WorldWideScience

Sample records for early medication change

  1. Why change habits? Early modern medical innovation between medicalisation and medical culture.

    Science.gov (United States)

    Loetz, Francisca

    2010-01-01

    Based on a discussion of the concept of medicalisation and medical culture in Anglo-American, French-, and German-speaking historiography the paper argues that medical innovation in Europe from the sixteenth to the mid-nineteenth century should be approached in a different way. Instead of asking from the perspective of a too narrow concept of medicalisation why medical innovations were rejected by the population, (medical) historians should analyse medical culture and ask why people should have changed their health and illness behaviour. This conceptual argument is deduced from four empirical examples: the introduction of smallpox vaccination, "medical police," the problem of medical professionalization, and the questions arising around the relations between the healthy/sick and their practitioners.

  2. The Process of Change in Cognitive Therapy for Depression when Combined with Antidepressant Medication: Predictors of Early Intersession Symptom Gains

    Science.gov (United States)

    Strunk, Daniel R.; Cooper, Andrew A.; Ryan, Elizabeth T.; DeRubeis, Robert J.; Hollon, Steven D.

    2012-01-01

    Objective: Previous studies of cognitive therapy (CT) for depression have examined therapist adherence and the therapeutic alliance as predictors of subsequent symptom change. However, little is known about these CT process variables when CT is delivered in combination with antidepressant medication. Method: In a sample of 176 depressed…

  3. Medical education: Changes and perspectives

    OpenAIRE

    Zhang, Qin; Lee, Liming; Larry D. Gruppen; Ba, Denian

    2013-01-01

    As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international tr...

  4. Predictors of medical student remediation and their underlying causes: early lessons from a curriculum change in the University of Auckland Medical Programme.

    Science.gov (United States)

    Grainger, Brian; Yielder, Jill; Reid, Papaarangi; Bagg, Warwick

    2017-08-11

    The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change. A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 2013 and 2014, combined with thematic qualitative analysis of educator perspectives derived by interview on factors underlying remediation and the quality of that currently provided by the faculty. 17.7% of all students required some form of remedial assistance and 93% of all students offered remediation passed their year of study. Multivariate analysis showed international students (OR 4.59 95% CI 2.62-7.98) and students admitted via the Māori and Pacific Admission Scheme (OR 3.43 2.29-5.15) were significantly more likely to require remediation. Male students were also slightly more likely than their female classmates to require assistance. No effect was observed for rural origin students, completion of a prior degree or completion of clinical placement in a peripheral hospital. Knowledge application and information synthesis were the most frequently identified underlying problems. Most faculty believed remediation was successful, however, flexibility in the programme structure, improved diagnostics and improved access to dedicated teaching staff were cited as areas for improvement. Remediation is required by nearly a fifth of University of Auckland medical students, with MAPAS and international students being particularly vulnerable groups. Remediation is largely successful, however, interventions addressing reasoning and knowledge application may improve its effectiveness.

  5. Medical education: Changes and perspectives

    Science.gov (United States)

    Zhang, Qin; Lee, Liming; Gruppen, Larry D.; Ba, Denian

    2013-01-01

    As medical education undergoes significant internationalization, it is important for the medical education community to understand how different countries structure and provide medical education. This article highlights the current landscape of medical education in China, particularly the changes that have taken place in recent years. It also examines policies and offers suggestions about future strategies for medical education in China. Although many of these changes reflect international trends, Chinese medical education has seen unique transformations that reflect its particular culture and history. PMID:23631405

  6. The impact of health changes on labor supply: evidence from merged data on individual objective medical diagnosis codes and early retirement behavior.

    Science.gov (United States)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-06-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing risk specification distinguishes complete multiperiod routes to retirement, such as unemployment followed by early retirement. A result on comparison of coefficients across all states is offered. The empirical results indicate a strong impact of health changes on retirement and hence a large potential for public policy measures intended to retain older workers longer in the labor force. Disability responds more to health shocks than early retirement, especially to diseases of the circulatory, respiratory, and musculoskeletal systems, as well as mental and behavioral disorders. Some unemployment spells followed by early retirement appear voluntary and spurred by life style diseases.

  7. Randomized controlled study of early medication change for non-improvers to antidepressant therapy in major depression--The EMC trial.

    Science.gov (United States)

    Tadić, André; Wachtlin, Daniel; Berger, Mathias; Braus, Dieter F; van Calker, Dietrich; Dahmen, Norbert; Dreimüller, Nadine; Engel, Alice; Gorbulev, Stanislav; Helmreich, Isabella; Kaiser, Anne-Katrin; Kronfeld, Kai; Schlicht, Konrad F; Tüscher, Oliver; Wagner, Stefanie; Hiemke, Christoph; Lieb, Klaus

    2016-04-01

    Patients with Major Depressive Disorder (MDD) and no improvement after two weeks of antidepressant pharmacotherapy have a high risk of treatment failure. The aim of the study was to determine whether an early medication change (EMC) strategy is superior to a guideline-based treatment in MDD patients without improvement after two weeks of antidepressant pharmacotherapy. Eight-hundred-and-eighty-nine patients with MDD were enrolled, 879 patients received the SSRI escitalopram. Of those, 192 patients had no improvement, defined as a reduction of EMC strategy (n = 97; venlafaxine XR for study days 15-56; in case of sustained non-improvement on day 28, lithium augmentation for days 29-56) or TAU (n = 95; escitalopram continuation; non-responders on day 28 were switched to venlafaxine XR for four weeks, i.e. days 29-56). The primary outcome was remission (HAMD-17 ≤ 7) after 8 weeks of treatment as assessed by blinded raters. Remission rates were 24% for EMC and 16% for TAU, which was not significantly different (p = 0.2056). Sensitivity analyses for the primary and secondary effectiveness endpoints consistently showed favorable results for patients randomized to EMC. The results confirm data from post-hoc analyses of clinical trials showing that early non-improvement identifies patients who likely need alternate interventions. However, the herein used two-step switch/augmentation strategy for this risk group was not more effective than the control intervention. Alternate strategies and other design aspects are discussed in order to support researchers addressing the same research question.

  8. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    People quit the labor force for many different reasons, voluntarily or not, through various arrangements such as unemployment benefits, disability benefits or specially designed early retirement schemes. This paper complements the existing literature by considering a large, register-based sample...... the e¤ect of any remaining mismeasurement of true work incapacity. Together, these improvements should help distinguish empirically important effects of health and economic variables on retirement. We distinguish a number of alternative exit routes, in particular, disability, early retirement...... find sizeable differences in retirement behavior across marital status, gender, labor market attachment, occupation, income, and in particular health. We find that the disability retirement exit route that requires specific medical criteria to be met is different from the early retirement route...

  9. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-01-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration...... spells followed by early retirement appear voluntary, and spurred by life style diseases....... until retirement is modeled using single and competing risk specifications, observed and unobserved heterogeneity, and flexible baseline hazards. Wealth is used as a proxy for elapsed duration to mitigate the potential selection bias stemming from conditioning on initial participation. The competing...

  10. Antipsychotic medication for early episode schizophrenia

    Science.gov (United States)

    Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

    2014-01-01

    Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications

  11. The Effect of Early Clinical Exposure Program on Attitude Change of Undergraduate Medical Students toward their preparation for Attending Clinical Setting in Internal Medicine, Surgery and Pediatrics Wards during 2013-2014

    Directory of Open Access Journals (Sweden)

    M.A. Seifrabei

    2016-01-01

    Full Text Available Introduction & Objective: This study was conducted to evaluate the effect of early clinical exposure on medical students’ attitude toward their preparation for attending clinical setting. Material & Methods: In an interventional before -after study, 52 fourth semester medical students studying at Hamadan University of medical sciences were enrolled in the study. The participants filled out a self-structured questionnaire before and after taking part in a 4 month course in three different wards including: surgery, pediatric and internal wards . The staff’s opinions about the program were also gathered. Result: Mean attitude score increased significantly after taking part in the course in these areas: satisfaction about basic science lessons (P=0.019, understanding social determinants of health (P= 0.03 and understanding clinical thinking and simple clinical skills (P= 0.01. Passing the course did not have any significant effect in communication skills and current semester scores (P.0.05 in both issues. Forty one percent of the academic staff in the mentioned wards believed in the necessity of early clinical exposure in basic science stage, 29.5% denied it's necessity and 29.5% did not express their opinions. Conclusion: It seems that despite the mean score increase of some items, early clinical exposure program doesn’t have any positive effect on the measured items. Therefore, it is recommended to change the medical education program. Sci J Hamadan Univ Med Sci . 2016; 22 (4 :323-330

  12. Risky, early, controversial. Puberty in medical discourses.

    Science.gov (United States)

    Cozzi, Donatella; Vinel, Virginie

    2015-10-01

    This article comes within the compass of a research program (entitled CorAge. Bodily Experiences and AgePassages among 9-13 year-olds (ANR-09-ENFT-017) conducted between 2009 and 2013 about the emergence of a "new" age in life--"preadolescence"--as instanced in France (Alsace, Lorraine) and Italy (Venetia). The impressive amount of references to "early puberty" and "precocious puberty", in a context of feeling of a premature end of childhood, led us to make an in-depth study of this issue: first, through an analysis of international and French and Italian medical journals; second, through interviews with health professionals. Following the thesis of Foucault, we assume that the discourses on puberty timing participate of classifications of the child body drenched with moral representations of childhood, especially on gender and age issue. Our results: the question of whether a secular trend in puberty timing even exists continues to be debated between American and European scientists. Second, the terms "puberty", "precocious puberty", "early puberty" have been used to indicate a variety of puberty markers, increasing confusion. A controversy has focused on early breast development in girls, because this attribute is questioning the order of ages and gender. Moreover, psychosocial factors presented as accelerating early puberty, do not demonstrate the relation between earliness and risk behavior. The literature, as it is moved by the female precocity, creates a medical category to objectify the complex and flexible process of puberty and invent female child precocity. These differences between American and European scholars and the interviews with French and Italian health professional show a gap between the international literature and practitioners, clinicians and nurses who regularly work with children: they neither find pubertal advancement, nor increase of "true precocious puberty", although they share concerns about premature feminization of girls (France) or

  13. Early radiology and the National Medical Association.

    Science.gov (United States)

    Oestreich, Alan E

    2011-01-01

    Both the discovery of the x-ray and the founding of the National Medical Association (NMA) occurred in 1895. Radiologists have participated importantly in the NMA since the lecture of Dr Marcus F. Wheatland at the 1909 Annual Meeting in Boston, Massachusetts, which led to his election as president of the NMA for the following year. More recently, Dr Tracy M. Walton was president of the NMA in its centennial year. This article details early and continued participation in the NMA by radiologists, including the founding of the Section on Radiology in 1949, with its first chairman, Dr William E. Allen, Jr, longtime leader in radiology, the section, and the NMA.

  14. Medical leadership in changing times.

    Science.gov (United States)

    Bhugra, Dinesh

    2011-09-01

    Medical leadership is becoming an increasingly popular buzz word. However, its importance, skills inherent in it and training for such a role are often not clear. In this paper, some of these factors are described. Medical leadership, like other leadership roles, must have passion, courage, vision and an ability to scan the horizon for health care policies, which may affect health services directly or indirectly. Medical leaders often have the skills to look at the problems in a longitudinal manner and have a broader perspective in understanding dynamics of policy. One of the key tasks for any leader is development of strategy and communicating such strategy to others, especially stakeholders. Medical leadership must also work with some stakeholders in a much more proactive way rather than a reactive one. In this paper, some theories of leadership are highlighted and medical leadership is placed in that context. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Early experiences with big data at an academic medical center.

    Science.gov (United States)

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  16. Risk of early, intermediate, and late rejection following heart transplantation: Trends over the past 25 years and relation to changes in medical management. Tertiary center experience: The Sheba Heart Transplantation Registry.

    Science.gov (United States)

    Katz, Moshe; Freimark, Dov; Raichlin, Eugenia; Har-Zahav, Yedael; Arad, Michael; Kassif, Yigal; Peled, Amir; Asher, Elad; Elian, Dan; Kogan, Alexander; Shlomo, Nir; Ofek, Efrat; Lavee, Jacob; Goldenberg, Ilan; Peled, Yael

    2017-10-01

    To explore the trends in the risk for rejection following heart transplantation (HT) over the past 25 years, and their relation to changes in medical management. The study population comprised 216 HT patients. Rejection periods were defined as follows: 0-3 months (early), 3-12 months (intermediate), and 12+ months (late). HT era was dichotomized as follows: 1991-1999 (remote era) and 2000-2016 (recent era). Medication combination was categorized as newer (TAC, MMF, and everolimus) vs older therapies (AZA, CSA). Multivariate analysis showed that patients who underwent HT during the recent era experienced a significant reduction in the risk for major rejection. These findings were consistent for early (OR = 0.44 [95% CI 0.22-0.88]), intermediate (OR = 0.02 [95% CI 0.003-0.11]), and late rejections (OR = 0.18 [95% CI 0.05-0.52]). Using the year of HT as a continuous measure showed that each 1-year increment was independently associated with a significant reduction in the risk for early, intermediate, and late rejections (5%, 21%, 18%, respectively). In contrast, the risk reduction associated with newer types of immunosuppressive therapies was not statistically significant after adjustment for the treatment period. Major rejection rates following HT have significantly declined over the past 2 decades even after adjustment for changes in immunosuppressive therapies, suggesting that other factors may also play a role in the improved outcomes of HT recipients. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Assessing and changing medical practice culture.

    Science.gov (United States)

    Hills, Laura

    2011-01-01

    Your medical practice has an existing culture that manifests itself daily in literally hundreds of ways. Some aspects of your culture likely support your practice's growth; others may be impeding your progress. This article describes the characteristics of medical practice culture and provides numerous examples of how culture influences behavior. It describes how culture is expressed in a medical practice through objects and artifacts, language, emotions, interactions, practice management systems, and daily work habits. It offers three techniques for assessing an existing medical practice culture and a checklist for conducting culture observations. This article also provides guidelines for identifying a desired medical practice culture and explores why changing culture is so difficult. It describes five reasons employees are likely to resist culture change and provides 12 fundamental changes that will enable a practice to improve its culture. Finally, this article explores how medical practice cultures are formed and perpetuated and provides more than a dozen questions to ask employees in a culture survey.

  18. Preparing Australian medical students for climate change.

    Science.gov (United States)

    Green, Evelyn I Hamel; Blashki, Grant; Berry, Helen L; Harley, David; Horton, Graeme; Hall, Gillian

    2009-09-01

    Climate change is now recognised as a global public health problem and the future medical workforce will be working during a period when the health impacts of climate change are likely to be significant. This article discusses the ongoing training on the health impacts of climate change for the current and future medical workforce. The role of medical practitioners in the coming decades will need to include assisting communities to adapt to changing climatic conditions, managing climate sensitive illnesses, and contributing to mitigation efforts to prevent climate change. Climate change and health should be built into the curricula of Australian medical schools spanning public health, clinical medicine, preventive health and global health. We propose a problem based learning approach to highlight clinical and public health implications, and present two hypothetical case studies suitable for teaching purposes.

  19. The Impact of Health Changes on Labor Supply: Evidence from Merged Data on Individual Objective Medical Diagnosis Codes and Early Retirement Behavior

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene

    2012-01-01

    The justification bias in the estimated impact of health shocks on retirement is mitigated by using objective health measures from a large, register-based longitudinal data set including medical diagnosis codes, along with labor market status, financial, and socio-economic variables. The duration...

  20. Medical students' professional identity development in an early nursing attachment.

    NARCIS (Netherlands)

    Helmich, E.; Derksen, E.; Prevoo, M.; Laan, R.F.J.M.; Bolhuis, S.; Koopmans, R.T.C.M.

    2010-01-01

    OBJECTIVES: The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an ass

  1. Spillover Effects of Early-Life Medical Interventions

    DEFF Research Database (Denmark)

    Breining, Sanni Nørgaard; Daysal, N. Meltem; Simonsen, Marianne;

    2015-01-01

    substantial positive spillovers on all our measures of academic achievement. Our estimates suggest that siblings of focal children who were slightly below the VLBW cutoff have higher 9th grade language and math test scores, as well as higher probability of enrolling in a high school by age 19. Our results......We investigate the spillover effects of early-life medical treatments on the siblings of treated children. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we first confirm...... the findings in the previous literature that children who are slightly below the VLBW cutoff have better short- and long-term health, and higher math test scores in 9th grade. We next investigate spillover effects on siblings and find no evidence of an impact on their health outcomes. However, we find...

  2. Mid-Career Change and Early Retirement.

    Science.gov (United States)

    Patton, Carl V.

    1978-01-01

    An NSF study suggests that important qualitative changes in the faculty may be obtained through increased attention to mid-career change and early retirement programs. Interest in career options, early retirement alternatives, evaluation criteria, mid-career change alternatives, internship, fellowship programs, and retraining programs are…

  3. The changing role of the medical illustrator?

    Science.gov (United States)

    Diedrick, M D

    1975-11-01

    The author takes issue with the claim that the role of the medical illustrator is changing today. Not so, he says. The role is the same, and the need is as great as it ever was. Rather, some medical illustrators are changing in the desire to expand their field and become "biocommunicators.' Such expansion, the author suggests, is not for everyone, and those who choose to continue in their traditional role need make no apologies. It is a vital one.

  4. Utilizing Electronic Medical Records to Discover Changing Trends of Medical Behaviors Over Time*

    Science.gov (United States)

    Yin, Liangying; Dong, Wei; He, Chunhua; Duan, Huilong

    2017-01-01

    Summary Objectives Medical behaviors are playing significant roles in the delivery of high quality and cost-effective health services. Timely discovery of changing frequencies of medical behaviors is beneficial for the improvement of health services. The main objective of this work is to discover the changing trends of medical behaviors over time. Methods This study proposes a two-steps approach to detect essential changing patterns of medical behaviors from Electronic Medical Records (EMRs). In detail, a probabilistic topic model, i.e., Latent Dirichlet allocation (LDA), is firstly applied to disclose yearly treatment patterns in regard to the risk stratification of patients from a large volume of EMRs. After that, the changing trends by comparing essential/critical medical behaviors in a specific time period are detected and analyzed, including changes of significant patient features with their values, and changes of critical treatment interventions with their occurring time stamps. Results We verify the effectiveness of the proposed approach on a clinical dataset containing 12,152 patient cases with a time range of 10 years. Totally, 135 patients features and 234 treatment interventions in three treatment patterns were selected to detect their changing trends. In particular, evolving trends of yearly occurring probabilities of the selected medical behaviors were categorized into six content changing patterns (i.e, 112 growing, 123 declining, 43 up-down, 16 down-up, 35 steady, and 40 jumping), using the proposed approach. Besides, changing trends of execution time of treatment interventions were classified into three occurring time changing patterns (i.e., 175 early-implemented, 50 steady-implemented and 9 delay-implemented). Conclusions Experimental results show that our approach has an ability to utilize EMRs to discover essential evolving trends of medical behaviors, and thus provide significant potential to be further explored for health services redesign and

  5. Early medical abortion without prior ultrasound.

    Science.gov (United States)

    Raymond, Elizabeth G; Bracken, Hillary

    2015-09-01

    To explore the potential for using last menstrual period (LMP) rather than ultrasound to establish gestational age (GA) eligibility for medical abortion. We used the results of a recently published systematic review to identify studies with data on the number of abortion patients with GA more than 63 or 70 days by ultrasound but less than those or other specific limits by LMP. We analyzed data from these studies to estimate the proportion of women with GAs greater than 63 or 70 days by ultrasound in various subgroups of women defined by LMP. We found three studies with relevant data. One enrolled 4257 medical abortion patients of whom 4% had GAs of >70 days by ultrasound. Of the 2681 who were certain that their LMPs began no more than 56 days prior, only 16 (0.6%) were >70 days by ultrasound. In a second much smaller study of surgical abortion patients, of whom 19% were >70 days by ultrasound, 90 women were certain that their LMPs started more than 56 days prior, and of those, 7 (7.8%) had GAs of >70 days by ultrasound. In the third study, which included surgical abortion patients with a mean GA of 61 days, at least 12% of the 138 patients with LMPs 70 days by ultrasound. The possibility that access to medical abortion can be enhanced for selected women by omitting the requirement for a screening ultrasound is promising and should be further investigated. Gestational dating using LMP rather than ultrasound may be reasonable for selected patients before medical abortion. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. 78 FR 60291 - Investigational Device Exemptions for Early Feasibility Medical Device Clinical Studies...

    Science.gov (United States)

    2013-10-01

    ... ``Investigational Device Exemptions (IDEs) for Early Feasibility Medical Device Clinical Studies, Including Certain... facilitate early feasibility studies of medical devices, using appropriate risk mitigation strategies, under the IDE regulations. Early feasibility studies allow for limited early clinical evaluations of...

  7. Early Detection and Outpatient Management of Alcoholism: A Curriculum for Medical Residents.

    Science.gov (United States)

    Barnes, Henrietta N.; And Others

    1984-01-01

    A course in the early detection and outpatient management of alcoholism for medical residents is discussed. Unlike other courses on alcoholism that have emphasized changes in physicians' attitudes, this course was designed to promote changes in residents' practice behavior and to foster the development of necessary clinical skills. (MLW)

  8. [Changing aspects in continuing medical education].

    Science.gov (United States)

    Okisaka, Shigekuni

    2007-02-01

    Self-directed learning based on adult education theory and self-assessment are necessary for continuing medical education. Self-directed learning is the process whereby the individual takes the initiative in diagnosing his learning needs and setting his own individual learning goals, showing clearly the human and physical resources, putting an appropriate plan into practice, and evaluating the learning outcome. Because self-assessment is the evaluation of the process where the individual confirms his actual learning, portfolio assessment is utilized for this purpose. In the continuing medical education program of the Japanese Ophthalmological Society, it is vital that the appropriate credit and recognition program keep up with the changes in adult education theory. Therefore, portfolio assessment is introduced for self-assessment. The Ophthalmic Pathology Slide Seminar is a model of medical education based on self-directed learning.

  9. Early detection of influenza like illness through medication sales.

    Science.gov (United States)

    Socan, Maja; Erculj, Vanja; Lajovic, Jaro

    2012-06-01

    Monitoring sales of medications is a potential candidate for an early signal of a seasonal influenza epidemic. To test this theory, the data from a traditional, consultation-oriented influenza surveillance system were compared to medication sales and a predictive model was developed. Weekly influenza-like incidence rates from the National Influenza Sentinel Surveillance System were compared to sales of seven groups of medications (nasal decongestants, medicines for sore throat (MST), antitussives, mucolytics, analgo-antipyretics, non-steroidal anti-inflamatory drugs (NSAIDs), betalactam antibiotics, and macrolide antibiotics) to determine the correlation of medication sales with the sentinel surveillance system - and therefore their predictive power. Poisson regression and regression tree approaches were used in the statistical analyses. The fact that NSAIDs do not exhibit any seasonality and that prescription of antibiotics requires a visit to the doctor's office makes the two medication groups inappropriate for predictive purposes. The influenza-like illness (ILI) curve is the best matched by the mucolytics and antitussives sales curves. Distinct seasonality is also observed with MST and decongestants. The model including these four medication groups performed best in prediction of ILI incidence rate using the Poisson regression model. Sales of antitussives proved to be the best single predictive variable for regression tree model. Sales of medication groups included in the model were demonstrated to have a predictive potential for early detection of influenza season. The quantitative information on medication sales proves to be a useful supplementary system, complementing the traditional consultation-oriented surveillance system.

  10. Early-life medical care and human capital accumulation

    DEFF Research Database (Denmark)

    Daysal, N. Meltem

    2015-01-01

    that both types of interventions may benefit not only child health but also long-term educational outcomes. In addition, early-life medical interventions may improve the educational outcomes of siblings. These findings can be used to design policies that improve long-term outcomes and reduce economic...

  11. Review of early assessment models of innovative medical technologies

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Krahn, Murray D; Kidholm, Kristian

    2017-01-01

    INTRODUCTION: Hospitals increasingly make decisions regarding the early development of and investment in technologies, but a formal evaluation model for assisting hospitals early on in assessing the potential of innovative medical technologies is lacking. This article provides an overview of models...... for early assessment in different health organisations and discusses which models hold most promise for hospital decision makers. METHODS: A scoping review of published studies between 1996 and 2015 was performed using nine databases. The following information was collected: decision context, decision...... problem, and a description of the early assessment model. RESULTS: 2362 articles were identified and 12 studies fulfilled the inclusion criteria. An additional 12 studies were identified and included in the review by searching reference lists. The majority of the 24 early assessment studies were variants...

  12. Early Childhood Teachers Coping with Educational Change

    Science.gov (United States)

    Kilgallon, Pam; Maloney, Carmel; Lock, Graeme

    2008-01-01

    This paper describes a study of early childhood teachers' (educators of children aged four - eight years in school settings) perceptions of key factors which impact on their ability to cope with the implementation of mandated educational change in the workplace. Using qualitative methodology including surveys, focus groups and in-depth interviews,…

  13. Early characteristic radiographic changes in mucolipidosis II

    Energy Technology Data Exchange (ETDEWEB)

    Lai, Lillian M. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); Lachman, Ralph S. [Lucile Packard Children' s Hospital and Stanford University, Pediatric Radiology, Palo Alto, CA (United States); University of California, International Skeletal Dysplasia Registry, Los Angeles, CA (United States)

    2016-11-15

    Although mucolipidosis type II has similar metabolic abnormalities to those found in all the mucopolysaccharidoses and mucolipidoses, there are distinctive diagnostic radiographic changes of mucolipidosis II in the perinatal/newborn/infant period. To describe the early characteristic radiographic changes of mucolipidosis II and to document when these changes manifest and resolve. We retrospectively reviewed radiographs and clinical records of 19 cases of mucolipidosis II from the International Skeletal Dysplasia Registry (1971-present; fetal age to 21/2 years). A radiologist with special expertise in skeletal dysplasias evaluated the radiographs. The most common abnormalities were increased vertebral body height (80%, nonspecific), talocalcaneal stippling (86%), periosteal cloaking (74%) and vertebral body rounding (50%). Unreported findings included sacrococcygeal sclerosis (54%) and vertebral body sclerosis (13%). Rickets and hyperparathyroidism-like (pseudohyperparathyroidism) changes (rarely reported) were found in 33% of cases. These changes invariably started in the newborn period and resolved by 1 year of age. The conversion from these early infantile radiographic features to dysostosis multiplex changes occurred in 41% of cases, and within the first year after birth. Several findings strongly suggest the diagnosis of mucolipidosis II, including cloaking in combination with one or more of the following radiographic criteria: talocalcaneal stippling, sacrococcygeal or generalized vertebral body sclerosis, vertebral body rounding, or rickets/hyperparathyroidism-like changes in the perinatal/newborn/infancy period. These findings are not found in the other two forms of mucolipidosis nor in any of the mucopolysaccharidoses. (orig.)

  14. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis

    DEFF Research Database (Denmark)

    Drake, Richard J; Nordentoft, Merete; Haddock, Gillian

    2015-01-01

    the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6......We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined...... medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test...

  15. Medical Connections and Exchanges in the Early Modern World

    Directory of Open Access Journals (Sweden)

    Michael Naylor Pearson

    2011-12-01

    Full Text Available For most of human history there have been extensive exchanges of medical information all over Eurasia. Some diseases were considered to be geographically determined, and hence had to be cured using local knowledge. Other ailments were found in many places, but cures could differ according to location. Most healers, whether book based or experiential, took a non-judgemental approach to different healing methods, as seen especially in India in the early colonial period.

  16. Medical students' preparedness for professional activities in early clerkships.

    Science.gov (United States)

    Bosch, Josefin; Maaz, Asja; Hitzblech, Tanja; Holzhausen, Ylva; Peters, Harm

    2017-08-22

    Sufficient preparedness is important for transitions to workplace participation and learning in clinical settings. This study aims to analyse medical students' preparedness for early clerkships using a three-dimensional, socio-cognitive, theory-based model of preparedness anchored in specific professional activities and their supervision level. Medical students from a competency-based undergraduate curriculum were surveyed about preparedness for 21 professional activities and level of perceived supervision during their early clerkships via an online questionnaire. Preparedness was operationalized by the three dimensions of confidence to carry out clerkship activities, being prepared through university teaching and coping with failure by seeking support. Factors influencing preparedness and perceived stress as outcomes were analysed through step-wise regression. Professional activities carried out by the students (n = 147; 19.0%) and their supervision levels varied. While most students reported high confidence to perform the tasks, the activity-specific analysis revealed important gaps in preparation through university teaching. Students regularly searched for support in case of difficulty. One quarter of the variance of each preparedness dimension was explained by self-efficacy, supervision quality, amount of prior clerkship experience and nature of professional activities. Preparedness contributed to predicting perceived stress. The applied three-dimensional concept of preparedness and the task-specific approach provided a detailed and meaningful view on medical students' workplace participation and experiences in early clerkships.

  17. MEDICAL MANAGEMENT OF DENTAL CARIES: A CHANGE IN THERAPEUTIC APPROACH

    Directory of Open Access Journals (Sweden)

    Amit Malhotra

    2013-01-01

    Full Text Available Dental caries is an infectious, communicable disease, which causes destruction of teeth by acid-forming bacteria found in dental plaque. Caries progression or reversal is determined by the balance between protective and pathological factors in the mouth. There have been revolutions in every field and dentistry is no exception to it, these changes have led to a change in concept from the conventional surgical approach of removing dental decay and cutting of tooth structure to the medical model which deals with interception of disease at different stages and possible reversal of the disease process. The key to medical paradigm is determination of caries risk in an individual and effective early detection of initial carious lesions. There are various equipments available in market which uses different principles for diagnosing caries susceptibility in an individual. In the years of thorough research different agents have been investigated for their role in caries prevention and reversal. There is a separate treatment plan for managing patients falling in different risk category. This article outlines the need for the medical management of dental caries and how it can be a viable option in dental decay management.

  18. Advancing medical-surgical nursing practice: improving management of the changing patient condition.

    Science.gov (United States)

    Monroe, Heidi; Plylar, Peggy; Krugman, Mary

    2014-01-01

    Higher patient acuities and more novice nurses on medical-surgical units have Educators focused on achieving positive outcomes with changes in patient condition. An educational program was developed to enhance nurses' knowledge, skill, and confidence in assessing hemodynamics, recognizing early signs of instability, and administering vasoactive medications. The program was successful with significant knowledge improvement as well as an increased use of the Medical Emergency Team while maintaining a low number of code calls.

  19. THE EARLY BIRD CATCHES THE WORM : EARLY COST-EFFECTIVENESS ANALYSIS OF NEW MEDICAL TESTS

    NARCIS (Netherlands)

    Buisman, Leander R; Rutten-van Mölken, Maureen P M H; Postmus, Douwe; Luime, Jolanda J; Uyl-de Groot, Carin A; Redekop, William K

    2016-01-01

    OBJECTIVES: There is little specific guidance on performing an early cost-effectiveness analysis (CEA) of medical tests. We developed a framework with general steps and applied it to two cases. METHODS: Step 1 is to narrow down the scope of analysis by defining the test's application, target populat

  20. Perceived Behavioral Changes in Early Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Fabiana Souza Lima

    2007-01-01

    Full Text Available Acquired behavioral changes have essentially been described in advanced multiple sclerosis (MS. The present study was designed to determine whether behavioral modifications specifically related to the MS pathological process could be identified in the initial phase of the disease, as compared to control patients with chronic, relapsing and progressive inflammatory disorders not involving the central nervous system (CNS. Eighty-eight early MS patients (Expanded Disability Status Scale score ≤ 2.5 and 48 controls were tested. Perceived changes by informants in behavioral control, goal-directed behavior, decision making, emotional expression, insight and interpersonal relationships were assessed using the Iowa Scale of Personality Change (ISPC. Executive behavioral disturbances were screened using the Dysexecutive Questionnaire (DEX. The mean change between the premorbid and postmorbid ISPC ratings was similar in the MS [12.2 (SD 15.6] and in the control [11.5 (SD 15.1] group. The perceived behavioral changes (PBCs most frequently reported in both groups were lack of stamina, lability/moodiness, anxiety, vulnerability to stress and irritability. Pathological scores in the DEX were also similar in both groups. Correlations between PBCs and DEX scores were different in MS and control groups. MS patients with cognitive impairment had a marginally higher number of PBCs than control patients (p = 0.056 and a significantly higher DEXp score (p = 0.04. These results suggest that (1 PBCs occurring in early MS patients were not different from those induced by comparable chronic non-CNS disorders, (2 qualitative differences in the relationship between behavioral symptoms and executive-behavioral changes may exist between MS and control groups, and (3 behavioral symptoms seem associated with cognitive deficits in MS. We further plan to assess these observations longitudinally.

  1. Alcohol consumption in early adolescence and medical care.

    Science.gov (United States)

    Borrás Santiesteban, Tania

    2016-10-01

    Alcohol consumptionin adolescents is a risky behavior that can be prevented. Objective. To determine health care and alcohol consumption pattern in early adolescence and its relation to determinants of health (biological, environmental, social and health system factors). A qualitative-quantitative, crosssectional study was carried out in the four schools belonging to Popular Council 8 of Mario Gutiérrez Ardaya health sector in May, 2013. The study universe was made up of adolescents aged 10-14. The sample was determined through a simple randomized sampling. Surveys were administered to adolescents, parents, educators and senior health staff members to determine alcohol consumption, medical care quality and level of knowledge on the problem. A nominal group with health professionals was created. Two hundred and eighty eight adolescents were included. 54.5% were alcohol users, of which 30.2% were 10-11 years old. Those classified as low risk were prevailing (55.6%). 100% of the senior health staff expressed the need for a methodology of care. 90.4% of education staff considered adolescence as a vulnerable stage. Relatives reported that there should be adolescent-specific medical appointments (61.8%). The nominal group's most important opinions were based on the main features that a consultation for adolescents should have and on the problems hindering proper care. Alcohol consumption was considered high and early start prevailed. Insufficient care to early adolescents who use alcohol was made evident. Sociedad Argentina de Pediatría.

  2. How lead consultants approach educational change in postgraduate medical education.

    NARCIS (Netherlands)

    Fokkema, J.P.; Westerman, M.; Teunissen, P.W.; Lee, N.; Scherpbier, A.J.J.A.; Vleuten, C.P.M. van der; Dorr, P.J.; Scheele, F.

    2012-01-01

    CONTEXT: Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead

  3. Changing Attitudes of Medical Teachers Towards Medical Education

    Science.gov (United States)

    Gale, Janet; And Others

    1976-01-01

    Based on the theory of cognitive dissonance, the experience-linked practical problem solving approach of this workshop method encourages behavior change, presuming this to cause attitude change. Testing by a Likert-type attitude scale and follow-up studies showed that attitudes were changed. (Author/LBH)

  4. Use of mifepristone and sublingual misoprostol for early medical abortion.

    Science.gov (United States)

    Lin, Mau; Li, Yiu-Tai; Chen, Fu-Min; Wu, Shu-Fang; Tsai, Ching-Wan; Chen, Tien-Hui; Kuo, Tsung-Cheng

    2006-12-01

    Existing drug-induced abortion techniques involve oral administration of 200 mg of mifepristone, followed by oral administration of 600 microg of misoprostol 48 hours later, but the effects are variable. As revealed by recent research, sublingual and oral administrations of misoprostol are equally efficacious in terms of rapid absorption, but the former lasts longer in serum. Hence, in the near future, sublingual administration of misoprostol may become the most effective way to induce abortion. Women with intrauterine pregnancy up to 49 gestational days received vaginal ultrasonography, followed by oral administration of mifepristone 200 mg and sublingual administration of misoprostol 600 microg 48 hours later. They returned for follow-up consultations 3 and 14 days after. The definition of a successfully induced complete medical abortion was that the abortion occurred without surgery or evacuating the uterus. A total of 356 women underwent medical abortion; the complete abortion rate was 98.3% (350 women). Medical abortion was unsuccessful in five (1.7%) women, who eventually had to undergo dilation and curettage. Patients found the side effects to be bearable; the reported satisfaction rate was 89.9% (325 women). Medical abortion for early termination of pregnancy should be achieved by oral administration of mifepristone, followed by sublingual administration of misoprostol.

  5. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    Science.gov (United States)

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  6. EARLY MEDICAL REHABILITATION OF THE PATIENTS WITH SPINAL CORD INJURY

    Directory of Open Access Journals (Sweden)

    Aleš Demšar

    2003-12-01

    Full Text Available Background. Early medical rehabilitation (EMR of the patients with spinal cord injury is discussed in this article.For successful rehabilitation adequate surgical treatment, which enables early verticalisation, is compulsory.Predictable respiratory, vascular, intestinal and urologic complications, contractures and bed sores are described and algorhytms of EMR in the period of spinal shock and after, until transferring the patient to the IRSR, are presented.Respiratory therapy, thromboprophylaxis, kinesiotherapy and functional electrical stimulation as well as the methods of early bladder and bowel control, contractures and bed sores prevention, as procedures of EMR are fully presented.With special importance early verticalisation from the 5th post operative day with help of the tilt table is presented as the key point of EMR.Conclusions. With aggressive EMR the paraplegic patient is able to gain erect posture from the 5th post operative day, sits in a wheel chair from 10th to 14th day and stands in the paralel bar from 15th day on.

  7. The changing role of the medical illustrator.

    Science.gov (United States)

    Morton, R; Nicholls, J; Williams, R

    2000-06-01

    The annual meeting of the Australian Institute of Medical and Biological Illustration in Melbourne in November 1998 included keynote addresses from Richard Morton and Robin Williams. Both speakers looked at the future of the medical illustration profession, and in particular the impact of new technology. This matter was also addressed by Joe Nicholls in a presentation given at the Institute of Medical Illustrators' Annual Symposium in Warwick, UK, in September 1998. This paper is a synthesis of the ideas presented by these three speakers and elaborates on common themes in their presentations.

  8. Early gene expression changes with rush immunotherapy

    Directory of Open Access Journals (Sweden)

    Barnett Sherry

    2011-09-01

    Full Text Available Abstract Background To examine whether whole genome expression profiling could reveal changes in mRNA expression of peripheral blood mononuclear cells (PBMC from allergic patients undergoing rush immunotherapy (RIT that might be manifest within the first few months of treatment. Methods For this study, PBMC from three allergic patients undergoing RIT were assessed at four timepoints: prior to RIT, at 1 week and 7 week post-RIT, during build-up and at 4 months, after establishment of a maintenance dose. PBMC mRNA gene expression changes over time were determined by oligonucleotide microarrays using the Illumina Human-6 BeadChip Platform, which simultaneously interrogates expression profiles of > 47,000 transcripts. Differentially expressed genes were identified using well-established statistical analysis for microarrays. In addition, we analyzed peripheral blood basophil high-affinity IgE receptor (Fc epsilon RI expression and T-regulatory cell frequency as detected by expression of CD3+CD4+CD25bright cells at each timepoint using flow cytometry. Results In comparing the initial 2 timepoints with the final 2 timepoints and analyzing for genes with ≥1.5-fold expression change (p less than or equal to 0.05, BH-FDR, we identified 507 transcripts. At a 2-fold change (p less than or equal to 0.05, BH-FDR, we found 44 transcripts. Of these, 28 were up-regulated and 16 were down-regulated genes. From these datasets, we have identified changes in immunologically relevant genes from both the innate and adaptive response with upregulation of expressed genes for molecules including IL-1β, IL-8, CD40L, BTK and BCL6. At the 4 month timepoint, we noted a downward trend in Fc epsilon RI expression in each of the three patients and increased allergen-specific IgG4 levels. No change was seen in the frequency of peripheral T-regulatory cells expressed over the four timepoints. Conclusions We observed significant changes in gene expression early in peripheral

  9. Effect of Type D personality on medication adherence in early adolescents with asthma.

    Science.gov (United States)

    van de Ven, Monique O M; Witteman, Cilia L M; Tiggelman, Dana

    2013-12-01

    Medication adherence for daily preventive asthma medication is especially low during adolescence. In the present study, we aimed to test whether Type D personality (both as a category and with its constituent components (negative affectivity: NA and social inhibition: SI) separately and in interaction) predicts medication adherence of early adolescents with asthma. In a prospective study, 188 early adolescents with asthma who were prescribed daily preventive asthma medication completed questionnaires on Type D personality, medication adherence, socio-demographic and clinical information, and depressive symptoms in the Spring/Summer of 2011 (T1) and again 12months later (T2). Multiple regression analyses, controlling for demographic and clinical information and for depressive symptoms, were conducted to test whether Type D personality (either as a categorical or dimensional construct) predicted changes in medication adherence over time. Adherence was significantly lower at T2 than at T1 and this decrease was predicted by the categorical construct of Type D personality. Analyses of the two separate dimensions NA and SI and their interaction showed that higher scores on NA at T1 predicted more decrease in adherence over time. Neither SI nor the interaction between NA and SI predicted changes in adherence. This is the first study to test the relationship between Type D personality and medication adherence in adolescents. Although categorical Type D personality predicts mediation adherence of adolescent with asthma over time, dimensional analyses suggest that this is due to negative affectivity only, and not to the combination of negative affectivity and social inhibition. © 2013.

  10. Early Lessons on Bundled Payment at an Academic Medical Center.

    Science.gov (United States)

    Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

    2017-09-01

    Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate

  11. Changing Medical Students' Attitudes toward Older Adults

    Science.gov (United States)

    Gonzales, Ernest; Morrow-Howell, Nancy; Gilbert, Pat

    2010-01-01

    Given the growth in the number of older adults and the ageist attitudes many in the health care profession hold, interventions aimed at improving health professionals' attitudes toward older adults are imperative. Vital Visionaries is an intergenerational art program designed to improve medical students' attitudes toward older adults. Participants…

  12. Expanding Women's Rural Medical Work in Early Modern Brittany: The Daughters of the Holy Spirit

    Science.gov (United States)

    McHugh, Tim

    2012-01-01

    During the eighteenth century, orders of nursing sisters took on an expanded role in the rural areas of Brittany. This article explores the impact of religious change on the medical activities of these women. While limits were placed on the medical practice of unlicensed individuals, areas of new opportunity for nuns as charitable practitioners were created by devout nobles throughout the eighteenth century. These nuns provided comprehensive care for the sick poor on their patrons' estates, acting not only as nurses, but also in lieu of physicians, surgeons, and apothecaries. This article argues that the medical knowledge and expertise of these sisters from the nursing orders were highly valued by the elites of early modern Brittany. PMID:21724643

  13. Expanding women's rural medical work in early modern Brittany: the Daughters of the Holy Spirit.

    Science.gov (United States)

    McHugh, Tim

    2012-07-01

    During the eighteenth century, orders of nursing sisters took on an expanded role in the rural areas of Brittany. This article explores the impact of religious change on the medical activities of these women. While limits were placed on the medical practice of unlicensed individuals, areas of new opportunity for nuns as charitable practitioners were created by devout nobles throughout the eighteenth century. These nuns provided comprehensive care for the sick poor on their patrons' estates, acting not only as nurses, but also in lieu of physicians, surgeons, and apothecaries. This article argues that the medical knowledge and expertise of these sisters from the nursing orders were highly valued by the elites of early modern Brittany.

  14. Changing perspectives in medical practice: disruptive innovation.

    Science.gov (United States)

    Paterick, Zachary R; Pradhan, Sala R; Paterick, Timothy E; Waterhouse, Blake E

    2009-01-01

    Disruptive innovation represents a business model that identifies a market location and increases consumer options. Retail clinics may represent a disruptive healthcare innovation that identifies strategies to reduce the cost of healthcare at the primary care level. The future of healthcare demands disruptive innovation that will allow for the 50 million uninsured members of our society to receive medical care. Disruptive innovative solutions need to ensure access, quality, and reasonable cost. Retail clinics represent the tip of the iceberg in disruptive innovative thinking. The obstacles that retail clinics must solve will be lessons learned for those that identify future innovative techniques.

  15. Informatics and Medical Libraries: Changing Needs and Changing Roles.

    Science.gov (United States)

    Frisse, Mark E.; And Others

    1995-01-01

    Although the challenges faced by librarians and medical informaticians are sometimes different, the evolution of information technology and new forms of biomedical communication suggest an increasing convergence between the two disciplines. Both groups serve as information deliverers and curators, apply information technology to knowledge…

  16. Medical specialty considerations by medical students early in their clinical experience

    Directory of Open Access Journals (Sweden)

    Weissman Charles

    2012-03-01

    Full Text Available Abstract Background Specialty selection by medical students determines the future composition of the physician workforce. Selection of career specialties begins in earnest during the clinical rotations with exposure to the clinical and intellectual environments of various specialties. Career specialty selection is followed by choosing a residency program. This is the period where insight into the decision process might help healthcare leaders ascertain whether, when, and how to intervene and attempt to influence students' decisions. The criteria students consider important in selecting a specialty and a residency program during the early phases of their clinical rotations were examined. Methods Questionnaires distributed to fifth-year medical students at two Israeli medical schools. Results 229 of 275 (83% questionnaires were returned. 80% of the students had considered specialties; 62% considered one specialty, 25% two, the remainder 3-5 specialties. Students took a long-range view; 55% considered working conditions after residency more important than those during residency, another 42% considered both equally important. More than two-thirds wanted an interesting and challenging bedside specialty affording control over lifestyle and providing a reasonable relationship between salary and lifestyle. Men were more interested in well-remunerated procedure-oriented specialties that allowed for private practice. Most students rated as important selecting a challenging and interesting residency program characterized by good relationships between staff members, with positive treatment by the institution, and that provided much teaching. More women wanted short residencies with few on-calls and limited hours. More men rated as important residencies affording much responsibility for making clinical decisions and providing research opportunities. More than 50% of the students considered it important that their residency be in a leading department, and in

  17. Teaching About Climate Change in Medical Education: An Opportunity.

    Science.gov (United States)

    Maxwell, Janie; Blashki, Grant

    2016-04-26

    Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors' experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education. Significance for public healthThere is a strong case for teaching about climate change in medical education. Anthropogenic climate change is accepted by scientists, governments and health authorities internationally. Given the dire implications for human health, climate change is of fundamental relevance to future doctors. Integrating climate change into medical education offers an opportunity for future doctors to develop skills and insights essential for clinical practice and a public health role in a climate-changing world. This echoes a broader call for improved public health literacy among medical graduates. This paper provides medical schools with a rationale and an outline for teaching on climate change.

  18. Early adoption of new drug treatments: the role of continuing medical education and physician adaptivity.

    Science.gov (United States)

    Mascarenhas, Desmond; Singh, Baljit K; Singh, Amoolya H; Veer, Sally Vander

    2007-03-01

    The influence of continuing medical education (CME) on the adoption of new treatments is widely regarded as self-evident. Less well understood is how the dynamics of dissemination of new healthcare practices are influenced by the intersection of education with the adaptive characteristics of providers. We developed and validated a 43-item online instrument (eSAIL) for measuring adaptive style and used it to investigate the interplay of physician adaptivity with key components of effective medical education. Satisfactory Cronbach alpha and test-retest reliability coefficients were observed for all primary psychometric scales and a composite adaptivity scale. Discriminant, convergent, and predictive validities of eSAIL scales were consistent across all cohorts. Using an online medical education program for which data on physician behavioral change are available, we show that the rate of adoption of new drugs is driven by both psychological (adaptivity) and environmental (educational) inputs. We show for the first time that topic eminence, length of reinforcement period and physician adaptive score in the eSAIL are each proportional to early-adoption-related behavioral change. Using a simple forced-choice question, a cohort of 208 physicians was segmented into "A" (adaptive) and "C" (conservative) segments based on their eSAIL adaptivity z scores (+0.170 versus -0.234 respectively; P new drug treatments by similarly segmented physician cohorts was driven almost entirely by A-segment physicians, but only when those physicians were additionally exposed to effective medical education.

  19. Medically managing obesity: Offering hope or a disincentive to change?

    Science.gov (United States)

    Ogden, Jane; Arulgnanaseelan, Juliet

    2017-01-01

    As weight loss in primary care remains minimal, Health Professionals are advised to medically manage obesity-related risk factors including blood pressure and cholesterol. This experimental study evaluated the impact of medically managing risk factors on obese patients' motivation to change their behaviour. A vignette study with two arms: successful medical management (ie risk factors have improved) vs failed medical management (ie no change) set in three General Practices in the South of England. Overweight and obese patients (n=170) rated their behavioural intentions and beliefs after reading a vignette describing an overweight patient who had received either successful or failed medical management of their risk factors (blood pressure and cholesterol). Following successful medical management overweight and obese patients reported increased intentions to lose weight and a greater understanding of their condition. Medical management may change patient's understanding of their weight problem and motivate them to lose weight. Successful management relating to improvements in blood pressure and cholesterol may offer renewed hope and motivate obese patients to change their behaviour. This could be used as a teachable moment to encourage patients to see that obesity need not be an inevitable part of their lives. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Changes to postgraduate medical education in the 21st century.

    Science.gov (United States)

    Patel, Mehool

    2016-08-01

    Medicine is a constantly evolving profession, especially with the advent of rapid advances in the scientific base that underpins this vocation. In order to ensure that training in medicine is contemporary with the continuous evolution of the profession, there has been a multitude of changes to postgraduate medical education, particularly in the UK. This article aims to provide an overview of relevant key changes to postgraduate medical education in the UK during the 21st century, including changes to the structure, governance and commissioning of medical education, effects of European Working Time Directive on training, recent recommendations in the Future Hospital Commission report and Shape of training report, and recent requirements for accreditation of medical education trainers. Many of these recommendations will require complex discussions often at organisational levels, hopefully with some realistic and pragmatic solutions for implementation.

  1. Change and continuity in early modern cosmology

    CERN Document Server

    Bonner, Patrick

    2011-01-01

    Seen as a flash point of the Scientific Revolution, early modern astronomy witnessed an explosion of views about the function and structure of the world. This study explores these theories in a wide variety of settings, and challenges our view of modern science as the straightforward successor of Aristotelian natural philosophy.

  2. Early resistance change and stress/electromigrationmodeling in aluminium interconnects

    NARCIS (Netherlands)

    Petrescu, V.; Mouthaan, A.J.; Schoenmaker, W.

    1997-01-01

    A complete description for early resistance change and two dimensional simulation of mechanical stress evolution in confined Al interconnects, related to the electromigration, is given in this paper. The model, combines the stress/ vacancy concentration evolution with the early resistance change of

  3. Improving medical literature sourcing by first-year medical students in problem-based learning: outcomes of early interventions.

    Science.gov (United States)

    Krasne, Sally; Stevens, Carl D; Wilkerson, LuAnn

    2014-07-01

    To describe and report outcomes of interventions implemented in the preclerkship curriculum at the David Geffen School of Medicine at UCLA to guide students toward use of high-quality information sources and build a foundation for developing fluency in applying primary medical literature to answer clinical questions. The authors introduced three phases of change to instruction in literature searching and sourcing for beginning medical students writing learning issue essays: in phase 1 (2003-2006), students were introduced to online resources during orientation week and received a lecture on high-yield literature searching midway through their first curricular block; in phase 2 (2007-2008), the high-yield lecture shifted to orientation week, and a resource matrix and librarian-guided workshop on locating authoritative sources were added; and in phase 3 (2009), peer evaluation and collaboration were implemented. To track changes in sourcing skills, the authors analyzed 3,199 references from 665 essays written by 465 first-year students for two problem-based learning (PBL) cases during the first block of one representative year per phase (2006, 2008, 2009). Over the study period, the authors found significantly increased citations to peer-reviewed journal articles and guidelines and decreased citations to general public Web sites and highly abstracted resources. Peer feedback and collaboration in phase 3 were associated with maintenance of these gains. Early introduction of instruction on medical literature searching and sourcing, a librarian-guided workshop, and peer collaboration and feedback improved the quality of references cited by students in PBL essays during their first curricular block.

  4. Managing curricular change in the UWI medical schools.

    Science.gov (United States)

    Uchegbu, B O

    2001-12-01

    The ideal operational curriculum is dynamic. It is alive, constantly responding to changes within the social milieu served by its programmes. The medical curriculum of the University of the West Indies (UWI) has not been readily responsive to its catchment society's changing needs. This lack of resilience has created both curricular and administrative problems that have remained unsolved. Now, at the threshold of the twenty-first century, many more fundamental curricular changes are imperative in the UWI medical programme if the Faculty of Medical Sciences (FMS) is to be able to withstand the territorial invasions imminent from the global digital institutions of the new age. The new changes that will place the medical curriculum in line with the demands of the new Information Age will also remove the obnoxious effects of the 'dual curriculum' question and related issues. The Change Formula (Ch = V x P x D > C) that has worked the corporate transformations and realignments of the late twentieth century is applied to the thoughts of a reformed management of the UWI medical curriculum, and its ability to break down walls of resistance to change and liberate the curriculum to full dynamism is discussed.

  5. Benjamin Moore, Science, and Medical Planning in Early Twentieth-Century Britain

    Science.gov (United States)

    Lawson, Gordon S.

    2008-01-01

    Benjamin Moore (1867-1922), physiologist and biochemist, was an eminent member of the British scientific and medical community in the early twentieth century. As a founder and president of the State Medical Services Association (SMSA) from its establishment in 1912 until his untimely death in 1922, Moore was a prominent medical services activist…

  6. Managing change in postgraduate medical education: still unfreezing?

    Science.gov (United States)

    Agius, Steven J; Willis, Sarah C; McArdle, Patricia J; O'Neill, Paul A

    2008-01-01

    Modernizing Medical Careers (MMC) is an ambitious project to change the training of UK doctors. A key to its successful implementation is the ways that MMC is perceived and operationalized by senior doctors who act as local educational leaders and supervisors. To analyse hospital consultants' perceptions of the modernization process and its impact on their role as the primary educators of Senior House Officers (SHOs), using Schein's extended model to explain their stage in the process of change. We interviewed medical directors, College and clinical tutors and education supervisors at 6 Trusts. The transcripts were analysed using Schein's change model to explore the perceptions and assumptions of senior medical staff and to determine their stage in the process of change. 12 tutors, 12 supervisors, and 4/6 medical directors approached agreed to participate (28/30). Nine themes emerged from transcript analysis. These were related to the three-stage model of change. Most participants were at the stage of 'unfreezing', expressing views around disconfirmation of expectations, guilt and anxiety and feelings of some psychological safety. A smaller number were at the stage of 'moving to a new position'. There were limited examples of 'refreezing'. At the local delivery level, most senior doctors were aware of the need to review their current position and alter their approaches and assumptions about postgraduate medical education. Yet only a minority were moving forward. Considerable work remains for successful implementation of MMC.

  7. Teaching about climate change in medical education: an opportunity

    Directory of Open Access Journals (Sweden)

    Janie Maxwell

    2016-04-01

    Full Text Available Climate change threatens many of the gains in development and health over the last century. However, it could also be a catalyst for a necessary societal transformation to a sustainable and healthy future. Doctors have a crucial role in climate change mitigation and health system adaptation to prepare for emergent health threats and a carbon-constrained future. This paper argues that climate change should be integrated into medical education for three reasons: first, to prepare students for clinical practice in a climate-changing world; secondly, to promote public health and eco-health literacy; and finally, to deepen existing learning and strengthen graduate attributes. This paper builds on existing literature and the authors’ experience to outline potential learning objectives, teaching methods and assessment tasks. In the wake of recent progress at the United Nations climate change conference, COP-21, it is hoped that this paper will assist universities to integrate teaching about climate change into medical education.

  8. Protecting health from climate change: Preparedness of medical interns

    Directory of Open Access Journals (Sweden)

    Majra Jai

    2009-01-01

    Full Text Available Context : Climate change is a significant and emerging threat to public health and to meet the challenge, health systems require qualified staff. Aims : To study the preparedness of medical interns to meet the challenge of protecting health from climate change. Settings and Design: Medical colleges in a coastal town. Cross-sectional study. Materials and Methods: A proportionate number of medical interns from five medical colleges were included in the study. Level of awareness was used as a criterion to judge the preparedness. A self-administered, pretested, open-ended questionnaire was used. Responses were evaluated and graded. Statistical Analysis Used: Proportions, percentage, Chi-test. Results : About 90% of the medical interns were aware of the climate change and human activities that were playing a major role. Ninety-four percent were aware of the direct health impacts due to higher temperature and depletion in ozone concentration, and about 78% of the respondents were aware about the change in frequency / distribution of vector-borne diseases, water borne / related diseases, malnutrition, and health impact of population displacement. Knowledge regarding health protection was limited to mitigation of climate change and training / education. Options like adaptation, establishing / strengthening climate and disease surveillance systems, and health action in emergency were known to only nine (7%, eight (6%, and 17 (13%, respectively. Collegewise difference was statistically insignificant. Extra / co-curricular activities were the major source of knowledge. Conclusions : Majority of medical interns were aware of the causes and health impacts of climate change, but their knowledge regarding health protection measures was limited.

  9. Organizational factors and change strategies associated with medical home transformation.

    Science.gov (United States)

    Solberg, Leif I; Stuck, Logan H; Crain, A Lauren; Tillema, Juliana O; Flottemesch, Thom J; Whitebird, Robin R; Fontaine, Patricia L

    2015-01-01

    There is limited information about how to transform primary care practices into medical homes. The research team surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. These surveys measured priority for transformation, the presence of medical home practice systems, and the presence of various organizational factors and change strategies. Survey response rates were 98% for the Change Process Capability Questionnaire survey and 92% for the Physician Practice Connections survey. They showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies. Higher priority for this change (P = .001) and use of more strategies (P = .05) were predictive of greater change in systems. Clinics contemplating medical home transformation should consider the factors and strategies identified here and should be sure that such a change is indeed a high priority for them. © The Author(s) 2014.

  10. Motivation, Work Satisfaction, and Teacher Change among Early Childhood Teachers

    Science.gov (United States)

    Wagner, Brigid Daly; French, Lucia

    2010-01-01

    This study tests the explanatory power of Deci and Ryan's (1985) self-determination theory as a framework for describing how interactions between early childhood teachers and the systems within which their work is embedded influence motivation for professional growth and change in teaching practice. Fifty-four early childhood teachers and teacher…

  11. Academia in Transition. Mid-Career Change or Early Retirement.

    Science.gov (United States)

    Patton, Carl V.

    The impact of early retirement plans and career change on the professional and personal lives of professors and on the manpower and fiscal structures of the universities they serve is examined. The book is based on more than 50 accounts of academics who took early retirement options and a comprehensive review of incentive programs for early…

  12. Scaffolding conceptual change in early childhood

    Science.gov (United States)

    Fleer, Marilyn

    1990-01-01

    The general educational literature draws our attention to the limitations of Piaget’s work and presents a number of interesting ideas that science educators and researchers could consider. Of interest are Soviet psychologist Lev Vygotsky’s writings on the zone of proximal development and the more recent writings of Jerome Bruner on scaffolding. The notion of learning as a a socially constructed process in opposition to the more individualistic orientation of Piaget has challenged much of our educational practice. This paper will briefly explore the basic tenets of constructivism and contrast the theories developed from within this paradigm to the work of Vygotsky and Bruner through an analysis of classroom discourse collected from a number of early childhood classes involved in the interactive teaching approach to science. Transcripts of teacher-child discourse are presented as evidence to support the proposition that when the teacher’s role is not clearly defined, the range of teacher-child interactions will vary enormously, and the subsequent learning outcomes for children will be quite different.

  13. Early phase telemedicine requirements elicitation in collaboration with medical practitioners

    NARCIS (Netherlands)

    Larburu Rubio, Nekane; Widya, I.A.; Bults, Richard G.A.; Hermens, Hermanus J.; Napolitano, Carlo

    2013-01-01

    Ubiquity of Information and Communication Technology enables innovative telemedicine treatment applications for disease management of ambulant patients. Development of new treatment applications must comply with medical protocols and ‘way of working’ to obtain safety and efficacy evidence before

  14. Change management - recommendations for successful electronic medical records implementation.

    Science.gov (United States)

    Shoolin, J S

    2010-01-01

    Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician's attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management.

  15. Change Management – Recommendations for Successful Electronic Medical Records Implementation

    Science.gov (United States)

    Shoolin, J.S.

    2010-01-01

    Summary Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician’s attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management. PMID:23616842

  16. Patient-doctor relationship: Changing perspectives and medical litigation

    Science.gov (United States)

    Ganesh, K.

    2009-01-01

    The patient doctor relational dimer has become complex with the hierarchical or fiduciary manner changing to an equal or un equal relationship. Trust and control are interchangeable, leading to increased patient requirements for disclosure and expectations of a cafeteria approach in diagnoses and management of his/her bodily condition. From any mismatch, there is a potential for medical litigation. In this context, the rise of global consumerism, the explosion of information available on the internet, and the changed manner of the medical profession from being shrouded in mystic / ceremony to trifurcation of medical services to doctoral diagnoses and management, ancillary pharmacy industry, and paramedical services like nursing, counselling and the new age quackery have contributed to this dimer. PMID:19881132

  17. Patient-doctor relationship: Changing perspectives and medical litigation

    Directory of Open Access Journals (Sweden)

    K Ganesh

    2009-01-01

    Full Text Available The patient doctor relational dimer has become complex with the hierarchical or fiduciary manner changing to an equal or un equal relationship. Trust and control are interchangeable, leading to increased patient requirements for disclosure and expectations of a cafeteria approach in diagnoses and management of his/her bodily condition. From any mismatch, there is a potential for medical litigation. In this context, the rise of global consumerism, the explosion of information available on the internet, and the changed manner of the medical profession from being shrouded in mystic / ceremony to trifurcation of medical services to doctoral diagnoses and management, ancillary pharmacy industry, and paramedical services like nursing, counselling and the new age quackery have contributed to this dimer.

  18. Patient-doctor relationship: Changing perspectives and medical litigation.

    Science.gov (United States)

    Ganesh, K

    2009-07-01

    The patient doctor relational dimer has become complex with the hierarchical or fiduciary manner changing to an equal or un equal relationship. Trust and control are interchangeable, leading to increased patient requirements for disclosure and expectations of a cafeteria approach in diagnoses and management of his/her bodily condition. From any mismatch, there is a potential for medical litigation. In this context, the rise of global consumerism, the explosion of information available on the internet, and the changed manner of the medical profession from being shrouded in mystic / ceremony to trifurcation of medical services to doctoral diagnoses and management, ancillary pharmacy industry, and paramedical services like nursing, counselling and the new age quackery have contributed to this dimer.

  19. Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson's Disease.

    Science.gov (United States)

    Hacker, Mallory L; Currie, Amanda D; Molinari, Anna L; Turchan, Maxim; Millan, Sarah M; Heusinkveld, Lauren E; Roach, Jonathon; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Byrne, Daniel W; Charles, David

    2016-01-01

    Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson's disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT). The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs. Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS. Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD.

  20. Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson’s Disease

    Science.gov (United States)

    Hacker, Mallory L.; Currie, Amanda D.; Molinari, Anna L.; Turchan, Maxim; Millan, Sarah M.; Heusinkveld, Lauren E.; Roach, Jonathon; Konrad, Peter E.; Davis, Thomas L.; Neimat, Joseph S.; Phibbs, Fenna T.; Hedera, Peter; Byrne, Daniel W.; Charles, David

    2016-01-01

    Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson’s disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT). Objective: The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs. Methods: Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS. Results: Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p <  0.05; OR = 0.2; 95% CI: 0.04–0.97). Conclusions: STN-DBS in early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD. PMID:26967937

  1. Why employees resist change in medical group practice acquisitions.

    Science.gov (United States)

    Fabrizio, N

    1999-01-01

    Understanding employees' values and considerations is important in undergoing major organizational change. This research provides an insight of the business and financial aspects vs. the human relations aspects of acquiring a medical group practice. The five employees interviewed in this analysis provide insight as to the factors that employees consider in resisting change. Considering how employees feel through communicating will have a significant impact on efficiency, effectiveness and turnover.

  2. Intrasubject registration for change analysis in medical imaging

    NARCIS (Netherlands)

    Staring, M.

    2008-01-01

    Image matching is important for the comparison of medical images. Comparison is of clinical relevance for the analysis of differences due to changes in the health of a patient. For example, when a disease is imaged at two time points, then one wants to know if it is stable, has regressed, or

  3. Name Changes for Fungi of Medical Importance, 2012 to 2015.

    Science.gov (United States)

    Warnock, David W

    2017-01-01

    This article lists proposed new or revised species names and classification changes associated with fungi of medical importance for the years 2012 through 2015. While many of the revised names listed have been widely adopted without further discussion, some may take longer to achieve more general usage. Copyright © 2016 American Society for Microbiology.

  4. Medical students' emotional development in early clinical experience: a model.

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

    2014-08-01

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development.

  5. The relation between antihistamine medication during early pregnancy & birth defects

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2015-10-01

    Full Text Available Antihistamines are a group of medications which can inhibit various histaminic actions at one of two histamine receptors (H1 or H2. H1 receptor antagonists are used for the relief of allergic dermatological and nondermatological conditions. We will review classes of antihistamines (H1 antagonists and the relationship between specific antihistamines and specific birth defects. Although many findings provide reassurance about the relative safety of many antihistamine drugs and that any malformation reported is most probably caused by chance, studies are still required to assure fetal safety. As pruritus is sometimes troublesome for pregnant women topical medications like emollients should be tried first in the first trimester of pregnancy. Also pregnant women should be advised to consult their health care provider before taking any medication.

  6. Medical rota changes and venous thromboembolism prophylaxis in orthopaedic patients.

    Science.gov (United States)

    Bohler, Iain; George Mackenzie Jardine, Alan

    2014-01-01

    Efficacy of clinical guidelines to improve patient care is highly dependent on the ability of hospital teams to interpret and implement advised standards of care. Trimester and bi-annual rotation changes often see transference and loss of acquired experience and knowledge from wards with ensuing shortfalls in patient safety and care quality. Such shortfalls were noticed in the ability of our unit to adhere to national venous thromboembolism (VTE) prophylaxis measures. A prospective quality improvement audit was embarked upon to address this. An initial audit of VTE prophylaxis in 112 patients demonstrated just 71% compliance with suggested measures. Errors were predominantly medical in origin and secondary to poor understanding, interpretation, and knowledge of VTE guidelines. Errors were also noted in nursing and patient compliance to measures. Repeated re-auditing demonstrated increased error (following initial improvement post audit) after periods of medical staff rotation. Through education of junior medical and nursing staff, and of patients, the unit was able to achieve 100% compliance. Rota changes often induce conflict of interest between maintaining adequate services and high levels of patient care or providing suitable and informed induction programmes for new medical staff. Emphasised education of VTE prophylaxis guidelines has now become part of induction of junior medical staff, whilst ward based measures ensure daily compliance. The success of the audit strategy has led to its use throughout other surgical units within the hospital.

  7. Learning styles of medical students change in relation to time.

    Science.gov (United States)

    Gurpinar, Erol; Bati, Hilal; Tetik, Cihat

    2011-09-01

    The aim of the present study was to investigate if any changes exist in the learning styles of medical students over time and in relation to different curriculum models with these learning styles. This prospective cohort study was conducted in three different medical faculties, which implement problem-based learning (PBL), hybrid, and integrated curriculum models. The study instruments were Kolb's Learning Style Inventory (LSI) and a questionnaire describing the students' demographic characteristics. Sample selection was not done, and all first-year students (n = 547) were targeted. This study was designed in two phases. In the first year, the study instruments were delivered to the target group. The next year, the same instruments were delivered again to those who had fully completed the first questionnaire (n = 525). Of these, 455 students had completed the instruments truly and constituted the study group. The majority of the students were assimilators and convergers in both the first and second years. A change in learning style was observed between 2 yr in 46.9% of the students in the integrated curriculum, in 49.3% of the students in the hybrid curriculum, and 56.4% of the students in the PBL curriculum. The least and most changes observed between the learning style groups were in assimilators and divergers, respectively. Curriculum models and other independent variables had no significant effect on the change between learning styles. The learning styles of medical students may change over time. Further followup studies in larger groups are needed to clarify this relation.

  8. Measuring Changes in the Economics of Medical Practice.

    Science.gov (United States)

    Fleming, Christopher; Rich, Eugene; DesRoches, Catherine; Reschovsky, James; Kogan, Rachel

    2015-08-01

    For the latter third of the twentieth century, researchers have estimated production and cost functions for physician practices. Today, those attempting to measure the inputs and outputs of physician practice must account for many recent changes in models of care delivery. In this paper, we review practice inputs and outputs as typically described in research on the economics of medical practice, and consider the implications of the changing organization of medical practice and nature of physician work. This evolving environment has created conceptual challenges in what are the appropriate measures of output from physician work, as well as what inputs should be measured. Likewise, the increasing complexity of physician practice organizations has introduced challenges to finding the appropriate data sources for measuring these constructs. Both these conceptual and data challenges pose measurement issues that must be overcome to study the economics of modern medical practice. Despite these challenges, there are several promising initiatives involving data sharing at the organizational level that could provide a starting point for developing the needed new data sources and metrics for physician inputs and outputs. However, additional efforts will be required to establish data collection approaches and measurements applicable to smaller and single specialty practices. Overcoming these measurement and data challenges will be key to supporting policy-relevant research on the changing economics of medical practice.

  9. Work-Stress Burnout in Emergency Medical Technicians and the Use of Early Recollections.

    Science.gov (United States)

    Vettor, Susan M.; Kosinski, Frederick A., Jr.

    2000-01-01

    Numerous studies have indicated a high work-stress burnout rate of emergency medical technicians, although none have used techniques predicting work-stress burnout. Discusses early memories that are representative of emergency medical technicians who may be susceptible to burnout, and memories that may indicate an individual's resistance to…

  10. Medical errors; causes, consequences, emotional response and resulting behavioral change.

    Science.gov (United States)

    Bari, Attia; Khan, Rehan Ahmed; Rathore, Ahsan Waheed

    2016-01-01

    To determine the causes of medical errors, the emotional and behavioral response of pediatric medicine residents to their medical errors and to determine their behavior change affecting their future training. One hundred thirty postgraduate residents were included in the study. Residents were asked to complete questionnaire about their errors and responses to their errors in three domains: emotional response, learning behavior and disclosure of the error. The names of the participants were kept confidential. Data was analyzed using SPSS version 20. A total of 130 residents were included. Majority 128(98.5%) of these described some form of error. Serious errors that occurred were 24(19%), 63(48%) minor, 24(19%) near misses,2(2%) never encountered an error and 17(12%) did not mention type of error but mentioned causes and consequences. Only 73(57%) residents disclosed medical errors to their senior physician but disclosure to patient's family was negligible 15(11%). Fatigue due to long duty hours 85(65%), inadequate experience 66(52%), inadequate supervision 58(48%) and complex case 58(45%) were common causes of medical errors. Negative emotions were common and were significantly associated with lack of knowledge (p=0.001), missing warning signs (p=<0.001), not seeking advice (p=0.003) and procedural complications (p=0.001). Medical errors had significant impact on resident's behavior; 119(93%) residents became more careful, increased advice seeking from seniors 109(86%) and 109(86%) started paying more attention to details. Intrinsic causes of errors were significantly associated with increased information seeking behavior and vigilance (p=0.003) and (p=0.01) respectively. Medical errors committed by residents have inadequate disclosure to senior physicians and result in negative emotions but there was positive change in their behavior, which resulted in improvement in their future training and patient care.

  11. Changes in intern attitudes toward medical error and disclosure.

    Science.gov (United States)

    Varjavand, Nielufar; Bachegowda, Lohith S; Gracely, Edward; Novack, Dennis H

    2012-07-01

    The 2000 Institute of Medicine report, 'To Err is Human: Building a Safer Health System', focused the medical community on medical error. This focus led to educational initiatives and legislation designed to minimise errors and increase their disclosure. This study aimed to investigate whether increased general awareness about medical error has affected interns' attitudes toward medical error and disclosure by comparing responses to surveys of interns carried out at either end of the last decade. Two cohorts of interns for the academic years 1999, 2000 and 2001 (n = 304) and 2008 and 2009 (n = 206) at a university hospital were presented with two hypothetical scenarios involving errors that resulted in, respectively, no permanent harm and an adverse outcome. The interns were questioned regarding their likely responses to error and disclosure. We collected 510 surveys (100% response rate). For both scenarios, the percentage of interns who would be willing to fully disclose their mistakes increased substantially from 1999-2001 to 2008-2009 ('no permanent harm': 38% and 71%, respectively [p interns in both scenarios believed 'the patient's right to full information' to be the primary reason for their disclosure. Fear of litigation in response to error disclosure decreased (70% and 52%, respectively), the percentage of interns who felt that 'medical mistakes are preventable if doctors know enough' decreased (49% and 31%, respectively), belief that competent doctors keep emotions and uncertainties to themselves decreased (51% and 14%, respectively), and agreement with leaving medicine if one (as an intern) caused harm or death decreased (50% and 3%, respectively). Prior training about medical mistakes increased more than four-fold between the cohorts. This comparison of intern responses to a survey administered at either end of the last decade reveals that there may have been some important changes in interns' intended disclosure practices and attitudes toward medical

  12. Changing opinions about research by Saudi medical students.

    Science.gov (United States)

    Abulaban, Ahmad; Alharbi, Abdulrahman; BinDajam, Osama; Al Jarbou, Mohammed; Alharbi, Hatem; Alanazi, Faiz; Aldamiri, Khalid; Althobaiti, Ahmed; Al Sayyari, Abdulla

    2017-01-01

    The objective of this study was to investigate and compare the opinions and attitudes of medical students toward medical research in five Saudi universities and examine the changes observed in these opinions and attitudes in one of these universities over a period of time. This is a cross-sectional study conducted among medical students in five Saudi universities. This study was based on a survey undertaken in 2015. The survey consisted of five questions inquiring about the opinions and attitudes of medical students toward medical research. The same survey was carried out 8 years earlier in one of these universities (King Abdulaziz University [KAU]), and the results obtained during the two periods (2007 and 2015) were compared. A convenient sample of 924 students was selected from five Saudi universities. Ninety-five (10.3%) of the medical students were not aware of the usefulness and importance scientific research will have on their future careers. A total of 409 (44.3%) stated that they had no knowledge on how to conduct scientific research. On the other hand, a vast majority of medical students (98.1%) expressed a willingness and interest to participate in scientific research if provided with an opportunity. The percentage of students from KAU strongly agreeing to participate in research rose from 33.1% in 2007 to 81.5% in 2015 (P=0.001). Of all the students surveyed, 431 (46.6%) had participated in scientific research as undergraduates. Most students in five Saudi universities expressed enthusiasm for participating in a research project, but only a few of them had sufficient knowledge on basic research. There was considerable improvement in students' perception of research in KAU when comparing their responses in 2007 to those in 2015.

  13. Expected Benefits of Streamlining Undergraduate Medical Education by Early Commitment to Specific Medical Specialties

    Science.gov (United States)

    Benbassat, Jochanan; Baumal, Reuben

    2012-01-01

    Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be…

  14. Early versus late misoprostol administration after mifepristone for medical abortion.

    Science.gov (United States)

    Tendler, Rene; Bornstein, Jacob; Kais, Mohamad; Masri, Irina; Odeh, Marwan

    2015-11-01

    To evaluate the successful medical termination of pregnancy comparing two regimens: misoprostol 2 or 48 h after mifepristone administration. Prospective randomized study. Department of Obstetrics and Gynecology. One hundred pregnant women admitted for medical termination of pregnancy were enrolled; no pregnancies were over 55 days gestational age. All subjects were randomly assigned for misoprostol administration either 2 or 48 h after mifepristone. All participants underwent transvaginal ultrasound examination for uterine contents 48 h and 3 weeks after mifepristone. Procedure failure, defined as the presence of fetal heart activity, presence of a gestational sac, or a need for uterine curettage after misoprostol administration. Each group consisted of 50 women. Fetal heart activity was significantly more frequent after 48 h in the 2-h interval group (10/50) than in the 48-h interval group (0/50) (p = 0.002). Three weeks after misoprostol administration, fetal heart activity was present in 4/50 (8 %) in the 2-h interval group (p = 0.118) and none of the 48-h interval group. At 48 h residual tissue was present in 13/50 (26 %) and 5/50 (10 %) in the 2 and 48-h interval groups, respectively (p = 0.031); this was reduced to 12/50 (24 %) compared to 5/50 (10 %) in the two groups, respectively (p = 0.054) after 3 weeks. Successful medical termination of pregnancy can be achieved using misoprostol administration 2 h after mifepristone in 76 % of cases. However, this regimen is not recommended as it is significantly inferior to the traditional 48-h interval regimen.

  15. Changing opinions about research by Saudi medical students

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    Abulaban A

    2017-08-01

    Full Text Available Ahmad Abulaban, Abdulrahman Alharbi, Osama BinDajam, Mohammed Al Jarbou, Hatem Alharbi, Faiz Alanazi, Khalid Aldamiri, Ahmed Althobaiti, Abdulla Al Sayyari Department of Medicine, Division of Neurology, King Saud bin-Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia Objective: The objective of this study was to investigate and compare the opinions and attitudes of medical students toward medical research in five Saudi universities and examine the changes observed in these opinions and attitudes in one of these universities over a period of time.Methods: This is a cross-sectional study conducted among medical students in five Saudi universities. This study was based on a survey undertaken in 2015. The survey consisted of five questions inquiring about the opinions and attitudes of medical students toward medical research. The same survey was carried out 8 years earlier in one of these universities (King Abdulaziz University [KAU], and the results obtained during the two periods (2007 and 2015 were compared.Results: A convenient sample of 924 students was selected from five Saudi universities. Ninety-five (10.3% of the medical students were not aware of the usefulness and importance scientific research will have on their future careers. A total of 409 (44.3% stated that they had no knowledge on how to conduct scientific research. On the other hand, a vast majority of medical students (98.1% expressed a willingness and interest to participate in scientific research if provided with an opportunity. The percentage of students from KAU strongly agreeing to participate in research rose from 33.1% in 2007 to 81.5% in 2015 (P=0.001. Of all the students surveyed, 431 (46.6% had participated in scientific research as undergraduates.Conclusion: Most students in five Saudi universities expressed enthusiasm for participating in a research project, but only a few of them had

  16. Resilience in Change: Positive Perspectives on the Dynamics of Change in Early Childhood Systems

    Science.gov (United States)

    Douglass, Anne

    2016-01-01

    Change is a central feature of the early care and education landscape today. Much of the research on educational change focuses on the negative or challenging aspects of change. This study employed a critical theory framework from the organizational sciences field, positive organizational scholarship, to offer a new way of thinking about change in…

  17. An evaluation of early medication use for COPD: a population-based cohort study

    Science.gov (United States)

    Falk, Jamie; Dik, Natalia; Bugden, Shawn

    2016-01-01

    Purpose The aim of this study was to evaluate the first initiation, sequence of addition, and appropriate prescribing of COPD medications in Manitoba, Canada. Patients and methods A population-based cohort study of COPD medication use was conducted using administrative health care data (1997–2012). Those aged ≥35 years with COPD based on three or more COPD-related outpatient visits over a rolling 24-month window or at least one COPD-related hospitalization were included. The first medication(s) dispensed on or after the date of COPD diagnosis were determined based on pharmacy claims. The next medication(s) in sequence were determined to be additions or switches to the previous regimen. Evaluation of guideline-based appropriateness to receive inhaled corticosteroids (ICS) was based on exacerbation history and past medication use. Results Of 13,369 patients dispensed COPD medications after diagnosis, 66.0% were dispensed short-acting bronchodilators as first medications. Although long-acting bronchodilators alone were uncommonly used as first or subsequent medications, ICS were dispensed as first medications in 28.2% of patients. Over the study period, use of short-acting bronchodilators as first medications declined from 70.6% to 59.4% (PICS as a first medication increased from 23.5% to 34.4% (PICS plus a long-acting β-agonist increased dramatically from 1.2% to 27.3% (PICS, 52.4% met Canadian guideline criteria for initiating an ICS, whereas 0.3% met Global Initiative for Chronic Obstructive Lung Disease guideline criteria. Conclusion The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly predominant use of multiple first medications, indicates a significant degree of medication burden in this already complex patient population. PMID:27994449

  18. The origins of scientific cinematography and early medical applications.

    Science.gov (United States)

    Barboi, Alexandru C; Goetz, Christopher G; Musetoiu, Radu

    2004-06-08

    To examine the neurologic cinematographic contributions of Gheorghe Marinescu. Near the end of the 19th century, cinematography developed and was immediately recognized as a new technique applicable to medical documentation. After studying with several prominent European neurologists and deeply influenced by Jean-Martin Charcot, Marinescu returned to Bucharest in 1897 and applied moving picture techniques to the study of neurologic patients. The Romanian State Archives were researched for original Marinescu films, and related publications were translated from Romanian and French. Between 1899 and 1902, Marinescu perfected the use of cinematography as a research method in neurosciences and published five articles based on cinematographic documents. He focused his studies particularly on organic gait disorders, locomotor ataxia, and hysteria. He adapted Charcot's method of lining up several patients with the same disorder and showing them together to permit appreciation of archetypes and formes frustes. He decomposed the moving pictures into sequential tracings for publication. He documented treatment results with cases filmed before and after therapy. Processed and digitized excerpts of these films accompany this manuscript. Marinescu's cinematographic studies led to several original contributions in clinical neurology. Remaining film archives include examples of many neurologic diseases, his examination techniques, and the working medical environment of the young founder of the Romanian school of neurology.

  19. Regenerative Medicine at Early Echelons: Changing Medical Care & Outcomes

    Science.gov (United States)

    2010-04-01

    cells from the epidermis and the bulge region of hair follicles also participate in this re-epithelialization event [28, 29]. When the wound is near...Stem cells in the hair follicle bulge contribute to wound repair but not to homeostasis of the epidermis. Nature Medicine 2005; 11:1351-1354. PMID...Different cells, suspended in solution, are placed in cartridges much like an inkjet printer. Thus, multiple cell types could be delivered to targeted

  20. A History of Medicine and the Establishment of Medical Institutions in Middlesex County, New Jersey that Transformed Doctor and Patient Relationships during the Early Twentieth Century

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    Whitfield-Spinner, Linda

    2011-01-01

    The early twentieth century was a period of tremendous advancements in medicine and technology and as a result experienced a revolutionary change in the delivery of healthcare in America. Modern medicine which encompassed specialized knowledge, technical procedures, and rules of behavior, changed the way medical care was provided in the United…

  1. A History of Medicine and the Establishment of Medical Institutions in Middlesex County, New Jersey that Transformed Doctor and Patient Relationships during the Early Twentieth Century

    Science.gov (United States)

    Whitfield-Spinner, Linda

    2011-01-01

    The early twentieth century was a period of tremendous advancements in medicine and technology and as a result experienced a revolutionary change in the delivery of healthcare in America. Modern medicine which encompassed specialized knowledge, technical procedures, and rules of behavior, changed the way medical care was provided in the United…

  2. Other than healing: medical practitioners and the business of life assurance during the nineteenth and early twentieth centuries.

    Science.gov (United States)

    Dupree, M W

    1997-04-01

    The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.

  3. Early versus Delayed Insertion of Intrauterine Contraception after Medical Abortion — A Randomized Controlled Trial

    Science.gov (United States)

    Sääv, Ingrid; Stephansson, Olof; Gemzell-Danielsson, Kristina

    2012-01-01

    Background Today, a large proportion of early abortions are medical terminations, in accordance to the woman's choice. Intrauterine contraceptives (IUC) provide highly effective, reversible, long-acting contraception. However, the effects of timing of IUC insertion after medical abortion are not known. Methods Women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUC were randomised to early insertion (day 5–9 after mifepristone) or delayed (routine) insertion (at 3–4 weeks after mifepristone). The primary outcome was the rate of IUC expulsion at six months after IUC insertion. Results A total of 129 women were randomized, and 116 women had a successful IUC insertion. There was no difference in expulsion rate between early (9.7%) vs. delayed (7.4%) IUC insertion (risk difference −9.2–13.4). Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI: 1.8–20.6%, p = 0.015), and a higher proportion of women (41%) had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16%) (p = 0.015). Adverse events were rare and did not differ between the groups. Conclusions Early insertion of IUC after medical abortion was safe and well tolerated with no increased incidence for expulsions or complications. Women were more likely to return for the IUC insertion if scheduled early after the abortion, and less likely to have had an unprotected intercourse prior to the IUC insertion. Early insertion should be offered as a routine for women undergoing first trimester medical abortion. Trial Registration ClinicalTrials.gov NCT01537562 PMID:23155432

  4. Early versus delayed insertion of intrauterine contraception after medical abortion - a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Ingrid Sääv

    Full Text Available BACKGROUND: Today, a large proportion of early abortions are medical terminations, in accordance to the woman's choice. Intrauterine contraceptives (IUC provide highly effective, reversible, long-acting contraception. However, the effects of timing of IUC insertion after medical abortion are not known. METHODS: Women undergoing medical abortion with mifepristone and misoprostol up to 63 days gestation and opting for IUC were randomised to early insertion (day 5-9 after mifepristone or delayed (routine insertion (at 3-4 weeks after mifepristone. The primary outcome was the rate of IUC expulsion at six months after IUC insertion. RESULTS: A total of 129 women were randomized, and 116 women had a successful IUC insertion. There was no difference in expulsion rate between early (9.7% vs. delayed (7.4% IUC insertion (risk difference -9.2-13.4. Furthermore, 1.5% of women randomized to early and 11.5% to delayed insertion did not attend the follow up (proportion difference 10.0%, 95% CI: 1.8-20.6%, p = 0.015, and a higher proportion of women (41% had had unprotected intercourse prior to returning for insertion in the delayed group compared with the early group (16% (p = 0.015. Adverse events were rare and did not differ between the groups. CONCLUSIONS: Early insertion of IUC after medical abortion was safe and well tolerated with no increased incidence for expulsions or complications. Women were more likely to return for the IUC insertion if scheduled early after the abortion, and less likely to have had an unprotected intercourse prior to the IUC insertion. Early insertion should be offered as a routine for women undergoing first trimester medical abortion. TRIAL REGISTRATION: ClinicalTrials.gov NCT01537562.

  5. The changing role of economic evaluation in valuing medical technologies.

    Science.gov (United States)

    Rotter, Jason S; Foerster, Douglas; Bridges, John Fp

    2012-12-01

    Economic evaluation is established within health-technology assessment but is challenged by those wanting to use economic evaluation to inform pricing and/or incorporate nontraditional sources of value and the views of diverse stakeholders. The changing role of economic evaluation in (formally or informally) assessing prices/values in four jurisdictions (UK, Australia, Germany and USA) is detailed and the authors propose a taxonomy of factors impacting the value of medical technology spanning clinical utility (effectiveness, safety/tolerability and quality of evidence), consumer demand (consumer preferences, process utility and unmet need), economic incentives (innovation, option value and market competition) and the societal perspective (social justice, social values and national interest). The authors suggest that multicriteria decision analysis methods grounded in hedonic-pricing theory can facilitate the valuing/pricing of medical technologies. The use of such an approach is hindered by a paucity of relevant educational opportunities, vested interests and aversion to placing prices/values on health.

  6. Complex and novel determinants of empathy change in medical students

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    Gerald Sng Gui Ren

    2016-03-01

    Full Text Available Purpose: Physician empathy is a core attribute in medical professionals, giving better patient outcomes. Medical school is an opportune time for building empathetic foundations. This study explores empathy change and focuses on contributory factors. Methods: We conducted a cross-sectional study involving 881 students (63% from Years 1 to 5 in a Singaporean medical school using the Jefferson Scale of Physician Empathy-Student version (JSPE-S and a questionnaire investigating the relationship between reported and novel personal-social empathy determinants. Results: Empathy declined significantly between preclinical and clinical years. Female and medical specialty interest respondents had higher scores than their counterparts. Despite strong internal consistency, factor analysis suggested that the JSPE model is not a perfect fit. Year 1 students had highest Perspective Taking scores and Year 2 students had highest Compassionate Care scores. High workload and inappropriate learning environments were the most relevant stressors. Time spent with family, arts, and community service correlated with higher empathy scores, whilst time spent with significant others and individual leisure correlated with lower scores. Thematic analysis revealed that the most common self-reported determinants were exposure to activity (community service or socialisation, personal and family-related event as well as environment (high work-load. Conclusion: While the empathy construct in multicultural Singapore is congruent with a Western model, important differences remain. A more subtle understanding of the heterogeneity of the medical student experience is important. A greater breadth of determinants of empathy, such as engagement in arts-related activities should be considered.

  7. Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study.

    Science.gov (United States)

    Hardeman, Rachel R; Przedworski, Julia M; Burke, Sara E; Burgess, Diana J; Phelan, Sean M; Dovidio, John F; Nelson, Dave; Rockwood, Todd; van Ryn, Michelle

    2015-09-01

    In this study, authors sought to characterize race and gender disparities in mental health in a national sample of first year medical students early in their medical school experience. This study used cross-sectional baseline data of Medical Student CHANGES, a large national longitudinal study of a cohort of medical students surveyed in the winter of 2010. Authors ascertained respondents via the American Association of Medical Colleges questionnaire, a third-party vendor-compiled list, and referral sampling. A total of 4732 first year medical students completed the baseline survey; of these, 301 were African American and 2890 were White. Compared to White students and after adjusting for relevant covariates, African American students had a greater risk of being classified as having depressive (relative risk (RR)=1.59 [95 % confidence interval, 1.37-2.40]) and anxiety symptoms (RR=1.66 [1.08-2.71]). Women also had a greater risk of being classified as having depressive (RR=1.36 [1.07-1.63]) and anxiety symptoms (RR-1.95 [1.39-2.84]). At the start of their first year of medical school, African American and female medical students were at a higher risk for depressive symptoms and anxiety than their White and male counterparts, respectively. The findings of this study have practical implications as poor mental and overall health inhibit learning and success in medical school, and physician distress negatively affects quality of clinical care.

  8. Association among change in medical costs, level of comorbidity, and change in adherence behavior.

    Science.gov (United States)

    Kymes, Steven M; Pierce, Richard L; Girdish, Charmaine; Matlin, Olga S; Brennan, Tryoen; Shrank, William H

    2016-08-01

    Interventions to improve medication adherence are effective, but resource intensive. Interventions must be targeted to those who will potentially benefit most. We examined what heterogeneity exists in the value of adherence based on levels of comorbidity, and the changes in spending on medical services that followed changes in adherence behavior. Retrospective cohort study examining medical spending for 2 years (April 1, 2011, to March 31, 2013) in commercial insurance beneficiaries. Multivariable linear modeling was used to adjust for differences in patient characteristics. Analyses were performed at the patient/condition level in 2 cohorts: adherent at baseline and nonadherent at baseline. We evaluated 857,041 patients, representing 1,264,797 patient therapies consisting of 40% high cholesterol, 48% hypertension, and 12% diabetes. Among those with 3 or more conditions, annual savings associated with becoming adherent were $5341, $4423, and $2081 for patients with at least diabetes, hypertension, and high cholesterol, respectively. The increased costs for patients in this group who became nonadherent were $4653, $7946, and $4008, respectively. Depending on the condition and the direction of behavior change, savings were 2 to 7 times greater than the value for individuals with fewer than 3 conditions. In most cases, the value of preventing nonadherence (ie, persistence) was greater than the value of moving people who are nonadherent to an adherent state. There is important heterogeneity in the impact of medication adherence on medical spending. Clinicians and policy makers should consider this when promoting the change of adherence behavior.

  9. University libraries and the indispensable changes in Medical Sciences

    Directory of Open Access Journals (Sweden)

    Maria Elinor Dulzaides Iglesias

    2009-03-01

    Full Text Available This work deals with some aspects related with university libraries as an ideal environment to articulate science, knowledge and culture and the need of reorganization of structures and functions within these institutions. We make reference to the changes in the Higher Educational System, which have an impact in other teaching levels. We discuss the new challenges in information and knowledge management and conditions in Medical Science field to adapt traditional methods to the new environment. We discuss how to support the required transformations to turn libraries into research and educational centres.

  10. Gestational Medication Use, Birth Conditions, and Early Postnatal Exposures for Childhood Asthma

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    Yang-Ching Chen

    2012-01-01

    Full Text Available Our aim is to explore (1 whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2 the dose responsiveness of such exposure, and (3 their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance.

  11. Solcoseryl prevents early postradiation changes in the lungs.

    Science.gov (United States)

    Starosławska, E; Chyczewski, L; Peszyński, J; Sobolewski, K; Bańkowski, E; Chyczewska, E; Nikliński, J; Donica, H; Kojtych, A

    1994-01-01

    The aim of the study was to test the influence of Solcoseryl on early postradiation changes in the lungs of rats. The chests of the rats were irradiated with Co-60, fractional dose 250 cGy/DT, total dose 2500 cGy/DT. Solcoseryl was given intraperitoneally in quantities of 0,1ml daily, during 60 days of the experiment. Morphological examinations of the lungs revealed that Solcoseryl decreased significantly the effects of early postradiation damage of the respiratory organ in rats.

  12. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review.

    Science.gov (United States)

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-02-09

    This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Early prehospital phase of a major incident. Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and 'major incidents' to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. CRD42013004473. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Medical conditions affect the outcome of early intervention in preschool children with autism spectrum disorders.

    Science.gov (United States)

    Eriksson, Mats Anders; Westerlund, Joakim; Hedvall, Åsa; Åmark, Per; Gillberg, Christopher; Fernell, Elisabeth

    2013-01-01

    The aim was to explore the frequency of genetic and other medical conditions, including epilepsy, in a population-based group of 208 preschool children with early diagnosis of Autism spectrum disorders (ASD) and to relate outcome at a 2-year follow-up to the co-existing medical findings. They had all received early intervention. The Vineland Adaptive Behaviour Scales (VABS-II) composite score served as the primary outcome measure. In the total group, 38/208 children (18 %) had a significant medical or genetic condition. Epilepsy was present in 6.3 % at the first assessment and in 8.6 % at follow-up and was associated with more severe intellectual impairment. A history of regression was reported in 22 %. Children with any medical/genetic condition, including epilepsy, as well as children with a history of regression had significantly lower VABS-II scores at the 2-year follow-up. Children with a medical/genetic condition, including epilepsy, had been diagnosed with ASD at an earlier age than those without such conditions, and early age at diagnosis also correlated negatively with adaptive functioning outcome. The results underscore the importance of considering medical/genetic aspects in all young children with ASD and the requirement to individualize and tailor interventions according to their specific needs.

  14. Doctors in society. Medical professionalism in a changing world.

    Science.gov (United States)

    2005-01-01

    Medicine bridges the gap between science and society. Indeed, the application of scientific knowledge to human health is a crucial aspect of clinical practice. Doctors are one important agent through which that scientific understanding is expressed. But medicine is more than the sum of our knowledge about disease. Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moments of fear, anxiety, and doubt. In this extremely vulnerable position, it is medical professionalism that underpins the trust the public has in doctors. This Working Party was established to define the nature and role of medical professionalism in modern society. Britain's health system is undergoing enormous change. The entry of multiple health providers, the wish for more equal engagement between patients and professionals, and the ever-greater contribution of science to advances in clinical practice all demand a clear statement of medicine's unifying purpose and doctors' common values. What is medical professionalism and does it matter to patients? Although evidence is lacking that more robust professionalism will inevitably lead to better health outcomes, patients certainly understand the meaning of poor professionalism and associate it with poor medical care. The public is well aware that an absence of professionalism is harmful to their interests. The Working Party's view, based on the evidence it has received, is that medical professionalism lies at the heart of being a good doctor. The values that doctors embrace set a standard for what patients expect from their medical practitioners. The practice of medicine is distinguished by the need for judgement in the face of uncertainty. Doctors take responsibility for these judgements and their consequences. A doctor's up-to-date knowledge and skill provide the explicit scientific and often tacit experiential basis for such judgements. But because so much of medicine's unpredictability calls for

  15. An evaluation of early medication use for COPD: a population-based cohort study

    Directory of Open Access Journals (Sweden)

    Falk J

    2016-12-01

    .Conclusion: The use of first-line medications has declined over time, replaced primarily by combination inhalers prescribed early without prior trials of appropriate next step medications. This, along with an increasingly predominant use of multiple first medications, indicates a significant degree of medication burden in this already complex patient population. Keywords: COPD, medication, inhaled steroids, Canada, guideline, appropriate

  16. Medical Students' Perspectives on Implementing Curriculum Change at One Institution.

    Science.gov (United States)

    Yengo-Kahn, Aaron M; Baker, Courtney E; Lomis, And Kimberly D

    2017-04-01

    Training physicians to be effective practitioners throughout their careers begins in undergraduate medical education with particular focus on self-directed inquiry, professional and interprofessional development, and competency-based assessment. A select number of medical schools are restructuring their curricula by placing the student at the center of content delivery to enhance the learning experience. While this restructuring may benefit the adult learner, administrators often make assumptions about how students will perceive and respond to such innovative and unfamiliar educational concepts. This can create a disconnect between students and their curriculum. Administrative mindfulness of student experiences is needed to ensure successful implementation of curricular change, facilitate the transition from old to new modalities, and train competent physician graduates.Vanderbilt University School of Medicine (VUSM) recently completed a curriculum update, and student representatives have been essential participants in the transition, from the earliest stages in preplanning to rapid-cycle feedback as the curriculum runs. Two of the authors are members of VUSM's Student Curriculum Committee, which facilitates gathering and relaying student feedback to the administration. Drawing from their experiences, five specific considerations to address and manage when implementing student-centered curricular change are presented: (1) Communicate the rationale, (2) acknowledge anxiety, (3) adjust extracurricular leadership roles, (4) manage "The Bulge" of learners in the clinical environment, and (5) foster ongoing collaboration of students and administrators. For each consideration, examples and proposed solutions are provided.

  17. Neural changes underlying early stages of L2 vocabulary acquisition.

    Science.gov (United States)

    Pu, He; Holcomb, Phillip J; Midgley, Katherine J

    2016-11-01

    Research has shown neural changes following second language (L2) acquisition after weeks or months of instruction. But are such changes detectable even earlier than previously shown? The present study examines the electrophysiological changes underlying the earliest stages of second language vocabulary acquisition by recording event-related potentials (ERPs) within the first week of learning. Adult native English speakers with no previous Spanish experience completed less than four hours of Spanish vocabulary training, with pre- and post-training ERPs recorded to a backward translation task. Results indicate that beginning L2 learners show rapid neural changes following learning, manifested in changes to the N400 - an ERP component sensitive to lexicosemantic processing and degree of L2 proficiency. Specifically, learners in early stages of L2 acquisition show growth in N400 amplitude to L2 words following learning as well as a backward translation N400 priming effect that was absent pre-training. These results were shown within days of minimal L2 training, suggesting that the neural changes captured during adult second language acquisition are more rapid than previously shown. Such findings are consistent with models of early stages of bilingualism in adult learners of L2 (e.g. Kroll and Stewart's RHM) and reinforce the use of ERP measures to assess L2 learning.

  18. Resistance to medical educational change: management and communication.

    Science.gov (United States)

    Tsai, Tsuen-Chiuan

    2007-01-01

    Medical education in Taiwan is currently undergoing active renovation. Reform and changes always bring resistance from the levels of individuals, institution and even the society. As an educational leader, to be able to manage resistance is a key to successful reform. This review article provides management strategies and communication skills to solve the resistance problem. The best solution to the problem is "to prevent" resistance from happening through identifying those who may be reluctant to change, and the reasons behind the potential resistance. Some of the reasons for resistance are threatening of self-interest and a loss of face, excess uncertainty, conservatism, fear of personal-worth declination in the organization, and different assessment or perception. The management and communication strategies are suggested to adjust to fit reform process, i.e., recognizing the needs for change, planning process, implementation, and institutionalization innovation. Finally, it is only with respect, empathy, sincerity and support that the resistance to changes can be resolved and difficulties can be overcome.

  19. Neuroscience curriculum changes and outcomes: medical university of South Carolina, 2006 to 2010.

    Science.gov (United States)

    Holden, Kenton R; Cooper, S Lewis; Wong, Jeffrey G

    2012-07-01

    To develop future neurologists and translational neuroscientists, we created a neurosciences pathway throughout our medical school curriculum that included early exposure to clinical neurosciences decision-making and added variety to the choices of later clinical neurosciences experiences. Our curricular innovation had 3 parts: (1) integrating basic neurosciences content into an explicit clinical context in a College of Medicine (COM) first year of medical school; (2) expanding pathophysiological principles related to neurosciences in COM second year of medical school; and (3) creating a variety of 3-week clinical neurosciences selectives in COM third year of medical school and 4-week electives/externships for interested learners in COM fourth year of medical school. These new changes were evaluated (1) by comparing national standardized examinations including Neurology Subject examination scores for students choosing clinical neurosciences selectives; (2) by student satisfaction Graduate Questionnaires; and (3) by the total number of our graduates matching in US neurosciences disciplines. Students taking neuroscience selectives demonstrated a nonsignificant trend toward higher Step 2 Clinical Knowledge scores. The students' Neurology Subject examination scores were comparable with those scores reported nationally for other US COM third year of medical school students on 4-week rotations. Student-reported satisfaction in clinical neurology teaching improved from 43.9% (before) to 81.8% (after). The percentage of students matching into clinical neuroscience disciplines rose from 2% (before) to 6% (after). Our neurosciences curricular innovation increased graduating student satisfaction scores, had a mild positive impact on Step 2 Clinical Knowledge scores, and increased the number of students choosing careers in the clinical neurosciences. This model may be a consideration for other medical schools who wish to integrate neurosciences teaching throughout their

  20. Perspectives of Therapist's Role in Care Coordination between Medical and Early Intervention Services

    Science.gov (United States)

    Ideishi, Roger I.; O'Neil, Margaret E.; Chiarello, Lisa A.; Nixon-Cave, Kim

    2010-01-01

    This study explored perspectives of therapist's role in care coordination between early intervention (EI) and medical services, and identified strategies for improving service delivery. Fifty adults participated in one of six focus groups. Participants included parents, pediatricians, and therapists working in hospital and EI programs. Structured…

  1. Defining smallness for gestational age in the early years of the Danish Medical Birth Registry

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Mathiasen, Rene; Greisen, Gorm

    2011-01-01

    Being born small for gestational age (SGA) is associated with decreased insulin sensitivity and increased blood pressure in childhood, but the association with clinical disease in early adulthood is less certain. The Danish Medical Birth Registry has registered all births in Denmark since 1973, b...

  2. The Early Interventionist and the Medical Problems of the Child with Down Syndrome.

    Science.gov (United States)

    Roizen, Nancy J.

    2003-01-01

    This article describes medical problems that occur more frequently in young children with Down syndrome. These include common cardiac, hearing, and vision problems and less common thyroid and celiac diseases. Guidelines for preventing dental and obesity problems are followed by suggestions to early interventionists for watching for leukemia, neck…

  3. Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer

    DEFF Research Database (Denmark)

    Iversen, L.H.; Bulow, S.; Christensen, Ib Jarle

    2008-01-01

    . The strongest risk factor for early death was postoperative medical complications (cardiopulmonary, renal, thromboembolic and infectious), with an odds ratio of 11.7 (95 percent confidence interval 8.8 to 15.5). Such complications occurred in 24.4 per cent of patients, of whom 57.8 per cent died. Other...

  4. Defining smallness for gestational age in the early years of the Danish Medical Birth Registry

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Mathiasen, Rene; Greisen, Gorm

    2011-01-01

    Being born small for gestational age (SGA) is associated with decreased insulin sensitivity and increased blood pressure in childhood, but the association with clinical disease in early adulthood is less certain. The Danish Medical Birth Registry has registered all births in Denmark since 1973...

  5. Increased knowledge of thalassemia promotes early carrier status examination among medical students

    Directory of Open Access Journals (Sweden)

    Julius Broto Dewanto

    2016-04-01

    A higher thalassemia knowledge score causes medical students to be willing to undergo thalassemia carrier status examination at an earlier point in timing. A well-organized educational program focusing on thalassemia and early screening in young adults may enhance the thalassemia prevention program.

  6. Changing the culture of medical training: An important step toward the implementation of competency-based medical education.

    Science.gov (United States)

    Ferguson, Peter C; Caverzagie, Kelly J; Nousiainen, Markku T; Snell, Linda

    2017-06-01

    The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.

  7. Early action on HFCs mitigates future atmospheric change

    Science.gov (United States)

    Hurwitz, Margaret M.; Fleming, Eric L.; Newman, Paul A.; Li, Feng; Liang, Qing

    2016-11-01

    As countries take action to mitigate global warming, both by ratifying the UNFCCC Paris Agreement and enacting the Kigali Amendment to the Montreal Protocol to manage hydrofluorocarbons (HFCs), it is important to consider the relative importance of the pertinent greenhouse gases and the distinct structure of their atmospheric impacts, and how the timing of potential greenhouse gas regulations would affect future changes in atmospheric temperature and ozone. HFCs should be explicitly considered in upcoming climate and ozone assessments, since chemistry-climate model simulations demonstrate that HFCs could contribute substantially to anthropogenic climate change by the mid-21st century, particularly in the upper troposphere and lower stratosphere i.e., global average warming up to 0.19 K at 80 hPa. The HFC mitigation scenarios described in this study demonstrate the benefits of taking early action in avoiding future atmospheric change: more than 90% of the climate change impacts of HFCs can be avoided if emissions stop by 2030.

  8. [The provincial medical system during the early days of Koryo Dynasty].

    Science.gov (United States)

    Lee, Kyung-Lock

    2007-12-01

    This article explores the setup and development of the provincial medical system during the early days of Koryo (918-1392) Dynasty. Under the reign of King HyunJong (1009-1031) the dualistic medical system of the UiSa (a medical officer) and the YakJumSa (a provincial medical officer) was established. The former, the officer of central government, were sent to the local government, and the latter, the successor of provincial powerful clan, operated the YakJum. The Uisa supervised the YakJumSa in 13 local governments, and it indicates the will and the limitation of the power of Koryo government. On the other hand, a great number of the YakJumSa were spreaded throughout the country except the capital and the vice capital, and it means the development of medical system during the early days of Koryo. The missions of the Uisa and the YakJumSa were instructing the medical students, collecting the tribute herbs, treatment, and relieve the poor people. And they just took the right of collecting tax of the land as their salaries, and it was different from the another officers. This dualistic medical system of the UiSa and the YakJumSa got under way in the reign of King MoonJong (1046-1083). But after the reign of King YeJong (1105-1122) the YakJumSa became the only provincial medical officer as the UiSa had been perished for reducing the ruling system. So the monistic medical system of the YakJumSa was the final provincial medical system of Koryo. Despite accomplishing the nationwide medical network with the YakJumSa, Koryo government failed to maintain and develop the provincial medical system with the UiSa. And it caused the difference of medical standard between the ruling class of the capital and the people of the province. Therefore, it can be said that the important principal of the medical system of Koryo was hierarchy accordance with the regional difference.

  9. Changes in moral reasoning and the teaching of medical ethics

    DEFF Research Database (Denmark)

    Holm, S; Norup, M; Vegner, A

    1995-01-01

    Courses in medical ethics are becoming an integral part of many medical school curricula in Europe. At the medical school of the University of Copenhagen, a course on philosophy of medicine has been compulsory for all medical students since 1988. The effect of such courses on the ethical awareness...

  10. Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

    2015-01-01

    Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

  11. Visual change detection recruits auditory cortices in early deafness.

    Science.gov (United States)

    Bottari, Davide; Heimler, Benedetta; Caclin, Anne; Dalmolin, Anna; Giard, Marie-Hélène; Pavani, Francesco

    2014-07-01

    Although cross-modal recruitment of early sensory areas in deafness and blindness is well established, the constraints and limits of these plastic changes remain to be understood. In the case of human deafness, for instance, it is known that visual, tactile or visuo-tactile stimuli can elicit a response within the auditory cortices. Nonetheless, both the timing of these evoked responses and the functional contribution of cross-modally recruited areas remain to be ascertained. In the present study, we examined to what extent auditory cortices of deaf humans participate in high-order visual processes, such as visual change detection. By measuring visual ERPs, in particular the visual MisMatch Negativity (vMMN), and performing source localization, we show that individuals with early deafness (N=12) recruit the auditory cortices when a change in motion direction during shape deformation occurs in a continuous visual motion stream. Remarkably this "auditory" response for visual events emerged with the same timing as the visual MMN in hearing controls (N=12), between 150 and 300 ms after the visual change. Furthermore, the recruitment of auditory cortices for visual change detection in early deaf was paired with a reduction of response within the visual system, indicating a shift from visual to auditory cortices of part of the computational process. The present study suggests that the deafened auditory cortices participate at extracting and storing the visual information and at comparing on-line the upcoming visual events, thus indicating that cross-modally recruited auditory cortices can reach this level of computation.

  12. Undergraduate Medical Education Research in Malaysia: Time for a Change.

    Science.gov (United States)

    Salam, Abdus; Hamzah, Jemaima Che; Chin, Tan Geok; Siraj, Harlina Halizah; Idrus, Ruszymah; Mohamad, Nabishah; Raymond, Azman Ali

    2015-01-01

    Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication. It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1(st) seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals. Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education.

  13. Children with medical complexity: the change in the pediatric epidemiology

    Directory of Open Access Journals (Sweden)

    Rino Agostiniani

    2014-06-01

    Full Text Available In the last years, epidemiological landscape of pediatric illness is changed; we are facing a progressive raising of the number of children affected by chronic illness (children with special health care needs [CSHCN], mainly due to the amelioration in surviving and in care. These patients have become the majority of the inpatients in some specialist hospitals, like the Meyer Children’s Hospital (Florence, Italy, in 2012. One important group of CSHCN is represented by the children who are most medically fragile and have the most intensive health care needs (children with medical complexity [CMC]. In these patients, the complexity of the pathological framework frequently results in a plenty of visits and tests, with high risk of redundant and expensive cares. They also need outside support networks such as advocacy and accommodations at school, at home, in social life. The CMC needs specific skill and new strategies that could involve pediatricians in hospital as in home care. The professional competencies are ready but a clear and shared strategy is lacking. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  14. Early career retention of Malawian medical graduates: a retrospective cohort study.

    Science.gov (United States)

    Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylene; Gwesele, Lyson; Dzowela, Titha; Hanson, Kara; Muula, Adamson S

    2015-01-01

    There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  15. The validity of student tutors’ judgments in early detection of struggling in medical school

    DEFF Research Database (Denmark)

    Dyhrberg O'Neill, Lotte

    2016-01-01

    of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted...... to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical...... students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4–1/3 of the students who eventually failed or dropped out, and for 3/4 of the strugglers they identified, they were correct in their judgments. Informal student tutor’s judgements showed incremental...

  16. [The evolutionist fallacy of early visitors. Analogies between 'primitive peoples' and prehistoric man in medical historiography].

    Science.gov (United States)

    Bruchhausen, Walter

    2006-01-01

    Accounts of 'prehistoric medicine' and 'ethnomedicine' have sometimes led to conclusions by analogy in medical historiography that are seen as highly problematic in modern cultural anthropology. However, this review of medical historical writings of the last three centuries shows that evolutionist identifications of early with foreign medicine were not a permanent trait of medical historiography. This approach flourished mainly in the climate of certain movements or periods that were characterised by fanatical belief in progress and by social utopias: the French Revolution, Darwinism and the period of industrial expansion in Germany, and National Socialism. Medical historiography shared this problematic approach with contemporary (social and cultural) anthropology, and - despite this methodological misuse - both acknowledged the legitimacy or even requirement of studying also similarities in the development of different periods and cultures.

  17. Mountains as early warning indicators of climate change

    Science.gov (United States)

    Williams, M. W.

    2015-12-01

    The panoramic splendor and complexity of mountain environments have inspired and challenged humans for centuries. These areas have been variously perceived as physical structures to be conquered, as sites of spiritual inspiration, and as some of the last untamed natural places on Earth. In our time, the perception that "mountains are forever" may provide solace to those seeking stability in a rapidly changing world. However, changes in the hydrology and in the abundance and species composition of the native flora and fauna of mountain ecosystems are potential bellwethers of global change, because these systems have a propensity to amplify environmental changes within specific portions of this landscape. Mountain areas are thus sentinels of climate change. We are seeing effects today in case histories I present from the Himalaya's, Andes, Alps, and Rocky Mountains. Furthermore, these ecosystem changes are occurring in mountain areas before they occur in downstream ecosystems. Thus, mountains are early warning indicators of perturbations such as climate change. The sensitivity of mountain ecosystems begs for enhanced protection and worldwide protection. Our understanding of the processes that control mountain ecosystems—climate interactions, snowmelt runoff, biotic diversity, nutrient cycling—is much less developed compared to downstream ecosystems where human habitation and development has resulted in large investments in scientific knowledge to sustain health and agriculture. To address these deficiencies, I propose the formation of an international mountain research consortium.

  18. Change in Physical Attraction in Early Romantic Relationships

    Directory of Open Access Journals (Sweden)

    Victor Karandashev

    2014-12-01

    Full Text Available The goal of our research was to study the changes in physical attraction during the early stages of romantic relationships. The longitudinal study explored the personality characteristics of a partner and relationship events affecting physical attraction of early (within the first year romantic relationships. Participants completed an eight-week longitudinal rating of their attraction toward their romantic partner. Factor analysis revealed behavioral, cognitive, emotional, and physiological dimensions. The behavioral and emotional dimensions play the largest role in attraction among both genders, with cognitive dimension also affecting attraction in women. Personality characteristics of one’s partner are significant predictors of physical attraction for both men and women. However, events occurring in the relationship seem to be only reliable predictors for a women’s attraction.

  19. Early postural changes in individuals with idiopathic Parkinson's disease.

    Science.gov (United States)

    Khallaf, Mohamed Elsayed; Fayed, Eman Elsayed

    2015-01-01

    Background and Objectives. Postural changes are frequent and disabling complications of Parkinson's disease (PD). Many contributing factors have been evident either related to disease pathology or to adaptive changes. This study aimed at studying the postural changes in subjects with Parkinson's disease and its relation to duration of illness and disease severity. Methods. Eighteen patients with PD and 18 healthy matched volunteers represented the sample of the study. The patients were at stage 1 or 1.5 according to the Modified Hoehn and Yahr Staging with duration of illness between 18 and 36 months. Three-dimensional analysis of the back surface was conducted to explore the postural changes in the sagittal and frontal planes in both the patients and the healthy subjects. Results. Kyphotic angle, lordotic angle, fleche cervicale, fleche lombaire, scoliotic angle, and associated vertebral rotation and pelvic obliquity were significantly increased in patients with PD compared to the healthy subjects (P ≤ 0.05). There was no association between the measured postural changes and duration of illness as well as the severity of the IPD (P ≤ 0.05). Conclusion. Postural changes start in the early stages of idiopathic PD and they have no relationship to the duration of illness and disease severity.

  20. MEDICAL FEE REFORMS, CHANGES IN MEDICAL SUPPLY DENSITIES, AND SUPPLIER-INDUCED DEMAND: EMPIRICAL EVIDENCE FROM JAPAN

    OpenAIRE

    2013-01-01

    This study empirically investigates whether several negative income shocks to medical suppliers lead them to provide patients with unnecessary and/or excessive treatments. We use a variable that is objectively assessed as representing inducement: the amount of fraudulent and/or incorrect claims detected during the bill inspection processes. The empirical results indicate that medical suppliers increase inducement by 7.5 percent in response to a 1 percent medical fee reduction, but that change...

  1. Prescription for change: accessing medication in transitional Russia.

    Science.gov (United States)

    Perlman, Francesca; Balabanova, Dina

    2011-11-01

    BACKGROUND Many Russians experienced difficulty in accessing prescription medication during the widespread health service disruption and rapid socio-economic transition of the 1990s. This paper examines trends and determinants of access in Russia during this period. METHODS Data were from nine rounds (1994-2004) of the Russia Longitudinal Monitoring Survey, a 38-centre household panel survey. Trends were measured in failing to access prescribed medication for the following reasons: unobtainable from a pharmacy, unable to afford and 'other' reasons. Determinants of unaffordability were studied in 1994, 1998 and 2004, using cross-sectional, age-adjusted logistic regression, with further multivariate analyses of unaffordability and failure to access for 'other' reasons in 2004. RESULTS After 1994, reporting of unavailability in pharmacies fell sharply from 25% to 4%. Meanwhile, unaffordability increased to 20% in 1998 but declined to 9% by 2004. In 1994, significant determinants of unaffordability were unemployment and lacking health care insurance in men. By 2004, determinants included low income and material goods in both sexes; rented accommodation and low education in men; and chronic disease and disability-related retirement in women. Not obtaining medicines for 'other' reasons was more likely amongst frequent male drinkers, and low educated or cohabiting women. Regional and gender differences were widest in 1998, coinciding with the Russian financial crisis. CONCLUSIONS Rapid improvements in drug availability in the late 1990s in Russia are a probable consequence of a more liberalized pharmaceutical sector and an improved pharmacy network, whilst later improvements in affordability may relate to expanded health care insurance coverage and economic recovery after the 1998 crash. A significant minority still finds prescription costs problematic, notably poorer and sick individuals, with inequalities apparently widening. Non-monetary determinants of affordability

  2. [Medical tourism: changing a world trend into a national resource].

    Science.gov (United States)

    Rotem, Amitai; Toker, Asaf; Mor-Yossef, Shlomo

    2009-01-01

    Medical tourism is a new world trend that has great potential. Many countries, especially in the Far East, invest in this emerging industry in order to build a modern medical infrastructure that will attract foreigners and will create a new source of income, while improving the medical services provided to the local community. This article reviews relevant Literature and recent research on medical tourism. We suggest that israel adopt a health policy that will use local know-how to turn it into a world leader in medical tourism.

  3. The Early Tech Development Course: Experiential Commercialization Education for the Medical Academician.

    Science.gov (United States)

    Servoss, Jonathan; Chang, Connie; Fay, Jonathan; Ward, Kevin

    2017-04-01

    Research produced by medical academicians holds promise for developing into biomedical innovations in therapeutics, devices, diagnostics, and health care information technology; however, the road to biomedical innovation is fraught with risk, including the challenge of moving from basic research insight onto a viable commercialization path. Compounding this challenge is the growing demand on medical academicians to be more productive in their clinical, teaching, and research duties within a resource-constrained environment. In 2014, the University of Michigan (UM) Medical School and College of Engineering codesigned and implemented an accelerated, biomedical-focused version of the National Science Foundation (NSF) Innovation Corps (I-Corps) program. The UM Early Tech Development (ETD) Course, designed for medical academicians exploring the commercial potential of early-stage ideas, covers the NSF I-Corps concept; supports the formation of teams of faculty, graduate, and medical students; and accommodates medical academicians' schedules. From 2014 to 2015, the ETD Course graduated 39 project teams from UM and other institutions. One-third of the teams have continued to pursue their projects, receiving additional funding, engaging industry partners, or enrolling in the NSF I-Corps program. The ETD Course, a potential pipeline to the NSF I-Corps program, captures a target audience of medical academicians and others in academic medicine. To better understand the long-term effects of the course and its relationship to the NSF I-Corps program, the authors will conduct a study on the careers of all ETD Course graduates, including those who have enrolled in NSF I-Corps versus those who have not.

  4. Early modern "citation index"? Medical authorities in academic treatises on plague (1480-1725).

    Science.gov (United States)

    Cerný, K

    2012-01-01

    The paper deals with the problem of early modern scientific citations. It attempts to establish a measure of scientific popularity in a specific area of the academic medicine in a way which resembles a modern evaluation of scientific activity (citation index). For this purpose an analysis of a series of plague treatises written between 1480 and 1725 in Europe was conducted. Citations for various historical medical authorities (Hippocrates, Galen, etc.) are given in Tables which reflect a long time development of popularity. The authorities from various groups (Ancient, Medieval, Arabic, Early Modern) are linked together, and "generic authorities" are explained and discussed.

  5. Changes, trends and challenges of medical education in Latin America.

    Science.gov (United States)

    Pulido M, Pablo A; Cravioto, Alejandro; Pereda, Ana; Rondón, Roberto; Pereira, Gloria

    2006-02-01

    This paper briefly reviews the current situation of Latin American medical schools and the search to improve the quality and professionalism of medical education through the region. Institutional evaluation and accreditation programs based on nationally ongoing developing standards have been accepted, now optimized and complemented by the framework of the Global & International Standards of Medical Education working jointly with the WFME. More recently, the process has evolved to look into the quality of the outcomes of the medicals as seen by examinations implemented at the end of medical studies and the initiation of medical practice. In addition, there is vision for the application of new programs such as the global minimum essential requirements advanced by the Institute for International Medical Education (IIME). The PanAmerican Federation of Associations of Medical Schools (PAFAMS), an academic, non-governmental organization, is fostering the exchange of ideas and experiences among members, associations and affiliated medical schools geared to focus on the quality and professionalism of the graduates of medical schools in Latin America. These actions also aim to consolidate databases of information on medical education and innovative endeavors in continuing professional education and development through e-learning projects in the region.

  6. Preterm births and use of medication in early adulthood: a population-based registry study.

    Science.gov (United States)

    Engeland, Anders; Bjørge, Tone; Klungsøyr, Kari; Skurtveit, Svetlana; Furu, Kari

    2017-07-01

    To explore associations between preterm birth and use of medications in young adulthood as a proxy for different diseases. We linked data on birth characteristics from the Medical Birth Registry of Norway (1967-1999) and the Norwegian Prescription Database (2004-2015). Individuals born as singletons during 1974-1984 and alive at the age of 31 were included (main analyses) (n = 450 555). Relative risks (RRs) with 95% confidence intervals (CIs) of using different medications were estimated by log-binomial regression. Population attributable risk and attributable risk percentage (PAR% and AR%) due to preterm birth were calculated. Individuals born preterm used more specific medications at age 30 than those born at term. The risks of being dispensed psychotropic medications overall and the subgroups antiepileptics, antipsychotics, anxiolytics and hypnotics were elevated in individuals born preterm. For attention-deficit/hyperactivity disorder medications, the risk was elevated in males born extremely preterm (RR 5.8; 95%CI: 2.2-15). The risk of being dispensed antiasthmatics increased by shorter gestational ages. For psychotropic medications, PAR% was 0.6% in males and 0.7% in females at age 30; AR% was 13% in males and 17% in females. For antiasthmatics, the corresponding figures were 1.4, 1.1, 24 and 23%. Individuals born preterm used more psychotropic medications overall and antiasthmatics around age 30 than those born at term. The proportions using these medications increased for those born at earlier gestational ages. Those born preterm, especially before 32 weeks of gestation, should be given special attention during early adulthood regarding development of symptoms and signs of certain diseases. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  7. Increased knowledge of thalassemia promotes early carrier status examination among medical students

    OpenAIRE

    Julius Broto Dewanto; Haryono Tansah; Sari Puspa Dewi; Helena Napitu; Ramdan Panigoro; Edhyana Sahiratmadja

    2016-01-01

    BACKGROUND Thalassemia is an autosomal recessive genetic disorder, in which the patient requires life-long blood transfusion. As Indonesia harbors 6 to 10% thalassemia carriers, thalassemia prevention measures such as early screening and education in the community are urgently needed. The aim of this study was to explore the knowledge, attitude and practice about thalassemia among young medical students. METHODS A cross-sectional analytic observational study was conducted on 179 su...

  8. [Early detection of cervical cancer in Chile: time for change].

    Science.gov (United States)

    Léniz Martelli, Javiera; Van De Wyngard, Vanessa; Lagos, Marcela; Barriga, María Isabel; Puschel Illanes, Klaus; Ferreccio Readi, Catterina

    2014-08-01

    Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80's changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities.

  9. The effect of early in-hospital medication review on health outcomes: a systematic review

    Science.gov (United States)

    Hohl, Corinne M; Wickham, Maeve E; Sobolev, Boris; Perry, Jeff J; Sivilotti, Marco L A; Garrison, Scott; Lang, Eddy; Brasher, Penny; Doyle-Waters, Mary M; Brar, Baljeet; Rowe, Brian H; Lexchin, Joel; Holland, Richard

    2015-01-01

    Aims Adverse drug events are an important cause of emergency department visits, unplanned admissions and prolonged hospital stays. Our objective was to synthesize the evidence on the effect of early in-hospital pharmacist-led medication review on patient-oriented outcomes based on observed data. Methods We systematically searched eight bibliographic reference databases, electronic grey literature, medical journals, conference proceedings, trial registries and bibliographies of relevant papers. We included studies that employed random or quasi-random methods to allocate subjects to pharmacist-led medication review or control. Medication review had to include, at a minimum, obtaining a best possible medication history and reviewing medications for appropriateness and adverse drug events. The intervention had to be initiated within 24 h of emergency department presentation or 72 h of admission. We extracted data in duplicate and pooled outcomes from clinically homogeneous studies of the same design using random effects meta-analysis. Results We retrieved 4549 titles of which seven were included, reporting the outcomes of 3292 patients. We pooled data from studies of the same design, and found no significant differences in length of hospital admission (weighted mean difference [WMD] –0.04 days, 95% confidence interval [CI] –1.63, 1.55), mortality (odds ratio [OR] 1.09, 95% CI 0.69, 1.72), readmissions (OR 1.15, 95% CI 0.81, 1.63) or emergency department revisits at 3 months (OR 0.60, 95% CI 0.27, 1.32). Two large studies reporting reductions in readmissions could not be included in our pooled estimates due to differences in study design. Conclusions Wide confidence intervals suggest that additional research is likely to influence the effect size estimates and clarify the effect of medication review on patient-oriented outcomes. This systematic review failed to identify an effect of pharmacist-led medication review on health outcomes. PMID:25581134

  10. Exploring Terrestrial Temperature Changes during the Early Eocene Hyperthermals

    Science.gov (United States)

    Snell, K. E.; Clyde, W. C.; Fricke, H. C.; Eiler, J. M.

    2012-12-01

    The Early Eocene is marked by a number of rapid global warming events called hyperthermals. These hyperthermals are associated with negative carbon isotope excursions (CIE) in both marine and terrestrial records. Multiple theories exist to explain the connection of these hyperthermals with the CIEs and each theory predicts different responses by the climate system. Characterizing the timing, duration and magnitude of temperature change that is associated with these hyperthermals is important for determining whether the hyperthermals are all driven by the same underlying climate dynamics or perhaps differ from one another in cause and climatic consequences. In the simplest case, all share a common underlying mechanism; this predicts that the associated temperature changes scale in a predictable way with the magnitude of the CIE (and perhaps exhibit other similarities, such as the relative amplitudes of marine and terrestrial temperature change). To our knowledge, however, the only hyperthermal with paleotemperature data from land is the Paleocene-Eocene Thermal Maximum (PETM). Here we present preliminary carbonate clumped isotope paleotemperature estimates for Early Eocene hyperthermal ETM2/H2 from paleosol carbonates from the Bighorn Basin in Wyoming, USA. We compare the results to existing clumped isotope paleotemperature estimates for the PETM in the Bighorn Basin. Temperatures recorded by paleosol carbonates (which likely reflect near-peak summer ground temperatures) prior to each CIE are ~30°C and increase to ~40-43°C during the apex of each CIE. Following both CIEs, temperatures drop back to pre-CIE values. In the case of ETM2/H2, temperatures begin to rise again immediately, possibly in association with a later hyperthermal, though further work needs to be done to establish this with certainty. These preliminary data suggest that both the absolute values and the magnitudes of temperature changes associated with the PETM and ETM2/H2 are similar; the

  11. Physical Activity and Early Rehabilitation in Hospitalized Elderly Medical Patients: Systematic Review of Randomized Clinical Trials.

    Science.gov (United States)

    Martínez-Velilla, N; Cadore, L; Casas-Herrero, Á; Idoate-Saralegui, F; Izquierdo, M

    2016-01-01

    To critically review the effect of interventions incorporating exercise and early rehabilitation (physical therapy, occupational therapy, and physical activity) in the functional outcomes (i.e., active daily living tests, such as Barthel Index Scores, Timed-up-and go, mobility tests), and feasibility in hospitalized elderly medical patients. Systematic review of the literature. A literature search was conducted using the following databases and medical resources from 1966 to January 2014: PubMed (Medline), PEDro, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, Google Scholar, ClinicalTrials.gov, Clinical Evidence, SportsDiscus, EMBASE and UptoDate. Studies must have mentioned the effects of early rehabilitation on the above mentioned functional outcomes and feasibility. Data on the mortality, economic profile and average stay were also described. From the 6564 manuscripts potentially related to exercise performance in hospitalized elderly patients, the review focused on 1086, and 17 articles were ultimately included. Regarding functional outcomes after discharge, four studies observed significant improvement in functional outcomes following early rehabilitation, even up to twelve months after discharge. Eight studies directly or indirectly assessed the economic impact of exercise intervention. Five of them did not show any increase in costs, while three concluded that the intervention was cost effective. No adverse effect related with the interventions were mentioned. The introduction of an exercise program for hospitalized elderly patients may be feasible, and may not increase costs. Importantly, early rehabilitation may also improve the functional and healthcare.

  12. Primary Study on Medical Abortion in Early Pregnant Women with Myoma of Uterus

    Institute of Scientific and Technical Information of China (English)

    Chen CHEN; Xiao-ai LIU; Yu-cui JIN

    2002-01-01

    Objective To study the effectiveness and acceptability of the medical termination of early pregnancy accompanied with myoma Methods A total of 92 early pregnant women with myoma were admitted. Every woman was administrated mifepristone 150 mg in the first two days and Misoprostol 1 000 μg on d 3.Results The complete abortion rate was 89. 13%. The average bleeding duration was 11. 89± 6. 87 d. The expulsion time of gestational cyst was affected by the size of myoma. The bleeding duration and the expulsion time of gestational cyst were affected by the size of myoma and gestational cyst. The location and the number of myoma had no effect on the bleeding duration and the recovery of menses.Conclusion Mifepristone and Misoprostol could be safely and effectively used in the termination of early pregnancy with myoma.

  13. Power and Resistance: Leading Change in Medical Education

    Science.gov (United States)

    Sundberg, Kristina; Josephson, Anna; Reeves, Scott; Nordquist, Jonas

    2017-01-01

    A key role for educational leaders within undergraduate medical education is to continually improve the quality of education; global quality health care is the goal. This paper reports the findings from a study employing a power model to highlight how educational leaders influence the development of undergraduate medical curricula and the…

  14. Power and Resistance: Leading Change in Medical Education

    Science.gov (United States)

    Sundberg, Kristina; Josephson, Anna; Reeves, Scott; Nordquist, Jonas

    2017-01-01

    A key role for educational leaders within undergraduate medical education is to continually improve the quality of education; global quality health care is the goal. This paper reports the findings from a study employing a power model to highlight how educational leaders influence the development of undergraduate medical curricula and the…

  15. High resolution ultrasound and arterial wall changes in early atherosclerosis

    Science.gov (United States)

    Renton, Sophie Caroline

    Non-invasive vascular testing evolved initially to meet the needs of the surgeon to identify haemodynamically significant lesions. However, with refinement of techniques and the development of high resolution ultrasound, it has become possible to detect early lesions and to measure the thickness of die arterial wall with an accuracy of 0.2mm. Such measurements have epidemiological and prognostic potential. They may allow the study of progression (or regression) of atherosclerotic disease before symptoms develop. The aim of this thesis was to assess the value of arterial wall measurements of intima-media thickness and compliance of the common carotid artery in the prediction of early atherosclerotic disease. Four different anatomical patterns of carotid bulb morphology have been identified, according to the position of the bulb origin in relation to the flow divider. It has been demonstrated that bulb morphology influences the site of early plaque formation. The presence of plaque at the carotid and femoral bifurcations was found to be associated with increased intima-media thickening of the common carotid artery. Histological analysis of common carotid arteries taken at post-mortem showed that this diffuse intima-media thickening is the result of deposition of cholesterol crystals, medial atrophy, fatty and fibrous change, and accumulation of necrotic debris, the features characteristic of plaques, even though discrete plaques rarely occur at this site. Subsequently, a number of clinical studies were undertaken which demonstrated that the intima-media thickness is increased in diabetics, hypopituitary patients and claudicants as compared to controls. It was found that the intima-media thickness of the common carotid artery could be used to predict the presence of bifurcation plaques and macrovascular disease. The work of this thesis has demonstrated that high resolution ultrasound is a powerful technique for die study of the arterial wall and should be tested in

  16. Emerging Use of Early Health Technology Assessment in Medical Product Development: A Scoping Review of the Literature.

    Science.gov (United States)

    IJzerman, Maarten J; Koffijberg, Hendrik; Fenwick, Elisabeth; Krahn, Murray

    2017-07-01

    Early health technology assessment is increasingly being used to support health economic evidence development during early stages of clinical research. Such early models can be used to inform research and development about the design and management of new medical technologies to mitigate the risks, perceived by industry and the public sector, associated with market access and reimbursement. Over the past 25 years it has been suggested that health economic evaluation in the early stages may benefit the development and diffusion of medical products. Early health technology assessment has been suggested in the context of iterative economic evaluation alongside phase I and II clinical research to inform clinical trial design, market access, and pricing. In addition, performing early health technology assessment was also proposed at an even earlier stage for managing technology portfolios. This scoping review suggests a generally accepted definition of early health technology assessment to be "all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty". The present review also aimed to identify recent published empirical studies employing an early-stage assessment of a medical product. With most included studies carried out to support a market launch, the dominant methodology was early health economic modeling. Further methodological development is required, in particular, by combining systems engineering and health economics to manage uncertainty in medical product portfolios.

  17. Faculty Development for Fostering Clinical Reasoning Skills in Early Medical Students Using a Modified Bayesian Approach.

    Science.gov (United States)

    Addy, Tracie Marcella; Hafler, Janet; Galerneau, France

    2016-01-01

    Clinical reasoning is a necessary skill for medical students to acquire in the course of their education, and there is evidence that they can start this process at the undergraduate level. However, physician educators who are experts in their given fields may have difficulty conveying their complex thought processes to students. Providing faculty development that equips educators with tools to teach clinical reasoning may support skill development in early medical students. We provided faculty development on a modified Bayesian method of teaching clinical reasoning to clinician educators who facilitated small-group, case-based workshops with 2nd-year medical students. We interviewed them before and after the module regarding their perceptions on teaching clinical reasoning. We solicited feedback from the students about the effectiveness of the method in developing their clinical reasoning skills. We carried out this project during an institutional curriculum rebuild where clinical reasoning was a defined goal. At the time of the intervention, there was also increased involvement of the Teaching and Learning Center in elevating the status of teaching and learning. There was high overall satisfaction with the faculty development program. Both the faculty and the students described the modified Bayesian approach as effective in fostering the development of clinical reasoning skills. Through this work, we learned how to form a beneficial partnership between a clinician educator and Teaching and Learning Center to promote faculty development on a clinical reasoning teaching method for early medical students. We uncovered challenges faced by both faculty and early learners in this study. We observed that our faculty chose to utilize the method of teaching clinical reasoning in a variety of manners in the classroom. Despite obstacles and differing approaches utilized, we believe that this model can be emulated at other institutions to foster the development of clinical

  18. Early changes in corticospinal excitability when seeing fearful body expressions.

    Science.gov (United States)

    Borgomaneri, Sara; Vitale, Francesca; Avenanti, Alessio

    2015-09-21

    Quick inhibition of approach tendencies in response to signals of potential threats is thought to promote survival. However, little is known about the effect of viewing fearful expressions on the early dynamics of the human motor system. We used the high temporal resolution of single-pulse and paired-pulse transcranial magnetic stimulation (TMS) over the motor cortex to assess corticospinal excitability (CSE) and intracortical facilitation (ICF) during observation of happy, fearful and neutral body postures. To test motor circuits involved in approach tendencies, CSE and ICF were recorded from the first dorsal interosseous (FDI), a muscle involved in grasping, and the abductor pollicis brevis (APB), which served as a control. To test early motor dynamics, CSE and ICF were measured 70-90 ms after stimulus onset. We found a selective reduction in CSE in the FDI when participants observed fearful body expressions. No changes in ICF or in the excitability of APB were detected. Our study establishes an extremely rapid motor system reaction to observed fearful body expressions. This motor modulation involves corticospinal downstream projections but not cortical excitatory mechanisms, and appears to reflect an inhibition of hand grasping. Our results suggest a fast visuo-motor route that may rapidly inhibit inappropriate approaching actions.

  19. Occupational, social and medical characteristics of early prenatal leave in France.

    Science.gov (United States)

    Vigoureux, Solène; Blondel, Béatrice; Ringa, Virginie; Saurel-Cubizolles, Marie-Josèphe

    2016-12-01

    In France, most women of childbearing age work. The prenatal leave law in France protects women during pregnancy and their employment. We aimed to describe how long before delivery women stopped working and analyse the association between occupational, social and medical factors and early prenatal leave (before 24 weeks' gestation). The sample was extracted from the 2010 French National Perinatal Survey. Women were interviewed in French maternity units during a 1-week period. We focused on all women with a singleton live birth who were working during pregnancy (n = 10 149). Women were interviewed between delivery and discharge to collect information on employment, date of leave, sociodemographic and medical characteristics. Among women who worked during pregnancy, 27.5% reported early occupational leave (before 24 weeks' gestation). Early occupational leave was more frequent among women with unstable jobs (fixed-term vs. non-fixed-term contract: adjusted odds ratio aOR = 1.60 [95% confidence interval 1.40-1.84]) and with less-qualified occupational categories (manual workers vs. managers and upper-intellectual positions: aOR = 2.96 [2.30-3.82]), even after adjusting for sociodemographic and other employment characteristics. Women with a pathological or at risk pregnancy left work earlier than other women. After stratification on type of pregnancy there was still a higher rate of early leave for women with less qualified occupational group. In France, social vulnerability of pregnant women, linked to low sociodemographic situation or low occupational categories, is associated with early leave during pregnancy, even after stratification on type of pregnancy. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  20. Early serum human chorionic gonadotropin (hCG) trends after medication abortion.

    Science.gov (United States)

    Pocius, Katherine D; Maurer, Rie; Fortin, Jennifer; Goldberg, Alisa B; Bartz, Deborah

    2015-06-01

    Despite increased reliance on human chorionic gonadotropin (hCG) for early pregnancy monitoring, there is limited information about hCG trends soon after medication abortion. The purpose of this study was to determine if there is a predictable decline in serum hCG values shortly after medication abortion. This is a retrospective study of women with early intrauterine pregnancies who underwent medication abortion with mifepristone and misoprostol and had a serum hCG level on Day 1 (day of mifepristone) and a repeat value on Day 2 to 6. The percent hCG decline was calculated from baseline to repeat measure, with repeat values from the same patient accounted for through repeated measure analysis of variance. Eighty-eight women with a mean gestational age of 5.5 weeks and median baseline hCG of 5220 IU met study criteria over a 3-year period. The mean decline (±SD) in hCG from the Day 1 baseline value was 56.9%±29.5% on Day 3, 73.5%±38.6% on Day 4, 86.1%±8.8% on Day 5, and 92.9%±3.4% on Day 6. Eighty-two women (93% of the cohort) had a complete abortion without further intervention. The least square means hCG decline among these women was 57.6% [95% confidence interval (CI): 50.3-64.9%] on Day 3, 78.9% (95% CI: 75.0-82.8%) on Day 4 and 86.2% (95% CI: 81.3-91.1%) on Day 5. There is a rapid decline in serum hCG within the first few days after early medication abortion. Further research is needed to delineate how soon after medication abortion this decline may be specific enough to confirm abortion completion. This study provides the largest cohort of patients followed with serial hCG values in the first few days after medication abortion. Our findings demonstrate the trend in hCG decline in this population, which may be predictable by Day 5. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Medical Malpractice Phenomena: Signals for Changing Medical and Health Care Values

    DEFF Research Database (Denmark)

    Brødsgaard, I.; Moore, R.

    1990-01-01

    Excellent discussion of the economic factors such as medical malpractice and corporate medicine that have begun to interfere with the doctor-patient relationship and why this relationship is so essential in order to prevent medical malpractice. Issues of quality assurance are relevant to the doctor-patient...... relationship and the quality of health care....

  2. [Studies on the development of the medical occupational image in Egypt's early times].

    Science.gov (United States)

    Engelmann, Heinz; Hallof, Jochen

    2004-01-01

    Shamanism in pre-dynastic Egypt, practise by Sem-priests, combines social, psycho-hygienic and para-medical elements of both Near-Eastern and African provenance. These activities, which included health care and medical prophylaxes, were organised by highly qualified advisors of the Pharaoh with the establishment of Egyptian state religion. Their aim was to protect the rulers against his "enemies". These enemies included illnesses of all kinds, as well as injuries to health caused by impure food. The importance of this task is emphasised by the fact that it was usually the eldest son of the Pharoah who was responsible for the correct performance of the royal rituals, which included these medical aspects. Changes in religious concepts made these special advisors and priests superfluous. They took over other tasks in the funeral service of the Pharaoh or were included in the professional group of physicians, known from the time of the pyramids as "Sahkmet-priests", i.e. medical specialists. They were particularly responsible for precautionary measures against epidemics and for curing snake and scorpion bites. They created the first medical papyri and established the legal foundation for the medical care of the inhabitants of Egypt by royal order.

  3. Early warning of changing drinking water quality by trend analysis.

    Science.gov (United States)

    Tomperi, Jani; Juuso, Esko; Leiviskä, Kauko

    2016-06-01

    Monitoring and control of water treatment plants play an essential role in ensuring high quality drinking water and avoiding health-related problems or economic losses. The most common quality variables, which can be used also for assessing the efficiency of the water treatment process, are turbidity and residual levels of coagulation and disinfection chemicals. In the present study, the trend indices are developed from scaled measurements to detect warning signs of changes in the quality variables of drinking water and some operating condition variables that strongly affect water quality. The scaling is based on monotonically increasing nonlinear functions, which are generated with generalized norms and moments. Triangular episodes are classified with the trend index and its derivative. Deviation indices are used to assess the severity of situations. The study shows the potential of the described trend analysis as a predictive monitoring tool, as it provides an advantage over the traditional manual inspection of variables by detecting changes in water quality and giving early warnings.

  4. [Development of modern medical doctors in Japan from late Edo to early Meiji].

    Science.gov (United States)

    Kim, OckJoo; Takuya, Miyagawa

    2011-12-31

    Western medicine began to be introduced to Japan since late 16th century. Japanese encounter with Western medicine centered on Dejima in Nagasaki in the seventeenth and eighteenth century and the initial process of introduction was gradual and slow. In the mid-nineteenth century, facing threats from Western countries, Tokugawa bakufu asked Dutch naval surgeon, J. L. C. Pompe van Meerdervoort to teach western medicine at the Kaigun Denshujo naval academy in Nagasaki. The government also supported the western medical school in Edo. This paper deals with how modern western medical doctors were developed in Japan from late Edo to early Meiji. The publication of the New Text on Anatomy in 1774 translated by Sugita Genpaku and his colleagues stimulated Japanese doctors and scholars to study western medicine, called Rangaku. During the Edo period, western medicine spread into major cities and countryside in Japan through Rangaku doctors. In 1838, for example, Dr. Ogata Koan established the Rangaku school named Tekijuku and educated many people with western medicine. When smallpox vaccination was introduced in Japan in 1849, Rangaku doctors played an important role in practiving the vaccination in cities and in countryside. After the Edo bakufu and the feudal lords of han(han) actively pursued to introduce western medicine to their hans by sending their Samurai to Edo or Nagasaki or abroad and by establishing medical schools and hospitals until their abolition in 1871. In late Edo and early Meiii military doctors were the main focus of training to meet the urgent need of military doctors in the battle fields of civil wars. The new Meiji government initiated a series of top-down reformations concerning army recruitment, national school system, public health and medical system. In 1874, the government introduced a law on medicine to adopt western medicine only and to launch a national licence system for medical doctors. Issuing supplementary regulations in the following

  5. Acceptability and feasibility of mifepristone medical abortion in the early first trimester in Azerbaijan.

    Science.gov (United States)

    Louie, Karmen S; Tsereteli, Tamar; Chong, Erica; Aliyeva, Faiza; Rzayeva, Gulnara; Winikoff, Beverly

    2014-12-01

    To examine the acceptability and feasibility of early medical abortion using mifepristone and misoprostol in Azerbaijan. A total of 863 women in Baku and two regions of Azerbaijan who sought termination of gestations up to 63 days were enrolled in the study. In the capital, women swallowed 200 mg mifepristone in the clinic and were given the option of taking 800 μg misoprostol buccally either at the clinic or at home 24-48 hours later. In the regions, women were given the option of taking both drugs at home. Follow-up visits were to take place two weeks after mifepristone administration to determine abortion status. Seventy-four percent of women in the regions chose home administration of mifepristone, and 92% of women from all locations selected misoprostol home administration. Ninety-seven percent of women had complete abortions, and 97% were satisfied or very satisfied with the method. The vast majority of participants preferred medical abortion for a future procedure (96%). Nearly all women (98%) would recommend medical abortion for pregnancy termination to a friend. Mifepristone-misoprostol medical abortion with the option of home administration of both drugs is an acceptable and feasible option for women in Azerbaijan.

  6. Medical confidentiality in the late nineteenth and early twentieth centuries: an Anglo-German comparison1

    Science.gov (United States)

    2012-01-01

    Summary Professional secrecy of doctors became an issue of considerable medico-legal and political debate in the late nineteenth and early twentieth centuries in both Germany and England, although the legal preconditions for this debate were quite different in the two countries. While in Germany medical confidentiality was a legal obligation and granted in court, no such statutory recognition of doctors’ professional secrecy existed in England. This paper is a comparative analysis of medical secrecy in three key areas - divorce trials, venereal disease and abortion - in both countries. Based on sources from the period between c.1870 and 1939, our paper shows how doctors tried to define the scope of professional secrecy as an integral part of their professional honour in relation to important matters of public health. PMID:21077462

  7. How learning analytics can early predict under-achieving students in a blended medical education course.

    Science.gov (United States)

    Saqr, Mohammed; Fors, Uno; Tedre, Matti

    2017-07-01

    Learning analytics (LA) is an emerging discipline that aims at analyzing students' online data in order to improve the learning process and optimize learning environments. It has yet un-explored potential in the field of medical education, which can be particularly helpful in the early prediction and identification of under-achieving students. The aim of this study was to identify quantitative markers collected from students' online activities that may correlate with students' final performance and to investigate the possibility of predicting the potential risk of a student failing or dropping out of a course. This study included 133 students enrolled in a blended medical course where they were free to use the learning management system at their will. We extracted their online activity data using database queries and Moodle plugins. Data included logins, views, forums, time, formative assessment, and communications at different points of time. Five engagement indicators were also calculated which would reflect self-regulation and engagement. Students who scored below 5% over the passing mark were considered to be potentially at risk of under-achieving. At the end of the course, we were able to predict the final grade with 63.5% accuracy, and identify 53.9% of at-risk students. Using a binary logistic model improved prediction to 80.8%. Using data recorded until the mid-course, prediction accuracy was 42.3%. The most important predictors were factors reflecting engagement of the students and the consistency of using the online resources. The analysis of students' online activities in a blended medical education course by means of LA techniques can help early predict underachieving students, and can be used as an early warning sign for timely intervention.

  8. Native language change during early stages of second language learning.

    Science.gov (United States)

    Bice, Kinsey; Kroll, Judith F

    2015-11-11

    Research on proficient bilinguals has demonstrated that both languages are always active, even when only one is required. The coactivation of the two languages creates both competition and convergence, facilitating the processing of cognate words, but slowing lexical access when there is a requirement to engage control mechanisms to select the target language. Critically, these consequences are evident in the native language (L1) as well as in the second language (L2). The present study questioned whether L1 changes can be detected at early stages of L2 learning and how they are modulated by L2 proficiency. Native English speakers learning Spanish performed an English (L1) lexical decision task that included cognates while event-related potentials were recorded. They also performed verbal fluency, working memory, and inhibitory control tasks. A group of matched monolinguals performed the same tasks in English only. The results revealed that intermediate learners demonstrate a reduced N400 for cognates compared with noncognates in English (L1), and an emerging effect is visually present in beginning learners as well; however, no behavioral cognate effect was present for either group. In addition, slower reaction times in English (L1) are related to a larger cognate N400 magnitude in English (L1) and Spanish (L2), and to better inhibitory control for learners but not for monolinguals. The results suggest that contrary to the claim that L2 affects L1 only when L2 speakers are highly proficient, L2 learning begins to impact L1 early in the development of the L2 skill.

  9. Recent changes in Criminal Procedure Code and Indian Penal Code relevant to medical profession.

    Science.gov (United States)

    Agarwal, Swapnil S; Kumar, Lavlesh; Mestri, S C

    2010-02-01

    Some sections in Criminal Procedure Code and Indian Penal Code have a direct binding on medical practitioner. With changing times, few of them have been revised and these changes are presented in this article.

  10. Diagnosis and authority in the early-twentieth-century medical practice of Richard C. Cabot.

    Science.gov (United States)

    Crenner, Christopher

    2002-01-01

    This paper examines diagnostic practices using the early twentieth-century medical literature and the patient correspondence and records from the clinic of Richard Cabot. What shaped medicine's rapidly growing persuasive authority in the twentieth century? Diagnostic expertise demonstrated the doctor's control over disease but offered a service of ambiguous value to patients. Cabot and his peers offered differing views on how new diagnostic techniques would influence their relationships to their patients. In his busy private clinic Cabot put into effect an exacting diagnostic process, modeled on his innovative Clinicopathological Conferences. The people who came to the clinic often sought his technical expertise but accepted his diagnostic practices and opinions sometimes only provisionally.

  11. Early or Late Surgical Ligation of Medical Refractory Patent Ductus Arteriosus in Premature Infants

    Directory of Open Access Journals (Sweden)

    Chien-Chou Hsiao

    2009-01-01

    Full Text Available Optimal time to surgical ligation of patent ductus arteriosus (PDA in very-low-birth-weight ( 14 days groups. Basic clinical features, major morbidity of prematurity and mortality were compared. Clinical features and major outcomes were similar. The early ligation group had earlier onset of symptomatic PDA (5.7 ± 1.6 days vs. 8.1 ± 3.6 days, p = 0.024, and fewer days of total parenteral nutrition (TPN (39.6 ± 13.9 days vs. 60.4 ± 31.4 days, p = 0.025 and ventilator use (11.1 ± 6.7 days vs. 18.6 ± 10.5 days, p = 0.019. Early ligation of medical refractory PDA in very-low-birth-weight premature infants improves enteral feeding tolerance and reduces TPN and ventilator use, but long-term benefits need further investigation.

  12. [Lung and heart-lung transplantation in Rabin medical center: early experience with 70 cases].

    Science.gov (United States)

    Kramer, Mordechai R; Saute, Milton; Eidelman, Leonid; Aravot, Dan; Fink, Gershon; Shitrit, David; Izbicky, Gabriel; Izvicky, Gavriel; Dayan, Daniel Ben; Bakal, Ilana; Kogan, Alex; Gendel, Boris; Vidne, Bernardo; Sahar, Gideon

    2004-01-01

    Lung transplantation is a relatively new field in solid organ transplantation. We present our early experience with the first 70 cases at the Rabin Medical Center during the years 1997-2003. Forty seven patients underwent single lung, eight double lung and eight heart-lung transplantations. The patients treated included 49 men and 21 women aged 5-66 years. There were 26 cases with emphysema COPD. 30 patients with pulmonary fibrosis. 5 patients with pulmonary hypertension/Eisenmenger and 9 patients with cystic fibrosis and bronchiectasis. Although early results (1997-1999) showed 1 and 3 year survival of only 50%, in the last 3 years (2000-2003), survival reached 84% and 82% at 1 and 3 years respectively. Improvement in the success rate is due to better patient selection, new immunosuppressive regimen and, most importantly, excellent teamwork. We conclude that lung transplantation is a viable option for selected patients with end-stage lung disease.

  13. Enough is not enough: Medical students’ knowledge of early warning signs of childhood cancer

    Directory of Open Access Journals (Sweden)

    Jennifer Ann Geel

    2017-07-01

    Full Text Available Background. The reported incidence of childhood cancer in upper-middle-income South Africa (SA is much lower than in high-income countries, partly due to under-diagnosis and under-reporting. Documented survival rates are disturbingly low, prompting an analysis of potential factors that may be responsible. Objectives. To determine final-year medical students’ level of knowledge of early warning signs of childhood cancer and whether a correlation existed between test scores and participants’ age, gender and previous exposure to a person with cancer. Methods. A two-part questionnaire based on the Saint Siluan mnemonic, testing both recall and recognition of early warning signs of childhood cancer, was administered. The Mann-Whitney-Wilcoxon test was used to assess differences in continuous and count variables between demographic data, experience and responses, and Fisher’s exact test and Spearman’s rank correlation coefficient were used to determine correlations between demographic data, previous contact with persons with cancer and test scores. A novel equality ratio was calculated to compare the recall and recognition sections and allowed analysis of recall v. recognition. Results. The 84 participants recalled a median of six signs each (interquartile range 4 - 7 and correctly recognised a median of 70% in the recognition section, considered a pass mark. There was no correlation between participants’ age, gender, previous contact with a person with cancer and recognition scores. Students with previous exposure to a person with cancer had higher scores in the recall section, but this did not achieve statistical significance. Students were able to recognise more signs of haematological malignancies than central nervous system (CNS malignancies. Conclusion. The study demonstrated a marked inconsistency between recall and recognition of signs of childhood cancer, with signs of CNS malignancies being least recognised. However, the majority

  14. A prospective cohort study among new Chinese coal miners: the early pattern of lung function change

    Energy Technology Data Exchange (ETDEWEB)

    Wang, M.L.; Wu, Z.E.; Du, Q.G.; Petsonk, E.L.; Peng, K.L.; Li, Y.D.; Li, S.K.; Han, G.H.; Atffield, M.D. [NIOSH, Morgantown, WV (United States)

    2005-11-01

    The early pattern of lung function changes in 317 newly hired Chinese underground coal miners was compared to 132 referents. This three year prospective cohort study involved a pre-employment and 15 follow up health surveys, including a questionnaire and spirometry tests. Twice a month, total and respirable dust area sampling was done. The authors used a two stage analysis and a linear mixed effects model approach to analyse the longitudinal spirometry data, and to investigate the changes in forced expiratory volume in 1 second (FEV1) over time, controlling for age, height, pack years of smoking, mean respirable dust concentration, the room temperature during testing, and the group x time interaction terms. Results: FEV1 change over time in new miners is non-linear. New miners experience initial rapid FEV1 declines, primarily during the first year of mining, little change during the second year, and partial recovery during the third year. Both linear and quadratic time trends in FEV1 change are highly significant. Smoking miners lost more FEV1 than non-smokers. Referents, all age less than 20 years, showed continued lung growth, whereas the miners who were under age 20 exhibited a decline in FEV1. Conclusion: Dust and smoking affect lung function in young, newly hired Chinese coal miners. FEV1 change over the first three years of employment is non-linear. The findings have implications for both methods and interpretation of medical screening in coal mining and other dusty work: during the first several years of employment more frequent testing may be desirable, and caution is required in interpreting early FEV1 declines.

  15. Early auditory change detection implicitly facilitated by ignored concurrent visual change during a Braille reading task.

    Science.gov (United States)

    Aoyama, Atsushi; Haruyama, Tomohiro; Kuriki, Shinya

    2013-09-01

    Unconscious monitoring of multimodal stimulus changes enables humans to effectively sense the external environment. Such automatic change detection is thought to be reflected in auditory and visual mismatch negativity (MMN) and mismatch negativity fields (MMFs). These are event-related potentials and magnetic fields, respectively, evoked by deviant stimuli within a sequence of standard stimuli, and both are typically studied during irrelevant visual tasks that cause the stimuli to be ignored. Due to the sensitivity of MMN/MMF to potential effects of explicit attention to vision, however, it is unclear whether multisensory co-occurring changes can purely facilitate early sensory change detection reciprocally across modalities. We adopted a tactile task involving the reading of Braille patterns as a neutral ignore condition, while measuring magnetoencephalographic responses to concurrent audiovisual stimuli that were infrequently deviated either in auditory, visual, or audiovisual dimensions; 1000-Hz standard tones were switched to 1050-Hz deviant tones and/or two-by-two standard check patterns displayed on both sides of visual fields were switched to deviant reversed patterns. The check patterns were set to be faint enough so that the reversals could be easily ignored even during Braille reading. While visual MMFs were virtually undetectable even for visual and audiovisual deviants, significant auditory MMFs were observed for auditory and audiovisual deviants, originating from bilateral supratemporal auditory areas. Notably, auditory MMFs were significantly enhanced for audiovisual deviants from about 100 ms post-stimulus, as compared with the summation responses for auditory and visual deviants or for each of the unisensory deviants recorded in separate sessions. Evidenced by high tactile task performance with unawareness of visual changes, we conclude that Braille reading can successfully suppress explicit attention and that simultaneous multisensory changes can

  16. Change and predictors of change in parental self-efficacy from early to middle adolescence.

    Science.gov (United States)

    Glatz, Terese; Buchanan, Christy M

    2015-10-01

    Parental self-efficacy (PSE) describes parents' beliefs about being able to handle developmentally specific issues and being able to influence their child in a way that fosters the child's positive development and adjustment (Bandura, 1997). Parents of adolescents have been shown to feel less efficacious than parents of preadolescent children (Ballenski & Cook, 1982), but little is known about the factors behind low levels of PSE among parents of adolescents. This study examined mean-level changes in PSE and predictors of change among parents of adolescents. The sample was derived from a 3-wave longitudinal data set of 398 parents of children starting spanning early (11 or 12 years) to middle (14 or 15 years) adolescence (47% boys). Latent growth curve analysis was performed, and it was hypothesized that theoretically driven predictors reflecting the developing child, as well as the ecological context, would predict the level of PSE. Despite generally high levels of PSE across all time points, parents decreased in PSE during the developmental period. Some predictors were of particular importance for the level and amount of change in PSE, such as physical changes in the child, parents' target-based expectations for risk taking during adolescence, the quality of parent-adolescent communication, and ethnicity. This study adds insight into the development of PSE during the critical transitional period of early and middle adolescence. The findings advance theory of PSE, as it illuminates why some parents' decrease in PSE more than do other parents.

  17. How 3D immersive visualization is changing medical diagnostics

    Science.gov (United States)

    Koning, Anton H. J.

    2011-03-01

    Originally the only way to look inside the human body without opening it up was by means of two dimensional (2D) images obtained using X-ray equipment. The fact that human anatomy is inherently three dimensional leads to ambiguities in interpretation and problems of occlusion. Three dimensional (3D) imaging modalities such as CT, MRI and 3D ultrasound remove these drawbacks and are now part of routine medical care. While most hospitals 'have gone digital', meaning that the images are no longer printed on film, they are still being viewed on 2D screens. However, this way valuable depth information is lost, and some interactions become unnecessarily complex or even unfeasible. Using a virtual reality (VR) system to present volumetric data means that depth information is presented to the viewer and 3D interaction is made possible. At the Erasmus MC we have developed V-Scope, an immersive volume visualization system for visualizing a variety of (bio-)medical volumetric datasets, ranging from 3D ultrasound, via CT and MRI, to confocal microscopy, OPT and 3D electron-microscopy data. In this talk we will address the advantages of such a system for both medical diagnostics as well as for (bio)medical research.

  18. Identifying early changes in myocardial microstructure in hypertensive heart disease.

    Directory of Open Access Journals (Sweden)

    Pranoti Hiremath

    Full Text Available The transition from healthy myocardium to hypertensive heart disease is characterized by a series of poorly understood changes in myocardial tissue microstructure. Incremental alterations in the orientation and integrity of myocardial fibers can be assessed using advanced ultrasonic image analysis. We used a modified algorithm to investigate left ventricular myocardial microstructure based on analysis of the reflection intensity at the myocardial-pericardial interface on B-mode echocardiographic images. We evaluated the extent to which the novel algorithm can differentiate between normal myocardium and hypertensive heart disease in humans as well as in a mouse model of afterload resistance. The algorithm significantly differentiated between individuals with uncomplicated essential hypertension (N = 30 and healthy controls (N = 28, even after adjusting for age and sex (P = 0.025. There was a trend in higher relative wall thickness in hypertensive individuals compared to controls (P = 0.08, but no difference between groups in left ventricular mass (P = 0.98 or total wall thickness (P = 0.37. In mice, algorithm measurements (P = 0.026 compared with left ventricular mass (P = 0.053 more clearly differentiated between animal groups that underwent fixed aortic banding, temporary aortic banding, or sham procedure, on echocardiography at 7 weeks after surgery. Based on sonographic signal intensity analysis, a novel imaging algorithm provides an accessible, non-invasive measure that appears to differentiate normal left ventricular microstructure from myocardium exposed to chronic afterload stress. The algorithm may represent a particularly sensitive measure of the myocardial changes that occur early in the course of disease progression.

  19. Identifying early changes in myocardial microstructure in hypertensive heart disease.

    Science.gov (United States)

    Hiremath, Pranoti; Bauer, Michael; Aguirre, Aaron D; Cheng, Hui-Wen; Unno, Kazumasa; Patel, Ravi B; Harvey, Bethany W; Chang, Wei-Ting; Groarke, John D; Liao, Ronglih; Cheng, Susan

    2014-01-01

    The transition from healthy myocardium to hypertensive heart disease is characterized by a series of poorly understood changes in myocardial tissue microstructure. Incremental alterations in the orientation and integrity of myocardial fibers can be assessed using advanced ultrasonic image analysis. We used a modified algorithm to investigate left ventricular myocardial microstructure based on analysis of the reflection intensity at the myocardial-pericardial interface on B-mode echocardiographic images. We evaluated the extent to which the novel algorithm can differentiate between normal myocardium and hypertensive heart disease in humans as well as in a mouse model of afterload resistance. The algorithm significantly differentiated between individuals with uncomplicated essential hypertension (N = 30) and healthy controls (N = 28), even after adjusting for age and sex (P = 0.025). There was a trend in higher relative wall thickness in hypertensive individuals compared to controls (P = 0.08), but no difference between groups in left ventricular mass (P = 0.98) or total wall thickness (P = 0.37). In mice, algorithm measurements (P = 0.026) compared with left ventricular mass (P = 0.053) more clearly differentiated between animal groups that underwent fixed aortic banding, temporary aortic banding, or sham procedure, on echocardiography at 7 weeks after surgery. Based on sonographic signal intensity analysis, a novel imaging algorithm provides an accessible, non-invasive measure that appears to differentiate normal left ventricular microstructure from myocardium exposed to chronic afterload stress. The algorithm may represent a particularly sensitive measure of the myocardial changes that occur early in the course of disease progression.

  20. Changing Bilingual Self-Perceptions from Early Adolescence to Early Adulthood: Empirical Evidence from a Mixed-Methods Case Study

    Science.gov (United States)

    Caldas, Stephen J.

    2008-01-01

    In the emerging tradition of language socialization research, this study examines the changing bilingual self-perceptions of three children, identical twin girls and their older brother, from early adolescence through early adulthood. The children were reared in a predominantly French-speaking home in south Louisiana by French/English bilingual…

  1. ECG Changes In Patients On Chronic Psychotropic medication

    African Journals Online (AJOL)

    2006-08-31

    Aug 31, 2006 ... lack of exercise, obesity, substance misuse) and high autonomic ... heart; however, it might precipitate complete heart block in the presence of .... ECG changes such as rate, rhythm, T waves and QT interval changes have ...

  2. Changing cultures, changing cuisines: Cultural transitions and dietary change in Iron Age, Roman, and Early Medieval Croatia.

    Science.gov (United States)

    Lightfoot, E; Slaus, M; O'Connell, T C

    2012-08-01

    Food is well-known to encode social and cultural values, for example different social groups use different consumption patterns to act as social boundaries. When societies and cultures change, whether through drift, through population replacement or other factors, diet may also alter despite unchanging resource availability within a region. This study investigates the extent to which dietary change coincides with cultural change, to understand the effects of large-scale migrations on the populations' diets. Through stable carbon and nitrogen isotope analysis of Iron Age, Roman, and Early Medieval human bone collagen, we show that in Croatia large-scale cultural change led to significant changes in diet. The isotopic evidence indicates that Iron Age diet consisted of C(3) foodstuffs with no isotopic evidence for the consumption of C(4) or marine resources. With the Roman conquest, marine resources were added to the diet, although C(3) foodstuffs continued to play an important role. In the Early Medieval period, this marine component was lost and varying amounts of C(4) foodstuffs, probably millet, were added to the otherwise C(3) diet. In both of these transitions it is likely that the changes in diet are related to the arrival of a new people into the area.

  3. Lipidomics reveals early metabolic changes in subjects with schizophrenia: effects of atypical antipsychotics.

    Directory of Open Access Journals (Sweden)

    Joseph McEvoy

    Full Text Available There is a critical need for mapping early metabolic changes in schizophrenia to capture failures in regulation of biochemical pathways and networks. This information could provide valuable insights about disease mechanisms, trajectory of disease progression, and diagnostic biomarkers. We used a lipidomics platform to measure individual lipid species in 20 drug-naïve patients with a first episode of schizophrenia (FE group, 20 patients with chronic schizophrenia that had not adhered to prescribed medications (RE group, and 29 race-matched control subjects without schizophrenia. Lipid metabolic profiles were evaluated and compared between study groups and within groups before and after treatment with atypical antipsychotics, risperidone and aripiprazole. Finally, we mapped lipid profiles to n3 and n6 fatty acid synthesis pathways to elucidate which enzymes might be affected by disease and treatment. Compared to controls, the FE group showed significant down-regulation of several n3 polyunsaturated fatty acids (PUFAs, including 20:5n3, 22:5n3, and 22:6n3 within the phosphatidylcholine and phosphatidylethanolamine lipid classes. Differences between FE and controls were only observed in the n3 class PUFAs; no differences where noted in n6 class PUFAs. The RE group was not significantly different from controls, although some compositional differences within PUFAs were noted. Drug treatment was able to correct the aberrant PUFA levels noted in FE patients, but changes in re patients were not corrective. Treatment caused increases in both n3 and n6 class lipids. These results supported the hypothesis that phospholipid n3 fatty acid deficits are present early in the course of schizophrenia and tend not to persist throughout its course. These changes in lipid metabolism could indicate a metabolic vulnerability in patients with schizophrenia that occurs early in development of the disease.

  4. Early response to medical treatment of trigeminal neuralgia in a Nigerian population

    Directory of Open Access Journals (Sweden)

    Osawe Felix Omoregie

    2015-01-01

    Full Text Available Background: This study evaluates the clinical profile of patients suffering from trigeminal neuralgia (TN and correlates the findings with early response of the patients to medical treatment. Patients and Methods: A 4-year prospective study in which patients diagnosed of TN were treated medically and followed up weekly for 8 weeks to determine early treatment outcome, in the University of Benin Teaching Hospital, Benin City, Nigeria. Results: Of the 287 patients seen during the study period, a total of 14 (4.9% patients were diagnosed of TN. Thirteen (4.5% of the cases were selected based on compliance to the 8-week follow-up visits, consisting of 8 (61.5% males and 5 (38.5% females, giving a ratio of 1.6:1. The mean age of the patients was 50±1.5 years. The mandibular (n = 6, 46.2% and maxillary (n = 5, 38.5% divisions of the trigeminal nerve were mostly affected. The lesion was slightly more common on the right side of the face (n = 7, 53.8% than the left side (n = 6, 46.2%. Talking (n=4, 30.8% and chewing (n = 3, 23.1% were the most frequent trigger factors. The patients mostly described the pain as severe, spontaneous, and sharp (n = 5, 38.2%. Most patients became stable on tablets carbamazepine 200 mg 12 hourly, folic acid 5 mg daily, and phenytoin 100 mg daily. Good response was observed in most patients within 2 weeks (n = 6, 46.2% of medical treatment, especially in patients at the seventh decade of age (n = 3, 23.1% and those with lesions involving the mandibular division of the trigeminal nerve (n = 3, 23.1%. Conclusion: This study shows early response of TN to medical treatment. We recommend combination therapy of carbamazepine and folic acid in the treatment of patients, especially elderly patients with lesions involving the mandibular division of the trigeminal nerve.

  5. Consultant medical trainers, modernising medical careers (MMC and the European time directive (EWTD: tensions and challenges in a changing medical education context

    Directory of Open Access Journals (Sweden)

    Payne Heather

    2008-05-01

    Full Text Available Abstract Background We analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers' in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC and the European Working Time Directive (EWTD. Methods Qualitative study. Learning and continuing professional development (CPD, were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005. Results Consultant Trainers felt that new working patterns resulting from the EWTD and MMC have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the quality of medical training and patient care. Consultant Trainers' perceptions of medical education were embedded in a traditional medical education culture, which expected long hours' availability, personal sacrifices and learning without formal educational support and supervision. Over-reliance on apprenticeship in combination with lack of organisational support for Consultant Trainers' new responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in teaching, supervision and assessment represent potentially significant barriers to progress. Conclusion This study identifies issues with significant implications for the implementation of MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS: Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and aspire to excellence. Further research is needed to investigate the views and educational practices of Consultant Medical Trainers and medical trainees.

  6. Disciplined doctors: the electronic medical record and physicians' changing relationship to medical knowledge.

    Science.gov (United States)

    Reich, Adam

    2012-04-01

    This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, U.S. integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors' interactions with the EMR reconcile these perspectives by making physicians' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners' professional identities are reconciled with bureaucratic subordination across the different departments studies.

  7. Are Medications Involved in Vision and Intracranial Pressure Changes Seen in Spaceflight?

    Science.gov (United States)

    Wotring, V. E.

    2016-01-01

    It has recently been reported that intracranial pressure (ICP) and/or vision changes, have occurred in a number of long duration astronauts. Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. The reasons for these potentially debilitating medical issues are currently unknown. The potential role of administered medications has not yet been examined, but it is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we proposed an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms. The purpose of this study was to use medication usage records for affected and unaffected crew to determine if use of particular medications seemed to correlate with VIIP occurrence or severity. Due to the limited amount of data available from crewmembers, we added a large terrestrial data set to this study. Using publically available FDA Adverse Event Reports (FDA AERs) from many medications and medication classes, we identified increased reports of vision or intracranial pressure changes in several medication categories, which are presumed to be the most likely medications that could be involved in VIIP occurrence or severity.

  8. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

    Science.gov (United States)

    Edelstein, Burton L; Ng, Man Wai

    2015-01-01

    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

  9. DOES BONE MINERAL DENSITY CHANGE IN EARLY AXIAL SPONDYLOARTHRITIS?

    Directory of Open Access Journals (Sweden)

    E. E. Gubar

    2016-01-01

    Full Text Available The rate of osteoporosis (OP and the mechanism  of its development in patients with ankylosing spondylitis (AS and other spondyloarthrititides (SpA have not been sufficiently investigated. Steady-state  inflammatory disease activity is anticipated  to be the leading factor of OP in AS.Objective: to investigate lumbar spine (LS and femoral neck (FN  bone mineral density (BMD  in patients with early axial SpA (axSpA and to reveal its association with inflammatory disease activity.Subjects and methods. A total of 150 patients (59 men and 91 women aged 18 to 45 years with inflammatory back pain for ≥3 months and ≤5 years were examined. The diagnosis of axSpA was established in accordance  with the 2009 ASAS criteria. BASDAI and ASDAS-CRP were used to assess activity and functional status was evaluated with BASFI. The examination  included determination of HLA-B27, X-ray of the pelvis and LS, magnetic resonance imaging (MRI  of the sacroiliac joints, LS, and hip joints (in the presence of clinical signs of their involvement,  and densitometry of LS (LI–IV  and FN. By taking into account the patients’ young age, the Z score was used to estimate BMD. The Z-score -2 SD or lower in at the least one of the regions examined is considered to be diminished BMD. Results and discussion. The median Z-score was -0.7 [-1.3; -0.2] SD for FN and -0.9 [-1.6; -0.6] SD for LS. Reduced BMD in at the least one of the regions examined was diagnosed in 27 (18.0% patients. There was lower BMD in LS in 21 (14.0% patients and in FN in 8 (5.3%. Two (1.3% patients were diagnosed as having osteopenia in the two examined regions. There was no association between diminished BMD and age, gender, disease activity assessed with BASDAI, ASDAS-СRP, erythrocyte sedimentation rate (ESR and C-reactive protein (CRP. An association was found between inflammatory LS changes, as evidenced by MRI (MRI spondylitis, and reduced BMD in at least one of the examined regions. MRI

  10. Associations of desire for change in sexual life amongst female medical students in North America

    OpenAIRE

    Shindel, AW; Breyer, BN; Smith, JF

    2013-01-01

    We analyzed associations of dissatisfaction with sexual life and desire for change in female medical students. Students enrolled in medical schools in North America between February and July 2008 were invited to participate in an internet-based survey of sexual function. The principle outcome measure was a single item question on sexual life satisfaction and desire for change. Women who reported dissatisfaction and desire for change were classified as 'sexually bothered'. The survey also asse...

  11. Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women.

    LENUS (Irish Health Repository)

    Cleary, Brian J

    2012-02-01

    PURPOSE: To examine the extent, nature and determinants of medication use in early pregnancy. METHODS: We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). RESULTS: Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines\\/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). CONCLUSIONS: Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders.

  12. Early changes of urinary amylase isoenzymes in diabetes mellitus.

    Science.gov (United States)

    Recio, F; Villamil, F; Recio, C; Ferrer, C

    1992-10-01

    The altered excretion of isoenzymes of amylase in urine was used as an early indicator of the loss of electric charges in the glomerular basement membrane, in 202 juvenile-onset insulin-dependent diabetic patients, compared with the pattern of excretion in 51 normal subjects matched for age and sex. Diabetics showed an increased excretion of salivary amylase. The salivary to pancreatic amylase ratio in urine (S/P ratio) was always below 1 in control subjects, but was elevated in 33.2% of diabetics, although microalbuminuria was present in only 26.2% of diabetic patients. The concentrations of other proteins in urine were within the reference ranges in nearly all patients, indicating that the kidney was not seriously affected. The increased salivary amylase excretion was not due to changes in the plasma concentration of any of the isoamylases, but to a real increase in excretion, as its fractional excretion in relation to creatinine clearance was clearly increased (1.0 +/- 0.7 vs. 1.52 +/- 1.99, p ratio of their clearances was also increased (0.35 +/- 0.18 vs. 0.49 +/- 0.61, p > 0.05). Moreover, the prevalence of altered S/P ratios was higher than the prevalence of microalbuminuria (36.6% vs. 18.8% of patients in the first decade of evolution of insulin-dependent diabetes mellitus). Altered S/P ratios were most prevalent in the first decade, whereas microalbuminuria was most prevalent in the second decade of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Managing the Near Term Functions of Change in Medical Units.

    Science.gov (United States)

    1986-06-06

    1961) and Kurt Lewin (1957), involves three basic stages: unfreezing, changing, and refreezing. The first stage is unfreezing. At this stage...the change process as it has been researched and explained by Kurt Lewin , Edgar Schein, Arnold 1). Kaluzny, Robert S. Blake, Robert J. House, Gene W

  14. Climate change: what competencies and which medical education and training approaches?

    Directory of Open Access Journals (Sweden)

    Bell Erica J

    2010-04-01

    Full Text Available Abstract Background Much research has been devoted to identifying healthcare needs in a climate-changing world. However, while there are now global and national policy statements about the importance of health workforce development for climate change, little has been published about what competencies might be demanded of practitioners in a climate-changing world. In such a context, this debate and discussion paper aims to explore the nature of key competencies and related opportunities for teaching climate change in medical education and training. Particular emphasis is made on preparation for practice in rural and remote regions likely to be greatly affected by climate change. Discussion The paper describes what kinds of competencies for climate change might be included in medical education and training. It explores which curricula, teaching, learning and assessment approaches might be involved. Rather than arguing for major changes to medical education and training, this paper explores well established precedents to offer practical suggestions for where a particular kind of literacy--eco-medical literacy--and related competencies could be naturally integrated into existing elements of medical education and training. Summary The health effects of climate change have, generally, not yet been integrated into medical education and training systems. However, the necessary competencies could be taught by building on existing models, best practice and innovative traditions in medicine. Even in crowded curricula, climate change offers an opportunity to reinforce and extend understandings of how interactions between people and place affect health.

  15. Measures for assessing practice change in medical practitioners

    Directory of Open Access Journals (Sweden)

    Green Sally

    2006-12-01

    Full Text Available Abstract Background There are increasing numbers of randomised trials and systematic reviews examining the efficacy of interventions designed to bring about a change in clinical practice. The findings of this research are being used to guide strategies to increase the uptake of evidence into clinical practice. Knowledge of the outcomes measured by these trials is vital not only for the interpretation and application of the work done to date, but also to inform future research in this expanding area of endeavour and to assist in collation of results in systematic reviews and meta-analyses. Methods The objective of this review was to identify methods used to measure change in the clinical practices of health professionals following an intervention aimed at increasing the uptake of evidence into practice. All published trials included in a recent, comprehensive Health Technology Assessment of interventions to implement clinical practice guidelines and change clinical practice (n = 228 formed the sample for this study. Using a standardised data extraction form, one reviewer (SH, extracted the relevant information from the methods and/or results sections of the trials. Results Measures of a change of health practitioner behaviour were the most common, with 88.8% of trials using these as outcome measures. Measures that assessed change at a patient level, either actual measures of change or surrogate measures of change, were used in 28.8% and 36.7% of studies (respectively. Health practitioners' knowledge and attitudes were assessed in 22.8% of the studies and changes at an organisational level were assessed in 17.6%. Conclusion Most trials of interventions aimed at changing clinical practice measured the effect of the intervention at the level of the practitioner, i.e. did the practitioner change what they do, or has their knowledge of and/or attitude toward that practice changed? Less than one-third of the trials measured, whether or not any change

  16. Comparing two early medical abortion regimens: mifepristone+misoprostol vs. misoprostol alone.

    Science.gov (United States)

    Ngoc, Nguyen Thi Nhu; Blum, Jennifer; Raghavan, Sheila; Nga, Nguyen Thi Bach; Dabash, Rasha; Diop, Ayisha; Winikoff, Beverly

    2011-05-01

    Nonsurgical abortion methods have the potential to improve access to high-quality abortion care. Until recently, availability and utilization of mifepristone medical abortion in low-resource countries were restricted due to the limited availability and perceived high cost of mifepristone, leading some providers and policymakers to support use of misoprostol-only regimens. Yet, this may not be desirable if misoprostol-only regimens are considerably less effective and ultimately more costly for health care systems. This study sought to document the differences in efficacy between two nonsurgical abortion regimens. This double-blind randomized placebo-controlled trial enrolled women with gestational ages up to 63 days seeking early medical abortion from August 2007 to March 2008 at a large tertiary hospital in Ho Chi Minh City, Vietnam. Eligible consenting women received either (1) two doses of 800 mcg buccal misoprostol 24 h apart or (2) 200 mg mifepristone and 800 mcg buccal misoprostol 24 h later. Participants self-administered all study drugs and returned to the hospital for follow-up 1 week later. The trial is registered at ClinicalTrials.gov as NCT00680394. Four hundred women were randomized to either misoprostol-only (198) or mifepristone+misoprostol (202). Complete abortion occurred for 76.2% (n=147) of women allocated to misoprostol-only vs. 96.5% (n=194) of those given mifepristone+misoprostol (RR 0.79, 95% CI 0.73-0.86). Ongoing pregnancy was documented for 16.6% (32) of misoprostol-only users and 1.5% (3) of mifepristone+misoprostol users (1.62, 0.68-3.90). Side effects were generally similar for both groups, although significantly more women allocated to misoprostol-only reported diarrhea. Mifepristone+misoprostol is significantly more effective than use of misoprostol-alone for early medical abortion. The number of ongoing pregnancies documented with misoprostol-only warranted an early end of the trial after unblinding of the study at interim analysis

  17. The Changing Drug Culture: Medical and Recreational Marijuana.

    Science.gov (United States)

    Albertson, Timothy E; Chenoweth, James A; Colby, Daniel K; Sutter, Mark E

    2016-02-01

    The major psychoactive compounds in marijuana (cannabis) are cannabinoids, the most significant of which is delta-9-tetrahydrocannabinol. There are also two synthetic pharmaceutical cannabinoids, nabilone and dronabinol, available by prescription in the United States. The use of marijuana has increased in the United States with passage of medical marijuana laws in many states and legalization of recreational marijuana use in several states. In addition, the potency of marijuana has increased in recent years. Marijuana has been used for a variety of medical purposes, including management of nausea and vomiting, appetite and immunologic stimulation in patients with HIV infection and AIDS, glaucoma, neurologic disorders, and pain relief. Studies on the benefits of marijuana as a treatment for various conditions have been inconsistent, except for those on pain management. Marijuana has adverse effects, and has been associated with driving impairment, psychosis, dependence and withdrawal syndromes, hyperemesis, acute cardiac events, some cancers, and impaired lung function. As with studies on the benefits of marijuana, studies of adverse effects have yielded inconsistent results. Except for impaired driving and the occurrence of dependence and withdrawal syndromes, the adverse effects of marijuana use have not been fully studied.

  18. Timing and indication for curettage after medical abortion in early pregnant women with prior uterine incision.

    Science.gov (United States)

    Wang, Guoyun; Li, Dong; Manconi, Frank; Dong, Baihua; Zhang, Yuncun; Sun, Bingcui

    2010-01-01

    Termination of pregnancy is an important and necessary back-up method for family planning services in many countries. The combination of mifepristone and misoprostol is a widely used alternative to surgical evacuation of the uterus in early pregnancy; however, there are few reports about medical abortion in women with a prior uterine incision and few studies have described curettage occurring as part of the procedure and an indication for the intervention. Curettage in a prior uterine incision can increase operative complications. The purpose of this study was to investigate whether vaginal bleeding intervals, routine ultrasound scan and serum beta-hCG test after medical abortion could accurately identify women with uterine scars who would require curettage. Six hundred sixty-eight women with a uterine scar and at up to 49 days of gestation underwent a medical abortion with mifepristone and misoprostol. Each woman took 50 mg and 25 mg of mifepristone orally in the morning and in the evening, respectively, for 2 days and 600 mcg of misoprostol orally on the third day. Of the 668 women, 6 (0.9%) were lost to follow-up. The overall complete abortion rate was 91.7%; 55 women underwent curettage, including 2 women with heavy bleeding, 3 women with ongoing pregnancy and 34 women with incomplete abortion. The incomplete abortion rate was significantly greater in women with persistent bleeding lasting 21 days than in women with persistent bleeding lasting 14 days (pabortion rate was also greater in women whose serum beta-hCG was >or=500 IU/L than in women whose serum beta-hCG was or=500 IU/L) were 97.1% and 62.5%, respectively. Moreover, the incomplete abortion rate was greater in women with an endometrial thickness >or=15 mm than in women with an endometrial thickness or=15 mm) were 94.1% and 75%, respectively. No complication occurred. The combination of mifepristone and misoprostol was found to be a safe and effective method to terminate early pregnancy in women with a

  19. Early-age volume changes of extrudable reactive powder concrete

    Directory of Open Access Journals (Sweden)

    De Noirfontaine M.N.

    2010-06-01

    Full Text Available This article presents a study on the early-age autogenous deformations of Extrudable Reactive Powder Concretes (ERPCs, especially designed for the making of concrete pipes by extrusion. Different ERPC mixtures, with variable amounts of polycarboxylate superplasticizer (SP, have been investigated. Results on 28-day mechanical properties, early-age hydration rate, autogenous shrinkage and premature cracking risk are analyzed and discussed in relation with the ERPC mix parameters.

  20. Early-age volume changes of extrudable reactive powder concrete

    Science.gov (United States)

    Cherkaoui, K.; Courtial, M.; Dunstetter, F.; Khelidj, A.; Mounanga, P.; de Noirfontaine, M. N.

    2010-06-01

    This article presents a study on the early-age autogenous deformations of Extrudable Reactive Powder Concretes (ERPCs), especially designed for the making of concrete pipes by extrusion. Different ERPC mixtures, with variable amounts of polycarboxylate superplasticizer (SP), have been investigated. Results on 28-day mechanical properties, early-age hydration rate, autogenous shrinkage and premature cracking risk are analyzed and discussed in relation with the ERPC mix parameters.

  1. Early-age volume changes of extrudable reactive powder concrete

    OpenAIRE

    De Noirfontaine M.N.; Mounanga P.; Khelidj A.; Dunstetter F.; Cherkaoui K.; Courtial M.

    2010-01-01

    This article presents a study on the early-age autogenous deformations of Extrudable Reactive Powder Concretes (ERPCs), especially designed for the making of concrete pipes by extrusion. Different ERPC mixtures, with variable amounts of polycarboxylate superplasticizer (SP), have been investigated. Results on 28-day mechanical properties, early-age hydration rate, autogenous shrinkage and premature cracking risk are analyzed and discussed in relation with the ERPC mix parameters.

  2. Knowledge and awareness about breast cancer and its early symptoms among medical and non-medical students of Southern Punjab, Pakistan.

    Science.gov (United States)

    Noreen, Mamoona; Murad, Sheeba; Furqan, Muhammad; Sultan, Aneesa; Bloodsworth, Peter

    2015-01-01

    Breast cancer is the leading cause of morbidity and mortality globally but has an even more significant impact in developing countries. Pakistan has the highest prevalence among Asian countries. A general lack of public awareness regarding the disease often results in late diagnosis and poor treatment outcomes. The literacy rate of the Southern Punjab (Pakistan) is low compared to its Northern part. It is therefore vital that university students and especially medical students develop a sound knowledge about the disease so that they can spread awareness to others who may be less educated. This study therefore considers current knowledge and understanding about the early signs of breast cancer amongst a study group of medical and non-medical university students of the Southern Punjab, Pakistan. A cross-sectional descriptive analysis of the university students was carried out using a self-administered questionnaire to assess their awareness of breast cancer from March to May 2014. A total of 566 students participated in this study, out of which 326 were non-medical and 240 were from a medical discipline. Statistical analysis was carried out using Graph Pad Prism Version 5 with a significance level set at pstudents were aware of the early warning signs of the breast cancer development. Knowledge of medical students about risk factors was significantly better than the non medical ones, but on the whole was insufficient. Our study indicated that knowledge regarding breast cancer was generally insufficient amongst the majority of the university students (75% non-medical and 55% medical) of Southern Punjab, Pakistan. This study highlights the need to formulate an awareness campaign and to organize conferences to promote breast cancer awareness among students in this region.

  3. Are Medications Involved in Vision and intracranial Pressure Changes Seen in Spaceflight?

    Science.gov (United States)

    Wotring, V. E.

    2016-01-01

    Some crewmembers have experienced changes in their vision after long-duration spaceflight on the ISS. These impairments include visual performance decrements, development of cotton-wool spots or choroidal folds, optic-disc edema, optic nerve sheath distention, and/or posterior globe flattening with varying degrees of severity and permanence. These changes are now used to define the visual impairment/intracranial pressure (VIIP) syndrome. The reasons for these potentially debilitating medical issues are currently unknown. The potential role of administered medications has not yet been examined, but it is known that many medications can have side effects that are similar to VIIP symptoms. Some medications raise blood pressure, which can affect intracranial pressure. Many medications that act in the central nervous system can affect intracranial pressures and/or vision. About 40% of the medications in the ISS kit are known to cause side effects involving changes in blood pressure, intracranial pressure and/or vision. For this reason, we proposed an investigation of the potential relationship between ISS medications and their risk of causing or exacerbating VIIP-like symptoms. The purpose of this study was to use medication usage records for affected and unaffected crew to determine if use of particular medications seemed to correlate with VIIP occurrence or severity.

  4. Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients.

    Science.gov (United States)

    Jones, Guy C; Kehrer, Jason D; Kahn, Jenna; Koneru, Bobby N; Narayan, Ram; Thomas, Tarita O; Camphausen, Kevin; Mehta, Minesh P; Kaushal, Aradhana

    2015-11-01

    Lung cancer is among the most common cancers worldwide and is the leading cause of cancer death in both men and women. For patients with early stage (American Joint Committee on Cancer T1-2, N0) non-small-cell lung cancer, the current standard of care is lobectomy with systematic lymph node evaluation. Unfortunately, patients with lung cancer often have medical comorbities, which may preclude the option of surgical resection. In such cases, a number of minimally invasive to noninvasive treatment options have gained popularity in the treatment of these high-risk patients. These modalities provide significant advantages, including patient convenience, treatment in an outpatient setting, and acceptable toxicities, including reduced impact on lung function and a modest risk of postprocedure chest wall pain. We provide a comprehensive review of the literature, including reported outcomes, complications, and limitations of sublobar resection with or without intraoperative brachytherapy, radiofrequency ablation, microwave ablation, percutaneous cryoablation, photodynamic therapy, and stereotactic body radiotherapy.

  5. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education - a unifying perspective.

    Science.gov (United States)

    Genn, J M

    2001-01-01

    This paper looks at five focal terms in education - curriculum, environment, climate, quality and change - and the interrelationships and dynamics bemeen and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifetation of the curriculum and the other three concepts. Ideas pertaining w the theory of climate and its measurement can provide a greater understanding of the medical cumadurn. The environment is an impoltant detemzinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related w behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students' experiences of the climate of their medical education environment are related w their achievements, sangaction and success. Measures of educational climate are reviewed and the possibilities of new climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it inw dzfferent components giving, for example, separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, w report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. The climate is important for staff as well as for students. The organizational climate that teaching staff experience in the work environment that they inhabit is important for their well-being, and that of their students. The medical school is a learning organization evolving and changing in the

  6. Early Holocene environmental change, the presence and disappearance of early Mesolithic habitation near Zutphen (The Netherlands)

    NARCIS (Netherlands)

    Bos, J.A.A.; Geel, B. van; Groenewoudt, B.J.; Lauwerier, R.C.G.M

    2005-01-01

    The Early Holocene landscape near Zutphen (The Netherlands) is reconstructed by means of microfossil, macroremain and bone analyses. In this area early Mesolithic sites were found on a river dune along a former river channel. AMS14C dating provided a detailed chronology for the sites and river chann

  7. Syphilis and prostitution in the socio-medical geographies of Turkey's early republican provinces.

    Science.gov (United States)

    Evered, Kyle T; Evered, Emine Ö

    2012-05-01

    During and after the Ottoman Empire's collapse, Turkey's fledgling public health and social services ministry sought to deal with the increasing prevalence of syphilis-especially in its rural communities. This article examines the emergence of state-led information collection in Turkey during the 1920s and early 1930s and the anti-syphilis campaigns that resulted, and thus explores how the state created a new medical and moral order surrounding its citizens' sexualities that came to focus its gaze upon prostitution. Utilizing information from official primary sources, we analyze this transformation as part of a broader process of medicalization and state expansion that made syphilis a subject for state regulation. Within this context, moral pronouncements regarding the disease, traditional medicine, and prostitution and the potential benefits of regulated brothels were reframed, represented, and dispersed as directives for public health policy. Through this research, we assess how field-based surveys contributed ultimately to republican regimes of regulating sex work that still persist.

  8. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

    Directory of Open Access Journals (Sweden)

    Daniel Chiung-Jui Su

    2015-01-01

    Full Text Available Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab and delayed rehabilitation (Delayed Rehab. Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001 higher medical and rehabilitation expenses and more outpatient department (OPD visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR: 3.152; 95% confidence interval (CI: 1.211–8.203; p<0.05 than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.

  9. Early Brain changes May Help Predict Autism Among High-Risk Infants

    Science.gov (United States)

    ... Media Resources Interviews & Selected Staff Profiles Multimedia Early brain changes may help predict autism among high-risk ... Share this: Page Content NIH-funded researchers link brain changes at 6 and 12 months of age ...

  10. Evaluation of early changes of cartilage biomarkers following arthroscopic meniscectomy in young Egyptian adults

    Directory of Open Access Journals (Sweden)

    Hamdy Khamis Koryem

    2015-09-01

    Conclusion: Cartilage volume loss by MRI combined with changes in cartilage matrix turnover detected by molecular biomarkers may reflect the initial changes associated with cartilage degeneration that account for early OA.

  11. Taxonomic update on proposed nomenclature and classification changes for bacteria of medical importance, 2016.

    Science.gov (United States)

    Janda, J Michael

    2017-02-13

    A key aspect of medical, public health, and diagnostic microbiology laboratories is the accurate identification and rapid reporting and communication to medical staff regarding patients with infectious agents of clinical importance. Microbial taxonomy in the age of molecular diagnostics and phylogenetics creates changes in taxonomy at a logarithmic rate further complicating this process. This update focuses on the description of new species and classification changes proposed in 2016.

  12. Children's Physic: Medical Perceptions and Treatment of Sick Children in Early Modern England, c. 1580-1720.

    Science.gov (United States)

    Newton, Hannah

    2010-12-01

    Historians of medicine, childhood and paediatrics have often assumed that early modern doctors neither treated children, nor adapted their medicines to suit the peculiar temperaments of the young. Through an examination of medical textbooks and doctors' casebooks, this article refutes these assumptions. It argues that medical authors and practising doctors regularly treated children, and were careful to tailor their remedies to complement the distinctive constitutions of children. Thus, this article proposes that a concept of 'children's physic' existed in early modern England. This term refers to the notion that children were physiologically distinct, requiring special medical care. Children's physic was rooted in the ancient traditions of Hippocratic and Galenic medicine: it was the child's humoral make-up that underpinned all medical ideas about children's bodies, minds, diseases and treatments. Children abounded in the humour blood, which made them humid and weak, and in need of medicines of a particularly gentle nature.

  13. Early rehospitalizations of frail elderly patients – the role of medications: a clinical, prospective, observational trial

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2017-08-01

    Full Text Available Niklas Ekerstad,1,2 Kristoffer Bylin,3 Björn W Karlson3,4 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, 3Department of Acute and Internal Medicine, NU (NÄL-Uddevalla Hospital Group, Trollhättan, 4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Background and objective: Early readmissions of frail elderly patients after an episode of hospital care are common and constitute a crucial patient safety outcome. Our purpose was to study the impact of medications on such early rehospitalizations. Patients and methods: This is a clinical, prospective, observational study on rehospitalizations within 30 days after an acute hospital episode for frail patients over the age of 75 years. To identify adverse drug reactions (ADRs, underuse of evidence-based treatment and avoidability of rehospitalizations, the Naranjo score, the Hallas criteria and clinical judgment were used. Results: Of 390 evaluable patients, 96 (24.6% were rehospitalized. The most frequent symptoms and conditions were dyspnea (n = 25 and worsened general condition (n = 18. The most frequent diagnoses were heart failure (n = 17 and pneumonia/acute bronchitis (n = 13. By logistic regression analysis, independent risk predictors for rehospitalization were heart failure (odds ratio [OR] = 1.8; 95% CI = 1.1–3.1 and anemia (OR = 2.3; 95% CI = 1.3–4.0. The number of rehospitalizations due to probable ADRs was 13, of which two were assessed as avoidable. The number of rehospitalizations probably due to underuse of evidence-based drug treatment was 19, all of which were assessed as avoidable. The number of rehospitalizations not due to ADRs or underuse of evidence-based drug treatment was 64, of which none was assessed as avoidable. Conclusion: One out of four

  14. A medical school's organizational readiness for curriculum change (MORC): development and validation of a questionnaire.

    Science.gov (United States)

    Jippes, Mariëlle; Driessen, Erik W; Broers, Nick J; Majoor, Gerard D; Gijselaers, Wim H; van der Vleuten, Cees P M

    2013-09-01

    Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's organizational readiness for curriculum change (MORC). In 2012, a panel of medical education experts judged and adapted a preliminary MORC questionnaire through a modified Delphi procedure. The authors administered the resulting questionnaire to medical school faculty involved in curriculum change and tested the psychometric properties using exploratory and confirmatory factor analysis, and generalizability analysis. The mean relevance score of the Delphi panel (n = 19) reached 4.2 on a five-point Likert-type scale (1 = not relevant and 5 = highly relevant) in the second round, meeting predefined criteria for completing the Delphi procedure. Faculty (n = 991) from 131 medical schools in 56 countries completed MORC. Exploratory factor analysis yielded three underlying factors-motivation, capability, and external pressure-in 12 subscales with 53 items. The scale structure suggested by exploratory factor analysis was confirmed by confirmatory factor analysis. Cronbach alpha ranged from 0.67 to 0.92 for the subscales. Generalizability analysis showed that the MORC results of 5 to 16 faculty members can reliably evaluate a school's organizational readiness for change. MORC is a valid, reliable questionnaire for measuring organizational readiness for curriculum change in medical schools. It can identify which elements in a change process require special attention so as to increase the chance of successful implementation.

  15. Instituting Change in Early Childhood Education: Recent Developments in Singapore

    Science.gov (United States)

    Ebbeck, Marjory; Chan, Yvonne Yoke Yin

    2011-01-01

    In an effort to improve preschool education, the Singapore government has embraced the need for change by identifying needed policies related to preschool education. These changes require teachers to rethink their approach to learning and teaching. A proposed tool suggested in this paper that may help facilitate curriculum change is the use of…

  16. The medical school as a social organization: the sources of resistance to change.

    Science.gov (United States)

    Bloom, S W

    1989-05-01

    Medical schools vary by nation and by culture but, for students, the experience appears to be very similar. Also, despite a half-century of radical changes in medical practice, education as a process of socialization for the profession is relatively unchanged. At the same time, medical educators have frequently instituted curricular reforms. To analyse this history of reform without change, this paper first establishes what the content and structure of medical education is, and how it came to be that way; second it traces a process whereby the scientific mission of academic medicine has crowded out its social responsibility to train for society's most basic health-care delivery needs. The main argument is that medical education's manifest humanistic mission is little more than a screen for the research mission that is the major thrust of the institution's social structure.

  17. Changing the Perspective on Early Development of Rett Syndrome

    Science.gov (United States)

    Marschik, Peter B.; Kaufmann, Walter E.; Sigafoos, Jeff; Wolin, Thomas; Zhang, Dajie; Bartl-Pokorny, Katrin D.; Pini, Giorgio; Zappella, Michele; Tager-Flusberg, Helen; Einspieler, Christa; Johnston, Michael V.

    2013-01-01

    We delineated the achievement of early speech-language milestones in 15 young children with Rett syndrome ("MECP2" positive) in the first two years of life using retrospective video analysis. By contrast to the commonly accepted concept that these children are normal in the pre-regression period, we found markedly atypical development of…

  18. Early electroretinografic changes in elderly RA patients treated with hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    C. Gelmi

    2011-09-01

    Full Text Available Objective: to evaluate the effectiveness of fundoscopy, electrooculography, electroretinogram and visually evoked potentials in early detection of hydroxychloroquine retinal toxicity in RA patients and to evaluate the influence of patients’ age, drug dosage, concomitant therapy (prednisone and methotrexate and serum creatinine levels in the development of this side effect. Methods: from september to december 1999, we have enrolled 32 RA patients (13 males, 19 females starting hydroxichlorochine treatment. The patients underwent regular ophthalmological examination (fundoscopy, electro-oculography, electro-retinogram and visually evoked potentials every 4 months. Disease activity was evaluated every two months by clinical and routine serological examination. Results: no patients developed retinopathy during 1 year’s follow-up; fundoscopy, electrooculography, and visually evoked potentials did not vary from the baseline. On the other hand, electroretinogram showed early alterations of scotopic and photopic response; moreover a significant statistical correlation between patients’ age (more than 65 years and b1 photopic wave increase (p < 0,05 was observed. No correlation was found between the developement of electro- retinographic alterations and hydroxychloroquine dosage, concomitant therapy and serum creatinine levels Conclusion: our data show the inefficacy of fundoscopy, electrooculography and visually evoked potentials in early detection of hydroxychloroquine retinopathy. On the other hand electroretinogram allows early detection of retinal alterations during hydroxychloroquine treatment, in patients older than 65 years.

  19. Early Career Teachers' Resilience and Positive Adaptive Change Capabilities

    Science.gov (United States)

    Bowles, Terry; Arnup, Jessica L.

    2016-01-01

    This research is an investigation of the link between adaptive functioning and resilience in early career teachers (ECT). Resilience is considered an important capability of teachers and research has shown that teachers who are resourceful, demonstrate agency and develop positive management strategies overcome adversity. In this research, we aim…

  20. Does Early Mathematics Intervention Change the Processes Underlying Children's Learning?

    Science.gov (United States)

    Watts, Tyler W.; Clements, Douglas H.; Sarama, Julie; Wolfe, Christopher B.; Spitler, Mary Elaine; Bailey, Drew H.

    2017-01-01

    Early educational intervention effects typically fade in the years following treatment, and few studies have investigated why achievement impacts diminish over time. The current study tested the effects of a preschool mathematics intervention on two aspects of children's mathematical development. We tested for separate effects of the intervention…

  1. Israeli medical education: international perspectives, and reflections on challenges and changes.

    Science.gov (United States)

    Katz, David R

    2016-01-01

    Medical education is a dynamic and continually evolving process, some of which is style, and some of which is linked to changing perspectives in medical practice. A paper by Reis et al., taken in conjunction with the recent paper from an ad hoc International Review Committee (Schoenbaum et al.), provides a reflective view of where Israeli medical education stood in 2014 and places it in an international perspective. Reis at al also take this further, showing that in Israel change is occurring as a result of this review and comment on a number of important issues where further reflection, discussion, and work is required.

  2. Early resistance change and stress/electromigration evolution in near bamboo interconnects

    NARCIS (Netherlands)

    Petrescu, V.; Mouthaan, A.J.; Dima, G.; Govoreanu, B.; Mitrea, O.; Profirescu, M.

    1997-01-01

    A complete description for early resistance change and mechanical stress evolution in near-bamboo interconnects, related to the electromigration, is given in this paper. The proposed model, for the first time, combines the stress/vacancy concentration evolution with the early resistance change of

  3. Changes in early-successional hardwood forest area in four bird conservation regions across four decades

    Science.gov (United States)

    Sonja N. Oswalt; Kathleen E. Franzreb; David A. Buehler

    2012-01-01

    Early successional hardwood forests constitute important breeding habitat for many migratory songbirds. Declines in populations of these species suggest changes in habitat availability either on the species’ wintering grounds or on their early successional breeding grounds. We used Forest Inventory and Analysis data from 11 states across four decades to examine changes...

  4. Managing Risks? Early Warning Systems for Climate Change

    Science.gov (United States)

    Sitati, A. M.; Zommers, Z. A.; Habilov, M.

    2014-12-01

    Early warning systems are a tool with which to minimize risks posed by climate related hazards. Although great strides have been made in developing early warning systems most deal with one hazard, only provide short-term warnings and do not reach the most vulnerable. This presentation will review research results of the United Nations Environment Programme's CLIM-WARN project. The project seeks to identify how governments can better communicate risks by designing multi-hazard early warning systems that deliver actionable warnings across timescales. Household surveys and focus group discussions were conducted in 36 communities in Kenya, Ghana and Burkina Faso in order to identify relevant climate related hazards, current response strategies and early warning needs. Preliminary results show significant variability in both risks and needs within and between countries. For instance, floods are more frequent in rural western parts of Kenya. Droughts are frequent in the north while populations in urban areas face a range of hazards - floods, droughts, disease outbreaks - that sometimes occur simultaneously. The majority of the rural population, especially women, the disabled and the elderly, do not have access to modern media such as radio, television, or internet. While 55% of rural populace never watches television, 64% of urban respondents watch television on a daily basis. Communities have different concepts of how to design warning systems. It will be a challenge for national governments to create systems that accommodate such diversity yet provide standard quality of service to all. There is a need for flexible and forward-looking early warning systems that deliver broader information about risks. Information disseminated through the system could not only include details of hazards, but also long-term adaptation options, general education, and health information, thus increasingly both capabilities and response options.

  5. PSO-based methods for medical image registration and change assessment of pigmented skin

    Science.gov (United States)

    Kacenjar, Steve; Zook, Matthew; Balint, Michael

    2011-03-01

    There are various scientific and technological areas in which it is imperative to rapidly detect and quantify changes in imagery over time. In fields such as earth remote sensing, aerospace systems, and medical imaging, searching for timedependent, regional changes across deformable topographies is complicated by varying camera acquisition geometries, lighting environments, background clutter conditions, and occlusion. Under these constantly-fluctuating conditions, the use of standard, rigid-body registration approaches often fail to provide sufficient fidelity to overlay image scenes together. This is problematic because incorrect assessments of the underlying changes of high-level topography can result in systematic errors in the quantification and classification of interested areas. For example, in the current naked-eye detection strategies of melanoma, a dermatologist often uses static morphological attributes to identify suspicious skin lesions for biopsy. This approach does not incorporate temporal changes which suggest malignant degeneration. By performing the co-registration of time-separated skin imagery, a dermatologist may more effectively detect and identify early morphological changes in pigmented lesions; enabling the physician to detect cancers at an earlier stage resulting in decreased morbidity and mortality. This paper describes an image processing system which will be used to detect changes in the characteristics of skin lesions over time. The proposed system consists of three main functional elements: 1.) coarse alignment of timesequenced imagery, 2.) refined alignment of local skin topographies, and 3.) assessment of local changes in lesion size. During the coarse alignment process, various approaches can be used to obtain a rough alignment, including: 1.) a manual landmark/intensity-based registration method1, and 2.) several flavors of autonomous optical matched filter methods2. These procedures result in the rough alignment of a patient

  6. WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion.

    Science.gov (United States)

    Honkanen, Helena; Piaggio, Gilda; Hertzen, Helena; Bártfai, Gyorgy; Erdenetungalag, Radnaabazar; Gemzell-Danielsson, Kristina; Gopalan, Sarala; Horga, Mihai; Jerve, Fridtjof; Mittal, Suneeta; Thi Nhu Ngoc, Nguyen; Peregoudov, Alexandre; Prasad, R N V; Pretnar-Darovec, Alenka; Shah, Rashmi S; Song, Si; Tang, Oi Shan; Wu, Shang Chun

    2004-07-01

    To compare the side effect profiles of regimens of oral and vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone and to investigate patients' perceptions of medical abortion. Double-blind, randomised controlled trial. Fifteen gynaecological clinics in 11 countries. A total of 2219 healthy pregnant women requesting medical abortion with misoprostol either orally or vaginally on day three. The oral group (O/O group) and one of the vaginal groups (V/O group) continued with 0.4 mg of oral misoprostol, and the vaginal-only group (V-only group) with oral placebo, twice daily for seven days. Side effects were recorded daily by women and reported at each visit. After misoprostol administration at the clinic, side effects were recorded at 1-hour interval up to 3 hours. Patients' perceptions were asked at the second follow up visit, six weeks after treatment. The outcome measures were the following: pregnancy-related symptoms (nausea, vomiting, breast tenderness, fatigue, dizziness, headache), drug-related side effects (diarrhoea, fever, rash and blood pressure change), side effects related to the abortion process (lower abdominal pain) and women's perceptions of the method. The pregnancy-related symptoms decreased in all groups after misoprostol, and breast tenderness decreased already after mifepristone. Oral administration of misoprostol was associated with a higher frequency of nausea and vomiting than vaginal administration at 1 hour after administration. With oral misoprostol, diarrhoea was more frequent at 1, 2 and at 3 hours after administration than with vaginal administration. Misoprostol induced fever during at least 3 hours after administration in up to 6% of the women, this peak being slightly higher and taking place later with the vaginal route. Lower abdominal pain peaked at 1 and 2 hours after oral misoprostol, while it did so at 2 and 3 hours after vaginal misoprostol. In the two groups that continued misoprostol, 27% of

  7. Global inter-annual gravity changes from GRACE: Early results

    DEFF Research Database (Denmark)

    Andersen, Ole Baltazar; Hinderer, J.

    2005-01-01

    with an accuracy of 0.4 muGal corresponding to 9 mm water thickness on spatial scales longer than 1300 km. Four of the most widely used global hydrological models have been investigated for their spatial comparison with GRACE observations of inter-annual gravity field variations due to changes in continental water...... storage. The Global Land Data Assimilation System model has a spatial correlation coefficient with GRACE observations of 0.65 over the northern hemisphere. This demonstrates that the observed gravity field changes on these scales are largely related to changes in continental water storage.......Fifteen monthly gravity field solutions from the GRACE twin satellites launched more than two years ago have been studied to estimate gravity field changes between 2002 and 2003. The results demonstrate that GRACE is capable of capturing the changes in ground water on inter-annual scales...

  8. Speech disorders in Parkinson's disease: early diagnostics and effects of medication and brain stimulation.

    Science.gov (United States)

    Brabenec, L; Mekyska, J; Galaz, Z; Rektorova, Irena

    2017-03-01

    Hypokinetic dysarthria (HD) occurs in 90% of Parkinson's disease (PD) patients. It manifests specifically in the areas of articulation, phonation, prosody, speech fluency, and faciokinesis. We aimed to systematically review papers on HD in PD with a special focus on (1) early PD diagnosis and monitoring of the disease progression using acoustic voice and speech analysis, and (2) functional imaging studies exploring neural correlates of HD in PD, and (3) clinical studies using acoustic analysis to evaluate effects of dopaminergic medication and brain stimulation. A systematic literature search of articles written in English before March 2016 was conducted in the Web of Science, PubMed, SpringerLink, and IEEE Xplore databases using and combining specific relevant keywords. Articles were categorized into three groups: (1) articles focused on neural correlates of HD in PD using functional imaging (n = 13); (2) articles dealing with the acoustic analysis of HD in PD (n = 52); and (3) articles concerning specifically dopaminergic and brain stimulation-related effects as assessed by acoustic analysis (n = 31); the groups were then reviewed. We identified 14 combinations of speech tasks and acoustic features that can be recommended for use in describing the main features of HD in PD. While only a few acoustic parameters correlate with limb motor symptoms and can be partially relieved by dopaminergic medication, HD in PD seems to be mainly related to non-dopaminergic deficits and associated particularly with non-motor symptoms. Future studies should combine non-invasive brain stimulation with voice behavior approaches to achieve the best treatment effects by enhancing auditory-motor integration.

  9. Importance of early weight change in a pediatric weight management trial.

    Science.gov (United States)

    Goldschmidt, Andrea B; Stein, Richard I; Saelens, Brian E; Theim, Kelly R; Epstein, Leonard H; Wilfley, Denise E

    2011-07-01

    Early weight change is associated with overall weight loss treatment response in adults but has been relatively unexplored in youth. We investigated the importance of early weight change in a pediatric weight control trial. Overweight children aged 7 to 12 years (n=204) participated in a randomized controlled trial of 2 weight maintenance treatments (MTs) after a 20-week family-based behavioral weight loss treatment (FBT). Hierarchical regression was used to investigate the relation between children's percentage weight change at sessions 4, 6, and 8 of FBT and BMI z-score reductions after FBT and at the 2-year follow-up. Correlations and hierarchical regression were used to identify child and parent factors associated with children's early weight change. Children's percentage weight change by FBT session 8 was the best predictor of BMI z-score reductions after FBT and at 2-year follow-up. Percentage weight change in children at session 8 was associated with better FBT attendance and with greater percentage weight change in parents at FBT session 8. Early weight change seems to be related to treatment response through the end of treatment and 2-year follow-up. Future research should include investigation of strategies to promote early weight change in children and parents and identification of mechanisms through which early weight change is related to overall treatment response. Copyright © 2011 by the American Academy of Pediatrics.

  10. Clinical Observation on Combined Tuina and Medicated Bath for Early Intervention of Neonatal Brain Injuries

    Institute of Scientific and Technical Information of China (English)

    刘振寰; 丁建英; 韩丑萍

    2010-01-01

    目的:观察推拿、药浴等中医疗法早期干预对婴儿脑损伤的临床疗效.方法:对60例中重度脑损伤婴儿进行小儿健脑推拿及中药浴式水疗,同时配合中医传统五行音乐聆听及运动疗法等治疗.分别于治疗前、治疗3个月后采用Gesell测查法进行发育商(Development Quotient,DQ)评估,并在治疗1年半后进行远期随访.结果:治疗前、治疗3个月及一年半后发育商分别为(34.98±28.94),(66.17±14.91)和(75.40±14.69),与治疗前比较,治疗3个月及一年半后发育商各指标均有显著提高(P=0.000).结论:对脑损伤婴儿进行推拿中医早期干预可促进大脑发育,修复神经损伤,促进运动、认知的发育,有效预防神经系统后遗症的发生.%Objective: To observe the clinical effect of early intervention of combined tuina with medicated bath for neonatal brain injuries.Methods: Brain-benefiting tuina manipulations,medicated bath and music plus exercise therapies were employed in 60 infants with medium or severe brain injuries.The Gesell measurement methods were adopted prior to and 3 months after treatment to evaluate the development quotient(DQ).In addition,the long-term follow-up was made after one and a half years.Result: The scores of DQ prior to treatment,3 month after treatment and 1.5 years after treatment were(34.98±28.94),(66.17±14.91)and(75.40±14.69)respectively,showing a marked improvement after 3months and 1.5 years of treatment(P=0.000).Conclusion: Early intervention using tuina manipulations could enhance the brain development,repair the nerve injury,improve the motion and cognitive ability and prevent the sequela of the nervous system.

  11. Methods for assessment of innovative medical technologies during early stages of development.

    Science.gov (United States)

    Bartelmes, Marc; Neumann, Ulrike; Lühmann, Dagmar; Schönermark, Matthias P; Hagen, Anja

    2009-11-05

    Conventional Health Technology Assessment (HTA) is usually conducted at a point in time at which the development of the respective technology may no longer be influenced. By this time developers and/or purchasers may have misinvested resources. Thus the demand for Technology Assessment (TA) which incorporates appropriate methods during early development stages of a technology becomes apparent. Against this health political background, the present report describes methods for a development-accompanying assessment of innovative medical technologies. Furthermore, international research programmes set out to identify or apply such methods will be outlined. A systematic literature search as well as an extensive manual literature search are carried out in order to obtain literature and information. The greatest units of the identified methods consist of assessment concepts, decision support methods, modelling approaches and methods focusing on users and their knowledge. Additionally, several general-purpose concepts have been identified. The identified research programmes INNO-HTA and MATCH (Multidisciplinary-Assessment-of-Technology-Centre-for-Healthcare) are to be seen as pilot projects which so far have not been able to generate final results. MATCH focuses almost entirely on the incorporation of the user-perspective regarding the development of non-pharmaceutical technologies, whereas INNO-HTA is basically concerned with the identification and possible advancement of methods for the early, socially-oriented technology assessment. Most references offer only very vague descriptions of the respective method and the application of greatly differing methods seldom exceeds the character of a pilot implementation. A standardisation much less an institutionalisation of development-accompanying assessment cannot be recognized. It must be noted that there is no singular method with which development-accompanying assessment should be carried out. Instead, a technology and

  12. Methods for assessment of innovative medical technologies during early stages of development

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-11-01

    Full Text Available Conventional Health Technology Assessment (HTA is usually conducted at a point in time at which the development of the respective technology may no longer be influenced. By this time developers and/or purchasers may have misinvested resources. Thus the demand for Technology Assessment (TA which incorporates appropriate methods during early development stages of a technology becomes apparent. Against this health political background, the present report describes methods for a development-accompanying assessment of innovative medical technologies. Furthermore, international research programmes set out to identify or apply such methods will be outlined. A systematic literature search as well as an extensive manual literature search are carried out in order to obtain literature and information. The greatest units of the identified methods consist of assessment concepts, decision support methods, modelling approaches and methods focusing on users and their knowledge. Additionally, several general-purpose concepts have been identified. The identified research programmes INNO-HTA and MATCH (Multidisciplinary-Assessment-of-Technology-Centre-for-Healthcare are to be seen as pilot projects which so far have not been able to generate final results. MATCH focuses almost entirely on the incorporation of the user-perspective regarding the development of non-pharmaceutical technologies, whereas INNO-HTA is basically concerned with the identification and possible advancement of methods for the early, socially-oriented technology assessment. Most references offer only very vague descriptions of the respective method and the application of greatly differing methods seldom exceeds the character of a pilot implementation. A standardisation much less an institutionalisation of development-accompanying assessment cannot be recognized. It must be noted that there is no singular method with which development-accompanying assessment should be carried out. Instead, a

  13. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the "pros" of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other in various subspecialties, and correlated these with patients′ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery, preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection, along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS.

  14. Transfusion-associated circulatory overload in adult, medical emergency patients with perspectives on early warning practice: a single-centre, clinical study.

    Science.gov (United States)

    Gosmann, Fanny; Nørgaard, Astrid; Rasmussen, Maj-Britt; Rahbek, Charlotte; Seeberg, Jens; Møller, Tom

    2017-01-26

    Transfusion-associated circulatory overload is characterised by acute respiratory distress, tachycardia, increased blood pressure, acute pulmonary oedema and/or evidence of positive fluid balance occurring within 6 hours after transfusion. Transfusion-associated circulatory overload is a serious, underreported reaction, which makes this iatrogenic condition difficult to prevent. We present an audit of patients admitted to a medical emergency unit, aiming to investigate: (i) the incidence of transfusion-associated circulatory overload; and (ii) whether cases were reported to the haemovigilance system. The clinical implications are discussed within the frame of the Early Warning Score. We conducted a retrospective audit of electronic hospital medical records of patients receiving blood transfusion in a single medical emergency unit. Patients were admitted during a 6-month period and data on symptoms and vital signs were extracted from the records. Of 4,353 consecutively admitted patients, 156 patients were transfused with a total of 411 blood components. The audit identified five cases of transfusion-associated circulatory overload (incidence 3.2%) and four cases of transfusion-associated dyspnoea. Vital signs and changes in dyspnoea and blood pressure were registered within the frame of the Early Warning Score, and one case was documented as being transfusion-related in the medical record. No cases were reported to the haemovigilance system. The incidence of transfusion-associated circulatory overload in acute emergency patients was similar to that in other clinical studies. Lack of recognition and reporting was marked, even though changes in vital signs were monitored in the context of the Early Warning Score. This study points to a missing link in the transfusion chain, namely recognising the vital signs of circulatory overload during or shortly after transfusion as being a serious adverse transfusion reaction.

  15. Are Medications Involved in Vision and Intracrancial Pressure Changes Seen in Spaceflight?

    Science.gov (United States)

    Faust, K. M.; Wotring, V. E.

    2014-01-01

    The Food and Drug Association Adverse Event Reports (FDA AER) from 2009-2011 were used to create a database from millions of known and suspected medication-related adverse events among the general public. Vision changes, sometimes associated with intracranial pressure changes (VIIP), have been noted in some long duration crewmembers. Changes in vision and blood pressure (which can subsequently affect intracranial pressure) are fairly common side effects of medications. The purpose of this study was to explore the possibility of medication involvement in crew VIIP symptoms. Reports of suspected medication-related adverse events may be filed with the Food and Drug Administration (FDA) by medical professionals or consumers. Quarterly compilations of these reports are available for public download. Adverse Event Reporting System (AERS) reports from 1/1/2009- 6/30/2012 were downloaded and compiled into a searchable database for this study. Reports involving individuals under the age of 18 and older than 65 were excluded from this analysis. Case reports involving chronic diseases such as cancer, diabetes, multiple sclerosis and other serious conditions were also excluded. A scan of the medical literature for medication-related VIIP-like adverse events was used to create a list of suspect medications. These medications, as well as certain medications used frequently by ISS crew, were used to query the database. Queries for use of suspected medications were run, and the nature of the symptoms reported in those cases were tabulated. Symptoms searched in the FDA AERS were chosen to include the typical symptoms noted in crewmembers with VIIP. Vision symptoms searched were: visual acuity reduced, visual impairment, and vitreous floaters. Pressure changes included: abnormal sensation in eye, intracranial pressure increased, intraocular pressure increased, optic neuritis, optic neuropathy, and papilloedema. Limited demographic information is included with the FDA AERS; relevant

  16. The Changing Health Care Landscape and Implications of Organizational Ethics on Modern Medical Practice

    NARCIS (Netherlands)

    Castlen, Joseph P; Cote, David J; Moojen, Wouter A.; Robe, Pierre A.; Balak, Naci; Brennum, Jannick; Ammirati, Mario; Mathiesen, Tiit; Broekman, Marike L.D.

    2017-01-01

    Introduction Medicine is rapidly changing, both in the level of collective medical knowledge and in how it is being delivered. The increased presence of administrators in hospitals helps to facilitate these changes and ease administrative workloads on physicians; however, tensions sometimes form

  17. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.

    2015-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  18. Continuing medical education costs and benefits: lessons for competing in a changing health care economy.

    Science.gov (United States)

    Mazmanian, Paul E

    2009-01-01

    Current approaches to evaluation in continuing medical education (CME) feature results defined as changes in participation, satisfaction, knowledge, behavior, and patient outcomes. Few studies link costs and effectiveness of CME to improved quality of care. As continuing education programs compete for scarce resources, cost-inclusive evaluation offers strategies to measure change and to determine value for resources spent.

  19. Probability Elicitation to Inform Early Health Economic Evaluations of New Medical Technologies : A Case Study in Heart Failure Disease Management

    NARCIS (Netherlands)

    Cao, Qi; Postmus, Douwe; Hillege, Hans L.; Buskens, Erik

    2013-01-01

    Objectives: Early estimates of the commercial headroom available to a new medical device can assist producers of health technology in making appropriate product investment decisions. The purpose of this study was to illustrate how this quantity can be captured probabilistically by combining probabil

  20. Attitude of medical students towards Early Clinical Exposure in learning endocrine physiology.

    Science.gov (United States)

    Sathishkumar, Solomon; Thomas, Nihal; Tharion, Elizabeth; Neelakantan, Nithya; Vyas, Rashmi

    2007-09-05

    Different teaching-learning methods have been used in teaching endocrine physiology for the medical students, so as to increase their interest and enhance their learning. This paper describes the pros and cons of the various approaches used to reinforce didactic instruction in endocrine physiology and goes on to describe the value of adding an Early Clinical Exposure program (ECE) to didactic instruction in endocrine physiology, as well as student reactions to it as an alternative approach. Various methods have been used to reinforce didactic instruction in endocrine physiology such as case-stimulated learning, problem-based learning, patient-centred learning and multiple-format sessions. We devised a teaching-learning intervention in endocrine physiology, which comprised of traditional didactic lectures, supplemented with an ECE program consisting of case based lectures and a hospital visit to see patients. A focus group discussion was conducted with the medical students and, based on the themes that emerged from it, a questionnaire was developed and administered to further enquire into the attitude of all the students towards ECE in learning endocrine physiology. The students in their feedback commented that ECE increased their interest for the subject and motivated them to read more. They also felt that ECE enhanced their understanding of endocrine physiology, enabled them to remember the subject better, contributed to their knowledge of the subject and also helped them to integrate their knowledge. Many students said that ECE increased their sensitivity toward patient problems and needs. They expressed a desire and a need for ECE to be continued in teaching endocrine physiology for future groups of students and also be extended for teaching other systems as well. The majority of the students (96.4%) in their feedback gave an overall rating of the program as good to excellent on a 5 point Likert scale. The ECE program was introduced as an alternative approach to

  1. Attitude of medical students towards Early Clinical Exposure in learning endocrine physiology

    Directory of Open Access Journals (Sweden)

    Neelakantan Nithya

    2007-09-01

    Full Text Available Abstract Background Different teaching-learning methods have been used in teaching endocrine physiology for the medical students, so as to increase their interest and enhance their learning. This paper describes the pros and cons of the various approaches used to reinforce didactic instruction in endocrine physiology and goes on to describe the value of adding an Early Clinical Exposure program (ECE to didactic instruction in endocrine physiology, as well as student reactions to it as an alternative approach. Discussion Various methods have been used to reinforce didactic instruction in endocrine physiology such as case-stimulated learning, problem-based learning, patient-centred learning and multiple-format sessions. We devised a teaching-learning intervention in endocrine physiology, which comprised of traditional didactic lectures, supplemented with an ECE program consisting of case based lectures and a hospital visit to see patients. A focus group discussion was conducted with the medical students and, based on the themes that emerged from it, a questionnaire was developed and administered to further enquire into the attitude of all the students towards ECE in learning endocrine physiology. The students in their feedback commented that ECE increased their interest for the subject and motivated them to read more. They also felt that ECE enhanced their understanding of endocrine physiology, enabled them to remember the subject better, contributed to their knowledge of the subject and also helped them to integrate their knowledge. Many students said that ECE increased their sensitivity toward patient problems and needs. They expressed a desire and a need for ECE to be continued in teaching endocrine physiology for future groups of students and also be extended for teaching other systems as well. The majority of the students (96.4% in their feedback gave an overall rating of the program as good to excellent on a 5 point Likert scale. Summary The

  2. Attitude of medical students towards Early Clinical Exposure in learning endocrine physiology

    Science.gov (United States)

    Sathishkumar, Solomon; Thomas, Nihal; Tharion, Elizabeth; Neelakantan, Nithya; Vyas, Rashmi

    2007-01-01

    Background Different teaching-learning methods have been used in teaching endocrine physiology for the medical students, so as to increase their interest and enhance their learning. This paper describes the pros and cons of the various approaches used to reinforce didactic instruction in endocrine physiology and goes on to describe the value of adding an Early Clinical Exposure program (ECE) to didactic instruction in endocrine physiology, as well as student reactions to it as an alternative approach. Discussion Various methods have been used to reinforce didactic instruction in endocrine physiology such as case-stimulated learning, problem-based learning, patient-centred learning and multiple-format sessions. We devised a teaching-learning intervention in endocrine physiology, which comprised of traditional didactic lectures, supplemented with an ECE program consisting of case based lectures and a hospital visit to see patients. A focus group discussion was conducted with the medical students and, based on the themes that emerged from it, a questionnaire was developed and administered to further enquire into the attitude of all the students towards ECE in learning endocrine physiology. The students in their feedback commented that ECE increased their interest for the subject and motivated them to read more. They also felt that ECE enhanced their understanding of endocrine physiology, enabled them to remember the subject better, contributed to their knowledge of the subject and also helped them to integrate their knowledge. Many students said that ECE increased their sensitivity toward patient problems and needs. They expressed a desire and a need for ECE to be continued in teaching endocrine physiology for future groups of students and also be extended for teaching other systems as well. The majority of the students (96.4%) in their feedback gave an overall rating of the program as good to excellent on a 5 point Likert scale. Summary The ECE program was introduced

  3. [Becoming medical doctors in colonial Korea: focusing on the faculty of medical colleges in early north Korea].

    Science.gov (United States)

    Kim, Geun Bae

    2014-12-01

    This paper traces how Koreans of north area became medical doctors in colonial Korea. Most of the past research have focused only on the well-known medical doctors, or even when they discussed a great number of doctors, many research tended to only pay attention to the explicit final results of those doctors. This research, on the other hand, includes ordinary medical doctors as well as the renowed ones, and adjusts the focus to the lifetime period of their growth and activities. As a result, the misunderstanding and obscurity about the Korean medical doctors of north area during this period have been cleared. The new characteristics of the Korean medical doctors of this period have been found, along with their embodiment of historical significance. At the time, Koreans had to get through a number of qualifications in order to become doctors. First is the unique background of origin in which the family held interest in the modern education and was capable of supporting it financially. Second is the long-term status of education that the education from elementary to high school was completed without interruption. Third is the academic qualification that among various institutions of higher education, medical science was chosen as a major. Fourth is the condition of career in which as the career as a doctor had consistently continued. Thus, in oder to become a modern medical doctor, Koreans had to properly complete these multiple steps of process. The group of Korean medical doctors in north area, which was formed after getting through these series of process, possessed a number of characteristics. Firstly, as the upper-middle classes constituted the majority of medical doctors in Korea, the societal status of doctors rose and the foundation for the career as a doctor to be persisted as the family occupation settled. Secondly, the research career and academic degree became the principal method to escape from the discrimination and hierarchy existed between doctors. A

  4. Role of Clinical Pharmacists in Early Detection, Reporting and Prevention of Medication Errors in a Medical Ward

    Directory of Open Access Journals (Sweden)

    Solmaz Hassani

    2017-03-01

    Full Text Available Background: Drug utilization evaluation (DUE is an effective process in order to identifying variability in drug use and subsequent application of effective interventions for improving  patient outcomes. In this study, appropriate uses of drugs were evaluated by pharmacy service.Methods: A prospective, interventional study was designed for determining frequency and type of clinical pharmacists’ interventions and medication errors occurred in the infectious disease ward of Loghman hospital, affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran during 8 months. Results: During the 8 months of the study period, 498 errors were detected among 419 patients that admitted to infectious disease ward of Loghman hospital. Most common errors were related to DVT prophylaxis, SUP and vancomycin monitoring. Discussion: Our result showed that clinical pharmacy interventions can have an important role in reducing adverse drug events and their activities can be effective for reducing of medication error.

  5. Branched chain and aromatic amino acids change acutely following two medical therapies for type 2 diabetes mellitus

    Science.gov (United States)

    Walford, Geoffrey A.; Davis, Jaclyn; Warner, A. Sofia; Ackerman, Rachel J.; Billings, Liana K.; Chamarthi, Bindu; Fanelli, Rebecca R.; Hernandez, Alicia M.; Huang, Chunmei; Khan, Sabina Q.; Littleton, Katherine R.; Lo, Janet; McCarthy, Rita M.; Rhee, Eugene P.; Deik, Amy; Stolerman, Elliot; Taylor, Andrew; Hudson, Margo S.; Wang, Thomas J.; Altshuler, David; Grant, Richard W.; Clish, Clary B.; Gerszten, Robert E.; Florez, Jose C.

    2013-01-01

    Objective Elevated circulating levels of branched chain and aromatic amino acids (BCAA/AAAs) are associated with insulin resistance and incident type 2 diabetes (T2D). BCAA/AAAs decrease acutely during an oral glucose tolerance test (OGTT), a diagnostic test for T2D. It is unknown whether changes in BCAA/AAAs also signal an early response to commonly used medical therapies for T2D. Materials and Methods A liquid chromatography-mass spectrometry approach was used to measure BCAA/AAAs in 30 insulin sensitive (IS) and 30 insulin resistant (IR) subjects before and after: 1) one dose of a sulfonylurea medication, glipizide, 5 mg orally; 2) two days of twice daily metformin 500 mg orally; and 3) a 75-gram OGTT. Percent change in BCAA/AAAs was determined after each intervention. Results Following glipizide, which increased insulin and decreased glucose in both subject groups, BCAA/AAAs decreased in the IS subjects only (all P<0.05). Following metformin, which decreased glucose and insulin in only the IR subjects, 4 BCAA/AAAs increased in the IR subjects at or below P=0.05, and none changed in the IS subjects. Following OGTT, which increased glucose and insulin in all subjects, BCAA/AAAs decreased in all subjects (P<0.05). Conclusions BCAA/AAAs changed acutely during glipizide and metformin administration, and the magnitude and direction of change differed by the insulin resistance status of the individual and the intervention. These results indicate that BCAA/AAAs may be useful biomarkers for monitoring the early response to therapeutic interventions for T2D. PMID:23953891

  6. Rate of change in early Huntington's disease: a clinicometric analysis.

    Science.gov (United States)

    Meyer, Christina; Landwehrmeyer, Bernhard; Schwenke, Carsten; Doble, Adam; Orth, Michael; Ludolph, Albert C

    2012-01-01

    Sensitive outcome measures for patients with Huntington's disease (HD) are required for future clinical trials. Longitudinal data were collected from a 3-year study of 379 patients suffering from early HD who were not treated by antipsychotics. Progression of UHDRS item scores was evaluated by linear regression and slope, whereas correlation coefficient, standard error, and P values were estimated on the basis of the data of eight evaluations from screening to study end (36 months). For the functional assessment dimension, the proportion of "no" responses at baseline and at study end was determined. Linear progression was observed for the motor score and for all three functional measures (i.e., functional assessment score, independence assessment score, and total functional capacity score). In contrast, there was little evidence for progression of the behavioral assessment score over the study period, whereas the cognitive assessment score was intermediate. Twenty-two motor-score items showed linear progression, with a slope of >0.003. These included all chorea items, finger tapping and pronation/supination (left and right), gait, tongue protrusion, and tandem walking. Different symptom domains and individual items evolved at different rates in this group of patients suffering from early HD. It may be possible to select sensitive items to create a simplified version of the UHDRS, which would be more efficient and more sensitive for the assessment of disease progression in clinical trials and natural history studies.

  7. Philip King Brown and Arequipa Sanatorium: early occupational therapy as medical and social experiment.

    Science.gov (United States)

    Harley, Lilas; Schwartz, Kathleen Barker

    2013-01-01

    Historical inquiry enriches occupational therapy practice by identifying enduring values and inspiring future excellence. This study presents for the first time the pioneering life and work of Philip King Brown, a San Francisco physician who used occupation to treat the physical, mental, and social effects of tuberculosis (TB) at Arequipa Sanatorium, the institution he founded in 1911. Through textual analysis of the Arequipa Sanatorium Records, this article evaluates and defends Brown's assertion that his institution was medically and socially experimental. The Arequipa Sanatorium promoted occupational therapy by demonstrating its viability in the treatment of TB, the era's most critical health threat. It also put into practice the ideals of holism, humanism, and occupational justice that resonate within the profession today. Finally, Arequipa provided an example of how an occupation program can change the public perception of disability.

  8. Teaching medical ethics to meet the realities of a changing health care system.

    Science.gov (United States)

    Millstone, Michael

    2014-06-01

    The changing context of medical practice--bureaucratic, political, or economic--demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.

  9. Primary treatment options for high risk/medically inoperable early stage NSCLC patients

    Science.gov (United States)

    Jones, Guy C.; Kehrer, Jason D.; Kahn, Jenna; Koneru, Bobby N.; Narayan, Ram; Thomas, Tarita O.; Camphausen, Kevin; Mehta, Minesh P; Kaushal, Aradhana

    2015-01-01

    Lung cancer is among the most common cancers worldwide, and the leading cause of cancer death in both men and women. For patients with early stage (AJCC T1-2, N0) non-small cell lung cancer the current standard of care is lobectomy with systematic lymph node evaluation. Unfortunately, medical comorbities often present in patients with lung cancer, may preclude the option of surgical resection . In such cases, a number of minimal to non-invasive treatment options have gained popularity in the treatment of these high-risk patients. These modalities provide significant advantages including patient convenience, treatment in an outpatient setting, and acceptable toxicities including reduced impact on lung function and a modest risk of post-procedure chest wall pain. This manuscript seeks to provide a comprehensive review of the literature including reported outcomes, complications and limitations of sublobar resection with or without intraoperative brachytherapy, radiofrequency ablation, microwave ablation, percutaneous cryoablation, photodynamic therapy and stereotactic body radiation therapy. PMID:26027433

  10. Evolution and acceptability of medical applications of RFID implants among early users of technology.

    Science.gov (United States)

    Smith, Alan D

    2007-01-01

    RFID as a wireless identification technology that may be combined with microchip implants have tremendous potential in today's market. Although these implants have their advantages and disadvantages, recent improvements how allowed for implants designed for humans. Focus was given to the use of RFID tags and its effects on technology and CRM through a case study on VeriChip, the only corporation to hold the rights and the patent to the implantable chip for humans, and an empirically based study on working professionals to measure perceptions by early adopters of such technology. Through hypotheses-testing procedures, it was found that although some resistance to accept microchip implants was found in several applications, especially among gender, it was totally expected that healthcare and medical record keeping activities would be universally treated in a positive light and the use of authorities (namely governmental agencies) would be equally treated in a negative light by both sexes. Future trends and recommendations are presented along with statistical results collected through personal interviews.

  11. Organizational readiness for change: Preceptor perceptions regarding early immersion of student pharmacists in health-system practice.

    Science.gov (United States)

    Sanders, Kimberly A; Wolcott, Michael D; McLaughlin, Jacqueline E; D'Ostroph, Amanda; Shea, Christopher M; Pinelli, Nicole R

    To examine preceptors' perceptions regarding readiness for change pre- and post-implementation of a pilot early immersion program engaging student pharmacists in direct patient care. Student pharmacists enrolled in the second professional year of a Doctor of Pharmacy degree program completed a four-week health-system introductory pharmacy practice experience (IPPE) which was modified to include direct patient care roles in operational (drug preparation and dispensing) and clinical (comprehensive medication management) pharmacy environments. Pharmacy preceptors with direct oversight for program implementation completed a pre/post Organizational Readiness for Implementing Change (ORIC) survey and a 50-min interview or focus group post-experience. The ORIC survey evaluates two dimensions of organizational readiness for change - change commitment and change efficacy. Additional items assessed included implementation needs, support, and perceived value of the change. ORIC survey constructs were compared before and after the experience. Interviews and focus groups were audio recorded, transcribed, and evaluated by constant comparative analysis. A mixed methods approach was used to triangulate findings and develop greater understanding of the ORIC survey results. Twenty pharmacy preceptors (37 ± 8 years of age, 60% female, 65% clinical pharmacist position, 70% prior preceptor experience) participated in the study. There were no significant changes in pre/post survey constructs, except for a decline in the perception of organizational change commitment (p change (p changes for student pharmacist engagement. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Overcoming the Challenges of Conducting Early Feasibility Studies of Medical Devices in the United States.

    Science.gov (United States)

    Holmes, David R; Califf, Robert; Farb, Andrew; Abel, Dorothy; Mack, Michael; Syrek Jensen, Tamara; Zuckerman, Bram; Leon, Martin; Shuren, Jeff

    2016-10-25

    Initial clinical studies of new medical technologies involve a complex balance of research participant benefits versus risks and costs of uncertainty when novel concepts are tested. The Food and Drug Administration Center for Devices and Radiological Health has recently introduced the Early Feasibility Study (EFS) Program for facilitating the conduct of these studies under the Investigational Device Exemption regulations. However, a systematic approach is needed to successfully implement this program while affording appropriate preservation of the rights and interests of patients. For this to succeed, a holistic reform of the clinical studies ecosystem for performing early-stage clinical research in the United States is necessary. The authors review the current landscape of the U.S. EFS and make recommendations for developing an efficient EFS process to meet the goal of improving access to early-stage, potentially beneficial medical devices in the United States.

  13. Efficacy of early induced medical abortion with mifepristone when beginning progestin-only contraception on the same day.

    Science.gov (United States)

    Douthwaite, Megan; Candelas, Jose A; Reichwein, Barbara; Eckhardt, Carla; Ngo, Thoai D; Domínguez, Adriana

    2016-06-01

    To investigate whether starting progestin-only contraception immediately after mifepristone reduced the efficacy of early medical abortion with a mifepristone-misoprostol regimen. A review of patient records from October 1, 2012 to March 31, 2013 from four Marie Stopes Mexico clinics in Mexico City was conducted. Patients were eligible for inclusion if they had undergone a medical abortion with mifepristone-misoprostol at no later than 63days of pregnancy, had a recorded outcome, and had either started progestin-only contraception immediately after mifepristone administration or had not started contraception. The primary outcome-successful induced abortion-was defined as the complete evacuation of uterine contents without the need for further intervention. A secondary outcome was the number of induced abortions completed without the need for manual vacuum aspiration. Records from 2204 patients were included; 448 (20.3%) patients had started progestin-only contraception, and 1756 (79.7%) had not. Patients not taking progestin-only contraception were significantly more likely to be primigravidas and nulliparous. Medical abortion success did not vary between the two groups; 1890 (85.8%) were successful and 2085 (94.6%) were completed without the need for manual vacuum aspiration. Different methods of progestin-only contraception did not affect medical abortion outcomes. Beginning progestin-only contraception immediately following mifepristone for early medical abortion was not associated with reduced medical abortion effectiveness. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Comparison of United States and Canadian Glaucoma Medication Costs and Price Change from 2006 to 2013

    Directory of Open Access Journals (Sweden)

    Matthew B. Schlenker

    2015-01-01

    Full Text Available Objective. Compare glaucoma medication costs between the United States (USA and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA and the Ontario Drug Benefit Price (Canada. Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x–6.9x, averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%–349%; Canadian range: 9%–16%. US generic wholesale prices increased modestly (US range: −23%–58%, and Canadian wholesale prices decreased (Canadian range: −38%–0%. Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation. The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada.

  15. Ultrastructural changes in goat interspecies and intraspecies reconstructed early embryos

    DEFF Research Database (Denmark)

    Tao, Yong; Gheng, Lizi; Zhang, Meiling;

    2008-01-01

    and dispered gradually from the 4-cell period. The nucleolus of GC and GG embryos changed from electron dense to a fibrillo-granular meshwork at the 16-cell stage, showing that nucleus function in the reconstructed embryos was activated. The broken nuclear envelope and multiple nucleoli in one blastomere......- and intraspecies reconstructed embryos have a similar pattern of developmental change to that of in vivo-produced embryos for ZP, rough ER, Gi and nucleolus, but differ for mitochondria, LD, vesicles, nucleus and gap junction development. In particular, the interspecies cloned embryos showed more severe...

  16. Early Forest Soils and Their Role in Devonian Global Change

    Science.gov (United States)

    Retallack

    1997-04-25

    A paleosol in the Middle Devonian Aztec Siltstone of Victoria Land, Antarctica, is the most ancient known soil of well-drained forest ecosystems. Clay enrichment and chemical weathering of subsurface horizons in this and other Devonian forested paleosols culminate a long-term increase initiated during the Silurian. From Silurian into Devonian time, red clayey calcareous paleosols show a greater volume of roots and a concomitant decline in the density of animal burrows. These trends parallel the decline in atmospheric carbon dioxide determined from isotopic records of pedogenic carbonate in these same paleosols. The drawdown of carbon dioxide began well before the Devonian appearance of coals, large logs, and diverse terrestrial plants and animals, and it did not correlate with temporal variation in volcanic or metamorphic activity. The early Paleozoic greenhouse may have been curbed by the evolution of rhizospheres with an increased ratio of primary to secondary production and by more effective silicate weathering during Silurian time.

  17. Podocyte number and density changes during early human life.

    Science.gov (United States)

    Kikuchi, Masao; Wickman, Larysa; Rabah, Raja; Wiggins, Roger C

    2017-05-01

    Podocyte depletion, which drives progressive glomerulosclerosis in glomerular diseases, is caused by a reduction in podocyte number, size or function in the context of increasing glomerular volume. Kidneys obtained at autopsy from premature and mature infants who died in the first year of life (n = 24) were used to measure podometric parameters for comparison with previously reported data from older kidneys. Glomerular volume increased 4.6-fold from 0.13 ± 0.07 μm(3) x10(6) in the pre-capillary loop stage, through 0.35 μm(3) x10(6) at the capillary loop, to 0.60 μm(3) x10(6) at the mature glomerular stage. Podocyte number per glomerulus increased from 326 ± 154 per glomerulus at the pre-capillary loop stage to 584 ± 131 per glomerulus at the capillary loop stage of glomerular development to reach a value of 589 ± 166 per glomerulus in mature glomeruli. Thus, the major podocyte number increase occurs in the early stages of glomerular development, in contradistinction to glomerular volume increase, which continues after birth in association with body growth. As glomeruli continue to enlarge, podocyte density (number per volume) rapidly decreases, requiring a parallel rapid increase in podocyte size that allows podocyte foot processes to maintain complete coverage of the filtration surface area. Hypertrophic stresses on the glomerulus and podocyte during development and early rapid growth periods of life are therefore likely to play significant roles in determining how and when defects in podocyte structure and function due to genetic variants become clinically manifest. Therapeutic strategies aimed at minimizing mismatch between these factors may prove clinically useful.

  18. Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    White Mary T

    2011-06-01

    Full Text Available Abstract Background Increasing access to safe abortion services is the most effective way of preventing the burden of unsafe abortion, which is achieved by increasing safe choices for pregnancy termination. Medical abortion for termination of early abortion is said to safe, effective, and acceptable to women in several countries. In Ethiopia, however, medical methods have, until recently, never been used. For this reason it is important to assess women's preferences and the acceptability of medical abortion and manual vacuum aspiration (MVA in the early first trimester pregnancy termination and factors affecting acceptability of medical and MVA abortion services. Methods A prospective study was conducted in two hospitals and two clinics from March 2009 to November 2009. The study population consisted of 414 subjects over the age of 18 with intrauterine pregnancies of up to 63 days' estimated gestation. Of these 251 subjects received mifepristone and misoprostol and 159 subjects received MVA. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit. Results The study groups were similar with respect to age, marital status, educational status, religion and ethnicity. Their mean age was about 23, majority in both group completed secondary education and about half were married. Place of residence and duration of pregnancy were associated with method choice. Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (91.2% vs 82.4%; P Conclusions Women receiving medical abortion were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. We conclude that medical abortion can be used widely as an alternative method for early pregnancy termination.

  19. The role of advocacy in occasioning community and organizational change in a medical-legal partnership.

    Science.gov (United States)

    Anderson-Carpenter, Kaston D; Collie-Akers, Vicki; Colvin, Jeffrey D; Cronin, Katie

    2013-01-01

    Health disparities among low-income individuals remain a significant problem. A number of social determinants are associated with adverse health outcomes. Medical-legal partnerships address legal concerns of low-income individuals to improve health and wellness in adults and children. The Medical-Legal Partnership at Legal Aid of Western Missouri provides free direct legal services for patients with legal concerns affecting health. There is limited evidence regarding the association between advocacy-related efforts and changes within both the medical-legal partnership structure and in health-care facilities. Three health-care organizations in Kansas City, MO participated in implementing the medical-legal partnership model between 2007 and 2010. Advocacy efforts conducted by key medical-legal partnership personnel were strongly associated with changes in health-care organizations and within the medical-legal partnership structure. This study extends the current evidence base by examining the types of advocacy efforts required to bring about community and organizational changes.

  20. Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer

    Directory of Open Access Journals (Sweden)

    Sudharsan NM

    2004-04-01

    Full Text Available Abstract Background Mathematical modelling and analysis is now accepted in the engineering design on par with experimental approaches. Computer simulations enable one to perform several 'what-if' analyses cost effectively. High speed computers and low cost of memory has helped in simulating large-scale models in a relatively shorter time frame. The possibility of extending numerical modelling in the area of breast cancer detection in conjunction with medical thermography is considered in this work. Methods Thermography enables one to see the temperature pattern and look for abnormality. In a thermogram there is no radiation risk as it only captures the infrared radiation from the skin and is totally painless. But, a thermogram is only a test of physiology, whereas a mammogram is a test of anatomy. It is hoped that a thermogram along with numerical modelling will serve as an adjunct tool. Presently mammogram is the 'gold-standard' in breast cancer detection. But the interpretation of a mammogram is largely dependent on the radiologist. Therefore, a thermogram that looks into the physiological changes in combination with numerical simulation performing 'what-if' analysis could act as an adjunct tool to mammography. Results The proposed framework suggested that it could reduce the occurrence of false-negative/positive cases. Conclusion A numerical bioheat model of a female breast is developed and simulated. The results are compared with experimental results. The possibility of this method as an early detection tool is discussed.

  1. Change in Autism Classification with Early Intervention: Predictors and Outcomes

    Science.gov (United States)

    Ben Itzchak, Esther; Zachor, Ditza A.

    2009-01-01

    The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18-35 months (M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive…

  2. Evaluation of early changes of cartilage biomarkers following ...

    African Journals Online (AJOL)

    Hamdy Khamis Koryem

    2014-08-15

    Aug 15, 2014 ... cartilage changes and degeneration that may stay invisible for a long period of time before ... addition they allow classification of disease severity, risk of onset and ... Varicose veins of the lower limbs. ... A positioning device was used to ... ible as a light gray or white band between the dark1 subchondral ...

  3. The validity of student tutors’ judgments in early detection of struggling in medical school. A prospective cohort study

    DEFF Research Database (Denmark)

    O'Neill, Lotte; Mørcke, Anne Mette; Eika, Berit

    2016-01-01

    of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted...... to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical...... students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4–1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor’s judgements showed incremental...

  4. Medical student mental health 3.0: improving student wellness through curricular changes.

    Science.gov (United States)

    Slavin, Stuart J; Schindler, Debra L; Chibnall, John T

    2014-04-01

    Medical education can have significant negative effects on the well-being of medical students. To date, efforts to improve student mental health have focused largely on improving access to mental health providers, reducing the stigma and other barriers to mental health treatment, and implementing ancillary wellness programs. Still, new and innovative models that build on these efforts by directly addressing the root causes of stress that lie within the curriculum itself are needed to properly promote student wellness. In this article, the authors present a new paradigm for improving medical student mental health, by describing an integrated, multifaceted, preclinical curricular change program implemented through the Office of Curricular Affairs at the Saint Louis University School of Medicine starting in the 2009-2010 academic year. The authors found that significant but efficient changes to course content, contact hours, scheduling, grading, electives, learning communities, and required resilience/mindfulness experiences were associated with significantly lower levels of depression symptoms, anxiety symptoms, and stress, and significantly higher levels of community cohesion, in medical students who participated in the expanded wellness program compared with those who preceded its implementation. The authors discuss the utility and relevance of such curricular changes as an overlooked component of change models for improving medical student mental health.

  5. Total and regional body-composition changes in early postmenopausal women

    DEFF Research Database (Denmark)

    Wang, Q; Hassager, C; Ravn, Pernille;

    1994-01-01

    Total and regional body composition were measured in 373 early postmenopausal women aged 49-60 y by dual-energy x-ray absorptiometry to evaluate whether the changes in body composition in the early postmenopausal years are related to menopause itself or merely to age. Both fat mass and fat...

  6. Visualizing reproduction: a cultural history of early-modern and modern medical illustrations.

    Science.gov (United States)

    Harvey, Karen

    2010-03-01

    Written as a response to a conference exhibition of medical illustrations of reproduction, this article considers the gains of an interdisciplinary study of medical illustration to both historians and medics. The article insists that we should not only be attuned to the cultural work that such representations perform but also that such illustrations are the product of material medical practices and the often humane impulses that drive them.

  7. Medical diagnosis of legal culpability: the impact of early psychiatric testimony in the 19th century English criminal trial.

    Science.gov (United States)

    Toole, Ciara J

    2012-01-01

    Fast-paced developments in psychiatry, neuroscience and emerging neuroimaging technologies place continual pressure on the legal recognition of mental illness and disease across jurisdictional boundaries. Nevertheless, the Canadian legal definition of exculpatory mental disease in the context of criminal liability has remained largely static, sheltered from the immediate influence of medical theory and advancements. In order to effectively reflect on the intersection of mental health and criminal justice systems in this area, it is important to understand its historical development and the English common law origins of the current approach. Specifically turning to the early 19th century, documented history and accounts of early medical witness testimony on the mental state of the accused provide a unique opportunity to understand the initial collision between fundamental concepts of moral and legal culpability and new scientific understandings of mental function and disease. In this article, I suggest that early psychiatric testimony to the accused's mental state challenged the evolving criminal law of 19th century England to reconcile its restrictive definition of "insanity" with expanding scientific reasoning and accounts of mental disease. The trial of Edward Oxford, an attempted royal assassination case of 1840, is examined as a symbolic height in this conflict prior to the first common law pronouncement of the current approach in 1843. As debate continues on the role of medical advancement in the identification of exculpatory medical disorders in law, this historical perspective may serve as a touchstone in balancing the enforcement of legal culpability with our society's greater appreciation for mental illness.

  8. The effect of early in‐hospital medication review on health outcomes: a systematic review

    National Research Council Canada - National Science Library

    Hohl, Corinne M; Wickham, Maeve E; Sobolev, Boris; Perry, Jeff J; Sivilotti, Marco L. A; Garrison, Scott; Lang, Eddy; Brasher, Penny; Doyle‐Waters, Mary M; Brar, Baljeet; Rowe, Brian H; Lexchin, Joel; Holland, Richard

    2015-01-01

    ... while minimizing their potential for harm is a public health priority . Medication review, a structured and critical examination of an individual patient's medications by a qualified healthcare provider aims to accomplish exactly these goals . Medication review is performed by a qualified healthcare provider, usually a pharmacist, and includes e...

  9. Teaching of medical pharmacology: the need to nurture the early development of desired attitudes for safe and rational drug prescribing.

    Science.gov (United States)

    Gwee, Matthew C E

    2009-09-01

    Pharmacology, as a basic medical science discipline, provides the scientific basis of therapeutics, i.e. the scientific foundation for safe and rational prescribing of drugs. The public, lay media, and the medical profession have raised serious concerns over the high incidence of errors of drug prescribing which compromise patient safety, including death of some patients, attributed mainly to inadequate teaching of medical pharmacology and, consequently, to medical graduates lacking skills in safe and effective drug prescribing. There is also overwhelming evidence that the pervasive and prevalent doctor-drug industry relationships have a strong influence over the prescribing habits and drug education of doctors. The British Pharmacological Society and American Association of Medical Colleges have crafted some insightful guidelines, including the learning of desired attitudes, for designing a medical pharmacology curriculum aimed at enhancing patient safety. This article will critically review the major issues relating to errors of drug prescribing, including the need to nurture the early development of desired attitudes which foster safe and rational drug prescribing. A simple educational approach, using a task analysis of drug prescribing, is applied to identify desired attitudes which should be incorporated into a basic pharmacology course for medical students in the twenty-first century.

  10. Preparing for the changing role of instructional technologies in medical education.

    Science.gov (United States)

    Robin, Bernard R; McNeil, Sara G; Cook, David A; Agarwal, Kathryn L; Singhal, Geeta R

    2011-04-01

    As part of an international faculty development conference in February 2010, a working group of medical educators and physicians discussed the changing role of instructional technologies and made recommendations for supporting faculty in using these technologies in medical education. The resulting discussion highlighted ways technology is transforming the entire process of medical education and identified several converging trends that have implications for how medical educators might prepare for the next decade. These trends include the explosion of new information; all information, including both health knowledge and medical records, becoming digital; a new generation of learners; the emergence of new instructional technologies; and the accelerating rate of change, especially related to technology. The working group developed five recommendations that academic health leaders and policy makers may use as a starting point for dealing with the instructional technology challenges facing medical education over the next decade. These recommendations are (1) using technology to provide/support experiences for learners that are not otherwise possible-not as a replacement for, but as a supplement to, face-to-face experiences, (2) focusing on fundamental principles of teaching and learning rather than learning specific technologies in isolation, (3) allocating a variety of resources to support the appropriate use of instructional technologies, (4) supporting faculty members as they adopt new technologies, and (5) providing funding and leadership to enhance electronic infrastructure to facilitate sharing of resources and instructional ideas.

  11. Mathematical Rigor vs. Conceptual Change: Some Early Results

    Science.gov (United States)

    Alexander, W. R.

    2003-05-01

    Results from two different pedagogical approaches to teaching introductory astronomy at the college level will be presented. The first of these approaches is a descriptive, conceptually based approach that emphasizes conceptual change. This descriptive class is typically an elective for non-science majors. The other approach is a mathematically rigorous treatment that emphasizes problem solving and is designed to prepare students for further study in astronomy. The mathematically rigorous class is typically taken by science majors. It also fulfills an elective science requirement for these science majors. The Astronomy Diagnostic Test version 2 (ADT 2.0) was used as an assessment instrument since the validity and reliability have been investigated by previous researchers. The ADT 2.0 was administered as both a pre-test and post-test to both groups. Initial results show no significant difference between the two groups in the post-test. However, there is a slightly greater improvement for the descriptive class between the pre and post testing compared to the mathematically rigorous course. There was great care to account for variables. These variables included: selection of text, class format as well as instructor differences. Results indicate that the mathematically rigorous model, doesn't improve conceptual understanding any better than the conceptual change model. Additional results indicate that there is a similar gender bias in favor of males that has been measured by previous investigators. This research has been funded by the College of Science and Mathematics at James Madison University.

  12. A study of the changes in how medically related events are reported in Japanese newspapers.

    Science.gov (United States)

    Kishi, Yukiko; Murashige, Naoko; Kodama, Yuko; Hamaki, Tamae; Murata, Kazuhiro; Nakada, Haruka; Komatsu, Tsunehiko; Narimatsu, Hiroto; Kami, Masahiro; Matsumura, Tomoko

    2010-01-01

    Media reports of medically related events have a major effect on the healthcare community but there have been few detailed investigations conducted to investigate their content. The Nikkei Telecom 21 database was used to investigate the number of reports concerning medically related events between 1992 and 2007 in Japan's 5 national newspapers. For this period, both the total number of articles and the number of articles containing medically-related keywords were determined. The number of reports relating to medically related occurrences increased sharply from 1999 to 2000 and displayed a decrease from 2003 before increasing again in 2008. As of 2008, such reports account for 0.17% of total newspaper articles. The use of the word 'iryokago' (medical professional negligence or error) drastically increased in 1999 but showed a consistent decrease from 2004. On the other hand the frequency of reports relating to 'litigation' and 'punishment' increased rapidly in 1999 before leveling off. Despite this, the number of articles relating to medically related occurrences that were caused by doctor shortages and system errors increased sharply between 2006 and the present. Results indicate that the manner in which newspapers report medically related events is undergoing major changes.

  13. Of paradox and plausibility: the dynamic of change in medical law.

    Science.gov (United States)

    Harrington, John

    2014-01-01

    This article develops a model of change in medical law. Drawing on systems theory, it argues that medical law participates in a dynamic of 'deparadoxification' and 'reparadoxification' whereby the underlying contingency of the law is variously concealed through plausible argumentation, or revealed by critical challenge. Medical law is, thus, thoroughly rhetorical. An examination of the development of the law on abortion and on the sterilization of incompetent adults shows that plausibility is achieved through the deployment of substantive common sense and formal stylistic devices. It is undermined where these elements are shown to be arbitrary and constructed. In conclusion, it is argued that the politics of medical law are constituted by this antagonistic process of establishing and challenging provisionally stable normative regimes.

  14. Motivation of university and non-university stakeholders to change medical education in Vietnam.

    Science.gov (United States)

    Luu, Ngoc Hoat; Nguyen, Lan Viet; van der Wilt, G J; Broerse, J; Ruitenberg, E J; Wright, E P

    2009-07-24

    Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

  15. Motivation of university and non-university stakeholders to change medical education in Vietnam

    Directory of Open Access Journals (Sweden)

    Ruitenberg EJ

    2009-07-01

    Full Text Available Abstract Background Both university and non-university stakeholders should be involved in the process of curriculum development in medical schools, because all are concerned with the competencies of the graduates. That may be difficult unless appropriate strategies are used to motivate each stakeholder. From 1999 to 2006, eight medical schools in Vietnam worked together to change the curriculum and teaching for general medical students to make it more community oriented. This paper describes the factors that motivated the different stakeholders to participate in curriculum change and teaching in Vietnamese medical schools and the activities to address those factors and have sustainable contributions from all relevant stakeholders. Methods Case study analysis of contributions to the change process, using reports, interviews, focus group discussions and surveys and based on Herzberg's Motivation Theory to analyze involvement of different stakeholders. Results Different stakeholders were motivated by selected activities, such as providing opportunities for non-university stakeholders to share their opinions, organizing interactions among university stakeholders, stimulating both bottom-up and top-down inputs, focusing on learning from each other, and emphasizing self-motivation factors. Conclusion The Herzberg Motivation theory helped to identify suitable approaches to ensure that teaching topics, materials and assessment methods more closely reflected the health care needs of the community. Other medical schools undertaking a reform process may learn from this experience.

  16. Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students.

    Science.gov (United States)

    Calabrese, Leonard H; Bianco, Joseph A; Mann, Douglas; Massello, David; Hojat, Mohammadreza

    2013-12-01

    Many studies have reported a decline in empathy as allopathic medical students progress through medical school. Data are needed to compare the pattern of changes in empathy in osteopathic and allopathic medical students. Also, it is important to investigate the associations between measures of empathy and attitudes toward interprofessional collaboration, which are among major elements of professionalism in medicine. (1) To investigate correlations between empathy and interprofessional collaboration in osteopathic medical students; (2) to examine differences in empathy and interprofessional collaboration scores by sex, class year, and specialty interest; and (3) to compare empathy scores by class year between osteopathic and allopathic medical students. Correlational and comparative study. Ohio University Heritage College of Osteopathic Medicine. Osteopathic medical students enrolled in academic year 2011-2012. The Jefferson Scale of Empathy (JSE) and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) scores. Student respondents (N=373) included 197 women (53%) and 176 men (47%). Significant correlation was found between scores on the JSE and JSAPNC (r=0.42, P<.01). Women scored higher than men on the JSE (mean scores, 117.1 and 111.9, respectively; F1,371=19.6, P<.01) and the JSAPNC (mean scores, 50.1 and 48.7, respectively; F1,371=6.5, P<.01). No statistically significant difference on the scores of the 2 scales was observed among students who planned to pursue "people-oriented" specialties (150 [40%]) compared with those interested in "technology/procedure-oriented" specialties (170 [45%]). No statistically significant change in empathy scores was found in different class years of the osteopathic medical students. Comparisons of empathy scores with allopathic medical students showed no significant difference in the first and second years, but osteopathic medical students had a higher mean empathy score (M=114.4) than their allopathic

  17. Early electrocortical changes consistent with ischemic preconditioning in rat

    DEFF Research Database (Denmark)

    Zagrean, L.; Moldovan, M.; Munteanu, Ana-Maria

    2002-01-01

    Ischemic preconditioning (IPC) of the brain describes the neuroprotection induced by a short, conditioning ischemic episode (CIE) to a subsequent severe (test) ischemic episode (TIE). Most of the supporting evidence for IPC is based on histological assessment, several days after TIE. The aim...... of this study is to investigate if changes induced by IPC can be detected within 30 min of reperfusion following the ischemic episode. A rat model of "four-vessel occlusion" transient global cerebral ischemia and parametric analysis of electrocorticogram were used. A control group was subjected directly to a 10...... min TIE, and in a preconditioned group TIE was induced 48 h after a 3 min CIE. Quantitative histology was performed 48 h after TIE. Our key finding is that, 30 min after reperfusion, there is a significant increase in the electrocortical slow activity in the control group but not in the preconditioned...

  18. [Relationship between developmental prognosis and changing picture of postural findings in early infancy among early treated children].

    Science.gov (United States)

    Yuge, M; Yamori, Y; Kanda, T; Ando, R

    1992-09-01

    We followed 93 infants prospectively who were treated because of moderate and severe grades of cerebral coordination disturbances since less than 6 months of age. They were divided into 3 groups according to developmental prognosis at 4 years of age; normal 44, mental retardation 18, and cerebral palsy 31. We compared the postural findings in supine and prone position, and 7 postural reactions at the first examination with those at discharge about 50 days after the first examination. We assessed the changing pictures of postural findings as improved, not changed or worsened. We analyzed the relationship between the changing pictures of postural findings during the short period in early infancy and the developmental prognosis among the 3 groups. The normal group showed improvement in a larger number of items than the other two groups. The findings of cerebral palsied children showed poor improvement, and more postural reactions changed to be more pathologic than those in the other two groups. Among the cerebral palsied children, ambulatory cases showed better improvement than those who could not crawl. But we found no significant difference between ambulatory and crawling children. This study demonstrated that assessment of changing pictures of postural findings in early infancy was helpful to predict developmental prognosis.

  19. 'Bolam' to 'Montgomery' is result of evolutionary change of medical practice towards 'patient-centred care'.

    Science.gov (United States)

    Lee, Albert

    2017-01-01

    The Supreme Court judgement in 'Montgomery v Lanarkshire Health Board' has caused a change in the law concerning the duty of doctors on disclosure of information to patients regarding risks. The law now requires a doctor to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. Are doctors totally removed from the protective shield even if the practice is accepted by a reasonable body of medical opinion previously laid down by 'Bolam' with the recent Supreme Court decision in the 'Montgomery' case? This paper questions whether the 'Bolam' principle needs to be discarded or re-interpreted in the modern context of health care. Adopting 'patient-centred' care to unfold the 'significant risks' attached to patients would align with the evolving changes in medical law. It should be the changing context of health care driving the evolving change of law.

  20. Changes in early maladaptive schemas after residential treatment for substance use.

    Science.gov (United States)

    Shorey, Ryan C; Stuart, Gregory L; Anderson, Scott; Strong, David R

    2013-09-01

    Early maladaptive schemas are cognitive and behavioral patterns that cause considerable distress and are theorized to underlie mental health problems. Research suggests that early maladaptive schemas may underlie substance abuse and that the intensity of early maladaptive schemas may decrease after brief periods of abstinence. The current study examined changes in early maladaptive schemas after a 4-week residential substance use treatment program. Preexisting records of a sample of male alcohol- and opioid-dependent treatment seeking adults (N = 97; mean age = 42.55) were reviewed for the current study. Pre-post analyses demonstrated that 8 of the early maladaptive schemas significantly decreased by the end of the 4-week treatment. Findings indicate that early maladaptive schemas can be modified during brief substance use treatment and may be an important component of substance use intervention programs. Implications of these findings for substance use treatment are discussed. © 2013 Wiley Periodicals, Inc.

  1. Oral health changes during early phase of orthodontic treatment.

    Science.gov (United States)

    Sudarević, Karlo; Jurela, Antonija; Repić, Dario; Jokić, Dražen; Mikić, Ivana Medvedec; Pejda, Slavica

    2014-12-01

    The aim of the study was to assess the influence of fixed orthodontic appliance on Streptococcus (S.) mutans and S. sobrinus counts in orthodontic patients with regard to their previous caries experience (Decayed, Missing and Filled Teeth (DMFT) index) during the first 12 weeks of orthodontic treatment. Twenty-two patients that satisfied inclusion criteria (healthy systemic and periodontal condition, avoidance of antibiotic therapy and antiseptic mouthwashes in the past three months) were included. All clinical measurements took place prior to and 12 weeks after fixed orthodontic appliance placement, in the following order: 1) stimulated saliva flow (SS); 2) Simplified Oral Hygiene Index (OHI-S); and 3) DMFT. The method of polymerase chain reaction (PCR) was used to detect the presence of S. mutans and S. sobrinus at T1 and T2. T-test showed significant increase in DMFT index and SS between T1 and T2. Results also indicated significant improvement in OHI-S index. By use of the PCR method, S. mutans was detected in two patients at T1. At T2, two more patients had S. mutans, but the increase was not statistically significant. Using the same method, S. sobrinus was detected only in two patients at T2. In conclusion, fixed orthodontic appliances did not induce statistically significant changes in caries microflora even in the presence of enhanced oral hygiene habits.

  2. A study of the changes in how medically related events are reported in Japanese newspapers

    Directory of Open Access Journals (Sweden)

    Yukiko Kishi

    2010-08-01

    Full Text Available Yukiko Kishi1, Naoko Murashige2, Yuko Kodama1, Tamae Hamaki1, Kazuhiro Murata3, Haruka Nakada1, Tsunehiko Komatsu3, Hiroto Narimatsu1,4, Masahiro Kami1, Tomoko Matsumura11Division of Social Communication System for Advanced Clinical Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan; 2Ministry of Health, Labor and Welfare, Aide of the Minister, Health Sector Reform Office, Tokyo, Japan; 3Department of Hematology, Teikyo University Chiba Medical Center, Chiba, Japan, 4Advanced Molecular Epidemiology Research Institute, Faculty of Medicine, Yamagata University, Yamagata, JapanAbstract: Media reports of medically related events have a major effect on the healthcare ­community but there have been few detailed investigations conducted to investigate their content. The Nikkei Telecom 21 database was used to investigate the number of reports concerning medically related events between 1992 and 2007 in Japan’s 5 national newspapers. For this period, both the total number of articles and the number of articles containing medically-related keywords were determined. The number of reports relating to medically related occurrences increased sharply from 1999 to 2000 and displayed a decrease from 2003 before increasing again in 2008. As of 2008, such reports account for 0.17% of total newspaper articles. The use of the word ‘iryokago’ (medical professional negligence or error drastically increased in 1999 but showed a consistent decrease from 2004. On the other hand the frequency of reports relating to ‘litigation’ and ‘punishment’ increased rapidly in 1999 before leveling off. Despite this, the number of articles relating to medically related occurrences that were caused by doctor shortages and system errors increased sharply between 2006 and the present. Results indicate that the manner in which newspapers report medically related events is undergoing major changes.Keywords: coverage, incident, doctor shortage

  3. [Antipsychotic medication change and reduction of rehospitalization in clients of ACT-J].

    Science.gov (United States)

    Satake, Naoko

    2011-01-01

    Polypharmacy and high-dose treatment of antipsychotics have been major problems in Japanese mental health. Although importance of simplifying prescription has been recognized, polypharmacy and high-dose medication especially for Schizophrenia remains prevalent. It's considered that psycho-social approach; for example, improvement of coping skills and social support such as care management can make reform of treatment efficiently and also improve patient's QOL. In ACT service, Medication, rehabilitation and social support work closely together and it could make prescription change even for SMI patients. Low-dose medication leads improvement of cognitive function and furthermore social activity. Considering the higher dose of antipsychotics prescribed concurrency in Japan, it's important to evaluate the change in medication for patients of ACT in Japan. We did one year follow up study about prescription change for 52 patients who have used ACT program at ACT-J team for more than one year at the end of December 2009. It was found that the dosage antipsychotics significantly decreased from 1131.3 mg converted to the relative potency equivalent of 100 mg of Chlorpromazine (CPZ eq), to 731.3 mg (CPZ eq) over the course of the 12 months. But there was no significant change about polyphamacy. Also it could be possible to reduce rehospitalization under the ACT program. Because recovery model could make improve not only drop out from psychiatric service, but user's dependency for hospitalization.

  4. The Impact of Perceived Adverse Effects on Medication Changes in Heart Failure Patients

    NARCIS (Netherlands)

    De Smedt, Ruth H. E.; Jaarsma, Tiny; Haaijer-Ruskamp, Flora M.; Denig, Petra

    2010-01-01

    Background: Given the importance of patient safety and well-being, we quantified the likelihood and type of medication changes observed after 5 possible adverse effects (AE) perceived by heart failure (HF) patients. Methods and Results: We conducted a retrospective cohort study using 18 months follo

  5. Curriculum change in the 1980s. A report of 40 southern US medical schools.

    Science.gov (United States)

    Kuske, T T; Fleming, G A; Jarecky, R K; Levine, J H; Lewis, L A

    1985-11-15

    Forty southern medical schools were surveyed to evaluate the nature and mechanisms of curricular change during 1980 to 1983. Ninety percent of schools experienced change in some aspect of curriculum. Faculty, curriculum committees, the dean, and external forces were stimuli for change. Internal self-review or self-criticism seemed to be the most important reasons for change. Proposals were considered by curriculum committees and the dean, but veto power often rested with the dean, although departmental chairmen and faculty occasionally had veto power. Types of change were divided equally between content, timing of courses, and the educational process. Half the schools stated that they had evaluated the changes or planned to do so. Thirteen of 38 changes in curriculum were in the direction of curricular innovations of the 1960s and 1970s and 25 were in the opposite direction.

  6. International outsourcing of medical research by high-income countries: changes from 1995 to 2005.

    Science.gov (United States)

    Belforti, Raquel K; Wall, Michal Sarah; Lindenauer, Peter K; Pekow, Penelope S; Rothberg, Michael B

    2010-02-01

    Medical research outsourcing provides a financial benefit to those conducting research and financial incentives to the developing countries hosting the research. Little is known about how frequently outsourcing occurs or the type of research that is outsourced. To document changes in medical research outsourcing over a 10-year period, we conducted a cross-sectional comparison of 3 medical journals: Lancet, The New England Journal of Medicine, and JAMA: The Journal of the American Medical Association in the last 6 months of 1995 and 2005. The main outcome measure was the 10-year change in proportion of studies including patients from low-income countries. We reviewed 598 articles. During the 10-year period, the proportion of first authors from low-income countries increased from 3% to 6% (P = 0.21), whereas studies with participants from low-income countries increased from 8% to 22% (P = Outsourcing of medical research seems to be increasing. Additional studies are required to know if subjects from low-income countries are being adequately protected.

  7. Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

    Science.gov (United States)

    Fukuda, Haruhisa

    2017-06-30

    The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

  8. Driving change in rural workforce planning: the medical schools outcomes database.

    Science.gov (United States)

    Gerber, Jonathan P; Landau, Louis I

    2010-01-01

    The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project ofmedical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives.

  9. Ultrastructural changes in the optic nerve and capillary vessels during early stages of optic nerve injury

    Institute of Scientific and Technical Information of China (English)

    Xuehong Ju; Xiuyun Li; Xiaoshuang Li; Hongtao Tang; Hongguo Liu

    2008-01-01

    BACKGROUND: Capillaries are the only blood supply for optic nerves, which makes the system more vulnerable to impaired blood circulation. OBJECTIVE: To observe the ultrastructural changes in the optic nerves and capillaries in rabbits following intracanalicular segment injury to the optic nerve. DESIGN, TIME AND SETTING: Comparative, observational, pathological morphology was performed at the Department of Anatomy, Weifang Medical College from September to November 2007. MATERIALS: Models of intracanalicular segment injury to the optic nerve were induced in the right eye of thirty healthy, adult rabbits by a flee-falling metal cylinder. The H-7500 transmission electron microscope was provided by Hitachi, Japan. METHODS: All rabbits were randomly assigned into experimental (n = 25) and control (n = 5) groups. Optic nerve specimens were obtained from the experimental group at 0.5, 6, 12, 48, and 96 hours, respectively, following injury. Uitrastructural changes to the optic nerves and their capillaries were observed by electron microscopy. Optic nerve injury was not established in the control group, but optic nerve specimens were collected similarly to the experimental group. MAIN OUTCOME MEASURES: Ultrastructural changes in the injured optic nerves and their capillaries. RESULTS: Thirty rabbits were included in the final analysis. In the control group, cross-sections of the optic nerves exhibited varied thicknesses with regularly arranged fibers. The axons appeared to be smooth with condensed myelin sheaths and oval mitochondria. The microtubules and mierofilaments were clearly seen. The lumens of the capillaries were regular with densely arranged endothelial cells and visible mitochondria. In the experimental group, 30 minutes after injury to the optic nerves, swollen axons, sparse myelin sheath, disordered microtubules and microfilaments, swollen mitochondria, and a decreased number of pinocytosis vesicles and microfilaments in endothelial cells of the capillaries

  10. Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces.

    Science.gov (United States)

    Yardley, Sarah; Brosnan, Caragh; Richardson, Jane; Hays, Richard

    2013-12-01

    This paper addresses the question 'what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?' AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role-a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for 'risk'-moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.

  11. California forests show early indications of both range shifts and local persistence under climate change

    Science.gov (United States)

    Josep M. Serra-Diaz; Janet Franklin; Whalen W. Dillon; Alexandra D. Syphard; Frank W. Davis; Ross K. Meentemeyer

    2015-01-01

    Aim Forest regeneration data provide an early signal of the persistence and migration of tree species, so we investigated whether species shifts due to climate change exhibit a common signal of response or whether changes vary by species. Location California Floristic Province, United...

  12. Cross-Cultural Interpretations of Changes in Early Childhood Education in the USA, Russia, and Finland

    Science.gov (United States)

    Vlasov, Janniina; Hujala, Eeva

    2016-01-01

    The purpose of this study was to examine changes that have taken place in centre-based early childhood education (ECE) in the USA, Russia, and Finland between 1991 and 2014. The cross-culturally conducted study aimed to identify and contrast socio-cultural differences and similarities of the perceived changes in the context of the studied…

  13. Frameworks for Change: Four Recurrent Themes for Quality in Early Childhood Curriculum Initiatives

    Science.gov (United States)

    Burgess, Jennifer; Fleet, Alma

    2009-01-01

    This paper reports on the first phase of a case study that investigated how early childhood teachers experience organisational change. As one of three levels of quality improvement, State government-funded curriculum initiatives were developed with an aim to promote change. Three curriculum documents, one each focusing on literacy, pedagogy and…

  14. Mentors' Perceptions of Factors Associated with Change in Early Childhood Classrooms

    Science.gov (United States)

    Howe, Nina; Jacobs, Ellen

    2013-01-01

    Mentors' perceptions of factors associated with educational change were identified following an individualized mentoring program about constructivist curriculum for early childhood educators. A qualitative case study analysis of the mentors' journals of six classrooms was conducted to review their perceptions of change. Classroom…

  15. Cross-Cultural Interpretations of Changes in Early Childhood Education in the USA, Russia, and Finland

    Science.gov (United States)

    Vlasov, Janniina; Hujala, Eeva

    2016-01-01

    The purpose of this study was to examine changes that have taken place in centre-based early childhood education (ECE) in the USA, Russia, and Finland between 1991 and 2014. The cross-culturally conducted study aimed to identify and contrast socio-cultural differences and similarities of the perceived changes in the context of the studied…

  16. [Social media and medical apps: how they can change health communication, education and care].

    Science.gov (United States)

    Santoro, Eugenio

    2013-05-01

    Social media and medical apps for smartphones and tablets are changing health communication, education and care. This change involves physicians and other health care professionals which for their education, training and updating have started to follow public pages and profiles opened by medical journals and professional societies on the online social networking sites (such as Facebook, Twitter and Google+), to access scientific content (videos, images, slides) available on user-generated contents sites (such as SlideShare, Pinterest and YouTube) or on health professional online communities such as Sermo, and to use medical and health apps on their smartphones and tablets. As shown by a number of experiences conducted in US by health institutions such as the Centers for Disease Control and Prevention of Atlanta and hospitals such a the Mayo Clinic, these tools are also transforming the way to make health promotion activities and communication, promote healthy habits and lifestyles, and prevent chronic diseases. Finally this change involves patients which are starting to use medical and health apps on their smartphones and tablets to monitor their diseases, and tools such as Patients Like Me (an online patients' community), Facebook and Twitter to share with others the same disease experience, to learn about the disease and treatments, and to find opinions on physicians, hospitals and medical centers. These new communication tools allow users to move to a kind of collaborative education and updating where news and contents (such as public health recommendations, results of the most recent clinical researches or medical guidelines) may be shared and discussed.

  17. Women Physicians Are Early Adopters of On-Line Continuing Medical Education

    Science.gov (United States)

    Harris, John M., Jr.; Novalis-Marine, Cheryl; Harris, Robin B.

    2003-01-01

    Introduction: On-line continuing medical education (CME) provides advantages to physicians and to medical educators. Although practicing physicians increasingly use on-line CME to meet their educational needs, the overall use of on-line CME remains limited. There are few data to describe the physicians who use this new educational medium; yet,…

  18. Community Oncology Medical Homes: Physician-Driven Change to Improve Patient Care and Reduce Costs.

    Science.gov (United States)

    Waters, Teresa M; Webster, Jennifer A; Stevens, Laura A; Li, Tao; Kaplan, Cameron M; Graetz, Ilana; McAneny, Barbara L

    2015-11-01

    Although the patient-centered medical home is a well-established model of care for primary care providers, adoption by specialty providers has been relatively limited. Recently, there has been particular interest in developing specialty medical homes in medical oncology because of practice variation, care fragmentation, and high overall costs of care. In 2012, the Center for Medicare and Medicaid Innovation awarded Innovative Oncology Business Solutions a 3-year grant for their Community Oncology Medical Home (COME HOME) program to implement specialty medical homes in seven oncology practices across the country. We report our early experience and lessons learned.Through September 30, 2014, COME HOME has touched 16,353 unique patients through triage encounters, patient education visits, or application of clinical pathways. We describe the COME HOME model and implementation timeline, profile use of key services, and report patient satisfaction. Using feedback from practice sites, we highlight patient-centered innovations and overall lessons learned.COME HOME incorporates best practices care driven by triage and clinical pathways, team-based care, active disease management, enhanced access and care, as well as financial support for the medical home infrastructure. Information technology plays a central role, supporting both delivery of care and performance monitoring. Volume of service use has grown steadily over time, leveling out in second quarter 2014. The program currently averages 1,265 triage encounters, 440 extended hours visits, and 655 patient education encounters per month.COME HOME offers a patient-centered model of care to improve quality and continuity of care. Copyright © 2015 by American Society of Clinical Oncology.

  19. Temporal changes in tolerance of uncertainty among medical students: insights from an exploratory study

    Directory of Open Access Journals (Sweden)

    Paul K. J. Han

    2015-09-01

    Full Text Available Background: Physicians’ tolerance of uncertainty (TU is a trait potentially associated with desirable outcomes, and emerging evidence suggests it may change over time. Past studies of TU, however, have been cross-sectional and have not measured tolerance of the different, specific types of uncertainty that physicians confront. We addressed these limitations in a longitudinal exploratory study of medical students. Methods: At the end of medical school (Doctor of Medicine degree Years 1 and 4, a cohort of 26 students at a US medical school completed measures assessing tolerance of different types of uncertainty: 1 complexity (uncertainty arising from features of information that make it difficult to comprehend; 2 risk (uncertainty arising from the indeterminacy of future outcomes; and 3 ambiguity (uncertainty arising from limitations in the reliability, credibility, or adequacy of information. Change in uncertainty-specific TU was assessed using paired t-tests. Results: Between Years 1 and 4, there was a significant decrease in tolerance of ambiguity (t=3.22, p=0.004, but no change in students’ tolerance of complexity or risk. Conclusions: Tolerance of ambiguity – but not other types of uncertainty – decreases during medical school, suggesting that TU is a multidimensional, partially mutable state. Future studies should measure tolerance of different uncertainties and examine how TU might be improved.

  20. Medical library downsizing administrative, professional, and personal strategies for coping with change

    CERN Document Server

    Schott, Michael

    2005-01-01

    Learn how to stay ahead of the game when budgets and staff are cut Medical Library Downsizing: Administrative, Professional, and Personal Strategies for Coping with Change explores corporate downsizing and other company-wide events as they relate to medical librarians in their organization. This training manual is designed to help librarians prepare for a new era where shrinking budgets, inflated journal costs, and the increasing demand for new and expensive services now put salaries and jobs at risk. While focused on health care issues, this book will appeal to a general library audience and

  1. Challenges Faced by International Medical Students Due to Changes in Canadian Entrance Exam Policy

    Directory of Open Access Journals (Sweden)

    Pishoy Gouda

    2015-03-01

    Full Text Available The Medical Council of Canada has set new eligibility criteria for examinations that are required in order to apply to postgraduate training. This is to facilitate the establishment of the National Assessment Collaboration Objective Structured Clinical Examination. These changes result in increased hardships on Canadians studying abroad who are wishing to apply for postgraduate training in Canada. While these exams are crucial to protect medical standards and the quality of healthcare in Canada, slight modifications of the examination timelines may alleviate some of the burdens caused by these exams.

  2. [Globalization of higher education in Europe. The precursor of changes in Chilean medical education].

    Science.gov (United States)

    Rosselot, Eduardo

    2005-07-01

    At the present time, higher education is a central process shaping the society of knowledge. The mutual strength of society and education influence worldwide changes. Globalization, that mainly embraces politics and commerce, is also promoting changes in professional training, modifying programs, structures and the organization of superior education. The European example is attractive and has a great projection. It will cause a profound impact in culture, development and life of Europeans. Universities in Latin America, in an attempt to achieve the same objectives than their European counterparts, are experiencing premonitory changes, that will have the same effects as in Europe. In the medical area, several changes will occur and we will have to provide initiatives to facilitate these changes in a timely manner. The revision of the model in its inception, is convenient to assimilate changes in our culture.

  3. 3D quantitative analysis of early decomposition changes of the human face.

    Science.gov (United States)

    Caplova, Zuzana; Gibelli, Daniele Maria; Poppa, Pasquale; Cummaudo, Marco; Obertova, Zuzana; Sforza, Chiarella; Cattaneo, Cristina

    2017-07-13

    Decomposition of the human body and human face is influenced, among other things, by environmental conditions. The early decomposition changes that modify the appearance of the face may hamper the recognition and identification of the deceased. Quantitative assessment of those changes may provide important information for forensic identification. This report presents a pilot 3D quantitative approach of tracking early decomposition changes of a single cadaver in controlled environmental conditions by summarizing the change with weekly morphological descriptions. The root mean square (RMS) value was used to evaluate the changes of the face after death. The results showed a high correlation (r = 0.863) between the measured RMS and the time since death. RMS values of each scan are presented, as well as the average weekly RMS values. The quantification of decomposition changes could improve the accuracy of antemortem facial approximation and potentially could allow the direct comparisons of antemortem and postmortem 3D scans.

  4. Does Emotional Intelligence Change during Medical School Gross Anatomy Course? Correlations with Students' Performance and Team Cohesion

    Science.gov (United States)

    Holman, Michelle A.; Porter, Samuel G.; Pawlina, Wojciech; Juskewitch, Justin E.; Lachman, Nirusha

    2016-01-01

    Emotional intelligence (EI) has been associated with increased academic achievement, but its impact on medical education is relatively unexplored. This study sought to evaluate change in EI, performance outcomes, and team cohesion within a team-based medical school anatomy course. Forty-two medical students completed a pre-course and post-course…

  5. Does Emotional Intelligence Change during Medical School Gross Anatomy Course? Correlations with Students' Performance and Team Cohesion

    Science.gov (United States)

    Holman, Michelle A.; Porter, Samuel G.; Pawlina, Wojciech; Juskewitch, Justin E.; Lachman, Nirusha

    2016-01-01

    Emotional intelligence (EI) has been associated with increased academic achievement, but its impact on medical education is relatively unexplored. This study sought to evaluate change in EI, performance outcomes, and team cohesion within a team-based medical school anatomy course. Forty-two medical students completed a pre-course and post-course…

  6. CHANGING TRENDS IN LIFESTYLE BEHAVIOUR AND PHYSICAL ACTIVITY ON BODY MASS INDEX AMONG MEDICAL STUDENTS

    Directory of Open Access Journals (Sweden)

    Viji

    2016-03-01

    Full Text Available BACKGROUND Early sleep, early waking up, regular breakfast and light-to-moderate exercise all constitute healthy habits. Balanced diet, regular sleep and adequate physical activity are major factors in the promotion and maintenance of good health in human life. Regrettably these habits are not very frequent among medical students, because of exceptionally tiring schedule, protracted studies and burden of performing well in medical colleges. The study aims to correlate the trends in breakfast habits, mid-day snacking, sleeping habits and physical activity in relation to body mass index among medical students. METHOD This was a single centre cross-sectional questionnaire based study conducted at Jubilee Mission Medical College & Research Institute, Thrissur, Kerala. The target population was 1 st year MBBS students. We collected data from 234 students. The study duration was from August 2014 till September 2015. Convenient sampling was implied for the collection of data. RESULTS Mean age of participants was 20.85 ± 0.9 years, while mean BMI of participants was 24.7 ± 6.31 kg/m2. Average sleep duration was 7.1 hours ± 3.9 hours while average physical activity was 208 min/week ± 92 min/week. We observed that females (63.4% tend to skip breakfast twice more than males (27.9%. Students who had regular breakfast were found to have a lower BMI than those who did not. Moreover, those who took breakfast were found to be more physically active than those who skipped breakfast. CONCLUSION Since it was found that a regular consumption of breakfast, adequate sleep and exercise not only lowers BMI but also makes a person more physically fit. Therefore, it is recommended to start the day with a healthy breakfast having all the essential nutrients.

  7. Pilot Point-of-Care Ultrasound Curriculum at Harvard Medical School: Early Experience

    Science.gov (United States)

    Rempell, Joshua S.; Saldana, Fidencio; DiSalvo, Donald; Kumar, Navin; Stone, Michael B.; Chan, Wilma; Luz, Jennifer; Noble, Vicki E.; Liteplo, Andrew; Kimberly, Heidi; Kohler, Minna J.

    2016-01-01

    Introduction Point-of-care ultrasound (POCUS) is expanding across all medical specialties. As the benefits of US technology are becoming apparent, efforts to integrate US into pre-clinical medical education are growing. Our objective was to describe our process of integrating POCUS as an educational tool into the medical school curriculum and how such efforts are perceived by students. Methods This was a pilot study to introduce ultrasonography into the Harvard Medical School curriculum to first- and second-year medical students. Didactic and hands-on sessions were introduced to first-year students during gross anatomy and to second-year students in the physical exam course. Student-perceived attitudes, understanding, and knowledge of US, and its applications to learning the physical exam, were measured by a post-assessment survey. Results All first-year anatomy students (n=176) participated in small group hands-on US sessions. In the second-year physical diagnosis course, 38 students participated in four sessions. All students (91%) agreed or strongly agreed that additional US teaching should be incorporated throughout the four-year medical school curriculum. Conclusion POCUS can effectively be integrated into the existing medical school curriculum by using didactic and small group hands-on sessions. Medical students perceived US training as valuable in understanding human anatomy and in learning physical exam skills. This innovative program demonstrates US as an additional learning modality. Future goals include expanding on this work to incorporate US education into all four years of medical school. PMID:27833681

  8. Local adaptation in brown trout early life-history traits: implications for climate change adaptability

    DEFF Research Database (Denmark)

    Jensen, L.F.; Hansen, Michael Møller; Pertoldi, C.

    2008-01-01

    to adapt. Temperature-related adaptability in traits related to phenology and early life history are expected to be particularly important in salmonid fishes. We focused on the latter and investigated whether four populations of brown trout (Salmo trutta) are locally adapted in early life-history traits...... and heritable variation in phenotypic plasticity suggest that although increasing temperatures are likely to affect some populations negatively, they may have the potential to adapt to changing temperature regimes.  ...

  9. Anatomy Education in a Changing Medical Curriculum in India: Medical Student Feedback on Duration and Emphasis of Gross Anatomy Teaching

    Science.gov (United States)

    Holla, Sunil Jonathan; Ramachandran, Kalpana; Isaac, Bina; Koshy, Shajan

    2009-01-01

    Authors report here a survey of medical student feedback on the effectiveness of two different anatomy curricula at Christian Medical College, Vellore, India. Undergraduate medical students seeking the Bachelor in Medicine and Bachelor in Surgery (M.B.B.S.) degrees were divided into two groups by the duration of their respective anatomy…

  10. Reflective writing by final year medical students: lessons for curricular change.

    Science.gov (United States)

    Ganesh, Alka; Ganesh, Gayatri

    2010-01-01

    Reflective writinghas been used in undergraduate medical curricula to inculcate empathetic attitudes in medical students. Journal writing has been used to enhance reflection in a confidential space. We aimed to introduce our medical students to reflective writing of their daily experiences, both to enhance empathetic attitudes as well as to use the entries to Inform curricular changes. We invited 16 final year medical students posted in the Department of Medicine to record their emotional experiences during a 6-week posting. Freedom to abstain without prejudice was emphasized, yet all 16 students complied. According to the principle of grounded theory, the entries were grouped into 8 themes: (i) doctor-patient relationship; (ii) personal inadequacy; (iii) empathy; (iv) communication skills; (v) doctor's competence; (vi) patient behaviour; (vii) hospital practices; and (viii) personal feelings. There were 179 entries which were evaluable under the above categories, with no significant gender differences. Based on the entries, the following curricular suggestions were made: (i) use of diaries by medical students to express their emotional reactions and make value judgements, followed by guided discussion by experienced facilitators; (ii) introduction of communication skills courses at appropriate points to enhance Interview skills, empathetic listening, conflict resolution and breaking bad news; (iii) encourage reflection on healthcare delivery and its inequities and suggest methods of dealing with individual patients; and (iv) use of positive feedback and encouragement by faculty. Conclusions. Reflective journal writing by medical students in India gives valuable insights into improving communication skills and professionalism. Appropriate curricular changes should be made to meet the challenges posed by the existing healthcare system.

  11. Integrating nutrition education into the cardiovascular curriculum changes eating habits of second-year medical students.

    Science.gov (United States)

    Vargas, Eric J; Zelis, Robert

    2014-01-01

    Survey of medical curricula continues to show that nutrition education is not universally adequate. One measure of nutritional educational competence is a positive change in student eating habits. The objective of this study was to evaluate whether integrating nutrition education within the second-year cardiovascular course for medical students, using the "Rate Your Plate" (RYP) questionnaire, coupled with knowledge of student personal 30-year risk of a cardiovascular event was useful in changing students' eating behaviors. Thirty-two students completed an unpublished 24-item questionnaire (modified-RYP) about their eating habits in the spring of their first year. The same students then completed the questionnaire in the spring of their second year. Paired t test was used to analyze the difference in RYP scores. Pearson correlation coefficients were calculated for the Framingham 30-year cardiovascular event risk and change in RYP score to examine whether risk knowledge may have changed eating habits. Mean scores at baseline and 1 year later were 57.19 and 58.97, respectively (paired t test, P risk, adjusted for family history, and change in RYP score was -0.322. Although medical students were eating healthy at baseline, integration of nutrition education within the second-year cardiovascular medical curriculum was associated with improved heart healthy eating habits. Because student attitudes about prevention counseling are influenced by personal eating habits, this suggests that students with a more healthy diet will be more likely to recommend the same for their patients. Copyright © 2014 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  12. A research agenda for moving early medical pregnancy termination over the counter.

    Science.gov (United States)

    Kapp, Nathalie; Grossman, Daniel; Jackson, Emily; Castleman, Laura; Brahmi, Dalia

    2017-03-19

    Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone-misoprostol regimen for medical termination at ≤10 weeks gestation meet U.S. FDA regulatory criteria for over-the-counter (OTC) approval, and if not, what are the present research gaps? We conducted a literature review of consumer behaviors necessary for a successful OTC application for medical termination ≤10 weeks and identified crucial research gaps. If we were to embark on a development program for OTC or more generally, self-use of medical termination, the critical elements missing are the label comprehension, self -selection and actual use studies. This article is protected by copyright. All rights reserved.

  13. Preconception and early pregnancy maternal haemodynamic changes in healthy women in relation to pregnancy viability.

    Science.gov (United States)

    Foo, F L; Collins, A; McEniery, C M; Bennett, P R; Wilkinson, I B; Lees, C C

    2017-05-01

    . Similarly, between the groups, there were no differences in pregnancy adaptation with similar trends in cardiovascular function changes from pre-pregnancy to 6 weeks gestation. Whilst this is the first study to investigate preconception and early pregnancy haemodynamic and arterial function in relation to viability, the relatively modest number of miscarriages may not be sufficient to show subtle differences in haemodynamic changes if these were present. This study suggests that pre-pregnancy haemodynamic and arterial function is unlikely to be the causal link between miscarriages and future cardiovascular disease. Our findings suggests that factors other than the presence of a viable embryo drive cardiovascular changes in early pregnancy. This study raises new questions about miscarriages as an independent risk event which predisposes women to increased cardiovascular risk later in life. The investigators are funded by NIHR Imperial BRC, NIHR Cambridge BRC, Action Medical Research, Imperial College Healthcare Charity and Tommy's Charity. We acknowledge the loan of ultrasound equipment from Samsung Medison (South Korea)/MIS Ltd and provision of fertility monitors from SPD Development Company Ltd (Bedford, UK). There are no competing interests. C.C.L. is supported by the UK National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare National Health Service Trust and Imperial College London. N/A.

  14. Dental and medical students' perspectives on early exposure to PBL in Taiwan.

    Science.gov (United States)

    Tu, Ming-Gene; Yu, Chien-Hung; Wu, Lii-Tzu; Li, Tsai-Chung; Kwan, Chiu-Yin

    2012-06-01

    A hybrid problem-based learning (PBL) curriculum adopted in 2002 for medical students at China Medical University, Taiwan, was extended to dental students in 2007. Before that, PBL workshops were conducted for all students. Two PBL cases on basic biomedical issues were used for second-year medical students and second-year dental students to explore the feasibility of adopting PBL as part of the dental curriculum. This study compared the medical and dental students' attitudes toward the PBL tutorials and PBL curricula. Upon completion of the PBL component, an eighteen-item questionnaire asked students to assess (on a ten-point scale with 10 as the most positive response) their perceptions of the learning process in the PBL tutorials. Forty-six dental students from a cohort of fifty (92 percent) and 107 medical students from a cohort of 119 (90 percent) completed the questionnaires (fifty-three females and 100 males). The importance of all items was rated above 6.00. The medical students' mean score (7.29) was higher than the dental students' mean score (7.10). Of the eighteen attributes of the PBL process, the students indicated being generally comfortable with fourteen. No statistical significance was found between the dental and medical students' scores, but there was a significant difference (p=0.006) in their perception of PBL curricula. Overall, the medical students expressed a more positive outlook toward the PBL learning process than the dental students and were more willing to accept PBL as a pedagogy.

  15. Early

    Directory of Open Access Journals (Sweden)

    Kamel Abd Elaziz Mohamed

    2014-04-01

    Conclusion: Early PDT is recommended for patients who require prolonged tracheal intubation in the ICU as outcomes like the duration of mechanical ventilation length of ICU stay and hospital stay were significantly shorter in early tracheostomy.

  16. Socrates was not a pimp: changing the paradigm of questioning in medical education.

    Science.gov (United States)

    Kost, Amanda; Chen, Frederick M

    2015-01-01

    The slang term "pimping" is widely recognized by learners and educators in the clinical learning environment as the act of more senior members of the medical team publicly asking questions of more junior members. Although questioning as a pedagogical practice has many benefits, pimping, as described in the literature, evokes negative emotions in learners and leads to an environment that is not conducive to adult learning. Medical educators may employ pimping as a pedagogic technique because of beliefs that it is a Socratic teaching method. Although problems with pimping have previously been identified, no alternative techniques for questioning in the clinical environment were suggested. The authors posit that using the term "pimping" to describe questioning in medical education is harmful and unprofessional, and they propose clearly defining pimping as "questioning with the intent to shame or humiliate the learner to maintain the power hierarchy in medical education." Explicitly separating pimping from the larger practice of questioning allows the authors to make three recommendations for improving questioning practices. First, educators should examine the purpose of each question they pose to learners. Second, they should apply historic and modern interpretations of Socratic teaching methods that promote critical thinking skills. Finally, they should consider adult learning theories to make concrete changes to their questioning practices. These changes can result in questioning that is more learner centered, aids in the acquisition of knowledge and skills, performs helpful formative and summative assessments of the learner, and improves community in the clinical learning environment.

  17. Are Early Childhood Disparities Narrowing? The Changing Nature of Early Childhood and Its Link to Narrowing School-Entry Achievement Gaps

    Science.gov (United States)

    Bassok, Daphna; Finch, Jenna; Lee, RaeHyuck; Reardon, Sean F.; Waldfogel, Jane

    2016-01-01

    To date, no studies have documented how much early childhood experiences have changed over time. In the current study, researchers use two large, nationally representative datasets of kindergarten entrants to document the following: (1) How have children's early childhood experiences changed between 1998 and 2010?; (2) To what extent have…

  18. Institutions and non-linear change in governance. Reforming the governance of medical performance in Europe.

    Science.gov (United States)

    Burau, Viola; Vrangbaek, Karsten

    2008-01-01

    The paper aims to account for the substance of non-linear governance change by analysing the importance of sector-specific institutions and the pathways of governing they create. The analysis uses recent reforms of the governance of medical performance in four European countries as a case, adopting an inductively oriented approach to comparison. The governance of medical performance is a good case as it is both, closely related to redistributive policies, where the influence of institutions tends to be pertinent, and is subject to considerable policy pressures. The overall thrust of reforms is similar across countries, while there are important differences in relation to how individual forms of governance and the balance between different forms of governance are changing. More specifically, sector-specific institutions can account for the specific ways in which reforms redefine hierarchy and professional self-regulation and for the extent to which reforms strengthen hierarchy and affect the balance with other forms of governance. The recent literature on governance mainly focuses on mapping out the substance of non-linear change, whereas the development of explanations of the substance of governance change is less systematic. In the present paper, therefore, it is suggested coupling the notion of non-linear change with an analysis of sector specific institutions inspired by the historical institutionalist tradition to better account for the substance of non-linear governance change. Further, the analysis offers interesting insights into the complexity of redrawing boundaries between the public and the private in health care.

  19. LINE-1 and inflammatory gene methylation levels are early biomarkers of metabolic changes: association with adiposity.

    Science.gov (United States)

    Carraro, Júlia Cristina Cardoso; Mansego, Maria Luisa; Milagro, Fermin Ignacio; Chaves, Larissa Oliveira; Vidigal, Fernanda Carvalho; Bressan, Josefina; Martínez, J Alfredo

    2016-11-01

    We analyzed whether global and inflammatory genes methylation can be early predictors of metabolic changes and their associations with the diet, in a cross-sectional study (n = 40). Higher global methylation was associated to adiposity, insulin resistance, and lower quality of the diet. Methylation of IL-6, SERPINE1 and CRP genes was related to adiposity traits and macronutrients intake. SERPINE1 hypermethylation was also related to some metabolic alterations. CRP methylation was a better predictor of insulin resistance than CRP plasma concentrations. Global and inflammatory gene promoter hypermethylation can be good early biomarkers of adiposity and metabolic changes and are associated to the quality of the diet.

  20. Innovative Approaches To Educating Medical Students for Practice in a Changing Health Care Environment: The National UME-21 Project.

    Science.gov (United States)

    Rabinowitz, Howard K.; Babbott, David; Bastacky, Stanford; Pascoe, John M.; Patel, Kavita K.; Pye, Karen L.; Rodak, John, Jr.; Veit, Kenneth J.; Wood, Douglas L.

    2001-01-01

    Describes the major curriculum changes that have been implemented through Undergraduate Medical Education for the 21st Century (UME-21), a 3-year national demonstration project to encourage innovation in medical education. Discusses challenges that occurred in carrying out those changes, and outlines the strategies for evaluating the project. (EV)

  1. EARLY POSTOPERATIVE HOMEOSTATIC CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND WAYS OF PREVENTING ITS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    D. Yu. Volkov

    2014-07-01

    Full Text Available During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

  2. EARLY POSTOPERATIVE HOMEOSTATIC CHANGES AFTER TRANSURETHRAL RESECTION OF THE PROSTATE AND WAYS OF PREVENTING ITS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    D. Yu. Volkov

    2011-01-01

    Full Text Available During the study, the authors assessed changes in the blood coagulation system and made a spectral analysis of serum and prostate tissue. They revealed immunological changes suggesting occult disseminated intravascular coagulation, an evolving systemic inflammatory response and the latter caused by endothelial damage, microcirculatory disorders, lipid peroxidation, and release of inflammatory factors. The findings permit a tactic for medical prevention of complications to be elaborated.

  3. Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system.

    Science.gov (United States)

    Finlay, G Duncan; Rothman, Michael J; Smith, Robert A

    2014-02-01

    Early detection of an impending cardiac or pulmonary arrest is an important focus for hospitals trying to improve quality of care. Unfortunately, all current early warning systems suffer from high false-alarm rates. Most systems are based on the Modified Early Warning Score (MEWS); 4 of its 5 inputs are vital signs. The purpose of this study was to compare the accuracy of MEWS against the Rothman Index (RI), a patient acuity score based upon summation of excess risk functions that utilize additional data from the electronic medical record (EMR). MEWS and RI scores were computed retrospectively for 32,472 patient visits. Nursing assessments, a category of EMR inputs only used by the RI, showed sharp differences 24 hours before death. Receiver operating characteristic curves for 24-hour mortality demonstrated superior RI performance with c-statistics, 0.82 and 0.93, respectively. At the point where MEWS triggers an alarm, we identified the RI point corresponding to equal sensitivity and found the positive likelihood ratio (LR+) for MEWS was 7.8, and for the RI was 16.9 with false alarms reduced by 53%. At the RI point corresponding to equal LR+, the sensitivity for MEWS was 49% and 77% for RI, capturing 54% more of those patients who will die within 24 hours.

  4. Comparison or oral versus vaginal misoprostol & continued use of misoprostol after mifepristone for early medical abortion.

    Science.gov (United States)

    Mittal, Suneeta; Agarwal, Sonika; Kumar, Sunesh; Batra, Ashima

    2005-08-01

    Medical abortion though legalized in India, is still not very popular. A disadvantage of medical abortion is the longer duration of bleeding compared with surgical abortion which may reduce acceptability. Due consideration needs to be given to the issues related to medical abortion for improving the reproductive health status of women suffering from consequences of unsafe and illegal surgical abortion. The present study compared the efficacy of oral and vaginal administration of misoprostol after a single dose of 200 mg of mifepristone and evaluated the influence of continuing misoprostol for one week on efficacy and side effects. A double-blind randomized controlled trial with 150 healthy pregnant women requesting medical abortion with misoprostol either orally or vaginally on day three. Women in the oral group and one of the two vaginal groups continued 0.4 mg of oral misoprostol twice daily for seven days. Complete abortion rate in each of the groups was 96-100 per cent. The addition of misoprostol 0.4 mg twice a day from day 4-10 did not help in increasing successful outcome or shortening of duration or amount of bleeding. Medical abortion for pregnancy up to 63 days using misoprostol 0.8 mg vaginal/oral after pretreatment with mifepristone 200 mg is a safe and successful procedure. No differences in efficacy or duration of bleeding were observed with addition of oral misoprostol for 1 wk after abortion.

  5. Early changes in Huntington's disease patient brains involve alterations in cytoskeletal and synaptic elements.

    Science.gov (United States)

    DiProspero, Nicholas A; Chen, Er-Yun; Charles, Vinod; Plomann, Markus; Kordower, Jeffrey H; Tagle, Danilo A

    2004-09-01

    Huntington's disease (HD) is caused by a polyglutamine repeat expansion in the N-terminus of the huntingtin protein. Huntingtin is normally present in the cytoplasm where it may interact with structural and synaptic elements. The mechanism of HD pathogenesis remains unknown but studies indicate a toxic gain-of-function possibly through aberrant protein interactions. To investigate whether early degenerative changes in HD involve alterations of cytoskeletal and vesicular components, we examined early cellular changes in the frontal cortex of HD presymptomatic (PS), early pathological grade (grade 1) and late-stage (grade 3 and 4) patients as compared to age-matched controls. Morphologic analysis using silver impregnation revealed a progressive decrease in neuronal fiber density and organization in pyramidal cell layers beginning in presymptomatic HD cases. Immunocytochemical analyses for the cytoskeletal markers alpha -tubulin, microtubule-associated protein 2, and phosphorylated neurofilament demonstrated a concomitant loss of staining in early grade cases. Immunoblotting for synaptic proteins revealed a reduction in complexin 2, which was marked in some grade 1 HD cases and significantly reduced in all late stage cases. Interestingly, we demonstrate that two synaptic proteins, dynamin and PACSIN 1, which were unchanged by immunoblotting, showed a striking loss by immunocytochemistry beginning in early stage HD tissue suggesting abnormal distribution of these proteins. We propose that mutant huntingtin affects proteins involved in synaptic function and cytoskeletal integrity before symptoms develop which may influence early disease onset and/or progression.

  6. Changes in muscle force-length properties affect the early rise of force in vivo

    DEFF Research Database (Denmark)

    Blazevich, Anthony J; Cannavan, Dale; Horne, Sara

    2009-01-01

    Changes in contractile rate of force development (RFD), measured within a short time interval from contraction initiation, were measured after a period of strength training that led to increases in muscle fascicle length but no measurable change in neuromuscular activity. The relationship between...... training-induced shifts in the moment-angle relation and changes in RFD measured to 30 ms (i.e., early) and 200 ms (i.e., late) from the onset of isometric knee extension force were examined; shifts in the moment-angle relation were used as an overall measure of changes in quadriceps muscle fascicle length...

  7. An analysis of reflective writing early in the medical curriculum: The relationship between reflective capacity and academic achievement.

    Science.gov (United States)

    Ottenberg, Abigale L; Pasalic, Dario; Bui, Gloria T; Pawlina, Wojciech

    2016-07-01

    To examine the relationship between reflection, gender, residency choice, word count, and academic achievement among medical students. A modified version of the Reflection Evaluation for Learners' Enhanced Competencies Tool (REFLECT) was developed and used for this study (Cronbach's alpha of 0.86 with an intraclass correlation coefficient [ICC] of 0.68). This was applied to writing samples about professionalism in gross anatomy from first-year medical students between 2005 and 2011. Four analysts reviewed and scored written reflections independently. Composite reflection scores were compared with gender, residency choice, length of written reflection, NBME® Gross Anatomy and Embryology Subject Examination scores, and final gross anatomy course. Total of 319 written reflections were evaluated. Female students who pursued medicine specialties had the highest composite reflection scores (87 [27.2%]). Word count frequently correlated with reflection score (p reflection scores and NBME® Gross Anatomy and Embryology Subject Examination scores (p = 0.16) or anatomy course grades (p = 0.90). This study suggests there are likely no correlations between reflective capacity and academic performance on tests of medical knowledge administered early in the medical curriculum.

  8. Efficacy and acceptability of early mifepristone-misoprostol medical abortion in Ukraine: results of two clinical trials.

    Science.gov (United States)

    Raghavan, Sheila; Maistruk, Galina; Shochet, Tara; Bannikov, Vladimir; Posohova, Svetlana; Zhuk, Svetlana; Lishchuk, Vladimir; Winikoff, Beverly

    2013-04-01

    Abortion services are legally available in Ukraine although there are issues in quality and access. Two studies were conducted in Ukraine to expand options for women, and to determine the efficacy and acceptability of medical abortion. Two open-label clinical trials were conducted at six clinics in Ukraine. Women were given 200 mg mifepristone followed after 48 hours by 400 μg oral misoprostol (Study One) and mifepristone followed after 24 hours by 400 μg sublingual misoprostol (Study Two). Follow-up visits were scheduled for two weeks after mifepristone administration to assess whether complete uterine evacuation had occurred. Success rates were 97% in the first study and 98% in the second one. The vast majority of participants were satisfied or very satisfied with their abortion method (Study One: 94%; Study Two: 98%). The two studies demonstrate high rates of success and acceptability of early medical abortion in Ukraine.

  9. Early childhood hearing loss: clinical and molecular genetics. An educational slide set of the American College of Medical Genetics.

    Science.gov (United States)

    Alford, Raye L; Friedman, Thomas B; Keats, Bronya J B; Kimberling, William J; Proud, Virginia K; Smith, Richard J H; Arnos, Kathleen S; Korf, Bruce R; Rehm, Heidi L; Toriello, Helga V

    2003-01-01

    An educational slide set entitled "Early Childhood Hearing Loss: Clinical and Molecular Genetics" is offered by the American College of Medical Genetics (ACMG). The slide set is produced in Microsoft PowerPoint 2002. It is extensively illustrated and supported with teaching tools, explanations of each slide and figure, links to Internet resources, and a bibliography. The slide set is expected to be used as a resource for self-directed learning and in support of medical genetics teaching activities. The slide set is available through the ACMG (http://www.acmg.net) for $20, plus applicable tax and shipping. It is the first in a series of educational slide sets to be developed by the ACMG.

  10. Response of Late Carboniferous and Early Permian Plant Communities to Climate Change

    Science.gov (United States)

    Dimichele, William A.; Pfefferkorn, Hermann W.; Gastaldo, Robert A.

    Late Carboniferous and Early Permian strata record the transition from a cold interval in Earth history, characterized by the repeated periods of glaciation and deglaciation of the southern pole, to a warm-climate interval. Consequently, this time period is the best available analogue to the Recent in which to study patterns of vegetational response, both to glacial-interglacial oscillation and to the appearance of warm climate. Carboniferous wetland ecosystems were dominated by spore-producing plants and early gymnospermous seed plants. Global climate changes, largely drying, forced vegetational changes, resulting in a change to a seed plant-dominated world, beginning first at high latitudes during the Carboniferous, reaching the tropics near the Permo-Carboniferous boundary. For most of this time plant assemblages were very conservative in their composition. Change in the dominant vegetation was generally a rapid process, which suggests that environmental thresholds were crossed, and involved little mixing of elements from the wet and dry floras.

  11. Response of Late Carboniferous and Early Permian plant communities to climate change

    Energy Technology Data Exchange (ETDEWEB)

    DiMichele, W.A.; Pfefferkorn, H.W.; Gastaldo, R.A. [Smithsonian Institute, Washington, DC (USA). National Museum of National History

    2001-07-01

    Late Carboniferous and Early Permian strata record the transition from a cold interval in Earth history, characterized by the repeated periods of glaciation and deglaciation of the southern pole, to a warm-climate interval. Consequently, this time period is the best available analogue to the Recent in which to study patterns of vegetational response, both to glacial-interglacial oscillation and to the appearance of warm climate. Carboniferous wetland ecosystems were dominated by spore-producing plants and early gymnospermous seed plants. Global climate changes, largely drying, forced vegetational changes, resulting in a change to a seed plant-dominated world, beginning first at high latitudes during the Carboniferous, reaching the tropics near the Permo-Carboniferous boundary. For most of this time plant assemblages were very conservative in their composition. Change in the dominant vegetation was generally a rapid process, which suggests that environmental thresholds were crossed, and involved little mixing of elements from the wet and dry floras.

  12. Contacto precoz con la realidad asistencial: una experiencia piloto en medicina Early contact with medical practice: a pilot experience in medical students

    Directory of Open Access Journals (Sweden)

    J.E. Baños

    2011-03-01

    Full Text Available Introducción: Varios estudios han sugerido que el contacto precoz del estudiante de medicina con la realidad asistencial puede tener unos efectos beneficiosos sobre su motivación, el conocimiento de la relación médico-paciente y la aceptación de la importancia de las materias médicas básicas. En el nuevo grado conjunto de Medicina de la Universitat Autònoma de Barcelona y la Universitat Pompeu Fabra se ha incorporado una asignatura denominada 'Prácticas de Grado' que se imparte durante los tres primeros años, destinada a permitir el contacto de los estudiantes con la asistencia primaria, los equipos de enfermería y los centros sociosanitarios. El presente artículo describe la experiencia y la opinión de los estudiantes que la cursaron durante el primer año. Materiales y métodos: El artículo describe las características académicas de la asignatura. Se realizó una encuesta a los estudiantes al finalizar la asignatura para evaluar su grado de satisfacción y su percepción sobre el cumplimiento de los objetivos y las competencias que debían alcanzarse. Resultados: Existió una elevada satisfacción con la nueva actividad y una percepción entre los estudiantes de que las competencias preestablecidas se habían alcanzado en su mayor parte. Conclusión: El contacto precoz con la realidad asistencial es un elemento esencial para la comprensión de la actividad médica por los estudiantes de medicina de primer año.Introduction: Several studies have suggested that early contact of medical students with medical care may have beneficial effects on their motivation, knowledge of doctor-patient relationship and acceptance of the interest of biomedical sciences. In the new joint degree of Medicine of Autonomous University of Barcelona and Pompeu Fabra University we have incorporated the subject 'Prácticas de Grado' during the first three years. It is devoted to permit the early contact of medical students with primary care, nursing

  13. Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME.

    Science.gov (United States)

    Price, David

    2005-05-01

    Healthcare providers and systems are being asked to measure and improve the quality of care delivered to their patients. Additionally, the American Board of Medical Specialties now requires physicians to participate in systems-based practice and practice-based learning and improvement activities as part of maintenance of specialty board certification. These changing paradigms provide opportunities for continuing medical education to become more aligned with health system goals and help prepare clinicians to practice in this new environment. Organizational change and quality improvement principles have much in common with continuing medical education planning processes. Medical education can play a role in helping organizations improve. Continuing medical education must move beyond delivering content to individual clinicians towards becoming a facilitator of organizational improvement. Research is needed to determine the effect of integrating continuing medical education with organizational change approaches on professional competence, organizational processes and patient outcomes.

  14. Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa.

    Directory of Open Access Journals (Sweden)

    Heidi Bart Johnston

    Full Text Available To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit.Diagnostic accuracy study.Ethiopia, India and South Africa.Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam.Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa.The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.

  15. Salivary changes in medically compromised patients: A clinical and biochemical study

    Directory of Open Access Journals (Sweden)

    Yehoshuva R Tummuru

    2017-01-01

    Full Text Available Introduction: Medically compromised patients require special attention when dental procedures are performed on them. These individuals may require modified or slightly altered techniques. Aims and Objectives: The present study was taken up with two main objectives. The first one being examining and recording various oral manifestations in medically compromised patients, and the second objective was to collect samples of saliva from such patients and to analyze and establish any salivary changes in such medically compromised patients. Materials and Methods: A total of 100 patients were selected for the study. These patients were divided into four groups of 25 patients each: diabetes mellitus group, chronic renal failure group, liver cirrhosis group and control group. All the selected patients were subjected to a detailed general and intra oral examinations and the relevant data was recorded on a specially designed proforma; salivary analysis was done to know the flow rate, pH, total salivary proteins, sodium, potassium, and LDH levels. Results: From the findings, it can be inferred that salivary changes namely changes in salivary pH, salivary flow rates, salivary sodium, salivary potassium, salivary total proteins, and salivary lactate dehydrogenase are significant in medically compromised patients namely uncontrolled diabetes mellitus, chronic renal failure, cirrhosis of liver compared to the control group. Conclusion: pH of saliva was elevated in chronic renal failure patients. Salivary flow rates and sodium were decreased in diabetes mellitus, chronic renal failure, and cirrhosis of liver patients. There was a significant elevation of salivary potassium in chronic renal failure patients. LDH elevation was significant in uncontrolled diabetes mellitus.

  16. Early change in proteinuria as a surrogate end point for kidney disease progression

    DEFF Research Database (Denmark)

    Inker, Lesley A; Levey, Andrew S; Pandya, Kruti

    2014-01-01

    BACKGROUND: It is controversial whether proteinuria is a valid surrogate end point for randomized trials in chronic kidney disease. STUDY DESIGN: Meta-analysis of individual patient-level data. SETTING & POPULATION: Individual patient data for 9,008 patients from 32 randomized trials evaluating 5...... intervention types. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials of kidney disease progression until 2007 with measurements of proteinuria both at baseline and during the first year of follow-up, with at least 1 further year of follow-up for the clinical outcome. PREDICTOR: Early change....... Pooled estimates for the proportion of treatment effect on the clinical outcome explained by early decline in proteinuria ranged from -7.0% (95%CI, -40.6% to 26.7%) to 43.9% (95%CI, 25.3% to 62.6%) across 5 intervention types. The direction of the pooled treatment effects on early change in proteinuria...

  17. Early MR changes in vertebral bone marrow for patients following radiotherapy.

    Science.gov (United States)

    Onu, M; Savu, M; Lungu-Solomonescu, C; Harabagiu, I; Pop, T

    2001-01-01

    Our study aimed to evaluate the vertebral marrow changes in patients following radiotherapy (RT) by measuring the T2 relaxation times before and during RT. We were mostly interested in evaluating early MR marrow changes during RT. Fifteen patients treated by RT for cervical cancer were submitted to MR examination before and during RT (5-23 days of RT). T2 values were calculated for irradiated and non-irradiated tissues (lumbar and sacral vertebral bone marrow, symphysis pubis marrow, and regional muscle). Fourteen patients presented increased T2 values for irradiated vertebral bone marrow (VBM), and 3 patients showed increased T2 values even for non-irradiated VBM. We found T2 variations for VBM as early as in the fifth day of RT for an absorbed dose as small as 9 Gy. Calculated T2 values in irradiated and also in non-irradiated tissues prove very early tissue alterations.

  18. Fostering Entrepreneurial Investment Decision in Medical Technology Ventures in a Changing Business Environment

    Directory of Open Access Journals (Sweden)

    Sonja Bettina Keppler

    2015-02-01

    Full Text Available This paper presents the results obtained from a survey among public and private venture capitalists from countries which attract a large amount of venture capital investment: Germany, Switzerland, Austria and Israel. The objective is to investigate venture capitalists’ investment criteria for medical technology ventures in the start-up or expansion phase. Since existing research evaluated venture capitalists’ general investment criteria, the aim of this study is to provide specific results on entrepreneurial investment decisions for the medical technology sector, which constantly attracted a significant share of European venture capital. The research used semi-structured interviews with 39 venture capitalists and experts. The results show that venture capitalists prefer to invest in companies which develop products for treating and diagnosing diseases showing a high prevalence and large market volumes, such as cardiovascular, metabolic and neurological diseases, and orthopaedic disorders. The study confirms that venture capitalists use a number of industry-specific criteria highly relevant in a changing business environment. These include a high medical need for the product, availability of clinical data, stage of European Conformity approval, high probability of receiving reimbursement from health insurances, medical key opinion leaders supporting technology, management’s regulatory experience and their communication ability with doctors and key opinion leaders.

  19. An exploration of changes in cognitive and emotional empathy among medical students in the Caribbean

    Science.gov (United States)

    Youssef, Farid F.; Nunes, Paula; Sa, Bidyadhar; Williams, Stella

    2014-01-01

    Objectives: This study explored the empathy profile of students across five years of medical training. In addition the study examined whether the Jefferson Scale for Physician Empathy correlated with a measure of cognitive empathy, the Reading the Mind in the Eyes Test and a measure of affective empathy, the Toronto Empathy Questionnaire. Methods: The study was a comparative cross-sectional design at one Caribbean medical school. Students were contacted in class, participation was voluntary and empathy was assessed using all three instruments Descriptive statistics were calculated and differences between groups evaluated using non-parametric tests. Results: Overall 669 students participated (response rate, 67%). There was a significant correlation between the Jefferson Scale of Physician Empathy and the Toronto Empathy Questionnaire (P = 0.48), both scales indicating a decline in medical student empathy scores over time. There was, however, little correlation between scores from the Reading the Mind in the Eyes Test and the Jefferson Scale of Physician Empathy. Female students demonstrated significantly higher scores on all three measures. Conclusions: Medical students’ lower empathy scores during their final years of training appear to be due to a change in the affective component of empathy. These findings may reflect an adaptive neurobiological response to the stressors associated with encountering new clinical situations. Attention should be paid not only to providing empathy training for students but also to teaching strategies for improved cognitive processing capacity when they are encountering new and challenging circumstances. PMID:25341229

  20. Prediction and prevention of failure: an early intervention to assist at-risk medical students

    NARCIS (Netherlands)

    Winston, K.A.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.

    2014-01-01

    BACKGROUND: Consistent identification and prevention of failure for at-risk medical students is challenging, failing courses is costly to all stakeholders, and there is need for further research into duration, timing and structure of interventions to help students in difficulty. AIMS: To verify the

  1. Early Seizure Frequency and Aetiology Predict Long-Term Medical Outcome in Childhood-Onset Epilepsy

    Science.gov (United States)

    Sillanpaa, Matti; Schmidt, Dieter

    2009-01-01

    In clinical practice, it is important to predict as soon as possible after diagnosis and starting treatment, which children are destined to develop medically intractable seizures and be at risk of increased mortality. In this study, we determined factors predictive of long-term seizure and mortality outcome in a population-based cohort of 102…

  2. Early assessment of medical technologies to inform product development and market access

    NARCIS (Netherlands)

    IJzerman, Maarten J.; Steuten, Lotte M.G.

    2011-01-01

    Worldwide, billions of dollars are invested in medical product development and there is an increasing pressure to maximize the revenues of these investments. That is, governments need to be informed about the benefits of spending public resources, companies need more information to manage their prod

  3. Medical Students' Emotional Development in Early Clinical Experience: A Model

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Dornan, Tim; Koopmans, Raymond

    2014-01-01

    Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in…

  4. Changes in the welfare state and the ethics of early childhood educators

    DEFF Research Database (Denmark)

    Hjort, Katrin

    2016-01-01

    Ethical reflection is more relevant than ever before. As a reaction to both the trend of utilitarianism in early childhood education and the changes in the organisation of welfare sevices in the Nordic countries a professional ethics of virtue must be revitalized. However, it is not an easy path...

  5. Early Diagnosis of Autism Spectrum Disorder: Stability and Change in Clinical Diagnosis and Symptom Presentation

    Science.gov (United States)

    Guthrie, Whitney; Swineford, Lauren B.; Nottke, Charly; Wetherby, Amy M.

    2013-01-01

    Background: Although a diagnosis of autism spectrum disorder (ASD) appears to be stable in children as young as age three, few studies have explored stability of a diagnosis in younger children. Predictive value of diagnostic tools for toddlers and patterns of symptom change are important considerations for clinicians making early diagnoses. Most…

  6. Early onset of cannabis use: Does personality modify the relation with changes in perceived parental involvement?

    NARCIS (Netherlands)

    Creemers, Hanneke E.; Buil, J. Marieke; van Lier, Pot A. C.; Keijsers, Loes; Meeus, W.H.J.; Koot, Hans M.; Huizink, Anja C.

    2015-01-01

    Background The present study examined (1) the association between changes in perceived parental control and support from age 13 to 15 and early onset of cannabis use (before age 16), and (2) whether personality modifies the association between a decline in perceived parental control and support and

  7. How Does Early Feedback in an Online Programming Course Change Problem Solving?

    Science.gov (United States)

    Ebrahimi, Alireza

    2012-01-01

    How does early feedback change the programming problem solving in an online environment and help students choose correct approaches? This study was conducted in a sample of students learning programming in an online course entitled Introduction to C++ and OOP (Object Oriented Programming) using the ANGEL learning management system platform. My…

  8. Mexican-Origin Youth's Cultural Orientations and Adjustment: Changes from Early to Late Adolescence

    Science.gov (United States)

    Updegraff, Kimberly A.; Umana-Taylor, Adriana J.; McHale, Susan M.; Wheeler, Lorey A.; Perez-Brena, Norma J.

    2012-01-01

    Drawing from developmental and cultural adaptation perspectives and using a longitudinal design, this study examined: (a) mean-level changes in Mexican-origin adolescents' cultural orientations and adjustment from early to late adolescence and (b) bidirectional associations between cultural orientations and adjustment using a cross-lag panel…

  9. Early Diagnosis of Autism Spectrum Disorder: Stability and Change in Clinical Diagnosis and Symptom Presentation

    Science.gov (United States)

    Guthrie, Whitney; Swineford, Lauren B.; Nottke, Charly; Wetherby, Amy M.

    2013-01-01

    Background: Although a diagnosis of autism spectrum disorder (ASD) appears to be stable in children as young as age three, few studies have explored stability of a diagnosis in younger children. Predictive value of diagnostic tools for toddlers and patterns of symptom change are important considerations for clinicians making early diagnoses. Most…

  10. DEVELOPMENTAL CHANGES IN SEROTONIN SIGNALING: IMPLICATIONS FOR EARLY BRAIN FUNCTION, BEHAVIOR AND ADAPTATION

    Science.gov (United States)

    BRUMMELTE, S.; GLANAGHY, E. MC; BONNIN, A.; OBERLANDER, T. F.

    2017-01-01

    The neurotransmitter serotonin (5-HT) plays a central role in brain development, regulation of mood, stress reactivity and risk of psychiatric disorders, and thus alterations in 5-HT signaling early in life have critical implications for behavior and mental health across the life span. Drawing on preclinical and emerging human evidence this narrative review paper will examine three key aspects when considering the consequences of early life changes in 5-HT: (1) developmental origins of variations of 5-HT signaling; (2) influence of genetic and epigenetic factors; and (3) preclinical and clinical consequences of 5-HT-related changes associated with antidepressant exposure (SSRIs). The developmental consequences of altered prenatal 5-HT signaling varies greatly and outcomes depend on an ongoing interplay between biological (genetic/epigenetic variations) and environmental factors, both pre and postnatally. Emerging evidence suggests that variations in 5-HT signaling may increase sensitivity to risky home environments, but may also amplify a positive response to a nurturing environment. In this sense, factors that change central 5-HT levels may act as ‘plasticity’ rather than ‘risk’ factors associated with developmental vulnerability. Understanding the impact of early changes in 5-HT levels offers critical insights that might explain the variations in early typical brain development that underlies behavioral risk. PMID:26905950

  11. The Alliance in Couple Therapy: Partner Influence, Early Change, and Alliance Patterns in a Naturalistic Sample

    Science.gov (United States)

    Anker, Morten G.; Owen, Jesse; Duncan, Barry L.; Sparks, Jacqueline A.

    2010-01-01

    Objective: The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. Method:…

  12. Professional Development of Preschool Teachers and Changing the Culture of the Institution of Early Education

    Science.gov (United States)

    Vujicic, Lidija; Camber Tambolaš, Akvilina

    2017-01-01

    The culture of institutions of early education is a strong network of customs, rules, norms and behaviours that affect the daily life and work of all its individuals. Consequently, the professional development of preschool teachers is not only an individual process of professional advancement, but also a process that changes the culture of the…

  13. Changing the culture of academic medicine: the C-Change learning action network and its impact at participating medical schools.

    Science.gov (United States)

    Krupat, Edward; Pololi, Linda; Schnell, Eugene R; Kern, David E

    2013-09-01

    The culture of academic medicine has been described as hierarchical, competitive, and not highly supportive of female or minority faculty. In response to this, the authors designed the Learning Action Network (LAN), which was part of the National Initiative on Gender, Culture and Leadership in Medicine (C-Change). The LAN is a five-school consortium aimed at changing the organizational culture of its constituent institutions. The authors selected LAN schools to be geographically diverse and representative of U.S. medical schools. Institutional leaders and faculty representatives from constituent schools met twice yearly for four years (2006-2010), forming a cross-institutional learning community. Through their quarterly listing of institutional activities, schools reported a wide array of actions. Most common were increased faculty development and/or mentoring, new approaches to communication, and adoption of new policies and procedures. Other categories included data collection/management, engagement of key stakeholders, education regarding gender/diversity, and new/expanded leadership positions. Through exit interviews, most participants reported feeling optimistic about maintaining the momentum of change. However, some, especially in schools with leadership changes, expressed uncertainty. Participants reported that they felt that the LAN enabled, empowered, facilitated, and/or caused the reported actions.For others who might want to work toward changing the culture of academic medicine, the authors offer several lessons learned from their experiences with C-Change. Most notably, people, structures, policies, and reward systems must be put into place to support cultural values, and broad-based support should be created in order for changes to persist when inevitable transitions in leadership occur.

  14. Alternatives to a routine follow-up visit for early medical abortion.

    Science.gov (United States)

    Clark, Wesley; Bracken, Hillary; Tanenhaus, Jini; Schweikert, Suzanne; Lichtenberg, E Steve; Winikoff, Beverly

    2010-02-01

    To evaluate the ability of women and their providers to assess abortion outcome without the routine use of ultrasonography. This multicenter trial enrolled 4,484 women seeking medical abortion at 10 clinics in the United States. Women received the standard medical abortion care with mifepristone-misoprostol in those clinics and blinded clinical assessments before follow-up ultrasonography. Data were collected prospectively on abortion outcomes, receipt of additional treatment, and clinical, laboratory, and ultrasound assessments associated with the procedure. We constructed five model algorithms for evaluating women's postabortion status, each using a different assortment of data. Four of the algorithms (algorithms 1-4) rely on data collected by the woman and on the results of the low-sensitivity pregnancy test. Algorithm 5 relies on the woman's assessment, the results of the pregnancy test, and follow-up physician assessment (sometimes including bimanual or speculum examination). A total of 3,054 women received medical abortion and had adequate data for evaluation. Twenty women (0.7%) had an ongoing pregnancy; 26 (0.9%) received curettage for retained tissue, empiric treatment for possible infection, or both; and 55 (1.8%) received additional uterotonics or other medical abortion-related care. Screening algorithms including patient-observed outcomes, a low-sensitivity pregnancy test, and nonsonographic clinical evaluation were as effective as sonography in identifying women who received interventions at or after the follow-up visit. Relying on women's observations, a low-sensitivity pregnancy test, and clinical examination, women and their providers can accurately assess whether follow-up care is required after medical abortion without routine ultrasonography. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00120224. II.

  15. Temporal changes in rates and reasons for medical induction of term labor, 1980-1996.

    Science.gov (United States)

    Yawn, B P; Wollan, P; McKeon, K; Field, C S

    2001-03-01

    This study was undertaken to assess temporal changes in rates and reasons for medical induction of term labor. A retrospective medical record review was conducted on a population-based cohort of 1293 women with term deliveries. The rate of medical labor induction increased from 12.9% in 1980 to 25.8% in 1995. Stated indications also changed, with a 2-fold increase in induction for postdate gestation, a 23-fold increase in induction for macrosomia, a 15-fold increase in elective induction, and a 22-fold decline in induction for premature rupture of membranes. The average gestational age at delivery of postdate pregnancies declined from 41.9 weeks in 1980 to 41.0 weeks in 1995. By 1995, the average maternal length of stay and the percentage of cesarean deliveries were higher among women with induced labor at term than among those with spontaneous labor at term. Induction of term labor has almost doubled in prevalence during the past 15 years. The most common indications are elective induction and postdate pregnancy, often applied to gestations of 40 to 41 weeks' duration.

  16. Can we change the natural history of Crohn's disease with early immunomodulation?

    Science.gov (United States)

    Markowitz, James

    2014-01-01

    In both children and adults, the natural history of Crohn's disease (CD) is characterized by relapsing and remitting bouts of intestinal inflammation, often associated with a progressive shift from inflammatory to complicated stricturing or penetrating disease behavior. The past 2 decades have seen a dramatic shift in therapeutic approach with the increasingly common use of early thiopurine immunomodulation. These maintenance medications were initially introduced primarily as corticosteroid-sparing agents capable of minimizing recurrent flares of inflammatory disease and have proven to be quite efficacious. Increasing evidence suggests, however, that thiopurines may only delay rather than prevent the development of complicated disease behavior. Data from both adult and pediatric CD populations from around the world are reviewed in terms of the effect of early immunomodulation on progression to complicated disease behavior, need for surgery, and prevention of recurrent disease after resection. The effect of thiopurines on the growth of children is also reviewed.

  17. The Impact of Everyday Discrimination and Racial Identity Centrality on African American Medical Student Well-Being: a Report from the Medical Student CHANGE Study.

    Science.gov (United States)

    Perry, Sylvia P; Hardeman, Rachel; Burke, Sara E; Cunningham, Brooke; Burgess, Diana J; van Ryn, Michelle

    2016-09-01

    Positive psychological well-being is an important predictor of and contributor to medical student success. Previous work showed that first-year African American medical students whose self-concept was highly linked to their race (high racial identity centrality) were at greater risk for poor well-being. The current study extends this work by examining (a) whether the psychological impact of racial discrimination on well-being depends on African American medical students' racial identity centrality and (b) whether this process is explained by how accepted students feel in medical school. This study used baseline data from the Medical Student Cognitive Habits and Growth Evaluation (CHANGE) Study, a large national longitudinal cohort study of 4732 medical students at 49 medical schools in the USA (n = 243). Regression analyses were conducted to test whether medical student acceptance mediated an interactive effect of discrimination and racial identity centrality on self-esteem and well-being. Both racial identity centrality and everyday discrimination were associated with negative outcomes for first-year African American medical students. Among participants who experienced higher, but not lower, levels of everyday discrimination, racial identity centrality was associated with negative outcomes. When everyday discrimination was high, but not low, racial identity was negatively related to perceived acceptance in medical school, and this in turn was related to increased negative outcomes. Our results suggest that discrimination may be particularly harmful for African American students who perceive their race to be central to their personal identity. Additionally, our findings speak to the need for institutional change that includes commitment and action towards inclusivity and the elimination of structural racism.

  18. Medical Complications of the Critically Ill Newborn: A Review for Early Intervention Professionals.

    Science.gov (United States)

    McNab, Theresa C.; Blackman, James A.

    1998-01-01

    Provides early-intervention professionals with a basic familiarity and understanding of some of the newest technologies employed in the neonatal intensive care units for neonates with respiratory distress syndrome, persistent fetal circulation, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. Early…

  19. Comorbidity, Use of Common Medications, and Risk of Early Death in Patients with Localized or Locally Advanced Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Carsten Nieder

    2011-01-01

    Full Text Available In this paper, we analyze predictive factors for early death from comorbidity (defined as death within 3 years from diagnosis and unrelated to prostate cancer in patients with localized or locally advanced prostate cancer. Such information may guide individually tailored treatment or observation strategies, and help to avoid overtreatment. We retrospectively analyzed baseline parameters including information on comorbidity and medication use among 177 patients (median age at diagnosis 70 years. Actuarial survival analyses were performed. During the first 3 years, two patients (1.1% died from progressive prostate cancer after they had developed distant metastases. The risk of dying from other causes (3.4% was numerically higher, although not to a statistically significant degree. Six patients who died from other causes had age-adjusted Charlson comorbidity index (CCI scores ≥5 (CCI is a sum score where each comorbid condition is assigned with a score depending on the risk of dying associated with this condition. The main comorbidity was cardiovascular disease. The two statistically significant predictive factors were medication use and age-adjusted CCI score ≥5 (univariate analysis. However, medication use was not an independent factor as all patients with age-adjusted CCI score ≥5 also used at least one class of medication. Median survival was 30 months in patients with age-adjusted CCI score ≥5. Prediction of non-prostate cancer death may be important to prevent overtreatment in patients who are more threatened by comorbidity. Our data suggest that simple parameters such as use of medications vs. none, or presence of serious cardiac disease vs. none, are not sufficient, and that age-adjusted CCI scores outperform the other factors included in our analysis.

  20. Perceived mistreatment and attitude change by graduating medical students: a retrospective study.

    Science.gov (United States)

    Wolf, T M; Randall, H M; von Almen, K; Tynes, L L

    1991-05-01

    The goal of this study was to assess types and sources of perceived mistreatment, perceived attitude change, and academic performance of graduating medical students. A total of 87 of 143 (61%) students anonymously completed a mistreatment questionnaire, an attitude questionnaire, and questions about academic performance. The percentage of mistreatment was widespread (98.9%) with psychological mistreatment (shouting and humiliating) by residents/interns being most frequent. Over half of the students perceived sexual harassment, with women reporting greater harassment than men. There was a high incidence of disparaging remarks about doctors and medicine as a profession from a variety of sources. Increased mistreatment was positively associated with a perceived increase in cynicism. The potentially adverse effects of mistreatment on the individual student, the teacher-student relationship, and the doctor-patient relationship are discussed with recommendations for improving medical education.

  1. The changing purpose of mental health law: From medicalism to legalism to new legalism.

    Science.gov (United States)

    Brown, Jennifer

    2016-01-01

    The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.

  2. Early-career researchers in medical applications @ CERN | 6 June | Main Auditorium

    CERN Multimedia

    2016-01-01

      Discover how technological advances for high-energy physics have become essential tools for modern medicine. CERN seeks to answer fundamental questions about the Universe, and this mission naturally contributes to advancing the frontiers of technology. State-of-the-art techniques developed for particle accelerators, detectors, and physics computing have applications beyond the high-energy physics community in the medical field. These applications now have an essential role in clinical practices and medical research centres: from imaging devices, accelerator-technology dedicated to cancer therapy, to simulations and data science tools. This knowledge transfer from the high energy physics community to innovation in other fields is an inherent component of CERN’s mission and culture. It fuels scientific collaboration and technological advances, and drives innovation. In addition, it motivates future generations of scientists, and contributes to the public awareness of the impact of fu...

  3. Is the global rise of asthma an early impact of anthropogenic climate change?

    Directory of Open Access Journals (Sweden)

    Paul John Beggs

    Full Text Available The increase in asthma incidence, prevalence, and morbidity over recent decades presents a significant challenge to public health. Pollen is an important trigger of some types of asthma, and both pollen quantity and season depend on climatic and meteorological variables. Over the same period as the global rise in asthma, there have been considerable increases in atmospheric carbon dioxide concentration and global average surface temperature. We hypothesize anthropogenic climate change as a plausible contributor to the rise in asthma. Greater concentrations of carbon dioxide and higher temperatures may increase pollen quantity and induce longer pollen seasons. Pollen allergenicity can also increase as a result of these changes in climate. Exposure in early life to a more allergenic environment may also provoke the development of other atopic conditions, such as eczema and allergic rhinitis. Although the etiology of asthma is complex, the recent global rise in asthma could be an early health effect of anthropogenic climate change.

  4. Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence.

    Science.gov (United States)

    Amin, Krutika; Farley, Joel F; Maciejewski, Matthew L; Domino, Marisa E

    2017-03-01

    In 2001, the North Carolina (NC) Medicaid program reduced the number of days prescription supply that enrollees could fill from 100 days to 34 days and increased copayments for brand-name medications. Previous work has shown that a change in these policies led to a decrease in medication adherence from 2.9 to 8.0 percentage points in specific populations with chronic conditions. Studies have also shown that days supply limits and copayment increases have heterogeneous effects based on enrollees' baseline characteristics, including baseline adherence. However, this phenomenon has not been studied in the Medicaid population. We undertook this study to assess the heterogeneous effect of the NC Medicaid policy changes in groups with varying levels of baseline adherence. To examine whether restrictions on days supply had heterogeneous effects in subgroups defined by medication adherence before the policy changes. A partial difference-in-difference-in-differences model with fixed effects was used to compare medication adherence before and after the NC Medicaid policy changes among Medicaid enrollees subject to the policy changes because of their use of long prescriptions (> 40 days) as compared with (a) NC Medicaid enrollees using short prescriptions (consideration the heterogeneity of responses by the enrollees to these policies. Furthermore, policies that consider baseline characteristics of enrollees may be more effective in improving adherence. This study was partly funded by a grant from the Robert Wood Johnson Foundation for use in data creation. Maciejewski was supported by a Research Career Scientist Award from the Department of Veterans Affairs (RCS 10-391) and owns stock in Amgen. Farley reports consultancy fees from Daiichi Sankyo outside of the conduct of this study. The other authors report no financial or other conflicts of interest related to the subject of this article. The views expressed in this article are those of the authors and do not reflect the

  5. A statistical test on diversity changes of Early and Middle Permian fusulinacean fauna in South China

    Institute of Scientific and Technical Information of China (English)

    SHI Yukun; YANG Xiangning

    2005-01-01

    The rarefaction analysis has been conducted to test the species diversity changes of the Early and Middle Permian fusulinacean fauna in South China. The results reveal that the number of species dramatically increased since the earliest Permian and quickly reached the maximum value in the early Zisongian representing the highest species diversity for the whole Early and Middle Permian. The species diversity stabilized in the plateau through the Zisongian;however, it started to decline in the following Longlinian and sustained a longstanding low level during the mid-Early Permian. With the appearance of new fusulinacean taxa with septulum structures, the number of species raised again in the late-Early Permian, followed by a decline in the Middle Permian Neoschwagerina simplex zone. Although the species diversity increased apparently in the Kuhfengian, it never rebounded back to the same level as in the Early Permian.In the mid-Middle Permian, species diversity began to decrease continuously and led to the disappearance of most fusulinacean species by the end of the Middle Permian.

  6. Examining the impact of early longitudinal patient exposure on medical students' career choices.

    Science.gov (United States)

    Kwok, Jason; Wu, Vincent; Sanfilippo, Anthony; Bowes, Kathryn; Pinchin, Sheila

    2017-02-01

    Medical schools include career direction experiences to help students make informed career decisions. Most experiences are short, precluding students from attaining adequate exposure to long-term encounters within medicine. We investigated the impact of the First Patient Program (FPP), which fosters longitudinal patient exposure by pairing junior medical students with chronically ill patients through their healthcare journey, in instilling career direction. Medical students who completed at least 6-months in the FPP participated in a cross-sectional survey. Students' answers were analyzed with respect to the number of FPP appointments attended. Thematic analysis was conducted to explore qualitative responses. One hundred and forty-eight students participated in the survey. Only 28 (19%) students stated that the FPP informed their career decisions. Thirty-nine percent of students who attended four or more appointments indicated that the FPP informed their career decisions, compared to 16% of students who attended less (p=0.021). Thematic analysis revealed two themes: 1) Students focused mainly on patient encounters within FPP; and 2) Students sought career directions from other experiences. The majority of students did not attain career guidance from the FPP, but rather used the program to understand the impact of chronic illness from the patient's perspective.

  7. Ultra-Structural Changes of the Early Childhood Caries Starting Phases of Development

    Directory of Open Access Journals (Sweden)

    Kokoceva-Ivanovska Olga

    2014-03-01

    Full Text Available In the recent 20 years, besides dramatic reduction of caries in many countries where complex programme of prevention is carried out, prevalence of Early Childhood Caries (ECC has expressed continual growth trend. The aim of our research was to determine precisely ultra-structural changes in the enamel substance at the initial lesion of the ECC (white spot lesion, as initial change of great importance for its preventive aspect. Therefore, we directed our experiment to evaluate ultra-structural changes of the teeth enamel in primary teeth with circular caries in its opening stages of development: initial caries lesion and superficial form.

  8. CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression.

    Science.gov (United States)

    Turner, Hannah; Marshall, Emily; Wood, Francesca; Stopa, Lusia; Waller, Glenn

    2016-02-01

    Whilst studies have consistently identified early symptom reduction as an important predictor of treatment outcome, the impact of early change on common comorbid features has not been investigated. This study of CBT for eating disorders explored patterns of early change in eating pathology and longer-term change in personality pathology, anxiety and depression. It also explored the impact of early change in eating pathology on overall change in personality pathology, anxiety and depression. Participants were 179 adults diagnosed with eating disorders who were offered a course of CBT in an out-patient community eating disorders service in the UK. Patients completed a measure of eating disorder psychopathology at the start of treatment and following the 6th session. They also completed measures of personality disorder cognitions, anxiety and depression at the start and end of treatment. There were significant changes in eating pathology over the first six sessions of treatment. Significant improvements were also seen in personality disorder pathology, anxiety and depression by the end of therapy. Effect sizes were medium to large for both completer and intention to treat analyses. Early changes in eating pathology were associated with later changes in common comorbid features, with early reduction in restraint being a key predictor. These findings demonstrate that early symptom change can be achieved in CBT for eating disorders when delivered in routine clinical practice. Such change has long-term benefits that go beyond the domain of eating pathology, enhancing change in personality pathology, anxiety and depression.

  9. Implementing change in primary care practices using electronic medical records: a conceptual framework

    Directory of Open Access Journals (Sweden)

    Stuart Gail W

    2008-01-01

    Full Text Available Abstract Background Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR. Methods Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. Results A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of

  10. Coping with a changing environment: The effects of early life stress

    DEFF Research Database (Denmark)

    Vindas, Marco A.; Madaro, Angelico; Fraser, Thomas W.K.

    2016-01-01

    Ongoing rapid domestication of Atlantic salmon implies that individuals are subjected to evolutionarily novel stressors encountered under conditions of artificial rearing, requiring new levels and directions of flexibility in physiological and behavioural coping mechanisms. Phenotypic plasticity...... to environmental changes is particularly evident at early life stages. We investigated the performance of salmon, previously subjected to an unpredictable chronic stress (UCS) treatment at an early age (10 month old parr), over several months and life stages. The UCS fish showed overall higher specific growth...... farming environments may be beneficial, because in such situations individuals may be able to reallocate energy from stress responses into other life processes, such as growth....

  11. Analysis of corneal morphologic and pathologic changes in early-stage congenital aniridic keratopathy

    Science.gov (United States)

    Du, Juan; Liu, Rong-Qiang; Ye, Lei; Li, Zhi-Hui; Zhao, Feng-Tu; Jiang, Nan; Ye, Lin-Hong; Shao, Yi

    2017-01-01

    AIM To determine typical corneal changes of congenital aniridic keratopathy (CAK) using corneal topography and confocal systems, and to identify characteristics that might assist in early diagnosis. METHODS Patients with CAK and healthy control subjects underwent detailed ophthalmic examinations including axial length, corneal thickness, tear film condition, corneal topography, and laser-scanning in vivo confocal microscopy (IVCM). RESULTS In early stage aniridic keratopathy, Schirmer I test (SIT), break-up time (BUT), mean keratometry (mean K) and simulated keratometry (sim K) were reduced relative to controls (Pcorneal astigmatism (sim A) and corneal thickness were increased (Pcorneal morphology in borderline situations can be useful to confirm the diagnosis of CAK. PMID:28393028

  12. Evaluating the Relationship Between Participation in Student-Run Free Clinics and Changes in Empathy in Medical Students.

    Science.gov (United States)

    Modi, Anita; Fascelli, Michele; Daitch, Zachary; Hojat, Mohammadreza

    2017-07-01

    We explored differences in changes in medical student empathy in the third year of medical school between volunteers at JeffHOPE, a multisite medical student-run free clinic of Sidney Kimmel Medical College (SKMC), and nonvolunteers. Volunteerism and leadership experience at JeffHOPE were documented for medical students in the Class of 2015 (n = 272) across their medical educations. Students completed the Jefferson Scale of Empathy at the beginning of medical school and at the end of the third year. Students who reported participation in other Jefferson-affiliated clinics (n = 44) were excluded from this study. Complete data were available for 188 SKMC students. Forty-five percent of students (n = 85) volunteered at JeffHOPE at least once during their medical educations. Fifteen percent of students (n = 48) were selected for leadership positions involving weekly clinic participation. Nonvolunteers demonstrated significant decline in empathy in medical school ( P = 0.009), while those who volunteered at JeffHOPE at least once over the course of their medical educations did not show any significant decline ( P = 0.07). These findings suggest that medical students may benefit from volunteering at student-run free clinics to care for underserved populations throughout medical school.

  13. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Peter Laszlo Lakatos; Zsofia Czegledi; Tamas Szamosi; Janos Banai; Gyula David; Ferenc Zsigmond; Tunde Pandur; Zsuzsanna Erdelyi; Orsolya Gemela; Janos Papp; Laszlo Lakatos

    2009-01-01

    AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/ biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location ( P = 0.001), presence of perianal disease ( P < 0.001), prior steroid use ( P = 0.006), early AZA ( P = 0.005) or AZA/biological therapy ( P = 0.002), or smoking ( P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

  14. Methods for assessment of innovative medical technologies during early stages of development.

    OpenAIRE

    Hagen, Anja; Schönermark, Matthias P.; Lühmann, Dagmar; Neumann, Ulrike; Bartelmes, Marc

    2009-01-01

    Conventional Health Technology Assessment (HTA) is usually conducted at a point in time at which the development of the respective technology may no longer be influenced. By this time developers and/or purchasers may have misinvested resources. Thus the demand for Technology Assessment (TA) which incorporates appropriate methods during early development stages of a technology becomes apparent. Against this health political background, the present report describes methods for a development-acc...

  15. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan

    Directory of Open Access Journals (Sweden)

    Mei-Yu Tseng

    2013-01-01

    Full Text Available Objectives. Endoscopic submucosal dissection (ESD is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1 lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG ≧20 mm and laterally spreading tumors-granular type (LST-G ≧30 mm; (2 lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3±12.9 years, and the male-female ratio was 1.8 : 1. The mean tumor size was 37.2±17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0% and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD.

  16. RU OK? The acceptability and feasibility of remote technologies for follow-up after early medical abortion.

    Science.gov (United States)

    Bracken, Hillary; Lohr, Patricia A; Taylor, Jeanette; Morroni, Chelsea; Winikoff, Beverly

    2014-07-01

    We tested the effectiveness and feasibility of remote communication technologies to increase follow-up after early medical abortion. Women (n=999) were randomized to 'remote' follow-up incorporating a low-sensitivity pregnancy test and standardized symptom questionnaire administered online, by text message or telephone by a non-clinical call center operator 2 weeks after treatment, or to 'clinic-based' follow-up with ultrasound at 1 week. Women in the clinic-based group who could not return performed a high-sensitivity pregnancy test at 3 weeks and had a telephone call with clinic staff. The primary outcome was completion of follow-up. Rates of complications, acceptability and preferences were compared. The overall follow-up rate did not differ by group {clinic-based, 73% vs. remote, 69%; risk ratio (RR) 1.0 [95% confidence interval (CI) 0.9-1.2]}. In the clinic-based group, 83% did not return for an ultrasound scan and were followed up by phone. In the remote group, follow-up by phone or text was more successful than online (text: 75.4%; phone: 73.7%; online: 46.5%, pafter medical abortion using remote communication is feasible and, for most women, preferable to a clinic visit. Medical abortion protocols typically use follow-up visits to ensure early identification of complications. This study demonstrates that follow-up can be achieved using remote communication technologies. This model may reduce the burden of multiple clinic visits on patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial.

    Science.gov (United States)

    Iyengar, Kirti; Klingberg-Allvin, Marie; Iyengar, Sharad D; Paul, Mandira; Essén, Birgitta; Gemzell-Danielsson, Kristina

    2016-02-01

    Although home use of misoprostol for early medical abortion is considered to be safe, effective and feasible, it has not become standard service delivery practice. The aim of this study was to compare the efficacy, safety, and acceptability of home use of misoprostol with clinic misoprostol in a low-resource setting. This was a secondary analysis of a randomized controlled trial conducted in six primary care clinics in India. Women seeking medical abortion within up to nine gestational weeks (n = 731) received mifepristone in the clinic and were allocated either to home or clinic administration of misoprostol. Follow-up contact was after 10-15 days. Of 731 participants, 73% were from rural areas and 55% had no formal education. Complete abortion rates in the home and clinic misoprostol groups were 94.2 and 94.4%, respectively. The rate of adverse events was similar in both groups (0.3%). A greater proportion of home users (90.2%) said that they would opt for misoprostol at home in the event of a future abortion compared with clinic users (79.7%) who would opt for misoprostol at the clinic in a similar situation (p = 0.0002). Ninety-six percent women using misoprostol at home or in the clinic were satisfied with their abortion experience. Home-use of misoprostol for early medical abortion is as effective and acceptable as clinic use, in low resource settings. Women should be offered a choice of this option regardless of distance of their residence from the clinic and communication facilities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  18. Laparoscopic Management of Uterine Rupture After Early Second-Trimester Medical Abortion in a Patient With a Prior Cesarean Section.

    Science.gov (United States)

    Namazov, Ahmed; Grin, Leonti; Volodarsky, Michael; Anteby, Eyal; Gemer, Ofer

    2016-01-01

    To show the possibility of laparoscopic management of uterine rupture. Video with explanations. In the medical management with misoprostol for termination of pregnancy at any time the risk of uterine rupture may be possible. The risk is likely higher in women with a previous uterus surgery. In a systematic review of available studies, the risk of rupture was .28% among women with a prior cesarean delivery who were undergoing second-trimester misoprostol-induced abortion, meaning if 414 women with a history of cesarean delivery were given misoprostol for second-trimester abortion, 1 would experience uterine rupture. Uterine rupture has only been reported 3 times in first-trimester abortion and only once managed via laparoscopy: a missed abortion reported in 2005, a case of a ruptured unscarred uterus in a women undergoing medical abortion, and a case of a delayed miscarriage at 8 weeks' gestation after misoprostol managed by laparotomy and sharp curettage. Total laparoscopic management in a patient with uterine tear after misoprostol treatment. Early second-trimester medical abortions with misoprostol can cause uterine rupture. In hemodynamically stable cases, total laparoscopic management is possible approach. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  19. Determinants of preferences for lifestyle changes versus medication and beliefs in ability to maintain lifestyle changes. A population-based survey

    Directory of Open Access Journals (Sweden)

    Dorte Ejg Jarbøl

    2017-06-01

    For conclusion we found a pervasive preference for lifestyle changes over medical treatment when individuals were promised the same benefits. Lifestyle risk factors and socioeconomic characteristics were associated with preference for lifestyle changes as well as belief in ability to maintain lifestyle changes. For health professionals risk communication should not only focus on patient preferences but also on patients' beliefs in their own ability to initiate lifestyle changes and possible barriers against maintaining changes.

  20. Value of routine ultrasound in detecting early joint changes in children with haemophilia using the 'Haemophilia Early Arthropathy Detection with UltraSound' protocol

    NARCIS (Netherlands)

    Foppen, W; van der Schaaf, I C; Fischer, K

    2016-01-01

    INTRODUCTION: Patients with haemophilia tend to bleed in large joints even during prophylactic replacement therapy. Detection of early blood-induced joint changes may improve monitoring of treatment. The aim of this study was to explore the value of routine ultrasound in detecting early joint abnorm

  1. Medical physics education from the view of the possible structural changes.

    Science.gov (United States)

    Ferencova, E; Kukurova, E

    2001-01-01

    Teaching subject physics at the university level represents a specific didactic transformation of the scientific field--physics. The determination of the content, extent, used methods, mutual relation to other subjects of curriculum as well as to the entrance knowledge of students are the most important parts of pedagogical activities in the educational process. Based on own experiences, successes and mistakes in teaching so-called medical physics the authors discuss didactic procedures which should support the interest and creativity of students. Some changes in the structure of physics education are recommended. The usefulness of the international collaboration in the framework of projects such as TEMPUS, ERASMUS is also remembered.

  2. Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium.

    Science.gov (United States)

    Bilsen, Johan; Vander Stichele, Robert; Broeckaert, Bert; Mortier, Freddy; Deliens, Luc

    2007-08-01

    Changes in medical practices during transitions in regulating healthcare are rarely investigated. In this study, we investigated changes in medical end-of-life decisions with a possible or certain life-shortening effect (ELDs) that occurred during the legalization process of euthanasia in Belgium. We took representative random samples from deaths reported to registries in Flanders, Belgium in 1998 (n=3999) at the beginning of the process and in 2001 (N=5005), at the end of the process. The reporting physicians received an anonymous mail questionnaire about possible ELDs preceding the death involved. We found no significant shifts in the epidemiology of diseases between 1998 and 2001. The overall incidence of ELDs did not change. The incidence decreased for euthanasia, administering life-ending drugs without patient's explicit request, and alleviation of pain and symptoms with life-shortening co-intention. Incidence increased for alleviation of pain and symptom without life-shortening intention, and remained stable for non-treatment decisions. All decisions in 2001 were more often discussed with patients, their relatives and nurses. In 2001, continuous deep sedation was reported in 8.3% of deaths. We can conclude that physicians' end-of-life practices have substantially changed during the short but tumultuous legalization process of euthanasia in Belgium. Although follow-up research is needed to investigate the continuance of these changes, it is important for policy makers to keep in mind that social factors related to transitions in healthcare regulation may play an important role in the physicians' actual behaviour.

  3. Climate change decouples drought from early wine grape harvests in France

    Science.gov (United States)

    Cook, B.; Wolkovich, E. M.

    2016-12-01

    Across the world, wine grape phenology has advanced in recent decades, in step with climate-change-induced trends in temperature—the main driver of fruit maturation—and drought. Fully understanding how climate change contributes to changes in harvest dates, however, requires analysing wine grape phenology and its relationship to climate over a longer-term context, including data predating anthropogenic interference in the climate system. Here, we investigate the climatic controls of wine grape harvest dates from 1600-2007 in France and Switzerland using historical harvest and climate data. Early harvests occur with warmer temperatures (-6 days/C) and are delayed by wet con- ditions (+0.07 days/mm; +1.68 days/PDSI unit) during spring and summer. In recent decades (1981-2007), however, the relationship between harvest timing and drought has broken down. Historically, high summer temperatures in Western Europe, which would hasten fruit maturation, required drought conditions to generate extreme heat. The relationship between drought and temperature in this region, however, has weakened in recent decades and enhanced warming from anthropogenic greenhouse gases can generate the high temperatures needed for early harvests without drought. Our results suggest that climate change has fundamentally altered the climatic drivers of early wine grape harvests in France, with possible ramifications for viticulture management and wine quality.

  4. Early changes in emotional processing as a marker of clinical response to SSRI treatment in depression.

    Science.gov (United States)

    Godlewska, B R; Browning, M; Norbury, R; Cowen, P J; Harmer, C J

    2016-11-22

    Antidepressant treatment reduces behavioural and neural markers of negative emotional bias early in treatment and has been proposed as a mechanism of antidepressant drug action. Here, we provide a critical test of this hypothesis by assessing whether neural markers of early emotional processing changes predict later clinical response in depression. Thirty-five unmedicated patients with major depression took the selective serotonin re-uptake inhibitor (SSRI), escitalopram (10 mg), over 6 weeks, and were classified as responders (22 patients) versus non-responders (13 patients), based on at least a 50% reduction in symptoms by the end of treatment. The neural response to fearful and happy emotional facial expressions was assessed before and after 7 days of treatment using functional magnetic resonance imaging. Changes in the neural response to these facial cues after 7 days of escitalopram were compared in patients as a function of later clinical response. A sample of healthy controls was also assessed. At baseline, depressed patients showed greater activation to fear versus happy faces than controls in the insula and dorsal anterior cingulate. Depressed patients who went on to respond to the SSRI had a greater reduction in neural activity to fearful versus happy facial expressions after just 7 days of escitalopram across a network of regions including the anterior cingulate, insula, amygdala and thalamus. Mediation analysis confirmed that the direct effect of neural change on symptom response was not mediated by initial changes in depressive symptoms. These results support the hypothesis that early changes in emotional processing with antidepressant treatment are the basis of later clinical improvement. As such, early correction of negative bias may be a key mechanism of antidepressant drug action and a potentially useful predictor of therapeutic response.

  5. Diffusion imaging changes in grey matter in Alzheimer's disease: a potential marker of early neurodegeneration.

    Science.gov (United States)

    Weston, Philip S J; Simpson, Ivor J A; Ryan, Natalie S; Ourselin, Sebastien; Fox, Nick C

    2015-01-01

    Alzheimer's disease (AD) is recognized to have a long presymptomatic period, during which there is progressive accumulation of molecular pathology, followed by inexorable neuronal damage. The ability to identify presymptomatic individuals with evidence of neurodegenerative change, to stage their disease, and to track progressive changes will be important for early diagnosis and for prevention trials. Despite recent advances, particularly in magnetic resonance imaging, our ability to identify early neurodegenerative changes reliably is limited. The development of diffusion-weighted magnetic resonance imaging, which is sensitive to microstructural changes not visible with conventional volumetric techniques, has led to a number of diffusion imaging studies in AD; these have largely focused on white matter changes. However, in AD cerebral grey matter is affected very early, with pathological studies suggesting that grey matter changes predate those in white matter. In this article we review the growing number of studies that assess grey matter diffusivity changes in AD. Although use of the technique is still at a relatively early stage, results so far have been promising. Initial studies identified changes in diffusion measures in the hippocampi of patients with mild cognitive impairment, which predated macroscopic volume loss, with positive predictive value for progression to AD dementia. More recent studies have identified abnormalities in multiple neocortical areas (particularly the posterior cingulate) at various stages of disease progression. Studies of patients who carry genetic mutations predisposing to autosomal dominant familial AD have shown cortical and subcortical grey matter diffusivity changes several years before the expected onset of the first clinical symptoms. The technique is not without potential methodological difficulties, especially relating to partial volume effects, although recent advances appear to be reducing such issues. Going forward

  6. Leading change: introducing an electronic medical record system to a paramedic service.

    Science.gov (United States)

    Baird, Shawn; Boak, George

    2016-05-03

    Purpose Leaders in health-care organizations introducing electronic medical records (EMRs) face implementation challenges. The adoption of EMR by the emergency medical and ambulance setting is expected to provide wide-ranging benefits, but there is little research into the processes of adoption in this sector. The purpose of this study is to examine the introduction of EMR in a small emergency care organization and identify factors that aided adoption. Design/methodology/approach Semi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company. Findings The user interfaces with the EMR, and perceived ease of use, were important factors affecting adoption. Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced flexibility of use, this enhanced both individual and collective ability to make sense of the change and removed barriers to acceptance. Research limitations/implications This is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR. Practical implications Leaders introducing EMR in similar situations may benefit from considering a sense-making perspective and responding promptly to feedback. Originality/value The study contributes to a wider understanding of issues faced by leaders who seek to implement EMRs in emergency medical services, a sector in which there has been to date very little research on this issue.

  7. African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

    Directory of Open Access Journals (Sweden)

    Christina M. Pettey

    2016-01-01

    Full Text Available More than 80 million Americans have hypertension (HTN, and African Americans (AAs are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs’ perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs’ perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years. Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments “passed down,” increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

  8. African Americans’ Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

    Science.gov (United States)

    Pettey, Christina M.; McSweeney, Jean C.; Stewart, Katharine E.; Cleves, Mario A.; Price, Elvin T.; Heo, Seongkum; Souder, Elaine

    2016-01-01

    More than 80 million Americans have hypertension (HTN), and African Americans (AAs) are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs’ perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs’ perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years). Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments “passed down,” increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group. PMID:27148469

  9. Effecting change through dialogue: Habermas' theory of communicative action as a tool in medical lifestyle interventions.

    Science.gov (United States)

    Walseth, Liv Tveit; Schei, Edvin

    2011-02-01

    Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas' theory of communicative action can be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients' everyday life it has to take into consideration the patient's practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one's preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient's perspective. The implementation and adjustments of Habermas' theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed.

  10. Climate Change in Lowland Central America During the Late Deglacial and Early Holocene

    Energy Technology Data Exchange (ETDEWEB)

    Hillesheim, M B; Hodell, D A; Leyden, B W; Brenner, M; Curtis, J H; Anselmetti, F S; Ariztegui, D; Buck, D G; Guilderson, T P; Rosenmeier, M F; Schnurrenberger, D W

    2005-02-08

    The transition from arid glacial to moist early Holocene conditions represented a profound change in northern lowland Neotropical climate. Here we report a detailed record of changes in moisture availability during the latter part of this transition ({approx}11,250 to 7,500 cal yr BP) inferred from sediment cores retrieved in Lake Peten Itza, northern Guatemala. Pollen assemblages demonstrate that a mesic forest had been largely established by {approx}11,250 cal yr BP, but sediment properties indicate that lake level was more than 35 m below modern stage. From 11,250 to 10,350 cal yr BP, during the Preboreal period, lithologic changes in sediments from deep-water cores (>50 m below modern water level) indicate several wet-dry cycles that suggest distinct changes in effective moisture. Four dry events (designated PBE1-4) occurred at 11,200, 10,900, 10,700, and 10,400 cal yr BP and correlate with similar variability observed in the Cariaco Basin titanium record and glacial meltwater pulses into the Gulf of Mexico. After 10,350 cal yr BP, multiple sediment proxies suggest a shift to a more persistently moist early Holocene climate. Comparison of results from Lake Peten Itza with other records from the circum-Caribbean demonstrates a coherent climate response during the entire span of our record. Furthermore, lowland Neotropical climate during the late deglacial and early Holocene period appears to be tightly linked to climate change in the high-latitude North Atlantic. We speculate that the observed changes in lowland Neotropical precipitation were related to the intensity of the annual cycle and associated displacements in the mean latitudinal position of the Intertropical Convergence Zone and Azores-Bermuda high-pressure system. This mechanism operated on millennial-to-submillennial timescales and may have responded to changes in solar radiation, glacial meltwater, North Atlantic sea ice, and the Atlantic meridional overturning circulation (MOC).

  11. Assessing Changes in Medical Student Attitudes toward Non-Traditional Human Sexual Behaviors Using a Confidential Audience Response System

    Science.gov (United States)

    Tucker, Phebe; Candler, Chris; Hamm, Robert M.; Smith, E. Michael; Hudson, Joseph C.

    2010-01-01

    Medical students encountering patients with unfamiliar, unconventional sexual practices may have attitudes that can affect open communication during sexual history-taking. We measured changes in first-year US medical student attitudes toward 22 non-traditional sexual behaviors before and after exposure to human sexuality instruction. An…

  12. Stability and Change of Interest in Obstetrics-Gynecology among Medical Students: Eighteen Years of Longitudinal Data.

    Science.gov (United States)

    Forouzan, Iraj; Hojat, Mohammadreza

    1993-01-01

    A study investigated, first, the percentage of medical students maintaining interest in obstetrics/gynecology during medical school compared to those maintaining interest in other specialties and, second, changes of interest from obstetrics/gynecology to other specialties and other specialties to obstetrics/gynecology. Results indicate instability…

  13. Stability and Change of Interest in Obstetrics-Gynecology among Medical Students: Eighteen Years of Longitudinal Data.

    Science.gov (United States)

    Forouzan, Iraj; Hojat, Mohammadreza

    1993-01-01

    A study investigated, first, the percentage of medical students maintaining interest in obstetrics/gynecology during medical school compared to those maintaining interest in other specialties and, second, changes of interest from obstetrics/gynecology to other specialties and other specialties to obstetrics/gynecology. Results indicate instability…

  14. Using Analogue Functional Analysis to Measure Variations in Problem Behavior Rate and Function after Psychotropic Medication Changes: A Clinical Demonstration

    Science.gov (United States)

    Valdovinos, Maria G.; Nelson, Samantha M.; Kuhle, Jennifer L.; Dierks, Abigail M.

    2009-01-01

    Individuals with intellectual and developmental disabilities are often prescribed psychotropic medication to treat behaviors such as aggression and self-injury. Evaluation of these medications is often based on caregiver report or changes in frequency of behavior. The purpose of this research was to characterize the rate and function of problem…

  15. Best practices in early phase medical device development: Engineering, prototyping, and the beginnings of a quality management system.

    Science.gov (United States)

    Fearis, Kristy; Petrie, Aidan

    2017-03-01

    Kristy Fearis is the founder and president of KPConsulting. She has held various positions in the medical device and research industry. She has led programs for medical industry leaders Medtronic, Edward Lifesciences, and Kimberly-Clark Healthcare to develop and commercialize Class II and III devices. Although a true quality management systems specialist at heart, Kristy has a passion for effectively and efficiently applying quality systems principles to early stage development to maximize benefit while minimizing impact on resources and time to market. Kristy works with both precommercial and commercial companies to build and implement quality systems that are "right sized" and support both an effective business model and high product quality. Aidan Petrie is the cofounder and chief innovation officer of Ximedica. Aidan drives innovation in Ximedica's core markets of medical device development and consumer healthcare. With a focus on human-centered design, usability, technical innovation and industrial design, Aidan has helped bring hundreds of products to market. Ranging from simple drug compliance aids to wearable therapeutics, home monitoring products, and complex surgical systems, Aidan challenges his teams to rethink the role design plays in the success of each product. Covering topics around usability, sensor and wearable technology, and current trends in medical design and development, Aidan is a sought-after industry speaker and widely published author. In addition to his role at Ximedica, Aidan advises multiple startups in the healthcare space and has interests in a number of related companies. He sits on the Board of MassArt and teaches and lectures at the Rhode Island School of Design, Massachusetts Institute of Technology, the Harvard iLab, and others. Aidan holds an undergraduate degree from Central St Martins in product design/engineering and a Masters in industrial design from the Rhode Island School of Design. Copyright © 2016 Elsevier Inc. All

  16. Implementation of a Pediatric Early Warning Scoring System at an Academic Medical Center.

    Science.gov (United States)

    Douglas, Kimberly; Collado, Jerry Christopher; Keller, Sheila

    2016-01-01

    Despite the addition of family-activated rapid response to the rapid response team algorithm, a children's hospital did not see an increase in utilization of the pediatric rapid response team. A Pediatric Early Warning Score in non-ICU pediatric inpatient units was implemented to increase the number of rapid response team activations. A retrospective review of the 130-bed facility, over a 12-month period, revealed an increase in pediatric rapid response calls, with a subsequent decrease in code team activations. The authors outline implementation strategies and discuss barriers encountered throughout the process, along with implications for nurse leaders.

  17. Frontal lobe changes occur early in the course of affective disorders in young people

    Directory of Open Access Journals (Sweden)

    Lagopoulos Jim

    2012-01-01

    Full Text Available Abstract Background More severe and persistent forms of affective disorders are accompanied by grey matter loss in key frontal and temporal structures. It is unclear whether such changes precede the onset of illness, occur early in the course or develop gradually with persistence or recurrence of illness. A total of 47 young people presenting with admixtures of depressive and psychotic symptoms were recruited from specialist early intervention services along with 33 age matched healthy control subjects. All participants underwent magnetic resonance imaging and patients were rated clinically as to current stage of illness. Twenty-three patients were identified as being at an early 'attenuated syndrome' stage, while the remaining were rated as having already reached the 'discrete disorder' or 'persistent or recurrent illness' stage. Contrasts were carried out between controls subjects and patients cohorts with attenuated syndromes and discrete disorders, separately. Results The patients that were identified as having a discrete or persisting disorder demonstrated decreased grey matter volumes within distributed frontal brain regions when contrasted to both the control subjects as well as those patients in the attenuated syndrome stage. Overall, patients who were diagnosed as more advanced in terms of the clinical stage of their illness, exhibited the greatest grey matter volume loss of all groups. Conclusions This study suggests that, in terms of frontal grey matter changes, a major transition point may occur in the course of affective illness between early attenuated syndromes and later discrete illness stages.

  18. THE ANALYSIS OF CHANGES AND INFLUENCING FACTORS OF EARLY POSTTHORACOTOMY PULMONARY FUNCTION

    Institute of Scientific and Technical Information of China (English)

    崔玉尚; 张志庸; 徐协群

    2003-01-01

    Objective. To investigate the changes and influencing factors of early postoperative pulmonary functionof thoracotomy.Methods. Pre-and early postoperative pulmonary function was studied in 64 consecutive cases withoptimal thoracotomy. Pain assessment was done before pulmonary function test, and the chief complaintsof patients were recorded after the procedure. The changing curves of pulmonary function were done andthe differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief com-plaint and preoperative conditions were analyzed.Results. Pulmonary function was severely lowered to about 40% of the base line on the first day,and it was rehabilitated to about 60% of the base line on the eighth day. There was a greater gradienton the recovery curve on the 3rd and 4th days. Epidural analgesia was able to improve pain relaxationand pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postopera-tive day and surgical style were the significant influencing factors for early postoperative pulmonary func-tion. By multiple-factor analysis, preoperative pulmonary function, age and postoperative pain were themain factors, while surgical style had only weak effect on it.Conclusions. Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabili-tate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure in-juries, especially injury to respiratory muscle system, and enough postoperative pain relief are the mostimportant means that would reduce pulmonary function impairment and consequently reduce postoperativepulmonary complications.

  19. Paleoclimate Changes during the Early Oligocene in the Hoh Xil Region, Northern Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    LIU Zhifei; WANG Chengshan; Alain TRENTESAUX; ZHAO Xixi; YI Haisheng; HU Xiumian; JIN Wei

    2003-01-01

    Sedimentological, cyclic-stratigraphic, paleomagnetic, and clay-mineralogical studies on the earlyOligocene Yaxicuo Group in the Hoh Xil Basin, the largest Cenozoic sedimentary basin in the hinterland of the TibetanPlateau, provide abundant information of paleoclimate changes. A 350-m thick section in the middle-lower YaxicuoGroup was analyzed to reveal the climatic history that occurred in the Hoh Xil region during the early Oligocene interval31.30-30.35 Ma, dated with the paleomagnetic chronostratigraphy. The results indicate that arid and cold climatedominated the Hoh Xil region during the early Oligocene in general, being related to the global cooling and dryingevents that occurred in the earliest Oligocene. Within this period, relatively warm and wet climate accompanied bystrong tectonic activity occurred in the 31.05-30.75 Ma interval; while arid and cold climate and relatively inactivetectonics occurred in the 31.30-31.05 and 30.75-30.35 Ma intervals. Furthermore, spectral analyses of high-temporalresolution paleoclimatic records show orbital periods including eccentricity, obliquity, and precession. It is concludedthat paleoclimate changes during the early Oligocene in the Hoh Xil region were forced by both tectonic activity andorbital periods.

  20. [Cotyla quid? On the early history of late medieval medical volume calculations].

    Science.gov (United States)

    Bergmann, Axel

    2005-01-01

    As can be made evident chiefly by their comparative numerical examination, the Egyptian pyramids (the step pyramids being excluded for the present purpose) have been, from the beginning up to the Egyptian fashion in early Imperial Rome, designed and built with the additional intention of physically manifesting a volume of pi x 10k x (average value) 0.96824 cm3, where k is either a positive integer or zero, and where pi is a short product, following very restrictive formation rules which to some extent are traceable in the papyrus Rhind, of prime numbers. Conceptually (but not really as to the Hin at least) this establishes the capacity units 1 [2]Heqat = 9682.4 cm3 and 1 Hin = 484.12 cm3 already for the Old Kingdom. It is shown further that the Attic Medimnos as introduced in the course of finishing Solon's reforms is identical with the Egyptian volume system's standard unification: pisigma = 2 x 3 x 5 x 7 x 11 x 23, and k = 0, so that 1 Medimnos = about 51443 cm3. Accordingly and by means of some adjacent considerations a Kotyle / Cotyla of 269 cm3 +/- 1 cm3 is established for the Hellenistic, early Arabic, and Medieval Latin medicine.

  1. Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago.

    Directory of Open Access Journals (Sweden)

    Pierpaolo Petrone

    Full Text Available Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP. Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.

  2. Early Medical Skull Surgery for Treatment of Post-Traumatic Osteomyelitis 5,000 Years Ago

    Science.gov (United States)

    Petrone, Pierpaolo; Niola, Massimo; Di Lorenzo, Pierpaolo; Paternoster, Mariano; Graziano, Vincenzo; Quaremba, Giuseppe; Buccelli, Claudio

    2015-01-01

    Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP). Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death. PMID:26018014

  3. Forests and Phenology: Designing the Early Warning System to Understand Forest Change

    Science.gov (United States)

    Pierce, T.; Phillips, M. B.; Hargrove, W. W.; Dobson, G.; Hicks, J.; Hutchins, M.; Lichtenstein, K.

    2010-12-01

    Vegetative phenology is the study of plant development and changes with the seasons, such as the greening-up and browning-down of forests, and how these events are influenced by variations in climate. A National Phenology Data Set, based on Moderate Resolution Imaging Spectroradiometer satellite images covering 2002 through 2009, is now available from work by NASA, the US Forest Service, and Oak Ridge National Laboratory. This new data set provides an easily interpretable product useful for detecting changes to the landscape due to long-term factors such as climate change, as well as finding areas affected by short-term forest threats such as insects or disease. The Early Warning System (EWS) is a toolset being developed by the US Forest Service and the University of North Carolina-Asheville to support distribution and use of the National Phenology Data Set. The Early Warning System will help research scientists, US Forest Service personnel, forest and natural resources managers, decision makers, and the public in the use of phenology data to better understand unexpected change within our nation’s forests. These changes could have multiple natural sources such as insects, disease, or storm damage, or may be due to human-induced events, like thinning, harvest, forest conversion to agriculture, or residential and commercial use. The primary goal of the Early Warning System is to provide a seamless integration between monitoring, detection, early warning and prediction of these forest disturbances as observed through phenological data. The system consists of PC and web-based components that are structured to support four user stages of increasing knowledge and data sophistication. Building Literacy: This stage of the Early Warning System educates potential users about the system, why the system should be used, and the fundamentals about the data the system uses. The channels for this education include a website, interactive tutorials, pamphlets, and other technology

  4. Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

    Directory of Open Access Journals (Sweden)

    Johanna Martinez

    2013-09-01

    Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

  5. Tracking a medically important spider: climate change, ecological niche modeling, and the brown recluse (Loxosceles reclusa.

    Directory of Open Access Journals (Sweden)

    Erin E Saupe

    Full Text Available Most spiders use venom to paralyze their prey and are commonly feared for their potential to cause injury to humans. In North America, one species in particular, Loxosceles reclusa (brown recluse spider, Sicariidae, causes the majority of necrotic wounds induced by the Araneae. However, its distributional limitations are poorly understood and, as a result, medical professionals routinely misdiagnose brown recluse bites outside endemic areas, confusing putative spider bites for other serious conditions. To address the issue of brown recluse distribution, we employ ecological niche modeling to investigate the present and future distributional potential of this species. We delineate range boundaries and demonstrate that under future climate change scenarios, the spider's distribution may expand northward, invading previously unaffected regions of the USA. At present, the spider's range is centered in the USA, from Kansas east to Kentucky and from southern Iowa south to Louisiana. Newly influenced areas may include parts of Nebraska, Minnesota, Wisconsin, Michigan, South Dakota, Ohio, and Pennsylvania. These results illustrate a potential negative consequence of climate change on humans and will aid medical professionals in proper bite identification/treatment, potentially reducing bite misdiagnoses.

  6. Smoking Response to Health and Medical Spending Changes and the Role of Insurance.

    Science.gov (United States)

    Marti, Joachim; Richards, Michael R

    2017-03-01

    Severe health shocks provide new information about one's personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post-shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out-of-pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65 years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults' medical spending changes separate from health shocks influence their smoking behavior. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Early Cytokine Profile Changes In Interstitial And Necrotic Forms Of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kostic Irena

    2015-03-01

    Full Text Available Acute pancreatitis (AP is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP and necrotic acute pancreatitis (NAP, especially in those patients who had lethal outcomes.

  8. Early-life exposure to climate change impairs tropical shark survival

    OpenAIRE

    Rosa, Rui; Baptista, Miguel; Lopes, Vanessa M.; Pegado, Maria Rita; Ricardo Paula, José; Trübenbach, Katja; Leal, Miguel Costa; Calado, Ricardo; Repolho, Tiago

    2014-01-01

    Sharks are one of the most threatened groups of marine animals worldwide, mostly owing to overfishing and habitat degradation/loss. Although these cartilaginous fish have evolved to fill many ecological niches across a wide range of habitats, they have limited capability to rapidly adapt to human-induced changes in their environments. Contrary to global warming, ocean acidification was not considered as a direct climate-related threat to sharks. Here we show, for the first time, that an early...

  9. Centennial-scale environmental and climatic changes during the early Holocene in the Middle Atlas, Morocco

    Science.gov (United States)

    Fletcher, W.; Joannin, S.; Zielhofer, C.; Mischke, S.; Mikdad, A.

    2013-12-01

    Mountain regions of North Africa and the Mediterranean represent one of the hotspots of current climate change, where increasing temperatures and drought stress may lead to significant changes in hydrological, ecological and geomorphological systems. Palaeoecological records can provide insights into the responses of montane systems to climate changes, with the impacts of rapid (centennial-scale) responses being of particular relevance. Here, we present the first results of high resolution (~40-50 yr) palynological and charcoal analyses as part of a multiproxy palaeoecological and palaeolimnological study of new lake sediment cores recovered from Lake Sidi Ali in the Middle Atlas mountains, Morocco (33° 03 N, 05° 00 W; 2,080 m a.s.l.). Focusing on the relatively poorly known early Holocene and early to mid-Holocene transition, we provide evidence for pseudo-cyclic centennial-scale changes in vegetation cover and composition, superimposed on the long-term transition from oak (Quercus spp.) dominated early Holocene vegetation to cedar (Cedrus atlantica) forest of the mid-Holocene. In the context of the intermediate position of the Middle Atlas mountains with respect to the influence of mid-latitude, moisture-bearing air-masses and low-latitude, southerly, Saharan air-masses, this early Holocene variability in vegetation cover is interpreted in terms of dynamics shifts in prevailing atmospheric circulation over this montane region of Northwest Africa. The geographical position of the record is ideal for testing patterns of climate variability previously detected in western Mediterranean marine sequences, and for evaluating linkages between mid- and low-latitude climate dynamics.

  10. Early assessment of medical technologies to inform product development and market access: a review of methods and applications.

    Science.gov (United States)

    Ijzerman, Maarten J; Steuten, Lotte M G

    2011-09-01

    Worldwide, billions of dollars are invested in medical product development and there is an increasing pressure to maximize the revenues of these investments. That is, governments need to be informed about the benefits of spending public resources, companies need more information to manage their product development portfolios and even universities may need to direct their research programmes in order to maximize societal benefits. Assuming that all medical products need to be adopted by the heavily regulated healthcare market at one point in time, it is worthwhile to look at the logic behind healthcare decision making, specifically, decisions on the coverage of medical products and decisions on the use of these products under competing and uncertain conditions. With the growing tension between leveraging economic growth through R&D spending on the one hand and stricter control of healthcare budgets on the other, several attempts have been made to apply the health technology assessment (HTA) methodology to earlier stages of technology development and implementation. For instance, horizon scanning was introduced to systematically assess emerging technologies in order to inform health policy. Others have introduced iterative economic evaluation, e.g. economic evaluations in earlier stages of clinical research. However, most of these methods are primarily intended to support governments in making decisions regarding potentially expensive new medical products. They do not really inform biomedical product developers on the probability of return on investment, nor do they inform about the market needs and specific requirements of technologies in development. It is precisely this aspect that increasingly receives attention, i.e. is it possible to use HTA tools and methods to inform biomedical product development and to anticipate further development and market access. Several methods have been used in previous decades, but have never been compiled in a comprehensive review

  11. Medical decision support using machine learning for early detection of late-onset neonatal sepsis.

    Science.gov (United States)

    Mani, Subramani; Ozdas, Asli; Aliferis, Constantin; Varol, Huseyin Atakan; Chen, Qingxia; Carnevale, Randy; Chen, Yukun; Romano-Keeler, Joann; Nian, Hui; Weitkamp, Jörn-Hendrik

    2014-01-01

    The objective was to develop non-invasive predictive models for late-onset neonatal sepsis from off-the-shelf medical data and electronic medical records (EMR). The data used in this study are from 299 infants admitted to the neonatal intensive care unit in the Monroe Carell Jr. Children's Hospital at Vanderbilt and evaluated for late-onset sepsis. Gold standard diagnostic labels (sepsis negative, culture positive sepsis, culture negative/clinical sepsis) were assigned based on all the laboratory, clinical and microbiology data available in EMR. Only data that were available up to 12 h after phlebotomy for blood culture testing were used to build predictive models using machine learning (ML) algorithms. We compared sensitivity, specificity, positive predictive value and negative predictive value of sepsis treatment of physicians with the predictions of models generated by ML algorithms. The treatment sensitivity of all the nine ML algorithms and specificity of eight out of the nine ML algorithms tested exceeded that of the physician when culture-negative sepsis was included. When culture-negative sepsis was excluded both sensitivity and specificity exceeded that of the physician for all the ML algorithms. The top three predictive variables were the hematocrit or packed cell volume, chorioamnionitis and respiratory rate. Predictive models developed from off-the-shelf and EMR data using ML algorithms exceeded the treatment sensitivity and treatment specificity of clinicians. A prospective study is warranted to assess the clinical utility of the ML algorithms in improving the accuracy of antibiotic use in the management of neonatal sepsis.

  12. The diagnostic value of sacroiliac CT for detecting early changes of ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ju Hyun; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee University Medical Center, Seoul (Korea, Republic of); Jin, Wook [East-West Neo Medical Center, Seoul (Korea, Republic of)

    2007-02-15

    We wanted to evaluate the diagnostic value of the various findings on sacroiliac CT for detecting the early changes of ankylosing spondylitis (AS). Between April 2005 and March 2006, 51 sacroiliac CT images with the clinical suspicion of AS, but no definite evidence of AS on the plain radiograph only, were retrospectively reviewed. Finally, 36 patients (mean age: 28.6 years; 34 males and 2 females), who were clinically diagnosed as AS (AS group, n = 26) or they had no evidence of AS (non-AS group, n = 10), were evaluated. Two musculoskeletal radiologists analyzed the presence of marginal irregularity, bony erosion and subchondral sclerosis. A statistical analysis was performed to evaluate the incidence, sensitivity and specificity of each finding. Marginal irregularity was seen in 21 of 26 AS subjects, and in 8 of 10 non-AS subjects. Bony erosion was only seen in 13 of 26 AS subjects. Subchondral sclerosis was observed in 19 of 26 AS subjects and in 8 of 10 non-AS subjects. The sensitivity/specificity for each findings were 72.4%/28.6%, 100%/43.5% and 70.4%/22.2%, respectively. Except for bony erosions, these results showed no statistical significance ({rho} = .006). Bony erosion on CT is a very sensitive finding for the early changes of AS, whereas marginal irregularity or subchondral sclerosis is not so helpful in differentiating AS from non-AS. Attention to these results may further enhance the accurate diagnosis of the early changes in AS.

  13. Changes in oscillatory dynamics in the cell cycle of early Xenopus laevis embryos.

    Directory of Open Access Journals (Sweden)

    Tony Y-C Tsai

    2014-02-01

    Full Text Available During the early development of Xenopus laevis embryos, the first mitotic cell cycle is long (∼85 min and the subsequent 11 cycles are short (∼30 min and clock-like. Here we address the question of how the Cdk1 cell cycle oscillator changes between these two modes of operation. We found that the change can be attributed to an alteration in the balance between Wee1/Myt1 and Cdc25. The change in balance converts a circuit that acts like a positive-plus-negative feedback oscillator, with spikes of Cdk1 activation, to one that acts like a negative-feedback-only oscillator, with a shorter period and smoothly varying Cdk1 activity. Shortening the first cycle, by treating embryos with the Wee1A/Myt1 inhibitor PD0166285, resulted in a dramatic reduction in embryo viability, and restoring the length of the first cycle in inhibitor-treated embryos with low doses of cycloheximide partially rescued viability. Computations with an experimentally parameterized mathematical model show that modest changes in the Wee1/Cdc25 ratio can account for the observed qualitative changes in the cell cycle. The high ratio in the first cycle allows the period to be long and tunable, and decreasing the ratio in the subsequent cycles allows the oscillator to run at a maximal speed. Thus, the embryo rewires its feedback regulation to meet two different developmental requirements during early development.

  14. Climate change and stratospheric ozone depletion. Early effects on our health in Europe

    Energy Technology Data Exchange (ETDEWEB)

    Kovats, S.; Menne, B.; McMichael, A.; Bertollini, R.; Soskolne, C. (eds.)

    2001-07-01

    People are concerned about the impact on their health of the climate warming and stratosperic ozone depletion that Europe has been experiencing for the last century. This publication attempts to clarify what early effects these environmental changes are having on our health, and what further effects they may have in the future. What is certain is that more frequent thermal stress, associated or not with air pollution, causes illness and death, especially among the elderly; extreme weather events such as floods cause death, illness and material damage; some water- and foodborne diseases increase during extreme weather conditions, such as heavy rainfall and heatwaves; malaria could increase with climate warming; and ozone depletion increases skin cancer and weakens the immune system. While much is still uncertain about the precise relationship between changes in the climate and changes in disease patterns, the need for action is clear; action either to reduce the climate change itself, or to reduce its harmful effects. (au)

  15. Text mining approach to predict hospital admissions using early medical records from the emergency department.

    Science.gov (United States)

    Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz

    2017-04-01

    Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ(2) and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  16. In Vivo Changes in Lamina Cribrosa Microarchitecture and Optic Nerve Head Structure in Early Experimental Glaucoma.

    Directory of Open Access Journals (Sweden)

    Kevin M Ivers

    Full Text Available The lamina cribrosa likely plays an important role in retinal ganglion cell axon injury in glaucoma. We sought to (1 better understand optic nerve head (ONH structure and anterior lamina cribrosa surface (ALCS microarchitecture between fellow eyes of living, normal non-human primates and (2 characterize the time-course of in vivo structural changes in the ONH, ALCS microarchitecture, and retinal nerve fiber layer thickness (RNFLT in non-human primate eyes with early experimental glaucoma (EG. Spectral domain optical coherence tomography (SDOCT images of the ONH were acquired cross-sectionally in six bilaterally normal rhesus monkeys, and before and approximately every two weeks after inducing unilateral EG in seven rhesus monkeys. ONH parameters and RNFLT were quantified from segmented SDOCT images. Mean ALCS pore area, elongation and nearest neighbor distance (NND were quantified globally, in sectors and regionally from adaptive optics scanning laser ophthalmoscope images. In bilaterally normal monkeys, ONH parameters were similar between fellow eyes with few inter-eye differences in ALCS pore parameters. In EG monkeys, an increase in mean ALCS Depth (ALCSD was the first structural change measured in 6 of 7 EG eyes. A decrease in mean minimum rim width (MRW simultaneously accompanied this early change in 4 of 6 EG eyes and was the first structural change in the 7th EG eye. Mean ALCS pore parameters were among the first or second changes measured in 4 EG eyes. Mean ALCS pore area and NND increased in superotemporal and temporal sectors and in central and peripheral regions at the first time-point of change in ALCS pore geometry. RNFLT and/or mean ALCS radius of curvature were typically the last parameters to initially change. Survival analyses found mean ALCSD was the only parameter to significantly show an initial change prior to the first measured loss in RNFLT across EG eyes.

  17. Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

    Science.gov (United States)

    Cunningham, Peter J

    2011-06-01

    This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

  18. Change in access to prescribed medication following an episode of deliberate self-poisoning: a multilevel approach.

    Directory of Open Access Journals (Sweden)

    Bergljot Gjelsvik

    Full Text Available OBJECTIVE: Patients with a history of deliberate self-poisoning (DSP are prescribed a greater amount of medication than the general public. DSP is the most robust risk factor for repeat episodes of DSP and subsequent death by suicide, and one might therefore expect that access to prescribed medication would be reduced following an episode of DSP. However, it is unclear whether access to prescribed medication changes after an episode of DSP. The objectives of this study were to investigate changes in 1 overall, psychotropic, non-psychotropic and the psychotropic subgroup antidepressant prescribed medication availability in DSP patients following an episode of DSP, 2 prescribing of the medication ingested in the episode, and 3 potential effects of gender, age and repeater status on such change. METHODS: The design was longitudinal. We included 171 patients admitted for DSP between January 2006 and March 2007. Data on patients' prescriptions prior to admission were retrieved from The Norwegian Prescription Database. The outcome measure was the difference between medication load in the year following compared to the year prior to the DSP episode. RESULTS: There was a significant increase in total medication load following DSP, including both psychotropic and non-psychotropic medication. Antidepressant medication load remained stable. There was a tendency for access to drugs ingested in the episode to increase following the episode, albeit not significantly. Medication load increased with age across all medication groups irrespective of time period and gender. CONCLUSIONS: The findings show that physicians do not curb prescribing to patients who have recently deliberately self-poisoned. Moreover, they highlight the need for cautious and judicious prescribing for these patients, in combination with psychological and social interventions.

  19. Contribution of Pharmacogenetic Testing to Modeled Medication Change Recommendations in a Long-Term Care Population with Polypharmacy.

    Science.gov (United States)

    Sugarman, Elaine A; Cullors, Ali; Centeno, Joel; Taylor, David

    2016-12-01

    Among long-term care facility residents, polypharmacy is common, and often appropriate, given the need to treat multiple, complex, chronic conditions. Polypharmacy has, however, been associated with increased healthcare costs, adverse drug events, and drug interactions. The current study evaluates the potential medication cost savings of adding personalized pharmacogenetic information to traditional medication management strategies. One hundred and twelve long-term care residents completed pharmacogenetic testing for targeted variants in the following genes: CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4/CYP3A5, HTR2A, HTR2C, SLC6A4, SLC6A2 COMT, OPRM1, SLCO1B1, VKORC1 and MTHFR. Following reporting of the IDgenetix Polypharmacy(®) test results, an internal medication management assessment was performed by a licensed clinical pharmacist to identify potential opportunities for regimen optimization through medication changes or discontinuations. The medication cost differences before and after the pharmacogenetic-guided review were assessed. Medication review following pharmacogenetic result reporting identified 54 patients (48.2%) with a total of 132 drug change recommendations (45 reductions; 87 replacements) and an average of 2.4 proposed medication changes (range 1-6) per patient. Medication cost savings related to the identified reduction and replacement opportunities exceeded the cost of testing and are estimated to be US$ 1300 (year 2016 cost) per patient annually assuming full implementation. Compared with traditional medication review, pharmacogenetic testing resulted in a 38% increase in the number of patients with current medication change opportunities and also offered valuable genetic information that could be referenced to personalize future prescribing decisions for all patients.

  20. Associations of desire for change in sexual life amongst female medical students in North America

    Science.gov (United States)

    Shindel, Alan W.; Breyer, Benjamin N.; Smith, James F.

    2012-01-01

    We analyzed associations of dissatisfaction with sexual life and desire for change in female medical students. Students enrolled in medical schools in North America between February and July 2008 were invited to participate in an internet based survey of sexual function. The principle outcome measure was a single item question on sexual life satisfaction and desire for change. Women who reported dissatisfaction and desire for change were classified as “sexually bothered”. The survey also assessed ethnodemographic factors, student status, sexual history, and depressive symptoms. Respondents completed the Female Sexual Function Index (FSFI) and the Index of Sex Life (ISL). Descriptive statistics, ANOVA, and multivariable logistic regression were utilized to analyze responses. There were 661 non-virgin female subjects with data adequate for analysis. Whereas 281 (43%) of these met criteria for High Risk of Female Sexual Dysfunction (HRFSD) based on FSFI scoring, just 173 (26%) reported sexual bother. Among women with HRFSD, 126 (45%) reported sexual bother; in women without HRFSD, 362 (95%) were not sexually bothered. Interference in sexual life from tiredness and stress were associated with sexual bother. Progressively better scores on the FSFI-desire, orgasm, and satisfaction domains were significantly associated with lower odds of sexual bother. Few women in this cohort with FSFI score >26.55 reported sexual bother. Women with FSFI less than 26.55 had greater odds of sexual bother but this criterion alone was not pathognomonic for sexual concerns. Issues of sexual desire and orgasm appear to play a more important role than lubrication, arousal, and sexual pain issues in this population. PMID:22971616

  1. Omeprazole versus ranitidine in the medical treatment of acute upper gastrointestinal bleeding: assessment by early repeat endoscopy.

    Science.gov (United States)

    Fasseas, P; Leybishkis, B; Rocca, G

    2001-12-01

    The purpose of this study was to assess the effects of acid suppression in patients with upper gastrointestinal bleeding using early repeat endoscopy. Ninety-two patients with the diagnosis of acute upper gastrointestinal bleeding (endoscopically verified), entered a single-blind, randomised study comparing two treatment groups: omeprazole (40 mg orally daily) to ranitidine (50 mg intravenously four times daily). The lesions considered were gastric ulcers, duodenal ulcers and erosive gastritis. All patients were candidates for medical treatment. The parameters assessed included: 1) stabilisation of the lesion by repeat endoscopy at 7.0 +/- 3.0 days, 2) bleeding recurrence, 3) duration of stay in the intermediate medical care unit. For erosive gastritis only parameters 2 and 3 were considered. The study was limited to the hospitalisation period. Endoscopic stabilisation rate at 7.0 +/- 3.0 days for duodenal lesions was higher in the omeprazole group (71% vs 37%, p=0.03), but there was no significant difference for gastric lesions (50% vs 54%, NS). The overall bleeding recurrence rate (0% vs 17%, p=0.013) and the duration of stay (3.9 vs 6.4 days, p<0.01) were significantly lower in the omeprazole group. Our study suggests that omeprazole is more effective than ranitidine in the pharmacological treatment of acute upper gastrointestinal bleeding.

  2. Evidence for Dust Destruction from the Early-time Colour Change of GRB 120119A

    CERN Document Server

    Morgan, Adam N; Cenko, S B; Bloom, J S; Cucchiara, A; Richards, J W; Filippenko, A V; Haislip, J B; LaCluyze, A; Corsi, A; Melandri, A; Cobb, B E; Gomboc, A; Horesh, A; James, B; Li, W; Mundell, C G; Reichart, D E; Steele, I

    2013-01-01

    We present broadband observations and analysis of Swift gamma-ray burst (GRB) 120119A. Our early-time afterglow detections began under 15 s after the burst in the host frame (redshift z = 1.73), and they yield constraints on the burst energetics and local environment. Late-time afterglow observations of the burst show evidence for a moderate column of dust (A_V ~ 1.1 mag) similar to, but statistically distinct from, dust seen along Small Magellanic Cloud sightlines. Deep late-time observations reveal a dusty, rapidly star-forming host galaxy. Most notably, our early-time observations exhibit a significant red-to-blue colour change in the first ~200 s after the trigger at levels heretofore unseen in GRB afterglows. This colour change, which is coincident with the final phases of the prompt emission, is a hallmark prediction of the photodestruction of dust in GRB afterglows. We test whether dust-destruction signatures are significantly distinct from other sources of colour change, namely a change in the intrins...

  3. Global situational awareness and early warning of high-consequence climate change.

    Energy Technology Data Exchange (ETDEWEB)

    Backus, George A.; Carr, Martin J.; Boslough, Mark Bruce Elrick

    2009-08-01

    Global monitoring systems that have high spatial and temporal resolution, with long observational baselines, are needed to provide situational awareness of the Earth's climate system. Continuous monitoring is required for early warning of high-consequence climate change and to help anticipate and minimize the threat. Global climate has changed abruptly in the past and will almost certainly do so again, even in the absence of anthropogenic interference. It is possible that the Earth's climate could change dramatically and suddenly within a few years. An unexpected loss of climate stability would be equivalent to the failure of an engineered system on a grand scale, and would affect billions of people by causing agricultural, economic, and environmental collapses that would cascade throughout the world. The probability of such an abrupt change happening in the near future may be small, but it is nonzero. Because the consequences would be catastrophic, we argue that the problem should be treated with science-informed engineering conservatism, which focuses on various ways a system can fail and emphasizes inspection and early detection. Such an approach will require high-fidelity continuous global monitoring, informed by scientific modeling.

  4. Organizational change, psychosocial work environment, and non-disability early retirement

    DEFF Research Database (Denmark)

    Breinegaard, Nina; Jensen, Johan Høy; Bonde, Jens Peter

    2017-01-01

    Objective: This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. Methods: In January and February 2011, Danish senior public service employees aged 58–64 years (N=3254) from the Capital...... Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly...... did not (HR 1.03, 95% CI 0.79–1.33). Work units with lower levels of social capital (HR 1.22, 95% CI 1.05–1.41), organizational justice, (HR 1.18, 95% CI 1.04–1.32), and quality of management (HR 1.14, 95% CI 1.02–1.25) increased rate of early retirement. Conclusion: Organizational change and poor...

  5. Financialization impedes climate change mitigation: Evidence from the early American solar industry.

    Science.gov (United States)

    Jerneck, Max

    2017-03-01

    The article investigates how financialization impedes climate change mitigation by examining its effects on the early history of one low-carbon industry, solar photovoltaics in the United States. The industry grew rapidly in the 1970s, as large financial conglomerates acquired independent firms. While providing needed financial support, conglomerates changed the focus from existing markets in consumer applications toward a future utility market that never materialized. Concentration of the industry also left it vulnerable to the corporate restructuring of the 1980s, when the conglomerates were dismantled and solar divisions were pared back or sold off to foreign firms. Both the move toward conglomeration, when corporations became managed as stock portfolios, and its subsequent reversal were the result of increased financial dominance over corporate governance. The American case is contrasted with the more successful case of Japan, where these changes to corporate governance did not occur. Insulated from shareholder pressure and financial turbulence, Japanese photovoltaics manufacturers continued to expand investment throughout the 1980s when their American rivals were cutting back. The study is informed by Joseph Schumpeter's theory of creative destruction and Hyman Minsky's theory of financialization, along with economic sociology. By highlighting the tenuous and conflicting relation between finance and production that shaped the early history of the photovoltaics industry, the article raises doubts about the prevailing approach to mitigate climate change through carbon pricing. Given the uncertainty of innovation and the ease of speculation, it will do little to spur low-carbon technology development without financial structures supporting patient capital.

  6. Information systems in a changing climate: Early warnings and drought risk management

    Directory of Open Access Journals (Sweden)

    Roger S. Pulwarty

    2014-06-01

    Full Text Available Drought is among the most damaging, and least understood, of all “natural” hazards. Although some droughts last a single season and affect only small areas, the instrumental and paleoclimate records show that droughts have sometimes continued for decades and have impacted millions of square kilometers in North America, West Africa, and East Asia. To cross the spectrum of potential drivers and impacts, drought information systems have multiple sub-systems which include an integrated risk assessment, communication and decision support system of which early warning is a central component and output. An early warning system is much more than a forecast – it is a linked risk information (including people׳s perception of risk and communication system that actively engages communities involved in preparedness. There are numerous drought systems warning systems being implemented at different scales of governance. We draw on the lessons of over 21 drought early warning systems around the world, in both developing and developed countries and at regional, national and community levels. The successes illustrate that effective early warning depends upon a multi-sectoral and interdisciplinary collaboration among all concerned actors at each stage in the warning process from monitoring to response and evaluation. However, the links between the community-based approach and the national and global EWSs are relatively weak. Using the rich experience of information systems across the globe, this paper identifies pathways for knowledge management and action at the relevant scales for decision-making in response to a changing climate.

  7. Behavioral and cognitive changes after early postnatal lesions of the rat mediodorsal thalamus.

    Science.gov (United States)

    Ouhaz, Zakaria; Ba-M'hamed, Saadia; Mitchell, Anna S; Elidrissi, Abdeslem; Bennis, Mohamed

    2015-10-01

    Early insults to the thalamus result in functional and/or structural abnormalities in the cerebral cortex. However, differences in behavioral and cognitive changes after early insult are not well characterized. The present study assessed whether early postnatal damage to mediodorsal nucleus of the thalamus (MD), reciprocally interconnected with the prefrontal cortex, causes behavioral and cognitive alterations in young adult rats. Rat pups at postnatal day 4 received bilateral electrolytic lesion of MD, or a MD Sham lesion or were anesthetized controls; on recovery they were returned to their mothers until weaning. Seven weeks later, all rats were tested with the following behavioral and cognitive paradigms: T-maze test, open field test, actimetry, elevated plus maze test, social interactions test and passive avoidance test. Rats with bilateral MD damage presented with disrupted recognition memory, deficits in shifting response rules, significant hypoactivity, increased anxiety-like behavior, deficits in learning associations as well as decreased locomotor activity, and reduced social interactions compared to MD Sham lesion and anesthetized Control rats. The lesion also caused significant decreases in pyramidal cell density in three frontal cortex regions: medial infralimbic cortex, dorsolateral anterior cortex, and cingulate Cg1 cortex. The present findings suggest a functional role for MD in the postnatal maturation of affective behavior. Further some of the behavioral and cognitive alterations observed in these young adult rats after early MD lesion are reminiscent of those present in major psycho-affective disorders, such as schizophrenia in humans.

  8. Abnormalities of white matter microstructure in unmedicated obsessive-compulsive disorder and changes after medication.

    Directory of Open Access Journals (Sweden)

    Qing Fan

    Full Text Available BACKGROUND: Abnormalities of myelin integrity have been reported in obsessive-compulsive disorder (OCD using multi-parameter maps of diffusion tensor imaging (DTI. However, it was still unknown to what degree these abnormalities might be affected by pharmacological treatment. OBJECTIVE: To investigate whether the abnormalities of white matter microstructure including myelin integrity exist in OCD and whether they are affected by medication. METHODOLOGY AND PRINCIPAL FINDINGS: Parameter maps of DTI, including fractional anisotropy (FA, axial diffusivity (AD, radial diffusivity (RD and mean diffusivity (MD, were acquired from 27 unmedicated OCD patients (including 13 drug-naïve individuals and 23 healthy controls. Voxel-based analysis was then performed to detect regions with significant group difference. We compared the DTI-derived parameters of 15 patients before and after 12-week Selective Serotonin Reuptake Inhibitor (SSRI therapies. Significant differences of DTI-derived parameters were observed between OCD and healthy groups in multiple structures, mainly within the fronto-striato-thalamo-cortical loop. An increased RD in combination with no change in AD among OCD patients was found in the left medial superior frontal gyrus, temporo-parietal lobe, occipital lobe, striatum, insula and right midbrain. There was no statistical difference in DTI-derived parameters between drug-naive and previously medicated OCD patients. After being medicated, OCD patients showed a reduction in RD of the left striatum and right midbrain, and in MD of the right midbrain. CONCLUSION: Our preliminary findings suggest that abnormalities of white matter microstructure, particularly in terms of myelin integrity, are primarily located within the fronto-striato-thalamo-cortical circuit of individuals with OCD. Some abnormalities may be partly reversed by SSRI treatment.

  9. Microstructural Changes of the Human Brain from Early to Mid-Adulthood.

    Science.gov (United States)

    Tian, Lixia; Ma, Lin

    2017-01-01

    Despite numerous studies on the microstructural changes of the human brain throughout life, we have indeed little direct knowledge about the changes from early to mid-adulthood. The aim of this study was to investigate the microstructural changes of the human brain from early to mid-adulthood. We performed two sets of analyses based on the diffusion tensor imaging (DTI) data of 111 adults aged 18-55 years. Specifically, we first correlated age with skeletonized fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) at global and regional level, and then estimated individuals' ages based on each DTI metric using elastic net, a kind of multivariate pattern analysis (MVPA) method that aims at selecting the model that achieves the best trade-off between goodness of fit and model complexity. We observed statistically significant negative age-vs-FA correlations and relatively less changes of MD. The negative age-vs-FA correlations were associated with negative age-vs-AD and positive age-vs-RD correlations. Regional negative age-vs-FA correlations were observed in the bilateral genu of the corpus callosum (CCg), the corticospinal tract (CST), the fornix and several other tracts, and these negative correlations may indicate the earlier changes of the fibers with aging. In brain age estimation, the chronological-vs-estimated-age correlations based on FA, MD, AD and RD were R = 0.62, 0.44, 0.63 and 0.69 (P = 0.002, 0.008, 0.002 and 0.002 based on 500 permutations), respectively, and these results indicate that even the microstructural changes from early to mid-adulthood alone are sufficiently specific to decode individuals' ages. Overall, the current results not only demonstrated statistically significant FA decreases from early to mid-adulthood and clarified the driving factors of the FA decreases (RD increases and AD decreases, in contrast to increases of both measures in late-adulthood), but highlighted the necessity of

  10. Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial.

    Science.gov (United States)

    von Hertzen, H; Huong, N T M; Piaggio, G; Bayalag, M; Cabezas, E; Fang, A H; Gemzell-Danielsson, K; Hinh, N D; Mittal, S; Ng, E H Y; Chaturachinda, K; Pinter, B; Puscasiu, L; Savardekar, L; Shenoy, S; Khomassuridge, A; Tuyet, H T D; Velasco, A; Peregoudov, A

    2010-09-01

    To compare 400 and 800 microg sublingual or vaginal misoprostol 24 hours after 200 mg mifepristone for noninferiority regarding efficacy in achieving complete abortion for pregnancy termination up to 63 days of gestation. Placebo-controlled, randomised, noninferiority factorial trial, stratified by centre and length of gestation. Misoprostol 400 or 800 microg, administered either sublingually or vaginally, with follow up after 2 and 6 weeks. Fifteen obstetrics/gynaecology departments in ten countries. Pregnant women (n = 3005) up to 63 days of gestation requesting medical abortion. Two-sided 95% CI for differences in failure of complete abortion and continuing pregnancy, with a 3% noninferiority margin, were calculated. Proportions of women with adverse effects were recorded. Complete abortion without surgical intervention (main); continuing live pregnancies, induction-to-abortion interval, adverse effects, women's perceptions (secondary). Efficacy outcomes analysed for 2962 women (98.6%): 90.5% had complete abortion after 400 microg misoprostol, 94.2% after 800 microg. Noninferiority of 400 microg misoprostol was not demonstrated for failure of complete abortion (difference: 3.7%; 95% CI 1.8-5.6%). The 400-microg dose showed higher risk of incomplete abortion (P abortion (P = 0.47, difference in sublingual minus vaginal -0.7%, 95% CI -2.6-1.2%). A similar pattern was observed for continuing pregnancies (P = 0.21). Fewer women reported adverse effects with vaginal than sublingual administration and with the 400-microg dose than the 800-microg dose. Of the women, 94% were satisfied or highly satisfied with the regimens, 53% preferred the sublingual route and 47% preferred the vaginal route. A 400-microg dose of misoprostol should not replace the 800-microg dose when administered 24 hours after 200 mg mifepristone for inducing abortion in pregnancies up to 63 days. Sublingual and vaginal misoprostol have similar efficacy, but vaginal administration is associated with

  11. Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

    Directory of Open Access Journals (Sweden)

    Adam B Landman

    Full Text Available BACKGROUND: As the United States embraces electronic health records (EHRs, improved emergency medical services (EMS information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. METHODS: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. RESULTS: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1 identify creative funding sources; 2 leverage regional health information organizations; and 3 build internal information technology capacity. CONCLUSION: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and

  12. Changes in fractal dimension and lacunarity as early markers of UV-induced apoptosis.

    Science.gov (United States)

    Pantic, Igor; Harhaji-Trajkovic, Ljubica; Pantovic, Aleksandar; Milosevic, Nebojsa T; Trajkovic, Vladimir

    2012-06-21

    The aim of our study was to employ fractal analysis for evaluation of ultrastructural changes during early stages of apoptosis. Apoptosis was induced in U251 human glioma cell line by exposure to UVB light. The cells were visualized by optical phase-contrast microscopy and photographed before the UV treatment, immediately after the treatment, as well as at 30 min intervals during 5h observation period. For each of the 32 cells analyzed, cellular and nuclear fractal dimension, as well as nuclear lacunarity, were determined at each time point. Our data demonstrate that cellular ultrastructural complexity determined by fractal dimension and lacunarity significantly decreases after the UV irradiation, with the nuclear lacunarity being a particularly sensitive parameter in detecting early apoptosis. Importantly, fractal analysis was able to detect cellular apoptotic changes earlier than conventional flow cytometric analysis of phosphatidylserine exposure, DNA fragmentation and cell membrane permeabilization. These results indicate that fractal analysis might be a powerful and affordable method for non-invasive early identification of apoptosis in cell cultures. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Synaptic changes in rat maculae in space and medical imaging: the link

    Science.gov (United States)

    Ross, M. D.

    1998-01-01

    Two different space life sciences missions (SLS-1 and SLS-2) have demonstrated that the synapses of the hair cells of rat vestibular maculae increase significantly in microgravity. The results also indicate that macular synapses are sensitive to stress. These findings argue that vestibular maculae exhibit neuroplasticity to macroenvironmental and microenvironmental changes. This capability should be clinically relevant to rehabilitative training and/or pharmacological treatments for vestibular disease. The results of this ultrastructural research also demonstrated that type I and type II hair cells are integrated into the same neuronal circuitry. The findings were the basis for development of three-dimensional reconstruction software to learn details of macular wiring. This software, produced for scientific research, has now been adapted to reconstruct the face and skull directly from computerized tomography scans. In collaboration with craniofacial reconstructive surgeons at Stanford University Medical Center, an effort is under way to produce a virtual environment workbench for complex craniofacial surgery. When completed, the workbench will help surgeons train for and simulate surgery. The methods are patient specific. This research illustrates the value of basic research in leading to unanticipated medical applications.

  14. Medical education for a changing world: moving beyond cultural competence into transnational competence.

    Science.gov (United States)

    Koehn, Peter H; Swick, Herbert M

    2006-06-01

    Given rapidly changing global demographic dynamics and the unimpressive evidence regarding health outcomes attributable to cultural competence (CC) education, it is time to consider a fresh and unencumbered approach to preparing physicians to reduce health disparities and care for ethnoculturally and socially diverse patients, including migrants. Transnational competence (TC) education offers a comprehensive set of core skills derived from international relations, cross-cultural psychology, and intercultural communication that are also applicable for medical education. The authors discuss five limitations (conceptual, vision, action, alliance, and pedagogical) of current CC approaches and explain how an educational model based on TC would address each problem area.The authors then identify and discuss the skill domains, core principles, and reinforcing pedagogy of TC education. The five skill domains of TC are analytic, emotional, creative, communicative, and functional; core principles include a comprehensive and consistent framework, patient-centered learning, and competency assessment. A central component of TC pedagogy is having students prepare a "miniethnography" for each patient that addresses not only issues related to physical and mental health, but also experiences related to dislocation and adaptation to unfamiliar settings. The TC approach promotes advances in preparing medical students to reduce health disparities among patients with multiple and diverse backgrounds, health conditions, and health care beliefs and practices. Perhaps most important, TC consistently directs attention to the policy and social factors, as well as the individual considerations, that can alleviate suffering and enhance health and well-being in a globalizing world.

  15. Changing medical students’ perception of the evaluation culture: Is it possible?

    Directory of Open Access Journals (Sweden)

    Jorie M. Colbert-Getz

    2016-02-01

    Full Text Available Student feedback is a critical component of the teacher-learner cycle. However, there is not a gold standard course or clerkship evaluation form and limited research on the impact of changing the evaluation process. Results from a focus group and pre-implementation feedback survey coupled with best practices in survey design were used to improve all course/clerkship evaluation for academic year 2013-2014. In spring 2014 we asked all subjected students in University of Utah School of Medicine, United States of America to complete the same feedback survey (post-implementation survey. We assessed the evaluation climate with 3 measures on the feedback survey: overall satisfaction with the evaluation process; time students gave effort to the process; and time students used shortcuts. Scores from these measures were compared between 2013 and 2014 with Mann-Whitney U-tests. Response rates were 79% (254 for 2013 and 52% (179 for 2014. Students’ overall satisfaction score were significantly higher (more positive post-implementation compared to pre-implementation (P<0.001. There was no change in the amount of time students gave effort to completing evaluations (P=0.981 and no change for the amount of time they used shortcuts to complete evaluations (P=0.956. We were able to change overall satisfaction with the medical school evaluation culture, but there was no change in the amount of time students gave effort to completing evaluations and times they used shortcuts to complete evaluations. To ensure accurate evaluation results we will need to focus our efforts on time needed to complete course evaluations across all four years.

  16. Changing medical students’ perception of the evaluation culture: Is it possible?

    Directory of Open Access Journals (Sweden)

    Jorie M. Colbert-Getz

    2016-02-01

    Full Text Available Student feedback is a critical component of the teacher-learner cycle. However, there is not a gold standard course or clerkship evaluation form and limited research on the impact of changing the evaluation process. Results from a focus group and pre-implementation feedback survey coupled with best practices in survey design were used to improve all course/clerkship evaluation for academic year 2013-2014. In spring 2014 we asked all subjected students in University of Utah School of Medicine, United States of America to complete the same feedback survey (post-implementation survey. We assessed the evaluation climate with 3 measures on the feedback survey: overall satisfaction with the evaluation process; time students gave effort to the process; and time students used shortcuts. Scores from these measures were compared between 2013 and 2014 with Mann-Whitney U-tests. Response rates were 79% (254 for 2013 and 52% (179 for 2014. Students’ overall satisfaction score were significantly higher (more positive post-implementation compared to pre-implementation (P<0.001. There was no change in the amount of time students gave effort to completing evaluations (P=0.981 and no change for the amount of time they used shortcuts to complete evaluations (P=0.956. We were able to change overall satisfaction with the medical school evaluation culture, but there was no change in the amount of time students gave effort to completing evaluations and times they used shortcuts to complete evaluations. To ensure accurate evaluation results we will need to focus our efforts on time needed to complete course evaluations across all four years.

  17. Cortisol secretion and change in sleep problems in early childhood: Moderation by maternal overcontrol.

    Science.gov (United States)

    Kiel, Elizabeth J; Hummel, Alexandra C; Luebbe, Aaron M

    2015-04-01

    Childhood sleep problems are prevalent and relate to a wide range of negative psychological outcomes. However, it remains unclear how biological processes, such as HPA activity, may predict sleep problems over time in childhood in the context of certain parenting environments. Fifty-one mothers and their 18-20 month-old toddlers participated in a short-term longitudinal study assessing how shared variance among morning levels, diurnal change, and nocturnal change in toddlers' cortisol secretion predicted change in sleep problems in the context of maternal overprotection and critical control. A composite characterized by low variability in, and, to a lesser extent, high morning values of cortisol, predicted increasing sleep problems from age 2 to age 3 when mothers reported high critical control. Results suggest value in assessing shared variance among different indices of cortisol secretion patterns and the interaction between cortisol and the environment in predicting sleep problems in early childhood.

  18. No pituitary gland volume change in medication-free depressed patients.

    Science.gov (United States)

    Eker, Cagdas; Ovali, Gulgun Yilmaz; Ozan, Erol; Eker, Ozlem Donat; Kitis, Omer; Coburn, Kerry; Gonul, Ali Saffet

    2008-10-01

    Increased serum cortisol levels and a hyperactive hypothalamo-pituitary-adrenal (HPA) axis have been proposed to play an important role in the pathophysiology of Major Depressive Disorder (MDD). However, there are inconsistent results regarding pituitary gland volume (PGV), which is one of the key elements of the HPA axis evaluated by MRI in depressed patients. In this study, we analyzed the PGV of medication-free moderately depressed MDD patients (N=34) and age and sex matched healthy controls (N=39). PGV did not differ between MDD patients and healthy controls [mean volume+/-S.D.; 0.76+/-0.17 cm3 and 0.75+/-0.14 cm3; ANCOVA, F1,69=1.25 p>0.05; respectively]. Our results confirm that volumetric PGV changes are not crucial for depression pathophysiology among unmedicated, moderately depressed adults.

  19. The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia

    Directory of Open Access Journals (Sweden)

    Jaklič Tatjana Kitić

    2015-12-01

    Full Text Available Background and Purpose: The modern environment requires that organizations (profit and non-profit continually harmonize their organizational models with changes in their respective environments and with their own visions and strategies for further development. The organizational structure of Emergency Medical Services (hereinafter EMS is currently a very topical issue in Slovenia, given that a project to establish a new organization of EMS is currently underway at the national level. By examining the case of one region in Slovenia, this article presents an analysis of factors that impact on the number and types of EMS activities and depicts a forecast of future trends for the requirement of EMS. The analysis presents the initial phase of a strategic planning process for the mentioned activity and consequently, a starting point for the formation of an organizational EMS model.

  20. Changing the culture of a medical school by orienting students and faculty toward community medicine.

    Science.gov (United States)

    Duffy, F Daniel; Miller-Cribbs, Julie E; Clancy, Gerard P; Van De Wiele, C Justin; Teague, T Kent; Crow, Sheila; Kollaja, Elizabeth A; Fox, Mark D

    2014-12-01

    Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.

  1. Late Pleistocene-early Holocene karst features, Laguna Madre, south Texas: A record of climate change

    Energy Technology Data Exchange (ETDEWEB)

    Prouty, J.S. [Texas A& M Univ., Corpus Christi, TX (United States)

    1996-09-01

    A Pleistocene coquina bordering Laguna Madre, south Texas, contains well-developed late Pleistocene-early Holocene karst features (solution pipes and caliche crusts) unknown elsewhere from coastal Texas. The coquina accumulated in a localized zone of converging longshore Gulf currents along a Gulf beach. The crusts yield {sup 14}C dates of 16,660 to 7630 B.P., with dates of individual crust horizons becoming younger upwards. The karst features provide evidence of regional late Pleistocene-early Holocene climate changes. Following the latest Wisconsinan lowstand 18,000 B.P. the regional climate was more humid and promoted karst weathering. Partial dissolution and reprecipitation of the coquina formed initial caliche crust horizons; the crust later thickened through accretion of additional carbonate laminae. With the commencement of the Holocene approximately 11,000 B.P. the regional climate became more arid. This inhibited karstification of the coquina, and caliche crust formation finally ceased about 7000 B.P.

  2. Summer in the country: changes in medical students' perceptions following an innovative rural community experience.

    Science.gov (United States)

    Kane, Kevin Y; Quinn, Kathleen J; Stevermer, James J; Porter, Jana L; Webb, Weldon D; Williamson, Harold A; Burdin, Julie

    2013-08-01

    The University of Missouri School of Medicine developed the Summer Community Program through which rising second-year medical students work alongside rural, community-based physician preceptors. This program is part of a comprehensive, longitudinal pipeline designed to increase student interest in rural practice. The authors describe the Summer Community Program, explain changes in students' perceptions of rural practice and rural lifestyle post program, and report participants' specialty choices and first practice locations. The authors analyzed 229 participant responses (1996-2010) to pre- and postexperience questionnaires focused on perceptions of rural practice and lifestyle. The authors calculated the likelihood of participants matching into primary care compared with nonparticipants and analyzed participants' first practice locations. After the experience, participants' perceptions toward rural practice and lifestyle changed favorably, and 72% (n=208) reported more interest in rural practice. Compared with nonparticipants, summer participants were more likely to enter a primary care residency (relative risk [RR]=1.31; 95% confidence interval [CI]: 1.12-1.50) and twice as likely to choose specifically family medicine (RR=2.21; 95% CI: 1.68-2.88). Forty-six percent (n=78) of participants chose rural locations for their first practices. This program has positively influenced students' perceptions of rural practice and lifestyle and increased their interest in rural practice. Participants entered primary care and family medicine residencies at higher rates than nonparticipants, and nearly half started their medical practices in rural locations. Replicating this program may increase interest in rural medicine and address rural physician workforce needs.

  3. Developmental competence and ultrastructural changes of heat-stressed mouse early blastocysts produced in vitro

    Institute of Scientific and Technical Information of China (English)

    Pingping QU; Wenru TIAN; Tao LI; Zhongling JIANG; Shansong GAO; Zhongjie TIAN; Mingzhi WANG

    2009-01-01

    Mouse early blastocysts were exposed to temporatures of 39℃ and 41℃ for 2 h,respectively,to determine their developmental competence and uhrastructural changes. The results showed that heat stress at 41 ℃ for 2 h,significantly reduced the percentages of expanded and hatched blastocysts,but not at 39℃ for 2 h. The average cell numbers in expanded blastocysts,which developed from early blastocysts heat-stressed at temperatures of 39℃ and 41 ℃,were significantly reduced. The average cell numbers in hatched blastocysts subjected to heat stress were no different from those in the control group cultured at 37℃ . The mitochondria of the early blastocysts heat-stressed at 39T℃ for 2 h,were slightly swollen,but they had recovered after culturing at 37℃ for 2 h. However,the mitochondria in the blastocysts heat stressed at 41 ℃ for 2 h were severely swollen,and their number increased. The ribosomes shed from the rough endoplasmic reticulum,and the number of secondary lysosomes in the plasma increased. The integrity of desmosomes was disrupted. The space between the nuclear envelope and the perivitelline membrane enlarged. The fibre fraction and the particulate fraction of nucleoli were separated. The heterochromatin in nucleoli was also increased in its quantity. There were some lamellar-shape structures and heterogeneous dense materials exhibiting in the cytoplasm. The ultrastructural changes induced by heat shock at 41 ℃ for 2 h were not reversible. In conclusion,the damage of heat stress to mitochondria,lysosomes,ribosomes and cell nucleus,may be one of the most important factors that inhibit the normal development of mouse early blastocysts.

  4. Perceptions of Medical School Seniors of the Current Changes in the U.S. Health Care System.

    Science.gov (United States)

    Hojat, Mohammadreza; Veloski, J. Jon; Louis, Daniel Z.; Xu, Gang; Ibarra, David; Gottlieb, Jonathan E.; Erdmann, James B.

    1999-01-01

    Surveyed 196 medical college seniors about changes in the health-care system. Of the respondents, 79% believed that cost reduction rather than quality of care is the primary consideration behind recent changes, and 78% thought that managed-care organizations hamper physician ability in rendering optimal care. Discusses implications for curricular…

  5. AMEE Medical Education Guide No. 23 (Part 1): Curriculum, environment, climate, quality and change in medical education-a unifying perspective.

    Science.gov (United States)

    Genn, J. M.

    2001-07-01

    This paper looks at five focal terms in education - curriculum, environment, climate, quality and change - and the interrelationships and dynamics between and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifestation of the curriculum and the other three concepts. Ideas pertaining to the theory of climate and its measurement can provide a greater understanding of the medical curriculum. The learning environment is an important determinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related to behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students' experiences of the climate of their medical education environment are related to their achievements, satisfaction and success. Measures of educational climate are reviewed and climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it into different components giving, for example, a separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, to report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. In addition to the educational climate of the environment that students inhabit, it is important to consider the organizational climate of the work environment that staff inhabit. This organizational climate is very significant, not only for staff, but for their students, too. The medical school is a

  6. Early Postural Changes in Individuals with Idiopathic Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Mohamed Elsayed Khallaf

    2015-01-01

    Full Text Available Background and Objectives. Postural changes are frequent and disabling complications of Parkinson’s disease (PD. Many contributing factors have been evident either related to disease pathology or to adaptive changes. This study aimed at studying the postural changes in subjects with Parkinson’s disease and its relation to duration of illness and disease severity. Methods. Eighteen patients with PD and 18 healthy matched volunteers represented the sample of the study. The patients were at stage 1 or 1.5 according to the Modified Hoehn and Yahr Staging with duration of illness between 18 and 36 months. Three-dimensional analysis of the back surface was conducted to explore the postural changes in the sagittal and frontal planes in both the patients and the healthy subjects. Results. Kyphotic angle, lordotic angle, fleche cervicale, fleche lombaire, scoliotic angle, and associated vertebral rotation and pelvic obliquity were significantly increased in patients with PD compared to the healthy subjects (P≤0.05. There was no association between the measured postural changes and duration of illness as well as the severity of the IPD (P≤0.05. Conclusion. Postural changes start in the early stages of idiopathic PD and they have no relationship to the duration of illness and disease severity.

  7. Heterogeneity in global vegetation and terrestrial climate change during the late Eocene to early Oligocene transition

    Science.gov (United States)

    Pound, Matthew J.; Salzmann, Ulrich

    2017-02-01

    Rapid global cooling at the Eocene – Oligocene Transition (EOT), ~33.9–33.5 Ma, is widely considered to mark the onset of the modern icehouse world. A large and rapid drop in atmospheric pCO2 has been proposed as the driving force behind extinctions in the marine realm and glaciation on Antarctica. However, the global terrestrial response to this cooling is uncertain. Here we present the first global vegetation and terrestrial temperature reconstructions for the EOT. Using an extensive palynological dataset, that has been statistically grouped into palaeo-biomes, we show a more transitional nature of terrestrial climate change by indicating a spatial and temporal heterogeneity of vegetation change at the EOT in both hemispheres. The reconstructed terrestrial temperatures show for many regions a cooling that started well before the EOT and continued into the Early Oligocene. We conclude that the heterogeneous pattern of global vegetation change has been controlled by a combination of multiple forcings, such as tectonics, sea-level fall and long-term decline in greenhouse gas concentrations during the late Eocene to early Oligocene, and does not represent a single response to a rapid decline in atmospheric pCO2 at the EOT.

  8. Changes in Gut Microbiota May Be Early Signs of Liver Toxicity Induced by Epoxiconazole in Rats.

    Science.gov (United States)

    Xu, Cheng; Liu, Qian; Huan, Fei; Qu, Jianhua; Liu, Wei; Gu, Aihua; Wang, Yubang; Jiang, Zhaoyan

    2014-01-01

    The gut microbiome is essential for human health due to its effects on disease development, drug metabolism and the immune system. It may also play a role in the interaction with environmental toxicants. However, the effect of epoxiconazole, a fungicide active ingredient from the class of azoles developed to protect crops, on the abundance and composition of the gut microbiome has never been studied. We put forward the hypothesis that changes in gut microbiota may be early signs of toxicity induced by epoxiconazole. In this study, female rats were fed with epoxiconazole-adulterated diets (0, 4 and 100 mg/kg/day) for 90 days. The gut microbiome was determined by 16S rRNA gene sequencing. Body and organ weight, and blood biochemistry were also measured after 90 days of oral epoxiconazole exposure. Interestingly, the abundance of gut Firmicutes decreased, and Bacteroidetes and Proteobacteria increased. At family level, Lachnospiraceae and Enterobacteriaceae were selectively enriched following epoxiconazole exposure. Our results indicate that epoxiconazole exposure may induce changes in the gut microbiome and potential liver toxicity. Changes in the gut microbiome may be used as early indicators for monitoring the health risk of the host. © 2015 S. Karger AG, Basel

  9. Heterogeneity in global vegetation and terrestrial climate change during the late Eocene to early Oligocene transition.

    Science.gov (United States)

    Pound, Matthew J; Salzmann, Ulrich

    2017-02-24

    Rapid global cooling at the Eocene - Oligocene Transition (EOT), ~33.9-33.5 Ma, is widely considered to mark the onset of the modern icehouse world. A large and rapid drop in atmospheric pCO2 has been proposed as the driving force behind extinctions in the marine realm and glaciation on Antarctica. However, the global terrestrial response to this cooling is uncertain. Here we present the first global vegetation and terrestrial temperature reconstructions for the EOT. Using an extensive palynological dataset, that has been statistically grouped into palaeo-biomes, we show a more transitional nature of terrestrial climate change by indicating a spatial and temporal heterogeneity of vegetation change at the EOT in both hemispheres. The reconstructed terrestrial temperatures show for many regions a cooling that started well before the EOT and continued into the Early Oligocene. We conclude that the heterogeneous pattern of global vegetation change has been controlled by a combination of multiple forcings, such as tectonics, sea-level fall and long-term decline in greenhouse gas concentrations during the late Eocene to early Oligocene, and does not represent a single response to a rapid decline in atmospheric pCO2 at the EOT.

  10. Radiology Exposure in the Undergraduate Curriculum: A Medical Student Perspective on Quality and Opportunities for Positive Change.

    Science.gov (United States)

    Visscher, Kari L; Faden, Lisa; Nassrallah, Georges; Speer, Stacey; Wiseman, Daniele

    2017-08-01

    This article is a continuation of a qualitative study designed to explore how radiology exposures can impact medical student opinions and perceptions of radiology and radiologists. We focused on: 1) conducting a radiology exposure inventory from the perspective of the medical student; 2) student evaluation of the quality of the radiology exposures and suggestions for positive change; and 3) development of a framework to address the needs of medical students as it relates to radiology education in the undergraduate medical curriculum. Research methodology and design for this qualitative study were described in detail in a previous article by Visscher et al [1]. Participants included 28 medical students; 18 were in medical school years 1 and 2 (preclerkship), and 10 were in years 3 and 4 (clerkship). Specific to the focus of this article, the data revealed 3 major findings: 1) multiple exposures to radiology exist, and they are received and valued differently depending on the medical student's stage of professional development; 2) medical students value radiology education and want their radiology exposure to be comprehensive and high quality; 3) Medical students have constructive suggestions for improving the quality of both formal and informal radiology exposures. Performing a radiology exposure inventory from a medical student perspective is a useful way to explore how students receive and value radiology instruction. Medical students want a more comprehensive radiology education that can be summarized using the 5 C's of Radiology Education framework. The 5 C's (curriculum, coaching, collaborating, career and commitment) reflect medical students' desires to learn content that will support them in clinical practice, be supported in their professional development, and have the necessary information to make informed career decisions. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  11. Physiological and morphological changes during early and later stages of fruit growth in Capsicum annuum.

    Science.gov (United States)

    Tiwari, Aparna; Vivian-Smith, Adam; Ljung, Karin; Offringa, Remko; Heuvelink, Ep

    2013-03-01

    Fruit-set involves a series of physiological and morphological changes that are well described for tomato and Arabidopsis, but largely unknown for sweet pepper (Capsicum annuum). The aim of this paper is to investigate whether mechanisms of fruit-set observed in Arabidopsis and tomato are also applicable to C. annuum. To do this, we accurately timed the physiological and morphological changes in a post-pollinated and un-pollinated ovary. A vascular connection between ovule and replum was observed in fertilized ovaries that undergo fruit development, and this connection was absent in unfertilized ovaries that abort. This indicates that vascular connection between ovule and replum is an early indicator for successful fruit development after pollination and fertilization. Evaluation of histological changes in the carpel of a fertilized and unfertilized ovary indicated that increase in cell number and cell diameter both contribute to early fruit growth. Cell division contributes more during early fruit growth while cell expansion contributes more at later stages of fruit growth in C. annuum. The simultaneous occurrence of a peak in auxin concentration and a strong increase in cell diameter in the carpel of seeded fruits suggest that indole-3-acetic acid stimulates a major increase in cell diameter at later stages of fruit growth. The series of physiological and morphological events observed during fruit-set in C. annuum are similar to what has been reported for tomato and Arabidopsis. This indicates that tomato and Arabidopsis are suitable model plants to understand details of fruit-set mechanisms in C. annuum.

  12. Implant Stability Changes during Early Phase of Healing:A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    A. Mesgarzadeh

    2009-06-01

    Full Text Available Objective: To assess the stability changes as a reflection of early healing around roughened-surface implants in human by resonance frequency analysis (RFA.Materials and Methods: One hundred and fifty one ITI SLA implants were placed in either maxilla or mandible of 68 patients. Bone type was classified into 4 groups according to Lekholm and Zarb index. RFA was used for direct implant stability measurement on theday of implant placement, and at 14, 30 and 60 days after placement. Student t-test and ANOVA served for statistical analysis.Results: No early failure occurred. The highest and lowest primary stability was measured in type 1 and type 4 bone, respectively. Implant stability increased over time in types 3 and 4 bone but continuously decreased in type 1 bone during the first 60 days of healing.In type 2 a small decrease in stability was observed until 30 days, and after that the stability increased. The difference between implant stability in type 2 and type 4 bone at eachtime point was highly significant (P0.05. The effect of implant length and diameter on stability at different times was tested with mixed model ANOVA, and no significant difference among groups was observed (P>0.05Conclusion: The present study demonstrated that the pattern of stability changes was different among various bone types. With regard to primary stability and pattern of stability changes in types 2 and 3 bone, immediate and early loading protocols can be recommended in these two bone types, respectively.

  13. Diffusion tensor imaging of early changes in corpus callosum after acute cerebral hemisphere lesions in newborns

    Energy Technology Data Exchange (ETDEWEB)

    Righini, Andrea; Doneda, Chiara; Parazzini, Cecilia; Arrigoni, Filippo; Triulzi, Fabio [Children' s Hospital V. Buzzi, ICP, Radiology and Neuroradiology Department, Milan (Italy); Matta, Ursula [University of Milan, Radiology Institute, Milan (Italy)

    2010-11-15

    The main purpose was to investigate any early diffusion tensor imaging (DTI) changes in corpus callosum (CC) associated with acute cerebral hemisphere lesions in term newborns. We retrospectively analysed 19 cases of term newborns acutely affected by focal or multi-focal lesions: hypoxic-ischemic encephalopathy, hypoglycaemic encephalopathy, focal ischemic stroke and deep medullary vein associated lesions. DTI was acquired at 1.5 Tesla with dedicated neonatal coil. DTI metrics (apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial {lambda} {sub parallel} and radial {lambda} diffusivity) were measured in the hemisphere lesions and in the CC. The control group included seven normal newborns. The following significant differences were found between patients and normal controls in the CC: mean ADC was lower in patients (0.88 SD 0.23 versus 1.18 SD 0.07 {mu}m{sup 2}/s) and so was mean FA (0.50 SD 0.1 versus 0.67 SD 0.05) and mean {lambda} {sub parallel} value (1.61 SD 0.52 versus 2.36 SD 0.14 {mu}m{sup 2}/s). In CC the percentage of ADC always diminished independently of lesion age (with one exception), whereas in hemisphere lesions, it was negative in earlier lesions, but exceeded normal values in the older lesions. CC may undergo early DTI changes in newborns with acute focal or multi-focal hemisphere lesions of different aetiology. Although a direct insult to CC cannot be totally ruled out, DTI changes in CC (in particular {lambda} {sub parallel}) may also be compatible with very early Wallerian degeneration or pre-Wallerian degeneration. (orig.)

  14. Changing medical students' perception of the evaluation culture: Is it possible?

    Science.gov (United States)

    Colbert-Getz, Jorie M; Baumann, Steven

    2016-01-01

    Student feedback is a critical component of the teacher-learner cycle. However, there is not a gold standard course or clerkship evaluation form and limited research on the impact of changing the evaluation process. Results from a focus group and pre-implementation feedback survey coupled with best practices in survey design were used to improve all course/clerkship evaluation for academic year 2013-2014. In spring 2014 we asked all subjected students in University of Utah School of Medicine, United States of America to complete the same feedback survey (post-implementation survey). We assessed the evaluation climate with 3 measures on the feedback survey: overall satisfaction with the evaluation process; time students gave effort to the process; and time students used shortcuts. Scores from these measures were compared between 2013 and 2014 with Mann-Whitney U-tests. Response rates were 79% (254) for 2013 and 52% (179) for 2014. Students' overall satisfaction score were significantly higher (more positive) post-implementation compared to pre-implementation (Pstudents gave effort to completing evaluations (P=0.981) and no change for the amount of time they used shortcuts to complete evaluations (P=0.956). We were able to change overall satisfaction with the medical school evaluation culture, but there was no change in the amount of time students gave effort to completing evaluations and times they used shortcuts to complete evaluations. To ensure accurate evaluation results we will need to focus our efforts on time needed to complete course evaluations across all four years.

  15. Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

    Directory of Open Access Journals (Sweden)

    Gunnarsson Ronny

    2008-12-01

    Full Text Available Abstract Background Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences. In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators. The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. Methods Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. Results Sixty students (70% and 15 facilitators (71% completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. Conclusion In this project, a new Early

  16. Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity.

    Science.gov (United States)

    Peters, Ubong; Hernandez, Paul; Dechman, Gail; Ellsmere, James; Maksym, Geoffrey

    2016-05-01

    Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry.

  17. Naturally-occurring changes in social-cognitive factors modify change in physical activity during early adolescence

    Science.gov (United States)

    Dowda, Marsha; McIver, Kerry L.; Saunders, Ruth P.; Pate, Russell R.

    2017-01-01

    Purpose To determine whether naturally-occurring changes in children’s motives and beliefs are associated with the steep decline in physical activity observed from childhood to early adolescence. Methods Latent growth modeling was applied in longitudinal tests of social-cognitive influences, and their interactions, on physical activity in a large cohort of boys and girls evaluated annually between 5th and 7th grades. Results Measurement equivalence of motives and beliefs was confirmed between boys and girls. After adjustment for gender and maturity differences, physical activity declined less in children who reported the least decreases in self-efficacy for overcoming barriers to activity and perceived parental support. Physical activity also declined less in students who persistently felt they had more parental and friend support for activity compared to those who reported the largest decrease in support from friends. After further adjustment for race, the decline in physical activity was less in those who had the largest decrease in perceived barriers and maintained a favorable perception of their neighborhood environment. Changes in enjoyment and social motives were unrelated to change in physical activity. Conclusion Using an objective measure of physical activity, we confirm that naturally-occurring changes in children’s beliefs about barriers to physical activity and their ability to overcome them, as well as perceptions of their neighborhood environment and social support, are concurrent with age-related declines in children’s physical activity. The longitudinal findings confirm these putative social-cognitive mediators as plausible, interacting targets of interventions designed to mitigate the marked decline in physical activity that occurs during the transition between elementary and middle schools. PMID:28187192

  18. Predictors of early change in bulimia nervosa after a brief psychoeducational therapy.

    Science.gov (United States)

    Fernàndez-Aranda, Fernando; Alvarez-Moya, Eva M; Martínez-Viana, Cristina; Sànchez, Isabel; Granero, Roser; Penelo, Eva; Forcano, Laura; Peñas-Lledó, Eva

    2009-06-01

    We aimed to examine baseline predictors of treatment response in bulimic patients. 241 seeking-treatment females with bulimia nervosa completed an exhaustive assessment and were referred to a six-session psychoeducational group. Regression analyses of treatment response were performed. Childhood obesity, lower frequency of eating symptomatology, lower body mass index, older age, and lower family's and patient's concern about the disorder were predictors of poor abstinence. Suicidal ideation, alcohol abuse, higher maximum BMI, higher novelty seeking and lower baseline purging frequency predicted dropouts. Predictors of early symptom changes and dropouts were similar to those identified in longer CBT interventions.

  19. Children's Elicitation of Changes in Parenting during the Early Childhood Years

    OpenAIRE

    Ansari, Arya; Crosnoe, Robert

    2015-01-01

    Using a subsample of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B; n = 1,550), this study identified parents who engaged in more developmentally problematic parenting—in the form of low investment, above average television watching, and use of spanking—when their children were very young (M = 24.41 months, SD = 1.23) but changed their parenting in more positive directions over time. Latent profile analysis and other techniques revealed that parents who demonstrated less optimal...

  20. Exploring glacial change - flying in the tailwind of the early 20th century Greenland explorers

    DEFF Research Database (Denmark)

    Bjork, A. A.; Kjaer, K. H.; Kjeldsen, K. K.

    In the early 1930s Greenlandic explorers and scientists began using airplanes as an effective mean of surveying and mapping the hitherto unknown and inaccessible lands. By replacing the dogsled and the drawing board with the seaplane and camera, huge areas could now be covered. Here in the 21st...... that vividly captures both the raw beauty of the land and the ongoing often dramatic glacial changes. As the historic flights covered nearly half the Greenlandic coast line, we capture both areas of massive retreat and areas of still stand and even advance....

  1. Changes of taxonomical composition of Late Jurassic Early Cretaceous palynofloras of Bureya Basin,Russia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The changes of taxonomical composition of the Late Jurassic-Early Cretaceous palynofloras are revealed,in the upper stream of Bureya River in Bureya Basin.The palynofloras are dominated as follows:the Berriasian one by ferns (Cyatheaceae,Dicksoniaceae,Osmundaceae), Classopollis and bisaccate pollen;the Valanginian-Hauterivian one by ferns (Cyatheaceae,Dicksoniaceae), Ginkgocycadophytus and bisaccate pollen;the Barremian one by ferns(Cyatheaceae,Dieksoniaceae);the Aptian one by ferns(Cyatheaceae,Dieksoniaceae,Gleicheniaceae)and Ginkgocycadophytus;and the Albian one by ferns(Schizaeaceae)and bisaccate pollen.In the Albian the floral diversity raises with the angiosperms appearing.

  2. Visual feedback of individuals' medical imaging results for changing health behaviour.

    Science.gov (United States)

    Hollands, Gareth J; Hankins, Matthew; Marteau, Theresa M

    2010-01-20

    Feedback of medical imaging results can reveal visual evidence of actual bodily harm attributable to a given behaviour. This may offer a particularly promising approach to motivating changes in health behaviour to decrease risk. Applicable behaviours include smoking cessation, skin self-examination, sun protection behaviour, dietary intake, physical activity and medication usage. The current review assembles and evaluates the evidence concerning the behavioural impact of showing and explaining images, in order to determine whether their communication is an effective intervention approach. To assess the extent to which feedback to individuals of images of their own bodies created during medical imaging procedures increases or decreases a range of health behaviours. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14 September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9 October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of articles. We also contacted authors of selected papers, and searched the ProQuest Dissertations and Theses database on 1 October 2009 for grey literature. Randomised or quasi-randomised controlled trials involving adult (18 years and over) non-pregnant individuals undergoing medical imaging procedures assessing risk of disease or of an existing condition, for which personal risk may be reduced by modification of behaviour. The sole or principal component of included interventions is visual feedback of individuals' medical imaging results, defined as individuals being shown, and having explained, source images (still or moving images) of their bodies generated by the procedure. Two authors searched for studies and independently extracted data from included studies, with disagreements resolved by consensus and a third author acting as arbiter. The risk of bias of included studies was assessed and reported in accordance with the

  3. Changing medical doctor productivity and its affecting factors in rural China.

    Science.gov (United States)

    Martineau, Tim; Gong, Youlong; Tang, Shenglan

    2004-01-01

    Using the data collected from the health facility-based survey, part of the national health service survey conducted in 1993 and 1998, this paper tries to examine changes in labour productivity among the county-level hospitals and township health centres in rural China, and to analyse factors affecting the changes. The results presented in the paper show that the average number of outpatient visits per doctor per day and the average number of inpatient days per doctor per day declined significantly over the period from 1986 to 1997. The main factors resulting in the reduction of productivity are associated with the increase of inappropriate staff recruitment in these health facilities, the significant decline of rural population covered by health insurance, particularly rural cooperative medical schemes (CMS), and the rapid rise of health care costs. The latter two factors also have brought about a reduction in the use of these health facilities by the rural population. The paper suggests that the government should tighten up the entrance of health and non-health staff into the rural health sector and develop effective measures aimed to avoid providing pervasive financial incentives to the over-provision of services and over-use of drugs. In addition, other measures that help to increase the demand for health services, such as the establishment of rural health insurance, should be considered seriously.

  4. Medical profession changes between religion, science, skill, ethics, law and economics.

    Science.gov (United States)

    Angeletti, L R

    1997-01-01

    How has the medical profession changed during the centuries? How has the evolution of the profession been influenced by the balance of different issues, e.g. magic, religion, philosophy, science, technology, ethics, law and/or economics? One needs to examine many historical changes leading from the hierarchized medicine of Ancient Egypt to the Asklepiadic and Hippocratic medicine at the time of Plato, from the newly organized medicine of the Renaissance to the emerging social medicine of the XIX century, from the nosological medicine centered on the evaluation of the symptoms to the medicine which explores the human body through technologies. Furthermore, an overview from the past to the future should analyze the new doctor-patient relationship in a health system of managed care, between market and solidarity, between the efficientistic guidelines of the providers (hospitals, physicians, etc.) and an anthropocentric view of the rights of the citizen-customers. These problems are presented and discussed by many Authors in three issues of Medicina nei Secoli (II/III.1997-I, 1998) as an aid to understanding what it means to be a physician today, from the past to the future.

  5. New phenomenon in early development of sporelings in Gracilaria asiatica Chang et Xia (Gracilariaceae, Rhodophyta)

    Institute of Scientific and Technical Information of China (English)

    ZHAO Fengjuan; WANG Aihua; LIU Jidong; DUAN Delin

    2006-01-01

    Study on the early development of sporelings from carpospores of Gracilaria asiatica Chang et Xia was conducted indoors under controlled culture conditions. Besides normal development of sporelings, a new developmental phenomenon of filamentous frond was observed. It was composed of one or two rows of cells, and took place from the outmost brim of the basal disc. During the early disc stage of germinated carpospores, one or two filamentous fronds formed on about 10% basal discs. Simultaneously, young fronds began to arch slightly from the centers of single and coalescent discs; lately more filamentous fronds up to 80% appeared on the brims of basal discs. Meanwhile one or more upright fronds protuberated on the basal discs. Generally, filamentous fronds exhibited in self-existence or co-existence forms with normal young sporelings on the same basal disc, and single cell detached from filamentous fronds developed into a new filamentous frond. This new phenomenon exhibited a unique differentiation pathway during the early development of G. asiatica, which would be potential for the application in artificial sporelings nursery.

  6. Dynamic changes in gene expression during human early embryo development: from fundamental aspects to clinical applications.

    Science.gov (United States)

    Assou, Said; Boumela, Imène; Haouzi, Delphine; Anahory, Tal; Dechaud, Hervé; De Vos, John; Hamamah, Samir

    2011-01-01

    The first week of human embryonic development comprises a series of events that change highly specialized germ cells into undifferentiated human embryonic stem cells (hESCs) that display an extraordinarily broad developmental potential. The understanding of these events is crucial to the improvement of the success rate of in vitro fertilization. With the emergence of new technologies such as Omics, the gene expression profiling of human oocytes, embryos and hESCs has been performed and generated a flood of data related to the molecular signature of early embryo development. In order to understand the complex genetic network that controls the first week of embryo development, we performed a systematic review and study of this issue. We performed a literature search using PubMed and EMBASE to identify all relevant studies published as original articles in English up to March 2010 (n = 165). We also analyzed the transcriptome of human oocytes, embryos and hESCs. Distinct sets of genes were revealed by comparing the expression profiles of oocytes, embryos on Day 3 and hESCs, which are associated with totipotency, pluripotency and reprogramming properties, respectively. Known components of two signaling pathways (WNT and transforming growth factor-β) were linked to oocyte maturation and early embryonic development. Omics analysis provides tools for understanding the molecular mechanisms and signaling pathways controlling early embryonic development. Furthermore, we discuss the clinical relevance of using a non-invasive molecular approach to embryo selection for the single-embryo transfer program.

  7. Changes in Laminin Expression Pattern during Early Differentiation of Human Embryonic Stem Cells.

    Directory of Open Access Journals (Sweden)

    Martin Pook

    Full Text Available Laminin isoforms laminin-511 and -521 are expressed by human embryonic stem cells (hESC and can be used as a growth matrix to culture these cells under pluripotent conditions. However, the expression of these laminins during the induction of hESC differentiation has not been studied in detail. Furthermore, the data regarding the expression pattern of laminin chains in differentiating hESC is scarce. In the current study we aimed to fill this gap and investigated the potential changes in laminin expression during early hESC differentiation induced by retinoic acid (RA. We found that laminin-511 but not -521 accumulates in the committed cells during early steps of hESC differentiation. We also performed a comprehensive analysis of the laminin chain repertoire and found that pluripotent hESC express a more diverse range of laminin chains than shown previously. In particular, we provide the evidence that in addition to α1, α5, β1, β2 and γ1 chains, hESC express α2, α3, β3, γ2 and γ3 chain proteins and mRNA. Additionally, we found that a variant of laminin α3 chain-145 kDa-accumulated in RA-treated hESC showing that these cells produce prevalently specifically modified version of α3 chain in early phase of differentiation.

  8. Changes in Laminin Expression Pattern during Early Differentiation of Human Embryonic Stem Cells.

    Science.gov (United States)

    Pook, Martin; Teino, Indrek; Kallas, Ade; Maimets, Toivo; Ingerpuu, Sulev; Jaks, Viljar

    2015-01-01

    Laminin isoforms laminin-511 and -521 are expressed by human embryonic stem cells (hESC) and can be used as a growth matrix to culture these cells under pluripotent conditions. However, the expression of these laminins during the induction of hESC differentiation has not been studied in detail. Furthermore, the data regarding the expression pattern of laminin chains in differentiating hESC is scarce. In the current study we aimed to fill this gap and investigated the potential changes in laminin expression during early hESC differentiation induced by retinoic acid (RA). We found that laminin-511 but not -521 accumulates in the committed cells during early steps of hESC differentiation. We also performed a comprehensive analysis of the laminin chain repertoire and found that pluripotent hESC express a more diverse range of laminin chains than shown previously. In particular, we provide the evidence that in addition to α1, α5, β1, β2 and γ1 chains, hESC express α2, α3, β3, γ2 and γ3 chain proteins and mRNA. Additionally, we found that a variant of laminin α3 chain-145 kDa-accumulated in RA-treated hESC showing that these cells produce prevalently specifically modified version of α3 chain in early phase of differentiation.

  9. Evolution of pancreas in aging: degenerative variation or early changes of disease?

    Science.gov (United States)

    Chantarojanasiri, Tanyaporn; Hirooka, Yoshiki; Ratanachu-Ek, Thawee; Kawashima, Hiroki; Ohno, Eizaburo; Goto, Hidemi

    2015-04-01

    Pancreatic changes in aging have been described for many decades. They involve not only pancreatic parenchyma but also pancreatic ductal, microscopic, and exocrine functional changes. There have been many studies of these changes based on pathology and various imaging modalities, as well as functional studies. The pancreatic volume was found to decrease with advancing age, with a higher incidence of pancreatic steatosis, as demonstrated in autopsy and imaging studies. The pancreatic ductal structure has been described with wide ranges of normal variation, but many studies have shown a tendency toward enlargement with advancing age. By endoscopic ultrasound imaging, the aging pancreas may exhibit abnormal findings similar to chronic pancreatitis. Microscopically, there has been evidence of patchy lobular fibrosis and papillary hyperplasia and demonstrable k-ras mutation in both normal and dysplastic ductal mucosa. The evidence of pancreatic exocrine insufficiency has yielded conflicting results, but most studies have shown a tendency toward decreased pancreatic exocrine function in the elderly. Differentiating pancreatic change in the elderly from early chronic pancreatitis may be difficult as there are limited studies to compare these two conditions in terms of structural and functional changes.

  10. Heterogeneous models for an early discrimination between sepsis and non-infective SIRS in medical ward patients: a pilot study.

    Science.gov (United States)

    Mearelli, Filippo; Fiotti, Nicola; Altamura, Nicola; Zanetti, Michela; Fernandes, Giovanni; Burekovic, Ismet; Occhipinti, Alessandro; Orso, Daniele; Giansante, Carlo; Casarsa, Chiara; Biolo, Gianni

    2014-10-01

    The objective of the study was to determine the accuracy of phospholipase A2 group II (PLA2-II), interferon-gamma-inducible protein 10 (IP-10), angiopoietin-2 (Ang-2), and procalcitonin (PCT) plasma levels in early ruling in/out of sepsis among systemic inflammatory response syndrome (SIRS) patients. Biomarker levels were determined in 80 SIRS patients during the first 4 h of admission to the medical ward. The final diagnosis of sepsis or non-infective SIRS was issued according to good clinical practice. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for sepsis diagnosis were assessed. The optimal biomarker combinations with clinical variables were investigated by logistic regression and decision tree (CART). PLA2-II, IP-10 and PCT, but not Ang-2, were significantly higher in septic (n = 60) than in non-infective SIRS (n = 20) patients (P ≤ 0.001, 0.027, and 0.002, respectively). PLA2-II PPV and NPV were 88 and 86%, respectively. The corresponding figures were 100 and 31% for IP-10, and 93 and 35% for PCT. Binary logistic regression model had 100% PPV and NPV, while manual and software-generated CART reached an overall accuracy of 95 and 98%, respectively, both with 100% NPV. PLA2-II and IP-10 associated with clinical variables in regression or decision tree heterogeneous models may be valuable biomarkers for sepsis diagnosis in SIRS patients admitted to medical ward (MW). Further studies are needed to introduce them into clinical practice.

  11. Expression Changes of Early Response Genes in Lung Due to High Volume Ventilation

    Institute of Scientific and Technical Information of China (English)

    WANG Yuelan; YAO Shanglong; XIONG Ping

    2005-01-01

    Summary: The expression changes of early response genes due to ventilation with high volume in adult rats in vivo were observed. Forty SD male rats were randomly divided into control and 30, 60, 90 and 120 min ventilation groups, respectively (n=8 in each group). The animals were ventilated with tidal volume of 42 ml/kg and a PEEP level of 0 cmH2O at a rate of 40 breaths per minute in room air with a ventilator was given to the small animals. The expression of Egr-1, C-jun and IL-1β mRNA and proteins was detected by RT-PCR and immunohistochemical technique, respectively. The pathological changes in lung tissues were examined by HE staining. The results indicated that the expression of Egr-1, C-jun and IL-1β mRNA was detectable at 30th min after overventilation, but there was no significant difference in comparison with that in control group until overventilation for 60 min. However, at 90 and 120 min there was a significent increase as compared with 30 min or control group (P<0.05). The expression of Egr-1, C-jun and IL-1β deteced by immunohistochemical assay also showed a similar tendency of the gradual increase. In the 120 min ventilation group, the expression intensity of Egr-1, C-jun and IL-1β proteins in lung cells was the strongest and the nuclear translocation was increased markedly in comparison with any other groups (P<0.05). HE staining suggested that the degree of lung injury was aggravated gradually with the ventialtion going on and had a similar tendency to the expression of these early response genes and proteins. The current data suggested that overventilation activated and upregulated the expression of early response genes and the expression of these genes may be taken as the early signal to predict the onset and degree of lung injury. These results may demonstrated partially that the expression of early response genes induced by the mechanical stretch is associated with biochamic lung injury.

  12. Early changes in shoot transcriptome of rice in response to Rhodotorula mucilaginosa JGTA-S1

    Directory of Open Access Journals (Sweden)

    Chinmay Saha

    2015-12-01

    Full Text Available Yeasts of Rhodotorula genus have been reported to show endophytic colonization in different plants. Some of the Rhodotorula species are found to exhibit plant growth promoting activities and also have been reported to protect plants against invading pathogens. A yeast strain closely related to Rhodotorula mucilaginosa was isolated from the endosphere of Typha angustifolia collected from a Uranium mine. A microarray analysis was performed to investigate the early changes in rice shoot transcripts in response to this yeast (R. mucilaginosa JGTA-S1. Transcriptional changes were monitored in 6 h and 24 h treated rice plant shoots as compared to 0 h control. The microarray data has been submitted to the NCBI GEO repository under the accession number of GSE64321.

  13. [External proprioceptors of locust locomotor organs and their changes during early larval ontogenesis].

    Science.gov (United States)

    Kuznetsova, T V; Severina, I Iu

    2009-01-01

    This work studies topography and structure of such important insect external proprioceptors as campaniform sensillae (CS). These mechanoreceptors are essential components of insect posture and locomotion regulation and participate in control of various forms of insect motor behavior (walking, jump, flight). There are traced their quantitative changes as well as differences in distribution of groups of these leg receptors at consecutive stages (from the 1st to the 4th) of ontogenetic development of larva of the locust Locusta migratoria L. The presence of groups of CS in proximal parts of extremities has been noted as early as in the 1st instar larvae. The CS groups in the wing pads were revealed only in the 4th instar larvae. The presented data allow connecting changes in structure and distribution of these proprioceptors on central generators of the locomotion rhythms.

  14. BACE1 in the retina: a sensitive biomarker for monitoring early pathological changes in Alzheimer's disease.

    Science.gov (United States)

    Li, Lan; Luo, Jia; Chen, Dan; Tong, Jian-Bin; Zeng, Le-Ping; Cao, Yan-Qun; Xiang, Jian; Luo, Xue-Gang; Shi, Jing-Ming; Wang, Hui; Huang, Ju-Fang

    2016-03-01

    Because of a lack of sensitive biomarkers, the diagnosis of Alzheimer's disease (AD) cannot be made prior to symptom manifestation. Therefore, it is crucial to identify novel biomarkers for the presymptomatic diagnosis of AD. While brain lesions are a major feature of AD, retinal pathological changes also occur in patients. In this study, we investigated the temporal changes in β-site APP-cleaving enzyme 1 (BACE1) expression in the retina and brain to determine whether it could serve as a suitable biomarker for early monitoring of AD. APP/PS-1 transgenic mice, 3, 6 and 8 months of age, were used as an experimental group, and age-matched C57/BL6 wild-type mice served as the control group. In the Morris water maze test, there were no significant differences in escape latency or in the number of crossings in the target area among mice of different ages. Compared with wild-type mice, no changes in learning or memory abilities were detected in transgenic mice at 3 months of age. However, compared with wild-type mice, the escape latency was significantly increased in transgenic mice at 6 months, starting on day 3, and at 8 months, starting on day 2, during Morris water maze training. In addition, the number of crossings of the target area was significantly decreased in transgenic mice. The learning and memory abilities of transgenic mice were further worsened at 8 months of age. Immunohistochemical staining revealed no BACE1 plaques in wild-type mice at 3, 6 or 8 months or in transgenic mice at 3 months, but they were clearly found in the entorhinal cortex, hippocampus and prefrontal cortex of transgenic mice at 6 and 8 months. BACE1 expression was not detected in the retina of wild-type mice at 3 months, but weak BACE1 expression was detected in the ganglion cell layer, inner plexiform layer and outer plexiform layer at 6 and 8 months. In transgenic mice, BACE1 expression in the ganglion cell layer was increased at 3 months, and BACE1 expression in the ganglion cell

  15. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

    Science.gov (United States)

    O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

    2016-02-25

    Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

  16. Academic medicine change management: the power of the liaison committee on medical education accreditation process.

    Science.gov (United States)

    Chandran, Latha; Fleit, Howard B; Shroyer, A Laurie

    2013-09-01

    Stony Brook University School of Medicine (SBU SOM) used a Liaison Committee on Medical Education (LCME) site visit to design a change management approach that engaged students, revitalized faculty, and enabled significant, positive institutional transformation while flexibly responding to concurrent leadership transitions. This "from-the-trenches" description of novel LCME site-visit-related processes may provide an educational program quality improvement template for other U.S. medical schools. The SBU SOM site visit processes were proactively organized within five phases: (1) planning (4 months), (2) data gathering (12 months), (3) documentation (6 months), (4) visit readiness (2 months), and (5) visit follow-up (16 months). The authors explain the key activities associated with each phase.The SBU SOM internal leadership team designed new LCME-driven educational performance reports to identify challenging aspects of the educational program (e.g., timeliness of grades submitted, midcourse feedback completeness, clerkship grading variability across affiliate sites, learning environment or student mistreatment incidents). This LCME process increased institutional awareness, identified the school's LCME vulnerabilities, organized corrective actions, engaged key stakeholders in communication, ensured leadership buy-in, and monitored successes. The authors' strategies for success included establishing a strong internal LCME leadership team, proactively setting deadlines for all phases of the LCME process, assessing and communicating vulnerabilities and action plans, building multidisciplinary working groups, leveraging information technology, educating key stakeholders through meetings, retreats, and consultants, and conducting a mock site visit. The urgency associated with an impending high-stakes LCME site visit can facilitate positive, local, educational program quality improvement.

  17. Financialization impedes climate change mitigation: Evidence from the early American solar industry

    Science.gov (United States)

    Jerneck, Max

    2017-01-01

    The article investigates how financialization impedes climate change mitigation by examining its effects on the early history of one low-carbon industry, solar photovoltaics in the United States. The industry grew rapidly in the 1970s, as large financial conglomerates acquired independent firms. While providing needed financial support, conglomerates changed the focus from existing markets in consumer applications toward a future utility market that never materialized. Concentration of the industry also left it vulnerable to the corporate restructuring of the 1980s, when the conglomerates were dismantled and solar divisions were pared back or sold off to foreign firms. Both the move toward conglomeration, when corporations became managed as stock portfolios, and its subsequent reversal were the result of increased financial dominance over corporate governance. The American case is contrasted with the more successful case of Japan, where these changes to corporate governance did not occur. Insulated from shareholder pressure and financial turbulence, Japanese photovoltaics manufacturers continued to expand investment throughout the 1980s when their American rivals were cutting back. The study is informed by Joseph Schumpeter’s theory of creative destruction and Hyman Minsky’s theory of financialization, along with economic sociology. By highlighting the tenuous and conflicting relation between finance and production that shaped the early history of the photovoltaics industry, the article raises doubts about the prevailing approach to mitigate climate change through carbon pricing. Given the uncertainty of innovation and the ease of speculation, it will do little to spur low-carbon technology development without financial structures supporting patient capital. PMID:28435862

  18. Phenological behaviour of early spring flowering trees in Spain in response to recent climate changes

    Science.gov (United States)

    Hidalgo-Galvez, M. D.; García-Mozo, H.; Oteros, J.; Mestre, A.; Botey, R.; Galán, C.

    2017-03-01

    This research reports the phenological trends of four early spring and late winter flowering trees in Spain (south Europe) from a recent period (1986-2012). The studied species were deciduous trees growing in different climatic areas: hazel (Corylus avellana L.), willow (Salix alba L.), ash (Fraxinus angustifolia Vahl.) and white mulberry (Morus alba L.). We analysed the response to climate and the trends of the following phenophases observed at the field: budburst, leaf unfolding, flowering, fruit ripening, fruit harvesting, leaf colour change and leaf-fall. The study was carried out in 17 sampling sites in the country with the aim of detecting the recent phenological response to the climate of these species, and the possible effect of climate change. We have observed differences in the phenological response to climate depending on each species. Sixty-one percent of studied sites suffered an advance of early spring phenophases, especially budburst on average by -0.67 days and flowering on average by -0.15 days during the studied period, and also in the subsequent fruit ripening and harvesting phases on average by -1.06 days. By contrast, it has been detected that 63% of sampling sites showed a delay in autumn vegetative phases, especially leaf-fall events on average by +1.15 days. The statistic correlation analysis shows in the 55% of the studied localities that phenological advances are the consequence of the increasing trend detected for temperature—being minimum temperature the most influential factor—and in the 52% of them, phenological advances occurred by rainfall variations. In general, leaf unfolding and flowering from these species showed negative correlations in relation to temperature and rainfall, whereas that leaf colour change and leaf-fall presented positive correlations. The results obtained have a great relevance due to the fact that they can be considered as reliable bio-indicators of the impact of the recent climate changes in southern

  19. Changes in food processing and occlusal dental wear during the early agricultural period in northwest Mexico.

    Science.gov (United States)

    Watson, James T

    2008-01-01

    Crown dimensions and occlusal surface wear rate and wear plane were evaluated using paired first and second mandibular molars from a sample of 84 Early Agricultural period (1600 B.C.-A.D. 200) skeletons from northwest Mexico. Although this period represents a major shift in subsistence strategies in the Sonoran Desert, from food-foraging to agriculture, archaeological and dental pathology studies have identified this period as one of relative dietary stability. It was therefore predicted that very little variation in occlusal wear would have occurred between the early phase (San Pedro: 1600-800 B.C.) and late phase (Cienega: 800 B.C.-A.D. 200). Comparison of crown diameters identified some phenotypic differences between sexes but not between archaeological phases. Molar occlusal surfaces were then divided into four quadrants, and wear scores recorded for each quadrant. Principle axis analysis was performed between total wear scores of paired, adjacent first and second mandibular molars to assess rate and occlusal wear plane over time. The analysis demonstrated that both wear rate and wear plane increased from the early to the late phase of the Early Agricultural period. These results indicate that although diet may have indeed remained stable during this period in the Sonoran Desert increases in the rate of wear and wear plane may reflect changes in food-processing techniques. It is suggested that more intensive processing of agricultural products during the Cienega phase simultaneously softened the diet to create more tooth-contact wear and introduced more grit to cause faster and more angled wear on the molar occlusal surfaces.

  20. Changes in vascular extracellular matrix composition during decidual spiral arteriole remodeling in early human pregnancy.

    Science.gov (United States)

    Smith, Samantha D; Choudhury, Ruhul H; Matos, Patricia; Horn, James A; Lye, Stephen J; Dunk, Caroline E; Aplin, John D; Jones, Rebecca L; Harris, Lynda K

    2016-05-01

    Uterine spiral arteriole (SA) remodeling in early pregnancy involves a coordinated series of events including decidual immune cell recruitment, vascular cell disruption and loss, and colonization by placental-derived extravillous trophoblast (EVT). During this process, decidual SA are converted from narrow, muscular vessels into dilated channels lacking vasomotor control. We hypothesized that this extensive alteration in SA architecture must require significant reorganization and/or breakdown of the vascular extracellular matrix (ECM). First trimester decidua basalis (30 specimens) was immunostained to identify spiral arterioles undergoing trophoblast-independent and -dependent phases of remodeling. Serial sections were then immunostained for a panel of ECM markers, to examine changes in vascular ECM during the remodeling process. The initial stages of SA remodeling were characterized by loss of laminin, elastin, fibrillin, collagen types III, IV and VI from the basement membrane, vascular media and/or adventitia, and surrounding decidual stromal cells. Loss of ECM correlated with disruption and disorganization of vascular smooth muscle cells, and the majority of changes occurred prior to extensive colonization of the vessel wall by EVT. The final stages of SA remodeling, characterized by the arrival of EVT, were associated with the increased mural deposition of fibronectin and fibrinoid. This study provides the first detailed analysis of the spatial and temporal loss of ECM from the walls of remodeling decidual SA in early pregnancy.

  1. Tactile stimulation partially prevents neurodevelopmental changes in visual tract caused by early iron deficiency.

    Science.gov (United States)

    Horiquini-Barbosa, Everton; Gibb, Robbin; Kolb, Bryan; Bray, Douglas; Lachat, Joao-Jose

    2017-02-15

    Iron deficiency has a critical impact on maturational mechanisms of the brain and the damage related to neuroanatomical parameters is not satisfactorily reversed after iron replacement. However, emerging evidence suggest that enriched early experience may offer great therapeutic efficacy in cases of nutritional disorders postnatally, since the brain is remarkably responsive to its interaction with the environment. Given the fact that tactile stimulation (TS) treatment has been previously shown to be an effective therapeutic approach and with potential application to humans, here we ask whether exposure to TS treatment, from postnatal day (P) 1 to P32 for 3min/day, could also be employed to prevent neuroanatomical changes in the optic nerve of rats maintained on an iron-deficient diet during brain development. We found that iron deficiency changed astrocyte, oligodendrocyte, damaged fiber, and myelinated fiber density, however, TS reversed the iron-deficiency-induced alteration in oligodendrocyte, damaged fiber and myelinated fiber density, but failed to reverse astrocyte density. Our results suggest that early iron deficiency may act by disrupting the timing of key steps in visual system development thereby modifying the normal progression of optic nerve maturation. However, optic nerve development is sensitive to enriching experiences, and in the current study we show that this sensitivity can be used to prevent damage from postnatal iron deficiency during the critical period. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Early changes in somatosensory function in spinal pain: a systematic review and meta-analysis.

    Science.gov (United States)

    Marcuzzi, Anna; Dean, Catherine M; Wrigley, Paul J; Hush, Julia M

    2015-02-01

    Alterations in sensory processing have been demonstrated in chronic low back and neck pain. However, it has not been yet systematically summarized how early these changes occur in spinal pain. This systematic review examines the available literature measuring somatosensory function in acute (<6 weeks) and subacute (6-12 weeks) spinal pain. The protocol for this review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO). An electronic search of 4 databases was conducted to retrieve studies assessing somatosensory function by quantitative sensory testing in adults with spinal pain of up to 12 weeks duration. Two reviewers independently screened the studies and assessed the risk of bias. Studies were grouped according to spinal pain condition (whiplash injury, idiopathic neck pain, and nonspecific low back pain), and, where possible, meta-analyses were performed for comparable results. Fifteen studies were included. Sources of bias included lack of assessor blinding, unclear sampling methods, and lack of control for confounders. We found that: (1) there is consistent evidence for thermal and widespread mechanical pain hypersensitivity in the acute stage of whiplash, (2) there is no evidence for pain hypersensitivity in the acute and subacute stage of idiopathic neck pain, although the body of evidence is small, and (3) hyperalgesia and spinal cord hyperexcitability have been detected in early stages of nonspecific low back pain, although evidence about widespread effects are conflicting. Future longitudinal research using multiple sensory modalities and standardized testing may reveal the involvement of somatosensory changes in the development and maintenance of chronic pain.

  3. Early Eocene hyperthermals record orbitally controlled changes in high latitude climates

    Science.gov (United States)

    Galeotti, S.; DeConto, R. M.; Lanci, L.; Pagani, M.; Rohl, U.; Westerhold, T.; Zachos, J. C.

    2012-04-01

    The Late Paleocene to Early Eocene records a succession of short-term (104 yr) negative carbon isotope excursions (CIEs) in marine carbonates and organic carbon. Available data indicate that at least three of these episodes, including the Paleocene Eocene Thermal Maximum (PETM) at ca. 55.5, the Eocene Thermal Maximum (ETM)2 at ca. 53.5 Ma and the ETM3 at ca. 52 Ma, were associated with rapid warming, and widespread marine carbonate dissolution forced by shoaling of the carbonate lysocline and lowering of the carbonate saturation state. Large temperature raises associated with decreased δ13C values in both terrestrial and oceanic records and concomitant acidification of oceanic waters implies that hyperthermals were caused by the addition of massive amounts of 13C-depleted greenhouse gases (CH4 and/or CO-2) into the atmosphere and subsequent sequestration by oceanic waters. Cyclostratigraphic analyses of marine sequences provided evidence that CIEs and associated carbonate dissolution episodes were linked to orbital changes in insolation. Here we show grounds that Early Eocene hyperthermals are part of a continuum of δ13C anomaly and carbonate dissolution episodes and are triggered by long-term orbitally-controlled changes in local climates at high latitudes.

  4. Serum fructosamine concentrations in relation to metabolic changes during late pregnancy and early lactation in mares.

    Science.gov (United States)

    Filipović, Natalija; Stojević, Zvonko; Prvanović, Nikica

    2010-01-01

    The changes in blood serum fructosamine concentrations as indicators of glycaemia during a longer period of time were investigated in mares during late pregnancy and early lactation, as well as their relationship to the changes in the concentration of biochemical indicators of energetic status. The samples were taken from eleven mares on 60 +/- 10 and 20 +/- 10 days before foaling, and 20 +/- 10 and 60 +/- 10 days after foaling. Concentrations of serum fructosamine, non-esterified fatty acids and triglycerides were higher during late pregnancy (from P < 0.05 to P < 0.0005), while the concentrations of beta- hydroxybutyrate increased significantly (P < 0.00001) during early lactation. A significant correlation between the concentrations of fructosamine and metabolic parameters was observed. The results indicate a relationship between energetic status and serum fructosamine in mares. Higher concentrations of fructosamine are related to the adaptation to late pregnancy. Therefore, the measurement of the serum fructosamine concentrations could serve as an indicator of energetic status of mares during pregnancy and lactation.

  5. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  6. Sudden early-morning awakening impairs immediate tactical planning in a changing 'emergency' scenario.

    Science.gov (United States)

    Horne, Jim; Moseley, Robert

    2011-06-01

    This was a realistic military-type exercise assessing unexpected, abrupt early-morning awakening effects on immediate 'executive function' and the ability to comprehend and deal with a sudden emergency under a changing situation. Twenty (average age 21years) healthy, highly motivated junior officer reservists were assigned randomly to two equal, independent groups, unforewarned as to what would happen. The experimental group was woken abruptly at 03:00h (plan of engagement with minimal loss of resources, to be completed within 15min. A control group slept until 07:30h; they were then presented with the identical emergency 1h later. Participants worked individually, under time pressure, receiving written information, map and other details, all containing relevant, irrelevant and misleading information. Halfway through, they were given (unexpectedly) a critical update necessitating a change of tactics. Performance was scored blind by instructors, under five categories. Eight of the experimental group versus three controls failed overall, with significant group differences on three specific categories relying on flexible decision-making: 'identification of available cover', 'use of available assets' and 'extraction of relevant from irrelevant information'. Other, logical and highly trained skills were unimpaired. Ours was a 'worst case scenario', combining short sleep, circadian 'trough' and sleep inertia, all of which differentiated the two groups, unlike typical laboratory studies. Nevertheless, it was relevant to real-life situations involving highly motivated, trained individuals making critical innovative decisions in the early morning versus the normal waking day. © 2010 European Sleep Research Society.

  7. Exploring glacial change - flying in the tailwind of the early 20th century Greenland explorers

    Science.gov (United States)

    Bjork, A. A.; Kjaer, K.; Kjeldsen, K. K.; Larsen, N. K.; Korsgaard, N. J.; Khan, S. A.

    2013-12-01

    In the early 1930s Greenlandic explorers and scientists began using airplanes as an effective mean of surveying and mapping the hitherto unknown and inaccessible lands. By replacing the dogsled and the drawing board with the seaplane and camera, huge areas could now be covered. Here in the 21st Century the photographs now serve as a snapshot of the state of the glaciers, and possess unique scientific value as they stand as the first testimony of hundreds of Greenlandic glaciers. In the summer of 2013, we flew in the paths of the early flights and captured the changes that occurred during the last 80 years. To revisit all the historic glaciers would be a near impossible, not to mention extremely expensive task, so we targeted the most important glaciers in terms of present mass loss as well as the most aesthetically appealing historical images. The result is a then-and-now comparison that vividly captures both the raw beauty of the land and the ongoing often dramatic glacial changes. As the historic flights covered nearly half the Greenlandic coast line, we capture both areas of massive retreat and areas of still stand and even advance. The Heinkel Seaplane is being prepared for a photo flight in southeast Greenland in 1933. Flying an open plane in 14.000 ft and -40 °C called for a special breed of pilots.

  8. Early weight changes after birth and serum high-molecular-weight adiponectin level in preterm infants.

    Science.gov (United States)

    Yoshida, Tomohide; Nagasaki, Hiraku; Asato, Yoshihide; Ohta, Takao

    2011-12-01

    Extra-uterine growth retardation (EUGR) is associated with an increased risk for cardiometabolic diseases later in life. The aim of the present study was to examine the relationship between early weight change after birth in preterm infants and adiponectin (adn) multimeric complexes. Subjects included 28 preterm infants born between weeks 24 and 33 of gestation. Serum adn multimeric complexes and the anthropometric parameters were measured in preterm infants at birth and at corrected term. Bodyweight (BW) decreased during the first week of life, with birthweight restored at approximately 19 days after birth. Nineteen of the subjects had EUGR at corrected term. Total (T)-adn, high-molecular-weight (H)-adn, and the ratio of H-adn to T-adn (H/T-adn) were significantly elevated at corrected term than at birth. Postmenstrual age, birthweight, birth length and lowest BW after birth were positively correlated with H-adn and H/T-adn. Weight reduction after birth was negatively correlated with H-adn. Age to restore birthweight was negatively correlated with T-adn, H-adn and H/T-adn. Stepwise multiple regression analysis indicated age to restore birthweight as the major predictor of T-adn and H-adn. Early weight changes after birth may alter serum adn level in preterm infants at corrected term. The appropriate nutritional support in the early postnatal period could reduce the prevalence of EUGR and the future risk for cardiometabolic diseases. © 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.

  9. Early anisotropy changes in the corpus callosum of patients with optic neuritis

    Energy Technology Data Exchange (ETDEWEB)

    Bester, M.; Ding, X.Q.; Holst, B.; Fiehler, J. [University Medical Center Hamburg-Eppendorf, Department of Neuroradiology, Hamburg (Germany); Heesen, C.; Schippling, S.; Martin, R. [University Medical Center Hamburg-Eppendorf, Department of Neuroradiology, Hamburg (Germany); University Medical Center Hamburg-Eppendorf, Institute for Neuroimmunology and Clinical MS Research, Hamburg (Germany)

    2008-07-15

    Optic neuritis (ON) and any other early manifestation of multiple sclerosis (MS) are referred to as clinically isolated syndrome (CIS) as long as MS is suspected. In this prospective study we aimed to determine whether diffusion tensor imaging (DTI) could quantify structural changes in patients with early MS. A total of 24 patients and 15 control subjects were prospectively followed by clinical examinations and MRI. the main inclusion criterion was presentation with ON. Patients underwent serial MRI scans: MRI1 (baseline, n=24), MRI2 (mean 6.6 months, n=24), MRI3 (mean 13.0 months, n=14), MRI4 (mean 39.4 months, n=5). Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were derived from DTI. Four regions of interest (ROIs) were defined in normal-appearing white matter (NAWM). In the temporal course FA decreased in the genu of the callosal body (GCC) from MRI1 to MRI4 (P=0.005) and in the splenium of the callosal body (SCC) (P=0.006). Patients already had lower FA values in the SCC (P<0.01) on MRI1 compared with the controls. Patients had lower FA values in the GCC (P<0.01) starting from MRI2. Patients with definite MS on follow-up (n=9) showed a correlation between FA in the SCC and time (r=-0.40, P=0.004), whereas patients without progression did not. Our findings suggest that the corpus callosum is an early site for development of anisotropy changes in MS patients with ON. There seems to be a primary FA decrease in all patients with ON that only deteriorates in the group developing definite MS. (orig.)

  10. Do Contact and Empathy Mitigate Bias Against Gay and Lesbian People Among Heterosexual Medical Students? A Report from Medical Student CHANGES

    Science.gov (United States)

    Burke, Sara E.; Dovidio, John F.; Przedworski, Julia M.; Hardeman, Rachel R.; Perry, Sylvia P.; Phelan, Sean M.; Nelson, David B.; Burgess, Diana J.; Yeazel, Mark W.; van Ryn, Michelle

    2015-01-01

    Purpose A recent Institute of Medicine report concluded that lesbian and gay individuals face discrimination from health care providers and called for research on provider attitudes. Medical school is a critical juncture for improving future providers’ treatment of sexual minorities. This study examined both explicit and implicit biases against lesbian women and gay men among medical students, focusing on two predictors of such bias, contact and empathy. Method This study included the 4,441 heterosexual first-year medical students who participated in the baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES), which employed a stratified random sample of 49 U.S. medical schools in fall 2010. The researchers measured explicit attitudes toward gay and lesbian people using feeling thermometer self-assessments, implicit attitudes using the Implicit Association Test (IAT), amount and favorability of contact using self-report items, and empathy using subscales of the Interpersonal Reactivity Index. Results Nearly half (45.79%; 956/2,088) of respondents with complete data on both bias measures expressed at least some explicit bias and most (81.51%; 1,702/2,088) exhibited at least some implicit bias against gay and lesbian individuals. Both amount and favorability of contact predicted positive implicit and explicit attitudes. Both cognitive and emotional empathy predicted positive explicit attitudes, but not implicit attitudes. Conclusions The prevalence of negative attitudes presents an important challenge for medical education, highlighting the need for more research on possible causes of bias. Findings on contact and empathy point to possible curriculum-based interventions aimed at ensuring high-quality care for sexual minorities. PMID:25674910

  11. Socio-economic position early in life, cognitive development and cognitive change from young adulthood to middle age

    DEFF Research Database (Denmark)

    Osler, Merete; Avlund, Kirsten; Mortensen, Erik Lykke

    2013-01-01

    We examine the influence of social circumstances early in life on changes in cognitive function fr