Economy.

PubMed

Cassell, Cynthia H; Bambery, Zoe; Roy, Kakoli; Meltzer, Martin I; Ahmed, Zara; Payne, Rebecca L; Bunnell, Rebecca E

To reduce the health security risk and impact of outbreaks around the world, the US Centers for Disease Control and Prevention and its partners are building capabilities to prevent, detect, and contain outbreaks in 49 global health security priority countries. We examine the extent of economic vulnerability to the US export economy posed by trade disruptions in these 49 countries. Using 2015 US Department of Commerce data, we assessed the value of US exports and the number of US jobs supported by those exports. US exports to the 49 countries exceeded $308 billion and supported more than 1.6 million jobs across all US states in agriculture, manufacturing, mining, oil and gas, services, and other sectors. These exports represented 13.7% of all US export revenue worldwide and 14.3% of all US jobs supported by all US exports. The economic linkages between the United States and these global health security priority countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics.

Relevance of Global Health Security to the US Export Economy

PubMed Central

Cassell, Cynthia H.; Bambery, Zoe; Roy, Kakoli; Meltzer, Martin I.; Ahmed, Zara; Payne, Rebecca L.

2017-01-01

To reduce the health security risk and impact of outbreaks around the world, the US Centers for Disease Control and Prevention and its partners are building capabilities to prevent, detect, and contain outbreaks in 49 global health security priority countries. We examine the extent of economic vulnerability to the US export economy posed by trade disruptions in these 49 countries. Using 2015 US Department of Commerce data, we assessed the value of US exports and the number of US jobs supported by those exports. US exports to the 49 countries exceeded $308 billion and supported more than 1.6 million jobs across all US states in agriculture, manufacturing, mining, oil and gas, services, and other sectors. These exports represented 13.7% of all US export revenue worldwide and 14.3% of all US jobs supported by all US exports. The economic linkages between the United States and these global health security priority countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics. PMID:29199867

Antibiotics-First Versus Surgery for Appendicitis: A US Pilot Randomized Controlled Trial Allowing Outpatient Antibiotic Management.

PubMed

Talan, David A; Saltzman, Darin J; Mower, William R; Krishnadasan, Anusha; Jude, Cecilia M; Amii, Ricky; DeUgarte, Daniel A; Wu, James X; Pathmarajah, Kavitha; Morim, Ashkan; Moran, Gregory J

2017-07-01

Randomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy. Patients aged 5 years or older with uncomplicated appendicitis at 1 US hospital were randomized to appendectomy or intravenous ertapenem greater than or equal to 48 hours and oral cefdinir and metronidazole. Stable antibiotics-first-treated participants older than 13 years could be discharged after greater than or equal to 6-hour emergency department (ED) observation with next-day follow-up. Outcomes included 1-month major complication rate (primary) and hospital duration, pain, disability, quality of life, and hospital charges, and antibiotics-first appendectomy rate. Of 48 eligible patients, 30 (62.5%) consented, of whom 16 (53.3%) were randomized to antibiotics-first and 14 (46.7%) to appendectomy. Median age was 33 years (range 9 to 73 years), median WBC count was 15,000/μL (range 6,200 to 23,100/μL), and median computed tomography appendiceal diameter was 10 mm (range 7 to 18 mm). Of 15 antibiotic-treated adults, 14 (93.3%) were discharged from the ED and all had symptom resolution. At 1 month, major complications occurred in 2 appendectomy participants (14.3%; 95% confidence interval [CI] 1.8% to 42.8%) and 1 antibiotics-first participant (6.3%; 95% CI 0.2% to 30.2%). Antibiotics-first participants had less total hospital time than appendectomy participants, 16.2 versus 42.1 hours, respectively. Antibiotics-first-treated participants had less pain and disability. During median 12-month follow-up, 2 of 15 antibiotics-first-treated participants (13.3%; 95% CI 3.7% to 37.9%) developed appendicitis and 1 was treated successfully with antibiotics; 1 had appendectomy. No more major complications occurred in either group. A multicenter US trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

A New Navigation System of Renal Puncture for Endoscopic Combined Intrarenal Surgery: Real-time Virtual Sonography-guided Renal Access.

PubMed

Hamamoto, Shuzo; Unno, Rei; Taguchi, Kazumi; Ando, Ryosuke; Hamakawa, Takashi; Naiki, Taku; Okada, Shinsuke; Inoue, Takaaki; Okada, Atsushi; Kohri, Kenjiro; Yasui, Takahiro

2017-11-01

To evaluate the clinical utility of a new navigation technique for percutaneous renal puncture using real-time virtual sonography (RVS) during endoscopic combined intrarenal surgery. Thirty consecutive patients who underwent endoscopic combined intrarenal surgery for renal calculi, between April 2014 and July 2015, were divided into the RVS-guided puncture (RVS; n = 15) group and the ultrasonography-guided puncture (US; n = 15) group. In the RVS group, renal puncture was repeated until precise piercing of a papilla was achieved under direct endoscopic vision, using the RVS system to synchronize the real-time US image with the preoperative computed tomography image. In the US group, renal puncture was performed under US guidance only. In both groups, 2 urologists worked simultaneously to fragment the renal calculi after inserting the miniature percutaneous tract. The mean sizes of the renal calculi in the RVS and the US group were 33.5 and 30.5 mm, respectively. A lower mean number of puncture attempts until renal access through the calyx was needed for the RVS compared with the US group (1.6 vs 3.4 times, respectively; P = .001). The RVS group had a lower mean postoperative hemoglobin decrease (0.93 vs 1.39 g/dL, respectively; P = .04), but with no between-group differences with regard to operative time, tubeless rate, and stone-free rate. None of the patients in the RVS group experienced postoperative complications of a Clavien score ≥2, with 3 patients experiencing such complications in the US group. RVS-guided renal puncture was effective, with a lower incidence of bleeding-related complications compared with US-guided puncture. Copyright © 2017 Elsevier Inc. All rights reserved.

Economic burden of seasonal influenza in the United States.

PubMed

Putri, Wayan C W S; Muscatello, David J; Stockwell, Melissa S; Newall, Anthony T

2018-05-22

Seasonal influenza is responsible for a large disease and economic burden. Despite the expanding recommendation of influenza vaccination, influenza has continued to be a major public health concern in the United States (U.S.). To evaluate influenza prevention strategies it is important that policy makers have current estimates of the economic burden of influenza. To provide an updated estimate of the average annual economic burden of seasonal influenza in the U.S. population in the presence of vaccination efforts. We evaluated estimates of age-specific influenza-attributable outcomes (ill-non medically attended, office-based outpatient visit, emergency department visits, hospitalizations and death) and associated productivity loss. Health outcome rates were applied to the 2015 U.S. population and multiplied by the relevant estimated unit costs for each outcome. We evaluated both direct healthcare costs and indirect costs (absenteeism from paid employment) reporting results from both a healthcare system and societal perspective. Results were presented in five age groups (<5 years, 5-17 years, 18-49 years, 50-64 years and ≥65 years of age). The estimated average annual total economic burden of influenza to the healthcare system and society was $11.2 billion ($6.3-$25.3 billion). Direct medical costs were estimated to be $3.2 billion ($1.5-$11.7 billion) and indirect costs $8.0 billion ($4.8-$13.6 billion). These total costs were based on the estimated average numbers of (1) ill-non medically attended patients (21.6 million), (2) office-based outpatient visits (3.7 million), (3) emergency department visit (0.65 million) (4) hospitalizations (247.0 thousand), (5) deaths (36.3 thousand) and (6) days of productivity lost (20.1 million). This study provides an updated estimate of the total economic burden of influenza in the U.S. Although we found a lower total cost than previously estimated, our results confirm that influenza is responsible for a substantial economic burden in the U.S. Copyright © 2018. Published by Elsevier Ltd.

Effect of ultrasound and dexpanthenol on collagen organization in tegumentary lesions.

PubMed

Guimarães, Gustavo N; Pires-De-Campos, Maria S M; Leonardi, Gislaine R; Dib-Giusti, Helena H K; Polacow, Maria L O

2011-01-01

To analyze the effect of ultrasound (US), dexpanthenol (d-P) and a combination of these treatments (US+d-P) on collagen fiber organization in tegumentary lesions in rats by birefringence analysis. Wistar rats (50) were anesthetized (Thionembutal - Sodic = 50 mg/Kg), 1 cm² of dorsal region skin was removed, and the animals were divided into five groups: control (C), gel (G), US (3 MHz, 0.1 W/cm2, 1 minute, continuous), d-P (10%) and US+d-P. After daily treatment for 7 and 14 days, 6 µm thick sections of lesioned areas were stained in picrosirius and measurements of the collagen birefringent area (µm²) were obtained using polarized light microscopy (Zeiss Axiolab-ZEISS- Germany) with histological image analysis software (KS 400 2.0 - Kontrol Eletronics, Munique, Germany). The means were compared by ANOVA followed by the Tukey test (p<0.05). The US+d-P group showed a significantly greater (p ≤ 0.001) birefringent area (1586.43±162.14) than the other experimental groups: C (139.36±35.35), US (317.55±129.9) and d-P (192.41±3657) by the 7th day of treatment, indicating acceleration of the wound healing process. By the 14th day of treatment, the US+d-P, US and d-P groups presented greater birefringence than the control group, but did not differ from each other. The combination of treatments (US+d-P) accelerated collagen fiber synthesis and organization in the early stages of cutaneous repair.

The U.S. legalization program: a preliminary final report.

PubMed

Papademetriou, D G

1989-03-01

The Immigration Reform and Control Act (IRCA) of 1986 made 4 types of aliens eligible to receive legalization benefits: 1) those who resided "continuously" in the US since January 1, 1982; 2) those who had worked in the US perishable-crop agriculture for 90 "man-days" in specified time periods (Special Agricultural Workers [SAWS]); 3) those who were in the US since before January 1, 1972; and 4) those classified as Cuban/Haitian entrants and who had been in the US since January 1, 1982. Estimates of the number of aliens eligible for legalization, not including SAWS, ranges from 1.834 million to 2.56 million. Estimates of undercounts of undocumented aliens are 10% for those who entered before 1975 and 37.5% for those who arrived after 1975. Other refinements in the estimates of undocumented aliens include adjustments for 1) ethnic group and location, 2) the growth of the undocumented population between the census date and the legalization eligibility date under IRCA, and 3) emigration and deportation rates. Out of the 1,581,800 applicants entered into the Immigration and Naturalization Service (INS) computers (from a total of 2.15 million applicants) as of May 20, 1988, 73.7% were Mexican nationals. Only 5 other countries contributed more than 1%: El Salvador (6.5%), Haiti (2.3%), Guatemala (2.2%), the Philippines (1%), and Colombia (1%). The Mexican percentage was unexpectedly high, perhaps because the legalization had been much more successful in the Southwest than anywhere else in the country. Reasons that Mexicans have a higher legalization participation rate than other nationalities include 1) the distant eligibility date; 2) ethnic differences among non-Mexican nationalities; 3) particularly in the northeast, fears of exposing one's illegal status to INS; 4) the difficulty of information reaching ethnic communities, 5) the reluctance of those already undergoing the naturalization process to risk the legalization process; and 6) the reluctance of employees to admit employment of undocumented aliens. In the end, more than 90% of applicants are expected to be granted temporary resident alien status (and about 70% of agricultural workers), for a total of more than 2 million people. Researchers estimate that 2.5 - 3 million more persons remain in an undocumented status in the US.

Lifetime Incidence of CKD Stages 3–5 in the United States

PubMed Central

Grams, Morgan E.; Chow, Eric K.H.; Segev, Dorry L.; Coresh, Josef

2013-01-01

Background Lifetime risk estimates of chronic kidney disease (CKD) can motivate preventative behaviors at the individual level and forecast disease burden and health care utilization at the population level. Study Design Markov Monte Carlo model simulation study. Setting & Population Current U.S. black and white population. Model, Perspective, & Timeframe Markov models simulating kidney disease development, using an individual perspective and lifetime horizon. Outcomes Age-, sex- and race-specific residual lifetime risks of CKD stages 3a+ (eGFR<60 ml/min/1.73m2), 3b+ (eGFR<45 ml/min/1.73 m2), and 4+ (eGFR<30 ml/min/1.73m2), and end stage renal disease (ESRD). Measurements State transition probabilities of developing CKD and of dying prior to its development were modeled using: 1) mortality rates from National Vital Statistics Report, 2) mortality risk estimates from a 2-million person meta-analysis, and 3) CKD prevalence from National Health and Nutrition Examination Surveys. Incidence, prevalence, and mortality related to ESRD were supplied by the US Renal Disease System. Results At birth, the overall lifetime risks of CKD stages 3a+, 3b+, 4+, and ESRD were 59.1%, 33.6%, 11.5%, and 3.6%, respectively. Women experienced greater CKD risk yet lower ESRD risk than men; blacks of both sexes had markedly higher CKD stage 4+ and ESRD risk (lifetime risks for white men, white women, black men, and black women, respectively: 53.6%, 64.9%, 51.8%, and 63.6% [CKD stage 3a+]; 29.0%, 36.7%, 33.7%, and 40.2% [CKD stage 3b+]; 9.3%, 11.4%, 15.8%, and 18.5% [CKD stage 4+]; and 3.3%, 2.2%, 8.5%, and 7.8% [ESRD]). Risk of CKD increased with age, with approximately one-half of CKD stage 3a+ cases developing after 70 years of age. Limitations CKD incidence estimates were modeled from prevalence in the U.S. population. Conclusions In the U.S., the lifetime risk of developing CKD stage 3a+ is high, underscoring the importance of primary prevention and effective therapy to reduce CKD-related morbidity and mortality. PMID:23566637

Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort.

PubMed

Bengtson, May-Bente; Martin, Christopher F; Aamodt, Geir; Vatn, Morten H; Mahadevan, Uma

2017-08-01

Malnutrition and weight loss are common features of patients with inflammatory bowel disease (IBD). To explore the impact of inadequate gestational weight gain (GWG) on adverse outcomes among IBD mothers in the prospective US pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort. The PIANO cohort comprises 559 and 363 pregnant mothers with Crohn's disease (CD) and ulcerative colitis (UC), respectively, enrolled between 2006 and 2014. The mothers were followed during and after pregnancy to ascertain medication, measurement of disease activity and complications during pregnancy and at delivery. Inadequate GWG was based on US Institute of Medicine recommendations. The associations between inadequate GWG and adverse pregnancy outcomes in maternal IBD were analyzed, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. Maternal CD and UC with inadequate GWG had a 2.5-fold increased risk of preterm birth (OR 2.5, CI 1.3, 4.9 and OR 2.5, CI 1.2, 5.6). Furthermore, an increased risk of intrauterine growth restriction and a trend for small for gestational age were demonstrated in CD but not in UC (OR 3.3, CI 1.1, 10.0, OR 4.5, CI 0.8, 24.3, p = 0.08). Flares increased risk of inadequate GWG (OR 1.6, CI 1.2, 2.3, p = 0.002) but did not change the associations between inadequate GWG and adverse pregnancy outcomes in our models. The US PIANO cohort demonstrated that inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD mothers.

The Economic Burden of Violence against Children in South Africa

PubMed Central

Fang, Xiangming; Zheng, Xiaodong; Fry, Deborah A.; Ganz, Gary; Casey, Tabitha; Hsiao, Celia

2017-01-01

The purpose of this study was to estimate the economic burden of violence against children in South Africa. We assembled summative estimates of lifetime prevalence, calculated the magnitude of associations with negative outcomes, and thereby estimated the economic burden of violence against children. According to our calculations, 2.3 million and 84,287 disability-adjusted life-years (DALYs) lost in South Africa in 2015 were attributable to nonfatal and fatal violence against children, respectively. The estimated economic value of DALYs lost to violence against children (including both fatal and nonfatal) in South Africa in 2015 totalled ZAR173 billion (US $13.5 billion)—or 4.3% of South Africa’s gross domestic product (GDP) in 2015. In addition, the reduced earnings attributable to childhood physical violence and emotional violence in South Africa in 2015 were ZAR25.2 billion (US $2.0 billion) and ZAR9.6 billion (US $750 million), respectively. In addition, South Africa spent ZAR1.6 billion (US $124 million) on child care and protection in fiscal year 2015/2016, many of which costs are directly related to violence against children. This study confirms the importance of prioritising violence against children as a key social and economic concern for South Africa’s future. PMID:29165332

Cost-Effectiveness of Early Versus Standard Antiretroviral Therapy in HIV-Infected Adults in Haiti

PubMed Central

Koenig, Serena P.; Bang, Heejung; Severe, Patrice; Jean Juste, Marc Antoine; Ambroise, Alex; Edwards, Alison; Hippolyte, Jessica; Fitzgerald, Daniel W.; McGreevy, Jolion; Riviere, Cynthia; Marcelin, Serge; Secours, Rode; Johnson, Warren D.; Pape, Jean W.; Schackman, Bruce R.

2011-01-01

Background In a randomized clinical trial of early versus standard antiretroviral therapy (ART) in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm3 in Haiti, early ART decreased mortality by 75%. We assessed the cost-effectiveness of early versus standard ART in this trial. Methods and Findings Trial data included use of ART and other medications, laboratory tests, outpatient visits, radiographic studies, procedures, and hospital services. Medication, laboratory, radiograph, labor, and overhead costs were from the study clinic, and hospital and procedure costs were from local providers. We evaluated cost per year of life saved (YLS), including patient and caregiver costs, with a median of 21 months and maximum of 36 months of follow-up, and with costs and life expectancy discounted at 3% per annum. Between 2005 and 2008, 816 participants were enrolled and followed for a median of 21 months. Mean total costs per patient during the trial were US$1,381 for early ART and US$1,033 for standard ART. After excluding research-related laboratory tests without clinical benefit, costs were US$1,158 (early ART) and US$979 (standard ART). Early ART patients had higher mean costs for ART (US$398 versus US$81) but lower costs for non-ART medications, CD4 cell counts, clinically indicated tests, and radiographs (US$275 versus US$384). The cost-effectiveness ratio after a maximum of 3 years for early versus standard ART was US$3,975/YLS (95% CI US$2,129/YLS–US$9,979/YLS) including research-related tests, and US$2,050/YLS excluding research-related tests (95% CI US$722/YLS–US$5,537/YLS). Conclusions Initiating ART in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm3 in Haiti, consistent with World Health Organization advice, was cost-effective (US$/YLS <3 times gross domestic product per capita) after a maximum of 3 years, after excluding research-related laboratory tests. Trial registration ClinicalTrials.gov NCT00120510 Please see later in the article for the Editors' Summary PMID:21949643

Comparative effectiveness study on human papillomavirus detection methods used in the cervical cancer screening programme

PubMed Central

Nygård, Mari; Røysland, Kjetil; Campbell, Suzanne; Dillner, Joakim

2014-01-01

Objectives To compare the short-term and long-term effectiveness of human papillomavirus (HPV) tests in Norwegian Cervical Cancer Screening Programme (NCCSP). Design Nationwide register-based prospective follow-up study. Setting In 2005, the NCCSP implemented HPV testing in follow-up of unsatisfactory, atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL) cytology. Participants 19 065 women with repeat cytology and HPV test after unsatisfactory ASC-US or LSIL screening result in 2005–2009. Interventions Through individual registry linkages we observed how women were treated in the regular medical care. Main outcome measures We estimated cumulative incidence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in 6 months and 3 years after repeat cytology and HPV test. Patients diagnosed with CIN2+ in 6 months and 3 years were assessed for initial HPV positivity. Results 5392 had ASC-US/LSIL and 13 673 had normal/unsatisfactory repeat cytology; for HPV detection 4715 used AMPLICOR HPV Test (Roche Diagnostics, Basel, Switzerland), 9162 Hybrid Capture 2 (HC2) High-Risk HPV DNA Test (QIAGEN, Gaithersburg, Maryland, USA) and 5188 PreTect HPV-Proofer (NorChip, Klokkarstua, Norway). Among those with ASC-US/LSIL repeat cytology, 3-year risk of CIN2+ was 15-fold in Amplicor/HC2-positives compared with Amplicor/HC2-negatives and sevenfold in Proofer-positives compared with Proofer-negatives; a 3-year risk of CIN2+ was 2.1% (95% CI 0.7% to 3.4%) in Amplicor-negatives and 7.2% (95% CI 5.4% to 8.9%) in Proofer-negatives. Close to 100% of patients with CIN2+ diagnosed within 6 months tested positive to HPV (all methods). Considering all patients diagnosed with CIN2+ in 3-year follow-up, 97% were initially positive in the Amplicor group and more than 94% in the HC2 group, compared with less than 80% in the Proofer group. Conclusions While the long-term evaluation of new screening routines showed a good overall performance of triage-HPV DNA testing, the management of HPV-negative women with persistent ASC-US/LSIL was suboptimal. PMID:24401720

41 CFR 301-10.136 - What exceptions to the Fly America Act requirements apply when I travel between the United States...

Code of Federal Regulations, 2010 CFR

2010-07-01

... destination, you must use the U.S. flag air carrier service unless such use would extend your travel time... the U.S. by 2 or more; or (2) Extend your travel time by at least 6 hours or more; or (3) Require a... Fly America Act requirements apply when I travel between the United States and another country? 301-10...

41 CFR 301-10.136 - What exceptions to the Fly America Act requirements apply when I travel between the United States...

Code of Federal Regulations, 2012 CFR

2012-07-01

... destination, you must use the U.S. flag air carrier service unless such use would extend your travel time... the U.S. by 2 or more; or (2) Extend your travel time by at least 6 hours or more; or (3) Require a... Fly America Act requirements apply when I travel between the United States and another country? 301-10...

41 CFR 301-10.136 - What exceptions to the Fly America Act requirements apply when I travel between the United States...

Code of Federal Regulations, 2013 CFR

2013-07-01

... destination, you must use the U.S. flag air carrier service unless such use would extend your travel time... the U.S. by 2 or more; or (2) Extend your travel time by at least 6 hours or more; or (3) Require a... Fly America Act requirements apply when I travel between the United States and another country? 301-10...

41 CFR 301-10.136 - What exceptions to the Fly America Act requirements apply when I travel between the United States...

Code of Federal Regulations, 2014 CFR

2014-07-01

... destination, you must use the U.S. flag air carrier service unless such use would extend your travel time... the U.S. by 2 or more; or (2) Extend your travel time by at least 6 hours or more; or (3) Require a... Fly America Act requirements apply when I travel between the United States and another country? 301-10...

41 CFR 301-10.136 - What exceptions to the Fly America Act requirements apply when I travel between the United States...

Code of Federal Regulations, 2011 CFR

2011-07-01

... destination, you must use the U.S. flag air carrier service unless such use would extend your travel time... the U.S. by 2 or more; or (2) Extend your travel time by at least 6 hours or more; or (3) Require a... Fly America Act requirements apply when I travel between the United States and another country? 301-10...

21 CFR 177.2460 - Poly(2,6-dimethyl-1,4-phenylene) oxide resins.

Code of Federal Regulations, 2012 CFR

2012-04-01

... will pass through a U.S. Standard Sieve No. 6 and 100 percent of the pellets will be held on a U.S. Standard Sieve No. 10. (d) Other limitations. The poly(2,6-dimethyl-1,4-phenylene) oxide resins identified...

21 CFR 177.2460 - Poly(2,6-dimethyl-1,4-phenylene) oxide resins.

Code of Federal Regulations, 2010 CFR

2010-04-01

... will pass through a U.S. Standard Sieve No. 6 and 100 percent of the pellets will be held on a U.S. Standard Sieve No. 10. (d) Other limitations. The poly(2,6-dimethyl-1,4-phenylene) oxide resins identified...

21 CFR 177.2460 - Poly(2,6-dimethyl-1,4-phenylene) oxide resins.

Code of Federal Regulations, 2011 CFR

2011-04-01

... will pass through a U.S. Standard Sieve No. 6 and 100 percent of the pellets will be held on a U.S. Standard Sieve No. 10. (d) Other limitations. The poly(2,6-dimethyl-1,4-phenylene) oxide resins identified...

21 CFR 177.2460 - Poly(2,6-dimethyl-1,4-phenylene) oxide resins.

Code of Federal Regulations, 2013 CFR

2013-04-01

... will pass through a U.S. Standard Sieve No. 6 and 100 percent of the pellets will be held on a U.S. Standard Sieve No. 10. (d) Other limitations. The poly(2,6-dimethyl-1,4-phenylene) oxide resins identified...

Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations: Implications for Clinical Guidelines.

PubMed

Gage, Julia C; Hunt, William C; Schiffman, Mark; Katki, Hormuzd A; Cheung, Li A; Myers, Orrin; Cuzick, Jack; Wentzensen, Nicolas; Kinney, Walter; Castle, Philip E; Wheeler, Cosette M

2016-12-01

To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P=.5), ASC-US (3.4% and 3.4%, respectively, P=.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P=.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P=.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P=.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. Current U.S. cervical screening and management recommendations are based on comparative risks of histologic high-grade CIN after screening test results. The similar results from these two large cohorts from different real-life clinical practice settings support risk-based management thresholds across U.S. clinical populations and practice settings.

Dignity in end-of-life care: results of a national survey of U.S. physicians.

PubMed

Antiel, Ryan M; Curlin, Farr A; James, Katherine M; Sulmasy, Daniel P; Tilburt, Jon C

2012-09-01

Debates persist about the relevance of "dignity" as an ethical concept in U.S. health care, especially in end-of-life care. To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to examine judgments about a clinical scenario in which dignity might be relevant. Two thousand practicing U.S. physicians, from all specialties, were mailed a survey. Main measures included physicians' judgments about an end-of-life clinical scenario (criterion variable), attitudes about the concept of dignity (predictors), and their religious characteristics (predictors). Responses were received from 1032 eligible physicians (54%). Nine (90%) of 10 physicians reported that dignity was relevant to their practice. After controlling for age, gender, region, and specialty, physicians who judged that the case patient had either some dignity or full dignity, and who agreed that dignity is given by a creator, were all positively associated with believing that the patient's life was worth living (odds ratio [OR] 10.2, 95% confidence interval [CI] 5.8-17.8, OR 20.5, 95% CI 11.4-36.8, OR 4.7, 95% CI 3.1-7.0, respectively). Respondents who strongly agreed that "all living humans have the same amount of dignity" were also more likely to believe that the patient's life was worth living (OR 1.8, 95% CI 1.2-2.7). Religious characteristics also were associated with believing that the case patient's life was worth living (OR 4.1, 95% CI 2.4-7.2, OR 3.2, 95% CI 1.6-6.3, OR 9.2, 95% CI 4.3-19.5, respectively). U.S. physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

A comparison of tumour size measurements with palpation, ultrasound and mammography in male breast cancer: first results of the prospective register study.

PubMed

Streng, Martin; Ignatov, Atanas; Reinisch, Mattea; Costa, Serban-Dan; Eggemann, Holm

2018-02-01

Precise presurgical diagnosis of tumour size is essential for adequate treatment of male breast cancer (MBC). This study is aimed to compare the accuracy of clinical measurement (CE), ultrasound (US) and mammography (MG) for preoperative estimation of tumour size. This study was conducted as a prospective, multicentre register study. One hundred and twenty-nine male patients with invasive breast cancer were included. CE, US and MG were performed in 107, 110 and 75 patients, respectively, and the estimated tumour size was compared with the histopathological (HP) tumour size. All methods tended to underestimate the HP tumour size. None of the methods were significantly more accurate than the others in determining the maximal tumour diameter. The sensitivity within 5 mm tolerance for US was 65.5%, which was better than for MG (61.3%) and CE (56.6%). In the group of patients with pT2 tumours, MG showed significantly better accuracy than US. The measurements obtained with each method were significantly correlated with the HP measurements. The highest correlation coefficient was observed for MG (0.788), followed by US (0.741) and CE (0.671). Our data demonstrate that MG and US have similar accuracy with regard to tumour size estimation. US assessment showed the highest sensitivity in determining tumour size, followed by MG and CE. However, MG demonstrated a significant advantage for estimating the real tumour size for pT2 tumours compared to US or CE.

Introduction: U.S. Homophile Internationalism.

PubMed

Stein, Marc

2017-01-01

This article introduces "U.S. Homophile Internationalism," a special issue of the Journal of Homosexuality. The introduction provides a broad overview of the "U.S. Homophile Internationalism" archive and exhibit, which was published on the Outhistory Web site in 2015. The archive and exhibit consists of more than 800 U.S. homophile magazine articles, letters, and other items that referenced non-U.S. regions of the world from 1953 to 1964. The essays in the special issue focus on (1) Africa; (2) Asia and the Pacific; (3) Canada; (4) Latin America and the Caribbean; (5) the Middle East; and (6) Russia, the Soviet Union, and Eastern Europe. There is also an article that addresses the public history and digital humanities dimensions of the project. The introduction concludes by discussing the essays' common goals, themes, and concerns.

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles.

PubMed

Orlandi, Davide; Mauri, Giovanni; Lacelli, Francesca; Corazza, Angelo; Messina, Carmelo; Silvestri, Enzo; Serafini, Giovanni; Sconfienza, Luca Maria

2017-11-01

Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ 2 , and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. © RSNA, 2017.

Real-time monitoring of radiofrequency ablation and postablation assessment: accuracy of contrast-enhanced US in experimental rat liver model.

PubMed

Wu, Hanping; Wilkins, Luke R; Ziats, Nicholas P; Haaga, John R; Exner, Agata A

2014-01-01

To examine the accuracy of the unenhanced zone at contrast material-enhanced ultrasonography (US) in predicting coagulative necrosis during and 21 days after radiofrequency (RF) ablation by using radiologic-pathologic comparison. Animal studies were approved by the Institutional Animal Care and Use Committee. The livers of 28 rats underwent US-guided RF ablation. In four animals, contrast-enhanced US was performed during ablation and 2 hours and 2, 7, 14, and 21 days after ablation. The unenhanced zone area on US images was measured. DiI-labeled microbubbles were administered during ablation at 2, 4, and 6 minutes or at 2 hours and 2, 7, 14, and 21 days after ablation in the remaining 24 animals (n = 3 at each time point). One minute later, the animal was euthanized, and the ablated liver was harvested. Tissue samples were imaged to quantify total fluorescence, and NADH staining was performed on the same slice. Hematoxylin-eosin staining was also performed. The findings on fluorescence images, NADH-stained images, and hematoxylin-eosin-stained images were compared. The areas of DiI bubble-negative zones, NADH-negative zones, and lightly NADH-staining zones were measured. Data were analyzed by using one-way analysis of variance. The area of the unenhanced zone on contrast-enhanced US images increased during RF ablation and reached a maximum within 2 days after ablation. At histopathologic examination, a transition zone manifested adjacent to the coagulation zone until 2 days after ablation. The DiI-bubble negative zone on fluorescence images and the damaged zone (transition zone plus coagulation zone) on NADH-stained images increased rapidly within 2 hours after ablation, then slowly reached the maximum on day 2. The ratios of the mean areas of these two zones at hour 2 to those at day 2 were 94.6% and 95.6%, respectively. High uniformity between the damaged zone on NADH-stained images and the DiI bubble-negative zone on fluorescence images was noted at all time points. The temporary transition zone in NADH staining is partially damaged and should transition to nonviability 2 days after ablation. These results demonstrate that contrast-enhanced US can help delineate the maximum area of cell damage (to within 5% of the maximum) as early as 2 hours after ablation. Contrast-enhanced US may be a simple and accurate tool for monitoring the effects of RF ablation and quantifying the size of thermal damage after treatment. © RSNA, 2013.

Interactive 3-D registration of ultrasound and magnetic resonance images based on a magnetic position sensor.

PubMed

Pagoulatos, N; Edwards, W S; Haynor, D R; Kim, Y

1999-12-01

The use of stereotactic systems has been one of the main approaches for image-based guidance of the surgical tool within the brain. The main limitation of stereotactic systems is that they are based on preoperative images that might become outdated and invalid during the course of surgery. Ultrasound (US) is considered the most practical and cost-effective intraoperative imaging modality, but US images inherently have a low signal-to-noise ratio. Integrating intraoperative US with stereotactic systems has recently been attempted. In this paper, we present a new system for interactively registering two-dimensional US and three-dimensional magnetic resonance (MR) images. This registration is based on tracking the US probe with a dc magnetic position sensor. We have performed an extensive analysis of the errors of our system by using a custom-built phantom. The registration error between the MR and the position sensor space was found to have a mean value of 1.78 mm and a standard deviation of 0.18 mm. The registration error between US and MR space was dependent on the distance of the target point from the US probe face. For a 3.5-MHz phased one-dimensional array transducer and a depth of 6 cm, the mean value of the registration error was 2.00 mm and the standard deviation was 0.75 mm. The registered MR images were reconstructed using either zeroth-order or first-order interpolation. The ease of use and the interactive nature of our system (approximately 6.5 frames/s for 344 x 310 images and first-order interpolation on a Pentium II 450 MHz) demonstrates its potential to be used in the operating room.

A Comparison of Ultrasound and MRI Measurements of the Cross-Sectional Area of the Median Nerve at the Wrist.

PubMed

Hersh, Beverly; D'Auria, Jennifer; Scott, Michael; Fowler, John R

2018-05-01

Ultrasound (US) measurement of cross-sectional area (CSA) of the median nerve has emerged as a viable alternative to electromyography/nerve conduction studies (EMG/NCS) for diagnosis of carpal tunnel syndrome (CTS). The purpose of this study is to compare CSA of the median nerve between US and MRI using current MRI and US technology. The null hypothesis is there is no difference between US and MRI CSA measurements. The study design was an observational cohort, enrolling patients presenting to clinic with MRI of the wrist. Participants with clinical signs and symptoms of CTS were excluded. The CSA measurements of the median nerve on MRI T1-weighted axial images were performed by a hand fellow blinded to results of US measurements, and US measurement of median nerve CSA was performed by a hand fellowship trained surgeon blinded to results of the MRI measurements. Results were analyzed via percent error, Pearson correlation, and t tests. Twenty participants were enrolled with mean age of 29.4 years. Four left wrists and 16 right wrists were measured. The US mean CSA of the median nerve was 6.8 mm 2 (±2.330 mm 2 ). The MRI mean CSA of the median nerve was 6.8 mm 2 (±2.153 mm 2 ), P = .442. Pearson correlation between modalities was 0.93, suggesting near-perfect correlation. Mean percent error was 8.8%. Results of this study suggest that US is an accurate method to measure CSA of the median nerve at the carpal tunnel inlet. The mean difference between US and MRI was unlikely to be clinically significant.

Gypsum

USGS Publications Warehouse

Crangle, R.D.

2012-01-01

The United States is the world's fourth leading producer and consumer of gypsum. Production of gypsum in the U.S. during 2011 was estimated to be 9.4 Mt (103 million st), an increase of 6 percent compared with 2010 production. The average price of mined crude gypsum was $7/t ($6.35/st). Synthetic gypsum, most of which is generated as a fluegas desulfurization process from coal-fired electric powerplants, was priced at approximately $1.50/t (1.36/st). Forty-seven companies produced gypsum in the U.S. at 54 mines and plants in 34 states. U.S. gypsum exports totaled about 300 kt (330,000 st). Imports were much higher at approximately 3.3 Mt (3.6 million st).

The Accuracy of p16/Ki-67 and HPV Test in the Detection of CIN2/3 in Women Diagnosed with ASC-US or LSIL

PubMed Central

Possati-Resende, Júlio C.; Fregnani, José H. T. G.; Kerr, Ligia M.; Mauad, Edmundo C.; Longatto-Filho, Adhemar; Scapulatempo-Neto, Cristovam

2015-01-01

The objective of this study was to compare the accuracies of double staining for p16/Ki-67 and the molecular test for high-risk HPV (hr-HPV) to identify high-grade cervical intraepithelial neoplasia (CIN2/CIN3) in women with cervical cytology of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Data were collected from 201 women who underwent cervical cytology screening in the Barretos Cancer Hospital and their results were categorized as ASC-US (n=96) or LSIL (n=105). All patients underwent colposcopy with or without cervical biopsy for diagnosis of CIN2/CIN3. The hr-HPV test (Cobas 4800 test) and immunocytochemistry were performed to detect biomarkers p16/Ki-67 (CINtec PLUS test). Two samples (1 ASC-US/1 LSIL) were excluded from the analysis due to inconclusive results of the histologic examination. There were 8 cases of CIN2/CIN3 among 95 women with ASC-US (8.4%), and 23 cases of CIN2/CIN3 among 104 women with LSIL (22.1%). In the group of women with ASC-US, the sensitivity and specificity in diagnosing CIN2/CIN3 were 87.5% and 79.5% for the HPV test and 62.5% and 93.1% for p16/Ki-67. Among women with LSIL, the sensitivity and specificity in the diagnosis of CIN2/CIN3 were 87% and 34.7% for the HPV test and 69.6% and 75.3% for immunocytochemistry. Superior performance was observed for p16/Ki-67 double staining, especially among women under 30 for whom the test had an area under the ROC curve of 0.762 (p<0.001). Both p16/Ki-67 double staining and the hr-HPV DNA test had similar performance in predicting high-grade cervical intraepithelial neoplasia among women with ASC-US. The best performance was observed in women aged >30 years. In younger women (≤30 years) with LSIL, p16/Ki-67 had greater accuracy in identifying precursor lesions. Among women >30 years diagnosed with LSIL, the two methods showed similar performance. PMID:26230097

Replacement of Expensive, Disposable Instruments With Old-fashioned Surgical Techniques for Improved Cost-effectiveness in Laparoscopic Hysterectomy

PubMed Central

Morrison, John E.

2004-01-01

Objective: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up ≥50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. Methods: We identified the 3 most expensive disposable devices: (1) an Endostapler, US $498 and 3 staple reloads, US $179 each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, US $853; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, US $321, and substituted them using classic conservative surgical techniques. Results: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were US $2209 per procedure; additional costs were US $266.33 for suture material and an Endopouch, resulting in an overall savings of US $50 509.42. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. Conclusion: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. PMID:15119671

Building High-Performing Commander Leader Teams: Intensive Collaboration Enabled by Information Technology and Knowledge Management

DTIC Science & Technology

2006-12-01

In- formation Officer (CIO)/G- 6 , and the U.S. Army Combined Arms Center, Ft. Leavenworth, Kansas in partial fulfillment of the “Independent...Army governance of BCKS (DA CIO/G- 6 , DA G-3, and Com- manding General, US Army Combined Arms Center) for the opportunity to develop these proposed...Operations Sketch for “Clear the Main Supply Route ” ............ G-4 Figure G-2. “Duffer’s Drift” Execution (Student-interactor overwatched by the

Costs of diarrhoea and acute respiratory infection attributable to not handwashing: the cases of India and China.

PubMed

Townsend, Joy; Greenland, Katie; Curtis, Val

2017-01-01

To estimate the national costs relating to diarrhoea and acute respiratory infections from not handwashing with soap after contact with excreta and the costs and benefits of handwashing behaviour change programmes in India and China. Data on the reduction in risk of diarrhoea and acute respiratory infection attributable to handwashing with soap were used, together with World Health Organization (WHO) estimates of disability-adjusted life years (DALYs) due to diarrhoea and acute respiratory infection, to estimate DALYs due to not handwashing in India and China. Costs and benefits of behaviour change handwashing programmes and the potential returns to investment are estimated valuing DALYs at per capita GDP for each country. Annual net costs to India from not handwashing are estimated at US$ 23 billion (16-35) and to China at US$ 12 billion (7-23). Expected net returns to national behaviour change handwashing programmes would be US$ 5.6 billion (3.4-8.6) for India at US$ 23 (16-35) per DALY avoided, which represents a 92-fold return to investment, and US$ 2.64 billion (2.08-5.57) for China at US$ 22 (14-31) per DALY avoided - a 35-fold return on investment. Our results suggest large economic gains relating to decreases in diarrhoea and acute respiratory infection for both India and China from behaviour change programmes to increase handwashing with soap in households. © 2016 John Wiley & Sons Ltd.

Agriculture in Pending U.S. Free Trade Agreements with Colombia, Panama, and South Korea

DTIC Science & Technology

2010-02-04

coffee, pineapple, bananas , and bakery products (Table 1). Agricultural imports accounted for 15% of total U.S. merchandise imports from Panama in...21.1% Raw Cane Sugar 15.9 29.1% Soybean Meal 59.0 13.7% Coffee a 15.3 27.9% Wheat 42.3 9.8% Fresh Pineapple 5.8 10.6% Rice 23.7 5.5% Fresh Bananas 3.4...Total Corn 625.7 37.3% Unroasted Coffee 805.0 45.5% Wheat 330.0 19.7% Fresh Roses 239.9 13.6% Soybean Meal 98.9 5.9% Fresh Bananas 162.7 9.2

Stereotactic mammography imaging combined with 3D US imaging for image guided breast biopsy

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

Surry, K. J. M.; Mills, G. R.; Bevan, K.

2007-11-15

Stereotactic X-ray mammography (SM) and ultrasound (US) guidance are both commonly used for breast biopsy. While SM provides three-dimensional (3D) targeting information and US provides real-time guidance, both have limitations. SM is a long and uncomfortable procedure and the US guided procedure is inherently two dimensional (2D), requiring a skilled physician for both safety and accuracy. The authors developed a 3D US-guided biopsy system to be integrated with, and to supplement SM imaging. Their goal is to be able to biopsy a larger percentage of suspicious masses using US, by clarifying ambiguous structures with SM imaging. Features from SM andmore » US guided biopsy were combined, including breast stabilization, a confined needle trajectory, and dual modality imaging. The 3D US guided biopsy system uses a 7.5 MHz breast probe and is mounted on an upright SM machine for preprocedural imaging. Intraprocedural targeting and guidance was achieved with real-time 2D and near real-time 3D US imaging. Postbiopsy 3D US imaging allowed for confirmation that the needle was penetrating the target. The authors evaluated 3D US-guided biopsy accuracy of their system using test phantoms. To use mammographic imaging information, they registered the SM and 3D US coordinate systems. The 3D positions of targets identified in the SM images were determined with a target localization error (TLE) of 0.49 mm. The z component (x-ray tube to image) of the TLE dominated with a TLE{sub z} of 0.47 mm. The SM system was then registered to 3D US, with a fiducial registration error (FRE) and target registration error (TRE) of 0.82 and 0.92 mm, respectively. Analysis of the FRE and TRE components showed that these errors were dominated by inaccuracies in the z component with a FRE{sub z} of 0.76 mm and a TRE{sub z} of 0.85 mm. A stereotactic mammography and 3D US guided breast biopsy system should include breast compression for stability and safety and dual modality imaging for target localization. The system will provide preprocedural x-ray mammography information in the form of SM imaging along with real-time US imaging for needle guidance to a target. 3D US imaging will also be available for targeting, guidance, and biopsy verification immediately postbiopsy.« less

Tenosynovitis US scoring systems follow synovitis and clinical scoring systems in RA and are responsive to change after biologic therapy.

PubMed

Vlad, Violeta; Berghea, Florian; Micu, Mihaela; Varzaru, Luminita; Bojinca, Mihai; Milicescu, Mihaela; Ionescu, Ruxandra; Naredo, Esperanza

2015-09-01

To investigate by ultrasonography (US) in a cohort of active RA patients starting biologic therapy the responsiveness of tenosynovitis of wrist and hands compared to the responsiveness of synovitis in a 6 month period follow-up, to compare the responsiveness of finger flexor tenosynovitis with the responsiveness of wrist extensor tenosynovitis and to describe the subclinical synovitis and tenosynovitis in RA patients in clinical remission. Fifty seven patients with active RA starting biologic therapy were included. Clinical, laboratory, and US evaluations were performed at baseline, 1, and 6 months. US evaluation included wrist and MCPs 2-5 joints, bilaterally for synovitis and extensor tendons compartments 2, 4, and 6 and finger flexors 2-5 for tenosynovitis. Eighteen US scores based on semiquantitative or binary grades were calculated at each visit. Responsiveness of synovitis and tenosynovitis scores was calculated using the standardized response mean (SRM). The responsiveness of US tenosynovitis was lower comparing with the responsiveness of US synovitis but both showed large effect of therapy. Furthermore, tenosynovitis responsiveness was similar to CRP responsiveness (SRM -0.90). Finger flexors tenosynovitis showed a higher responsiveness than extensor tenosynovitis on GS (-0.94 compared to -0.63) and a lower SRM on PD (-0.56 compared to -0.85). Tenosynovitis scores remission was overlapping clinical remission according to CDAI and SDAI in 100% of cases. Overall there was less subclinical tenosynovitis than subclinical synovitis at final visit according to clinical activity indices. Tenosynovitis US scoring in RA may be as good as synovitis scoring for characterization of disease activity and responsiveness.

Prevalence of glucose-6-phosphate dehydrogenase deficiency in U.S. Army personnel.

PubMed

Chinevere, Troy D; Murray, Clinton K; Grant, Earl; Johnson, Gregory A; Duelm, Felix; Hospenthal, Duane R

2006-09-01

The U.S. Army recently mandated that soldiers undergo glucose-6-phosphate dehydrogenase (G6PD) testing before deployment to malarious regions. We retrospectively characterize the presence and degree of G6PD deficiency in U.S. military personnel by sex, self-reported ethnicity, and World Health Organization deficiency classification through test results obtained October 1, 2004 through January 17, 2005. Data were available for 63,302 (54,874 males and 8,428 females) subjects; 2.5% of males and 1.6% of females were deficient, with most having only moderate enzyme deficiency. African American males (12.2%) and females (4.1%), along with Asian males (4.3%), had the highest rates of G6PD deficiency. Most males were found to have class III variants while most females were class IV variants. The most severely deficient were Asian males (class II). These results suggest that universal screening for G6PD deficiency is clinically warranted, and particularly essential for those male service members who self-report ethnicity as African American, Asian, or Hispanic.

Differences in Insulin Resistance in Mexican and U.S. Pima Indians with Normal Glucose Tolerance

PubMed Central

Esparza-Romero, Julian; Valencia, Mauro E.; Martinez, Maria Elena; Ravussin, Eric; Schulz, Leslie O.; Bennett, Peter H.

2010-01-01

Context: Insulin resistance is a major risk factor for the development of type 2 diabetes in Pima Indians, a population with the highest prevalence of type 2 diabetes mellitus in the world. Their Mexican counterpart, living a traditional lifestyle in the mountains of Sonora, have at least 5 times less diabetes than the U.S. Pima Indians. Objective: We evaluated whether Mexican Pima Indians had lower insulin resistance than U.S. Pima Indians. Design and Patients: We compared fasting insulin and homeostasis model assessment for insulin resistance (HOMA-IR) in 194 Mexican Pima Indians (100 females, 94 males) and 449 U.S. Pima Indians (246 females, 203 males) with normal glucose tolerance from a cross-sectional study. Adjusted differences of log-transformed outcomes (fasting insulin and HOMA-IR) between groups were evaluated using multiple linear regression models and paired t test in a matched subset. Results: Unadjusted fasting insulin and HOMA-IR were much lower in the Mexican Pima Indians than in their U.S. counterparts. After adjusting by obesity, age, and sex, mean (95% confidence interval) for fasting insulin was 6.22 (5.34–7.24) vs. 13.56 μU/ml (12.27–14.97) and for HOMA-IR 1.40 (1.20–1.64) vs. 3.07 (2.77–3.40), respectively, for Mexican Pima and U.S. Pima Indians. Results were confirmed in subset matched for age, sex, and body fat. Conclusion: Our results indicate that Mexican Pima Indians have lower insulin resistance in comparison with their genetically related U.S. counterparts, even after controlling for differences in obesity, age, and sex. This finding underscores the importance of lifestyle factors as protecting factors against insulin resistance in individuals with a high propensity to develop diabetes. PMID:20668044

Does the national health insurance scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

PubMed Central

Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Aborigo, Raymond; Awine, Timothy; Azongo, Daniel Kweku; Asaana, Prosper; Atuguba, Frank; Oduro, Abraham

2014-01-01

Introduction The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households. Objective To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. Methods We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Results Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330). Conclusion Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment. PMID:24836443

Does the National Health Insurance Scheme in Ghana reduce household cost of treating malaria in the Kassena-Nankana districts?

PubMed

Ayindenaba Dalaba, Maxwell; Akweongo, Patricia; Aborigo, Raymond; Awine, Timothy; Kweku Azongo, Daniel; Asaana, Prosper; Atuguba, Frank; Oduro, Abraham

2014-01-01

The Government of Ghana introduced the National Health Insurance Scheme (NHIS) in 2003 to replace out-of-pocket (OOP) payment for health services with the inherent aim of reducing the direct cost of treating illness to households. To assess the effects of the NHIS in reducing cost of treating malaria to households in the Kassena-Nankana districts of northern Ghana. We conducted a cross-sectional survey between October 2009 and October 2011 in the Kassena-Nankana districts. A sample of 4,226 households was randomly drawn from the Navrongo Health and Demographic Surveillance System household database and administered a structured interview. The costs of malaria treatment were collected from the patient perspective. Of the 4,226 households visited, a total of 1,324 (31%) household members reported fever and 51% (675) reported treatment for malaria and provided information on where they sought care. Most respondents sought malaria treatment from formal health facilities 63% (424), with the remainder either self-medicating with drugs from chemical shops 32% (217) or with leftover drugs or herbs 5% (34). Most of those who sought care from formal health facilities were insured 79% (334). The average direct medical cost of treating malaria was GH¢3.2 (US$2.1) per case with the insured spending less (GH¢2.6/US$1.7) per case than the uninsured (GH¢3.2/US$2.1). The overall average cost (direct and indirect) incurred by households per malaria treatment was GH¢20.9 (US$13.9). Though the insured accounted for a larger proportion of admissions at health facilities 76% (31) than the uninsured 24% (10), the average amount households spent on the insured was less (GH¢4/US$2.7) than their uninsured counterparts (GH¢6.4/US$4.3). The difference was not statistically significant (p=0.2330). Even though some insured individuals made OOP payments for direct medical care, there is evidence that the NHIS has a protective effect on cost (outpatient and in-patient) of malaria treatment.

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

Traynor, G.W.; Talbott, J.M.; Moses, D.O.

Building ventilation consumes about 5.8 exajoules of energy each year in the US The annual cost of this energy, used for commercial building fans (1.6 exajoules) and the heating and cooling of outside air (4.2 exajoules), is about $US 33 billion per year. Energy conservation measures that reduce heating and cooling season ventilation rates 15 to 35% in commercial and residential buildings can result in a national savings of about 0.6 to 1.5 exajoules ($US 3-8 billion) per year assuming no reduction of commercial building fan energy use. The most significant adverse environmental impact of reduced ventilation and infiltration ismore » the potential degradation of the buildings indoor air quality. Potential benefits to the US from the implementation of sound indoor air quality and building ventilation reduction policies include reduced building-sector energy consumption; reduced indoor, outdoor, and global air pollution; reduced product costs; reduced worker absenteeism; reduced health care costs; reduced litigation; increased worker well-being and productivity; and increased product quality and competitiveness.« less

Port and Navigation Infrastructure Development to Support U.S. Strategic Interests

DTIC Science & Technology

2012-02-01

recipients of U.S. cargo, receiving 9.6 million TEUs by 2038. Other Asian countries, Latin America and Europe will also be large importers of U.S. goods... impact of trade is much more than just the value of materials and products shipped. More than 13.3 million U.S. workers are supported by seaports...by air are significantly more costly and movement by ground only supports trade within the Americas . Because shipping by sea is the predominant

Comparison of electrocardiographic findings and associated risk factors between Taiwan Chinese and US White adults.

PubMed

Wu, Chih-Cheng; Yeh, Wen-Ting; Crow, Richard S; Bai, Chyi-Huey; Pan, Wen-Harn

2008-08-18

Electrocardiographic (ECG) findings are known to differ by race, however, systematic comparisons of findings between eastern and western countries are rare. To compare the ECG findings and associated coronary heart disease (CHD) risk factors between Taiwan Chinese and US White adults aged >or=40 years. We compared the prevalence rate of Minnesota Code criteria based ECG findings and associated CHD risk factors by using data from the third National Health and Nutrition Examination Survey (NHANES III) and the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996). Examining all the ECG findings collectively, we observed a higher prevalence of major Minnesota Code findings in Taiwan Chinese women than in US White women (15.0% vs. 10.5%), particularly ST segment depression (5.4% vs. 2.4%) and T wave abnormalities (10.8% vs. 4.8%). The prevalence of major Minnesota Code findings was similar in both Taiwan Chinese and US White men (22.7% vs. 19.6%). Taiwan Chinese men had a higher prevalence of ST segment elevation (13.7% vs. 0.9%). Taiwan Chinese also had a higher prevalence of left ventricular hypertrophy with repolarization change than US Whites in both sexes (2.7% vs. 1.4% for men, 4.3% vs. 1.3% for women). Taiwan Chinese had more favorable CHD risk factor profiles than US Whites, including lipid profile, obesity, central obesity, and smoking status. The prevalence of hypertension was similar between the two groups, however, a lower percentage of Taiwan Chinese received treatment. Taiwan Chinese men had a lower prevalence of diabetes mellitus than US White men, whereas Taiwan Chinese women had a higher prevalence than US White women. These results suggest that substantial differences in ECG findings exist between Taiwan Chinese and US Whites which cannot be entirely explained by CHD risk factors alone.

Radiation costing methods: a systematic review

PubMed Central

Rahman, F.; Seung, S.J.; Cheng, S.Y.; Saherawala, H.; Earle, C.C.; Mittmann, N.

2016-01-01

Objective Costs for radiation therapy (rt) and the methods used to cost rt are highly diverse across the literature. To date, no study has compared various costing methods in detail. Our objective was to perform a thorough review of the radiation costing literature to identify sources of costs and methods used. Methods A systematic review of Ovid medline, Ovid oldmedline, embase, Ovid HealthStar, and EconLit from 2005 to 23 March 2015 used search terms such as “radiation,” “radiotherapy,” “neoplasm,” “cost,” “ cost analysis,” and “cost benefit analysis” to locate relevant articles. Original papers were reviewed for detailed costing methods. Cost sources and methods were extracted for papers investigating rt modalities, including three-dimensional conformal rt (3D-crt), intensity-modulated rt (imrt), stereotactic body rt (sbrt), and brachytherapy (bt). All costs were translated into 2014 U.S. dollars. Results Most of the studies (91%) reported in the 33 articles retrieved provided rt costs from the health system perspective. The cost of rt ranged from US$2,687.87 to US$111,900.60 per treatment for imrt, followed by US$5,583.28 to US$90,055 for 3D-crt, US$10,544.22 to US$78,667.40 for bt, and US$6,520.58 to US$19,602.68 for sbrt. Cost drivers were professional or personnel costs and the cost of rt treatment. Most studies did not address the cost of rt equipment (85%) and institutional or facility costs (66%). Conclusions Costing methods and sources were widely variable across studies, highlighting the need for consistency in the reporting of rt costs. More work to promote comparability and consistency across studies is needed. PMID:27536189

Marketing of meat sheep with intensive finishing in southern state of Mexico.

PubMed

Mondragón-Ancelmo, Jaime; Hernández-Martínez, Juvencio; Rebollar-Rebollar, Samuel; Salem, Abdelfattah Zeidan Mohamed; Rojo-Rubio, Rolando; Domínguez-Vara, Ignacio Arturo; García-Martínez, Anastacio

2014-12-01

The objective of the present study was to quantify the marketing margins of cold sheep carcass and barbacoa meat in the southern state of Mexico. Data were obtained from the production chain links (production, industrialization, and marketing) where the marketing margins were calculated along with the benefit/cost (B/C) ratio. In the absolute marketing margin of the final consumer price per kilogram of carcass meat, the producer obtained US$2.7/kg (47 %) of the utilities, while the intermediaries obtained US$3.1/kg (53 %). Considering the final cooked product in barbacoa (typical dish), the margin was US$6.3/kg (29 %) for the producer and US$15.2/kg (71 %) for the intermediaries. The B/C ratio was 1.0, 1.1, 2, and 1.3 for the producer, stocker, butcher, and barbacoa seller, respectively. It is concluded that the best marketing channel for the producer was the producer-stocker-processor (butcher and barbacoa seller). The highest marketing margin was for the intermediaries followed by the producer. The order of importance of the B/C kilogram ratio of meat was for the butcher first, then barbacoa seller, and lastly stocker and producer.

Effect of packaging during storage time on retail display shelf life of longissimus muscle from two different beef production systems.

PubMed

Luzardo, S; Woerner, D R; Geornaras, I; Engle, T E; Delmore, R J; Hess, A M; Belk, K E

2016-06-01

Two studies were conducted to evaluate the influence of packaging and production system (PS) on retail display life color (L*, a*, and b*), fatty acid profile (% of total fatty acids), lipid oxidation (thiobarbituric acid reactive substances; mg malondialdehyde/kg of muscle), vitamin E content (µg/g of muscle), and odor (trained panelists) during storage of LM. Four (or 3) different packaging treatments were applied to LM from steers fattened on grazing systems (Uruguayan) or on high-concentrate diets (U.S.). From fabrication to application of treatments, Uruguayan LM were vacuum packaged for air shipment and U.S. LM were also vacuum packaged and kept in a cooler until Uruguayan samples arrived. Treatments were applied 7 d after slaughter. In Exp. 1, treatments were vacuum packaging (VP), low-oxygen (O) modified atmosphere packaging (MAP) with nitrogen (N2) and carbon dioxide (MAP/CO), low-O MAP with N2 plus CO and carbon monoxide (MAP/CO), and VP plus an application of peroxyacetic acid (VP/PAA). In Exp. 2 block 1, treatments were VP, MAP/CO, and VP with ethyl-arginate HCl incorporated into the film as an antimicrobial agent (VP/AM). In Exp. 2 block 2, treatments were VP, MAP/CO, MAP/CO, and VP/AM. After 35 d storage, steaks were evaluated during simulated retail display for up to 6 d. In Exp. 1, Uruguayan steaks under MAP/CO had greater ( < 0.05) a* values than VP/PAA and MAP/CO on d 6 of display. For U.S. beef, the MAP/CO had the reddest lean color ( < 0.05) compared with the other 3 packaging treatments on d 6 of display in Exp. 1. Packaging × PS × time interaction was significant ( < 0.05) in Exp. 1. In Exp. 2, MAP/CO in Uruguayan steaks also had the greatest a* values on d 6 of display, but no differences ( > 0.05) were detected among both VP and MAP/CO in U.S. steaks at this time. No significant ( > 0.05) packaging × PS × time interaction was observed in Exp. 2. Only PS (both experiments) and time (Exp. 1) affected ( < 0.05) L* values. In both experiments, U.S. steaks had greater ( < 0.05) L* values than Uruguayan steaks. Vitamin E content in Uruguayan steaks was greater ( < 0.05) than in U.S. steaks. Packaging × PS, PS × time, and packaging × PS × time interactions were not significant ( > 0.05) for any of the fatty acids. Beef from Uruguayan had lower ( < 0.05) SFA and MUFA and greater ( < 0.05) PUFA and n-6 and n-3 fatty acid percentages than U.S. beef. Complexity of fresh meat postmortem chemistry warrants a more comprehensive approach to maximize shelf life.

Degradation of 2,4-dichlorophenol using combined approach based on ultrasound, ozone and catalyst.

PubMed

Barik, Arati J; Gogate, Parag R

2017-05-01

The present work investigates the application of ultrasound and ozone operated individually and in combination with catalyst (ZnO and CuO) for establishing the possible synergistic effects for the degradation of 2,4-dichlorophenol. The dependency of extent of degradation on the operating parameters like temperature (over the range of 30-36°C), initial pH (3-9), catalyst as ZnO (loading of 0.025-0.15g/L) and CuO (loading of 0.02-0.1g/L) and initial concentration of 2,4-DCP (20-50ppm) has been established to maximize the efficacy of ultrasound (US) induced degradation. Using only US, the maximum degradation of 2,4-DCP obtained was 28.85% under optimized conditions of initial concentration as 20ppm, pH of 5 and temperature of 34°C. Study of effect of ozone flow rate for approach of only ozone revealed that maximum degradation was obtained at 400mg/h ozone flow rate. The combined approaches such as US+O 3 , US+ZnO, US+CuO, O 3 +ZnO, O 3 +CuO, US+O 3 +ZnO and US+O 3 +CuO have been subsequently investigated under optimized conditions and observed to be more efficient as compared to individual approaches. The maximum extent of degradation for the combined operation of US+O 3 (400mg/h)+ZnO (0.1g/L) and US+O 3 (400mg/h)+CuO (0.08g/L) has been obtained as 95.66% and 97.03% respectively. The degradation products of 2,4-DCP have been identified using GC-MS analysis and the toxicity analysis has also been performed based on the anti-microbial activity test (agar-well diffusion method) for the different treatment strategies. The present work has conclusively established that the combined approach of US+O 3 +CuO was the most efficient treatment scheme resulting in near complete degradation of 2,4-DCP with production of less toxic intermediates. Copyright © 2016 Elsevier B.V. All rights reserved.

Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.

PubMed

Zhang, Shanshan; Palazuelos-Munoz, Sarah; Balsells, Evelyn M; Nair, Harish; Chit, Ayman; Kyaw, Moe H

2016-08-25

Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain. We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation. The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9-$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay. This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.

Household expenditures on pneumonia and diarrhoea treatment in Ethiopia: a facility-based study

PubMed Central

Memirie, Solomon Tessema; Metaferia, Zewdu Sisay; Norheim, Ole F; Levin, Carol E; Verguet, Stéphane; Johansson, Kjell Arne

2017-01-01

Background Out-of-pocket (OOP) medical payments can lead to catastrophic health expenditure and impoverishment. We quantified household OOP expenditure for treatment of childhood pneumonia and diarrhoea and its impact on poverty for different socioeconomic groups in Ethiopia. Methods This study employs a mix of retrospective and prospective primary household data collection for direct medical and non-medical costs (2013 US$). Data from 345 pneumonia and 341 diarrhoea cases (0–59 months of age) were collected retrospectively through exit interviews from 35 purposively sampled health facilities in Ethiopia. Prospective 2-week follow-up interviews were conducted at the household level using a structured questionnaire. Results The mean total medical expenditures per outpatient visit were US$8 for pneumonia and US$6 for diarrhoea, while the mean for inpatient visits was US$64 for severe pneumonia and US$79 for severe diarrhoea. The mean associated direct non-medical costs (mainly transport costs) were US$2, US$2, US$13 and US$20 respectively. 7% and 6% of the households with a case of severe pneumonia and severe diarrhoea, respectively, were pushed below the extreme poverty threshold of purchasing power parity (PPP) US$1.25 per day. Wealthier and urban households had higher OOP payments, but poorer and rural households were more likely to be impoverished due to medical payments. Conclusions Households in Ethiopia incur considerable costs for the treatment of childhood diarrhoea and pneumonia with catastrophic consequences and impoverishment. The present circumstances call for revisiting the existing health financing strategy for high-priority services that places a substantial burden of payment on households at the point of care. PMID:28589003

36 CFR 79.11 - Conduct of inspections and inventories.

Code of Federal Regulations, 2011 CFR

2011-07-01

...; (2) Provides the Federal Agency Official will a list of any other U.S. Government-owned personal... remains and associated records; (6) Periodically inventories any other U.S. Government-owned personal... thereof) or any other U.S. Government-owned personal property, prepares and provides the Federal Agency...

Source apportionment of emissions from light-duty gasoline vehicles and other sources in the United States for ozone and particulate matter.

PubMed

Vijayaraghavan, Krish; Lindhjem, Chris; Koo, Bonyoung; DenBleyker, Allison; Tai, Edward; Shah, Tejas; Alvarez, Yesica; Yarwood, Greg

2016-02-01

Federal Tier 3 motor vehicle emission and fuel sulfur standards have been promulgated in the United States to help attain air quality standards for ozone and PM2.5 (particulate matter with an aerodynamic diameter <2.5 μm). The authors modeled a standard similar to Tier 3 (a hypothetical nationwide implementation of the California Low Emission Vehicle [LEV] III standards) and prior Tier 2 standards for on-road gasoline-fueled light-duty vehicles (gLDVs) to assess incremental air quality benefits in the United States (U.S.) and the relative contributions of gLDVs and other major source categories to ozone and PM2.5 in 2030. Strengthening Tier 2 to a Tier 3-like (LEV III) standard reduces the summertime monthly mean of daily maximum 8-hr average (MDA8) ozone in the eastern U.S. by up to 1.5 ppb (or 2%) and the maximum MDA8 ozone by up to 3.4 ppb (or 3%). Reducing gasoline sulfur content from 30 to 10 ppm is responsible for up to 0.3 ppb of the improvement in the monthly mean ozone and up to 0.8 ppb of the improvement in maximum ozone. Across four major urban areas-Atlanta, Detroit, Philadelphia, and St. Louis-gLDV contributions range from 5% to 9% and 3% to 6% of the summertime mean MDA8 ozone under Tier 2 and Tier 3, respectively, and from 7% to 11% and 3% to 7% of the maximum MDA8 ozone under Tier 2 and Tier 3, respectively. Monthly mean 24-hr PM2.5 decreases by up to 0.5 μg/m(3) (or 3%) in the eastern U.S. from Tier 2 to Tier 3, with about 0.1 μg/m(3) of the reduction due to the lower gasoline sulfur content. At the four urban areas under the Tier 3 program, gLDV emissions contribute 3.4-5.0% and 1.7-2.4% of the winter and summer mean 24-hr PM2.5, respectively, and 3.8-4.6% and 1.5-2.0% of the mean 24-hr PM2.5 on days with elevated PM2.5 in winter and summer, respectively. Following U.S. Tier 3 emissions and fuel sulfur standards for gasoline-fueled passenger cars and light trucks, these vehicles are expected to contribute less than 6% of the summertime mean daily maximum 8-hr ozone and less than 7% and 4% of the winter and summer mean 24-hr PM2.5 in the eastern U.S. in 2030. On days with elevated ozone or PM2.5 at four major urban areas, these vehicles contribute less than 7% of ozone and less than 5% of PM2.5, with sources outside North America and U.S. area source emissions constituting some of the main contributors to ozone and PM2.5, respectively.

Benchmarking CIN3+ risk as the basis for incorporating HPV and Pap cotesting into cervical screening and management guidelines

PubMed Central

Katki, Hormuzd A.; Schiffman, Mark; Castle, Philip E.; Fetterman, Barbara; Poitras, Nancy E.; Lorey, Thomas; Cheung, Li C.; Raine-Bennett, Tina R.; Gage, Julia C.; Kinney, Walter K.

2013-01-01

Objective In 2012, the United States Preventive Services Task Force (USPSTF) and a consensus of 25 organizations endorsed concurrent cytology and HPV testing (“cotesting”) for cervical cancer screening. Past screening and management guidelines were implicitly based on risks defined by Pap-alone, without consideration of HPV test results. To promote management that is consistent with accepted practice, new guidelines incorporating cotesting should aim to achieve equal management of women at equal risk of cervical intraepithelial neoplasia grade 3 and cancer (CIN3+). Methods We estimated cumulative 5-year risks of CIN3+ for 965,360 women aged 30–64 undergoing cotesting at Kaiser Permanente Northern California 2003–2010. We calculated the implicit risk thresholds for Pap-alone and applied them for new management guidance on HPV and Pap cotesting, citing 2 examples: HPV-positive/ASC-US and HPV-negative/Pap-negative. We call this guidance process “benchmarking”. Results LSIL, for which immediate colposcopy is prescribed, carries 5-year CIN3+ risk of 5.2%, suggesting that test results with similar risks should be managed with colposcopy. Similarly, ASC-US (2.6% risk) is managed with 6–12 month follow-up and Pap-negative (0.26% risk) is managed with 3-year follow-up. The 5-year CIN3+ risk for women with HPV-positive/ASC-US was 6.8% (95%CI 6.2% to 7.6%). This is greater than the 5.2% risk implicitly leading to referral to colposcopy, consistent with current management recommendations that HPV-positive/ASC-US should be referred for immediate colposcopy. The 5-year CIN3+ risk for women with HPV-negative/Pap-negative was 0.08% (95%CI 0.07% to 0.09%), far below the 0.26% implicitly required for a 3-year return and justifying a longer (e.g., 5-year) return. Conclusions Using the principle of “equal management of equal risks,” benchmarking to implicit risk thresholds based on Pap-alone can be used to achieve safe and consistent incorporation of cotesting. PMID:23519302

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, June 3, 1942 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view of Solomon Run, looking north, RB STA. 135+25 - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

The Ins and Outs of Keeping US Service Jobs at Work

DTIC Science & Technology

2006-06-14

out of the US and into Mexico, Honduras, and eventually Asia. Gregory Mankiw , former Economic Advisor to the President, in 2004 said, “More things are...Background 12 1.2 History of Economic Evolution 16 1.3 Dealing with Change 21 1.4 Preparing the Framework 22 Chapter 2...16 1-4 Economic Development 17 1-5 Service Sector Growth in Dollars 18 1-6 Service Sector Growth in Percent of GDP 19 1-7

Racial and Ethnic Diversity of U.S. Plastic Surgery Trainees.

PubMed

Silvestre, Jason; Serletti, Joseph M; Chang, Benjamin

Increased diversity of U.S. physicians can improve patient communication and mitigate health disparities for racial minorities. This study analyzes trends in racial and ethnic diversity of plastic surgery residents. Demographic data of surgical residents, medical students, and integrated plastic surgery residency applicants were obtained from the Association of American Medical Colleges. Data for college students and the general population were obtained from the U.S. Census for comparison with plastic surgery. Interspecialty differences and temporal trends in racial composition were analyzed with chi-square tests. From 1995 to 2014, Asian and Hispanic plastic surgery residents increased nearly 3-fold (7.4%-21.7%, p < 0.001) and 2-fold (4.6%-7.9%, p < 0.001), respectively. African American plastic surgery residents did not increase significantly (3.0%-3.5%, p = 0.129). Relative to the U.S. population, Hispanics (range: 0.1-0.5-fold) and African Americans (range: 0.1-0.4-fold) were underrepresented, whereas Asians (range: 2.2-5.3-fold) were overrepresented in plastic surgery. A "bottleneck" existed in the pipeline of African American and Hispanic plastic surgery residents. Significant differences in racial composition existed between plastic surgery and other surgical disciplines, which varied over time. The percentage of Hispanic (10.6% vs 7.0%, p = 0.402) and African American (6.4% vs 2.1%, p < 0.001) plastic surgery residency applicants exceeded those in residency. Hispanics and African Americans are underrepresented in plastic surgery residency relative to whites and Asians. This study underscores the need for greater initiatives to increase diversity in plastic surgery residency. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis

PubMed Central

Javanbakht, Mehdi; Mashayekhi, Atefeh; Baradaran, Hamid R.; Haghdoost, AliAkbar; Afshin, Ashkan

2015-01-01

Background The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030. Methods A Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model. Results We estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030. Conclusions The economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority. PMID:26200913

Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis.

PubMed

Javanbakht, Mehdi; Mashayekhi, Atefeh; Baradaran, Hamid R; Haghdoost, AliAkbar; Afshin, Ashkan

2015-01-01

The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030. A Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model. We estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030. The economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority.

Foreign civil aviation competition: 1976 summary and implications

NASA Technical Reports Server (NTRS)

Alford, W. J., Jr.; Maddalon, D. V.

1976-01-01

A summary assessment is made of foreign civil aviation as it relates to the posture of the United States civil aviation industry. Major findings include: (1) Main competitors - European Economic Community (EEC) and Union of Soviet Socialist Republics (USSR). (2) Largest commercial market - Transport aircraft. (3) Current market status and projections - U.S. currently dominates the civil aviation market but foreign markets show greater growth trends. (4) Competitive comparisons - Status comparisons are made in technology (aerodynamics, structures and materials, propulsion, avionics, systems, design coordination, and manufacturing); production runs; marketing; and postsales support. The U.S. generally leads except in aerodynamics and propulsion. (5) Multinational ventures - Joint U.S. industry/foreign government development of advanced technology engines is well developed; airframe industry discussions are now underway. (6) Implications - Although the U.S., is currently preeminent in most areas, this may be only a temporary condition. Past U.S. success in aviation has provided many benefits to the nation. These benefits may be lost.

Integration of 3D intraoperative ultrasound for enhanced neuronavigation

NASA Astrophysics Data System (ADS)

Paulsen, Keith D.; Ji, Songbai; Hartov, Alex; Fan, Xiaoyao; Roberts, David W.

2012-03-01

True three-dimensional (3D) volumetric ultrasound (US) acquisitions stand to benefit intraoperative neuronavigation on multiple fronts. While traditional two-dimensional (2D) US and its tracked, hand-swept version have been recognized for many years to advantage significantly image-guided neurosurgery, especially when coregistered with preoperative MR scans, its unregulated and incomplete sampling of the surgical volume of interest have limited certain intraoperative uses of the information that are overcome through direct volume acquisition (i.e., through 2D scan-head transducer arrays). In this paper, we illustrate several of these advantages, including image-based intraoperative registration (and reregistration) and automated, volumetric displacement mapping for intraoperative image updating. These applications of 3D US are enabled by algorithmic advances in US image calibration, and volume rasterization and interpolation for multi-acquisition synthesis that will also be highlighted. We expect to demonstrate that coregistered 3D US is well worth incorporating into the standard neurosurgical navigational environment relative to traditional tracked, hand-swept 2D US.

Type 2 diabetes in Vietnam: a cross-sectional, prevalence-based cost-of-illness study.

PubMed

Le, Nguyen Tu Dang; Dinh Pham, Luyen; Quang Vo, Trung

2017-01-01

According to the International Diabetes Federation, total global health care expenditures for diabetes tripled between 2003 and 2013 because of increases in the number of people with diabetes as well as in the average expenditures per patient. This study aims to provide accurate and timely information about the economic impacts of type 2 diabetes mellitus (T2DM) in Vietnam. The cost-of-illness estimates followed a prospective, prevalence-based approach from the societal perspective of T2DM with 392 selected diabetic patients who received treatment from a public hospital in Ho Chi Minh City, Vietnam, during the 2016 fiscal year. In this study, the annual cost per patient estimate was US $246.10 (95% CI 228.3, 267.2) for 392 patients, which accounted for about 12% (95% CI 11, 13) of the gross domestic product per capita in 2017. That includes US $127.30, US $34.40 and US $84.40 for direct medical costs, direct nonmedical expenditures, and indirect costs, respectively. The cost of pharmaceuticals accounted for the bulk of total expenditures in our study (27.5% of total costs and 53.2% of direct medical costs). A bootstrap analysis showed that female patients had a higher cost of treatment than men at US $48.90 (95% CI 3.1, 95.0); those who received insulin and oral antidiabetics (OAD) also had a statistically significant higher cost of treatment compared to those receiving OAD, US $445.90 (95% CI 181.2, 690.6). The Gradient Boosting Regression (Ensemble method) and Lasso Regression (Generalized Linear Models) were determined to be the best models to predict the cost of T2DM ( R 2 =65.3, mean square error [MSE]=0.94; and R 2 =64.75, MSE=0.96, respectively). The findings of this study serve as a reference for policy decision making in diabetes management as well as adjustment of costs for patients in order to reduce the economic impact of the disease.

Ebola research funding: a systematic analysis, 1997–2015

PubMed Central

Fitchett, Joseph RA; Lichtman, Amos; Soyode, Damilola T; Low, Ariel; Villar de Onis, Jimena; Head, Michael G; Atun, Rifat

2016-01-01

Background The latest outbreak of Ebola in West Africa overwhelmed the affected countries, with the impact on health extending far beyond Ebola–related deaths that have exceeded 11 000. The need to promptly mobilise resources to control emerging infections is widely recognized. Yet, data on research funding for emerging infections remains inadequately documented. Methods We defined research investment as all funding flows for Ebola and/or Marburg virus from 1997 to April 2015 whose primary purpose was to advance knowledge and new technologies to prevent or cure disease. We sourced data directly from funding organizations and estimated the investment in 2015 US dollars (US$). Results Funding for Ebola and Marburg virus research in 1997 to 2015 amounted to US$ 1.035 billion, including US$ 435.4 million (42.0%) awarded in 2014 and 2015. Public sources of funding invested US$ 758.8 million (73.1%), philanthropic sources US$ 65.1 million (6.3%), and joint public/private/philanthropic ventures accounted for US$ 213.8 million (20.6%). Prior to the Ebola outbreak in 2014, pre–clinical research dominated research with US$ 443.6 million (73.9%) investment. After the outbreak, however, investment for new product development increased 942.7–fold and that for clinical trials rose 23.5–fold. Investment in new tools to control Ebola and Marburg virus amounted to US$ 399.1 million, with 61.3% awarded for vaccine research, 29.2% for novel therapeutics research such as antivirals and convalescent blood products, and 9.5% for diagnostics research. Research funding and bibliometric output were moderately associated (Spearman’s ρ = 0.5232, P = 0.0259), however number of Ebola cases in previous outbreaks and research funding (ρ = 0.1706, P = 0.4985) and Ebola cases in previous outbreaks and research output (ρ = 0.3020, P = 0.0616) were poorly correlated. Conclusion Significant public and philanthropic funds have been invested in Ebola and Marburg virus research in 2014 and 2015, following the outbreak in West Africa. Long term, strategic vision and leadership are needed to invest in infections with pandemic potential early, including innovative financing measures and open access investment data to promote the development of new therapies and technologies. PMID:27909582

Ebola research funding: a systematic analysis, 1997-2015.

PubMed

Fitchett, Joseph Ra; Lichtman, Amos; Soyode, Damilola T; Low, Ariel; Villar de Onis, Jimena; Head, Michael G; Atun, Rifat

2016-12-01

The latest outbreak of Ebola in West Africa overwhelmed the affected countries, with the impact on health extending far beyond Ebola-related deaths that have exceeded 11 000. The need to promptly mobilise resources to control emerging infections is widely recognized. Yet, data on research funding for emerging infections remains inadequately documented. We defined research investment as all funding flows for Ebola and/or Marburg virus from 1997 to April 2015 whose primary purpose was to advance knowledge and new technologies to prevent or cure disease. We sourced data directly from funding organizations and estimated the investment in 2015 US dollars (US$). Funding for Ebola and Marburg virus research in 1997 to 2015 amounted to US$ 1.035 billion, including US$ 435.4 million (42.0%) awarded in 2014 and 2015. Public sources of funding invested US$ 758.8 million (73.1%), philanthropic sources US$ 65.1 million (6.3%), and joint public/private/philanthropic ventures accounted for US$ 213.8 million (20.6%). Prior to the Ebola outbreak in 2014, pre-clinical research dominated research with US$ 443.6 million (73.9%) investment. After the outbreak, however, investment for new product development increased 942.7-fold and that for clinical trials rose 23.5-fold. Investment in new tools to control Ebola and Marburg virus amounted to US$ 399.1 million, with 61.3% awarded for vaccine research, 29.2% for novel therapeutics research such as antivirals and convalescent blood products, and 9.5% for diagnostics research. Research funding and bibliometric output were moderately associated (Spearman's ρ  = 0.5232, P  = 0.0259), however number of Ebola cases in previous outbreaks and research funding (ρ = 0.1706, P  = 0.4985) and Ebola cases in previous outbreaks and research output (ρ = 0.3020, P  = 0.0616) were poorly correlated. Significant public and philanthropic funds have been invested in Ebola and Marburg virus research in 2014 and 2015, following the outbreak in West Africa. Long term, strategic vision and leadership are needed to invest in infections with pandemic potential early, including innovative financing measures and open access investment data to promote the development of new therapies and technologies.

Briefing book: Major projects in the upstream, downstream, petrochemical and power sectors of Vietnam. Final definitional mission report. Export trade information

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

NONE

1998-04-06

The purpose of the briefing book is to provide project information to U.S. Businesses who seek cooperative partnerships with Vietnamese officials on a number of major development projects. The report is divided into the following sections: (1) Executive Summary; (2) Overview of Vietnam; (3) Overview of the Upstream Sector; (4) Overview of the Downstream Sector; (5) Overview of the Petrochemical Sector; (6) Overview of the Electric Energy Sector; (7) Project Development Processes; (8) Project Financing; (9) Foreign Competition and U.S. Competitiveness; (10) Project Profiles; (11) Key Contracts; (12) U.S. Commercial Service.

A Limited Antiballistic Missile System

DTIC Science & Technology

1990-12-01

2.2 ABM Philosophy. .. .. .. .. ... ... ... ...... 2-1 2.3 Ballistic Missile Flight Phases .. .. .. .... ....... 2-3 2.4 Past US Systems...2-7 iii Page 2.4.4 SAFEGUARD .. .. .. .. .. ... ... ..... 2-8 2.4.5 Other Programs. .. .. .. .. ... ... ..... 2-9 2.5 Current ABM ...2.5.6 Summary of ABM Characteristics. .. .. ..... 2-11 2.6 The Threat .. .. .. .. ... ... ... ... ... ... 2-12 2.6.1 The Middle East

Economic evaluation of routine infant rotavirus immunisation program in Japan.

PubMed

Hoshi, Shu-Ling; Kondo, Masahide; Okubo, Ichiro

2017-05-04

Two rotavirus vaccines are currently available in Japan. We estimated the incremental cost-effectiveness ratio (ICER) of routine infant rotavirus immunisation program without defining which vaccine to be evaluated, which reflects the current deliberation at the Health Science Council in charge of Immunisation and Vaccine established by the Ministry of Health, Labor and Welfare of Japan. Three ICERs were estimated, one from payers' perspective and 2 from societal perspective depending on the scenarios to uptake vaccines. The health statuses following the birth cohort were as follows: not infected by rotavirus, asymptomatic infection, outpatients after infection, hospitalised after infection, developing encephalitis/encephalopathy followed by recovery, sequelae, and death. Costs of per course of vaccination was ¥30,000 (US$283; US$1 = ¥106). The model runs for 60 months with one month cycle. From payers' perspective, estimated ICERs were ¥6,877,000 (US$64,877) per QALY. From societal perspective, immunisation program turns out to be cost-saving for 75% simultaneous vaccination scenario, while it is at ¥337,000 (US$3,179) per QALY gained with vaccine alone scenario. The probability of rotavirus immunisation program to be under ¥5,000,000 (US$47,170) per QALY was at 19.8%, 40.7%, and 75.6% when costs per course of vaccination were set at ¥30,000 (US$283), ¥25,000 (US$236), and ¥20,000 (US$189), respectively. Rotavirus immunisation program has a potential to be cost-effective from payers' perspective and even cost-saving from societal perspective in Japan, however, caution should be taken with regard to the interpretation of the results as cost-effectiveness is critically dependent on vaccination costs.

The Payer and Patient Cost Burden of Open Breast Conserving Procedures Following Percutaneous Breast Biopsy.

PubMed

Kimball, Chloe C; Nichols, Christine I; Vose, Joshua G

2018-01-01

Percutaneous core-needle biopsy (PCNB) is the standard of care to biopsy and diagnose suspicious breast lesions. Dependent on histology, many patients require additional open procedures for definitive diagnosis and excision. This study estimated the payer and patient out-of-pocket (OOP) costs, and complication risk, among those requiring at least 1 open procedure following PCNB. This retrospective study used the Truven Commercial database (2009-2014). Women who underwent PCNB, with continuous insurance, and no history of cancer, chemotherapy, radiation, or breast surgery in the prior year were included. Open procedures were defined as open biopsy or lumpectomy. Study follow-up ended at chemotherapy, radiation, mastectomy, or 90 days-whichever occurred first. In total, 143 771 patients (mean age 48) met selection criteria; 85.1% underwent isolated PCNB, 12.4% one open procedure, and 2.5% re-excision. Incidence of complications was significantly lower among those with PCNB alone (9.2%) vs 1 open procedure (15.6%) or re-excision (25.3%, P  < .001). Mean incremental commercial payments were US $13 190 greater among patients with 1 open procedure vs PCNB alone (US $17 125 vs US $3935, P  < .001), and US $4767 greater with re-excision (US $21 892) relative to 1 procedure. Mean patient OOP cost was US $858 greater for 1 open procedure vs PCNB alone (US $1527 vs US $669), and US $247 greater for re-excision vs 1 procedure. A meaningful proportion of patients underwent open procedure(s) following PCNB which was associated with increased complication risk and costs to both the payer and the patient. These results suggest a need for technologies to reduce the proportion of cases requiring open surgery and, in some cases, re-excision.

Exposure to movie smoking: its relation to smoking initiation among US adolescents.

PubMed

Sargent, James D; Beach, Michael L; Adachi-Mejia, Anna M; Gibson, Jennifer J; Titus-Ernstoff, Linda T; Carusi, Charles P; Swain, Susan D; Heatherton, Todd F; Dalton, Madeline A

2005-11-01

Regional studies have linked exposure to movie smoking with adolescent smoking. We examined this association in a representative US sample. We conducted a random-digit-dial survey of 6522 US adolescents aged 10 to 14 years. Using previously validated methods, we estimated exposure to movie smoking, in 532 recent box-office hits, and examined its relation with adolescents having ever tried smoking a cigarette. The distributions of demographics and census region in the unweighted sample were almost identical to 2000 US Census estimates, confirming representativeness. Overall, 10% of the population had tried smoking. Quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.02 of adolescents in Q1 had tried smoking; 0.06 in Q2; 0.11 in Q3; and 0.22 in Q4. This association did not differ significantly by race/ethnicity or census region. After controlling for sociodemographics, friend/sibling/parent smoking, school performance, personality characteristics, and parenting style, the adjusted odds ratio for having tried smoking were 1.7 (95% confidence interval [CI]: 1.1, 2.7) for Q2, 1.8 (95% CI: 1.2, 2.9) for Q3, and 2.6 (95% CI: 1.7, 4.1) for Q4 compared with adolescents in Q1. The covariate-adjusted attributable fraction was 0.38 (95% CI: 0.20, 0.56), suggesting that exposure to movie smoking is the primary independent risk factor for smoking initiation in US adolescents in this age group. Smoking in movies is a risk factor for smoking initiation among US adolescents. Limiting exposure of young adolescents to movie smoking could have important public health implications.

Effects of Unstable Shoes on Energy Cost During Treadmill Walking at Various Speeds

PubMed Central

Koyama, Keiji; Naito, Hisashi; Ozaki, Hayao; Yanagiya, Toshio

2012-01-01

In recent years, shoes having rounded soles in the anterior-posterior direction have been commercially introduced, which are commonly known as unstable shoes (US). However, physiological responses during walking in US, particularly at various speeds, have not been extensively studied to date. The purpose of this study was to investigate the effect of wearing unstable shoes while walking at low to high speeds on the rate of perceived exertion (RPE), muscle activation, oxygen consumption (VO2), and optimum speed. Healthy male adults wore US or normal walking shoes (WS), and walked at various speeds on a treadmill with no inclination. In experiment 1, subjects walked at 3, 4, 5, 6, and 7 km·h-1 (duration, 3 min for all speeds) and were recorded on video from the right sagittal plane to calculate the step length and cadence. Simultaneously, electromyogram (EMG) was recorded from six different thigh and calf muscles, and the integrated EMG (iEMG) was calculated. In experiment 2, RPE, heart rate and VO2 were measured with the walking speed being increased from 3.6 to 7.2 km·h-1 incrementally by 0.9 km·h-1 every 6 min. The optimum speed, defined by the least oxygen cost, was calculated from the fitted quadratic relationship between walking speed and oxygen cost. Wearing US resulted in significantly longer step length and lower cadence compared with WS condition at any given speed. For all speeds, iEMG in the medial gastrocnemius and soleus muscles, heart rate, and VO2 were significantly higher in US than WS. However, RPE and optimum speed (US, 4.75 ± 0.32 km·h-1; WS, 4. 79 ± 0.18 km·h-1) did not differ significantly between the two conditions. These results suggest that unstable shoes can increase muscle activity of lower legs and energy cost without influencing RPE and optimum speed during walking at various speeds. Key points During walking at various speeds, wearing unstable shoes results in longer step length and lower cadence compared with wearing WS. Wearing unstable shoes increases muscle activities of lower leg. Wearing unstable shoes shifts the quadratic relationship between walking speed and oxygen cost upward and increases energy cost about 4% without changes in RPE and optimum speed. PMID:24150072

Relaxivity enhancement of aquated Tris(β-diketonate)gadolinium(III) chelates by confinement within ultrashort single-walled carbon nanotubes.

PubMed

Law, Justin J; Guven, Adem; Wilson, Lon J

2014-01-01

Ultrashort single-walled carbon nanotubes loaded with gadolinium ions (gadonanotubes) have been previously shown to exhibit extremely high T1 -weighted relaxivities (>100 mm(-1) s(-1) ). To further examine the effect of nanoconfinement on the relaxivity of gadolinium-based contrast agents for magnetic resonance imaging, a series of ultrashort single-walled carbon nanotube (US-tube) materials internally loaded with gadolinium chelates have been prepared and studied. US-tubes were loaded with Gd(acac)3  · 2H2 O, Gd(hfac)3  · 2H2 O, and Gd(thd)3 (acac = acetylacetone, hfac = hexafluoroacetylacetone, thd = tetramethylheptanedione). The longitudinal relaxivities of the prepared materials determined at 25°C in a 1.5 T field were 103 mm(-1) s(-1) for Gd(acac)3  · 2H2 O@US-tubes, 105 mm(-1) s(-1) for Gd(hfac)3  · 2H2 O@US-tubes and 26 mm(-1) s(-1) for Gd(thd)3 @US-tubes. Compared with the relaxivities obtained for the unloaded chelates (<10 mm(-1) s(-1) ) as well as accounting for the T1 reduction observed for the empty US-tubes, the boost in relaxivity for chelate-loaded US-tubes is attributed to confinement within the nanotube and depends on the number of coordinated water molecules. Copyright © 2014 John Wiley & Sons, Ltd.

Cervical cancer screening intervals and management for women living with HIV: a risk benchmarking approach.

PubMed

Robbins, Hilary A; Strickler, Howard D; Massad, L Stewart; Pierce, Christopher B; Darragh, Teresa M; Minkoff, Howard; Keller, Marla J; Fischl, Margaret; Palefsky, Joel; Flowers, Lisa; Rahangdale, Lisa; Milam, Joel; Shrestha, Sadeep; Colie, Christine; DʼSouza, Gypsyamber

2017-04-24

We suggested cervical cancer screening strategies for women living with HIV (WLHIV) by comparing their precancer risks to general population women, and then compared our suggestions with current Centers for Disease Control and Prevention (CDC) guidelines. We compared risks of biopsy-confirmed cervical high-grade squamous intraepithelial neoplasia or worse (bHSIL+), calculated among WLHIV in the Women's Interagency HIV Study, to 'risk benchmarks' for specific management strategies in the general population. We applied parametric survival models among 2423 WLHIV with negative or atypical squamous cell of undetermined significance (ASC-US) cytology during 2000-2015. Separately, we synthesized published general population bHSIL+ risks to generate 3-year risk benchmarks for a 3-year return (after negative cytology, i.e. 'rescreening threshold'), a 6-12-month return (after ASC-US), and immediate colposcopy [after low-grade squamous intraepithelial lesion (LSIL)]. Average 3-year bHSIL+ risks among general population women ('risk benchmarks') were 0.69% for a 3-year return (after negative cytology), 8.8% for a 6-12-month return (after ASC-US), and 14.4% for colposcopy (after LSIL). Most CDC guidelines for WLHIV were supported by comparing risks in WLHIV to these benchmarks, including a 3-year return with CD4 greater than 500 cells/μl and after either three negative cytology tests or a negative cytology/oncogenic human papillomavirus cotest (all 3-year risks≤1.3%); a 1-year return after negative cytology with either positive oncogenic human papillomavirus cotest (1-year risk = 1.0%) or CD4 cell count less than 500 cells/μl (1-year risk = 1.1%); and a 6-12-month return after ASC-US (3-year risk = 8.2% if CD4 cell count at least 500 cells/μl; 10.4% if CD4 cell count = 350-499 cells/μl). Other suggestions differed modestly from current guidelines, including colposcopy (vs. 6-12 month return) for WLHIV with ASC-US and CD4 cell count less than 350 cells/μl (3-year risk = 16.4%) and a lengthened 2-year (vs. 1-year) interval after negative cytology with CD4 cell count at least 500 cells/μl (2-year risk = 0.98%). Current cervical cancer screening guidelines for WLHIV are largely appropriate. CD4 cell count may inform risk-tailored strategies.

TMEM129 is a Derlin-1 associated ERAD E3 ligase essential for virus-induced degradation of MHC-I.

PubMed

van den Boomen, Dick J H; Timms, Richard T; Grice, Guinevere L; Stagg, Helen R; Skødt, Karsten; Dougan, Gordon; Nathan, James A; Lehner, Paul J

2014-08-05

The US11 gene product of human cytomegalovirus promotes viral immune evasion by hijacking the endoplasmic reticulum (ER)-associated degradation (ERAD) pathway. US11 initiates dislocation of newly translocated MHC I from the ER to the cytosol for proteasome-mediated degradation. Despite the critical role for ubiquitin in this degradation pathway, the responsible E3 ligase is unknown. In a forward genetic screen for host ERAD components hijacked by US11 in near-haploid KBM7 cells, we identified TMEM129, an uncharacterized polytopic membrane protein. TMEM129 is essential and rate-limiting for US11-mediated MHC-I degradation and acts as a novel ER resident E3 ubiquitin ligase. TMEM129 contains an unusual cysteine-only RING with intrinsic E3 ligase activity and is recruited to US11 via Derlin-1. Together with its E2 conjugase Ube2J2, TMEM129 is responsible for the ubiquitination, dislocation, and subsequent degradation of US11-associated MHC-I. US11 engages two degradation pathways: a Derlin-1/TMEM129-dependent pathway required for MHC-I degradation and a SEL1L/HRD1-dependent pathway required for "free" US11 degradation. Our data show that TMEM129 is a novel ERAD E3 ligase and the central component of a novel mammalian ERAD complex.

US LHCNet: Transatlantic Networking for the LHC and the U.S. HEP Community

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

Newman, Harvey B; Barczyk, Artur J

2013-04-05

US LHCNet provides the transatlantic connectivity between the Tier1 computing facilities at the Fermilab and Brookhaven National Labs and the Tier0 and Tier1 facilities at CERN, as well as Tier1s elsewhere in Europe and Asia. Together with ESnet, Internet2, and other R&E Networks participating in the LHCONE initiative, US LHCNet also supports transatlantic connections between the Tier2 centers (where most of the data analysis is taking place) and the Tier1s as needed. Given the key roles of the US and European Tier1 centers as well as Tier2 centers on both continents, the largest data flows are across the Atlantic, wheremore » US LHCNet has the major role. US LHCNet manages and operates the transatlantic network infrastructure including four Points of Presence (PoPs) and currently six transatlantic OC-192 (10Gbps) leased links. Operating at the optical layer, the network provides a highly resilient fabric for data movement, with a target service availability level in excess of 99.95%. This level of resilience and seamless operation is achieved through careful design including path diversity on both submarine and terrestrial segments, use of carrier-grade equipment with built-in high-availability and redundancy features, deployment of robust failover mechanisms based on SONET protection schemes, as well as the design of facility-diverse paths between the LHC computing sites. The US LHCNet network provides services at Layer 1(optical), Layer 2 (Ethernet) and Layer 3 (IPv4 and IPv6). The flexible design of the network, including modular equipment, a talented and agile team, and flexible circuit lease management, allows US LHCNet to react quickly to changing requirements form the LHC community. Network capacity is provisioned just-in-time to meet the needs, as demonstrated in the past years during the changing LHC start-up plans.« less

Market potential for guinea fowl (Numidia meleagris) products.

PubMed

Madzimure, James; Saina, Happyson; Ngorora, Grace P K

2011-12-01

The survey evaluated the market potential for guinea fowl (GF; Numidia meleagris) products in the city of Harare, Zimbabwe. Questionnaires were administered to traders/producers (n = 17), retailers (n = 12), cafeteria industry (n = 33) and consumers (n = 1,680) to establish their perceptions on guinea fowl products. The average household size was 6 ± 2. Each trader sold 10 ± 6.30 keets (mean ± standard error), 33 ± 15.05 growers, 20 ± 12.69 breeders and 20 ± 10.1 crates of 30 eggs per month. Each household consumed 2.5 ± 1.39 kg of GF meat and 3 ± 0.65 dozens of GF eggs per month. Retailers purchased 52 ± 44.42 crates of GF eggs and 41 ± 30.50/kg of GF meat whilst cafeteria purchased 33.6 ± 14 crates of GF eggs and 65.5 ± 33.52 kg of GF meat per month. Growers for breeding were the major product for sale by traders (94.1%) at a price of US$7.50 ± 1.74/bird. Different industries were offering different prices for guinea fowl products because of their scarcity on the market. The mean purchase price per crate of 30 guinea fowl eggs sold to the retail and cafeteria were US$3.00 ± 0.58 and US$4.50 ± 0.50, respectively. The mean purchase prices for GF meat was lower (P < 0.05) for retailers (US$2.5 ± 0.81/kg) than cafeteria (US$3.67 ± 0.83/kg). The challenges faced by producers in the marketing of guinea fowl products included poor supply due to the absence of good road networks to connect source areas and the market, perishability of dressed chickens due to power cuts and poor publicity. Overall, the study showed that there is greater market potential for guinea fowl products and farmers can channel their products through traders, cafeteria and retail industries.

Concepts for 18/30 GHz satellite communication system, volume 1A: Appendix

NASA Technical Reports Server (NTRS)

Jorasch, R.; Baker, M.; Davies, R.; Cuccia, L.; Mitchell, C.

1979-01-01

The following are appended: (1) Propagation phenomena and attenuation models; (2) Models and measurements of rainfall patterns in the U.S.; (3) Millimeter wave propagation experiments; (4) Comparison of the theory and Millimeter wave propagation experiments; (4) Comparison of theory and experiment; (5) A practical rain attenuation model for CONUS; (6) Space diversity; (7) Values of attenuation for selected U.S. cities; and (8) Additional considerations.

Validity and sensitivity to change of the semi-quantitative OMERACT ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis.

PubMed

Ammitzbøll-Danielsen, Mads; Østergaard, Mikkel; Naredo, Esperanza; Terslev, Lene

2016-12-01

The aim was to evaluate the metric properties of the semi-quantitative OMERACT US scoring system vs a novel quantitative US scoring system for tenosynovitis, by testing its intra- and inter-reader reliability, sensitivity to change and comparison with clinical tenosynovitis scoring in a 6-month follow-up study. US and clinical assessments of the tendon sheaths of the clinically most affected hand and foot were performed at baseline, 3 and 6 months in 51 patients with RA. Tenosynovitis was assessed using the semi-quantitative scoring system (0-3) proposed by the OMERACT US group and a new quantitative US evaluation (0-100). A sum for US grey scale (GS), colour Doppler (CD) and pixel index (PI), respectively, was calculated for each patient. In 20 patients, intra- and inter-observer agreement was established between two independent investigators. A binary clinical tenosynovitis score was performed, calculating a sum score per patient. The intra- and inter-observer agreements for US tenosynovitis assessments were very good at baseline and for change for GS and CD, but less good for PI. The smallest detectable change was 0.97 for GS, 0.93 for CD and 30.1 for PI. The sensitivity to change from month 0 to 6 was high for GS and CD, and slightly higher than for clinical tenosynovitis score and PI. This study demonstrated an excellent intra- and inter-reader agreement between two investigators for the OMERACT US scoring system for tenosynovitis and a high ability to detect changes over time. Quantitative assessment by PI did not add further information. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cultural differences in visual object recognition in 3-year-old children

PubMed Central

Kuwabara, Megumi; Smith, Linda B.

2016-01-01

Recent research indicates that culture penetrates fundamental processes of perception and cognition (e.g. Nisbett & Miyamoto, 2005). Here, we provide evidence that these influences begin early and influence how preschool children recognize common objects. The three tasks (n=128) examined the degree to which nonface object recognition by 3 year olds was based on individual diagnostic features versus more configural and holistic processing. Task 1 used a 6-alternative forced choice task in which children were asked to find a named category in arrays of masked objects in which only 3 diagnostic features were visible for each object. U.S. children outperformed age-matched Japanese children. Task 2 presented pictures of objects to children piece by piece. U.S. children recognized the objects given fewer pieces than Japanese children and likelihood of recognition increased for U.S., but not Japanese children when the piece added was rated by both U.S. and Japanese adults as highly defining. Task 3 used a standard measure of configural progressing, asking the degree to which recognition of matching pictures was disrupted by the rotation of one picture. Japanese children’s recognition was more disrupted by inversion than was that of U.S. children, indicating more configural processing by Japanese than U.S. children. The pattern suggests early cross-cultural differences in visual processing; findings that raise important questions about how visual experiences differ across cultures and about universal patterns of cognitive development. PMID:26985576

Cyclophilin C Participates in the US2-Mediated Degradation of Major Histocompatibility Complex Class I Molecules.

PubMed

Chapman, Daniel C; Stocki, Pawel; Williams, David B

2015-01-01

Human cytomegalovirus uses a variety of mechanisms to evade immune recognition through major histocompatibility complex class I molecules. One mechanism mediated by the immunoevasin protein US2 causes rapid disposal of newly synthesized class I molecules by the endoplasmic reticulum-associated degradation pathway. Although several components of this degradation pathway have been identified, there are still questions concerning how US2 targets class I molecules for degradation. In this study we identify cyclophilin C, a peptidyl prolyl isomerase of the endoplasmic reticulum, as a component of US2-mediated immune evasion. Cyclophilin C could be co-isolated with US2 and with the class I molecule HLA-A2. Furthermore, it was required at a particular expression level since depletion or overexpression of cyclophilin C impaired the degradation of class I molecules. To better characterize the involvement of cyclophilin C in class I degradation, we used LC-MS/MS to detect US2-interacting proteins that were influenced by cyclophilin C expression levels. We identified malectin, PDIA6, and TMEM33 as proteins that increased in association with US2 upon cyclophilin C knockdown. In subsequent validation all were shown to play a functional role in US2 degradation of class I molecules. This was specific to US2 rather than general ER-associated degradation since depletion of these proteins did not impede the degradation of a misfolded substrate, the null Hong Kong variant of α1-antitrypsin.

Cyclophilin C Participates in the US2-Mediated Degradation of Major Histocompatibility Complex Class I Molecules

PubMed Central

Chapman, Daniel C.; Stocki, Pawel; Williams, David B.

2015-01-01

Human cytomegalovirus uses a variety of mechanisms to evade immune recognition through major histocompatibility complex class I molecules. One mechanism mediated by the immunoevasin protein US2 causes rapid disposal of newly synthesized class I molecules by the endoplasmic reticulum-associated degradation pathway. Although several components of this degradation pathway have been identified, there are still questions concerning how US2 targets class I molecules for degradation. In this study we identify cyclophilin C, a peptidyl prolyl isomerase of the endoplasmic reticulum, as a component of US2-mediated immune evasion. Cyclophilin C could be co-isolated with US2 and with the class I molecule HLA-A2. Furthermore, it was required at a particular expression level since depletion or overexpression of cyclophilin C impaired the degradation of class I molecules. To better characterize the involvement of cyclophilin C in class I degradation, we used LC-MS/MS to detect US2-interacting proteins that were influenced by cyclophilin C expression levels. We identified malectin, PDIA6, and TMEM33 as proteins that increased in association with US2 upon cyclophilin C knockdown. In subsequent validation all were shown to play a functional role in US2 degradation of class I molecules. This was specific to US2 rather than general ER-associated degradation since depletion of these proteins did not impede the degradation of a misfolded substrate, the null Hong Kong variant of α1-antitrypsin. PMID:26691022

A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial.

PubMed

Konjen, Nipaporn; Napnark, Tapakorn; Janchai, Siriporn

2015-01-01

To compare the effectiveness ofradial extracorporeal shock wave therapy (rSWET) and ultrasound therapy (US) in the treatment of chronic plantar fasciitis. Randomized controlled trial. Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. Thirty patients who were diagnosed with plantar fasciitis for at least 3 months and who had not responded to other forms of conservative treatment were recruited for this study. They were randomly divided into two groups of 15 patients. The rESWT group was treated with 1 session per week and the US group with 3 sessions per week, with both groups undergoing a total of 6 consecutive weeks of treatment. Visual analog scale (VAS) assessments were performed before and after treatment at 1, 3, 6, 12, and 24 weeks. The mobility subscale of the plantar fasciitis pain and disability scale (PFPS) was measured before and after treatment. Patient satisfaction was evaluated at the conclusion of the 6-week treatment protocol. VAS pain intensity scores were significantly decreased in both groups (p < 0.001), when measured after treatment at 1, 3, 6, 12, and 24 weeks. The VAS pain scores for the rESWT group dropped significantly more than those of the US group (p < 0.001). At the end of treatment, the PFPS mobility subscale scores in both groups were significantly decreased (p < 0.001). Similar to the VAS pain score outcome, the PFPS mobility subscale score for the rESWT group decreased significantly more than that of the US group (p < 0.001). Patient satisfaction was significantly higher in the rESWT group, relative to the US group (p = 0.025). In chronic plantar fasciitis treatment, both rESWT and US were found to be effective in reducing pain and increasing mobility; however, statistical analysis showed that rESWT is significantly more effective than US.

Cultural Competency in Nursing Research.

PubMed

Cope, Diane G

2015-05-01

According to data from the U.S. Census Bureau (2010), the demographics of the United States will change dramatically in the next 50 years. Non-Caucasians will more than double from 116.2 million in 2012 to 241.3 million by 2060, representing 57% of the U.S. population (U.S. Census Bureau, 2010). The Asian population also is expected to double in the next five years and comprise 8% of the U.S. population (U.S. Census Bureau, 2012). The United States also is becoming an aging population. By 2060, about one in five residents will be aged 65 years and older (U.S. Census Bureau, 2012). Individuals aged 85 years and older will more than triple to 18.2 million and represent 4% of the U.S. population (U.S. Census Bureau, 2012). 
.

Survey and evidence based review of probiotics used in very low birth weight preterm infants within the United States.

PubMed

Viswanathan, S; Lau, C; Akbari, H; Hoyen, C; Walsh, M C

2016-12-01

Data from multiple clinical trials, mostly conducted outside the US, indicate that probiotic prophylaxis is an effective intervention for prevention of necrotizing enterocolitis (NEC) in preterm infants. Probiotics are routinely used in many countries. However, in the US, probiotic use in preterm infants is limited (6.7% of very low birth weight (VLBW) infants in the US were exposed to probiotics in 2014, Vermont Oxford Network (VON)). Probiotic products are often considered in 'generic' terms, but considerable variation exists between commercially available probiotics in terms of their quantity and quality. The study objectives were to identify the probiotic products used in VLBW infants within the US, and to determine whether their use was supported by reliable evidence. A phone survey of all neonatal intensive care units (NICU) participating in VON within the US was conducted between May and September 2015 to identify NICUs that are using probiotics in VLBW infants. Data was collected regarding specific probiotic brands, timing, dose and duration of probiotic use. An evidence based literature search, limited to randomized controlled trials in VLBW infants, was conducted to determine whether the use of identified probiotics were supported by reliable evidence. There was a 70.3% (500/711) response rate to the phone survey. During the survey period, 14.0% of NICUs were using probiotics in VLBW infants (70/500). Probiotics were routinely given to all VLBW infants in 8.8% (44/500) NICUs, while it was given in selected VLBW infants in 5.2% (26/500) of NICUs. The common indications for selective use of probiotics were feeding intolerance and antibiotic use. Sixteen commercial probiotics products were identified through the phone survey. Probiotic products most commonly used were Culturelle (27.1%), Biogaia (14.3%), Gerber Soothe (14.3%) and Florababy (8.6%). The literature search identified evidence that evaluated 4/16 probiotic products identified (Culturelle, Align, Biogaia and ABC Dophilus). Only ABC Dophilus was reported to have a protective effect against NEC, but is used sparingly in US NICUs (2.9%). The probiotics use in VLBW infants within the US is increasing, but is still limited. There was no evidence for safety or efficacy of 90% of the probiotics currently used in US NICUs, and therefore, caution is warranted.

U.S. ozone air quality under changing climate and anthropogenic emissions.

PubMed

Racherla, Pavan N; Adams, Peter J

2009-02-01

We examined future ozone (O3) air quality in the United States (U.S.) under changing climate and anthropogenic emissions worldwide by performing global climate-chemistry simulations, utilizing various combinations of present (1990s) and future (Intergovernmental Panel on Climate Change (IPCC) Special Report on Emissions Scenarios (SRES) A2 2050s) climates, and present and future (2050s; IPCC SRES A2 and B1) anthropogenic emissions. The A2 climate scenario is employed here because it lies at the upper extreme of projected climate change for the 21st century. To examine the sensitivity of U.S. O3 to regional emissions increases (decreases), the IPCC SRES A2 and B1 scenarios, which have overall higher and lower O3-precursor emissions for the U.S., respectively, have been chosen. We find that climate change, by itself, significantly worsens the severity and frequency of high-O3 events ("episodes") over most locations in the U.S., with relatively small changes in average O3 air quality. These high-O3 increases due to climate change alone will erode moderately the gains made under a U.S. emissions reduction scenario (e.g., B1). The effect of climate change on high- and average-O3 increases with anthropogenic emissions. Insofar as average O3 air quality is concerned, changes in U.S. anthropogenic emissions will play the most important role in attaining (or not) near-term U.S. O3 air quality standards. However, policy makers must plan appropriately for O3 background increases due to projected increases in global CH4 abundance and non-U.S. anthropogenic emissions, as well as potential local enhancements that they could cause. These findings provide strong incentives for more-than-planned emissions reductions at locations that are currently O3-nonattainment.

Accuracy of ultrasound in the detection of liver fibrosis in chronic viral hepatitis.

PubMed

D'Onofrio, Mirko; Martone, Enrico; Brunelli, Silvia; Faccioli, Niccolò; Zamboni, Giulia; Zagni, Irene; Fattovich, Giovanna; Pozzi Mucelli, Roberto

2005-10-01

To assess the accuracy of ultrasonography (US) in the identification and grading of hepatic fibrosis in patients afflicted with chronic viral liver disease, compared to histological examination as a gold standard. We prospectively studied 105 patients (32 F, 73 M) affected by chronic viral liver disease in 36 months. Patients were studied with B-mode US and then underwent US-guided liver biopsy. All the patients were studied with conventional US with a Sequoia 512, 6.0 (Acuson, Mountain View CA, USA). We evaluated the following US parameters: liver margins, parenchymal echotexture, portal vein caliber and spleen diameter. The four B-mode US parameters were used for the US grading (from 0 to 4). Scheuer's grading (from 0 to 4) was used for the histological score. Grades 3 and 4 were considered as positive for fibrosis. Sensitivity, specificity, positive and negative predictive values and accuracy were calculated in the case of absence, positivity of one or all the US parameters. The correlation between US and histological scores was evaluated with Spearman's test. At histology seventy-seven patients (73%) had absent grade 0 (1 patient; 1%), low-moderate grade 1 (35 patients; 33%) or grade 2 (41 patients; 39%) liver fibrosis. Twenty-eight patients (27%) had severe grade 3 (16 patients; 15%) or grade 4 (12 patients; 11%) fibrosis. In the case of absence of US parameters sensitivity was 32%, specificity 32%, positive predictive value 15%, negative predictive value 57% and accuracy 32%. In the case of positivity of at least one of the US parameters the values were 68%, 68%, 43%, 84% and 69%. In the case of presence of all the US signs the results were 25%, 100%, 100%, 79% and 80%. None of the 77 patients with a healthy liver or with low-grade fibrosis was positive for all the US parameters. All the patients positive for all of the ultrasonographic parameters had high-grade fibrosis or cirrhosis at liver biopsy. Correlation between B-mode and histological scores was not statistically significant (Rs=0.45; p=0.0001). US identification of liver fibrosis in chronic liver disease is possible with 25% sensitivity, 100% specificity, 100% positive predictive value and 79% negative predictive value, with an 80% diagnostic accuracy.

Summary of U.S. EPA Dioxin Workshop − Feb 2009

EPA Science Inventory

The U.S. Environmental Protection Agency (U.S. EPA) and Argonne National Laboratories, through an inter-Agency agreement with the U.S. Department of Energy, convened a workshop that identified and addressed issues related to the dose-response assessment of 2,3,7,8-tetrachlorodibe...

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience.

PubMed

Kao, Steven D; Morshedi, Maud M; Narsinh, Kazim H; Kinney, Thomas B; Minocha, Jeet; Picel, Andrew C; Newton, Isabel; Rose, Steven C; Roberts, Anne C; Kuo, Alexander; Aryafar, Hamed

2016-08-01

To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS). Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded. The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01). Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation. Copyright © 2016 SIR. All rights reserved.

Performance of crossbred heifers in different step-down waste milk-feeding strategies.

PubMed

Leão, Juliana Mergh; Lima, Juliana Aparecida Mello; Lana, Ângela Maria Quintão; Saturnino, Helton Mattana; Reis, Ronaldo Braga; Barbosa, Fabiano Alvim; de Azevedo, Rafael Alves; Sá Fortes, Robson Vilela; Coelho, Sandra Gesteira

2016-12-01

The aim of this study was to evaluate the consumption, performance, feed efficiency, glucose concentration, and the cost per kilogram of weight gain of crossbred Holstein-Gyr heifers (n = 33) subjected to one of the three waste milk step-down strategies: 6L-30d/4L-60d/2L-90d (T1), 6L-45d/4L-60d/2L-90d (T2), and 8L-30d/6L-60d/3L-90d (T3). Heifers were weaned at the age of 91 days. Water and starter were provided ad libitum. The average waste milk intake was higher in T3 than in T1 and T2 strategies until 30 days and between 60 and 90 days. The starter intake did not differ among the strategies until 45 days, but it was higher in strategy T1 than in strategy T3 between 60 and 90 days. The waste milk step-down strategy did not influence the total dry matter intake, average daily gain, body weight, and feed efficiency. Glucose concentrations in plasma varied within a range that could be considered normal and were similar among the treatments. The average cost per kilogram of weight gain was the lowest in strategy T1 (US$3.0) compared to that in the other strategies (T2, US$3.2, and T3, US$3.6). The 6L-30d/4L-60d/2L-90d waste milk step-down strategy was the most effective, since it increased the starter intake, led to normal glucose concentrations in plasma, and caused similar weight gain compared with the other strategies; however, it had a lower cost per kilogram.

The Changing Face of Noncardia Gastric Cancer Incidence Among US Non-Hispanic Whites.

PubMed

Anderson, William F; Rabkin, Charles S; Turner, Natalie; Fraumeni, Joseph F; Rosenberg, Philip S; Camargo, M Constanza

2018-01-19

The initial step for noncardia gastric carcinogenesis is atrophic gastritis, driven by either Helicobacter pylori infection or autoimmunity. In recent decades, the prevalence rates of these two major causes declined and increased, respectively, with changes in Western lifestyles. We therefore assessed gastric cancer incidence trends for US race/ethnic groups, 1995-2013. Age-standardized rates (ASRs) from 45 North American Association of Central Cancer Tumor Registries were summarized by estimated annual percentage change (EAPC) and 95% confidence intervals (CIs). Age period cohort models supplemented standard descriptive techniques and projected future trends. There were 137 447 noncardia cancers in 4.4 billion person-years of observation. Among non-Hispanic whites, the ASR was 2.2 per 100 000 person-years, with an EAPC of -2.3% (95% CI = -2.0% to -2.6%). Notwithstanding this overall decline, EAPCs rose 1.3% (95% CI = 0.6% to 2.1%) for persons younger than age 50 years and fell -2.6% (95% CI = -2.4% to -2.9%) for older individuals. These converging trends manifested a birth cohort effect more pronounced among women than men, with incidence among women born in 1983 twofold (95% CI = 1.1-fold to 3.6-fold) greater than those born in 1951. Age interaction was also statistically significant among Hispanic whites, with slightly increasing vs decreasing EAPCs for younger and older individuals, respectively. Incidence declined regardless of age for other races. Current trends foreshadow expected reversals in both falling incidence and male predominance among non-Hispanic whites. Dysbiosis of the gastric microbiome associated with modern living conditions may be increasing risk of autoimmune gastritis and consequent noncardia cancer. The changing face by age and sex of gastric cancer warrants analytical studies to identify potential causal mechanisms. Published by Oxford University Press 2018. This work is written by US Government employees and is in the public domain in the US.

Evaluation of corneal pachymetry measurements by Galilei dual Scheimpflug camera.

PubMed

Karimian, Farid; Feizi, Sepehr; Faramarzi, Amir; Doozandeh, Azadeh; Yaseri, Mehdi

2012-01-01

We present an evaluation of corneal pachymetry measurements by Galilei dual Scheimpflug camera by comparing central corneal thickness measured by Galilei with Orbscan II and ultrasonic pachymetry. Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences and Negah Eye Center, Tehran, Iran. Central corneal thickness (CCT) was measured in 184 eyes of 92 healthy subjects using Galilei, Orbscan II, and ultrasonic (US) pachymetry. Considered as a benchmark, the measurements by US pachymetry were compared with those measured by the other 2 systems. Mean CCT was 544.4 ± 33.4 µm, 546.7 ± 37.9 µm, and 555.8 ± 29.6 µm as measured by US pachymetry, Orbscan II, and Galilei systems, respectively. The mean difference of readings measured by US pachymetry with those measured by Orbscan II (acoustic coefficient 0.96) and Galilei were 2.3 µm and 10.2 µm, respectively. In spite of this discrepancy, the Galilei system had better agreement with US pachymetry than Orbscan II and US pachymetry (correlation coefficient 0.947 vs 0.817) and considering 0.98 as acoustic coefficient for Galilei CCT reading, makes its measurements identical to ultrasound pachymetry. Galilei measurements of CCT are well correlated with ultrasound pachymetry in normal eyes. After considering an acoustic coefficient equal to 0.98 for Galilei, its measurements will become equal to ultrasound values.

Profile of GMAT® Testing: North American Report. Testing Years 2010 through 2014. GMAC® Data-to-Go Series

ERIC Educational Resources Information Center

Chisholm, Alex

2014-01-01

This Data-to-Go brief summarizes five year GMAT testing trends for US and Canadian residents, and race/ethnicity breakdowns for US citizens. It includes: (1) GMAT exams taken by US region, US state of residence, and race/ethnicity of examinees (US citizens only), (2) GMAT exams taken by Canadian residents, by Canadian province, (3) GMAT exams…

Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients.

PubMed

Santos, L A; Oliveira, M A; Faresin, S M; Santoro, I L; Fernandes, A L G

2007-07-01

Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2%) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.

Sharing reference data and including cows in the reference population improve genomic predictions in Danish Jersey.

PubMed

Su, G; Ma, P; Nielsen, U S; Aamand, G P; Wiggans, G; Guldbrandtsen, B; Lund, M S

2016-06-01

Small reference populations limit the accuracy of genomic prediction in numerically small breeds, such like Danish Jersey. The objective of this study was to investigate two approaches to improve genomic prediction by increasing size of reference population in Danish Jersey. The first approach was to include North American Jersey bulls in Danish Jersey reference population. The second was to genotype cows and use them as reference animals. The validation of genomic prediction was carried out on bulls and cows, respectively. In validation on bulls, about 300 Danish bulls (depending on traits) born in 2005 and later were used as validation data, and the reference populations were: (1) about 1050 Danish bulls, (2) about 1050 Danish bulls and about 1150 US bulls. In validation on cows, about 3000 Danish cows from 87 young half-sib families were used as validation data, and the reference populations were: (1) about 1250 Danish bulls, (2) about 1250 Danish bulls and about 1150 US bulls, (3) about 1250 Danish bulls and about 4800 cows, (4) about 1250 Danish bulls, 1150 US bulls and 4800 Danish cows. Genomic best linear unbiased prediction model was used to predict breeding values. De-regressed proofs were used as response variables. In the validation on bulls for eight traits, the joint DK-US bull reference population led to higher reliability of genomic prediction than the DK bull reference population for six traits, but not for fertility and longevity. Averaged over the eight traits, the gain was 3 percentage points. In the validation on cows for six traits (fertility and longevity were not available), the gain from inclusion of US bull in reference population was 6.6 percentage points in average over the six traits, and the gain from inclusion of cows was 8.2 percentage points. However, the gains from cows and US bulls were not accumulative. The total gain of including both US bulls and Danish cows was 10.5 percentage points. The results indicate that sharing reference data and including cows in reference population are efficient approaches to increase reliability of genomic prediction. Therefore, genomic selection is promising for numerically small population.

Patent life of antiretroviral drugs approved in the US from 1987 to 2007.

PubMed

Rodriguez-Monguio, Rosa; Seoane-Vazquez, Enrique

2009-06-01

This study analyzes the effective patent life of antiretroviral (ARV) new molecular entities (NMEs) approved for marketing in the United States (US) between 1987 and 2007. The study includes all NMEs approved during the study period with at least one patent listed in the Orange Book (OB). Drugs discontinued from the market were excluded from the analysis. Data sources are the US Food and Drug Administration (FDA) and the US Patent and Trademark Office. A comparison between the effective patent life of ARV NMEs and NMEs from other therapeutic classes was performed. The first and last patents were used to estimate the minimum and maximum effective patent life of NMEs. Group differences were assessed using group comparison t-tests, Chi-Square and Fishers' exact tests. The FDA approved 547 NMEs during the study period; 153 NMEs did not have a patent listed in the OB or were discontinued from the US market. The patent analysis included 22 ARV NMEs and 372 other NMEs. ARV MNEs had a range from 1 to 15 patents listed in the OB. The FDA new drug application (NDA) review time was shorter for ARVs (5.8+/-2.3 months) than for other NMEs (23.6+/-18.7 months). ARV NMEs had an average of 13.2+/-3.8 years of effective patent life for the first patent versus 11.0+/-4.2 years for other NMEs. ARV NMEs had an average of 17.5+/-3.6 years of effective patent life for the last patent versus the 14.8+/-4.8 years for other NMEs. The effective patent life listed for the last patent of seven ARV NMEs (31.8%) exceeded 20 years. Shortening the drug approval process increased the effective patent life of ARVs and facilitated faster entry of new drugs into the market. ARVs had an average of 2-3 more years of effective patent life than other therapeutic classes and, therefore, a longer period without generic competition.

A Framework for Event Prioritization in Cyber Network Defense

DTIC Science & Technology

2014-07-15

U.S.," Reuters (US online Edition), pp. http://www.reuters.com/article/2013/11/06/net-us-usa-china- hacking - idUSBRE9A51AN20131106, 6 Nov 2013. [2...expressed individually, or as a single vector by using the magnitude of these three factors (cell J5 in Table 5

Comparing U.S. Army Systems with Foreign Counterparts: Identifying Possible Capability Gaps and Insights from Other Armies

DTIC Science & Technology

2015-01-01

C O R P O R A T I O N Research Report Comparing U.S. Army Systems with Foreign Counterparts Identifying Possible Capability Gaps and Insights from...Couffer; photo by E. Heidtmann, CC BY 3.0; photo by Black Mammmba, CC BY 3.0; and photo by Vitaly V. Kuzmin, CC BY 3.0. M1A2 Abrams Leopard 2A6 Merkava...photo by Mass Communication Specialist 1st Class Daniel N . Woods; photo by Daniel Steger, CC BY-SA 2.5; “MIL_Finlândia-Army_Demo Day 2005 Rovajärvellä

AmeriFlux US-Tw2 Twitchell Corn

DOE Data Explorer

Baldocchi, Dennis [University of California, Berkeley

2016-01-01

This is the AmeriFlux version of the carbon flux data for the site US-Tw2 Twitchell Corn. Site Description - The Twitchell Corn site is a corn field on peat soil. The tower was installed on May 17, 2012 and was equipped to analyze energy, H2O and CO2 fluxes. The field was planted in early May 2012 and harvested in early November 2012. The field was fallow during the non-growing season. The variety of corn used was ES-7477 hybrid corn commercialized by Eureka seeds. The site is near US-Tw1, US-Tw3 and US-Twt sites.

Intelligence Preparation of the Battlefield (IPB): One Size Fits All

DTIC Science & Technology

1991-12-10

higher levels because it was too detailed for that lev- el commander. 1 27 Battalion S2s must understand the level of derail needed for their product...82174-;-U- el . Te A10034iniiatvcoffesa excellent opprtnrity to involve commanders in the IPB process and clarify the inputs alnd outputs of the system...1.8. 57. Glass and Davidson, 62. 58. US Army, FE 34-1_30, 4-66. 59. US Army, FM 34, 2-3. 60. US Army, F11 34-8_0 El . 61. US Army, FM 71-2, 2--23. 62. US

Fatty liver disease in severe obese patients: Diagnostic value of abdominal ultrasound

PubMed Central

de Moura Almeida, Alessandro; Cotrim, Helma Pinchemel; Barbosa, Daniel Batista Valente; de Athayde, Luciana Gordilho Matteoni; Santos, Adimeia Souza; Bitencourt, Almir Galvão Vieira; de Freitas, Luiz Antonio Rodrigues; Rios, Adriano; Alves, Erivaldo

2008-01-01

AIM: To evaluate the sensitivity and specificity of abdominal ultrasound (US) for the diagnosis of hepatic steatosis in severe obese subjects and its relation to histological grade of steatosis. METHODS: A consecutive series of obese patients, who underwent bariatric surgery from October 2004 to May 2005, was selected. Ultrasonography was performed in all patients as part of routine preoperative time and an intraoperative wedge biopsy was obtained at the beginning of the bariatric surgery. The US and histological findings of steatosis were compared, considering histology as the gold standard. RESULTS: The study included 105 patients. The mean age was 37.2 ± 10.6 years and 75.2% were female. The histological prevalence of steatosis was 89.5%. The sensitivity and specificity of US in the diagnosis of hepatic steatosis were, respectively, 64.9% (95% CI: 54.9-74.3) and 90.9% (95% CI: 57.1-99.5). The positive predictive value and negative predictive value were, respectively, 98.4% (95% CI: 90.2-99.9) and 23.3% (95% CI: 12.3-39.0). The presence of steatosis on US was associated to advanced grades of steatosis on histology (P = 0.016). CONCLUSION: Preoperative abdominal US in our series has not shown to be an accurate method for the diagnosis of hepatic steatosis in severe obese patients. Until another non-invasive method demonstrates better sensitivity and specificity values, histological evaluation may be recommended to these patients undergoing bariatric surgery. PMID:18322958

Could US mayors achieve the entire US Paris climate target?

NASA Astrophysics Data System (ADS)

Gurney, K. R.; Huang, J.; Hutchins, M.; Liang, J.

2017-12-01

After the recent US Federal Administration announcement not to adhere to the Paris Accords, 359 mayors (and counting) in the US pledged to maintain their commitments, reducing emissions within their jurisdictions by 26-28% from their 2005 levels by the year 2025. While important, this leaves a large portion of the US landscape, and a large amount of US emissions, outside of the Paris commitment. With Federal US policy looking unlikely to change, could additional effort by US cities overcome the gap in national policy and achieve the equivalent US national Paris commitment? How many cities would be required and how deep would reductions need to be? Up until now, this question could not be reliably resolved due to lack of data at the urban scale. Here, we answer this question with new data - the Vulcan V3.0 FFCO2 emissions data product - through examination of the total US energy related CO2 emissions from cities. We find that the top 500 urban areas in the US could meet the national US commitment to the Paris Accords with a reduction of roughly 30% below their 2015 levels by the year 2025. This is driven by the share of US emissions emanating from cities, particularly the largest cohort. Indeed, as the number of urban areas taking on CO2 reduction targets grows, the less the reduction burden on any individual city. In this presentation, we provide an analysis of US urban CO2 emissions and US climate policy, accounting for varying definitions of urban areas, emitting sectors and the tradeoff between the number of policy-active cities and the CO2 reduction burden.

Prevalence of Eligibility Criteria for the Systolic Blood Pressure Intervention Trial in US Adults Among Excluded Groups: Age <50 Years, Diabetes Mellitus, or a History of Stroke.

PubMed

Bress, Adam P; Tanner, Rikki M; Hess, Rachel; Gidding, Samuel S; Colantonio, Lisandro D; Shimbo, Daichi; Muntner, Paul

2016-07-12

Adults <50 years old, with diabetes mellitus, or a history of stroke were not enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). Estimating the size and characteristics of these excluded groups who meet the other SPRINT eligibility criteria may provide information on the potential impact of providers extending the SPRINT findings to these populations. We analyzed the National Health and Nutrition Examination Survey 2003-2012 (n=25 076) to estimate the percentage and characteristics of US adults ≥20 years in 3 populations (age <50 years, diabetes mellitus, or history of stroke) excluded from SPRINT who otherwise meet the trial eligibility criteria: age ≥50 years, systolic blood pressure (SBP) 130-180 mm Hg, high cardiovascular disease risk, and not having trial exclusion criteria. Overall, 1.0% (95% CI 0.8-1.3) of US adults age <50 years, 25.4% (95% CI 23.4-27.6) with diabetes mellitus, and 19.0% (95% CI 16.0-22.4) with history of stroke met the other SPRINT eligibility criteria. Among US adults with SBP ≥130 mm Hg, other SPRINT eligibility criteria were met by 7.5% (95% CI 6.1-9.2) of those age <50 years, 32.9% (95% CI 30.5-35.4) with diabetes mellitus, and 23.0% (95% CI 19.4-27.0) with history of stroke. Among US adults meeting the other SPRINT eligibility criteria, antihypertensive medication was being taken by 31.0% (95% CI 23.9-41.3) of those <50 years, 63.0% (95% CI 58.2-67.6) with diabetes mellitus, and 68.9% (95% CI 59.4-77.1) with a history of stroke. A substantial percentage of US adults with diabetes mellitus or history of stroke and a small percentage <50 years old meet the other SPRINT eligibility criteria. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

An unconditioned stimulus retrieval extinction procedure to prevent the return of fear memory.

PubMed

Liu, Jianfeng; Zhao, Liyan; Xue, Yanxue; Shi, Jie; Suo, Lin; Luo, Yixiao; Chai, Baisheng; Yang, Chang; Fang, Qin; Zhang, Yan; Bao, Yanping; Pickens, Charles L; Lu, Lin

2014-12-01

Conditioned fear memories can be updated by extinction during reconsolidation, and this effect is specific to the reactivated conditioned stimulus (CS). However, a traumatic event can be associated with several cues, and each cue can potentially trigger recollection of the event. We introduced a technique to target all diverse cues associated with an aversive event that causes fear. In human experiments, 161 subjects underwent modified fear conditioning, in which they were exposed to an unconditioned stimulus (US) or unreinforced CS to reactivate the memory and then underwent extinction, spontaneous recovery, and reinstatement. In animal experiments, 343 rats underwent contextual fear conditioning under a similar protocol as that used in the human experiments. We also explored the molecular alterations after US reactivation in rats. Presentation of a lower intensity US before extinction disrupted the associations between the different CS and reactivated US in both humans and rats. This effect persisted for at least 6 months in humans and was selective to the reactivated US. This procedure was also effective for remote memories in both humans and rats. Compared with the CS, the US induced stronger endocytosis of alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid glutamate receptors 1 and 2 and stronger activation of protein kinase A, p70S6 kinase, and cyclic adenosine monophosphate response element binding protein in the dorsal hippocampus in rats. These findings demonstrate that a modified US retrieval extinction strategy may have a potential impact on therapeutic approaches to prevent the return of fear. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Multidrug-Resistant Tuberculosis Among Patients in Baja California, Mexico, and Hispanic Patients in California

PubMed Central

Bojorquez, Ietza; Barnes, Richard F. W.; Flood, Jennifer; López-Gatell, Hugo; Garfein, Richard S.; Bäcker, Claudia E.; Alpuche, Celia; Vinetz, Joseph M.; Catanzaro, Antonino; Kato-Maeda, Midori

2013-01-01

Objectives. We sought to compare prevalence and determinants of multidrug-resistant tuberculosis (MDR-TB) between tuberculosis patients in Baja California, Mexico, and Hispanic patients in California. Methods. Using data from Mexico’s National TB Drug Resistance Survey (2008–2009) and California Department of Public Health TB case registry (2004–2009), we assessed differences in MDR-TB prevalence comparing (1) Mexicans in Baja California, (2) Mexico-born Hispanics in California, (3) US-born Hispanics in California, and (4) California Hispanics born elsewhere. Results. MDR-TB prevalence was 2.1% in Baja California patients, 1.6% in Mexico-born California patients, 0.4% in US-born California patients, and 2.7% in Hispanic California patients born elsewhere. In multivariate analysis, previous antituberculosis treatment was associated with MDR-TB (odds ratio [OR] = 6.57; 95% confidence interval [CI] = 3.34, 12.96); Mexico-born TB patients in California (OR = 5.08; 95% CI = 1.19, 21.75) and those born elsewhere (OR = 7.69; 95% CI = 1.71, 34.67) had greater odds of MDR-TB compared with US-born patients (reference category). Conclusions. Hispanic patients born outside the US or Mexico were more likely to have MDR-TB than were those born within these countries. Possible explanations include different levels of exposure to resistant strains and inadequate treatment. PMID:23678924

Projected prevalence of US adults with self-reported doctor-diagnosed arthritis, 2005 to 2050.

PubMed

Fontaine, Kevin R; Haaz, Steffany; Heo, Moonseong

2007-05-01

Using population-based survey data from the 2003 Behavioral Risk Factor Surveillance Survey (BRFSS), we estimated the population prevalence of self-reported, doctor-diagnosed arthritis in the US from 2005 to 2050. Projected arthritis-prevalence data were estimated in 5-year increments along sex- and age-specific categories by multiplying the 2003 BRFSS arthritis prevalence data by the sex-stratified US Census projections. During this 45-year period, we estimate that the total number of US adults aged 20 years or older with arthritis will increase from 60 million to 96 million, a 1.6-fold increase. The increase is projected to be greater in those aged 65 years or older (a 2.3-fold increase) than for those aged 20 to 65 (a 1.3-fold increase). Given increases in the prevalence of known arthritis risk factors (e.g., obesity, Hispanic origin) our projections might underestimate the prevalence of arthritis in the coming years.

Dignity in end-of-life care: results of a national survey of US physicians

PubMed Central

Antiel, Ryan M.; Curlin, Farr A.; James, Katherine M.; Sulmasy, Daniel P.; Tilburt, Jon C.

2014-01-01

Context Debates persist about the relevance of “dignity” as an ethical concept in US healthcare, especially in end-of-life care. Objective To describe the attitudes and beliefs regarding the usefulness and meaning of the concept of dignity and to examine judgments about a clinical scenario in which dignity might be relevant. Methods 2000 practicing U.S. physicians, from all specialties, were mailed a survey. Main measures included physician’s judgments about an end-of-life clinical scenario (criterion variable), attitudes about the concept of dignity (predictors), and their religious characteristics (predictors). Results 1032 eligible physicians (54%) responded. Nine out of ten (90%) physicians reported that dignity was relevant to their practice. After controlling for age, gender, region, and specialty, physicians who judged that the case patient had either some dignity or full dignity, and who agreed that dignity is given by a creator, were all positively associated with believing that the patient’s life was worth living [OR 10.2 (5.8–17.8), OR 20.5 (11.4–36.8), OR 4.7 (3.1–7.0), respectively]. Respondents who strongly agreed that “all living humans have the same amount of dignity” were also more likely to believe that the patient’s life was worth living [OR 1.8 (1.2–2.7)]. Religious characteristics were also associated with believing that the case patient’s life was worth living [OR 4.1 (2.4–7.2), OR 3.2 (1.6–6.3), OR 9.2 (4.3–19.5), respectively]. Conclusion US physicians view the concept of dignity as useful. Those views are associated with their judgments about common end-of-life scenarios in which dignity concepts may be relevant. PMID:22762966

The role of follow-up ultrasound and clinical parameters after abdominal MDCT in patients with multiple trauma.

PubMed

Geyer, Lucas L; Körner, M; Linsenmaier, U; Wirth, S; Reiser, M F; Meindl, T

2014-05-01

Beside its value during the initial trauma work-up (focused assessment with sonography for trauma), ultrasound (US) is recommended for early follow-up examinations of the abdomen in multiple injured patients. However, multidetector CT (MDCT) has proven to reliably diagnose traumatic lesions of abdominal organs, to depict their extent, and to assess their clinical relevance. To evaluate the diagnostic impact of follow-up US studies after MDCT of the abdomen and to identify possible clinical parameters indicating the need of a follow-up US. During a 30-month period, patients with suspected multiple trauma were allocated. Patients with admission to the ICU, an initial abdominal MDCT scan, and an US follow-up examination after 6 and 24 h were included. Two patient cohorts were defined: patients with normal abdominal MDCT (group 1), patients with trauma-related pathologic abdominal MDCT (group 2). In all patients, parameters indicating alteration of vital functions or hemorrhage within the first 24 h were obtained by reviewing the medical charts. Forty-four of 193 patients were included: 24 were categorized in group 1 (mean age, 41.1 years; range, 21-90 years), 20 in group 2 (mean age, 36.6 years; range, 16-71 years). In group 1, US did not provide new information compared to emergency MDCT. In group 2, there were no contradictory 6- and 24-h follow-up US findings. In patients with positive MDCT findings and alterations of clinical parameters, US did not detect progression of a previously diagnosed pathology or any late manifestation of such a lesion. In none of the patients with negative abdominal MDCT and pathological clinical parameters US indicated an abdominal injury. Routine US follow-up does not yield additional information after abdominal trauma. In patients with MDCT-proven organ lesions, follow-up MDCT should be considered if indicated by abnormal clinical and/or laboratory findings.

Ocean Tides. Part 2. A Hydrodynamical Interpolation Model

DTIC Science & Technology

1980-01-01

bslaow 36 32.3W, 04.70W 3w9 Zahel (1970 I) StL Geoge islan 36 SL4ft 6470W 3M Ze~to at . (IOS) 00" a" 0GO I N 36 3UNP.U0 11 J . T . Kuo Lette (1077) am0...a, = 0 ff 106-* 0; {Us1U, s=0 for AC. Ul > 0, (6b) us = 0, Vh = A.+,.. otherwise; v= zlVi = 0 for A t + J ,+ < 0, 6) v i 0, Vi = BL. otherwise; and V2...and { AC’J+ - w4 I/C" for fV& O, [w =C/~fr~O (8a)0 for T = 0 with the second control limit IwI < ki (8b) where (see Equation 3) C = C. [ U j + U2 U4

The economic costs of malaria in children in three sub-Saharan countries: Ghana, Tanzania and Kenya

PubMed Central

2013-01-01

Background Malaria causes significant mortality and morbidity in sub-Saharan Africa (SSA), especially among children less than five years of age (U5 children). Although the economic burden of malaria in this region has been assessed previously, the extent and variation of this burden remains unclear. This study aimed to estimate the economic costs of malaria in U5 children in three countries (Ghana, Tanzania and Kenya). Methods Health system and household costs previously estimated were integrated with costs associated with co-morbidities, complications and productivity losses due to death. Several models were developed to estimate the expected treatment cost per episode per child, across different age groups, by level of severity and with or without controlling for treatment-seeking behaviour. Total annual costs (2009) were calculated by multiplying the treatment cost per episode according to severity by the number of episodes. Annual health system prevention costs were added to this estimate. Results Household and health system costs per malaria episode ranged from approximately US$ 5 for non-complicated malaria in Tanzania to US$ 288 for cerebral malaria with neurological sequelae in Kenya. On average, up to 55% of these costs in Ghana and Tanzania and 70% in Kenya were assumed by the household, and of these costs 46% in Ghana and 85% in Tanzania and Kenya were indirect costs. Expected values of potential future earnings (in thousands) lost due to premature death of children aged 0–1 and 1–4 years were US$ 11.8 and US$ 13.8 in Ghana, US$ 6.9 and US$ 8.1 in Tanzania, and US$ 7.6 and US$ 8.9 in Kenya, respectively. The expected treatment costs per episode per child ranged from a minimum of US$ 1.29 for children aged 2–11 months in Tanzania to a maximum of US$ 22.9 for children aged 0–24 months in Kenya. The total annual costs (in millions) were estimated at US$ 37.8, US$ 131.9 and US$ 109.0 nationwide in Ghana, Tanzania and Kenya and included average treatment costs per case of US$ 11.99, US$ 6.79 and US$ 20.54, respectively. Conclusion This study provides important insight into the economic burden of malaria in SSA that may assist policy makers when designing future malaria control interventions. PMID:24004482

Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study.

PubMed

Tann, Cally J; Nakakeeto, Margaret; Hagmann, Cornelia; Webb, Emily L; Nyombi, Natasha; Namiiro, Flaviah; Harvey-Jones, Kelly; Muhumuza, Anita; Burgoine, Kathy; Elliott, Alison M; Kurinczuk, Jennifer J; Robertson, Nicola J; Cowan, Frances M

2016-08-01

In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status. Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95)). In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.

Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study

PubMed Central

Tann, Cally J.; Nakakeeto, Margaret; Hagmann, Cornelia; Webb, Emily L.; Nyombi, Natasha; Namiiro, Flaviah; Harvey-Jones, Kelly; Muhumuza, Anita; Burgoine, Kathy; Elliott, Alison M.; Kurinczuk, Jennifer J.; Robertson, Nicola J.; Cowan, Frances M.

2016-01-01

Background: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. Methods: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status. Results: Scans were performed at median age 11.5 (interquartile range (IQR): 5.2–20.2) and 8.4 (IQR: 3.6–13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98–9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61–6.95)). Conclusion: In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia–ischemia (HI). Early abnormalities were a significant predictor of death. PMID:27064242

Accuracy of Liver Fat Quantification With Advanced CT, MRI, and Ultrasound Techniques: Prospective Comparison With MR Spectroscopy.

PubMed

Kramer, Harald; Pickhardt, Perry J; Kliewer, Mark A; Hernando, Diego; Chen, Guang-Hong; Zagzebski, James A; Reeder, Scott B

2017-01-01

The purpose of this study was to prospectively evaluate the accuracy of proton-density fat-fraction, single- and dual-energy CT (SECT and DECT), gray-scale ultrasound (US), and US shear-wave elastography (US-SWE) in the quantification of hepatic steatosis with MR spectroscopy (MRS) as the reference standard. Fifty adults who did not have symptoms (23 men, 27 women; mean age, 57 ± 5 years; body mass index, 27 ± 5) underwent liver imaging with un-enhanced SECT, DECT, gray-scale US, US-SWE, proton-density fat-fraction MRI, and MRS for this prospective trial. MRS voxels for the reference standard were colocalized with all other modalities under investigation. For SECT (120 kVp), attenuation values were recorded. For rapid-switching DECT (80/140 kVp), monochromatic images (70-140 keV) and fat density-derived material decomposition images were reconstructed. For proton-density fat fraction MRI, a quantitative chemical shift-encoded method was used. For US, echogenicity was evaluated on a qualitative 0-3 scale. Quantitative US shear-wave velocities were also recorded. Data were analyzed by linear regression for each technique compared with MRS. There was excellent correlation between MRS and both proton-density fat-fraction MRI (r 2 = 0.992; slope, 0.974; intercept, -0.943) and SECT (r 2 = 0.856; slope, -0.559; intercept, 35.418). DECT fat attenuation had moderate correlation with MRS measurements (r 2 = 0.423; slope, 0.034; intercept, 8.459). There was good correlation between qualitative US echogenicity and MRS measurements with a weighted kappa value of 0.82. US-SWE velocity did not have reliable correlation with MRS measurements (r 2 = 0.004; slope, 0.069; intercept, 6.168). Quantitative MRI proton-density fat fraction and SECT fat attenuation have excellent linear correlation with MRS measurements and can serve as accurate noninvasive biomarkers for quantifying steatosis. Material decomposition with DECT does not improve the accuracy of fat quantification over conventional SECT attenuation. US-SWE has poor accuracy for liver fat quantification.

Comparison of tobacco and alcohol use in films produced in Europe, Latin America, and the United States.

PubMed

Barrientos-Gutierrez, Inti; Kollath-Cattano, Christy; Mejía, Raul; Arillo-Santillán, Edna; Hanewinkel, Reiner; Morgenstern, Matthis; Sargent, James D; Thrasher, James F

2015-11-03

Studies that have evaluated tobacco and alcohol portrayals in films have mainly focused on US films. Our aim is to describe tobacco and alcohol portrayals in nationally produced films from six European and two Latin American countries, and compare them with US produced films. A sample of 337 nationally produced and 502 US produced films, consisting of top grossing films from 2004 to 2009 in each country, was content coded for presence of tobacco or alcohol and seconds of tobacco or alcohol use. Logistic and linear regression models were estimated for all films and youth-rated films (Ages 0-14) to assess cross country differences in tobacco and alcohol content, with US films as the reference category. Domestically produced films from several countries were more likely than US films to contain any tobacco use both overall (Iceland (OR = 9.29, CI: 1.22-70.89), Italy (OR = 3.58, CI: 1.72-7.43), Argentina (OR = 5.06, CI: 2.13-12.03), Mexico (OR = 4.87, CI: 2.17-10.90)) and for youth-rated films (Germany (OR = 2.24, CI: 1.21-4.16), Iceland (OR = 13.79, CI: 1.80-105.5), Italy (OR = 5.31, CI: 2.54-11.1), and Argentina (OR = 6.9, CI: 0.88-1.34)). Models for alcohol showed few differences compared to US, regardless of rating. Linear regression models for seconds of use in films with tobacco indicated that only Argentine films had more seconds of smoking than US films, regardless of the rating category. For films with alcohol use, Mexican films had higher seconds of alcohol use than US films. Smoking was more commonly depicted in films produced outside the US, however there were few differences in the means for smoking screen time in films that contained smoking. This may be partly explained by the prohibition of tobacco product placement in the US. Countries should consider banning paid placement of both products and eliminating subsidies for films with content that promotes tobacco and alcohol use.

Feature-based US to CT registration of the aortic root

NASA Astrophysics Data System (ADS)

Lang, Pencilla; Chen, Elvis C. S.; Guiraudon, Gerard M.; Jones, Doug L.; Bainbridge, Daniel; Chu, Michael W.; Drangova, Maria; Hata, Noby; Jain, Ameet; Peters, Terry M.

2011-03-01

A feature-based registration was developed to align biplane and tracked ultrasound images of the aortic root with a preoperative CT volume. In transcatheter aortic valve replacement, a prosthetic valve is inserted into the aortic annulus via a catheter. Poor anatomical visualization of the aortic root region can result in incorrect positioning, leading to significant morbidity and mortality. Registration of pre-operative CT to transesophageal ultrasound and fluoroscopy images is a major step towards providing augmented image guidance for this procedure. The proposed registration approach uses an iterative closest point algorithm to register a surface mesh generated from CT to 3D US points reconstructed from a single biplane US acquisition, or multiple tracked US images. The use of a single simultaneous acquisition biplane image eliminates reconstruction error introduced by cardiac gating and TEE probe tracking, creating potential for real-time intra-operative registration. A simple initialization procedure is used to minimize changes to operating room workflow. The algorithm is tested on images acquired from excised porcine hearts. Results demonstrate a clinically acceptable accuracy of 2.6mm and 5mm for tracked US to CT and biplane US to CT registration respectively.

45 CFR 270.6 - What data and other information must a State report to us?

Code of Federal Regulations, 2011 CFR

2011-10-01

... report to us? 270.6 Section 270.6 Public Welfare Regulations Relating to Public Welfare OFFICE OF FAMILY... SERVICES HIGH PERFORMANCE BONUS AWARDS § 270.6 What data and other information must a State report to us.... Each State must notify us on which of the measures it will compete in each bonus year. ...

The public's preparedness: self-reliance, flashbulb memories, and conservative values.

PubMed

Greenberg, Michael R; Dyen, Susannah; Elliott, Stacey

2013-06-01

We surveyed how many US residents engaged in 6 preparedness activities and measured the relationship between engagement and personal experience in hazard events, flashbulb memories of major events, self-reliance, and other indicators of a conservative philosophy. We used random digit dialing for national landline (75%) and cell phone (25%) surveys of 1930 US residents from July 6, 2011, to September 9, 2011; 1080 of the sample lived near 6 US Department of Energy nuclear waste management facilities and 850 were a national random sample. The median respondent engaged in 3 of the 6 activities; those who disproportionately engaged in 4 or more had experienced a hazard event, had distressing and strong flashbulb memories of major hazard events, and had strong feelings about the need for greater self-reliance. The results for the national and US Department of Energy site-specific surveys were almost identical. A cadre of US residents are disproportionately engaged in disaster preparedness, and they typically have stronger negative memories of past disasters and tend to be self-reliant. How their efforts can or should be integrated into local preparedness efforts is unclear.

77 FR 19835 - Grant of Individual Exemption Involving BlackRock, Inc. and Its Investment Advisory, Investment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-02

... implicit U.S. Government guarantee as opposed to an explicit U.S. Government guarantee, (a) the BlackRock... 2510.3-101(i) which is accompanied by an implicit U.S. Government guarantee as opposed to an explicit U... or any member of the ECO Function in the performance of his or her duties; 6. The ECO is responsible...

Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation-volvulus.

PubMed

Ward, Michael P; Patronek, Gary J; Glickman, Lawrence T

2003-09-12

The lifetime probability of death from gastric dilation-volvulus (GDV) for five dog breeds was estimated based on published breed-specific longevity and GDV incidence. These breeds were Great Dane, Irish Setter, Rottweiler, Standard Poodle and Weimaraner. Lifetime risk (95% CI) of GDV in these breeds ranged from 3.9% (0-11.2%) for Rottweiler to 36.7% (25.2-44.6%) for Great Dane. A decision-tree analysis for prophylactic gastropexy--using lifetime probability of death from GDV and expected cost savings for veterinary services as outcome measures--was undertaken to determine the preferred course of action in several dog breeds. Prophylactic gastropexy was the preferred choice of action for all breeds examined, with the reduction in mortality (versus no gastropexy) ranging from 2.2-fold (Rottweiler) to 29.6-fold (Great Dane). Assuming a prophylactic gastropexy costs US$ 400, the procedure was cost-effective when the lifetime risk of GDV was > or = 34%. The maximum and minimum estimated breakeven costs for the gastopexy procedure ranged from US$ 20 (Rottweiler) to US$ 435 (Great Dane). The cost-effectiveness of prophylactic gastropexy was most sensitive to the cost of treating GDV (US$ 1500). Prophylactic gastropexy raises ethical issues that need to be considered by veterinarians and dog breeders.

Multiscale predictions of aviation-attributable PM2.5 for US ...

EPA Pesticide Factsheets

Aviation activities represent an important and unique mode of transportation, but also impact air quality. In this study, we aim to quantify the impact of aircraft on air quality, focusing on aviation-attributable PM2.5 at scales ranging from local (a few kilometers) to continental (spanning hundreds of kilometers) using the Community Multiscale Air Quality-Advanced Plume Treatment (CMAQ-APT) model. In our CMAQ-APT simulations, a plume scale treatment is applied to aircraft emissions from 99 major U.S. airports over the contiguous U.S. in January and July 2005. In addition to the plume scale treatment, we account for the formation of non-traditional secondary organic aerosols (NTSOA) from the oxidation of semivolatile and intermediate volatility organic compounds (S/IVOCs) emitted from aircraft, and utilize alternative emission estimates from the Aerosol Dynamics Simulation Code (ADSC). ADSC is a 1-D plume scale model that estimates engine specific PM and S/IVOC emissions at ambient conditions, accounting for relative humidity and temperature. We estimated monthly and contiguous U.S. average aviation-attributable PM2.5 to be 2.7 ng m−3 in January and 2.6 ng m−3 in July using CMAQ-APT with ADSC emissions. This represents an increase of 40% and 12% in January and July, respectively, over impacts using traditional modeling approaches (traditional emissions without APT). The maximum fine scale (subgrid scale) hourly impacts at a major airport were 133.6 μg m−

Weighing in on type 2 diabetes in the military: characteristics of U.S. military personnel at entry who develop type 2 diabetes.

PubMed

Paris, R M; Bedno, S A; Krauss, M R; Keep, L W; Rubertone, M V

2001-11-01

Current incidence trends in type 2 diabetes portend a significant public health burden and have largely been attributed to similar trends in overweight and physical inactivity. Medical surveillance of the U.S. military indicates that the incidence of all types of diabetes is similar to that in the civilian population (1.9 vs. 1.6 cases per 1,000 person-years) despite weight and fitness standards. Differences in the common determinants of diabetes have not been studied in the military population, which may provide novel clues to the increasing incidence of diabetes in the U.S. A case-control study, 4-to-1 matched for age, sex, entry date, time in service, and service component (e.g., Army, Navy), was used to describe the association of race/ethnicity, socioeconomic status, and BMI and blood pressure at entry into military service with the subsequent development of type 2 diabetes. Increased BMI (adjusted odds ratio, 3.0 for the > or =30 kg/m(2) vs. < or =20 kg/m(2) categories and 2.0 for the 25.0-29.9 kg/m(2) category, compared with the reference category), African-American (adjusted odds ratio, 2.0) and Hispanic origin (adjusted odds ratio, 1.6) compared with white race and rank (adjusted odds ratio for junior enlisted versus officers, 4.1) were all associated with type 2 diabetes. Individuals with type 2 diabetes in the U.S. military have risk factors similar to the general U.S. population. Because diabetes is a preventable disease, it is of concern that it is occurring in this population of younger and presumably more fit individuals. This has significant implications for the prevention of diabetes in both military and civilian populations.

Real-time Monitoring of Radiofrequency Ablation and Postablation Assessment: Accuracy of Contrast-enhanced US in Experimental Rat Liver Model

PubMed Central

Wu, Hanping; Wilkins, Luke R.; Ziats, Nicholas P.; Haaga, John R.

2014-01-01

Purpose To examine the accuracy of the unenhanced zone at contrast material–enhanced ultrasonography (US) in predicting coagulative necrosis during and 21 days after radiofrequency (RF) ablation by using radiologic-pathologic comparison. Materials and methods Animal studies were approved by the Institutional Animal Care and Use Committee. The livers of 28 rats underwent US-guided RF ablation. In four animals, contrast-enhanced US was performed during ablation and 2 hours and 2, 7, 14, and 21 days after ablation. The unenhanced zone area on US images was measured. DiI-labeled microbubbles were administered during ablation at 2, 4, and 6 minutes or at 2 hours and 2, 7, 14, and 21 days after ablation in the remaining 24 animals (n = 3 at each time point). One minute later, the animal was euthanized, and the ablated liver was harvested. Tissue samples were imaged to quantify total fluorescence, and NADH staining was performed on the same slice. Hematoxylin-eosin staining was also performed. The findings on fluorescence images, NADH-stained images, and hematoxylin-eosin–stained images were compared. The areas of DiI bubble–negative zones, NADH-negative zones, and lightly NADH-staining zones were measured. Data were analyzed by using one-way analysis of variance. Results The area of the unenhanced zone on contrast-enhanced US images increased during RF ablation and reached a maximum within 2 days after ablation. At histopathologic examination, a transition zone manifested adjacent to the coagulation zone until 2 days after ablation. The DiI-bubble negative zone on fluorescence images and the damaged zone (transition zone plus coagulation zone) on NADH-stained images increased rapidly within 2 hours after ablation, then slowly reached the maximum on day 2. The ratios of the mean areas of these two zones at hour 2 to those at day 2 were 94.6% and 95.6%, respectively. High uniformity between the damaged zone on NADH-stained images and the DiI bubble–negative zone on fluorescence images was noted at all time points. Conclusion The temporary transition zone in NADH staining is partially damaged and should transition to nonviability 2 days after ablation. These results demonstrate that contrast-enhanced US can help delineate the maximum area of cell damage (to within 5% of the maximum) as early as 2 hours after ablation. Contrast-enhanced US may be a simple and accurate tool for monitoring the effects of RF ablation and quantifying the size of thermal damage after treatment. © RSNA, 2013 Online supplemental material is available for this article. PMID:23912621

Identification of Risk Factors for the Development of Pressure Ulcers Despite Standard Screening Methodology and Prophylaxis in Trauma Patients.

PubMed

Raff, Lauren A; Waller, Holly; Griffin, Russell L; Kerby, Jeffrey D; Bosarge, Patrick L

2016-07-01

To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Describe the previous PrU research, scope of the problem, and methodology of the study.2. Explain the results of the study identifying PrU risk factors for trauma patients. Pressure ulceration prevention has been emphasized  over the past several years in inpatient hospital settings with  subsequent decreases in the development of pressure ulcers (PrUs).  However, there remains a subset of trauma and burn patients  that develop PrUs despite standard screening methodology and  prophylaxis. This study determines the conditions that predict  development of pressure ulcers (PrUs) despite conventional  prophylaxis and screening.  Demographic and PrU data were collected over a  5-year period from June 2008 to May 2013. Patients diagnosed  with PrUs upon arrival in the trauma bay were excluded from  analysis. An ordinal logistic regression of PrU stage was used to  estimate odds ratios (ORs) and associated 95% confidence intervals  (CIs) for the association between characteristics of interest and  odds of a PrU. A backward selection process was used to select the  most parsimonious model.  During the study period, 14,616 trauma patients were  admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63-9.01), mechanical ventilation (OR, 1.95; CI, 1.23-3.10) and age 40 to 64 (OR, 2.09; CI, 1.24-3.52) and age ≥ 65 (OR, 4.48; CI, 2.52-7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32-0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than -6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development.  Spinal injuries, older than age 40, and mechanical  ventilation predict the development of PrUs for a subset of  patients, despite conventional prophylaxis and screening. Advanced  prevention methods, such as low-air-loss mattresses for these patient  subgroups should be considered immediately upon identification  of these risk factors during the hospital course.

Inpatient charges and mental illness: Findings from the Nationwide Inpatient Sample 1999-2007.

PubMed

Banta, Jim E; Belk, Ivorie; Newton, Kedon; Sherzai, Abdullah

2010-01-01

Inpatient costs related to mental illness are substantial, though declining as a percentage of overall mental health treatment costs. The public sector has become increasingly involved in funding and providing mental health services. Nationwide Inpatient Sample data for the years 1999-2007 were used to: 1) examine Medicare, Medicaid, and private insurance charges related to mental illness hospitalizations, including trends over time; and 2) examine trends in mental comorbidity with physical illness and its effect on charges. There were an estimated 12.4 million mental illness discharges during the 9-year period, with Medicare being the primary payer for 4.3 million discharges, Medicaid for 3.3 million, private insurance for 3.2 million, and 1.6 million for all other payers. Mean inflation-adjusted charges per hospitalization were US$17,528, US$15,651, US$10,539, and US$11,663, respectively. Charges to public sources increased for schizophrenia and dementia-related discharges, with little private/public change noted for mood disorders. Comorbid mood disorders increased dramatically from 1.5 million discharges in 1999 to 3.4 million discharges in 2007. Comorbid illness was noted in 14.0% of the 342 million inpatient discharges during the study period and was associated with increased charges for some medical conditions and decreased charges for other medical conditions.

Clean-Burning Diesel Engines.

DTIC Science & Technology

1983-08-01

ATCD-S 1 VEHICLES FORT MONROE VA 23651 ATTN: DRCPM-MI13 WARREN MI 48090 CDR US ARMY TRANSPORTATION SCHOOL PROJ MGR, MOBILE ELECTRIC POWER ATTN: ATS P-CD...for the Deutz F3L 912W and the Perkins 4.203.2 49 6 / t . . ...... ....low I. INTRODUCTION The U.S. Army currently uses electric forklifts in handling...hazardous materials. Although these electric forklifts have certain inherent desirable characteristics, i.e., no pollution or noise, the logistics

Use of cadaver models in point-of-care emergency ultrasound education for diagnostic applications.

PubMed

Zaia, Brita E; Briese, Beau; Williams, Sarah R; Gharahbaghian, Laleh

2012-10-01

As the use of bedside emergency ultrasound (US) increases, so does the need for effective US education. To determine 1) what pathology can be reliably simulated and identified by US in human cadavers, and 2) feasibility of using cadavers to improve the comfort of emergency medicine (EM) residents with specific US applications. This descriptive, cross-sectional survey study assessed utility of cadaver simulation to train EM residents in diagnostic US. First, the following pathologies were simulated in a cadaver: orbital foreign body (FB), retrobulbar (RB) hematoma, bone fracture, joint effusion, and pleural effusion. Second, we assessed residents' change in comfort level with US after using this cadaver model. Residents were surveyed regarding their comfort level with various US applications. After brief didactic sessions on the study's US applications, participants attempted to identify the simulated pathology using US. A post-lab survey assessed for change in comfort level after the training. Orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion were readily modeled in a cadaver in ways typical of a live patient. Twenty-two residents completed the pre- and post-lab surveys. After training with cadavers, residents' comfort improved significantly for orbital FB and RB hematoma (mean increase 1.6, p<0.001), bone fracture (mean increase 2.12, p<0.001), and joint effusion (1.6, p<0.001); 100% of residents reported that they found US education using cadavers helpful. Cadavers can simulate orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion, and in our center improved the comfort of residents in identifying all but pleural effusion. Copyright © 2012 Elsevier Inc. All rights reserved.

Obesity, diabetes, and length of time in the United States: Analysis of National Health and Nutrition Examination Survey 1999 to 2012.

PubMed

Tsujimoto, Tetsuro; Kajio, Hiroshi; Sugiyama, Takehiro

2016-08-01

Obesity prevalence remains high in the United States (US), and is rising in most other countries. This is a repeated cross-sectional study using a nationally representative sample of the National Health and Nutrition Examination Survey 1999 to 2012. Multivariate logistic regression analyses were separately performed for adults (n = 37,639) and children/adolescents (n = 28,282) to assess the associations between the length of time in the US, and the prevalences of obesity and diabetes. In foreign-born adults, the prevalences of both obesity and diabetes increased with the length of time in the US, and ≥20 years in the US was associated with significantly higher rates of obesity (adjusted odds ratio [aOR] 2.32, 95% confidence interval [CI] 1.22-4.40, P = 0.01) and diabetes (aOR 4.22, 95% CI 1.04-17.08, P = 0.04) compared with <1 year in the US. In children/adolescents, obesity prevalence was significantly higher in those born in the US than those who had been in the US for <1 year (aOR 3.15, 95% CI 1.51-6.56, P = 0.002). When analyzed by year, obesity prevalence was significantly higher in US-born than in foreign-born adults from 1999 to 2012. On the other hand, the gap in obesity prevalence between US-born and foreign-born children/adolescents decreased from 1999 to 2011 due to a rapid increase in obesity prevalence among the foreign-born population, until there was no significant difference in 2011 to 2012. This study revealed that the risks of obesity and diabetes have increased in foreign-born US residents with time living in the US. However, the obesity gap between US-born and foreign-born populations is closing.

Efficacy and safety of the adjustable gastric band - pooled interim analysis of the APEX and HERO studies at 48 weeks.

PubMed

Ponce, Jaime; Taheri, Shahrad; Lusco, Vincent; Cornell, Christopher; Ng-Mak, Daisy S; Shi, Rui; Okerson, Ted

2014-05-01

This 48 week combined analysis reports safety and clinical effectiveness of the LAP-BAND AP * laparoscopic adjustable gastric band (LAGB) in severely obese patients enrolled in the 5 year, prospective, observational, open-label APEX (NCT00501085) and HERO (NCT00953173) studies. The studies enrolled 1620 patients (APEX: N = 514; HERO: N = 1106), 1140 patients in the US (including all APEX patients), and 480 patients in the European Union (EU), Canada or Australia. APEX and HERO are non-randomized, non-comparator, open-label studies with differences in study management practices and follow-up. Notably, laboratory data were not collected during the APEX study. After 48 weeks, mean (SD) percentage weight loss (%WL) was for APEX: 18.7% (7.9); HERO-US: 17.9% (8.5); HERO-EU: 16.5% (10.3); HERO-Canada: 13.4% (8.9); and HERO-Australia: 12.3% (6.9). After 48 weeks, there were no significant differences in %WL for APEX vs. HERO-US. After 48 weeks in the combined analysis (APEX + HERO): (1) patients without vs. with type 2 diabetes at baseline had greater %WL (18% [8.7] vs. 16% [8.5], p = 0.002); (2) female patients had greater %WL vs. male patients (17.9% [8.5] vs. 15.9% [9.3], p = 0.003); (3) younger patients had greater %WL vs. older patients (<50 years: 17.8% [8.7] vs. ≥50 years: 16.7% [8.6], p = 0.035); (4) baseline BMI did not affect %WL (≤35 to ≤45 kg/m(2): 17.7% [8.4] vs. >45 kg/m(2): 17.1% [9.1], p = 0.272). Device-related serious adverse events and adverse events were reported in 1.9% and 17.7% of patients, respectively. Revision and explantation surgeries were carried out on 3.4% and 2.3% of patients, respectively during the 48 weeks of follow-up. This analysis demonstrates the effective weight loss and safety profile of the current LAGB system, with US patients achieving better weight loss than patients from outside the US.

Annual Cost of U.S. Hospital Visits for Pediatric Abusive Head Trauma.

PubMed

Peterson, Cora; Xu, Likang; Florence, Curtis; Parks, Sharyn E

2015-08-01

We estimated the frequency and direct medical cost from the provider perspective of U.S. hospital visits for pediatric abusive head trauma (AHT). We identified treat-and-release hospital emergency department (ED) visits and admissions for AHT among patients aged 0-4 years in the Nationwide Emergency Department Sample and Nationwide Inpatient Sample (NIS), 2006-2011. We applied cost-to-charge ratios and estimated professional fee ratios from Truven Health MarketScan(®) to estimate per-visit and total population costs of AHT ED visits and admissions. Regression models assessed cost differences associated with selected patient and hospital characteristics. AHT was diagnosed during 6,827 (95% confidence interval [CI] [6,072, 7,582]) ED visits and 12,533 (95% CI [10,395, 14,671]) admissions (28% originating in the same hospital's ED) nationwide over the study period. The average medical cost per ED visit and admission were US$2,612 (error bound: 1,644-3,581) and US$31,901 (error bound: 29,266-34,536), respectively (2012 USD). The average total annual nationwide medical cost of AHT hospital visits was US$69.6 million (error bound: 56.9-82.3 million) over the study period. Factors associated with higher per-visit costs included patient age <1 year, males, coexisting chronic conditions, discharge to another facility, death, higher household income, public insurance payer, hospital trauma level, and teaching hospitals in urban locations. Study findings emphasize the importance of focused interventions to reduce this type of high-cost child abuse. © The Author(s) 2015.

A population-based study of Kurdish breast cancer in northern Iraq: hormone receptor and HER2 status. A comparison with Arabic women and United States SEER data.

PubMed

Runnak, Majid A; Hazha, Mohammed A; Hemin, Hassan A; Wasan, Abdulmahdi A; Rekawt, Rashid M; Michael, Hughson D

2012-06-22

Hormone receptor (HR) and HER2 expression predict the therapeutic response and prognosis of breast cancer. In the Middle-East, breast cancer is diagnosed at a young age, and Arabic women are reported to have a low frequency of HR positive tumors. This study investigates HR and HER2 expression among Kurdish and Arabic women. During 2008-2010, the Sulaimaniyah Directorate of Health records identified 514 Sulaimaniyah Kurdish women, 227 Kurdish women of other Governates, and 83 Arabic women with a first diagnosis of breast cancer. The breast cancers of 432 women had immunohistochemistry (IHC) performed for estrogen and progesterone receptors (ER and PR) and HER2. Age specific and age standardized incidence rates were calculated for Sulaimaniyah Kurds. Results were compared with Egypt and with United States (US) SEER data. The median patient age was 46 years and 60.4% were < 50 years old. Tumors of 65.2% of women were ER+/HER2- with the rate increasing to 78.3% in patients ≥ 60 years old in proportions similar to US whites. The total annual age standardized incidence for breast cancer among Sulaimaniyah Kurds was 40.5/100,000 women, a rate similar to Egypt but much lower than the US. By HR/HER2 subtype, the highest age specific incidence rates were 16.4 and 45.4/100,000 for ER+/PR+/HER2- tumors in women < 50 or ≥ 50 years old, respectively (US whites: 37.7 and 226.1/100,000). Tumors of 20.4% of Sulaimaniyah women were HER2+ with annual incidence rates for ER-/PR-/HER2+ tumors of women <50 or ≥ 50 years old being 4.0 and 6.3/100,000 (US whites: 3.2 and 14.4/100,000). No significant differences in ER or HER2 status were found between Kurdish and Arabic patients. Compared to the US, low age standardized and age specific breast cancer incidence rates were found in Kurdish women; nevertheless, the proportional expression of HR and HER2 for both Kurds and Arabs was comparable to that of US white women. The great majority of the breast cancer was ER+/HER2- and should respond to anti-estrogen therapy.

Cultural differences in visual object recognition in 3-year-old children.

PubMed

Kuwabara, Megumi; Smith, Linda B

2016-07-01

Recent research indicates that culture penetrates fundamental processes of perception and cognition. Here, we provide evidence that these influences begin early and influence how preschool children recognize common objects. The three tasks (N=128) examined the degree to which nonface object recognition by 3-year-olds was based on individual diagnostic features versus more configural and holistic processing. Task 1 used a 6-alternative forced choice task in which children were asked to find a named category in arrays of masked objects where only three diagnostic features were visible for each object. U.S. children outperformed age-matched Japanese children. Task 2 presented pictures of objects to children piece by piece. U.S. children recognized the objects given fewer pieces than Japanese children, and the likelihood of recognition increased for U.S. children, but not Japanese children, when the piece added was rated by both U.S. and Japanese adults as highly defining. Task 3 used a standard measure of configural progressing, asking the degree to which recognition of matching pictures was disrupted by the rotation of one picture. Japanese children's recognition was more disrupted by inversion than was that of U.S. children, indicating more configural processing by Japanese than U.S. children. The pattern suggests early cross-cultural differences in visual processing; findings that raise important questions about how visual experiences differ across cultures and about universal patterns of cognitive development. Copyright © 2016 Elsevier Inc. All rights reserved.

17 CFR 240.15a-6 - Exemption of certain foreign brokers or dealers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... or dealer; or (2) Furnishes research reports to major U.S. institutional investors, and effects... those major U.S. institutional investors to follow up on the research reports, and does not otherwise...) Induces or attempts to induce the purchase or sale of any security by a U.S. institutional investor or a...

17 CFR 240.15a-6 - Exemption of certain foreign brokers or dealers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... or dealer; or (2) Furnishes research reports to major U.S. institutional investors, and effects... those major U.S. institutional investors to follow up on the research reports, and does not otherwise...) Induces or attempts to induce the purchase or sale of any security by a U.S. institutional investor or a...

17 CFR 240.15a-6 - Exemption of certain foreign brokers or dealers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... or dealer; or (2) Furnishes research reports to major U.S. institutional investors, and effects... those major U.S. institutional investors to follow up on the research reports, and does not otherwise...) Induces or attempts to induce the purchase or sale of any security by a U.S. institutional investor or a...

Sodium intake among U.S. school-age children: National Health and Nutrition Examination Survey, 2011-2012

USDA-ARS?s Scientific Manuscript database

Identifying current major dietary sources of sodium can enhance strategies to reduce excess sodium intake which occurs among 90% of U.S. school-aged children. We conducted a cross-sectional analysis of 24-hour dietary recall data from a nationally representative sample of 2,142 U.S. children aged 6...

Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece.

PubMed

Jun, Bokkwan; Berdahl, John P; Kim, Terry

2010-05-01

To evaluate the change and difference in the corneal surface, incision, and handpiece temperatures during longitudinal and torsional ultrasound (US) phacoemulsification with standard incisions (2.75 mm) and microincisions (2.20 mm) and the thermal effect on wounds. Department of Ophthalmology, Duke University, Durham, North Carolina, USA. In this prospective study, human cadaver eyes had simulated phacoemulsification. Group 1 had a 2.75 mm incision with 100% longitudinal US; Group 2, a 2.20 mm incision with 100% longitudinal US; Group 3, a 2.75 mm incision with 100% torsional US; and Group 4, a 2.20 mm incision with 100% torsional US. During phacoemulsification, the corneal incision was evaluated by surgical microscopy and scanning electron microscopy (SEM) and images of the corneal surface, incision, and handpiece were captured with an infrared camera. Twelve eyes (3 each group) were evaluated. The maximum incision temperature was higher in the longitudinal groups than in the torsional groups. With the same US modality, the maximum microincision temperature was higher than the maximum standard incision temperature. After application of full power for 40 seconds, wound burn was observed in all eyes in the longitudinal groups and no eyes in the torsional groups. On SEM, there was more extensive loss of Descemet membrane in the longitudinal groups than in the torsional groups. Incision temperature was influenced by US modality and was significantly lower with torsional US than with longitudinal US. Using torsional US with smaller incisions may decrease the risk for wound burn in eyes with denser cataracts. (c) 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Prevalence and risk factors for dysphagia: a U.S. community study

PubMed Central

Cho, So Yang; Choung, Rok Seon; Saito, Yuri A.; Schleck, Cathy D; Zinsmeister, Alan R; Locke, G. Richard; Talley, Nicholas J.

2014-01-01

Background Dysphagia is considered an alarm symptom but detailed population-based data on dysphagia are lacking. We aimed to estimate in a representative US Caucasian population the prevalence of dysphagia and potential risk factors. Methods A modified version of the previously validated Bowel Disease Questionnaire was mailed to a population based cohort (n=7640) of Olmsted County, MN. Dysphagia was measured by one validated question “In the last year, how often have you had difficulty swallowing (a feeling that food sticks in your throat or chest)?” The medical records were reviewed for organic causes of dysphagia. The associations of reported frequency of dysphagia with potential risk factors were assessed using logistic regression models. Results The sex-specific, age-adjusted (US White 2000) prevalence for dysphagia experienced at least weekly was 3.0 % (95% CI: 2.2, 3.7) in females and 3.0 % (95% CI: 2.0, 4.0) in males. Those with frequent heartburn [OR=5.9 (4.0, 8.6)] and acid regurgitation [OR=10.6 (6.8, 16.6)] were significantly more likely to report frequent dysphagia. PPI use was significantly associated with frequent (3.1, 95% CI 2.2, 4.4) and infrequent dysphagia (1.5, 955 CI 1.3, 1.8). GERD was the most common diagnosis in those reporting dysphagia on the medical record; other organic explanations were rare and only found in the frequent dysphagia group. Conclusions Frequent dysphagia is not rare in the community (3%), occurs in both women and men across all adult age groups, and is most likely to indicate underlying GERD. PMID:25376877

76 FR 63657 - Certain Devices for Mobile Data Communication; Notice of Institution of Investigation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-13

...Notice is hereby given that a complaint was filed with the U.S. International Trade Commission on August 31, 2011, under section 337 of the Tariff Act of 1930, as amended, 19 U.S.C. 1337, on behalf of Openwave Systems Inc. of Redwood City, California. Supplements to the complaint were received on September 1, 16, and 19, 2011. The complaint alleges violations of section 337 based upon the importation into the United States, the sale for importation, and the sale within the United States after importation of certain devices for mobile data communication by reason of infringement of certain claims of U.S. Patent No. 6,233,608 (``the `608 patent''); U.S. Patent No. 6,289,212 (``the `212 patent''); U.S. Patent No. 6,405,037 (``the `037 patent''); U.S. Patent No. 6,430,409 (``the `409 patent''); and U.S. Patent No. 6,625,447 (``the `447 patent''). The complaint further alleges that an industry in the United States exists or is in the process of being established as required by subsection (a)(2) of section 337. The complainant requests that the Commission institute an investigation and, after the investigation, issue an exclusion order and cease and desist orders.

10 CFR 75.6 - Facility and location reporting.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Facility and location reporting. 75.6 Section 75.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) SAFEGUARDS ON NUCLEAR MATERIAL-IMPLEMENTATION OF US/IAEA..., all communications concerning the regulations in this Part shall be addressed to the U.S. Nuclear...

10 CFR 75.6 - Facility and location reporting.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Facility and location reporting. 75.6 Section 75.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) SAFEGUARDS ON NUCLEAR MATERIAL-IMPLEMENTATION OF US/IAEA..., all communications concerning the regulations in this Part shall be addressed to the U.S. Nuclear...

10 CFR 75.6 - Facility and location reporting.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Facility and location reporting. 75.6 Section 75.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) SAFEGUARDS ON NUCLEAR MATERIAL-IMPLEMENTATION OF US/IAEA..., all communications concerning the regulations in this Part shall be addressed to the U.S. Nuclear...

10 CFR 75.6 - Facility and location reporting.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Facility and location reporting. 75.6 Section 75.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) SAFEGUARDS ON NUCLEAR MATERIAL-IMPLEMENTATION OF US/IAEA..., all communications concerning the regulations in this Part shall be addressed to the U.S. Nuclear...

10 CFR 75.6 - Facility and location reporting.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Facility and location reporting. 75.6 Section 75.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) SAFEGUARDS ON NUCLEAR MATERIAL-IMPLEMENTATION OF US/IAEA..., all communications concerning the regulations in this Part shall be addressed to the U.S. Nuclear...

Shear Wave Elastography (SWE) for Monitoring of Treatment of Tendinopathies: A Double-blinded, Longitudinal Clinical Study.

PubMed

Dirrichs, Timm; Quack, Valentin; Gatz, Matthias; Tingart, Markus; Rath, Björn; Betsch, Marcel; Kuhl, Christiane K; Schrading, Simone

2018-03-01

We aimed to investigate the diagnostic accuracy with which shear wave elastography (SWE) can be used to monitor response to treatment of tendinopathies, and to compare it to conventional ultrasound (US)-imaging methods (B-mode US (B-US) and power Doppler US (PD-US)). A prospective Institutional Review Board-approved longitudinal study on 35 patients with 47 symptomatic tendons (17 Achilles-, 15 patellar-, and 15 humeral-epicondylar) who underwent standardized multimodal US and standardized clinical assessment before and after 6 months of treatment (tailored stretching exercise, sport break, and local Polidocanol) was carried out. All US studies were performed by radiologists blinded to the clinical symptoms on both tendon sides to avoid biased interpretations, by B-US, PD-US, and SWE, conducted in the same order, using a high-resolution linear 15 MHz probe (Aixplorer). Orthopedic surgeons who were in turn blinded to US imaging results used established orthopedic scores (Victorian Institute of Sports Assessment questionnaire for Achilles, Victorian Institute of Sports Assessment questionnaire for patellar tendons, and Disability Arm Shoulder Hand scoring system) to rate presence, degree, and possible resolution of symptoms. We analyzed the diagnostic accuracy with which the different US imaging methods were able to detect symptomatic tendons at baseline as well as treatment effects, with orthopedic scores serving as reference standard. B-US, PD-US, and SWE detected symptomatic tendons with a sensitivity of 66% (31 of 47), 72% (34 of 47), and 87.5% (41 of 47), respectively. Positive predictive value was 0.67 for B-US, 0.87 for PD-US, and 1 for SWE. After treatment, clinical scores improved in 68% (32 of 47) of tendons. Treatment effects were observable by B-US, PD-US, and SWE with a sensitivity of 3.1% (1 of 32), 28.1% (9 of 32), and 81.3% (26 of 32), respectively. B-US was false-positive in 68.8% (20 of 32), PD-US in 46.9% (15 of 32), and SWE in 12.5% (4 of 32) (SWE). Clinical scores and B-US, PD-US, and SWE findings correlated poorly (r = 0.24), moderately (r = 0.59), and strongly (r = 0.80). Unlike B-US or PD-US, SWE is able to depict processes associated with tendon healing and may be a useful tool to monitor treatment effects. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Evaluation of uterine ultrasound imaging in cervical radiotherapy; a comparison of autoscan and conventional probe

PubMed Central

Cooper, David T; Behrens, Claus F

2016-01-01

Objective: In cervical radiotherapy, it is essential that the uterine position is correctly determined prior to treatment delivery. The aim of this study was to evaluate an autoscan ultrasound (A-US) probe, a motorized transducer creating three-dimensional (3D) images by sweeping, by comparing it with a conventional ultrasound (C-US) probe, where manual scanning is required to acquire 3D images. Methods: Nine healthy volunteers were scanned by seven operators, using the Clarity® system (Elekta, Stockholm, Sweden). In total, 72 scans, 36 scans from the C-US and 36 scans from the A-US probes, were acquired. Two observers delineated the uterine structure, using the software-assisted segmentation in the Clarity workstation. The data of uterine volume, uterine centre of mass (COM) and maximum uterine lengths, in three orthogonal directions, were analyzed. Results: In 53% of the C-US scans, the whole uterus was captured, compared with 89% using the A-US. F-test on 36 scans demonstrated statistically significant differences in interobserver COM standard deviation (SD) when comparing the C-US with the A-US probe for the inferior–superior (p < 0.006), left–right (p < 0.012) and anteroposterior directions (p < 0.001). The median of the interobserver COM distance (Euclidean distance for 36 scans) was reduced from 8.5 (C-US) to 6.0 mm (A-US). An F-test on the 36 scans showed strong significant differences (p < 0.001) in the SD of the Euclidean interobserver distance when comparing the C-US with the A-US scans. The average Dice coefficient when comparing the two observers was 0.67 (C-US) and 0.75 (A-US). The predictive interval demonstrated better interobserver delineation concordance using the A-US probe. Conclusion: The A-US probe imaging might be a better choice of image-guided radiotherapy system for correcting for daily uterine positional changes in cervical radiotherapy. Advances in knowledge: Using a novel A-US probe might reduce the uncertainty in interoperator variability during ultrasound scanning. PMID:27452268

Evaluation of uterine ultrasound imaging in cervical radiotherapy; a comparison of autoscan and conventional probe.

PubMed

Baker, Mariwan; Cooper, David T; Behrens, Claus F

2016-10-01

In cervical radiotherapy, it is essential that the uterine position is correctly determined prior to treatment delivery. The aim of this study was to evaluate an autoscan ultrasound (A-US) probe, a motorized transducer creating three-dimensional (3D) images by sweeping, by comparing it with a conventional ultrasound (C-US) probe, where manual scanning is required to acquire 3D images. Nine healthy volunteers were scanned by seven operators, using the Clarity(®) system (Elekta, Stockholm, Sweden). In total, 72 scans, 36 scans from the C-US and 36 scans from the A-US probes, were acquired. Two observers delineated the uterine structure, using the software-assisted segmentation in the Clarity workstation. The data of uterine volume, uterine centre of mass (COM) and maximum uterine lengths, in three orthogonal directions, were analyzed. In 53% of the C-US scans, the whole uterus was captured, compared with 89% using the A-US. F-test on 36 scans demonstrated statistically significant differences in interobserver COM standard deviation (SD) when comparing the C-US with the A-US probe for the inferior-superior (p < 0.006), left-right (p < 0.012) and anteroposterior directions (p < 0.001). The median of the interobserver COM distance (Euclidean distance for 36 scans) was reduced from 8.5 (C-US) to 6.0 mm (A-US). An F-test on the 36 scans showed strong significant differences (p < 0.001) in the SD of the Euclidean interobserver distance when comparing the C-US with the A-US scans. The average Dice coefficient when comparing the two observers was 0.67 (C-US) and 0.75 (A-US). The predictive interval demonstrated better interobserver delineation concordance using the A-US probe. The A-US probe imaging might be a better choice of image-guided radiotherapy system for correcting for daily uterine positional changes in cervical radiotherapy. Using a novel A-US probe might reduce the uncertainty in interoperator variability during ultrasound scanning.

Histopathology findings of non-mass cancers on breast ultrasound.

PubMed

Kim, Hye Rin; Jung, Hae Kyoung

2018-06-01

There is little research done on non-mass cancers (NMCs) on breast ultrasound (US). To evaluate large-sectional histopathology findings of NMCs on breast US. The mammographic and histopathology features of biopsy proven 36 breast cancers which showed pure non-mass lesions on US were retrospectively reviewed. The most common mammographic finding was microcalcification (23/35, 65.7%); fine pleomorphic microcalcification was predominant (18/23, 78.3%). The main tumor type was pure ductal carcinoma in situ (DCIS) (14/36, 38.9%) and DCIS with micro- or minimal invasion (11/36, 30.6%). Among the 25 DCIS, histologic grade was high in 15 (60.0%) and intermediate in nine (36%); comedo necrosis was seen in 17 (68%). Immunohistochemical analysis was available in 27 lesions and showed HER2-overexpression in 12 (44.4%) and triple-negative in two (7.4%). According to our limited patient sample, NMCs on breast US were mainly associated with high-grade DCIS.

National coal resource assessment non-proprietary data: Location, stratigraphy, and coal quality for selected tertiary coal in the Northern Rocky Mountains and Great Plains region

USGS Publications Warehouse

Flores, Romeo M.; Ochs, A.M.; Stricker, G.D.; Ellis, M.S.; Roberts, S.B.; Keighin, C.W.; Murphy, E.C.; Cavaroc, V.V.; Johnson, R.C.; Wilde, E.M.

1999-01-01

One of the objectives of the National Coal Resource Assessment in the Northern Rocky Mountains and Great Plains region was to compile stratigraphic and coal quality-trace-element data on selected and potentially minable coal beds and zones of the Fort Union Formation (Paleocene) and equivalent formations. In order to implement this objective, drill-hole information was compiled from hard-copy and digital files of the: (1) U.S. Bureau of Land Management (BLM) offices in Casper, Rawlins, and Rock Springs, Wyoming, and in Billings, Montana, (2) State geological surveys of Montana, North Dakota, and Wyoming, (3) Wyoming Department of Environmental Quality in Cheyenne, (4) U.S. Office of Surface Mining in Denver, Colorado, (5) U.S. Geological Survey, National Coal Resource Data System (NCRDS) in Reston, Virginia, (6) U.S. Geological Survey coal publications, (7) university theses, and (8) mining companies.

Migraine-related healthcare resource use and costs for subjects prescribed fixed-dose combination sumatriptan/naproxen sodium vs. single-entity oral triptans in a managed care population in the USA.

PubMed

Runken, M Chris; Goodwin, Bridgett; Shah, Manan; Eaddy, Michael; D'Souza, Anna; Bowers, Brian; Bell, Christopher F

2015-02-01

Randomized clinical trials have demonstrated that the efficacy of a fixed-dose single-tablet combination containing sumatriptan and naproxen sodium (S/NS) was greater than either of its individual components. Simplifying drug regimens (e.g., via a fixed-dose combination) has been shown to improve "real-world" outcomes by reducing pill burden and treatment regimen complexity, improving adherence, and reducing healthcare resource use and associated costs; however, no studies assessing such outcomes have been conducted to date for the acute treatment of migraine. To assess migraine-related healthcare resource use and associated costs for subjects prescribed S/NS vs. subjects prescribed single-entity oral triptans (SOTs) within a managed care population in the USA. In this retrospective analysis of administrative claims data from July 1, 2008 to December 31, 2009 (IMS LifeLink), subjects meeting the following criteria were selected: one or more pharmacy claim(s) for either S/NS or SOT (index date), aged 18-64 years; at least one migraine diagnosis, and continuous enrollment in the 6 months prior to and post the index date. The study population was subsequently stratified for two analyses: triptan-naïve (triptan naïve in the 6-month period prior to the index date) and triptan-switch (triptan user in the 6-month period prior to the index date and switching to another triptan). Subjects prescribed S/NS were propensity-score matched with subjects prescribed SOT (triptan-naïve analysis: 1:3; triptan-switch analysis: 1:1) to assess differences in healthcare resource use and associated costs (2009 US$) between the S/NS and SOT groups. Results from the triptan-naïve and triptan-switch analyses suggest that subjects prescribed S/NS are likely to have similar healthcare resource use patterns as those either newly initiated on an SOT or switching SOTs, as measured by migraine medication use, migraine-related healthcare resource use, and all-cause healthcare resource use. One exception was the observed increased use of opioids in the SOT group compared with the S/NS group (change in mean number of tablets pre-index vs. post-index, S/NS vs. SOT; triptan-naïve analysis: 8.6 vs.18.3, p = 0.045; triptan-switch analysis: -8.2 vs. 17.7; p = 0.120). Total costs from the triptan-naïve analysis indicated that the S/NS group had lower migraine-related (US$744 vs. US$820; p = 0.067) and all-cause healthcare costs (US$4,391 vs. US$4,870; p = 0.040) when compared with the SOT group, driven by savings in medical costs (migraine-related: US$252 vs. US$380; p = 0.001; all-cause: US$3,023 vs. US$3,599; p = 0.014). However, no significant differences were observed for total costs from the triptan-switch analysis (migraine-related healthcare costs, S/NS vs. SOT: US$1,159 vs. US$1,117; p = 0.929; all-cause healthcare costs: US$5,128 vs. US$4,788; p = 0.381). Study results suggest similar healthcare resource use patterns and associated costs when comparing S/NS and SOT across a triptan-naïve and triptan-experienced population. While the current study focuses on direct medical costs, future studies should extend beyond such a perspective to explore functional status, productivity, and health-related quality of life and satisfaction, attributes not captured in administrative claims data, but nonetheless important treatment goals.

Effect of therapeutic ultrasound intensity on subcutaneous tissue temperature and ulnar nerve conduction velocity.

PubMed

Kramer, J F

1985-02-01

Twenty subjects completed 5 min. periods of sonation, at each of six US intensities, over the ulnar nerve in the proximal forearm. All posttreatment NCV's differed significantly from the respective pretreatment velocities. The immediate posttreatment NCV associated with placebo US was significantly (p less than 0.01) less than that observed immediately pretreatment (2.81 m/s), while the five clinical US intensities produced significantly increased immediate posttreatment velocities: 0.5 w/cm2 (2.23 m/s) at (p less than 0.05), and 1.0 w/cm2 (2.78 m/s), 1.5 w/cm2 (3.15 m/s), 2.0 w/cm2 (4.47 m/s) and 2.5 w/cm2 (2.97 m/s) at (p less than 0.01). The posttreatment velocities associated with the five clinical intensities were all significantly greater (p less than 0.01) than that associated with placebo US. Subcutaneous tissue temperatures were directly related to the intensity of US. Not until US intensity had reached 1.5 w/cm2 did the heating effect of US negate the cooling effect of the US transmission gel, to produce significantly increased subcutaneous tissue temperatures after 5 min. sonation. The decreased ulnar motor NCV's associated with placebo US are attributed to the cooling effect of the US transmission gel. The increased ulnar motor NCV's associated with the clinical intensities of US are attributed to the deep heating effect of US. The breakdown of this linear relationship at 2.5 w/cm2 intensity suggests that at this point heating on the nerve and/or the mechanical effects of US were of sufficient magnitude so as to limit the increase in conduction velocity. Sonation over an area of approximately 4.5 times the soundhead for 5 min., along the proximal forearm, at clinical intensities did not have a bipositive effect on motor NCV.

Awareness and use of non-conventional tobacco products among U.S. students, 2012.

PubMed

Wang, Baoguang; King, Brian A; Corey, Catherine G; Arrazola, René A; Johnson, Sarah E

2014-08-01

Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth. This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics. Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip). Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products. Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth. Published by Elsevier Inc.

Awareness and Use of Non-conventional Tobacco Products Among U.S. Students, 2012

PubMed Central

Wang, Baoguang; King, Brian A.; Corey, Catherine G.; Arrazola, René A.; Johnson, Sarah E.

2015-01-01

Background Increasing diversity of the tobacco product landscape, including electronic cigarettes (e-cigarettes), hookah, snus, and dissolvable tobacco products (dissolvables), raises concerns about the public health impact of these non-conventional tobacco products among youth. Purpose This study assessed awareness, ever use, and current use of non-conventional tobacco products among U.S. students in 2012, overall and by demographic and tobacco use characteristics. Methods Data from the 2012 National Youth Tobacco Survey, a nationally representative survey of U.S. middle and high school students, were analyzed in 2013. Prevalence of awareness, ever use, and current use of e-cigarettes, hookah, snus, and dissolvables were calculated overall and by sex, school level, race/ethnicity, and conventional tobacco product use, including cigarettes, cigars, or smokeless tobacco (chewing tobacco, snuff, or dip). Results Overall, 50.3% of students were aware of e-cigarettes; prevalence of ever and current use of e-cigarettes was 6.8% and 2.1%, respectively. Awareness of hookah was 41.2% among all students, and that of ever and current use were 8.9% and 3.6%, respectively. Overall awareness; ever; and current use of snus (32%, 5.3%, 1.7%, respectively) and dissolvables (19.3%, 2.0%, 0.7%, respectively) were generally lower than those of e-cigarettes or hookah. Conventional tobacco product users were more likely to be aware of and to use non-conventional tobacco products. Conclusions Many U.S. students are aware of and use non-conventional tobacco products. Evidence-based interventions should be implemented to prevent and reduce all tobacco use among youth. PMID:25044194

Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging

PubMed Central

Choi, Ji-Hoon; Yun, Jung-Won; Kim, Yong-Sung; Lee, Eun-A; Hwang, Sang-Tae; Cho, Yong-Kyun; Kim, Hong-Joo; Park, Jung-Ho; Park, Dong-Il; Sohn, Chong-Il; Jeon, Woo-Kyu; Kim, Byung-Ik; Kim, Hyoung-Ook; Shin, Jun-Ho

2008-01-01

AIM: To determine the clinical data that might be useful for differentiating benign from malignant gallbladder (GB) polyps by comparing radiological methods, including abdominal ultrasonography (US) and computed tomography (CT) scanning, with postoperative pathology findings. METHODS: Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 mm. They were divided into two groups, one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender, age, symptoms, size and number of polyps, the presence of a GB stone, the radiologically measured maximum diameter of the polyp by US and CT scanning, and the measurements of diameter from postoperative pathology were recorded for comparative analysis. RESULTS: Fifteen of the 41 cases with cholesterol polyps (36.6%) were detected with US but not CT scanning, whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group, the maximum measured diameter of the polyp was smaller by CT scan than by US. Consequently, the discrepancy between those two scanning measurements was greater than for the non-cholesterol polyp group. CONCLUSION: The clinical signs indicative of a cholesterol polyp include: (1) a polyp observed by US but not observable by CT scanning, (2) a smaller diameter on the CT scan compared to US, and (3) a discrepancy in its maximum diameter between US and CT measurements. In addition, US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology. PMID:19058309

Pre-operative predictive factors for gallbladder cholesterol polyps using conventional diagnostic imaging.

PubMed

Choi, Ji-Hoon; Yun, Jung-Won; Kim, Yong-Sung; Lee, Eun-A; Hwang, Sang-Tae; Cho, Yong-Kyun; Kim, Hong-Joo; Park, Jung-Ho; Park, Dong-Il; Sohn, Chong-Il; Jeon, Woo-Kyu; Kim, Byung-Ik; Kim, Hyoung-Ook; Shin, Jun-Ho

2008-11-28

To determine the clinical data that might be useful for differentiating benign from malignant gallbladder (GB) polyps by comparing radiological methods, including abdominal ultrasonography (US) and computed tomography (CT) scanning, with postoperative pathology findings. Fifty-nine patients underwent laparoscopic cholecystectomy for a GB polyp of around 10 mm. They were divided into two groups, one with cholesterol polyps and the other with non-cholesterol polyps. Clinical features such as gender, age, symptoms, size and number of polyps, the presence of a GB stone, the radiologically measured maximum diameter of the polyp by US and CT scanning, and the measurements of diameter from postoperative pathology were recorded for comparative analysis. Fifteen of the 41 cases with cholesterol polyps (36.6%) were detected with US but not CT scanning, whereas all 18 non-cholesterol polyps were observed using both methods. In the cholesterol polyp group, the maximum measured diameter of the polyp was smaller by CT scan than by US. Consequently, the discrepancy between those two scanning measurements was greater than for the non-cholesterol polyp group. The clinical signs indicative of a cholesterol polyp include: (1) a polyp observed by US but not observable by CT scanning, (2) a smaller diameter on the CT scan compared to US, and (3) a discrepancy in its maximum diameter between US and CT measurements. In addition, US and the CT scan had low accuracy in predicting the polyp diameter compared to that determined by postoperative pathology.

[Ultra-sensitive C-reactive protein associated to nutritional status and biochemical profile in Mexican shoolchildren].

PubMed

Haro-Acosta, María Elena; Ruíz Esparza-Cisneros, Josefina; Delgado-Valdez, Jesús Hernán; Díaz-Molina, Raúl; Ayala-Figueroa, Rafael Iván

2014-01-01

C-reactive protein (CRP) is a nonspecific marker of inflammation with low serum levels, which are not usually detectable. In order to assess cardiovascular risk in adults apparently healthy, ultrasensitive methods are used, and the CRP measured through these techniques is known as ultrasensitive C-reactive protein (US-CRP). Some researchers report an association of US-CRP with some anthropometric parameters in children with no apparent disease. The aim was to associate US-CRP with nutritional status and biochemical profiles in Mexican schoolchildren. In this cross-sectional study 300 healthy children (aged 10 to 12 years) were evaluated. Weight, height, body mass index (BMI), waist circumference, body fat percentage, glucose, lipid profiles and US-CRP were measured. Exclusion criteria was: US-CRP > 10mg/L. We used multivariate regression models. 53.7 % were girls and 46.3 % were boys. The US-CRP median was of 0.3 mg/L (range: 0.3 mg/L-6.8 mg/L), and it was positively and significantly correlated with BMI (ß = 0.226, p = 0.032) and LDL-C (ß = -0.267, p = 0.007) and negatively associated with cholesterol (ß = -0.267, p = 0.007). There is an association between US-CRP and cardiovascular risk indicators, such as obesity and some lipid disorder in childhood; therefore, US-CRP may be used for close examination in Mexican children.

Trends in Critical Care Beds and Use Among Population Groups and Medicare and Medicaid Beneficiaries in the United States: 2000-2010.

PubMed

Halpern, Neil A; Goldman, Debra A; Tan, Kay See; Pastores, Stephen M

2016-08-01

To analyze patterns of critical care medicine beds, use, and costs in acute care hospitals in the United States and relate critical care medicine beds and use to population shifts, age groups, and Medicare and Medicaid beneficiaries from 2000 to 2010. Retrospective study of data from the federal Healthcare Cost Report Information System, American Hospital Association, and U.S. Census Bureau. None. None. Acute care U.S. hospitals with critical care medicine beds. From 2000 to 2010, U.S. hospitals with critical care medicine beds decreased by 17% (3,586-2,977), whereas the U.S. population increased by 9.6% (282.2-309.3M). Although hospital beds decreased by 2.2% (655,785-641,395), critical care medicine beds increased by 17.8% (88,235-103,900), a 20.4% increase in the critical care medicine-to-hospital bed ratio (13.5-16.2%). There was a greater percentage increase in premature/neonatal (29%; 14,391-18,567) than in adult (15.9%; 71,978-83,417) or pediatric (2.7%; 1,866-1,916) critical care medicine beds. Hospital occupancy rates increased by 10.4% (58.6-64.6%), whereas critical care medicine occupancy rates were stable (range, 65-68%). Critical care medicine beds per 100,000 total population increased by 7.4% (31.3-33.6). The proportional use of critical care medicine services by Medicare beneficiaries decreased by 17.3% (37.9-31.4%), whereas that by Medicaid rose by 18.3% (14.5-17.2%). Between 2000 and 2010, annual critical care medicine costs nearly doubled (92.2%; $56-108 billion). In the same period, the proportion of critical care medicine cost to the gross domestic product increased by 32.1% (0.54-0.72%). Critical care medicine beds, use, and costs in the United States continue to rise. The increasing use of critical care medicine by the premature/neonatal and Medicaid populations should be considered by healthcare policy makers, state agencies, and hospitals as they wrestle with critical care bed growth and the associated costs.

Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006-2012.

PubMed

An, Ruopeng; Wang, Peizhong Peter

2017-01-01

In this study, we examined the length of stay, hospitalization cost, and risk of in-hospital mortality among US adult inpatients with immune thrombocytopenic purpura (ITP). We analyzed nationally representative data obtained from Nationwide/National Inpatient Sample database of discharges from 2006 to 2012. In the US, there were an estimated 296,870 (95% confidence interval [CI]: 284,831-308,909) patient discharges recorded for ITP from 2006 to 2012, during which ITP-related hospitalizations had increased steadily by nearly 30%. The average length of stay for an ITP-related hospitalization was found to be 6.02 days (95% CI: 5.93-6.10), which is 28% higher than that of the overall US discharge population (4.70 days, 95% CI: 4.66-4.74). The average cost of ITP-related hospitalizations was found to be US$16,594 (95% CI: US$16,257-US$16,931), which is 48% higher than that of the overall US discharge population (US$11,200; 95% CI: US$11,033-US$11,368). Gender- and age-adjusted mortality risk in inpatients with ITP was 22% (95% CI: 19%-24%) higher than that of the overall US discharge population. Across diagnosis related groups, length of stay for ITP-related hospitalizations was longest for septicemia (7.97 days, 95% CI: 7.55-8.39) and splenectomy (7.40 days, 95% CI: 6.94-7.86). Splenectomy (US$25,262; 95% CI: US$24,044-US$26,481) and septicemia (US$18,430; 95% CI: US$17,353-US$19,507) were associated with the highest cost of hospitalization. The prevalence of mortality in ITP-related hospitalizations was highest for septicemia (11.11%, 95% CI: 9.60%-12.63%) and intracranial hemorrhage (9.71%, 95% CI: 7.65%-11.77%). Inpatients with ITP had longer hospital stay, bore higher costs, and faced greater risk of mortality than the overall US discharge population.

Residential segregation, political representation, and preterm birth among U.S.- and foreign-born Black women in the U.S. 2008-2010.

PubMed

Margerison-Zilko, Claire; Perez-Patron, Maria; Cubbin, Catherine

2017-07-01

Although racial residential segregation is associated with preterm birth (PTB) among non-Hispanic black (NHB) women in the U.S., prior work suggests that increased black political power arising from segregation may be protective for infant health. We examined associations between residential segregation, black political representation, and preterm birth (PTB) among U.S- and foreign-born NHB women in major U.S. cities using birth certificate data from 2008 to 2010 (n=861,450). Each 10-unit increase in segregation was associated with 3-6% increases in odds of PTB for both U.S.- and foreign-born NHB women. Black political representation was not associated with PTB and did not moderate the association between residential segregation and PTB. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cost-benefit analysis of first-generation antihistamines in the treatment of allergic rhinitis.

PubMed

Sullivan, Patrick W; Follin, Sheryl L; Nichol, Michael B

2004-01-01

The majority of individuals with allergic rhinitis in the US take first-generation antihistamines (FGAs). Although FGAs have been proven effective in alleviating allergic rhinitis symptoms, they have been associated with an increased risk of motor vehicle, aviation and occupational injuries and deaths, reduced productivity and impaired learning. The objective of this analysis was to quantify the total costs and benefits of FGA use in the US from the societal perspective. We used a decision-analytic model to quantify the annual societal costs and benefits of treatment with FGAs compared with the hypothetical alternative of no treatment for the population of individuals with allergic rhinitis and taking FGAs in the US in 2001. The benefit associated with FGA use was estimated using the willingness-to-pay framework and projected to the US population using published estimates of the prevalence of allergic rhinitis. The costs of FGA-associated sedation included lost productivity and the direct and indirect cost of unintentional injuries (including motor vehicle, occupational, public and home injuries and fatalities). The incidence of injuries and fatalities associated with FGA use was estimated using the risk of injury attributable to the sedentary effects of FGAs in the allergic rhinitis population. To evaluate uncertainty in the model assumptions, a probabilistic sensitivity analysis was conducted using Bayesian second-order Monte Carlo simulation. Costs and benefits are expressed in 2001 US dollars, using a 3% discount rate. Based on current utilisation, the total societal benefit (95% credible interval) associated with the use of FGAs for the treatment of allergic rhinitis was US 7.7 billion dollars (US 1.3 billion dollars to US 21 billion dollars). The societal cost of purchasing FGAs was only US 697 million dollars. However, the societal cost of FGA-associated sedation was US 11.3 billion dollars (US 2.4 billion dollars to US 50.8 billion dollars). The annual societal net benefit of FGA use for the treatment of allergic rhinitis in the US was -US4.2 billion dollars (-US 36 billion dollars to +US 0.296 billion dollars). The net benefit was negative in 97% of the 10,000 Monte Carlo simulations. The societal benefits of FGA use in alleviating the symptoms of allergic rhinitis are significant. However, based on the assumptions, probability distributions and parameter estimate ranges used in the current model, it is very likely that the costs associated with sedation exceed the benefits of FGA use in the US. The cost of FGA-associated sedation is comparable to estimates of the cost of all medical care expenditures on respiratory conditions in the US (US 12.1 billion dollars to US 31.3 billion dollars) [1996 values] and provides compelling evidence of the economic burden of sedation associated with FGA use.

Talofibular interval changes after acute ankle sprain: a stress ultrasonography study of ankle laxity.

PubMed

Croy, Theodore; Saliba, Susan; Saliba, Ethan; Anderson, Mark W; Hertel, Jay

2013-11-01

Quantifying talocrural joint laxity after ankle sprain is problematic. Stress ultrasonography (US) can image the lateral talocrural joint and allow the measurement of the talofibular interval, which may suggest injury to the anterior talofibular ligament (ATFL). The acute talofibular interval changes after lateral ankle sprain are unknown. Twenty-five participants (9 male, 16 female; age 21.8 ± 3.2 y, height 167.8 ± 34.1 cm, mass 72.7 ± 13.8 kg) with 27 acute, lateral ankle injuries underwent bilateral stress US imaging at baseline (<7 d) and on the affected ankle at 3 wk and 6 wk from injury in 3 ankle conditions: neutral, anterior drawer, and inversion. Talofibular interval (mm) was measured using imaging software and self-reported function (activities of daily living [ADL] and sports) by the Foot and Ankle Ability Measure (FAAM). The talofibular interval increased with anterior-drawer stress in the involved ankle (22.65 ± 3.75 mm; P = .017) over the uninvolved ankle (19.45 ± 2.35 mm; limb × position F1,26 = 4.9, P = .035) at baseline. Inversion stress also resulted in greater interval changes (23.41 ± 2.81 mm) than in the uninvolved ankles (21.13 ± 2.08 mm). A main effect for time was observed for inversion (F2,52 = 4.3, P = .019, 21.93 ± 2.24 mm) but not for anterior drawer (F2,52 = 3.1, P = .055, 21.18 ± 2.34 mm). A significant reduction in the talofibular interval took place between baseline and week 3 inversion measurements only (F1,26 = 5.6, P = .026). FAAM-ADL and sports results increased significantly from baseline to wk 3 (21.9 ± 16.2, P < .0001 and 23.8 ± 16.9, P < .0001) and from wk 3 to wk 6 (2.5 ± 4.4, P = .009 and 10.5 ± 13.2, P = .001). Stress US methods identified increased talofibular interval changes suggestive of talocrural laxity and ATFL injury using anterior drawer and inversion stress that, despite significant improvements in self-reported function, only marginally improved during the 6 wk after ankle sprain. Stress US provides a safe, repeatable, and quantifiable method of measuring the talofibular interval and may augment manual stress examinations in acute ankle injuries.

The descriptive epidemiology of gastric cancer in Central America and comparison with United States Hispanic populations.

PubMed

Corral, Juan E; Delgado Hurtado, Juan J; Domínguez, Ricardo L; Valdez de Cuéllar, Marisabel; Balmore Cruz, Carlos; Morgan, Douglas R

2015-03-01

The aims of this study were to delineate the epidemiology of gastric adenocarcinoma in Central America and contrast it with Hispanic-Latino populations in the USA. Published literature and Central America Ministry of Health databases were used as primary data sources, including national, population-based, and hospital-based registries. US data was obtained from the National Cancer Institute (NCI)-Epidemiology End Results Program (SEER) registry. Incident gastric adenocarcinoma cases were analyzed for available data between 1985 and 2011, including demographic variables and pathology information. In Central America, 19,741 incident gastric adenocarcinomas were identified. Two thirds of the cases were male, 20.5 % were under age 55, and 58.5 %were from rural areas. In the SEER database (n = 7871), 57.8 % were male and 28.9 % were under age 55. Among the US Hispanics born in Central America with gastric cancer (n = 1210), 50.3 % of cases were male and 38.1 % were under age 55. Non-cardia gastric cancer was more common in Central America (83.3 %), among US Hispanics (80.2 %), and Hispanics born in Central America (86.3 %). Cancers of the antrum were more common in Central America (73.6 %), whereas cancers of the corpus were slightly more common among US Hispanics (54.0 %). Adenocarcinoma of the diffuse subtype was relatively common, both in Central America (35.7 %) and US Hispanics (69.5 %), although Lauren classification was reported in only 50 % of cases. A significant burden of gastric adenocarcinoma is observed in Central America based upon limited available data. Differences are noted between Central America and US Hispanics. Strengthening population-based registries is needed for improved cancer control in Central America, which may have implications for the growing US Hispanic population.

Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria.

PubMed

Ibrahim, Nazaradden; Ramke, Jacqueline; Pozo-Martin, Francisco; Gilbert, Clare E

2018-06-01

Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs. In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined. Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from

Diagnosis of secondary pulmonary lymphangiectasia in congenital heart disease: a novel role for chest ultrasound and prognostic implications.

PubMed

Lam, Christopher Z; Bhamare, Tanmay Anant; Gazzaz, Tamadhir; Manson, David; Humpl, Tilman; Seed, Mike

2017-10-01

Secondary pulmonary lymphangiectasia is a complication of congenital heart disease that results from chronic pulmonary venous obstruction. We aimed to evaluate the performance of chest ultrasound (US) in diagnosing secondary pulmonary lymphangiectasia and to review the clinical course of children with secondary pulmonary lymphangiectasia. Chest US was performed on 26 children with hypoplastic left heart syndrome, total anomalous pulmonary venous connection or cor triatriatum in a prospective observational study. Thirteen children had pulmonary venous obstruction (62% male; median age: 17 days old, range: 1-430 days old) and 13 children did not have obstruction (62% male; median age: 72 days old, range: 4-333 days old). US features of secondary pulmonary lymphangiectasia were documented and diagnostic performance was determined. Clinical course of patients with secondary pulmonary lymphangiectasia was reviewed. Eleven of 13 (84.6%) patients in the obstructed group had a clinical and/or biopsy diagnosis of secondary pulmonary lymphangiectasia. Statistically significant chest US criteria for diagnosis were presence of irregular lung surface (likelihood ratio [LR] 6.8, 95% confidence interval [CI] 1.9-25.1), subpleural cystic appearing structures (LR 3.6, 95% CI 1.2-10.7), and combination of subpleural cystic appearing structures and surface irregularity together (LR 10.9, 95% CI 1.6-75.0). Seven of 11 (63.6%) patients with secondary pulmonary lymphangiectasia died during follow-up, the majority due to cardiopulmonary failure or complications. Chest US is an accurate and reproducible bedside method for diagnosing secondary pulmonary lymphangiectasia in patients with pulmonary venous obstruction. These patients may have worse prognoses.

On-line Robot Adaptation to Environmental Change

DTIC Science & Technology

2005-08-01

by the Department of the Interior under contract no. NBCH1040007, the US Army under contract no. DABT639910013, the US Air Force Research Laboratory...Probable Series Predictor algorithm. . . . . . . . . . . . . . . . . . . . . . . . . . 97 5.2 Accuracy of PSC in various test classification tasks...105 6.1 Probable Series Predictor algorithm. . . . . . . . . . . . . . . . . . . . . . . . . . 123 6.2 Accuracy of PSC in

Screening for the coexistence of congenital muscular torticollis and developmental dysplasia of hip.

PubMed

Kim, Sung Nyun; Shin, Yong Beom; Kim, Wan; Suh, Hwi; Son, Han Kyeong; Cha, Young Sun; Chang, Jae Hyeok; Ko, Hyun-Yoon; Lee, In Sook; Kim, Min Jeong

2011-08-01

To investigate the coexistence rate and related factors of developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT), and to determine whether ultrasonography (US) gives good value for screening of DDH in CMT. We prospectively examined 121 infants (73 males and 48 females) diagnosed with CMT to determine the incidence of DDH by US. We also assessed the relationship between neck US findings and DDH occurrence, and investigated the clinical features of CMT related to DDH. 18 patients (14.9%) were diagnosed as having DDH by US. However, most DDH was subclinical and spontaneously resolved. Only 2 patients (1.7%) needed to be treated with a harness. The positive predictive value of clinical examinations for DDH was 52.6% and patients treated by harness were all clinically positive. DDH was more common in the left side (13 left, 4 right, 1 both), but 6 out of 18 DDH (33.3%) cases presented on the contralateral side of CMT. Sex difference was not observed. Breech presentation and oligohydramnios were not related to DDH occurrence. Neck US findings did not correlate with DDH occurrence. The coexistence rate of CMT and DDH was concluded to be 14.9%. If only DDH cases that required treatment were included, the coexistence rate of these two disorders would be lowered to 1.7%. All of these patients showed positive findings in clinical examination. Therefore, hip US should not be recommended routinely for patients with CMT.

Semiautomatic registration of 3D transabdominal ultrasound images for patient repositioning during postprostatectomy radiotherapy

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

Presles, Benoît, E-mail: benoit.presles@creatis.insa-lyon.fr; Rit, Simon; Sarrut, David

2014-12-15

Purpose: The aim of the present work is to propose and evaluate registration algorithms of three-dimensional (3D) transabdominal (TA) ultrasound (US) images to setup postprostatectomy patients during radiation therapy. Methods: Three registration methods have been developed and evaluated to register a reference 3D-TA-US image acquired during the planning CT session and a 3D-TA-US image acquired before each treatment session. The first method (method A) uses only gray value information, whereas the second one (method B) uses only gradient information. The third one (method C) combines both sets of information. All methods restrict the comparison to a region of interest computedmore » from the dilated reference positioning volume drawn on the reference image and use mutual information as a similarity measure. The considered geometric transformations are translations and have been optimized by using the adaptive stochastic gradient descent algorithm. Validation has been carried out using manual registration by three operators of the same set of image pairs as the algorithms. Sixty-two treatment US images of seven patients irradiated after a prostatectomy have been registered to their corresponding reference US image. The reference registration has been defined as the average of the manual registration values. Registration error has been calculated by subtracting the reference registration from the algorithm result. For each session, the method has been considered a failure if the registration error was above both the interoperator variability of the session and a global threshold of 3.0 mm. Results: All proposed registration algorithms have no systematic bias. Method B leads to the best results with mean errors of −0.6, 0.7, and −0.2 mm in left–right (LR), superior–inferior (SI), and anterior–posterior (AP) directions, respectively. With this method, the standard deviations of the mean error are of 1.7, 2.4, and 2.6 mm in LR, SI, and AP directions, respectively. The latter are inferior to the interoperator registration variabilities which are of 2.5, 2.5, and 3.5 mm in LR, SI, and AP directions, respectively. Failures occur in 5%, 18%, and 10% of cases in LR, SI, and AP directions, respectively. 69% of the sessions have no failure. Conclusions: Results of the best proposed registration algorithm of 3D-TA-US images for postprostatectomy treatment have no bias and are in the same variability range as manual registration. As the algorithm requires a short computation time, it could be used in clinical practice provided that a visual review is performed.« less

Economic analysis of CDC's culture- and smear-based tuberculosis instructions for Filipino immigrants.

PubMed

Maskery, B; Posey, D L; Coleman, M S; Asis, R; Zhou, W; Painter, J A; Wingate, L T; Roque, M; Cetron, M S

2018-04-01

In 2007, the US Centers for Disease Control and Prevention (CDC) revised its tuberculosis (TB) technical instructions for panel physicians who administer mandatory medical examinations among US-bound immigrants. Many US-bound immigrants come from the Philippines, a high TB prevalence country. To quantify economic and health impacts of smear- vs. culture-based TB screening. Decision tree modeling was used to compare three Filipino screening programs: 1) no screening, 2) smear-based screening, and 3) culture-based screening. The model incorporated pre-departure TB screening results from Filipino panel physicians and CDC databases with post-arrival follow-up outcomes. Costs (2013 $US) were examined from societal, immigrant, US Public Health Department and hospitalization perspectives. With no screening, an annual cohort of 35 722 Filipino immigrants would include an estimated 450 TB patients with 264 hospitalizations, at a societal cost of US$9.90 million. Culture-based vs. smear-based screening would result in fewer imported cases (80.9 vs. 310.5), hospitalizations (19.7 vs. 68.1), and treatment costs (US$1.57 million vs. US$4.28 million). Societal screening costs, including US follow-up, were greater for culture-based screening (US$5.98 million) than for smear-based screening (US$3.38 million). Culture-based screening requirements increased immigrant costs by 61% (US$1.7 million), but reduced costs for the US Public Health Department (22%, US$750 000) and of hospitalization (70%, US$1 020 000). Culture-based screening reduced imported TB and US costs among Filipino immigrants.

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, September 1, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view of construction downstream at STA. 152+50 - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, July 23, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view downstream from RB STA. 144+00 - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, November 19, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, general view upstream from Hickory Street Bridge - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, November 19, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view of Solomon Run Outlet, looking north - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, November 19, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, general view downstream from Horner Street Bridge - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, May 28, 1941 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view upstream from Hickory Street Bridge - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Cervical cancer screening in the US-Mexico border region: a binational analysis.

PubMed

Herrera, Dyanne G; Schiefelbein, Emily L; Smith, Ruben; Rojas, Rosalba; Mirchandani, Gita G; McDonald, Jill A

2012-12-01

Cervical cancer mortality is high along the US-Mexico border. We describe the prevalence of a recent Papanicolaou screening test (Pap) among US and Mexican border women. We analyzed 2006 cross-sectional data from Mexico's National Survey of Health and Nutrition and the US Behavioral Risk Factor Surveillance System. Women aged 20-77 years in 44 US border counties (n = 1,724) and 80 Mexican border municipios (n = 1,454) were studied. We computed weighted proportions for a Pap within the past year by age, education, employment, marital status, health insurance, health status, risk behaviors, and ethnicity and adjusted prevalence ratios (APR) for the US, Mexico, and the region overall. Sixty-five percent (95 %CI 60.3-68.6) of US women and 32 % (95 %CI 28.7-35.2) of Mexican women had a recent Pap. US residence (APR = 2.01, 95 %CI 1.74-2.33), marriage (APR = 1.31, 95 %CI 1.17-1.47) and insurance (APR = 1.38, 95 %CI 1.22-1.56) were positively associated with a Pap test. Among US women, insurance and marriage were associated (APR = 1.21, 95 %CI 1.05-1.38 and 1.33, 95 %CI 1.10-1.61, respectively), and women aged 20-34 years were about 25 % more likely to have received a test than older women. Insurance and marriage were also positively associated with Pap testing among Mexican women (APR = 1.39, 95 %CI 1.17-1.64 and 1.50; 95 %CI 1.23-1.82, respectively), as were lower levels of education (≤8th grade or 9th-12th grade versus some college) (APR = 1.74; 95 %CI 1.21-2.52 and 1.60; 95 %CI 1.03-2.49, respectively). Marriage and insurance were associated with a recent Pap test on both sides of the border. Binational insurance coverage increases and/or cost reductions might bolster testing among unmarried and uninsured women, leading to earlier cervical cancer diagnosis and potentially lower mortality.

U.S. Food Guide Pyramid food group intake by Asian Indian immigrants in the U.S.

PubMed

Jonnalagadda, S S; Diwan, S; Cohen, D L

2005-01-01

This study examined the food group intake and the dietary quality of middle-aged and older Gujarati Asian Indian immigrants (45 years or older) living in two urban metropolitan areas in the U.S. Participants (90 men, 99 females) completed a 24-hour dietary recall, which was used to determine if they met the daily food group intake guidelines of the U.S. Food Guide Pyramid. The overall quality of their reported dietary intake was determined using the Healthy Eating Index based on their nutrient and food group intake. Both men and women met the daily number of servings recommendations for the grains (men: 9.3 servings/day; women: 6.9 servings/day) and vegetables (men: 4.5 servings/day; women: 3.6 servings/day) groups, but did not meet the recommendations for fruits, dairy and meats groups. The total score on the Healthy Eating Index of the diets of these participants was 73, indicative of a dietary intake that does not meet the established U.S. dietary guidelines. These immigrants should be educated about appropriate food choices (ethnic and non-ethnic) within each of the U.S. Food Guide Pyramid food groups to improve the overall quality of their dietary intakes.

Geographical Variations in the Environmental Determinants of Physical Inactivity among U.S. Adults.

PubMed

An, Ruopeng; Li, Xinye; Jiang, Ning

2017-10-31

Physical inactivity is a major modifiable risk factor for morbidity, disability and premature mortality worldwide. This study assessed the geographical variations in the impact of environmental quality on physical inactivity among U.S. adults. Data on county-level prevalence of leisure-time physical inactivity came from the Behavioral Risk Factor Surveillance System. County environment was measured by the Environmental Quality Index (EQI), a comprehensive index of environmental conditions that affect human health. The overall EQI consists of five subdomains-air, water, land, social, and built environment. Geographically weighted regressions (GWRs) were performed to estimate and map county-specific impact of overall EQI and its five subdomains on physical inactivity prevalence. The prevalence of leisure-time physical inactivity among U.S. counties was 25% in 2005. On average, one standard deviation decrease in the overall EQI was associated with an increase in county-level prevalence of leisure-time physical inactivity by nearly 1%. However, substantial geographical variations in the estimated environmental determinants of physical inactivity were present. The estimated changes of county-level prevalence of leisure-time physical inactivity resulted from one standard deviation decrease of the overall EQI ranged from an increase of over 3% to a decrease of nearly 2% across U.S. counties. Analogous, the estimated changes of county-level prevalence of leisure-time physical inactivity resulted from one standard deviation decrease of the EQI air, water, land, social, and built environment subdomains ranged from an increase of 2.6%, 1.5%, 2.9%, 3.3%, and 1.7% to a decrease of 2.9%, 1.4%, 2.4%, 2.4%, and 0.8% across U.S. counties, respectively. Given the substantial heterogeneities in the environmental determinants of physical inactivity, locally customized physical activity interventions are warranted to address the most concerning area-specific environmental issue.

Flexible Integration of Both High Imaging Resolution and High Power Arrays for Ultrasound-Induced Thermal Strain Imaging (US-TSI)

PubMed Central

Stephens, Douglas N.; Mahmoud, Ahmed M.; Ding, Xuan; Lucero, Steven; Dutta, Debaditya; Yu, Francois T.H.; Chen, Xucai

2013-01-01

Ultrasound-induced thermal strain imaging (US-TSI) for carotid artery plaque detection requires both high imaging resolution (<100 μm) and sufficient US induced heating to elevate the tissue temperature (~1-3°C within 1-3 cardiac cycles) in order to produce a noticeable change in sound speed in the targeted tissues. Since the optimization of both imaging and heating in a monolithic array design is particularly expensive and inflexible, a new integrated approach is presented that utilizes independent ultrasound arrays to meet the requirements for this particular application. This work demonstrates a new approach in dual-array construction. A 3D printed manifold was built to support both a high resolution 20 MHz commercial imaging array and 6 custom heating elements operating in the 3.5-4 MHz range. For the application of US-TSI on carotid plaque characterization, the tissue target site is 20 to 30 mm deep, with a typical target volume of 2 mm (elevation) × 8 mm (azimuthal) × 5 mm (depth). The custom heating array performance was fully characterized for two design variants (flat and spherical apertures), and can easily deliver 30 W of total acoustic power to produce intensities greater than 15 W/cm2 in tissue target region. PMID:24297029

No effect of bipolar interferential electrotherapy and pulsed ultrasound for soft tissue shoulder disorders: a randomised controlled trial

PubMed Central

van der Heijden, G. J M G; Leffers, P.; Wolters, P.; Verheijden, J.; van Mameren, H.; Houben, J.; Bouter, L.; Knipschild, P.

1999-01-01

OBJECTIVE—To assess the efficacy of bipolar interferential electrotherapy (ET) and pulsed ultrasound (US) as adjuvants to exercise therapy for soft tissue shoulder disorders (SD).
METHODS—Randomised placebo controlled trial with a two by two factorial design plus an additional control group in 17 primary care physiotherapy practices in the south of the Netherlands. Patients with shoulder pain and/or restricted shoulder mobility, because of a soft tissue impairment without underlying specific or generalised condition, were enrolled if they had not recovered after six sessions of exercise therapy in two weeks. They were randomised to receive (1) active ET plus active US; (2) active ET plus dummy US; (3) dummy ET plus active US; (4) dummy ET plus dummy US; or (5) no adjuvants. Additionally, they received a maximum of 12 sessions of exercise therapy in six weeks. Measurements at baseline, 6 weeks and 3, 6, 9, and 12 months later were blinded for treatment. Outcome measures: recovery, functional status, chief complaint, pain, clinical status, and range of motion.
RESULTS—After written informed consent 180 patients were randomised: both the active treatments were given to 73 patients, both the dummy treatments to 72 patients, and 35 patients received no adjuvants. Prognosis of groups appeared similar at baseline. Blinding was successfully maintained. At six weeks seven patients (20%) without adjuvants reported very large improvement (including complete recovery), 17 (23%) and 16 (22%) with active and dummy ET, and 19 (26%) and 14 (19%) with active and dummy US. These proportions increased to about 40% at three months, but remained virtually stable thereafter. Up to 12 months follow up the 95% CI for differences between groups for all outcomes include zero.
CONCLUSION—Neither ET nor US prove to be effective as adjuvants to exercise therapy for soft tissue SD.

 PMID:10460185

Attribution of net carbon change by disturbance type across forest lands of the conterminous United States.

PubMed

Harris, N L; Hagen, S C; Saatchi, S S; Pearson, T R H; Woodall, C W; Domke, G M; Braswell, B H; Walters, B F; Brown, S; Salas, W; Fore, A; Yu, Y

2016-12-01

Locating terrestrial sources and sinks of carbon (C) will be critical to developing strategies that contribute to the climate change mitigation goals of the Paris Agreement. Here we present spatially resolved estimates of net C change across United States (US) forest lands between 2006 and 2010 and attribute them to natural and anthropogenic processes. Forests in the conterminous US sequestered -460 ± 48 Tg C year -1 , while C losses from disturbance averaged 191 ± 10 Tg C year -1 . Combining estimates of net C losses and gains results in net carbon change of -269 ± 49 Tg C year -1 . New forests gained -8 ± 1 Tg C year -1 , while deforestation resulted in losses of 6 ± 1 Tg C year -1 . Forest land remaining forest land lost 185 ± 10 Tg C year -1 to various disturbances; these losses were compensated by net carbon gains of -452 ± 48 Tg C year -1 . C loss in the southern US was highest (105 ± 6 Tg C year -1 ) with the highest fractional contributions from harvest (92%) and wind (5%). C loss in the western US (44 ± 3 Tg C year -1 ) was due predominantly to harvest (66%), fire (15%), and insect damage (13%). The northern US had the lowest C loss (41 ± 2 Tg C year -1 ) with the most significant proportional contributions from harvest (86%), insect damage (9%), and conversion (3%). Taken together, these disturbances reduced the estimated potential C sink of US forests by 42%. The framework presented here allows for the integration of ground and space observations to more fully inform US forest C policy and monitoring efforts.

Automatic patient alignment system using 3D ultrasound.

PubMed

Kaar, Marcus; Figl, Michael; Hoffmann, Rainer; Birkfellner, Wolfgang; Stock, Markus; Georg, Dietmar; Goldner, Gregor; Hummel, Johann

2013-04-01

Recent developments in radiation therapy such as intensity modulated radiotherapy (IMRT) or dose painting promise to provide better dose distribution on the tumor. For effective application of these methods the exact positioning of the patient and the localization of the irradiated organ and surrounding structures is crucial. Especially with respect to the treatment of the prostate, ultrasound (US) allows for differentiation between soft tissue and was therefore applied by various repositioning systems, such as BAT or Clarity. The authors built a new system which uses 3D US at both sites, the CT room and the intervention room and applied a 3D/3D US/US registration for automatic repositioning. In a first step the authors applied image preprocessing methods to prepare the US images for an optimal registration process. For the 3D/3D registration procedure five different metrics were evaluated. To find the image metric which fits best for a particular patient three 3D US images were taken at the CT site and registered to each other. From these results an US registration error was calculated. The most successful image metric was then applied for the US/US registration process. The success of the whole repositioning method was assessed by taking the results of an ExacTrac system as golden standard. The US/US registration error was found to be 2.99 ± 1.54 mm with respect to the mutual information metric by Mattes (eleven patients) which revealed to be the most suitable of the assessed metrics. For complete repositioning chain the error amounted to 4.15 ± 1.20 mm (ten patients). The authors developed a system for patient repositioning which works automatically without the necessity of user interaction with an accuracy which seems to be suitable for clinical application.

First trimester medication abortion practice in the United States and Canada.

PubMed

Jones, Heidi E; O'Connell White, Katharine; Norman, Wendy V; Guilbert, Edith; Lichtenberg, E Steve; Paul, Maureen

2017-01-01

We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4%) were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US and Canada. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Research is needed on optimal antibiotic and analgesic use.

9 CFR 104.2 - Permit authorized.

Code of Federal Regulations, 2010 CFR

2010-01-01

... permits for importing biological products. They shall be: (1) U.S. Veterinary Biological Product Permit for Research and Evaluation; (2) U.S. Veterinary Biological Product Permit for Distribution and Sale; or (3) U.S. Veterinary Biological Product Permit for Transit Shipment Only. (b) A permit shall not be...

9 CFR 104.2 - Permit authorized.

Code of Federal Regulations, 2011 CFR

2011-01-01

... permits for importing biological products. They shall be: (1) U.S. Veterinary Biological Product Permit for Research and Evaluation; (2) U.S. Veterinary Biological Product Permit for Distribution and Sale; or (3) U.S. Veterinary Biological Product Permit for Transit Shipment Only. (b) A permit shall not be...

Utility of ultrasound for body fat assessment: validity and reliability compared to a multicompartment criterion.

PubMed

Smith-Ryan, Abbie E; Blue, Malia N M; Trexler, Eric T; Hirsch, Katie R

2018-03-01

Measurement of body composition to assess health risk and prevention is expanding. Accurate portable techniques are needed to facilitate use in clinical settings. This study evaluated the accuracy and repeatability of a portable ultrasound (US) in comparison with a four-compartment criterion for per cent body fat (%Fat) in overweight/obese adults. Fifty-one participants (mean ± SD; age: 37·2 ± 11·3 years; BMI: 31·6 ± 5·2 kg m -2 ) were measured for %Fat using US (GE Logiq-e) and skinfolds. A subset of 36 participants completed a second day of the same measurements, to determine reliability. US and skinfold %Fat were calculated using the seven-site Jackson-Pollock equation. The Wang 4C model was used as the criterion method for %Fat. Compared to a gold standard criterion, US %Fat (36·4 ± 11·8%; P = 0·001; standard error of estimate [SEE] = 3·5%) was significantly higher than the criterion (33·0 ± 8·0%), but not different than skinfolds (35·3 ± 5·9%; P = 0·836; SEE = 4·5%). US resulted in good reliability, with no significant differences from Day 1 (39·95 ± 15·37%) to Day 2 (40·01 ± 15·42%). Relative consistency was 0·96, and standard error of measure was 0·94%. Although US overpredicted %Fat compared to the criterion, a moderate SEE for US is suggestive of a practical assessment tool in overweight individuals. %Fat differences reported from these field-based techniques are less than reported by other single-measurement laboratory methods and therefore may have utility in a clinical setting. This technique may also accurately track changes. © 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Seroprevalence of poliovirus antibodies in the Kansas City metropolitan area, 2012-2013.

PubMed

Wallace, Gregory S; Pahud, Barbara A; Weldon, William C; Curns, Aaron T; Oberste, M Steven; Harrison, Christopher J

2017-04-03

No indigenous cases of poliomyelitis have occurred in the US since 1979; however the risk of importation persists until global eradication is achieved. The seropositivity rate for different age cohorts with exposures to different poliovirus vaccine types and wild virus in the US are not presently known. A convenience sample was conducted in the Kansas City metropolitan area during 2012-2103 with approximately 100 participants enrolled for each of 5 age cohorts categorized based on vaccine policy changes over time in the US. Immunization records for poliovirus vaccination were required for participants <18 y of age. We evaluated the prevalence of serum antibodies to all 3 poliovirus serotypes. Seroprevalence was evaluated by demographics as well as between polio serotypes. The overall seroprevalence to poliovirus was 90.7%, 94.4%, and 83.3%, for types 1, 2, and 3, respectively. Seroprevalence was high (88.6%-96.2%) for all 3 types of poliovirus for the 6-10 y old age group that was likely to have received a complete schedule of IPV-only vaccination. Children 2-3 y of age, who have not yet completed their full IPV series, had lower seroprevalence compared with all older age groups for types 1 and 2 (p-value <0. 05). Seroprevalence was high for all 3 types of poliovirus in the population surveyed. Seroprevalence for subjects aged 2-3 y was lower than all other age groups for serotypes 1 and 2 highlighting the importance of completing the recommended poliovirus vaccine series with a booster dose at age 4-6 y.

Identification of an Astrovirus Commonly Infecting Laboratory Mice in the US and Japan

PubMed Central

Ng, Terry Fei Fan; Kondov, Nikola O.; Hayashimoto, Nobuhito; Uchida, Ritsuki; Cha, Yunhee; Beyer, Ashley I.; Wong, Walt; Pesavento, Patricia A.; Suemizu, Hiroshi; Muench, Marcus O.; Delwart, Eric

2013-01-01

Mice (Mus musculus) are the most commonly used laboratory animals. Viral metagenomics on tissues of immunodeficient mice revealed sequences of a novel mammalian astrovirus. Using PCR, we screened mice from 4 breeders, 4 pharmaceutical companies, 14 research institutes and 30 universities in the US and Japan. Mice from one US breeder tested positive while none from Japanese breeders were positive for MuAstV. Mice in over half of the universities (19/30), institutes (7/14) and pharmaceutical animal facilities (2/4) investigated revealed the presence of MuAstV. Nine mice strains tested positive including both immunodeficient strains (NSG, NOD-SCID, NSG-3GS, C57BL6-Timp-3 −/−, and uPA-NOG) and immunocompetent strains (B6J, ICR, Bash2, BALB/c). Our data indicates that MuAstV has a wide geographical, institutional and host strain distribution. Comparison of the MuAstV RdRp sequences showed numerous mutations indicating ongoing viral divergence in different facilities. This study demonstrates the need for metagenomic screening of laboratory animals to identify adventitious infections that may affect experimental outcomes. PMID:23825590

Polyethylene glycol-covered ultra-small Gd2O3 nanoparticles for positive contrast at 1.5 T magnetic resonance clinical scanning

NASA Astrophysics Data System (ADS)

Fortin, Marc-André; Petoral, Rodrigo M., Jr.; Söderlind, Fredrik; Klasson, A.; Engström, Maria; Veres, Teodor; Käll, Per-Olof; Uvdal, Kajsa

2007-10-01

The size distribution and magnetic properties of ultra-small gadolinium oxide crystals (US-Gd2O3) were studied, and the impact of polyethylene glycol capping on the relaxivity constants (r1, r2) and signal intensity with this contrast agent was investigated. Size distribution and magnetic properties of US-Gd2O3 nanocrystals were measured with a TEM and PPMS magnetometer. For relaxation studies, diethylene glycol (DEG)-capped US-Gd2O3 nanocrystals were reacted with PEG-silane (MW 5000). Suspensions were adequately dialyzed in water to eliminate traces of Gd3+ and surfactants. The particle hydrodynamic radius was measured with dynamic light scattering (DLS) and the proton relaxation times were measured with a 1.5 T MRI scanner. Parallel studies were performed with DEG-Gd2O3 and PEG-silane-SPGO (Gd2O3,< 40 nm diameter). The small and narrow size distribution of US-Gd2O3 was confirmed with TEM (~3 nm) and DLS. PEG-silane-US-Gd2O3 relaxation parameters were twice as high as for Gd-DTPA and the r2/r1 ratio was 1.4. PEG-silane-SPGO gave low r1 relaxivities and high r2/r1 ratios, less compatible with positive contrast agent requirements. Higher r1 were obtained with PEG-silane in comparison to DEG-Gd2O3. Treatment of DEG-US-Gd2O3 with PEG-silane provides enhanced relaxivity while preventing aggregation of the oxide cores. This study confirms that PEG-covered Gd2O3 nanoparticles can be used for positively contrasted MR applications requiring stability, biocompatible coatings and nanocrystal functionalization.

Ultrasound assisted chrome tanning: Towards a clean leather production technology.

PubMed

Mengistie, Embialle; Smets, Ilse; Van Gerven, Tom

2016-09-01

Nowadays, there is a growing demand for a cleaner, but still effective alternative for production processes like in the leather industry. Ultrasound (US) assisted processing of leather might be promising in this sense. In the present paper, the use of US in the conventional chrome tanning process has been studied at different pH, temperature, tanning time, chrome dose and US exposure time by exposing the skin before tanning and during tanning operation. Both prior exposure of the skin to US and US during tanning improves the chrome uptake and reduces the shrinkage significantly. Prior exposure of the skin to US increase the chrome uptake by 13.8% or reduces the chrome dose from 8% to 5% (% based on skin weight) and shorten the process time by half while US during tanning increases the chrome uptake by 28.5% or reduces the chrome dose from 8% to 4% (half) and the tanning time to one third compared to the control without US. Concomitantly, the resulting leather quality (measured as skin shrinkage) improved from 5.2% to 3.2% shrinkage in the skin exposed to US prior tanning and to 1.3% in the skin exposed to US during the tanning experiment. This study confirms that US chrome tanning is an effective and eco-friendly tanning process which can produce a better quality leather product in a shorter process time with a lower chromium dose. Copyright © 2016 Elsevier B.V. All rights reserved.

[Population Council responsible for RU486 clinical trials in USA].

PubMed

Aguillaume, C J

1993-04-01

As a result of the sudden political change that came with the Clinton Administration, RU-486's manufacturer, Roussel-Uclaf, and the Population Council agreed on April 20, 1992, on the manufacture and distribution of RU-486 in the US. In the US, there are less than 1.6 million induced abortions annually. From now on, US women will be able to have a choice between medical and surgical abortion. The Population Council and Roussel-Uclaf have had a contract since 1982. The Council is solely responsible for the phase 2 clinical trial of RU-486 in the US and other countries. It must present to the US Food and Drug Administration (FDA) an amendment allowing it to begin phase 3 clinical trials. The Council will also lead the US medical facilities in this study. It will identify partners for future production of RU-486 and its distribution in the US. It will also submit to FDA a New Drug Application (NDA). FDA will review the scientific literature on RU-486 and evaluate all data submitted by the Population Council. There are still obstacles to be surmounted. The Population Council must demonstrate good judgment when selecting the criteria for choosing a pharmaceutical firm before a Technical Committee which will be part of a group of players promoting women's health, scientific experts, and other interested parties. It must find the necessary funds to conduct the clinical trials and prepare the NDA. Phase 3 clinical trials in the US must have at least 2000 women. They will test RU-486's efficacy, safety, and acceptability among women choosing medical abortion over surgical abortion. Since the Council operates in almost all countries in the world, has innovated contraceptive research and development activities, and has been endorsed by the UN, product approval of RU-486 in the US will affect policy in all countries concerned about abortion.

General surgery residency after graduation from U.S. medical schools: visa-related challenges for the international citizen.

PubMed

Datta, Jashodeep; Zaydfudim, Victor; Terhune, Kyla P

2013-03-01

International-United States medical graduates (I-USMGs) are non-US citizen graduates of U.S. medical schools. Although academically equivalent to US-citizen peers, they are subject to the same visa requirements as non-US citizen international medical graduates. We hypothesized that visa sponsorship policies of general surgery programs (GSPs) may be discordant with the enrollment patterns of I-USMGs. A total of 196 GSPs participated in a telephone survey regarding visa sponsorship policies. Whereas GSPs preferred J-1 to H-1B sponsorship (64.2% vs. 32.6%), I-USMG enrollment favored programs supporting H-1B sponsorship (72.1% vs. 7.5%) (P = .01). University-affiliated programs were more likely to sponsor H1-Bs than independent programs (39.6% vs. 24.4%) (P = .03) and trained a greater proportion of I-USMGs than independent programs (40.6% vs. 14.0%) (P < .01). Restrictive policies against H-1B sponsorship may limit GSPs' I-USMG applicant pool and restrict I-USMGs' surgical training options.

Assessment of undiscovered oil and gas resources in the Bossier Formation, U.S. Gulf Coast, 2016

USGS Publications Warehouse

Paxton, Stanley T.; Pitman, Janet K.; Kinney, Scott A.; Gianoutsos, Nicholas J.; Pearson, Ofori N.; Whidden, Katherine J.; Dubiel, Russell F.; Schenk, Christopher J.; Burke, Lauri A.; Klett, Timothy R.; Leathers-Miller, Heidi M.; Mercier, Tracey J.; Haines, Seth S.; Varela, Brian A.; Le, Phuong A.; Finn, Thomas M.; Gaswirth, Stephanie B.; Hawkins, Sarah J.; Marra, Kristen R.; Tennyson, Marilyn E.

2017-04-13

Using a geology-based assessment methodology, the U.S. Geological Survey estimated undiscovered, technically recoverable mean resources of 2.9 billion barrels of conventional oil and 108.6 trillion cubic feet of natural gas in the Upper Jurassic Bossier Formation in onshore lands and State waters of the U.S. Gulf Coast region.

Development and validation of an algorithm to establish a total antioxidant capacity database of the US diet.

PubMed

Floegel, Anna; Kim, Dae-Ok; Chung, Sang-Jin; Song, Won O; Fernandez, Maria Luz; Bruno, Richard S; Koo, Sung I; Chun, Ock K

2010-09-01

Estimation of total antioxidant intake is the first step to investigate the protective effects of antioxidants on oxidative stress-mediated disease. The present study was designed to develop an algorithm to estimate total antioxidant capacity (TAC) of the US diet. TAC of individual antioxidants and 50 popular antioxidant-rich food items in the US diet were determined by 2,2'-azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS) assay and the 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. Theoretical TAC of foods was calculated as the sum of individual antioxidant capacities of compounds. The top 10 TAC food items in the US diet according to standard serving size were blueberry > plum > green tea > strawberry > green tea (decaffeinated) > red wine > grape juice > black tea > cherry > grape. Major contributors to TAC were the total phenolic content (r = 0.952, P < 0.001) and flavonoid content (r = 0.827, P < 0.001) of 50 foods. Theoretical TAC was positively correlated to experimental TAC of 50 foods determined by the ABTS assay (r = 0.833, P < 0.001) and the DPPH assay (r = 0.696, P < 0.001), and to TAC from the USDA database for the oxygen radical absorbance capacity (r = 0.484, P = 0.001, n = 44). The TAC database of the US diet has been established and validated. In future studies, TAC of the US diet can be linked to biomarkers of chronic disease.

[Contribution of ultrasound signs for the prenatal diagnosis of posterior urethral valves: Experience of 3years at the maternity of the Bicêtre Hospital].

PubMed

Roy, S; Colmant, C; Cordier, A-G; Sénat, M-V

2016-05-01

Posterior urethral valves (PUV) are the most common cause of renal impairment in boys during early childhood. The aim of this study was to evaluate the value of ultrasound (US) criteria currently used to diagnose PUV. From 2009 to 2012, 31 patients were referred to the Bicêtre Hospital after detection of fetal bilateral hydronephrosis in male fetus. The ultrasound criteria were bladder dilation, thick-walled bladder, urethral dilation ("keyhole sign"), and amniotic fluid volume. Patients were divided in two groups: suspected or not to have PUV. US diagnosis of PUV was done in 18 fetuses and confirmed in 14 new borns, one of them without prenatal diagnosis. Sensitivity and specificity of US scan were 92.8 and 66.7%. The likelihood ratio (LHR) was 4.8 for a thick-walled bladder, 4.2 for oligohydramnios, 3.6 for the "keyhole sign", 2.4 for bladder dilation and 1.6 for ureteral dilation. The first four signs were combined in four fetuses, all of them with PUV. US scan is a very sensitive exam for the diagnosis of PUV but with a low specificity. A thick-walled bladder seems to have a better diagnostic performance than the "keyhole sign". Copyright © 2015 Elsevier Masson SAS. All rights reserved.

The Trans-Pacific Strategic Economic Partnership Agreement

DTIC Science & Technology

2009-12-07

used to shape the U.S. agenda with the region. Asia is viewed as of vital importance to U.S. trade and security interests. According to the U.S. Trade...Institute for International Economics, “ US Engagement in the Asia-Pacific: The Decision to Join the Trans-Pacific Strategic Economic Partnership,” East West...were also consulted. 2 Simon Crean, “Trans-Pacific Partnership Agreement,” Media Statement, November 14, 2009. 3 “ US Delays TPP Talks to Allow Obama

Social opportunity and ethanol drinking in rats.

PubMed

Tomie, Arthur; Burger, Kelly M; Di Poce, Jason; Pohorecky, Larissa A

2004-11-01

Two experiments were designed to evaluate the effects of pairings of ethanol sipper conditioned stimulus (CS) with social opportunity unconditioned stimulus (US) on ethanol sipper CS-directed drinking in rats. In both experiments, rats were deprived of neither food nor water, and initiation of drinking of unsweetened 3% ethanol was evaluated, as were the effects of increasing the concentration of unsweetened ethanol (3-10%) across sessions. In Experiment 1, Group Paired (n=8) received 35 trials per session wherein the ethanol sipper CS was presented for 10 s immediately prior to 15 s of social opportunity US. All rats initiated sipper CS-directed drinking of 3% ethanol. Increasing the concentration of ethanol in the sipper CS [(3%, 4%, 6%, 8%, 10% (vol./vol.)] across sessions induced escalation of daily g/kg ethanol intake. To evaluate the hypothesis that the drinking in Group Paired was due to autoshaping, Experiment 2 included a pseudoconditioning control that received sipper CS and social opportunity US randomly with respect to one another. All rats in Group Paired (n=6) and in Group Random (n=6) initiated sipper CS-directed drinking of 3% ethanol and daily mean g/kg ethanol intake in the two groups was comparable. Also comparable was daily g/kg ethanol intake, which increased for both groups with the availability of higher concentrations of ethanol in the sipper CS, up to a maximum of approximately 0.8 g/kg ethanol intake of 10% ethanol. Results indicate that random presentations of ethanol sipper CS and social opportunity US induced reliable initiation and escalation of ethanol intake, and close temporally contiguous presentations of CS and US did not induce still additional ethanol intake. This may indicate that autoshaping CR performance is not induced by these procedures, or that high levels of ethanol intake induced by factors related to pseudoconditioning produces a ceiling effect. Implications for ethanol drinking in humans are discussed.

Experiment on the factors for enhancing the susceptibility of cancer cells to chemotherapeutic drug by ultrasound microbubbles.

PubMed

Zhao, Ying-Zheng; Gao, Hui-Sheng; Zhou, Zhi-Cai; Tang, Qin-Qin; Lu, Cui-Tao; Jin, Zhuo; Tian, Ji-Lai; Xu, Yan-Yan; Tian, Xin-Qiao; Wang, Lee; Kong, Fan-Lei; Li, Xiao-Kun; Huang, Pin-Tong; He, Hui-Liao; Wu, Yan

2010-07-01

The objective of this study was to investigate the factors for enhancing the susceptibility of cancer cells to chemotherapeutic drug by ultrasound microbubbles. Ultrasound (US) combined with phospholipid-based microbubbles (MB) was used to enhance the susceptibility of colon cancer cell line SWD-620 to anticancer drugs Topotecan hydrochloride (TOP). Experiments were designed to investigate the influence of main factors on cell viability and cell inhibition, such as US intensity, MB concentration, drug combination with MB, asynchronous action between US triggered cavitation and drug entering cell, MB particle size. US exposure for 10 sec with US probe power at 0.6 W/cm(2) had satisfied cell viability. Treated with US combined with 15% MB, cell viability maintained more than 85% and cell inhibition 86.16%. Under optimal US combined with MB, TOP showed much higher cell inhibition than that of only TOP group. Cell inhibition under short delayed time (<2 h) for TOP addition did not show obvious difference. In terms of MB particle size, the order of cell inhibition was: Mixture > Micron bubble part > Nanometer bubble part. US combined with MB can enhance the susceptibility of cancer cells to chemotherapeutic drug, which may provide a potential method for US-mediated tumor chemotherapy.

Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis in US clinical practice.

PubMed

Weycker, Derek; Li, Xiaoyan; Barron, Rich; Li, Yanli; Reiner, Maureen; Kartashov, Alex; Figueredo, Jacqueline; Tzivelekis, Spiros; Garcia, Jacob

2016-06-01

Accumulating evidence suggests that not all cancer chemotherapy patients who receive first-cycle pegfilgrastim prophylaxis continue to receive it in subsequent cycles and that these patients may be subsequently at higher risk of febrile neutropenia (FN). Additional evidence from US clinical practice is warranted. Data from two US private healthcare claims repositories were employed. The source population comprised adults who received "intermediate-risk" or "high-risk" chemotherapy regimens for solid cancers or non-Hodgkin's lymphoma and first-cycle pegfilgrastim prophylaxis. From the source population, all patients who did not receive second-cycle pegfilgrastim prophylaxis ("comparison patients") were matched (1:1) to those who received it ("pegfilgrastim patients") based on cancer, regimen, and propensity score. Odds ratios (OR) for FN-broad and narrow definitions-during the second chemotherapy cycle were estimated for comparison patients versus pegfilgrastim patients using generalized estimating equations. A total of 2245 comparison patients (5.3 % of source population) were matched to pegfilgrastim patients; cohorts were well-balanced on baseline characteristics. Second-cycle FN incidence proportions for comparison and pegfilgrastim patients were 3.8 versus 2.2 % based on broad definition and 2.6 versus 0.8 % based on narrow definition; corresponding OR were 1.7 (95 % CI 1.2-2.5, p = 0.002) and 3.5 (95 % CI 2.0-6.0, p < 0.001). Results were similar within cancer/regimen-subgroups and were robust when using alternative methods for confounding adjustment. In this retrospective evaluation of cancer chemotherapy patients who received first-cycle pegfilgrastim prophylaxis in US clinical practice, a clinically relevant minority did not receive second-cycle prophylaxis. Second-cycle FN odds among this subset were significantly higher than they were among those who continued prophylaxis.

The Armed Forces Health Surveillance Center: Global Emerging Infections Surveillance & Response System, FY 2010

DTIC Science & Technology

2010-01-01

Kochel (2010), “Epidemiology of spotted fever group and typhus group rickettsial infection in the Amazon basin of Peru ,” Am J Trop Med Hyg, 82 (4), 683...Naval Medical Research Unit No. 3 (NAMRU-3) in Cairo, Egypt; and the US Naval Medical Research Unit No. 6 (NAMRU-6) in Lima, Peru . Working in...Collaborating Center for Emerging and Re-emerging Infectious Diseases in 2001 US NAVAL MEDICAL RESEARCH UNIT NO. 6 (NAMRU-6), LIMA, PERU

Adolescent reproductive behavior: an international comparison of developed countries.

PubMed

Forrest, J D

1990-01-01

A comparative study of adolescent reproductive behavior in the 1980s examined difference in pregnancy, birth, and abortion levels among teenagers in developed countries especially in the US, Canada, the UK, France, the Netherlands, and Sweden. Only 6 of 37 countries with total fertility rates 3.5 and per capita income US$2000/year, and at least 1 million people had adolescent birth rates higher than the US (Bulgaria, Cuba, Puerto Rico, Romania, Hungary, and Chile). The US had the highest abortion rate (42/1000) followed by Hungary (27/1000). Thus the US had the highest adolescent pregnancy rate (96/1000) as well as Hungary (96/1000). The 6 country analysis showed that reducing the level of sexual activity among teenagers is not necessarily needed to achieve lower pregnancy rates. For example, Sweden had the highest levels of sexual activity but its pregnancy rate were 33% as high as those of the US. The rates of sexual activity among teenagers in the Netherlands equaled those of the US, but its pregnancy rates were 14% as high as those of the US. All countries had earlier, more extensive, and better contraceptive use among sexually active teenagers than the US which accounted for their lower pregnancy rates. The more realistic acceptance of sexual activity among teenagers and provision of contraceptives in all the countries except the US differed from the societal ambivalence in the US. Thus ambivalence about sexuality and the appropriateness of contraceptive use results in lower contraceptive use and greater adolescent pregnancy rates. US adolescents constantly receive conflicting messages that sex is romantic, thrilling, and arousing but it is also immoral to have premarital sex. Thus adults need to be more candid about sexuality so they can clearly convey to adolescents their expectations for responsible behavior and to provide the information and services needed to make effective use of contraceptives when sexually active.

Hidden cost of U.S. agricultural exports: particulate matter from ammonia emissions.

PubMed

Paulot, Fabien; Jacob, Daniel J

2014-01-21

We use a model of agricultural sources of ammonia (NH3) coupled to a chemical transport model to estimate the impact of U.S. food export on particulate matter concentrations (PM2.5). We find that food export accounts for 11% of total U.S. NH3 emissions (13% of agricultural emissions) and that it increases the population-weighted exposure of the U.S. population to PM2.5 by 0.36 μg m(-3) on average. Our estimate is sensitive to the proper representation of the impact of NH3 on ammonium nitrate, which reflects the interplay between agricultural (NH3) and combustion emissions (NO, SO2). Eliminating NH3 emissions from food export would achieve greater health benefits than the reduction of the National Ambient Air Quality Standards for PM2.5 from 15 to 12 μg m(-3). Valuation of the increased premature mortality associated with PM2.5 from food export (36 billion US$ (2006) per year) amounts to 50% of the gross food export value. Livestock operations in densely populated areas have particularly large health costs. Decreasing SO2 and NOx emissions will indirectly reduce health impact of food export as an ancillary benefit.

Using homogenization, sonication and thermo-sonication to inactivate fungi

PubMed Central

Bevilacqua, Antonio; Sinigaglia, Milena; Corbo, Maria Rosaria

2016-01-01

Ultrasound (US), Thermo-sonication (TS) and High Pressure Homogenization (HPH) were studied as tools to inactivate the spores of Penicillium spp. and Mucor spp. inoculated in distilled water. For US, the power ranged from 40% to 100%, pulse from 2 to 10 s, and duration of the treatment from 2 to 10 min. TS was performed combining US (40–80% of power, for 8 min and pulse of 2 s) with a thermal treatment (50, 55 and 60°C at 4, 8 and 12 min). Homogenization was done at 30–150 MPa for 1, 2 and 3 times. Power was the most important factors to determine the antifungal effect of US and TS towards the conidia of Penicillium spp.; on the other hand, in US treatments Mucor spp. was also affected by pulse and time. HPH exerted a significant antifungal effect only if the highest pressures were applied for 2–3 times. PMID:27375964

Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys.

PubMed

Guarnizo-Herreño, Carol C; Tsakos, Georgios; Sheiham, Aubrey; Marmot, Michael G; Kawachi, Ichiro; Watt, Richard G

2015-12-16

To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries. Cross sectional analysis of US and English national surveys. Non-institutionalised adults living in their own homes. Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income. Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII). The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England. The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cost benefit analysis of malaria rapid diagnostic test: the perspective of Nigerian community pharmacists.

PubMed

Ezennia, Ifeoma Jovita; Nduka, Sunday Odunke; Ekwunife, Obinna Ikechukwu

2017-01-03

In 2010, the World Health Organization issued a guideline that calls for a shift from presumptive to test-based treatment. However, test-based treatment is still unpopular in community pharmacies. This could be due to unwillingness of customers to spend extra finance on rapid diagnostic test (RDT). It could also result from lack of interest from community pharmacists since they may perceive no financial gain attached to this service. This study assessed the cost-benefit of test-based malaria treatment to community pharmacists. The study was a community pharmacy-based cross sectional survey. Potential benefit of RDT was determined using customers' willingness-to-pay (WTP) for service. Average WTP was estimated using contingent valuation. Binary logistic regression was used to assess correlates of WTP acceptance while multiple linear regression was used to model the relationship between the independent variables and WTP amount. Cost associated with provision of RDT was estimated from provider's perspective. Probabilistic sensitivity analysis was used to capture parameter uncertainty. Benefit-cost ratio (BCR) was calculated to determine study objective. A total of 135 out of 235 participants (57.4%) responded to the WTP question. Of this subset, 111 participants (82.2%) preferred RDT before malaria treatment. Average WTP [minimum-maximum] was US$1.23 [US$0.0-US$5.03]. Educated participants had 1.8 times higher odds of WTP for RDT. Participants that understood RDT as described in the questionnaire had 18.3 times higher odds of WTP for RDT compared to participants that did not understand RDT as described in the questionnaire. Additionally, a unit increase in level of education (e.g. from primary to secondary school) led to US$0.298 increase in WTP amount for RDT. Also, a unit increase in malaria frequency (e.g. from 'never' to 'rarely') led to US$0.293 decrease in WTP amount for RDT. Average cost [minimum-maximum] of RDT test kit and pharmacist time spent in administering the test were US$0.15 [US$0.13-US$0.17] and US$0.41 [US$0.18-US$0.52], respectively. BCR of test-based malaria treatment was 6.7 (95% CI 6.4-7.0). Test-based malaria treatment is cost-beneficial for pharmacy practitioners. This finding could be used as an advocacy tool to increase community pharmacists' interest and uptake of test-based malaria treatment.

Ultrasound-promoted two-step synthesis of 3-arylselenylindoles and 3-arylthioindoles as novel combretastatin A-4 analogues

NASA Astrophysics Data System (ADS)

Wen, Zhiyong; Li, Xiaona; Zuo, Daiying; Lang, Binyue; Wu, Yang; Jiang, Mingyang; Ma, Huizhuo; Bao, Kai; Wu, Yingliang; Zhang, Weige

2016-04-01

A series of 3-(3‧-hydroxy-4‧-methoxyphenyl)selenyl-5,6,7-trimethoxy-1H-indoles and 3-(3‧-hydroxy-4‧-methoxyphenyl)thio-5,6,7-trimethoxy-1H-indoles were obtained as a new class of combretastatin A-4 (CA-4) analogues via a convenient ultrasound (US)-assisted two-step process involving 3-selenenylation/sulfenylation followed by O-deallylation. With the assistance of US irradiation, both the reaction rates and yields of selenenylation, sulfenylation and O-deallylation could be significantly improved. A comparison of the reaction rates of O-deallylation and ester reduction demonstrated that O-deallylation was more sensitive to US irradiation. Finally, these products were evaluated for their antiproliferative activities, and most of them showed moderate to potent activities against three human cancer cell lines in vitro.

Comparison of Injury Incidence Between the T-11 Advanced Tactical Parachute System and the T-10D Parachute, Fort Bragg, North Carolina, June 2010-November 2013

DTIC Science & Technology

2014-02-01

1.9-2.5 Amoroso et al., 1998 40 Ankle inversion sprains; US airborne trainees; no dates provided 3,674 Ankle brace No/Yes 6.9 0.9-56.1...Schumacher et al., 2000 44 Any ankle injury with duty limitation; US Army Airborne Rangers;1994– 1997 13,782 Ankle brace No/Yes 2.9 1.4-6.1 Craig and...School, Ft Benning GA, Apr 2005 to Dec 2006 102,784 Ankle brace Wind speed Time of day Equipment No/Yes 10-13/0-1 knots Night/Day Yes/No 1.2

Impact of Transpacific Aerosol on Air Quality over the United States: A Perspective from Aerosol-Cloud-Radiation Interactions

NASA Technical Reports Server (NTRS)

Tao, Zhining; Yu, Hongbin; Chin, Mian

2015-01-01

Observations have well established that aerosols from various sources in Asia, Europe, and Africa can travel across the Pacific and reach the contiguous United States (U.S.) at least on episodic bases throughout a year, with a maximum import in spring. The imported aerosol not only can serve as an additional source to regional air pollution (e.g., direct input), but also can influence regional air quality through the aerosol-cloud-radiation (ACR) interactions that change local and regional meteorology. This study assessed impacts of the transpacific aerosol on air quality, focusing on surface ozone and PM2.5, over the U.S. using the NASA Unified Weather Research Forecast model. Based on the results of 3- month (April to June of 2010) simulations, the impact of direct input (as an additional source) of transpacific aerosol caused an increase of surface PM2.5 concentration by approximately 1.5 micro-g/cu m over the west coast and about 0.5 micro-g/cu m over the east coast of the U.S. By influencing key meteorological processes through the ACR interactions, the transpacific aerosol exerted a significant effect on both surface PM2.5 (+/-6 micro-g/cu m3) and ozone (+/-12 ppbv) over the central and eastern U.S. This suggests that the transpacific transport of aerosol could either improve or deteriorate local air quality and complicate local effort toward the compliance with the U.S. National Ambient Air Quality Standards.

Burden of blood transfusion in knee and hip surgery in the US and Belgium.

PubMed

Blanchette, Christopher M; Joshi, Ashish V; Szpalski, Marek; Gunzburg, Robert; Du Bois, Mark; Donceel, Peter; Saunders, William B

2009-09-01

Transfusion services in orthopaedic surgery can lead to unnecessary complications and increased healthcare costs. The objective of this study was to assess treatments and costs associated with blood and blood product transfusions in a historical cohort of 189,457 inpatients in the US and 34,987 inpatients in Belgium undergoing knee or hip surgery. Descriptive analysis, logistic regression and ordinary least squares regression were used to describe the factors associated with the use and cost of allogeneic blood transfusion. Hospitalisation costs for joint replacement surgery totalled $12,718 (SD=6,356) and averaged 4.33 days in the US, while costs in Belgium were $6,526 (SD=3,192) and averaged 17.1 days. The use of low molecular weight heparin and tranexamic acid was much higher in Belgium than the US (36% and 99% compared to 0% and 40%, respectively). Patients in the US spent 12.7 (p<0.0001) fewer days in the hospital, 0.3 (p<0.0001) fewer days in the intensive care unit and were 88% less likely to have allogeneic blood transfusions (OR=0.22, 95% CI 0.22-0.23), but incurred $6,483 (p<0.0001) more costs per hospitalisation than patients in Belgium. While hospital costs for patients were greater in the US, length of stay was shorter and patients were less likely to have transfusion services than those patients in Belgium. While this study is limited by factors inherent to observational studies, such as omitted variable bias, misclassification, and disease comorbidity, there are substantial differences in the use of blood products between Belgium and the US.

The U.S. Navy in the World (2001-2010): Context for U.S. Navy Capstone Strategies and Concepts

DTIC Science & Technology

2011-12-01

Merchant Marine ocean- going shipbuilding each down to single digits US shipbuilding industry largely dependent on US Navy orders  Building few commercial...Merchant Marine ships 228 2000s: US shipbuilding industrial base 115 229 2000s: US government shipbuilding policies No US government ship construction ...Context for U.S. Navy Capstone Strategies and Concepts 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT

Tools to Improve the Accuracy of Kidney Stone Sizing with Ultrasound

PubMed Central

Dunmire, Barbrina; Hsi, Ryan S.; Cunitz, Bryan W.; Paun, Marla; Bailey, Michael R.; Sorensen, Mathew D.; Harper, Jonathan D.

2015-01-01

Abstract Purpose: Ultrasound (US) overestimates stone size when compared with CT. The purpose of this work was to evaluate the overestimation of stone size with US in an in vitro water bath model and investigate methods to reduce overestimation. Materials and Methods: Ten human stones (3–12 mm) were measured using B-mode (brightness mode) US by a sonographer blinded to the true stone size. Images were captured and compared using both a commercial US machine and software-based research US device. Image gain was adjusted between moderate and high stone intensities, and the transducer-to-stone depth was varied from 6 to 10 cm. A computerized stone-sizing program was developed to outline the stone width based on a grayscale intensity threshold. Results: Overestimation with the commercial device increased with both gain and depth. Average overestimation at moderate and high gain was 1.9±0.8 and 2.1±0.9 mm, respectively (p=0.6). Overestimation increased an average of 22% with an every 2-cm increase in depth (p=0.02). Overestimation using the research device was 1.5±0.9 mm and did not vary with depth (p=0.28). Overestimation could be reduced to 0.02±1.1 mm (p<0.001) with the computerized stone-sizing program. However, a standardized threshold consistent across depth, system, or system settings could not be resolved. Conclusion: Stone size is consistently overestimated with US. Overestimation increased with increasing depth and gain using the commercial machine. Overestimation was reduced and did not vary with depth, using the software-based US device. The computerized stone-sizing program shows the potential to reduce overestimation by implementing a grayscale intensity threshold for defining the stone size. More work is needed to standardize the approach, but if successful, such an approach could significantly improve stone-sizing accuracy and lead to automation of stone sizing. PMID:25105243

Early HIV Diagnosis Leads to Significantly Decreased Costs in the First 2 Years of HIV Care in an Urban Charity Hospital in New Orleans.

PubMed

Halperin, Jason; Katz, Morgan; Pathmanathan, Ishani; Myers, Leann; Van Sickels, Nicholas; Seal, Paula Sereebutra; Richey, Lauren E

We undertook a retrospective cohort study of patients with a positive HIV test in the emergency department who were then linked to care. Inpatient, outpatient, and emergency costs were collected for the first 2 years after HIV diagnosis. Fifty-six patients met the inclusion criteria; they were predominantly uninsured (73%) and African American (89%). The median total cost for a newly diagnosed patient over the first 2 years was US$36 808, driven predominantly by outpatient costs of US$17 512. Median inpatient and total costs were significantly different between the lowest (<200 cells/mm 3 ) and highest (>499 cells/mm 3 ) CD4 count categories (US$21 878 vs US$6607, P <.05; US$61 378 vs US$18 837, P <.05, respectively). Total costs were significantly different between viral load categories <100 000 HIV-RNA copies/mL and ≥100 000 HIV-RNA copies/mL (US$28 219 vs US$49 482, P <.05). Costs were significantly lower among patients diagnosed earlier in their disease. Decreased cost is another factor supporting early diagnosis and linkage to care for patients with HIV.

Bismuth@US-tubes as a Potential Contrast Agent for X-ray Imaging Applications

PubMed Central

Rivera, Eladio J.; Tran, Lesa A.; Hernández-Rivera, Mayra; Yoon, Diana; Mikos, Antonios G.; Rusakova, Irene A.; Cheong, Benjamin Y.; Cabreira-Hansen, Maria da Graça; Willerson, James T.; Perin, Emerson C.; Wilson, Lon J.

2013-01-01

The encapsulation of bismuth as BiOCl/Bi2O3 within ultra-short (ca. 50 nm) single-walled carbon nanocapsules (US-tubes) has been achieved. The Bi@US-tubes have been characterized by high-resolution transmission electron microscopy (HR-TEM), energy-dispersive X-ray spectroscopy (EDS), thermogravimetric analysis (TGA), X-ray photoelectron spectroscopy (XPS), and Raman spectroscopy. Bi@US-tubes have been used for intracellular labeling of pig bone marrow-derived mesenchymal stem cells (MSCs) to show high X-ray contrast in computed tomography (CT) cellular imaging for the first time. The relatively high contrast is achieved with low bismuth loading (2.66% by weight) within the US-tubes and without compromising cell viability. X-ray CT imaging of Bi@US-tubes-labeled MSCs showed a nearly two-fold increase in contrast enhancement when compared to unlabeled MSCs in a 100 kV CT clinical scanner. The CT signal enhancement from the Bi@US-tubes is 500 times greater than polymer-coated Bi2S3 nanoparticles and several-fold that of any clinical iodinated contrast agent (CA) at the same concentration. Our findings suggest that the Bi@US-tubes can be used as a potential new class of X-ray CT agent for stem cell labeling and possibly in vivo tracking. PMID:24288589

Co-benefits of global and regional greenhouse gas mitigation for US air quality in 2050

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

Zhang, Yuqiang; Bowden, Jared H.; Adelman, Zachariah

Policies to mitigate greenhouse gas (GHG) emissions will not only slow climate change but can also have ancillary benefits of improved air quality. Here we examine the co-benefits of both global and regional GHG mitigation for US air quality in 2050 at fine resolution, using dynamical downscaling methods, building on a previous global co-benefits study (West et al., 2013). The co-benefits for US air quality are quantified via two mechanisms: through reductions in co-emitted air pollutants from the same sources and by slowing climate change and its influence on air quality, following West et al. (2013). Additionally, we separate the totalmore » co-benefits into contributions from domestic GHG mitigation vs. mitigation in foreign countries. We use the Weather Research and Forecasting (WRF) model to dynamically downscale future global climate to the regional scale and the Sparse Matrix Operator Kernel Emissions (SMOKE) program to directly process global anthropogenic emissions to the regional domain, and we provide dynamical boundary conditions from global simulations to the regional Community Multi-scale Air Quality (CMAQ) model. The total co-benefits of global GHG mitigation from the RCP4.5 scenario compared with its reference are estimated to be higher in the eastern US (ranging from 0.6 to 1.0 µg m -3) than the west (0–0.4 µg m -3) for fine particulate matter (PM 2.5), with an average of 0.47 µg m -3 over the US; for O 3, the total co-benefits are more uniform at 2–5 ppb, with a US average of 3.55 ppb. Comparing the two mechanisms of co-benefits, we find that reductions in co-emitted air pollutants have a much greater influence on both PM 2.5 (96 % of the total co-benefits) and O 3 (89 % of the total) than the second co-benefits mechanism via slowing climate change, consistent with West et al. (2013). GHG mitigation from foreign countries contributes more to the US O 3 reduction (76 % of the total) than that from domestic GHG mitigation only (24 %), highlighting the importance of global methane reductions and the intercontinental transport of air pollutants. For PM 2.5, the benefits of domestic GHG control are greater (74 % of total). Since foreign contributions to co-benefits can be substantial, with foreign O 3 benefits much larger than those from domestic reductions, previous studies that focus on local or regional co-benefits may greatly underestimate the total co-benefits of global GHG reductions. We conclude that the US can gain significantly greater domestic air quality co-benefits by engaging with other nations to control GHGs.« less

Motivations and demographics of I-6 and traditional 5+2 cardiothoracic surgery resident applicants: insights from an academic training program.

PubMed

Varghese, Thomas K; Mokadam, Nahush A; Verrier, Edward D; Wallyce, Delloney; Wood, Douglas E

2014-09-01

The introduction of the integrated 6-year cardiothoracic surgery residency (I-6) has changed the training paradigm for future cardiothoracic surgeons. Increased interest in these programs emphasizes the need for an understanding of the applicant pool and of their differences from the traditional trainee (5+2). National trends (National Resident Matching Program data), objective (Electronic Residency Application Services documents, United States Medical Licensing Examination [USMLE] scores, transcripts) and subjective metrics (interviews, personal statements, and recommendation letters) were evaluated for invited applicants for I-6 and 5+2 positions in 2010, 2011, and 2012. Demographics and motivations for specialty selection were determined. Statistical analyses were performed with Student's t test for continuous variables and Fisher's exact test for categoric variables. The number of applicants completing the match for I-6 positions each year was as follows: 2010, 74 (49 United States [US]); 2011, 74 (53 US); 2012, 80 (59 US). The number completing the match for 5+2 positions was as follows: 2010, 93 (67 US); 2011, 87 (55 US); 2012, 90 (63 US). For I-6 positions we interviewed 9 candidates in 2010, 17 in 2011, and 16 in 2012; for the 5+2 program we interviewed 14 candidates in 2010, 17 in 2011, and 13 in 2012. Both groups had a similar percentage of female applicants, number of US medical graduates, additional degrees, and membership in Alpha Omega Alpha. The I-6 applicants were younger (mean age, 27.4 years), were less likely to take time off for research (43.5% vs 72.7%), were less published, and had higher surgery clinical honors and USMLE scores. The 5+2 applicants were less likely to have done a cardiothoracic medical school rotation and had done senior-level rotations on general thoracic during residency; yet, only 29.5% had done a senior level cardiac rotation. The most frequently cited motivation was a clinical encounter during a cardiothoracic rotation for both (94.9% I-6 applicants, 88.6% 5+2 applicants). The I-6 applicants had more interest in minimally invasive techniques. There were no differences in the influence of a mentor or a desire for an academic career. Institutional strategies to increase medical student and general surgery resident exposure to cardiothoracic surgery clinically will optimize our ability to attract and train the best candidates in our specialty. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Intensification of depolymerization of polyacrylic acid solution using different approaches based on ultrasound and solar irradiation with intensification studies.

PubMed

Prajapat, Amrutlal L; Gogate, Parag R

2016-09-01

Depolymerization of polyacrylic acid (PAA) as sodium salt has been investigated using ultrasonic and solar irradiations with process intensification studies based on combination with hydrogen peroxide (H2O2) and ozone (O3). Effect of solar intensity, ozone flow and ultrasonic power dissipation on the extent of viscosity reduction has been investigated for individual treatment approaches. The combined approaches such as US+solar, solar+O3, solar+H2O2, US+H2O2 and US+O3 have been subsequently investigated under optimum conditions and established to be more efficient as compared to individual approaches. Approach based on US (60W)+solar+H2O2 (0.01%) resulted in the maximum extent of viscosity reduction as 98.97% in 35min whereas operation of solar+H2O2 (0.01%), US (60W), H2O2 (0.3%) and solar irradiation resulted in about 98.08%, 90.13%, 8.91% and 90.77% intrinsic viscosity reduction in 60min respectively. Approach of US (60W)+solar+ozone (400mg/h flow rate) resulted in extent of viscosity reduction as 99.47% in 35min whereas only ozone (400mg/h flow rate), ozone (400mg/h flow rate)+US (60W) and ozone (400mg/h flow rate)+solar resulted in 69.04%, 98.97% and 98.51% reduction in 60min, 55min and 55min respectively. The chemical identity of the treated polymer using combined approaches was also characterized using FTIR (Fourier transform infrared) spectra and it was established that no significant structural changes were obtained during the treatment. Overall, it can be said that the combination technique based on US and solar irradiations in the presence of hydrogen peroxide is the best approach for the depolymerization of PAA solution. Copyright © 2016 Elsevier B.V. All rights reserved.

In the Shadow of the Cold War: The Caribbean and Central America in U.S. Foreign Policy. Teacher's Resource Book. Revised Edition.

ERIC Educational Resources Information Center

Malkasian, Mark; Davidson, Louise K.

This teacher's resource book is designed to be used with "In the Shadow of the Cold War: The Caribbean and Central America in U.S. Foreign Policy," which was written to help high school students to weigh important U.S. foreign policy issues. The resource book includes eight lessons. Lessons 3-6 focus specifically on the dimension of the…

Photographic copy of historic photograph, by Corps of Engineers, U.S. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photographic copy of historic photograph, by Corps of Engineers, U.S. Army, November 19, 1943 (original in possession of Corps of Engineers, U.S. Army, Pittsburgh District, Engineering Division files) Unit 6, view of WPA masonry wall and dike upstream from Central Avenue Bridge - Johnstown Local Flood Protection Project, Beginning on Conemaugh River approx 3.8 miles downstream from confluence of Little Conemaugh & Stony Creek Rivers at Johnstown, Johnstown, Cambria County, PA

Germany as a Study Abroad Destination of U.S. Students in the Science, Technology, Engineering and Mathematics (STEM) Fields

ERIC Educational Resources Information Center

Comp, David

2010-01-01

Of the 205,000 U.S. students abroad during the 2004-2005 academic year, only 6,557 or slightly more than 3% of them studied in Germany. The Ohio Alliance reports that only 13% of all U.S. students who studied abroad during the 2004-2005 academic year were from the STEM fields of study. The Institute of International Education Open Doors Report,…

Drought-sensitivity of fine dust in the US Southwest: Implications for air quality and public health under future climate change

NASA Astrophysics Data System (ADS)

Achakulwisut, P.; Mickley, L. J.; Anenberg, S. C.

2018-05-01

We investigate the present-day sensitivity of fine dust levels in the US Southwest to regional drought conditions and use the observed relationships to assess future changes in fine dust levels and associated health impacts under climate change. Empirical Orthogonal Function analysis reveals that the most dominant mode of fine dust interannual variability for each season consists of a pattern of large-scale co-variability across the Southwest. This mode is strongly correlated to the Standardized Precipitation-Evapotranspiration Index (SPEI) accumulated over 1–6 months in local and surrounding regions spanning the major North American deserts. Across the seasons, a unit decrease in the 2 month SPEI averaged over the US Southwest and northern Mexico is significantly associated with increases in Southwest fine dust of 0.22–0.43 μg m‑3. We apply these sensitivities to statistically downscaled meteorological output from 22 climate models following two Representative Concentration Pathways (RCPs), and project future increases in seasonal mean fine dust of 0.04–0.10 μg m‑3 (5%–8%) under RCP2.6 and 0.15–0.55 μg m‑3 (26%–46%) under RCP8.5 relative to the present-day (2076–2095 vs. 1996–2015). Combined with the same projections of future population and baseline incidence rates, annual premature mortality attributable to fine dust exposure could increase by 140 (24%) deaths under RCP2.6 and 750 (130%) deaths under RCP8.5 for adults aged ≥30 years, and annual hospitalizations due to cardiovascular and respiratory illnesses could increase by 170 (59%) admissions under RCP2.6 and 860 (300%) admissions under RCP8.5 for adults aged ≥65 years in the Southwest relative to the present-day. Our results highlight a climate penalty that has important socioeconomic and policy implications for the US Southwest but is not yet widely recognized.

A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS).

PubMed

Atiase, Yacoba; Farni, Kathryn; Plange-Rhule, Jacob; Luke, Amy; Bovet, Pascal; Forrester, Terrence G; Lambert, Vicki; Levitt, Naomi S; Kliethermes, Stephanie; Cao, Guichan; Durazo-Arvizu, Ramon A; Cooper, Richard S; Dugas, Lara R

2015-09-15

Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m(2) in men and from 25.8 to 34.8 kg/m(2) in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.

Outsourcing and Insourcing Jobs in the U.S. Economy: Evidence Based on Foreign Investment Data

DTIC Science & Technology

2008-05-13

production, retail trade, chemicals, and computers and equipment. Employment in the services sectors, mining, and the food sectors grew most rapidly from...focused on this region for some time to come. Nevertheless, from 2003 to 2005, employment by U.S. firms in Asia, particularly in China, Malaysia and...4,838.8 4,963.7 Food 384.2 390.5 551.3 Beverages and tobacco products 204.6 208.7 130.2 Textiles, apparel , and leather products 59.5 56.4 54.9

Clinical and imaging predictors of management in retained products of conception.

PubMed

Kamaya, Aya; Krishnarao, Priya Menon; Nayak, Nita; Jeffrey, R Brooke; Maturen, Katherine E

2016-12-01

To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC). 334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0-3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis. Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55-0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04-1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16-2.70, p < 0.01) were statistically significant predictors of need for surgery. Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.

77 FR 36581 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Advanced Pressurized Power Reactor (US-APWR) will hold a meeting on July 9-10, 2012, Room T-2B3, 11545...

76 FR 44964 - Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-27

... NUCLEAR REGULATORY COMMISSION Advisory Committee on Reactor Safeguards (ACRS); Meeting of the ACRS Subcommittee on U.S. Evolutionary Power Reactor; Notice of Meeting The ACRS Subcommittee on U.S. Evolutionary Power Reactor (U.S. EPR) will hold a meeting on August 18, 2011, Room T-2B3, 11545 Rockville Pike...

America in the World: A Guide to U.S. Foreign Policy.

ERIC Educational Resources Information Center

Irwin, Wallace, Jr.

The purpose of this book is to provide information about the history, development, and practices of U.S. foreign policy. Part 1, "The World and the Nation," provides: (1) an overview and brief history of the countries and organizations affecting U.S. foreign policy; (2) a summary of U.S. history; and (3) information about the process of foreign…

47 CFR 63.10 - Regulatory classification of U.S. international carriers.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... For purposes of paragraphs (a)(2) and (a)(3) of this section, the relevant markets on the foreign end... access facilities or services on the foreign end of a particular route. (1) A U.S. carrier that has no... the foreign end of the route to affect competition adversely in the U.S. market. If the U.S. carrier...

47 CFR 63.10 - Regulatory classification of U.S. international carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... For purposes of paragraphs (a)(2) and (a)(3) of this section, the relevant markets on the foreign end... access facilities or services on the foreign end of a particular route. (1) A U.S. carrier that has no... the foreign end of the route to affect competition adversely in the U.S. market. If the U.S. carrier...

47 CFR 63.10 - Regulatory classification of U.S. international carriers.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... For purposes of paragraphs (a)(2) and (a)(3) of this section, the relevant markets on the foreign end... access facilities or services on the foreign end of a particular route. (1) A U.S. carrier that has no... the foreign end of the route to affect competition adversely in the U.S. market. If the U.S. carrier...

Know Your America: Suggested Study Course in Americanism. Revised Edition.

ERIC Educational Resources Information Center

American Legion, Indianapolis, IN. Americanism and Children's Youth Div.

The purpose of this booklet is to increase understanding of fundamental U.S. documents, the U.S. flag, patriotic institutions, and of San Francisco (California), March 14-16, 1986 of U.S. residents. Unit 2 describes and interprets the code of displaying the U.S. flag and provides a suggested flag education unit of study. Units 3 and 4 offer…

22 CFR 203.3 - U.S. PVO conditions of registration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... U.S. organizations. The first four Conditions relate to whether an organization meets the definition... Section 501(C)(3) of the Internal Revenue Code; and (2) Is not a university, college, accredited degree... registration, conducts international program activities within the last three years. For example, if a U.S. PVO...

22 CFR 203.3 - U.S. PVO conditions of registration.

Code of Federal Regulations, 2013 CFR

2013-04-01

... U.S. organizations. The first four Conditions relate to whether an organization meets the definition... Section 501(C)(3) of the Internal Revenue Code; and (2) Is not a university, college, accredited degree... registration, conducts international program activities within the last three years. For example, if a U.S. PVO...

22 CFR 203.3 - U.S. PVO conditions of registration.

Code of Federal Regulations, 2014 CFR

2014-04-01

... U.S. organizations. The first four Conditions relate to whether an organization meets the definition... Section 501(C)(3) of the Internal Revenue Code; and (2) Is not a university, college, accredited degree... registration, conducts international program activities within the last three years. For example, if a U.S. PVO...

22 CFR 203.3 - U.S. PVO conditions of registration.

Code of Federal Regulations, 2011 CFR

2011-04-01

... U.S. organizations. The first four Conditions relate to whether an organization meets the definition... Section 501(C)(3) of the Internal Revenue Code; and (2) Is not a university, college, accredited degree... registration, conducts international program activities within the last three years. For example, if a U.S. PVO...

22 CFR 203.3 - U.S. PVO conditions of registration.

Code of Federal Regulations, 2012 CFR

2012-04-01

... U.S. organizations. The first four Conditions relate to whether an organization meets the definition... Section 501(C)(3) of the Internal Revenue Code; and (2) Is not a university, college, accredited degree... registration, conducts international program activities within the last three years. For example, if a U.S. PVO...

The Public’s Preparedness: Self-Reliance, Flashbulb Memories, and Conservative Values

PubMed Central

Dyen, Susannah; Elliott, Stacey

2013-01-01

Objectives. We surveyed how many US residents engaged in 6 preparedness activities and measured the relationship between engagement and personal experience in hazard events, flashbulb memories of major events, self-reliance, and other indicators of a conservative philosophy. Methods. We used random digit dialing for national landline (75%) and cell phone (25%) surveys of 1930 US residents from July 6, 2011, to September 9, 2011; 1080 of the sample lived near 6 US Department of Energy nuclear waste management facilities and 850 were a national random sample. Results. The median respondent engaged in 3 of the 6 activities; those who disproportionately engaged in 4 or more had experienced a hazard event, had distressing and strong flashbulb memories of major hazard events, and had strong feelings about the need for greater self-reliance. The results for the national and US Department of Energy site–specific surveys were almost identical. Conclusions. A cadre of US residents are disproportionately engaged in disaster preparedness, and they typically have stronger negative memories of past disasters and tend to be self-reliant. How their efforts can or should be integrated into local preparedness efforts is unclear. PMID:23597367

Self-Reported Sleep Duration and Weight-Control Strategies Among US High School Students

PubMed Central

Wheaton, Anne G.; Perry, Geraldine S.; Chapman, Daniel P.; Croft, Janet B.

2013-01-01

Study Objective: To determine if self-reported sleep duration was associated with weight-control behaviors among US high school students. Design: National Youth Risk Behavior Survey. Setting: United States, 2007. Participants: US high school students (N = 12,087). Measurements: Students were asked if they had engaged in several weight-control behaviors during the 30 days before the survey to lose or maintain weight. Self-reported sleep duration categories included very short (≤ 5 h), short (6 or 7 h), referent moderate (8 or 9 h), and long (≥ 10 h). Sex-specific logistic regression analyses with race/ethnicity, grade, and body mass index category as covariates were conducted using SUDAAN to account for complex study design. Results: Approximately half the students reported short sleep duration (51.8% of males and 54.3% of females), whereas very short sleep durations were reported by another 14.8% of males and 16.9% of females. Among males, very short sleepers were significantly (P < 0.05) more likely than moderate sleepers to report dieting (36.3% versus 26.1%), fasting (14.2% versus 4.3%), and purging (4.3% versus 1.1%) to lose or maintain weight during the 30 days before the survey. Among females, the respective very short, short, and moderate sleepers varied (P < 0.05) in dieting (59.9%, 55.0%, and 47.5% respectively), fasting (28.3%, 15.2%, and 10.3%, respectively), and taking diet pills (13.3%, 6.8%, and 4.3%, respectively). Prevalence of purging was significantly higher only for very short sleepers (12.3%, 6.0%, and 3.9%, respectively). Conclusion: Self-reported short sleep duration was associated with dieting and three unhealthy weight-control behaviors in this population. If our findings are confirmed, intervention studies should be conducted to examine the effect of educational interventions. Citation: Wheaton AG; Perry GS; Chapman DP; Croft JB. Self-reported sleep duration and weight-control strategies among US high school students. SLEEP 2013;36(8):1139-1145. PMID:23904673

Potential impact of a US climate policy and air quality regulations on future air quality and climate change

NASA Astrophysics Data System (ADS)

Lee, Y. H.; Shindell, D. T.; Faluvegi, G.; Pinder, R. W.

2015-11-01

We have investigated how future air quality and climate change are influenced by the US air quality regulations that existed or were proposed in 2013 and a hypothetical climate mitigation policy that reduces 2050 CO2 emissions to be 50 % below 2005 emissions. Using NASA GISS ModelE2, we look at the impacts in year 2030 and 2055. The US energy-sector emissions are from the GLIMPSE project (GEOS-Chem LIDORT Integrated with MARKAL for the Purpose of Scenario Exploration), and other US emissions and the rest of the world emissions are based on the RCP4.5 scenario. The US air quality regulations are projected to have a strong beneficial impact on US air quality and public health in the future but result in positive radiative forcing. Surface PM2.5 is reduced by ~ 2 μg m-3 on average over the US, and surface ozone by ~ 8 ppbv. The improved air quality prevents about 91 400 premature deaths in the US, mainly due to the PM2.5 reduction (~ 74 200 lives saved). The air quality regulations reduces the light-reflecting aerosols (i.e., sulfate and organic matter) more than the light-absorbing species (i.e., black carbon and ozone), leading a strong positive radiative forcing (RF) by both aerosols direct and indirect forcing: total RF is ~ 0.04 W m-2 over the globe; ~ 0.8 W m-2 over the US. Under the hypothetical climate policy, future US energy relies less on coal and thus SO2 emissions are noticeably reduced. This provides air quality co-benefits, but it leads to climate dis-benefits over the US. In 2055, the US mean total RF is +0.22 W m-2 due to positive aerosol direct and indirect forcing, while the global mean total RF is -0.06 W m-2 due to the dominant negative CO2 RF (instantaneous RF). To achieve a regional-scale climate benefit via a climate policy, it is critical (1) to have multi-national efforts to reduce GHGs emissions and (2) to target emission reduction of light-absorbing species (e.g., BC and O3) on top of long-lived species. The latter is very desirable as the resulting climate benefit occurs faster and provides co-benefits to air quality and public health.

Grand Strategy: Contending Contemporary Analyst Views and Implications for the U.S. Navy

DTIC Science & Technology

2011-11-01

Grand Strategy Contending Contemporary Analyst Views and Implications for the U.S. Navy Elbridge Colby CRM D0025423.A2/Final November...NOV 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Grand Strategy: Contending Contemporary Analyst Views...implications for the country, the U.S. armed forces, and the U.S. Navy. Two other categories—isolationism (an oft-mentioned contender in political

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial.

PubMed

Ulusoy, Aslihan; Cerrahoglu, Lale; Orguc, Sebnem

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm 2 ; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm 2 ); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles-Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

76 FR 55416 - In the Matter of Certain Led Photographic Lighting Devices and Components Thereof; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

...Notice is hereby given that a complaint was filed with the U.S. International Trade Commission on August 3, 2011, under section 337 of the Tariff Act of 1930, as amended, 19 U.S.C. 1337, on behalf of Litepanels, Ltd. of the United Kingdom and Litepanels, Inc. of Van Nuys, California. Supplements to the Complaint were filed on August 24, and August 25, 2011. The complaint alleges violations of section 337 based upon the importation into the United States, the sale for importation, and the sale within the United States after importation of certain LED photographic lighting devices and components thereof by reason of infringement of certain claims of U.S. Patent No. 7,972,022 (``the `022 patent''); U.S. Patent No. 7,510,290 (``the `290 patent''); U.S. Patent No. 7,429,117 (``the `117 patent''); U.S. Patent No. 7,318,652 (``the `652 patent''); and U.S. Patent No. 6,948,823 (``the `823 patent''). The complaint further alleges that an industry in the United States exists as required by subsection (a)(2) of section 337. The complainants request that the Commission institute an investigation and, after the investigation, issue an exclusion order and cease and desist orders.

Combined ultrasound-guided cutting-needle biopsy and standard pleural biopsy for diagnosis of malignant pleural effusions.

PubMed

Wang, Jinlin; Zhou, Xinghua; Xie, Xiaohong; Tang, Qing; Shen, Panxiao; Zeng, Yunxiang

2016-11-17

The most efficient approach to diagnose malignant pleural effusions (MPEs) is still controversial and uncertain. This study aimed to evaluate the utility of a combined approach using ultrasound (US)-guided cutting-needle biopsy (CNB) and standard pleural biopsy (SPB) for diagnosing MPE. Pleural effusions were collected from 172 patients for biochemical and microbiological analyses. US-guided CNB and SPB were performed in the same operation sequentially to obtain specimens for histological analysis. US-guided CNB and SPB procedures provided adequate material for histological analysis in 90.7 and 93.0% of cases, respectively, while a combination of the 2 techniques was in 96.5% of cases. The sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV) and diagnostic accuracy of US-guided CNB versus SPB were: 51.2 vs 63.4%, 100 vs 100%, 100 vs 100%, 64.9 vs 72.2% and 74.4 vs 81.3%, respectively. When CNB was combined with SPB, the corresponding values were 88.6, 100, 100, 88.6 and 93.9%, respectively. Whereas sensitivity, NPV and diagnostic accuracy were not significantly different between CNB and SPB, the combination of CNB and SPB significantly improved the sensitivity, NPV and diagnostic accuracy versus each technique alone (p < 0.05). Significant pain (eight patients), moderate haemoptysis (two patients) and chest wall haematomas (two patients) were observed following CNB, while syncope (four patients) and a slight pneumothorax (four patients) were observed following SPB. Use of a combination of US-guided CNB and SPB afforded a high sensitivity to diagnose MPEs, it is a convenient and safe approach.

Field Expedient Armor Modifications to US Armored Vehicles

DTIC Science & Technology

2006-06-01

Technology” (Fort Knox, KY: US Army Armor Center, 1983). 12 2Ian V. Hogg. Armour in Conflict, The Design and Tactics of Armoured Fighting...making their own whitewash. Lacking whitewash, they often resorted to commandeering white bed linen to drape over their vehicles. Both techniques proved...other Armoured Fighting Vehicles of World War II (New York: Exeter Books, 1983), 256. 19White, I. D., “Report on US vs. German Armor,” Exhibit 2, p. 6

The Glass Ceiling - A Question of Joint Officer Development - Why Only Five USAF Geographic Combatant Commanders?

DTIC Science & Technology

2010-07-26

kit/OEF.asp (accessed March 6, 2011). 19 U.S. Central Command. "US CENTCOM Leadership: General James N. Mattis , Commander,‖ http... Mattis , USMC Commander, USCENTCOM 0 2 Cmdr, Task Force 58 Cmdr, USJFCOM Admiral James G. Stavridis, USN Commander, USEUCOM 1 2 Plans Officer, JCS...U.S. Central Command. "US CENTCOM Leadership." General James N. Mattis . https://slsp.http://www.centcom.mil/en/about-centcom/leadership

Removal of polycyclic aromatic hydrocarbons (PAHs) from textile dyeing sludge by ultrasound combined zero-valent iron/EDTA/Air system.

PubMed

Man, Xiaoyuan; Ning, Xun-An; Zou, Haiyuan; Liang, Jieying; Sun, Jian; Lu, Xingwen; Sun, Jiekui

2018-01-01

This paper proposes a combined ultrasound (US) and zero-valent iron/EDTA/Air (ZEA) system to remove polycyclic aromatic hydrocarbons (PAHs) from textile dyeing sludge. The removal efficiencies of 16 PAHs using ZEA, US/Air (air injected into the US process), and US/ZEA treatments were investigated, together with the effects of various operating parameters. The enhanced mechanisms of US and the role of reactive oxygen species (ROS) in removing PAHs in the US/ZEA system were explored. Results showed that only 42.5% and 32.9% of ∑16 PAHs were removed by ZEA and US/Air treatments respectively, whereas 70.1% were removed by US/ZEA treatment, (with favorable operating conditions of 2.0 mM EDTA, 15 g/L ZVI, and 1.08 w/cm 3 ultrasonic density). The US/ZEA system could be used with a wide pH range. US led to synergistic improvement of PAHs removal in the ZEA system by enhancing sludge disintegration to release PAHs and promoting ZVI corrosion and oxygen activation. In the US/ZEA system, PAHs could be degraded by ROS (namely OH, O 2 - /HO 2 , and Fe(IV)) and adsorbed by ZVI, during which the ROS made the predominant contribution. This study provides important insights into the application of a US/ZEA system to remove PAHs from sludge. Copyright © 2017 Elsevier Ltd. All rights reserved.

Hepatitis B Sero-Prevalence and Risk Behaviors Among Immigrant Men in a Population-Based Household Survey in Low-Income Neighborhoods of Northern California

PubMed Central

Yuan, Jinwei; Ruiz, Juan; Morrow, Scott; Reardon, Juan; Facer, Mathew; Molitor, Fred; Allen, Barbara; Ajufo, Barbara Green; Bell-Sanford, Geneva; McFarland, Willi; Raymond, Henry F.; Kellogg, Tim; Page, Kimberly

2009-01-01

Background Despite an effective vaccine, 60,000 new HBV infections were reported in the US in 2004; 95% in adults. We evaluate HBV sero-prevalence, risk behaviors and self-reported vaccination among Latino immigrant, Asian immigrant and US born low income men in five northern California counties. Methods Population based, cross sectional survey of HBV sero-prevalence and risk behaviors in men aged 18 to 35 years. Results Among 1,512 men screened, Asian immigrants were most likely to have had prior HBV infection (15.1%) and chronic infection (3.8%) compared to US born (prior 5.1%, chronic 0.6%) and Latino immigrant men (prior 2.0%, chronic 0.3%.) Reported HBV vaccination was lowest for Latino immigrants (12%) compared to Asian immigrants and US born men (35% in both.) Latino immigrants reported less educational attainment, medical insurance coverage and access to a physician in the last six months. Discussion Healthcare providers should routinely screen Asian immigrants for HBV regardless of their self reported vaccination status. Latino immigrants may comprise an important group of under-vaccinated, at risk persons in California. HBV testing and vaccination of immigrants soon after US arrival should be encouraged. PMID:19319680

Obesity-related metabolite profiles of black women spanning the epidemiologic transition.

PubMed

Dugas, Lara R; Chorell, Elin; Plange-Rhule, Jacob; Lambert, Estelle V; Cao, Guichan; Cooper, Richard S; Layden, Brian T; Scholten, Denise; Olsson, Tommy; Luke, Amy; Goedecke, Julia H

2016-03-01

In developed countries, specific metabolites have been associated with obesity and metabolic diseases, e.g. type 2 diabetes. It is unknown whether a similar profile persists across populations of African-origin, at increased risk for obesity and related diseases. In a cross-sectional study of normal-weight and obese black women (33.3 ± 6.3 years) from the US ( N = 69, 65 % obese), South Africa (SA, N = 97, 49 % obese) and Ghana ( N = 82, 33 % obese) serum metabolite profiles were characterized via gas chromatography-time of flight/mass spectrometry. In US and SA women, BMI correlated with branched-chain and aromatic amino acids, as well as dopamine and aminoadipic acid. The relationship between BMI and lipid metabolites differed by site; BMI correlated positively with palmitoleic acid (16:1) in the US; negatively with stearic acid (18:0) in SA, and positively with arachidonic acid (20:4) in Ghana. BMI was also positively associated with sugar-related metabolites in the US; i.e. uric acid, and mannitol, and with glucosamine, glucoronic acid and mannitol in SA. While we identified a common amino acid metabolite profile associated with obesity in black women from the US and SA, we also found site-specific obesity-related metabolites suggesting that the local environment is a key moderator of obesity.

Obesity-related metabolite profiles of black women spanning the epidemiologic transition

PubMed Central

Plange-Rhule, Jacob; Lambert, Estelle V.; Cao, Guichan; Cooper, Richard S.; Layden, Brian T.; Scholten, Denise; Olsson, Tommy; Luke, Amy; Goedecke, Julia H.

2016-01-01

In developed countries, specific metabolites have been associated with obesity and metabolic diseases, e.g. type 2 diabetes. It is unknown whether a similar profile persists across populations of African-origin, at increased risk for obesity and related diseases. In a cross-sectional study of normal-weight and obese black women (33.3 ± 6.3 years) from the US (N = 69, 65 % obese), South Africa (SA, N = 97, 49 % obese) and Ghana (N = 82, 33 % obese) serum metabolite profiles were characterized via gas chromatography-time of flight/mass spectrometry. In US and SA women, BMI correlated with branched-chain and aromatic amino acids, as well as dopamine and aminoadipic acid. The relationship between BMI and lipid metabolites differed by site; BMI correlated positively with palmitoleic acid (16:1) in the US; negatively with stearic acid (18:0) in SA, and positively with arachidonic acid (20:4) in Ghana. BMI was also positively associated with sugar-related metabolites in the US; i.e. uric acid, and mannitol, and with glucosamine, glucoronic acid and mannitol in SA. While we identified a common amino acid metabolite profile associated with obesity in black women from the US and SA, we also found site-specific obesity-related metabolites suggesting that the local environment is a key moderator of obesity. PMID:27346989