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Sample records for excess direct medical

  1. Extragalactic Gamma Ray Excess from Coma Supercluster Direction ...

    Indian Academy of Sciences (India)

    and the experimental data from Compton Gamma Ray Observatory (CGRO) the pre- liminary results of which are given by Osborne et al. (1994), the diffuse γ ray excess from Coma supercluster direction is calculated. 2. Methods. In this research, the model presented by Osborne et al. (1994) was used. They have used the ...

  2. [Postmenopausal osteoporosis: Primary prevention or excessive use of medications].

    Science.gov (United States)

    Mendoza-Edroso, C; Sánchez Garrido-Lestache, N; Lopez-Picado, A

    2013-04-01

    [corrected] Estimate the percentage of excessive use of medicines (bisphosponates, strontium ranelate and raloxifene) in the prevention of fragility fractures in postmenopausal women. A descriptive study conducted in an urban health centre in Vitoria-Gasteiz. The participants were women aged between 50 and 70, treated during 2010 with some of aforementioned medicines. Out of the 253 women included, three died, two moved, one did not want to sake part, and another one could not be found, leaving 246 participants. It was determinated if the treatment was or not indicated, as recommended in the ESCEO, NAMS and NOF clinical practice guides. A data search, including fragility fracture history, densitometry performed, densitometry diagnoses, prescribed medicines and prescribing doctor, was carried out by looking in the Osabide and Global Clinic digital clinic records. Interviews were carried out with 72 patients for a more complete information. The mean patient age was 60.5 ± 4.9 years, and 91,5% of them (225) had undergone a densitometry. Three-quarters (75.1%, 169) had a diagnosis of osteoporosis and 4,4% (11) had previous history of fractures. More than a quarter (27.0%, 68) of treatments had no indication, and varied depending of the prescribing doctor (family doctors: 8.5%/ traumatologists: 58.5%) (p<0.001). The use of the medicine of choice, alendronate in 29.7% of cases, Was significantly higher (59.3%) in Primary Care than in other specialties. A high percentage of women are given excessive medication, exposing them to potentially severe secondary damages. Family doctors deal correctly with osteoporosis, with a high percentage of indicated treatments and a rational use of medicines, with alendronate as the first choice in the majority of cases. Copyright © 2012 Elsevier España, S.L. y SEMERGEN. All rights reserved.

  3. Future Directions in Medical Physics

    Science.gov (United States)

    Jeraj, Robert

    Medical Physics is a highly interdisciplinary field at the intersection between physics and medicine and biology. Medical Physics is aiming at development of novel applications of physical processes and techniques in various areas of medicine and biology. Medical Physics had and continues to have profound impact by developing improved imaging and treatment technologies, and helping to advance our understanding of the complexity of the disease. The general trend in medicine towards personalized therapy, and emphasis on accelerated translational research is having a profound impact on medical physics as well. In the traditional stronghold for medical physicists - radiation therapy - the new reality is shaping in the form of biologically conformal and combination therapies, as well as advanced particle therapy approaches, such as proton and ion therapies. Rapid increase in faster and more informative multi-modality medical imaging is bringing a wealth of information that is being complemented with data obtained from genomic profiling and other biomarkers. Novel data analysis and data mining approaches are proving grounds for employment of various artificial intelligence methods that will help further improving clinical decision making for optimization of various therapies as well as better understanding of the disease properties and disease evolution, ultimately leading to improved clinical outcomes.

  4. Adopting epidemic model to optimize medication and surgical intervention of excess weight

    Science.gov (United States)

    Sun, Ruoyan

    2017-01-01

    We combined an epidemic model with an objective function to minimize the weighted sum of people with excess weight and the cost of a medication and surgical intervention in the population. The epidemic model is consisted of ordinary differential equations to describe three subpopulation groups based on weight. We introduced an intervention using medication and surgery to deal with excess weight. An objective function is constructed taking into consideration the cost of the intervention as well as the weight distribution of the population. Using empirical data, we show that fixed participation rate reduces the size of obese population but increases the size for overweight. An optimal participation rate exists and decreases with respect to time. Both theoretical analysis and empirical example confirm the existence of an optimal participation rate, u*. Under u*, the weighted sum of overweight (S) and obese (O) population as well as the cost of the program is minimized. This article highlights the existence of an optimal participation rate that minimizes the number of people with excess weight and the cost of the intervention. The time-varying optimal participation rate could contribute to designing future public health interventions of excess weight.

  5. 41 CFR 102-36.460 - Do we report excess medical shelf-life items held for national emergency purposes?

    Science.gov (United States)

    2010-07-01

    ... medical shelf-life items held for national emergency purposes? 102-36.460 Section 102-36.460 Public... Disposal Requires Special Handling Shelf-Life Items § 102-36.460 Do we report excess medical shelf-life items held for national emergency purposes? When the remaining shelf life of any medical materials or...

  6. [Excessive Daytime Sleepiness, Poor Quality Sleep, and Low Academic Performance in Medical Students].

    Science.gov (United States)

    Machado-Duque, Manuel Enrique; Echeverri Chabur, Jorge Enrique; Machado-Alba, Jorge Enrique

    2015-01-01

    Quality of sleep and excessive daytime sleepiness (EDS) affect cognitive ability and performance of medical students. This study attempts to determine the prevalence of EDS, sleep quality, and assess their association with poor academic performance in this population. A descriptive, observational study was conducted on a random sample of 217 medical students from the Universidad Tecnológica de Pereira, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth sleepiness scale. Sociodemographic, clinic and academic variables were also measured. Multivariate analyses for poor academic performance were performed. The included students had a mean age of 21.7±3.3 years, of whom 59.4% were men. Almost half (49.8%) had EDS criteria, and 79.3% were poor sleepers (PSQI ≥ 5), while 43.3% had poor academic performance during the last semester. The bivariate analysis showed that having used tobacco or alcohol until intoxicated, fairly bad subjective sleep quality, sleep efficiency < 65%, and being a poor sleeper were associated with increased risk of low performance. Sleep efficiency < 65% was statistically associated with poor academic performance (P=.024; OR = 4.23; 95% CI, 1.12-15.42) in the multivariate analysis. A poor sleep quality determined by low efficiency was related to poor academic achievement at the end of semester in medical students. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  7. Direct medical cost of stroke in Singapore.

    Science.gov (United States)

    Ng, Charmaine Shuyu; Toh, Matthias Paul Han Sim; Ng, Jiaying; Ko, Yu

    2015-10-01

    Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority. © 2015 World Stroke Organization.

  8. Direct excess entropy calculation for a Lennard-Jones fluid by the integral equation method.

    Science.gov (United States)

    Jakse, N; Charpentier, I

    2003-06-01

    The present work is devoted to the calculation of excess entropy by means of correlation functions, in the framework of integral equation theory. The tangent linear method is set up to get exact thermodynamic derivatives of the pair-correlation function, essential for the calculation of the physical quantities, as well as to carry out an optimization process for the achievement of thermodynamic consistency. The two-body entropy of the Lennard-Jones fluid is in very good agreement with the available molecular dynamics results, attesting the high degree of accuracy of the integral equation scheme. It is shown that an accurate prediction of the excess entropy and the resulting residual multiparticle entropy relies on the correct evaluation of the excess chemical potential, especially at high density. Two independent routes to calculate the latter are compared, and the consequences are discussed.

  9. Medical Robots: Current Systems and Research Directions

    OpenAIRE

    Ryan A. Beasley

    2012-01-01

    First used medically in 1985, robots now make an impact in laparoscopy, neurosurgery, orthopedic surgery, emergency response, and various other medical disciplines. This paper provides a review of medical robot history and surveys the capabilities of current medical robot systems, primarily focusing on commercially available systems while covering a few prominent research projects. By examining robotic systems across time and disciplines, trends are discernible that imply future capabilities ...

  10. Medical Robots: Current Systems and Research Directions

    Directory of Open Access Journals (Sweden)

    Ryan A. Beasley

    2012-01-01

    Full Text Available First used medically in 1985, robots now make an impact in laparoscopy, neurosurgery, orthopedic surgery, emergency response, and various other medical disciplines. This paper provides a review of medical robot history and surveys the capabilities of current medical robot systems, primarily focusing on commercially available systems while covering a few prominent research projects. By examining robotic systems across time and disciplines, trends are discernible that imply future capabilities of medical robots, for example, increased usage of intraoperative images, improved robot arm design, and haptic feedback to guide the surgeon.

  11. Future directions in reptile medical education.

    Science.gov (United States)

    Jacobson, Elliott; Heard, Darryl; Isaza, Ramiro

    2006-01-01

    Reptile medicine has emerged as a specialty area within the broader field of zoological medicine. It encompasses the medical needs of approximately 7,500 vertebrate species. This vertebrate class is highly diversified, having biological and medical peculiarities that differ both between and within major groups. Historically, veterinarians who have become recognized specialists with reptiles have had limited formal training in their medical management. The pet reptile trade is a multi-million-dollar business, and the popularity of reptiles as pets has resulted in a need for more veterinarians with training in their medical management. While few private practices have high volumes of reptile cases, many small-animal practices will have the opportunity to see a significant number of reptiles on an annual basis. Most practitioners with reptile medical expertise have merged their experiences as reptile pet owners with the principles of veterinary medicine taught in veterinary college. Several North American veterinary colleges have reptile medicine courses, and most have didactic and clinical courses in exotic and zoo animal medicine that include lectures and practical experience. Most accredited zoological medicine residency training programs include training in reptile medicine. The case load and interest in reptile medicine will probably never be sufficient to lead the average veterinary college to develop much more than what is currently offered. Consequently, those few colleges having more extensive course offerings, both didactic and clinical, will serve as educational centers for this discipline. Future Web-based teaching programs in reptile medicine will allow students nationally and internationally to have access to instructional material that can be continually updated.

  12. European Medical Device Directive : impact on nuclear medicine

    NARCIS (Netherlands)

    Kuyvenhoven, JD; Lahorte, P; Persyn, K; De Geest, E; van Loon, PW; Jacobs, F; van Rijk, PP; Lemahieu, [No Value; Dierckx, R A

    2001-01-01

    The European Council Directive 93/42/EEC concerning medical devices (14 June 1993) assigns new responsibilities and imposes technical requirements both to the manufacturer and user of medical devices. In this paper the general outlines of the directive are discussed with a particular emphasis on the

  13. Medical imaging at risk from European directive

    Science.gov (United States)

    Keevil, Stephen

    2009-09-01

    The recent Forum article by Denis Le Bihan ("Threats to ultra-high-field MRI" August pp16-17) is a valuable addition to the ongoing debate about the impact on magnetic resonance imaging (MRI) of the European Commission's Physical Agents (EMF) directive. When this directive was introduced in 2004, exposure limits for static magnetic fields were excluded, because it was known that guidance published by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) in 1994 was being revised. It is likely that the new ICNIRP guidelines, to which Le Bihan refers, will now be incorporated into the directive. If so, this could indeed impact on ultra-highfield MRI, in which Europe has a worldleading position.

  14. Evaluation of Competence of Medical Students in Performing Direct ...

    African Journals Online (AJOL)

    Nigerian Journal of Ophthalmology / Jul-Dec 2014 / Vol 22 | Issue 2. 73 ophthalmic knowledge the students are expected to acquire. The skill of direct ophthalmoscopy continues to be important in general medical settings. This makes it crucial for proper acquisition of ophthalmoscopic skill for the medical students who may ...

  15. Evaluation of Competence of Medical Students in Performing Direct ...

    African Journals Online (AJOL)

    ... on the left eyes. There was statistically significant relationship between the group students belonged and performance with 2 = <0.001. Conclusion: Based on the CDR benchmark, students' performance was not satisfactory. Keywords: Direct ophthalmoscopy, medical curricula, medical students, ophthalmic education ...

  16. Association of current work and sleep situations with excessive daytime sleepiness and medical incidents among Japanese physicians.

    Science.gov (United States)

    Kaneita, Yoshitaka; Ohida, Takashi

    2011-10-15

    The aim of the present study was to clarify the current work and sleep situations of physicians in Japan and to clarify the association between these situations and excessive daytime sleepiness as well as medical incidents. A self-administered questionnaire survey was conducted among the members of the Japan Medical Association in 2008. The randomly selected subjects comprised 3,000 male physicians and 1,500 female physicians. Valid responses were obtained from 3,486 physicians (2,298 men and 1,188 women). Mean sleep duration was 6 h 36 min for men and 6 h 8 min for women. The prevalence of lack of rest due to sleep deprivation was 30.4% among men and 36.6% among women; the prevalence of insomnia was 21.0% and 18.1%, respectively; and the prevalence of EDS was 3.5%. The adjusted odds ratio for EDS was high for physicians who reported short sleep duration, lack of rest due to sleep deprivation, and a high frequency of on-call/overnight work. Physicians who had experienced a medical incident within the previous one month accounted for 19.0% of participants. The adjusted odds ratio for medical incidents was high for those subjected to long working hours, high frequency of on-call/overnight works, lack of rest due to sleep deprivation, and insomnia. In order to facilitate optimal health management for physicians as well as securing medical safety, it is important to fully consider the work and sleep situations of physicians.

  17. Family perspective on the necessity for advance medical directives.

    Science.gov (United States)

    Hogan, L

    1992-03-01

    Although our parents made no written advance medical directives before becoming terminally ill, with the support of the nursing staff we were able to assist them in their quest for a natural death with dignity. This article presents some of the dilemas faced by families in making end-of-life decisions. The author acknowledges the importance of permission for and support of the decision making by other health care providers, and reflects that advance directives would have facilitated the process.

  18. Excessive Daytime Sleepiness

    Directory of Open Access Journals (Sweden)

    Yavuz Selvi

    2016-06-01

    Full Text Available Excessive daytime sleepiness is one of the most common sleep-related patient symptoms, with preva-lence in the community estimated to be as high as 18%. Patients with excessive daytime sleepiness may exhibit life threatening road and work accidents, social maladjustment, decreased academic and occupational performance and have poorer health than comparable adults. Thus, excessive daytime sleepiness is a serious condition that requires investigation, diagnosis and treatment primarily. As with most medical condition, evaluation of excessive daytime sleepiness begins a precise history and various objective and subjective tools have been also developed to assess excessive daytime sleepiness. The most common causes of excessive daytime sleepiness are insufficient sleep hygiene, chronic sleep deprivation, medical and psychiatric conditions and sleep disorders, such as obstructive sleep apnea, medications, and narcolepsy. Treatment option should address underlying contributors and promote sleep quantity by ensuring good sleep hygiene. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2: 114-132

  19. Self-directed learning and research attitudes among medical students.

    Science.gov (United States)

    Mahmud, Waqas; Haroon, Mustafa; Munir, Ahmed; Hyder, Omar

    2014-03-01

    To describe the correlation between Self-directed Learning (SDL) and medical students' attitude towards research, based on the premise that self-directed learners are independent, motivated, and curious learners. Observational cross-sectional study. Rawalpindi Medical College, Rawalpindi, from August 2011 to January 2012. One hundred and ninety-four students of final (5th) year class at Rawalpindi Medical College, Rawalpindi participated in this cross-sectional study. SDL ability of students was measured using Oddi's Continuing Learning Inventory (OCLI) whereas Attitude Towards Research (ATR) scale was used to measure their research attitudes. Spearman's rank-order analysis was performed to measure correlation between SDL scores on OCLI and all the 18 items on ATR scale. Statistically significant relationships with correlation coefficients ranging from +0.12 to +0.32 were found for the correlation between scores on the OCLI and eleven statements highlighting research use and positive attributes of research (14 items). Those students who participated in extra-curricular research projects (n=58, 29.9%) had relatively higher scores on OCLI as compared to those who did not participate (n=136, 70.1%, p=0.041). Self-directed learners show a positive attitude towards research, though the relationship is not strong.

  20. Search for an Excess of Events in the Super-Kamiokande Detector in the Directions of the Astrophysical Neutrinos Reported by the IceCube Collaboration

    Science.gov (United States)

    Abe, K.; Bronner, C.; Pronost, G.; Hayato, Y.; Ikeda, M.; Iyogi, K.; Kameda, J.; Kato, Y.; Kishimoto, Y.; Marti, Ll.; Miura, M.; Moriyama, S.; Nakahata, M.; Nakano, Y.; Nakayama, S.; Okajima, Y.; Orii, A.; Sekiya, H.; Shiozawa, M.; Sonoda, Y.; Takeda, A.; Takenaka, A.; Tanaka, H.; Tasaka, S.; Tomura, T.; Akutsu, R.; Kajita, T.; Kaneyuki, K.; Nishimura, Y.; Okumura, K.; Tsui, K. M.; Labarga, L.; Fernandez, P.; Blaszczyk, F. d. M.; Gustafson, J.; Kachulis, C.; Kearns, E.; Raaf, J. L.; Stone, J. L.; Sulak, L. R.; Berkman, S.; Tobayama, S.; Goldhaber, M.; Elnimr, M.; Kropp, W. R.; Mine, S.; Locke, S.; Weatherly, P.; Smy, M. B.; Sobel, H. W.; Takhistov, V.; Ganezer, K. S.; Hill, J.; Kim, J. Y.; Lim, I. T.; Park, R. G.; Himmel, A.; Li, Z.; O'Sullivan, E.; Scholberg, K.; Walter, C. W.; Ishizuka, T.; Nakamura, T.; Jang, J. S.; Choi, K.; Learned, J. G.; Matsuno, S.; Smith, S. N.; Amey, J.; Litchfield, R. P.; Ma, W. Y.; Uchida, Y.; Wascko, M. O.; Cao, S.; Friend, M.; Hasegawa, T.; Ishida, T.; Ishii, T.; Kobayashi, T.; Nakadaira, T.; Nakamura, K.; Oyama, Y.; Sakashita, K.; Sekiguchi, T.; Tsukamoto, T.; Abe, KE.; Hasegawa, M.; Suzuki, A. T.; Takeuchi, Y.; Yano, T.; Cao, S. V.; Hayashino, T.; Hiraki, T.; Hirota, S.; Huang, K.; Jiang, M.; Minamino, A.; Nakamura, KE.; Nakaya, T.; Quilain, B.; Patel, N. D.; Wendell, R. A.; Anthony, L. H. V.; McCauley, N.; Pritchard, A.; Fukuda, Y.; Itow, Y.; Murase, M.; Muto, F.; Mijakowski, P.; Frankiewicz, K.; Jung, C. K.; Li, X.; Palomino, J. L.; Santucci, G.; Vilela, C.; Wilking, M. J.; Yanagisawa, C.; Ito, S.; Fukuda, D.; Ishino, H.; Kibayashi, A.; Koshio, Y.; Nagata, H.; Sakuda, M.; Xu, C.; Kuno, Y.; Wark, D.; Di Lodovico, F.; Richards, B.; Tacik, R.; Kim, S. B.; Cole, A.; Thompson, L.; Okazawa, H.; Choi, Y.; Ito, K.; Nishijima, K.; Koshiba, M.; Totsuka, Y.; Suda, Y.; Yokoyama, M.; Calland, R. G.; Hartz, M.; Martens, K.; Simpson, C.; Suzuki, Y.; Vagins, M. R.; Hamabe, D.; Kuze, M.; Yoshida, T.; Ishitsuka, M.; Martin, J. F.; Nantais, C. M.; Tanaka, H. A.; Konaka, A.; Chen, S.; Wan, L.; Zhang, Y.; Minamino, A.; Wilkes, R. J.; Super-Kamiokande Collaboration

    2017-12-01

    We present the results of a search in the Super-Kamiokande (SK) detector for excesses of neutrinos with energies above a few GeV that are in the direction of the track events reported in IceCube. Data from all SK phases (SK-I through SK-IV) were used, spanning a period from 1996 April to 2016 April and corresponding to an exposure of 225 kiloton-years. We considered the 14 IceCube track events from a data set with 1347 livetime days taken from 2010 to 2014. We use Poisson counting to determine if there is an excess of neutrinos detected in SK in a 10° search cone (5° for the highest energy data set) around the reconstructed direction of the IceCube event. No significant excess was found in any of the search directions we examined. We also looked for coincidences with a recently reported IceCube multiplet event. No events were detected within a ±500 s time window around the first detected event, and no significant excess was seen from that direction over the lifetime of SK.

  1. Measuring medical students’ empathy using direct verbal expressions

    Directory of Open Access Journals (Sweden)

    Yera Hur

    2016-09-01

    Full Text Available Purpose: Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students’ empathy through their direct verbal expressions. Methods: The medical students’ empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001. The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40. The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. Results: The students’ empathy scores were low (mean, 12.13; standard deviation, 2.55; their most common responses (78.6% registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, pmedical college; t=-1.935, p=0.053, and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001. Conclusion: Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.

  2. [Motivation and self-directed learning among medical students].

    Science.gov (United States)

    Fasce H, Eduardo; Ortega B, Javiera; Ibáñez G, Pilar; Márquez U, Carolina; Pérez V, Cristhian; Bustamante D, Carolina; Ortiz M, Liliana; Matus B, Olga; Bastías V, Nancy; Espinoza P, Camila

    2016-05-01

    Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

  3. Direct medical cost of type 2 diabetes in singapore.

    Directory of Open Access Journals (Sweden)

    Charmaine Shuyu Ng

    Full Text Available Due to the chronic nature of diabetes along with their complications, they have been recognised as a major health issue, which results in significant economic burden. This study aims to estimate the direct medical cost associated with type 2 diabetes mellitus (T2DM in Singapore in 2010 and to examine both the relationship between demographic and clinical state variables with the total estimated expenditure. The National Healthcare Group (NHG Chronic Disease Management System (CDMS database was used to identify patients with T2DM in the year 2010. DM-attributable costs estimated included hospitalisations, accident and emergency (A&E room visits, outpatient physician visits, medications, laboratory tests and allied health services. All charges and unit costs were provided by the NHG. A total of 500 patients with DM were identified for the analyses. The mean annual direct medical cost was found to be $2,034, of which 61% was accounted for by inpatient services, 35% by outpatient services, and 4% by A&E services. Independent determinants of total costs were DM treatments such as the use of insulin only (p<0.001 and the combination of both oral medications and insulin (p=0.047 as well as having complications such as cerebrovascular disease (p<0.001, cardiovascular disease (p=0.002, peripheral vascular disease (p=0.001, and nephropathy (p=0.041. In this study, the cost of DM treatments and DM-related complications were found to be strong determinants of costs. This finding suggests an imperative need to address the economic burden associated with diabetes with urgency and to reorganise resources required to improve healthcare costs.

  4. Physician medical direction and clinical performance at an established emergency medical services system.

    Science.gov (United States)

    Munk, Marc-David; White, Shaun D; Perry, Malcolm L; Platt, Thomas E; Hardan, Mohammed S; Stoy, Walt A

    2009-01-01

    Few developed emergency medical services (EMS) systems operate without dedicated medical direction. We describe the experience of Hamad Medical Corporation (HMC) EMS, which in 2007 first engaged an EMS medical director to develop and implement medical direction and quality assurance programs. We report subsequent changes to system performance over time. Over one year, changes to the service's clinical infrastructure were made: Policies were revised, paramedic scopes of practice were adjusted, evidence-based clinical protocols were developed, and skills maintenance and education programs were implemented. Credentialing, physician chart auditing, clinical remediation, and online medical command/hospital notification systems were introduced. Following these interventions, we report associated improvements to key indicators: Chart reviews revealed significant improvements in clinical quality. A comparison of pre- and post-intervention audited charts reveals a decrease in cases requiring remediation (11% to 5%, odds ratio [OR] 0.43 [95% confidence interval (CI) 0.20-0.85], p = 0.01). The proportion of charts rated as clinically acceptable rose from 48% to 84% (OR 6 [95% CI 3.9-9.1], p < 0.001). The proportion of misplaced endotracheal tubes fell (3.8% baseline to 0.6%, OR 0.16 [95% CI 0.004-1.06], (exact) p = 0.05), corresponding to improved adherence to an airway placement policy mandating use of airway confirmation devices and securing devices (0.7% compliance to 98%, OR 714 [95% CI 64-29,334], (exact) p < 0.001). Intravenous catheter insertion in unstable cases increased from 67% of cases to 92% (OR 1.31 [95% CI 1.09-1.71], p = 0.004). EMS administration of aspirin to patients with suspected ischemic chest pain improved from 2% to 77% (OR 178 [95% CI 35-1,604], p < 0.001). We suggest that implementation of a physician medical direction is associated with improved clinical indicators and overall quality of care at an established EMS system.

  5. Direct medical costs of motorcycle crashes in Ontario.

    Science.gov (United States)

    Pincus, Daniel; Wasserstein, David; Nathens, Avery B; Bai, Yu Qing; Redelmeier, Donald A; Wodchis, Walter P

    2017-11-20

    There is no reliable estimate of costs incurred by motorcycle crashes. Our objective was to calculate the direct costs of all publicly funded medical care provided to individuals after motorcycle crashes compared with automobile crashes. We conducted a population-based, matched cohort study of adults in Ontario who presented to hospital because of a motorcycle or automobile crash from 2007 through 2013. For each case, we identified 1 control absent a motor vehicle crash during the study period. Direct costs for each case and control were estimated in 2013 Canadian dollars from the payer perspective using methodology that links health care use to individuals over time. We calculated costs attributable to motorcycle and automobile crashes within 2 years using a difference-in-differences approach. We identified 26 831 patients injured in motorcycle crashes and 281 826 injured in automobile crashes. Mean costs attributable to motorcycle and automobile crashes were $5825 and $2995, respectively (p motorcycle crashes compared with automobile crashes (2194 injured annually/100 000 registered motorcycles v. 718 injured annually/100 000 registered automobiles; incidence rate ratio [IRR] 3.1, 95% confidence interval [CI] 2.8 to 3.3, p motorcycles v. 12 severe injuries annually/100 000 registered automobiles; IRR 10.4, 95% CI 8.3 to 13.1, p motorcycle in Ontario costs the public health care system 6 times the amount of each registered automobile. Medical costs may provide an additional incentive to improve motorcycle safety. © 2017 Joule Inc. or its licensors.

  6. Excessive somnolence

    Directory of Open Access Journals (Sweden)

    Stella Tavares

    Full Text Available Excessive somnolence can be quite a incapacitating manifestation, and is frequently neglected by physicians and patients. This article reviews the determinant factors, the evaluation and quantification of diurnal somnolence, and the description and treatment of the main causes of excessive somnolence.

  7. Excessive somnolence.

    Science.gov (United States)

    Tavares, S; Alóe, F; Gentil, V; Scaff, M

    1996-01-01

    Excessive somnolence can be quite a incapacitating manifestation, and is frequently neglected by physicians and patients. This article reviews the determinant factors, the evaluation and quantification of diurnal somnolence, and the description and treatment of the main causes of excessive somnolence.

  8. Excessive daytime sleepiness and adherence to antihypertensive medications among Blacks: analysis of the counseling African Americans to control hypertension (CAATCH trial

    Directory of Open Access Journals (Sweden)

    Williams NJ

    2014-03-01

    Full Text Available Natasha J Williams,1 Girardin Jean-Louis,1 Abhishek Pandey,2 Joseph Ravenell,1 Carla Boutin-Foster,3 Gbenga Ogedegbe1 1Center for Healthful Behavior Change, Division of Internal Medicine, NYU Medical Center, New York, 2Department of Family Medicine, SUNY Downstate Medical Center, Brooklyn, 3Center of Excellence in Disparities Research, Weill Cornell Medical College, New York, NY, USA Background: Excessive daytime sleepiness (EDS often occurs as a result of insufficient sleep, sleep apnea, illicit substance use, and other medical and psychiatric conditions. This study tested the hypothesis that blacks exhibiting EDS would have poorer self-reported adherence to hypertensive medication using cross-sectional data from the Counseling African-Americans to Control Hypertension (CAATCH trial. Methods: A total of 1,058 hypertensive blacks (average age 57±12 years participated in CAATCH, a randomized controlled trial evaluating the effectiveness of a multilevel intervention for participants who receive care from community health centers in New York City. Data analyzed in this study included baseline sociodemographics, medical history, EDS, and medication adherence. We used the Epworth Sleepiness Scale, with a cutoff score of ≥10, to define EDS. Medication adherence was measured using an abbreviated Morisky Medication Adherence scale, with a score >0 indicating nonadherence. Results: Of the sample, 71% were female, 72% received at least a high school education, 51% reported a history of smoking, and 33% had a history of alcohol consumption. Overall, 27% of the participants exhibited EDS, and 44% of those who exhibited EDS were classified as adherent to prescribed antihypertensive medications. Multivariable logistic regression analysis, adjusting for effects of age, body mass index, sex, education, and smoking and drinking history indicated that participants who exhibited EDS were more than twice as likely to be nonadherent (odds ratio 2.28, 95

  9. Objectives of teaching direct ophthalmoscopy to medical students.

    Science.gov (United States)

    Benbassat, Jochanan; Polak, Bettine C P; Javitt, Jonathan C

    2012-09-01

    To propose the objectives of undergraduate training in direct ophthalmoscopy (DO). Narrative review of the literature on (i) opinions about the expected proficiency from students in DO, and (ii) estimates of its diagnostic value. (i) Authorities disagree on the proficiency in DO that they expect from students. Textbooks of physical diagnosis differ in their coverage of DO. Surveys have indicated that US physicians expect students to be able to detect optic nerve head abnormalities. The Association of American Medical Colleges expects students to perform ophthalmoscopic examination and describe observations. The International Council of Ophthalmology expects students to recognize also diabetic and hypertensive retinopathies. The Association of University Professors in Ophthalmology requires that students recognize papilloedema, cholesterol emboli, glaucomatous cupping and macular degeneration. (ii) There is evidence that DO, even by ophthalmologists, is inadequate for screening for glaucoma, diabetic and hypertensive retinopathies. Two studies have suggested a limited value of DO in detecting clinical emergencies. The evidence that DO, even by ophthalmologists, is sub-optimal in detecting common abnormalities challenges existing the notions of training medical students. On pending the results of additional studies of the value of DO in detecting emergencies, we suggest that undergraduate teaching of DO should impart the following: (i) an ability to identify the red fundus reflex and optic disc; (ii) an ability to recognize signs of clinical emergencies in patients, mannequins or fundus photographs; and (iii) knowledge about, but not an ability to detect, other retinopathies. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

  10. Estimates of excess medically attended acute respiratory infections in periods of seasonal and pandemic influenza in Germany from 2001/02 to 2010/11.

    Directory of Open Access Journals (Sweden)

    Matthias An der Heiden

    Full Text Available BACKGROUND: The number of patients seeking health care is a central indicator that may serve several different purposes: (1 as a proxy for the impact on the burden of the primary care system; (2 as a starting point to estimate the number of persons ill with influenza; (3 as the denominator data for the calculation of case fatality rate and the proportion hospitalized (severity indicators; (4 for economic calculations. In addition, reliable estimates of burden of disease and on the health care system are essential to communicate the impact of influenza to health care professionals, public health professionals and to the public. METHODOLOGY/PRINCIPAL FINDINGS: Using German syndromic surveillance data, we have developed a novel approach to describe the seasonal variation of medically attended acute respiratory infections (MAARI and estimate the excess MAARI attributable to influenza. The weekly excess inside a period of influenza circulation is estimated as the difference between the actual MAARI and a MAARI-baseline, which is established using a cyclic regression model for counts. As a result, we estimated the highest ARI burden within the last 10 years for the influenza season 2004/05 with an excess of 7.5 million outpatient visits (CI95% 6.8-8.0. In contrast, the pandemic wave 2009 accounted for one third of this burden with an excess of 2.4 million (CI95% 1.9-2.8. Estimates can be produced for different age groups, different geographic regions in Germany and also in real time during the influenza waves.

  11. Building bridges: future directions for medical error disclosure research.

    Science.gov (United States)

    Hannawa, Annegret F; Beckman, Howard; Mazor, Kathleen M; Paul, Norbert; Ramsey, Joanne V

    2013-09-01

    The disclosure of medical errors has attracted considerable research interest in recent years. However, the research to date has lacked interdisciplinary dialog, making translation of findings into medical practice challenging. This article lays out the disciplinary perspectives of the fields of medicine, ethics, law and communication on medical error disclosure and identifies gaps and tensions that occur at these interdisciplinary boundaries. This article summarizes the discussion of an interdisciplinary error disclosure panel at the 2012 EACH Conference in St. Andrews, Scotland, in light of the current literature across four academic disciplines. Current medical, ethical, legal and communication perspectives on medical error disclosure are presented and discussed with particular emphasis on the interdisciplinary gaps and tensions. The authors encourage interdisciplinary collaborations that strive for a functional approach to understanding and improving the disclosure of medical errors with the ultimate goal to improve quality and promote safer medical care. Interdisciplinary collaborations are needed to reconcile the needs of the stakeholders involved in medical error disclosure. A particular challenge is the effective translation of error disclosure research into practice. Concrete research questions are provided throughout the manuscript to facilitate a resolution of the tensions that currently impede interdisciplinary progress. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Medication adherence and direct treatment cost among diabetes ...

    African Journals Online (AJOL)

    SH, Morisky DE. Adherence and satisfaction with oral hypoglycemic medications: a pilot study in Palestine. Int J Clin Pharm. 2011. Dec;33(6):942-8. 45. Mateo JF, Gil-Guillen VF, Mateo E, Orozco D, Carbayo JA, Merino. J. Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes.

  13. Medication Adherence and Direct Treatment Cost among Diabetes ...

    African Journals Online (AJOL)

    Saharan Africa, with associated health and socioeconomic consequences. Adherence to antidiabetic medications has been shown to improve glycaemic control, which subsequently improves both the short- and longterm prognosis of the ...

  14. International medical education and future directions: a global perspective.

    Science.gov (United States)

    Harden, Ronald M

    2006-12-01

    Internationalization, one of the most important forces in higher education today, presents a powerful challenge and an opportunity for medical schools. Factors encouraging internationalization include (1) globalization of health care delivery, (2) governmental pressures, (3) improved communication channels, (4) development of a common vocabulary, (5) outcome-based education and standards, (6) staff development initiatives, and (7) competitiveness and commercialization. A three-dimensional model--based on the student (local or international), the teacher (local or international), and the curriculum (local, imported, or international)-offers a range of perspectives for international medical education. In the traditional approach to teaching and learning medicine, local students and local teachers use a local curriculum. In the international medical graduate or overseas student model, students from one country pursue in another country a curriculum taught and developed by teachers in the latter. In the branch-campus model, students, usually local, have an imported curriculum taught jointly by international and local teachers. The future of medical education, facilitated by the new learning technologies and pedagogies, lies in a move from such international interconnected approaches, which emphasize the mobility of students, teachers, and curriculum across the boundaries of two countries, to a transnational approach in which internationalization is integrated and embedded within a curriculum and involves collaboration between a number of schools in different countries. In this approach, the study of medicine is exemplified in the global context rather than the context of a single country. The International Virtual Medical School serves as an example in this regard.

  15. Directing Discipline: State Medical Board Responsiveness to State Legislatures.

    Science.gov (United States)

    Lillvis, Denise F; McGrath, Robert J

    2017-02-01

    State medical boards are increasingly responsible for regulating medical and osteopathic licensure and professional conduct in the United States. Yet, there is great variation in the extent to which such boards take disciplinary action against physicians, indicating that some boards are more zealous regulators than others. We look to the political roots of such variation and seek to answer a simple, yet important, question: are nominally apolitical state medical boards responsive to political preferences? To address this question, we use panel data on disciplinary actions across sixty-four state medical boards from 1993 through 2006 and control for over-time changes in board characteristics (e.g., composition, independence, budgetary status), regulatory structure, and resources. We show that as state legislatures become more liberal [conservative], state boards increasingly [decreasingly] discipline physicians, especially during unified government and in the presence of highly professional legislatures. Our conclusions join others in emphasizing the importance of state medical boards and the contingent nature of political control of state regulation. In addition, we emphasize the roles that oversight capacity and strategy play in offsetting concerns regarding self-regulation of a powerful organized interest. Copyright © 2017 by Duke University Press.

  16. Racial disparities in living kidney donation: is there a lack of willing donors or an excess of medically unsuitable candidates?

    Science.gov (United States)

    Lunsford, Shayna L; Simpson, Kit S; Chavin, Kenneth D; Menching, Kerry J; Miles, Lucia G; Shilling, Lilless M; Smalls, Gilbert R; Baliga, Prabhakar K

    2006-10-15

    Live kidney donation is safe for healthy donors and an effective treatment for patients with end-stage renal disease. Many potential donors are referred for live kidney donation, but only a small percentage donate. This study aims to determine reasons for nondonation and establish if racial differences exist. A retrospective database and chart review of all patients that were referred for potential live kidney donation from January 1, 2000 to December 31, 2004 was conducted. In all, 30.3% of referred potential live kidney donors were lost to follow-up. Primary reasons for nondonation (n=1,050) included unsuitable donor health (43.1%) and recipient-based causes (41.3%). Immunologic incompatibility accounted for 9.7% of all nondonations. Racial differences indicated more African Americans had incompatible blood types (P=0.01) or ineligible recipients (26.7% vs. 14.4%, Pdonated (13.2% vs. 4.6%, Porgan (living/cadaveric) (20.0% versus 7.9%, Pdonation. More African American donor referrals are lost to follow-up while rates of other reasons were similar among races. This may indicate that African Americans are not more frequently medically unsuitable, but that the divergence in rates of live kidney donation is caused by a disparity in willingness to donate among African Americans.

  17. [Relationship between self-directed learning with learning styles and strategies in medical students].

    Science.gov (United States)

    Márquez U, Carolina; Fasce H, Eduardo; Pérez V, Cristhian; Ortega B, Javiera; Parra P, Paula; Ortiz M, Liliana; Matus B, Olga; Ibáñez G, Pilar

    2014-11-01

    Self-directed learning (SDL) skills are particularly important in medical education, considering that physicians should be able to regulate their own learning experiences. To evaluate the relationship between learning styles and strategies and self-directed learning in medical students. One hundred ninety nine first year medical students (120 males) participated in the study. Preparation for Independent Learning (EPAI) scale was used to assess self-direction. Schmeck learning strategies scale and Honey and Alonso (CHAEA) scales were used to evaluate learning styles and strategies. Theoretical learning style and deep processing learning strategy had positive correlations with self-direct learning. Medical students with theoretical styles and low retention of facts are those with greater ability to self-direct their learning. Further studies are required to determine the relationship between learning styles and strategies with SDL in medical students. The acquired knowledge will allow the adjustment of teaching strategies to encourage SDL.

  18. The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan.

    Science.gov (United States)

    Yoritaka, Asako; Fukae, Jiro; Hatano, Taku; Oda, Eisei; Hattori, Nobutaka

    2016-01-01

    Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.

  19. Objectives of teaching direct ophthalmoscopy to medical students

    NARCIS (Netherlands)

    Benbassat, J.; Polak, B.C.P.; Javitt, J.C.

    2012-01-01

    Purpose: To propose the objectives of undergraduate training in direct ophthalmoscopy (DO). Method: Narrative review of the literature on (i) opinions about the expected proficiency from students in DO, and (ii) estimates of its diagnostic value. Results: (i) Authorities disagree on the proficiency

  20. Medical models of teleoncology: current status and future directions.

    Science.gov (United States)

    Sabesan, Sabe

    2014-09-01

    Teleoncology has been adopted by many centers to provide cancer care closer to home for rural, remote, Indigenous and other disadvantaged people of our communities. A variety of medical models of teleoncology exist to provide various medical oncology services. While most centers use teleoncology to complement their face-to-face outreach services, some centers have replaced face-to-face with teleoncology models. Selection of patients and scheduling of clinics would depend on various factors including experience of the clinicians, complexity of treatment provided, capabilities and workforce of rural sites, and patient preferences. Many small studies reported high satisfaction rates of these models among patients and health professionals including Indigenous populations. One single center study reports that it is safe to supervise chemotherapy delivery remotely and many studies report cost savings to the health systems. Further studies on safety aspects of teleoncology are needed to further improve the current models. Future teleoncology models would need to include Web-based models, mobile technologies and remote chemotherapy supervision models so that patients from most rural towns could have at least some of their cancer care closer to home. © 2014 Wiley Publishing Asia Pty Ltd.

  1. Direct cost of medical care in patients with gonarthrosis.

    Science.gov (United States)

    Villarreal-Ríos, Enrique; Cedillo-García, Margarita; Vargas-Daza, Emma Rosa; Galicia-Rodríguez, Liliana; Martínez-González, Lidia; Escorcia-Reyes, Verónica

    2017-12-16

    To determine the cost of medical care in patients with gonarthrosis. Cost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopedics, hospitalization, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios. Grade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8 - 45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure. The average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  2. Transnational nurse migration: future directions for medical anthropological research.

    Science.gov (United States)

    Prescott, Megan; Nichter, Mark

    2014-04-01

    Transnational nurse migration is a serious global health issue in which inequitably distributed shortages hinder health and development goals. This article selectively reviews the literature on nurse migration that has emerged from nursing, health planning, and the social sciences and offers productive directions for future anthropological research. The literature on global nurse migration has largely focused on push/pull economic logic and the concept of brain drain to understand the causes and effects of nurse migration. These concepts obscure political-economic, historical, and cultural factors that pattern nurse migration and influence the complex effects of nurse migration. Global nurse care chain analysis helps illuminate the numerous nodes in the production and migration of nurses, and management of this transnational process. Examples are provided from the Philippines and India to illustrate ways in which this analysis may be deepened, refined and rendered more critical by anthropological research. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Excessive crying in infants

    Directory of Open Access Journals (Sweden)

    Ricardo Halpern

    2016-06-01

    Full Text Available ABSTRACT Objective: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. Data source: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms “excessive crying,” and “infantile colic,” as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. Summary of the findings: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. Conclusion: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative

  4. Nanoparticles in medical applications – a direction of the future?

    Directory of Open Access Journals (Sweden)

    Anna Jung

    2014-06-01

    Full Text Available Methods of producing nanoparticles, called nanotechnologies, have inspired lively interest over the recent years due to the broad possibilities for application of nanoparticles in numerous fields, including electronics, information technology, biotechnology, medicine, pharmacy, cosmetology and others. Nanoparticles are defined as particles which may occur in various shapes and which have at least one dimension smaller than 100 nm. Depending on the process of creation we can differentiate between natural nanoparticles occurring in the environment and designed nanoparticles, which are man-made. Designed nanoparticles are characterised by special physical properties which make them suitable for biomedical applications, among others. An example of such an application is the use of silver nanocomposites, which in a micronised form display a strong bacteriostatic and bactericidal effect. Graphene, the latest achievement of nanotechnology with unique mechanical and physical properties, is another material which raises much interest among researchers. The dynamic development of numerous directions in modern technologies based on nanotechnologies is an indisputable sign of progress. The discovery of the unique properties of nanomaterials opens wide possibilities for numerous applications; however, it also requires comprehensive research to ensure they are safe to use.

  5. Laser direct writing of micro- and nano-scale medical devices.

    Science.gov (United States)

    Gittard, Shaun D; Narayan, Roger J

    2010-05-01

    Laser-based direct writing of materials has undergone significant development in recent years. The ability to modify a variety of materials at small length scales and using short production times provides laser direct writing with unique capabilities for fabrication of medical devices. In many laser-based rapid prototyping methods, microscale and submicroscale structuring of materials is controlled by computer-generated models. Various laser-based direct write methods, including selective laser sintering/melting, laser machining, matrix-assisted pulsed-laser evaporation direct write, stereolithography and two-photon polymerization, are described. Their use in fabrication of microstructured and nanostructured medical devices is discussed. Laser direct writing may be used for processing a wide variety of advanced medical devices, including patient-specific prostheses, drug delivery devices, biosensors, stents and tissue-engineering scaffolds.

  6. Motivational foci and asthma medication tactics directed towards a functional day

    Directory of Open Access Journals (Sweden)

    Lötvall Jan

    2011-10-01

    Full Text Available Abstract Background There appears to be an obvious gap between a medical and patient adherence perspective. Deviating from a medication prescription could be regarded as fairly irrational, but with respect to patients' goals and/or concerns it could be seen as understandable. Thus, the aim was to elucidate adherence reasoning in relation to asthma medication. Methods This was a qualitative study; data collection and analysis procedures were conducted according to Grounded Theory methodology. Eighteen persons, aged 22 with asthma and regular asthma medication treatment, were interviewed. Results The emerged theoretical model illustrated that adherence to asthma medication was motivated by three foci, all directed towards a desired outcome in terms of a functional day as desired by the patient. A promotive focus was associated with the ambition to achieve a positive asthma outcome by being adherent either to the received prescription or to a self-adjusted dosage. A preventive focus was intended to ensure avoidance of a negative asthma outcome either by sticking to the prescription or by preventively overusing the medication. A permissive focus was associated with unstructured adherence behaviour in which medication intake was primarily triggered by asthma symptoms. Conclusions As all participants had consciously adopted functioning medication tactics that directed them towards the desired goal of a functional day. In an effort to bridge the gap between a patient- and a medical adherence perspective, patients need support in defining their desired functionality and guidance in developing a person-based medication tactic.

  7. Effects of a direct refill program for automated dispensing cabinets on medication-refill errors.

    Science.gov (United States)

    Helmons, Pieter J; Dalton, Ashley J; Daniels, Charles E

    2012-10-01

    The effects of a direct refill program for automated dispensing cabinets (ADCs) on medication-refill errors were studied. This study was conducted in designated acute care areas of a 386-bed academic medical center. A wholesaler-to-ADC direct refill program, consisting of prepackaged delivery of medications and bar-code-assisted ADC refilling, was implemented in the inpatient pharmacy of the medical center in September 2009. Medication-refill errors in 26 ADCs from the general medicine units, the infant special care unit, the surgical and burn intensive care units, and intermediate units were assessed before and after the implementation of this program. Medication-refill errors were defined as an ADC pocket containing the wrong drug, wrong strength, or wrong dosage form. ADC refill errors decreased by 77%, from 62 errors per 6829 refilled pockets (0.91%) to 8 errors per 3855 refilled pockets (0.21%) (p error type detected before the intervention was the incorrect medication (wrong drug, wrong strength, or wrong dosage form) in the ADC pocket. Of the 54 incorrect medications found before the intervention, 38 (70%) were loaded in a multiple-drug drawer. After the implementation of the new refill process, 3 of the 5 incorrect medications were loaded in a multiple-drug drawer. There were 3 instances of expired medications before and only 1 expired medication after implementation of the program. A redesign of the ADC refill process using a wholesaler-to-ADC direct refill program that included delivery of prepackaged medication and bar-code-assisted refill significantly decreased the occurrence of ADC refill errors.

  8. 42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

    Science.gov (United States)

    2010-10-01

    ... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services furnished...

  9. [Future trend medical apps. From the apps store directly into medical practice?].

    Science.gov (United States)

    Gehring, H; Pramann, O; Imhoff, M; Albrecht, U-V

    2014-12-01

    In day to day medical care, patients, nursing staff and doctors currently face a bewildering and rapidly growing number of health-related apps running on various "smart" devices and there are also uncountable possibilities for the use of such technology. Concerning regulation, a risk-based approach is applied for development and use (including safety and security considerations) of medical and health-related apps. Considering safety-related issues as well as organizational matters, this is a sensible approach but requires honest self-assessment as well as a high degree of responsibility, networking and good quality management by all those involved. This cannot be taken for granted. Apart from regulatory aspects it is important to not only consider what is reasonable, helpful or profitable. Quality aspects, safety matters, data protection and privacy as well as liability issues must also be considered but are often not adequately respected. If software quality is compromised, this endangers patient safety as well as data protection, privacy and data integrity. This can for example result in unwanted advertising or unauthorized access to the stored data by third parties; therefore, local, regional and international regulatory measures need to be applied in order to ensure safe use of medical apps in all possible areas, including the operating room (OR) with its highly specialized demands. Lawmakers need to include impulses from all stakeholders in their considerations and this should include input from existing private initiatives that already deal with the use and evaluation of apps in a medical context. Of course, this process needs to respect pre-existing national, European as well as international (harmonized) standards.

  10. PERSONNEL PROCESSES IN MEDICAL ORGANIZATIONS: THE STATE AND DIRECTIONS OF REGULATION

    Directory of Open Access Journals (Sweden)

    I. A. Kaprina

    2017-01-01

    Full Text Available Results of sociological research of problem questions of regulation of personnel processes in the medical organizations are presented in this article. The problem of reforming medical organizations is characterized. Proposals on the solution of currently important problems of personnel regulation in medical organizations are formulated.The purpose of the research is to substantiate the directions of improving the management of personnel processes in modern medical organizations based on the sociological analysis of personnel processes and relations in medical organizations.Materials and methods. The paper presents the results of a sociological study of the condition and problems of regulation of personnel processes in medical organizations. The survey involved 240 respondents from among the employees of medical organizations and 97 qualified medical experts.Results. It is proved that the successful functioning of medical organizations is possible with a scientific approach to the management of personnel processes and relations, including analysis of personnel policy issues, sociological support of personnel processes regulation, development of human resources technologies in modern medical organizations.Conclusions. Successful functioning of medical organizations is possible with a scientific approach to the management of personnel processes and relations, including analysis of personnel policy issues, sociological support of personnel processes regulation, development of modern personnel technologies in medical organizations. Achievement of effective management of personnel processes in medical organizations requires the development and implementation of scientifically sound human resources policy in the health care system, improving the regulatory and organizational support for the regulation of personnel processes, enhancing the role of self-regulatory organizationsin the management of personnel processes in medical organizations. 

  11. A Comparison of Expedition Medical Condition List Treatment Directives with Integrated Medical Model Simulation Data Presentation and Briefing Report

    Science.gov (United States)

    Lewis, Robert

    2013-01-01

    This aerospace medicine clerkship project is under the direction of Dr. Sharmila Watkins and is in cooperation with Dr. Eric Kerstman and Dr. Ronak Shah. The questions of the research project are: 1. What are the main drivers of evacuation and loss of crew life (LOCL) on three Design Reference Missions (DRMs): Near Earth Asteroid (NEA), Lunar Sortie and Lunar Outpost using an inexhaustible International Space Station medical kit 2. What are the treatment designations for these driving medical conditions as listed in Expedition Medical Condition List (EMCL) 3. Do the drivers make sense in the context of the given Design Reference Mission (DRM) 4. Do any EMCL treatment designations need re-assessing.

  12. Learner-Directed Nutrition Content for Medical Schools to Meet LCME Standards

    Directory of Open Access Journals (Sweden)

    Lisa A. Hark

    2015-01-01

    Full Text Available Deficiencies in medical school nutrition education have been noted since the 1960s. Nutrition-related non-communicable diseases, including heart disease, stroke, cancer, diabetes, and obesity, are now the most common, costly, and preventable health problems in the US. Training medical students to assess diet and nutritional status and advise patients about a healthy diet, exercise, body weight, smoking, and alcohol consumption are critical to reducing chronic disease risk. Barriers to improving medical school nutrition content include lack of faculty preparation, limited curricular time, and the absence of funding. Several new LCME standards provide important impetus for incorporating nutrition into existing medical school curriculum as self-directed material. Fortunately, with advances in technology, electronic learning platforms, and web-based modules, nutrition can be integrated and assessed across all four years of medical school at minimal costs to medical schools. Medical educators have access to a self-study nutrition textbook, Medical Nutrition and Disease, Nutrition in Medicine© online modules, and the NHLBI Nutrition Curriculum Guide for Training Physicians. This paper outlines how learner-directed nutrition content can be used to meet several US and Canadian LCME accreditation standards. The health of the nation depends upon future physicians’ ability to help their patients make diet and lifestyle changes.

  13. The relationship between assessment methods and self-directed learning readiness in medical education.

    Science.gov (United States)

    Monroe, Katherine S

    2016-03-11

    This research explored the assessment of self-directed learning readiness within the comprehensive evaluation of medical students' knowledge and skills and the extent to which several variables predicted participants' self-directed learning readiness prior to their graduation. Five metrics for evaluating medical students were considered in a multiple regression analysis. Fourth-year medical students at a competitive US medical school received an informed consent and an online survey. Participants voluntarily completed a self-directed learning readiness scale that assessed four subsets of self-directed learning readiness and consented to the release of their academic records. The assortment of metrics considered in this study only vaguely captured students' self-directedness. The strongest predictors were faculty evaluations of students' performance on clerkship rotations. Specific clerkship grades were mildly predictive of three subscales. The Pediatrics clerkship modestly predicted critical self-evaluation (r=-.30, p=.01) and the Psychiatry clerkship mildly predicted learning self-efficacy (r =-.30, p=.01), while the Junior Surgery clerkship nominally correlated with participants' effective organization for learning (r=.21, p=.05). Other metrics examined did not contribute to predicting participants' readiness for self-directed learning. Given individual differences among participants for the variables considered, no combination of students' grades and/or test scores overwhelmingly predicted their aptitude for self-directed learning. Considering the importance of fostering medical students' self-directed learning skills, schools need a reliable and pragmatic approach to measure them. This data analysis, however, offered no clear-cut way of documenting students' self-directed learning readiness based on the evaluation metrics included.

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

    Science.gov (United States)

    Tsouroufli, Maria; Payne, Heather

    2008-05-20

    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). 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. 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. 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.

  15. 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.

  16. Direct medical costs of constipation in children over 15 years: a population-based birth cohort

    Science.gov (United States)

    Choung, Rok Seon; Shah, Nilay D.; Chitkara, Denesh; Branda, Megan E.; Van Tilburg, Miranda A.; Whitehead, William E.; Katusic, Slavica K.; Locke, G. Richard; Talley, Nicholas J.

    2011-01-01

    Background Although direct medical costs for constipation-related medical visits are thought to be high, to date there have been no studies examining if longitudinal resource utilization is persistently elevated in children with constipation. Our aim was to estimate the incremental direct medical costs and types of health care utilization associated with constipation from childhood to early adulthood. Methods A nested case-control study was conducted to evaluate the incremental costs associated with constipation. The original sample consisted of 5,718 children in a population-based birth cohort who were born during 1976–1982 in Rochester, MN. The cases included individuals who presented to medical facilities with constipation. The controls were matched and randomly selected among all non-cases in the sample. Direct medical costs for cases and controls were collected from the time subjects were between 5–18 years of age or until the subject emigrated from the community. Results We identified 250 cases with a diagnosis of constipation in the birth cohort. While the mean inpatient costs for cases were $9994 (95% CI=2538, 37201) compared to $2391 (95% CI=923, 7452) for controls (p=0.22) over the time period, the mean outpatient costs for cases were $13927 (95% CI=11325, 16525) compared to $3448 (95% CI=3771, 4621) for controls (pconstipation have higher medical care utilization. Outpatient costs and ER utilization were significantly greater for individuals with constipation from childhood to early adulthood. PMID:20890220

  17. Evaluation of an online peer fundus photograph matching program in teaching direct ophthalmoscopy to medical students.

    Science.gov (United States)

    Kwok, Jason; Liao, Walter; Baxter, Stephanie

    2017-10-01

    Direct ophthalmoscopy is an important clinical skill that is often poorly performed by medical professionals and students. This is attributable to a declining emphasis on ophthalmology in medical school. We present and evaluate a self-directed approach of teaching ophthalmoscopy to medical students that is suitable for the current medical curriculum. Prospective medical education trial. Ninety-five second-year medical students at Queen's University: 32 in the experimental group and 63 in the control group. The experimental group consisted of medical students who practised ophthalmoscopy with one another using an online peer fundus photograph matching exercise created by the Department of Ophthalmology at Queen's University. To use the program, students first examined a peer with an ophthalmoscope and then selected an online photograph of a fundus corresponding to that of the examinee. The program notifies students if a correct selection is made. To encourage use of the program, students participated in a 2-week ophthalmoscopy competition during their ophthalmology rotation. The control group consisted of students who did not participate in the learning exercise. On assessment at the end of the ophthalmology rotation, the experimental group (n = 32) was more accurate in matching fundus photographs compared with the control group (n = 63) (p = 0.02). Participants were faster at performing ophthalmoscopy at the end of the learning exercise (p < 0.01). All students in the experimental group reported increased confidence levels in ophthalmoscopy after participation in the learning exercise. Matching online peer fundus photographs in a self-directed manner appeared to increase the skill and confidence of medical students in ophthalmoscopy. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  18. 42 CFR 415.160 - Election of reasonable cost payment for direct medical and surgical services of physicians in...

    Science.gov (United States)

    2010-10-01

    ... medical and surgical services of physicians in teaching hospitals: General provisions. 415.160 Section 415... Election of reasonable cost payment for direct medical and surgical services of physicians in teaching... cost basis for the direct medical and surgical services of its physicians in lieu of fee schedule...

  19. Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

    Science.gov (United States)

    Eristina; Andayani, T. M.; Oetari, R. A.

    2017-11-01

    Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

  20. Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

    Science.gov (United States)

    Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

    2010-01-01

    Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (1968–2009), EconLit (1969–2009), and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

  1. Direct medical costs of serious gastrointestinal ulcers among users of NSAIDs

    NARCIS (Netherlands)

    Vonkeman, H.E.; Klok, R.M.; Postma, M.J.; Brouwers, J.R.B.J.; van de Laar, M.A.F.J.

    2007-01-01

    Background: The occurrence and prevention of gastrointestinal ulcers during use of NSAIDs has become a major healthcare issue. Objective: To determine the direct medical costs of serious NSAID-related ulcer complications. Method: An observational cost-of-illness study was conducted in a large

  2. Developing technology-enhanced active learning for medical education: challenges, solutions, and future directions.

    Science.gov (United States)

    McCoy, Lise; Pettit, Robin K; Lewis, Joy H; Bennett, Thomas; Carrasco, Noel; Brysacz, Stanley; Makin, Inder Raj S; Hutman, Ryan; Schwartz, Frederic N

    2015-04-01

    Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities.

  3. The Role of teacher in medical student self-directed learning process

    Directory of Open Access Journals (Sweden)

    Francisca A Tjakradidjaja

    2016-02-01

    Full Text Available Self-directed learning (SDL is essential in medical education. The rapid development of medical science and the expansion of health problems need a physician who can meet that challenges. A physician must have lifelong learning ability. SDL is one of the important requirements for lifelong learning ability. In SDL, learners are the controller of learning and learners have the freedom to learn according to their needs. Therefore, it is necessary to explore the role of the teacher in the SDL process, particularly in medical education. This study used a qualitative exploratory design. Twelve teachers and 23 medical students were selected by purposive sampling. There were seven themes that emerged from the analysis. The role of teacher in the SDL process includes: (1 Competent; (2 Concern; (3 Creative; (4 Facilitator; (5 Motivator; (6 Partners; and (7 Role Model.

  4. A preliminary investigation of opinions and behaviors regarding advance directives for medical care.

    Science.gov (United States)

    Elpern, E H; Yellen, S B; Burton, L A

    1993-03-01

    Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.

  5. Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country.

    Science.gov (United States)

    Montini, Giovanni; Edefonti, Alberto; Galán, Yajaira Silva; Sandoval Díaz, Mabel; Medina Manzanarez, Marta; Marra, Giuseppina; Robusto, Fabio; Tognoni, Gianni; Sereni, Fabio

    2016-01-01

    The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations. We report a prospective outcome study on the independent contribution and reciprocal interaction of the medical and socioeconomic factors to the hard end-point of mortality in a cohort of children with chronic kidney disease in Nicaragua. Every child (n = 309) diagnosed with chronic kidney disease (CKD) and referred to the tertiary unit of Pediatric Nephrology in Managua (Nicaragua) from a network of nine hospitals serving 80% of the country's pediatric population was registered between January 2005 and December 2013. The three main socioeconomic determinants evaluated were family income, living conditions and the family's level of education. Further potential determinants of the outcomes included duration of exposure to disease, CKD stage at the first visit as suggested by the KDOQI guidelines in children, the time it took the patients to reach the reference centre and rural or urban context of life. Well-defined and systematically collected medical and socioeconomic data were available for 257 children over a mean follow-up period of 2.5±2.5 years. Mortality and lost to follow-up were considered as outcome end-points both independently and in combination, because of the inevitably progressive nature of the disease. A high proportion (55%) of children presented in the advanced stages of CKD (CKD stage IV and V) at the first visit. At the end of follow-up, 145 (57%) of the 257 cohort children were alive, 47 (18%) were lost to follow-up and 65 (25

  6. Non-Medical Risk Factors as Avoidable Determinants of Excess Mortality in Children with Chronic Kidney Disease. A Prospective Cohort Study in Nicaragua, a Model Low Income Country.

    Directory of Open Access Journals (Sweden)

    Giovanni Montini

    Full Text Available The widely recognized clinical and epidemiological relevance of the socioeconomic determinants of health-disease conditions is expected to be specifically critical in terms of chronic diseases in fragile populations in low-income countries. However, in the literature, there is a substantial gap between the attention directed towards the medical components of these problems and the actual adoption of strategies aimed at providing solutions for the associated socioeconomic determinants, especially in pediatric populations. We report a prospective outcome study on the independent contribution and reciprocal interaction of the medical and socioeconomic factors to the hard end-point of mortality in a cohort of children with chronic kidney disease in Nicaragua.Every child (n = 309 diagnosed with chronic kidney disease (CKD and referred to the tertiary unit of Pediatric Nephrology in Managua (Nicaragua from a network of nine hospitals serving 80% of the country's pediatric population was registered between January 2005 and December 2013. The three main socioeconomic determinants evaluated were family income, living conditions and the family's level of education. Further potential determinants of the outcomes included duration of exposure to disease, CKD stage at the first visit as suggested by the KDOQI guidelines in children, the time it took the patients to reach the reference centre and rural or urban context of life. Well-defined and systematically collected medical and socioeconomic data were available for 257 children over a mean follow-up period of 2.5±2.5 years. Mortality and lost to follow-up were considered as outcome end-points both independently and in combination, because of the inevitably progressive nature of the disease. A high proportion (55% of children presented in the advanced stages of CKD (CKD stage IV and V at the first visit. At the end of follow-up, 145 (57% of the 257 cohort children were alive, 47 (18% were lost to follow

  7. Sexuality education in North American medical schools: current status and future directions.

    Science.gov (United States)

    Shindel, Alan W; Parish, Sharon J

    2013-01-01

    Both the general public and individual patients expect healthcare providers to be knowledgeable and approachable regarding sexual health. Despite this expectation there are no universal standards or expectations regarding the sexuality education of medical students. To review the current state of the art in sexuality education for North American medical students and to articulate future directions for improvement. Evaluation of: (i) peer-reviewed literature on sexuality education (focusing on undergraduate medical students); and (ii) recommendations for sexuality education from national and international public health organizations. Current status and future innovations for sexual health education in North American medical schools. Although the importance of sexuality to patients is recognized, there is wide variation in both the quantity and quality of education on this topic in North American medical schools. Many sexual health education programs in medical schools are focused on prevention of unwanted pregnancy and sexually transmitted infection. Educational material on sexual function and dysfunction, female sexuality, abortion, and sexual minority groups is generally scant or absent. A number of novel interventions, many student initiated, have been implemented at various medical schools to improve the student's training in sexual health matters. There is a tremendous opportunity to mold the next generation of healthcare providers to view healthy sexuality as a relevant patient concern. A comprehensive and uniform curriculum on human sexuality at the medical school level may substantially enhance the capacity of tomorrow's physicians to provide optimal care for their patients irrespective of gender, sexual orientation, and individual sexual mores/beliefs. © 2013 International Society for Sexual Medicine.

  8. [The impact of a self-directed teaching approach on academic performance of medical students].

    Science.gov (United States)

    Williams, Carolina; Santelices, Lucía; Ávila, Mario; Soto, Mauricio; Dougnac, Alberto

    2017-05-01

    Students should be encouraged to become reflexive and develop autonomous, lifelong learning habits. Therefore, teachers should focus on learning strategies which stimulate autonomous learning. To assess the impact of a self-directed teaching methodology on the academic performance of medical students in cellular biology and biochemistry. During 2013, 85 students received a traditional teaching methodology and during 2014, 85 students received a self-directed learning methodology. The grades obtained and the number of failures in the courses of cellular biology and biochemistry were compared in both groups. The percentages of students approved at the end of the courses during 2013 and 2014 were 64 and 96% respectively (p teaching approach.

  9. Direct medical costs of accidental falls for adults with transfemoral amputations.

    Science.gov (United States)

    Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

    2017-12-01

    Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

  10. Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain.

    Science.gov (United States)

    Darbà, Josep; Kaskens, Lisette

    2015-01-01

    The objectives of this analysis were to examine how patients' dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer's disease (AD) in Spain. The Co-Dependence in Alzheimer's Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures) also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care. The mean (standard deviation) costs per patient over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00), €843.80 (€2,684.80), €464.20 (€1,639.00), and €33,232.20 (

  11. 21 CFR 250.12 - Stramonium preparations labeled with directions for use in self-medication regarded as misbranded.

    Science.gov (United States)

    2010-04-01

    ... for use in self-medication regarded as misbranded. 250.12 Section 250.12 Food and Drugs FOOD AND DRUG... for use in self-medication regarded as misbranded. (a) Stramonium products for inhalation have been... ingredients, will be regarded as misbranded if they are labeled with directions for use in self-medication. (2...

  12. Emergency repair of inguinal hernia in the premature infant is associated with high direct medical costs.

    Science.gov (United States)

    Verhelst, J; de Goede, B; van Kempen, B J H; Langeveld, H R; Poley, M J; Kazemier, G; Jeekel, J; Wijnen, R M H; Lange, J F

    2016-08-01

    Inguinal hernia repair is frequently performed in premature infants. Evidence on optimal management and timing of repair, as well as related medical costs is still lacking. The objective of this study was to determine the direct medical costs of inguinal hernia, distinguishing between premature infants who had to undergo an emergency procedure and those who underwent elective inguinal hernia repair. This cohort study based on medical records concerned premature infants with inguinal hernia who underwent surgical repair within 3 months after birth in a tertiary academic children's hospital between January 2010 and December 2013. Two groups were distinguished: patients with incarcerated inguinal hernia requiring emergency repair and patients who underwent elective repair. Real medical costs were calculated by multiplying the volumes of healthcare use with corresponding unit prices. Nonparametric bootstrap techniques were used to derive a 95 % confidence interval (CI) for the difference in mean costs. A total of 132 premature infants were included in the analysis. Emergency surgery was performed in 29 %. Costs of hospitalization comprised 65 % of all costs. The total direct medical costs amounted to €7418 per premature infant in the emergency repair group versus €4693 in the elective repair group. Multivariate analysis showed a difference in costs of €1183 (95 % CI -1196; 3044) in favor of elective repair after correction for potential risk factors. Emergency repair of inguinal hernia in premature infants is more expensive than elective repair, even after correction for multiple confounders. This deserves to be taken into account in the debate on timing of inguinal hernia repair in premature infants.

  13. Disease-specific direct-to-consumer advertising for reminding consumers to take medications.

    Science.gov (United States)

    Bhutada, Nilesh S; Rollins, Brent L

    2015-01-01

    To assess the relationship between disease-specific direct-to-consumer (DTC) advertising, via traditional advertising effectiveness measures, and consumers' self-reported medication-taking behavior. Data were gathered for 514 respondents (age 18 and above) using an online survey panel. Participants were exposed to a disease-specific (i.e., nonbranded) DTC advertising for depression. The advertising stimulus created for the study was based on the Food and Drug Administration guidelines for disease-specific DTC advertising and modeled after current print disease-specific DTC advertising. Participants reviewed the advertising stimulus through the online program and then responded to a questionnaire containing closed-ended questions assessing the constructs. Data were analyzed using chi-square tests. All tests were interpreted at an a priori alpha of 0.05. Significantly more respondents who were highly involved, paid more attention to the advertisement, and were responsive to DTC advertisements in the past indicated that the disease-specific DTC advertising stimulus reminded them to take their depression and other medications. These exploratory results show disease-specific DTC advertising can help people remember to take their prescription medication when viewed, which may lead to more positive medication-taking behavior and increased medication adherence. Additionally, given the fair balance and legal issues surrounding product-specific DTC advertising, disease-specific DTC advertising can serve as an effective component of the marketing mix for pharmaceutical manufacturers. Future research should attempt to study the impact of disease-specific DTC advertising on consumers' actual medication adherence using standardized adherence measures such as prescription records.

  14. Student-directed retrieval practice is a predictor of medical licensing examination performance.

    Science.gov (United States)

    Deng, Francis; Gluckstein, Jeffrey A; Larsen, Douglas P

    2015-12-01

    A large body of evidence indicates that retrieval practice (test-enhanced learning) and spaced repetition increase long-term information retention. Implementation of these strategies in medical curricula is unfortunately limited. However, students may choose to apply them autonomously when preparing for high-stakes, cumulative assessments, such as the United States Medical Licensing Examination Step 1. We examined the prevalence of specific self-directed methods of testing, with or without spaced repetition, among preclinical students and assessed the relationship between these methods and licensing examination performance. Seventy-two medical students at one institution completed a survey concerning their use of user-generated (Anki) or commercially-available (Firecracker) flashcards intended for spaced repetition and of boards-style multiple-choice questions (MCQs). Other information collected included Step 1 score, past academic performance (Medical College Admission Test [MCAT] score, preclinical grades), and psychological factors that may have affected exam preparation or performance (feelings of depression, burnout, and test anxiety). All students reported using practice MCQs (mean 3870, SD 1472). Anki and Firecracker users comprised 31 and 49 % of respondents, respectively. In a multivariate regression model, significant independent predictors of Step 1 score included MCQs completed (unstandardized beta coefficient [B] = 2.2 × 10(- 3), p academic and psychological factors. Medical students engage extensively in self-initiated retrieval practice, often with spaced repetition. These practices are associated with superior performance on a medical licensing examination and should be considered for formal support by educators.

  15. Promoting self-directed learning through portfolios in undergraduate medical education: the mentors' perspective.

    Science.gov (United States)

    van Schaik, Sandrijn; Plant, Jennifer; O'Sullivan, Patricia

    2013-01-01

    Medical students need to acquire self-directed learning (SDL) skills for effective lifelong learning. Portfolios allow learners to reflect on their progress, diagnose learning needs and create learning plans, all elements of SDL. While mentorship is deemed to be essential for successful portfolio use, it is not known what constitutes effective mentorship in this process. In-depth understanding of the SDL construct seems a prerequisite. The aim of this study was to examine how portfolio mentors perceive and approach SDL. Interviews with faculty members who mentored medical students in portfolio were audio-recorded, transcribed and analysed for themes. Eight mentors participated. Qualitative analysis revealed six major themes around mentors' definitions of SDL, their perception of innate SDL abilities of medical students, their own approach to SDL, their understanding of the value of learning plans, their perceptions of students' engagement with the portfolio and the impact of the portfolio process on the mentoring relationship. This study revealed tensions between mentors' beliefs regarding the importance of SDL, their own approach to SDL and their perceptions of students' SDL skills. Based on our analysis of these tensions, we recommend both explicit faculty development and institutional culture change for successful integration of SDL in medical education.

  16. Medical Students' and Tutors' Experiences of Directed and Self-Directed Learning Programs in Evidence-Based Medicine: A Qualitative Evaluation Accompanying a Randomized Controlled Trial

    Science.gov (United States)

    Bradley, Peter; Oterholt, Christina; Nordheim, Lena; Bjorndal, Arild

    2005-01-01

    This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In…

  17. A COMPARISON OF DIDACTIC LECTURES TO SELF-DIRECTED LEARNING IN MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Fatima Shamsuddin

    2017-01-01

    Full Text Available BACKGROUND Newer learning methods like Self-Directed Learning (SDL are being experimented in medical education. SDL has been advocated as an effective learning strategy for medical students to achieve competency. MATERIALS AND METHODS This is a comparative study done on 98 second year MBBS students. They were divided into 2 batches (Batch A and B of 49 each. On the first day, Batch A was given a didactic lecture (1 hour, while Batch B underwent a self-study session (1.5 hours with all the study materials provided. A pre and post-questionnaire (15 MCQs was administered. On the second day, the batches were reversed and another similar topic was dealt with. A pre and post-test questionnaire was administered. RESULTS There was statistically significant gain in knowledge following both methods of learning, but the gain in knowledge was more following traditional lecture. The mean (±SD value of the score of gain in knowledge was 3.99±1.88 (n=98 for the batch of students who had didactic lecture while the mean (±SD gain in knowledge for the batch who underwent SDL was 2.63±2.31 (n=98. A paired t-test comparing didactic lectures with self-directed learning also showed that the scores following didactic lectures were more compared to SDL and the results were statistically significant. An independent t-test comparing didactic lectures to SDL also showed statistically significant gain in knowledge following didactic lectures. CONCLUSION For second year medical students, traditional didactic lectures are more effective compared to self-directed learning. A feedback from students pointed out the fact that a judicious combination of both is desirable compared to either method used alone.

  18. Clinicians' responses to direct-to-consumer advertising of prescription medications.

    Science.gov (United States)

    Zachry, Woodie M; Dalen, James E; Jackson, Terrence R

    The direct-to-consumer advertising (DTCA) of prescription medications is proliferating in the United States. The relationship between patient exposure to DTCA and the response of clinicians is not well understood. A randomized postal survey of Arizona primary care provider physicians (n = 1080) and physician assistants (n = 704) was conducted. A questionnaire was created using a hypothetical patient scenario that varied according to the diagnosis of the patient (ie, hypertension, hypercholesterolemia, seasonal allergies, or obesity) and the type of informational exposure generating the patient's questions (ie, DTCA vs drug references such as Physicians' Desk Reference). Clinicians were randomly assigned 1 of 8 forms of the scenario and were asked standardized questions related to their responses when faced with the patient scenario. The response rate was 44% (40.5% of physicians and 49.3% of physician assistants). No statistically significant differences were found between the early and late responders or between responders and nonresponders. Relative to clinicians who received the "drug reference book" patient scenario, clinicians who received the DTCA patient scenario were more likely to become annoyed with a patient for asking for more information about medications (P =.003); less likely to answer the patient's questions (P =.03) or provide additional written information (P =.007); more likely to become frustrated (P =.003) and annoyed (P<.001) with the patient for asking to try a specific medication; and less likely to provide samples (P =.001) or a prescription (P<.001) for a specific medication. Clinicians are amenable to patients asking for drug information and medications, but they are less receptive to questions arising from DTCA.

  19. Madness at the movies: prioritised movies for self-directed learning by medical students.

    Science.gov (United States)

    Wilson, Nick; Heath, Deb; Heath, Tim; Gallagher, Peter; Huthwaite, Mark

    2014-10-01

    We aimed to systematically compile a list of 10 movies to facilitate self-directed learning in psychiatry by medical students. The selected areas were those of the top five mental health conditions from the Global Burden of Disease 2010 study. The search strategy for movies covered an extensive range of sources (published literature and websites), followed by closer examination and critical viewing of a sample. Out of a total of 503 potential movies that were identified, 23 were selected for viewing and more detailed critique. The final top 10 were: for depressive and anxiety disorders: Ordinary People (1980), Silver Linings Playbook (2012); for illicit drug use: Trainspotting (1996), Winter's Bone (2010), Rachel Getting Married (2008), Half Nelson (2006); for alcohol use disorders: Another Year (2010), Passion Fish (1992); and for schizophrenia: The Devil and Daniel Johnston (2006), and An Angel at My Table (1990). The final selection of 10 movies all appeared to have relatively high entertainment value together with rich content in terms of psychiatric themes. Further research could evaluate the extent to which medical students actually watch such movies, by assessing the level of withdrawals from a medical school library and surveying student responses. © The Royal Australian and New Zealand College of Psychiatrists 2014.

  20. A new direct pixel-based focusing method for medical ultrasound imaging: preliminary results

    Science.gov (United States)

    Lee, YuHwa; Piao, Chunsheng; Kim, TaeWan; Chang, Jin Ho; Song, Tai-Kyong; Yoo, Yangmo

    2011-03-01

    In medical ultrasound imaging, scan conversion is used to geometrically transform polar coordinate ultrasound data into Cartesian raster data for display. In scan conversion, Moiré undersampling artifacts can be avoided by using various interpolation techniques such as nearest neighbor and bilinear. However, this interpolation-based scan conversion introduces blurring of fine details in ultrasound images. In this paper, a new beamforming technique, named compounded direct pixel beamforming (CDPB), is proposed to remove blurring artifacts from scan conversion. In CDPB, receive focusing is performed directly on each display pixel in Cartesian coordinates with raw radio-frequency (RF) data from two adjacent transmit firings so that artifacts from scan conversion can be substantially removed. To evaluate the proposed CDPB method, 64-channel pre-beamformed RF data were captured by a commercial ultrasound machine (SA-9900, Medison Corp., Seoul, Korea) from a tissue mimicking phantom (ATS Laboratories, Bridgeport, CT, USA). To quantify the performance of the proposed method, the information entropy contrast (IEC) value was measured. From the experiments, the proposed method provided IEC improvement by 2.8 over the conventional scan conversion method. These results indicate that the proposed new beamforming method could be used for enhancing the image quality in medical ultrasound imaging.

  1. Tools for the direct observation and assessment of psychomotor skills in medical trainees: a systematic review.

    Science.gov (United States)

    Jelovsek, J Eric; Kow, Nathan; Diwadkar, Gouri B

    2013-07-01

    The Accreditation Council for Graduate Medical Education (ACGME) Milestone Project mandates programmes to assess the attainment of training outcomes, including the psychomotor (surgical or procedural) skills of medical trainees. The objectives of this study were to determine which tools exist to directly assess psychomotor skills in medical trainees on live patients and to identify the data indicating their psychometric and edumetric properties. An electronic search was conducted for papers published from January 1948 to May 2011 using the PubMed, Education Resource Information Center (ERIC), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science electronic databases and the review of references in article bibliographies. A study was included if it described a tool or instrument designed for the direct observation of psychomotor skills in patient care settings by supervisors. Studies were excluded if they referred to tools that assessed only clinical or non-technical skills, involved non-medical health professionals, or assessed skills performed on a simulator. Overall, 4114 citations were screened, 168 (4.1%) articles were reviewed for eligibility and 51 (1.2%) manuscripts were identified as meeting the study inclusion criteria. Three authors abstracted and reviewed studies using a standardised form for the presence of key psychometric and edumetric elements as per ACGME and American Psychological Association (APA) recommendations, and also assigned an overall grade based on the ACGME Committee on Educational Outcome Assessment grading system. A total of 30 tools were identified. Construct validity based on associations between scores and training level was identified in 24 tools, internal consistency in 14, test-retest reliability in five and inter-rater reliability in 20. The modification of attitudes, knowledge or skills was reported using five tools. The seven-item Global Rating Scale and the Procedure-Based Assessment received an

  2. Assessment of the Direct Medical Costs of Type 2 Diabetes Mellitus and its Complications in Turkey

    Directory of Open Access Journals (Sweden)

    Simten Malhan

    2014-06-01

    Full Text Available Purpose: To estimate the direct annual medical costs of Type 2 diabetes and its complications in diagnosed patients in Turkey. Material and Method: A cost-of-illness model was developed. The prevalence of Type 2 diabetes was derived from the Turkish Diabetes Epidemiology Study, estimated as 13.7% in adults, with one-third of patients previously undiagnosed. Complication costs were extracted from the records of 7095 patients at a Turkish tertiary care hospital in 2009. For each modelled complication, acute phase costs were applied to globally derived incidence rates, and one-year follow-up costs were applied to globally derived prevalence rates. Costs and frequencies of ongoing antihyperglycaemic treatment and disease management were derived from treatment guidelines and Turkish hospital records. Parameter variation was performed. Results: The cost of Type 2 diabetes in diagnosed patients was estimated at between 11.4 to 12.9 billion Turkish Lira, 1% of Gross Domestic Product. Cardiovascular complications comprised the largest share of total medical costs (between 24.3% and 32.6%, followed by renal complications-related costs (between 25% and 28.3% and concomitant cardiovascular and antihypertensive medication costs (between 14.2% and 16%. Antihyperglycaemic medications and screening costs comprised between 10.9% to 12.3% and between 4.4% to 5% of total costs, respectively. Discussion: Type 2 diabetes is a disease burden and economic burden in Turkey; the complications cost is higher than the cost of disease control. For preventing complications, any activities effect positively limited resources and also quality of life. Turk Jem 2014; 2: 39-43

  3. Definitions and goals of "self-directed learning" in contemporary medical education literature.

    Science.gov (United States)

    Ainoda, N; Onishi, H; Yasuda, Y

    2005-09-01

    Self-directed learning (SDL) has been an essential issue in medical education due to the expansion of knowledge, accessibility to information and greater emphasis on reflection. If SDL in educational research lacks a clear definition, terminological confusion may hinder the application of the results to practice. The aim of this study was to review and categorise the various forms of SDL described in the contemporary literature. A search of Medline was conducted using the key word "self-directed learning". Articles published between 2000 and 2004 were extracted. Review articles, letters and articles from health profession education other than medical education, were excluded. Sixty-three articles were analysed in 2 stages: first, whether the definition of SDL is explicitly described was investigated and next, contents in the articles on SDL were qualitatively analysed using a framework approach. The concept of a compassionate-empathic physician, as developed by Carmel and Glick (1996), was used as the framework. Only 5 articles (8.0%) had an explicit and concrete definition of SDL. Content analysis showed that 26 (50.0%) of the 52 articles dealt with SDL only in the scientific-technical dimension, 3 (5.8%) dealt with that only in the socio-emotional dimension and 23 (44.2%) did so in both dimensions. Although many researchers use the term "self-directed learning", only a few clearly defined it to avoid semantic confusion. Scientific-technical goals tended to be discussed more frequently in SDL. From a patient-centred viewpoint, socio-emotional goals should be stressed more.

  4. Type of oral solid medication packaging and medication preparation time in nursing homes: A direct observation study.

    Science.gov (United States)

    Cready, C M; Hudson, C; Dreyer, K

    2017-12-01

    Medication administration is a substantial portion of the workday in nursing homes, with the medication preparation step being the most time-consuming. However, little is known about how medication preparation time is affected by the type of packaging used for oral solid medications (ie, tablets/capsules). We examined the effects of two types of packaging. As fewer steps are associated with strip packaging compared to bingo card packaging, we hypothesized that the increase in medication preparation seconds per resident with each additional oral solid medication would be smaller when strip packaging was used. A total of 430 medication preparations conducted by eight nurses during the regularly scheduled morning medication administration period in two nursing homes-using strip packaging and bingo card packaging, respectively-were observed. Each medication preparation observation was matched to its corresponding medication administration record and observations averaged across resident. Using the resident sample (N=149), we estimated three regression models (adjusting the standard errors for the clustering of resident by nurse). The first model regressed medication preparation seconds on the number of oral solid medications. The second model added the type of packaging used and the control variables (type of unit [long-term care, post-acute care], the number of one-half pills and the dosage form diversity in the preparation). To test our hypothesis, the third model added an interaction term between the number of oral solid medications and the type of packaging used. As hypothesized, all else equal, the number of oral solid medications tended to increase medication preparation time per resident in both nursing homes, but the increase was smaller in the strip packaging nursing home (P<.05). Each additional oral solid medication in the bingo card packaging nursing home increased medication preparation by an average of 13 seconds (b=13.077), whereas each oral solid

  5. Excessive masturbation after epilepsy surgery.

    Science.gov (United States)

    Ozmen, Mine; Erdogan, Ayten; Duvenci, Sirin; Ozyurt, Emin; Ozkara, Cigdem

    2004-02-01

    Sexual behavior changes as well as depression, anxiety, and organic mood/personality disorders have been reported in temporal lobe epilepsy (TLE) patients before and after epilepsy surgery. The authors describe a 14-year-old girl with symptoms of excessive masturbation in inappropriate places, social withdrawal, irritability, aggressive behavior, and crying spells after selective amygdalohippocampectomy for medically intractable TLE with hippocampal sclerosis. Since the family members felt extremely embarrassed, they were upset and angry with the patient which, in turn, increased her depressive symptoms. Both her excessive masturbation behavior and depressive symptoms remitted within 2 months of psychoeducative intervention and treatment with citalopram 20mg/day. Excessive masturbation is proposed to be related to the psychosocial changes due to seizure-free status after surgery as well as other possible mechanisms such as Kluver-Bucy syndrome features and neurophysiologic changes associated with the cessation of epileptic discharges. This case demonstrates that psychiatric problems and sexual changes encountered after epilepsy surgery are possibly multifactorial and in adolescence hypersexuality may be manifested as excessive masturbation behavior.

  6. ANTISPASMODIC MEDICATION WITH DIRECTIVE EFFECT IN CHILDREN WITH ABDOMINAL PAIN AT THE STAGE OF DIAGNOSTIC SEARCH

    Directory of Open Access Journals (Sweden)

    Yu.A. Kozlova

    2010-01-01

    Full Text Available Additional examination is needed for the purpose of detection of its etiology in some patients with abdominal pain, and it takes several days to prove a diagnosis. In most cases this pain is a result of muscle spasm in gastrointestinal tract. The administration of antispasmodic medication with directive effect, particularly, of hyoscine butylbromide (Buscopan, is well-grounded. Hyoscine butylbromide is M-cholinergic antagonist, it does not penetrates blood-brain barrier, does not induce common for cholinergic antagonists vascular reactions and decrease of blood pressure. This drug is used in pediatric practice for a long time, it can be used in patients 6 years old anв older, and it has good safety profile. Key words: abdominal pain, hyoscine butylbromide.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(1:168-170

  7. Patient-directed Internet-based Medical Image Exchange: Experience from an Initial Multicenter Implementation.

    Science.gov (United States)

    Greco, Giampaolo; Patel, Anand S; Lewis, Sara C; Shi, Wei; Rasul, Rehana; Torosyan, Mary; Erickson, Bradley J; Hiremath, Atheeth; Moskowitz, Alan J; Tellis, Wyatt M; Siegel, Eliot L; Arenson, Ronald L; Mendelson, David S

    2016-02-01

    Inefficient transfer of personal health records among providers negatively impacts quality of health care and increases cost. This multicenter study evaluates the implementation of the first Internet-based image-sharing system that gives patients ownership and control of their imaging exams, including assessment of patient satisfaction. Patients receiving any medical imaging exams in four academic centers were eligible to have images uploaded into an online, Internet-based personal health record. Satisfaction surveys were provided during recruitment with questions on ease of use, privacy and security, and timeliness of access to images. Responses were rated on a five-point scale and compared using logistic regression and McNemar's test. A total of 2562 patients enrolled from July 2012 to August 2013. The median number of imaging exams uploaded per patient was 5. Most commonly, exams were plain X-rays (34.7%), computed tomography (25.7%), and magnetic resonance imaging (16.1%). Of 502 (19.6%) patient surveys returned, 448 indicated the method of image sharing (Internet, compact discs [CDs], both, other). Nearly all patients (96.5%) responded favorably to having direct access to images, and 78% reported viewing their medical images independently. There was no difference between Internet and CD users in satisfaction with privacy and security and timeliness of access to medical images. A greater percentage of Internet users compared to CD users reported access without difficulty (88.3% vs. 77.5%, P privacy. Copyright © 2015 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  8. Direct Medical Costs of Dengue Fever in Vietnam: A Retrospective Study in a Tertiary Hospital.

    Science.gov (United States)

    Vo, Nhung Thi Tuyet; Phan, Trang Ngo Diem; Vo, Trung Quang

    2017-05-01

    In Vietnam, dengue fever is a major health concern, yet comprehensive information on its economic costs is lacking. The present study investigated treatment costs associated with dengue fever from the perspective of health care provision. This retrospective study was conducted between January 2013 and December 2015 in Cu Chi General Hospital. The following dengue-related treatment costs were calculated: hospitalisation, diagnosis, specialised services, drug usage and medical supplies. Average cost per case and treatment cost across different age was calculated. In the study period, 1672 patients with dengue fever were hospitalised. The average age was 24.98 (SD = 14.10) years, and 47.5% were males (795 patients). Across age groups, the average cost per episode was USD 48.10 (SD = 3.22). The highest costs (USD 56.61, SD = 48.84) were incurred in the adult age group (> 15 years), and the lowest costs (USD 30.10, SD = 17.27) were incurred in the paediatric age group (< 15 years). The direct medical costs of dengue-related hospitalisation place a severe economic burden on patients and their families. The probable economic value of dengue management in Vietnam is significant.

  9. Prevention of excess gain.

    Science.gov (United States)

    Stevens, J; Truesdale, K P; Wang, C-H; Cai, J

    2009-11-01

    Obesity prevention trials are designed to promote healthy weight. The success of these trials is often assessed using one of three metrics--means, incidence or prevalence. In this study, we point out conceptual shortcomings of these metrics and introduce an alternative that we call 'excess gain'. A mathematical demonstration using simulated data shows a scenario in which the statistical power of excess gain compares favorably with that of incidence and prevalence. Prevention of excess gain communicates an easily understood public health message that is applicable to all individuals regardless of weight status.

  10. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland.

    Science.gov (United States)

    Lippuner, Kurt; Golder, Matthias; Greiner, Roger

    2005-03-01

    The aim of this study was to estimate the hospitalization incidence and the total number of hospital days related to all fractures and osteoporotic fractures in the year 2000 in Switzerland and to compare these with data from other frequent disorders in men and women. The official administrative and medical statistics database of the Swiss Federal Office of Statistics (SFOS) from the year 2000 was used. It covered 81.2% of all registered patient admissions and was considered to be representative of the entire population. We included the ICD-10 codes of 84 diagnoses that were compatible with an underlying osteoporosis and applied the best matching age-specific osteoporosis attribution rates published for the ICD-9 diagnosis codes to the individual ICD-10 codes. To preserve comparability with previously published data from 1992, we grouped the data related to the ICD-10 fracture codes into seven diagnosis pools (fractures of the axial skeleton, fractures of the proximal upper limbs, fractures of the distal upper limbs, fractures of the proximal lower limbs, fractures of the distal lower limbs, multiple fractures, and osteoporosis) and analyzed them separately for women and men by age group. Incidences of hospitalization due to fractures were calculated, and the direct medical costs related to hospitalization were estimated. In addition, we compared the results with those from chronic pulmonary obstructive disease (COPD), stroke, acute myocardial infarction, heart failure, diabetes and breast carcinoma from the same database. In Switzerland during 2000, 62,535 hospitalizations for fractures (35,586 women and 26,949 men) were registered. Fifty-one percent of all fractures in women and 24% in men were considered as osteoporotic. The overall incidences of hospitalization due to fractures were 969 and 768 per 100,000 in women and men, respectively. The hospitalization incidences for fractures of the proximal lower limbs and the axial skeleton increased exponentially after

  11. Excess wind power

    DEFF Research Database (Denmark)

    Østergaard, Poul Alberg

    2005-01-01

    analyses it is analysed how excess productions are better utilised; through conversion into hydrogen of through expansion of export connections thereby enabling sales. The results demonstrate that particularly hydrogen production is unviable under current costs but transmission expansion could...

  12. SOMNOLENCIA DIURNA EXCESIVA EN ESTUDIANTES DE NOVENO SEMESTRE DE MEDICINA DE LA UNIVERSIDAD NACIONAL DE COLOMBIA Excessive daytime drowsiness in ninth-semester medical students attending the Universidad Nacional de Colombia

    Directory of Open Access Journals (Sweden)

    Franklin Escobar-Córdoba

    2011-09-01

    Full Text Available Antecedentes. Tradicionalmente los estudiantes de medicina duermen poco, estudian largas jornadas nocturnas y como consecuencia padecen somnolencia diurna excesiva produciendo disminución en la atención que afecta su calidad de vida y rendimiento académico. Lo anterior se suma a los turnos nocturnos y al pobre conocimiento de higiene del sueño. En Colombia se conoce poco sobre la prevalencia, la gravedad de este síntoma y los efectos en esta población, al igual que en otros grupos como correturnos, vigilantes, personal sanitario, pilotos, militares, etc. Objetivo. Determinar la incidencia de somnolencia diurna excesiva en estudiantes de noveno semestre de medicina de la Universidad Nacional de Colombia, quienes realizan turnos nocturnos en las rotaciones asignadas y evaluar su relación con la calidad e higiene de sueño. Material y métodos. Estudio descriptivo transversal, realizado en una muestra de estudiantes 76,14% (n=83/ 109 de noveno semestre de medicina que aceptaron participar en la investigación mediante consentimiento informado. Se aplicó la escala de somnolencia de Epworth y el índice de calidad de sueño de Pittsburgh validados localmente y el índice de higiene de sueño validado en Perú. Resultados. Los evaluados tuvieron un promedio de edad de 23 años, presentaron somnolencia diurna excesiva el 60,24% (n=50/83. Se halló 79,52% (n=66/83 de sujetos malos dormidores y 44,58% (n=37/83 con mala higiene de sueño. Conclusiones. La prevalencia de somnolencia diurna excesiva en la población estudiada es cuantitativamente importante y superior a la hallada en otros estudios, muestra relación con la mala calidad de sueño y con una mala higiene de sueño considerable.Background. Medical students traditionally sleep very little, study during long nocturnal periods and consequently suffer excessive daytime sleepiness, thereby leading to reduced attention which affects their quality of life and academic performance. The

  13. Effect of the European directive on medical exposure on patients doses

    Energy Technology Data Exchange (ETDEWEB)

    Wade, P.; Heaton, B. [Aberdeen Royal Infirmary, Aberdeen (United Kingdom)

    2006-07-01

    Full text of publication follows: In 2000 the European Directive on medical exposures was incorporated into United Kingdom law. Whilst the primary aim was to ensure that all uses of ionising radiation in medical practice were justified and a benefit to the patient or volunteer was identified, there was an understanding that patient doses would be controlled and collective doses reduced. The Ionising Radiation (Medical Exposure) Regulations 2000 made a lot of new demands on radiology and Nuclear Medicine departments. No department is too small or specialized to ignore these regulations and the impact can be major. The Aberdeen Radiation Protection Service advises a number of users of ionising radiation on the implementation of these regulations ranging from single person dental practices to large radiology departments in busy regional hospitals. The particular problems and issues affecting different departments will be discussed. The regulations identified new key roles with Employers, Referrers, Practitioners and Operators all having specific responsibilities. Each of these groups needs to be identified, informed of their responsibilities and trained as necessary. The problems this has raised for the various staff groups will be discussed. A large number of procedures had to be written from how a patient is uniquely identified to how incidents are reported and investigated. There is much emphasis on optimising the use of equipment and techniques used, paying particular attention to women of child bearing age and children. Again there are problems in implementing this in practice and these issues will be discussed. A formal procedure for reporting 'near misses' and actual incidents of overexposure, were introduced. Each reported event is reviewed to identify issues and lessons which can be learnt by others. There is often a lateral thinking exercise involved to reduce the probability of an incident happening again and some novel solutions have been

  14. Outcomes of Irish graduate entry medical student engagement with self-directed learning of clinical skills.

    Science.gov (United States)

    McGrath, Deirdre; Crowley, Louise; Rao, Sanath; Toomey, Margaret; Hannigan, Ailish; Murphy, Lisa; Dunne, Colum P

    2015-02-19

    Existing literature is mixed as to whether self-directed learning (SDL) delivers improvements in knowledge, skills or attitudes of medical students compared with traditional learning methods. This study aimed to determine whether there is an association between engagement in SDL and student performance in clinical examinations, the factors that influence student engagement with SDL in clinical skills, and student perceptions of SDL. A retrospective analysis of electronic records of student bookings of SDL sessions from 2008 to 2010 was performed for students in the pre-clinical years of an Irish Graduate Entry Medical programme to assess their level of engagement with SDL. The extent to which this engagement influenced their performance in subsequent summative examinations was evaluated. A cross-sectional survey of students across the four years of the programme was also conducted to determine student perceptions of SDL and the factors that affect engagement. The level of engagement with SDL decreased over time from 95% of first years in 2008 to 49% of first years in 2010. There was no significant difference between the median exam performance for any clinical skills tested by level of engagement (none, one or more sessions) except for basic life support in first year (p =0.024). The main reason for engaging with SDL was to practice a clinical skill prior to assessment and the majority of respondents agreed that SDL sessions had improved their performance of the specific clinical skills being practised. Students viewed SDL as an opportunity to practise skills prior to assessment but there were no significant differences in subsequent summative assessment by the level of engagement for most clinical skills.

  15. [Meeting the needs of the European working time directive in german medical profession].

    Science.gov (United States)

    Friedrich, M; Popov, A F; Schmitto, J D; Bireta, C; Emmert, A; Tirilomis, T

    2011-06-01

    The legal obligation of the European Working Time Directive with its implementation into a German Working Hours Act requires German hospitals to give up old structures and requires the implementation of new working time models. The failure of the revision of the European Working Time Directive in April 2009 prevented that any changes of status quo might happen in the near future. Fundamental terms of the working law for the medical area have been elucidated and have been implemented into concrete calculation formulas. The planned working time has been clearly determined. Particularly, on-call duties and a signed "OptOut-declaration" have huge effects on the upper limit of the working time that is to be determined. Shift duty leads to the greatest limitations of the upper limit of the working time. The Working Hours Act defines the maximal, available, individual working time budget and thus the working time budget of a hospital and it limits the maximal availability of the service providers of a hospital as well as defining the maximal personnel costs. Transparency in this area lays the foundation for an effective time management and the creation of new working time models in accordance with the European Working Time Directive as well as the Working Hours Act and the "TVÄ" (labour contract for doctors at municipal hospitals). It is possible, with the knowledge of the maximal working time budget and the thereof resulting personnel costs, to calculate the economical revenues better. The reallocation of the working time of doctors enables efficiency enhancement. It is necessary to demand a clear definition of the tasks of doctors with the consequential discharge of tasks that should not/do not belong to the responsibilities of a doctor. This would lead to a more attractive working environment for doctors at hospitals and thus to an improvement of the care of the patients. The implementation of the European Time Directive is not to be seen as unrealizable, as has been

  16. 'Sometimes the work just needs to be done': socio-cultural influences on direct observation in medical training.

    Science.gov (United States)

    Watling, Christopher; LaDonna, Kori A; Lingard, Lorelei; Voyer, Stephane; Hatala, Rose

    2016-10-01

    Direct observation promises to strengthen both coaching and assessment, and calls for its increased use in medical training abound. Despite its apparent potential, the uptake of direct observation in medical training remains surprisingly limited outside the formal assessment setting. The limited uptake of observation raises questions about cultural barriers to its use. In this study, we explore the influence of professional culture on the use of direct observation within medical training. Using a constructivist grounded theory approach, we interviewed 22 residents or fellows (10 male, 12 female) about their experiences of being observed during training. Participants represented a range of specialties and training levels. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis. Observation was used selectively; specialties tended to observe the clinical acts that they valued most. Despite these differences, we found two cultural values that consistently challenged the ready implementation of direct observation across specialties: (i) autonomy in learning and (ii) efficiency in health care provision. Furthermore, we found that direct observation was a primarily learner-driven activity, which left learners caught in the middle, wanting observation but also wanting to appear independent and efficient. The cultural values of autonomy in learning and practice and efficiency in health care provision challenge the integration of direct observation into clinical training. Medical learners are often expected to ask for observation, but such requests are socially and culturally fraught, and likely to constrain the wider uptake of direct observation. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  17. Reducing Excessive Television Viewing.

    Science.gov (United States)

    Jason, Leonard A.; Rooney-Rebeck, Patty

    1984-01-01

    A youngster who excessively watched television was placed on a modified token economy: earned tokens were used to activate the television for set periods of time. Positive effects resulted in the child's school work, in the amount of time his family spent together, and in his mother's perception of family social support. (KH)

  18. HIV Excess Cancers JNCI

    Science.gov (United States)

    In 2010, an estimated 7,760 new cancers were diagnosed among the nearly 900,000 Americans known to be living with HIV infection. According to the first comprehensive study in the United States, approximately half of these cancers were in excess of what wo

  19. Effect of Direct-to-Consumer Advertising on Asthma Medication Sales and Healthcare Use.

    Science.gov (United States)

    Daubresse, Matthew; Hutfless, Susan; Kim, Yoonsang; Kornfield, Rachel; Qato, Dima M; Huang, Jidong; Miller, Kay; Emery, Sherry L; Alexander, G Caleb

    2015-07-01

    The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects. To quantify the association between asthma-related DTCA, pharmacy sales, and healthcare use. This was an ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales), and the MarketScan Commercial Claims data (healthcare use) for 75 designated market areas in the United States. We used multilevel Poisson regression to model the relationship between DTCA and rates of prescriptions and use within and across designated market areas. Main outcome measures include (1) volume of total, new, and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department use, (4) hospitalizations, and (5) outpatient encounters among the commercially insured. Four Food and Drug Administration-approved asthma medicines were advertised during the period examined: (1) fluticasone/salmeterol (Advair), (2) mometasone furoate (Asmanex), (3) montelukast (Singulair), and (4) budesonide/formoterol (Symbicort). After adjustment, each additional televised advertisement was associated with 2% (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.03) higher pharmacy sales rate from 2005 through 2009, although this effect varied across the three consistently advertised therapies examined. Among the commercially insured, DTCA was positively and significantly associated with emergency room visits related to asthma (incident rate ratio, 1.02; 95% confidence interval, 1.01-1.04), but there was no relationship with hospitalizations or outpatient encounters. Among this population, DTCA was associated with higher prescription sales and asthma-related emergency department use.

  20. Use of the guidelines directed medical therapy after coronary artery bypass graft surgery in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Khalid A. Alburikan

    2017-09-01

    Full Text Available Background: incidence of cardiovascular diseases in Saudi Arabia is growing and more patients are expected to have cardiac revascularization surgery. Optimal pharmacotherapy management with Guideline Directed Medical Therapy (GDMT post coronary artery bypass grafting (CABG plays an important role in the prevention of adverse cardiovascular outcomes. The objective of this study was to assess the utilization of GDMT for secondary prevention in CABG patients and determine whether specific patients' characteristics can influence GDMT utilization. Method: A retrospective chart review of patients discharged from the hospital after CABG surgery from April 2015 to April 2016. The primary outcome was the utilization of secondary prevention GDMT after CABG surgery - aspirin, B-blockers, statin and angiotensin-converting enzyme inhibitors (ACEI (or angiotensin receptor blockers (ARB in ACEI-intolerant patients. The proportions of eligible and ideal patients who received treatment were calculated, and mixed-effects logistic regression was used to estimate odds ratios (OR for the association of age, gender or patient nationality with the use of GDMT. Results: A total number of 119 patients included in the analysis. The median age of the cohort was 57.3 ± 11 years, and 83% were male (83.2%. Nearly 69.7% of patients had diabetes, and 82% had a previous diagnosis of hypertension. Nearly 91% received aspirin therapy and the rate was lower for B-blocker and statin. The rate of GDMT utilization did not change with the change in patient’s age, gender or nationality. Conclusion: Despite adjustments for contraindications to GDMT, the rate of GDMT utilization was suboptimal.

  1. Direct medical costs associated with the extrahepatic manifestations of hepatitis C virus infection in France.

    Science.gov (United States)

    Cacoub, P; Vautier, M; Desbois, A C; Saadoun, D; Younossi, Z

    2018-01-01

    The economic impact of extrahepatic manifestations of hepatitis C virus (HCV) infection remains unknown for France. To estimate the prevalence of extrahepatic manifestations of HCV and the direct medical costs associated with them. Estimates of 13 extrahepatic manifestations prevalence were obtained from (1) a retrospective data analysis of HCV-infected patients in a specialised centre and the baseline prevalence in the general French population and (2) an international systematic review. Per-patient-per-year costs to treat these manifestations were obtained from the literature, national databases or expert opinion. The impact of achieving HCV cure after anti-viral therapy was applied to the French healthcare costs. Using approach (1), increased prevalence rates in HCV patients compared to the general population were observed for most extrahepatic manifestations. The mean per-patient-per-year cost of these manifestations in the tertiary centre was 3296 € [95% CI 1829; 5540]. In France, HCV-extrahepatic manifestations amounted to a total cost of 215 million (M) € per year [144; 299]. Using approach (2), the mean per-patient-per-year cost was estimated to be 1117 €. The estimated total cost reduction in France associated with HCV cure was 13.9 M€ for diabetes, 8.6 M€ for cryoglobulinemia vasculitis, 6.7 M€ for myocardial infarction, 2.4 M€ for end-stage renal disease and 1.4 M€ for stroke. Extrahepatic manifestations of HCV infection substantially add to the overall economic burden of the disease in France. HCV cure after anti-viral therapy is expected to significantly reduce the total costs of managing these manifestations in France. © 2017 John Wiley & Sons Ltd.

  2. Chicago medical response to the 2010 earthquake in Haiti: translating academic collaboration into direct humanitarian response.

    Science.gov (United States)

    Babcock, Christine; Baer, Carolyn; Bayram, Jamil D; Chamberlain, Stacey; Chan, Jennifer L; Galvin, Shannon; Kim, Jimin; Kinet, Melodie; Kysia, Rashid F; Lin, Janet; Malik, Mamta; Murphy, Robert L; Olopade, C Sola; Theodosis, Christian

    2010-06-01

    On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability.

  3. Medication management policy, practice and research in Australian residential aged care: Current and future directions.

    Science.gov (United States)

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

    2017-02-01

    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Adherence to guideline-directed venous thromboembolism prophylaxis among medical and surgical inpatients at 33 academic medical centers in the United States.

    Science.gov (United States)

    Schleyer, Anneliese M; Schreuder, Astrid B; Jarman, Kenneth M; Logerfo, James P; Goss, J Richard

    2011-01-01

    This study's purpose was to describe compliance with established venous thromboembolism (VTE) prophylaxis guidelines in medical and surgical inpatients at US academic medical centers (AMCs). Data were collected for a 2007 University HealthSystem Consortium Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE) Benchmarking Project that explored VTE in AMCs. Prophylaxis was considered appropriate based on 2004 American College of Chest Physicians guidelines. A total of 33 AMCs from 30 states participated. In all, 48% of patients received guideline-directed prophylaxis-59% were medical and 41% were surgical patients. VTE history was more common among medical patients with guideline-directed prophylaxis. Surgical patients admitted from the emergency department and with higher illness severity were more likely to receive appropriate prophylaxis. Despite guidelines, VTE prophylaxis remains underutilized in these US AMCs, particularly among surgical patients. Because AMCs provide the majority of physician training and should reflect and set care standards, this appears to be an opportunity for practice and quality improvement and for education.

  5. The otherness of sexuality: excess.

    Science.gov (United States)

    Stein, Ruth

    2008-03-01

    The present essay, the second of a series of three, aims at developing an experience-near account of sexuality by rehabilitating the idea of excess and its place in sexual experience. It is suggested that various types of excess, such as excess of excitation (Freud), the excess of the other (Laplanche), excess beyond symbolization and the excess of the forbidden object of desire (Leviticus; Lacan) work synergistically to constitute the compelling power of sexuality. In addition to these notions, further notions of excess touch on its transformative potential. Such notions address excess that shatters psychic structures and that is actively sought so as to enable new ones to evolve (Bersani). Work is quoted that regards excess as a way of dealing with our lonely, discontinuous being by using the "excessive" cosmic energy circulating through us to achieve continuity against death (Bataille). Two contemporary analytic thinkers are engaged who deal with the object-relational and intersubjective vicissitudes of excess.

  6. Excessive crying in infants

    Directory of Open Access Journals (Sweden)

    Ricardo Halpern

    2016-05-01

    Conclusion: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.

  7. Guidelines: The do's, don'ts and don't knows of direct observation of clinical skills in medical education.

    Science.gov (United States)

    Kogan, Jennifer R; Hatala, Rose; Hauer, Karen E; Holmboe, Eric

    2017-09-27

    Direct observation of clinical skills is a key assessment strategy in competency-based medical education. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. The goal is to provide a practical list of Do's, Don'ts and Don't Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs. We built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do's, Don'ts, and Don't Knows about direct observation of clinical skills. Lists were compiled, discussed and revised. We then sought and compiled evidence to support each guideline and determine the strength of each guideline. A final set of 33 Do's, Don'ts and Don't Knows is presented along with a summary of evidence for each guideline. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation. High frequency, high quality direct observation of clinical skills can be challenging. These guidelines offer important evidence-based Do's and Don'ts that can help improve the frequency and quality of direct observation. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. Additional research to address the Don't Knows can help educators realize the full potential of direct observation in competency-based education.

  8. ACTIVATION PARAMETERS AND EXCESS THERMODYANAMIC ...

    African Journals Online (AJOL)

    Applying these data, viscosity-B-coefficients, activation parameters (Δμ10≠) and (Δμ20≠) and excess thermodynamic functions, viz., excess molar volume (VE), excess viscosity, ηE and excess molar free energy of activation of flow, (GE) were calculated. The value of interaction parameter, d, of Grunberg and Nissan ...

  9. Review article: New directions in medical education related to anesthesiology and perioperative medicine

    National Research Council Canada - National Science Library

    Bould, M Dylan; Naik, Viren N; Hamstra, Stanley J

    .... Recurring themes include the increasing use of simulation-based education, the importance of faculty development, challenges in teaching and assessing the non-medical expert roles, and the promise...

  10. Considering "Nonlinearity" Across the Continuum in Medical Education Assessment: Supporting Theory, Practice, and Future Research Directions.

    Science.gov (United States)

    Durning, Steven J; Lubarsky, Stuart; Torre, Dario; Dory, Valérie; Holmboe, Eric

    2015-01-01

    The purpose of this article is to propose new approaches to assessment that are grounded in educational theory and the concept of "nonlinearity." The new approaches take into account related phenomena such as "uncertainty," "ambiguity," and "chaos." To illustrate these approaches, we will use the example of assessment of clinical reasoning, although the principles we outline may apply equally well to assessment of other constructs in medical education. Theoretical perspectives include a discussion of script theory, assimilation theory, self-regulated learning theory, and situated cognition. Assessment examples to include script concordance testing, concept maps, self-regulated learning microanalytic technique, and work-based assessment, which parallel the above-stated theories, respectively, are also highlighted. We conclude with some practical suggestions for approaching nonlinearity. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  11. Update in medical education for pediatrics: insights and directions from the 2010 literature

    Science.gov (United States)

    Fromme, Helen Barrett; Whicker, Shari A.; Mahan, John D.; Turner, Teri Lee

    2012-01-01

    Background While most would agree that utilizing the literature to enhance individual educational practice and/or institutional success is the ideal method for improving medical education, methods to focus attention on the most relevant and valuable information have been heretofore lacking in the pediatric medical education literature. Methods We performed a review of the medical education literature for the year 2010. Utilizing a similar strategy employed by others in Internal Medicine, we selected 12 high-yield education journals and manually reviewed the table of contents to select titles that would have grassroots applicability for medical educators. A broad search through PubMed was then completed using search terms adopted from prior studies, and titles from this search were similarly selected. The abstracts of selected titles (n=147) were each reviewed by two of the authors, then all authors reached consensus on articles for full review (n=34). The articles were then discussed and scored to achieve consensus for the 11 articles for inclusion in this paper. Results Several themes emerged from reviewing these publications. We did not select topics or sections of interest a priori. The themes, grouped into four areas: supervision and leadership, hand-off communication, core competencies: teaching and assessment, and educational potpourri, reflect our community's current concerns, challenges, and engagement in addressing these topics. Each article is summarized below and begins with a brief statement of what the study adds to the practice of pediatric medical education. Discussion This review highlights multiple ‘articles of value’ for all medical educators. We believe the value of these articles and the information they contain for improving the methods used to educate medical students, residents, and fellows are significant. The organically derived thematic areas of the representative articles offer a view of the landscape of medical education research in

  12. Update in medical education for pediatrics: insights and directions from the 2010 literature

    Directory of Open Access Journals (Sweden)

    Helen Barrett Fromme

    2012-05-01

    Full Text Available Background: While most would agree that utilizing the literature to enhance individual educational practice and/or institutional success is the ideal method for improving medical education, methods to focus attention on the most relevant and valuable information have been heretofore lacking in the pediatric medical education literature. Methods : We performed a review of the medical education literature for the year 2010. Utilizing a similar strategy employed by others in Internal Medicine, we selected 12 high-yield education journals and manually reviewed the table of contents to select titles that would have grassroots applicability for medical educators. A broad search through PubMed was then completed using search terms adopted from prior studies, and titles from this search were similarly selected. The abstracts of selected titles (n=147 were each reviewed by two of the authors, then all authors reached consensus on articles for full review (n=34. The articles were then discussed and scored to achieve consensus for the 11 articles for inclusion in this paper. Results : Several themes emerged from reviewing these publications. We did not select topics or sections of interest a priori. The themes, grouped into four areas: supervision and leadership, hand-off communication, core competencies: teaching and assessment, and educational potpourri, reflect our community's current concerns, challenges, and engagement in addressing these topics. Each article is summarized below and begins with a brief statement of what the study adds to the practice of pediatric medical education. Discussion : This review highlights multiple ‘articles of value’ for all medical educators. We believe the value of these articles and the information they contain for improving the methods used to educate medical students, residents, and fellows are significant. The organically derived thematic areas of the representative articles offer a view of the landscape of

  13. Prescription medication changes following direct-to-consumer personal genomic testing: findings from the Impact of Personal Genomics (PGen) Study.

    Science.gov (United States)

    Carere, Deanna Alexis; VanderWeele, Tyler J; Vassy, Jason L; van der Wouden, Cathelijne H; Roberts, J Scott; Kraft, Peter; Green, Robert C

    2017-05-01

    To measure the frequency of prescription medication changes following direct-to-consumer personal genomic testing (DTC-PGT) and their association with the pharmacogenomic results received. New DTC-PGT customers were enrolled in 2012 and completed surveys prior to the return of results and 6 months after results; DTC-PGT results were linked to survey data. "Atypical response" pharmacogenomic results were defined as those indicating an increase or decrease in risk of an adverse drug event or likelihood of therapeutic benefit. At follow-up, participants reported prescription medication changes and health-care provider consultation. Follow-up data were available from 961 participants, of whom 54 (5.6%) reported changing a medication they were taking or starting a new medication due to their DTC-PGT results. Of these, 45 (83.3%) reported consulting with a health-care provider regarding the change. Pharmacogenomic results were available for 961 participants, of which 875 (91.2%) received one or more atypical response results. For each such result received, the odds of reporting a prescription medication change increased 1.57 times (95% confidence interval = 1.17, 2.11). Receipt of pharmacogenomic results indicating an atypical drug response is common with DTC-PGT and is associated with prescription medication changes; however, fewer than 1% of consumers report unsupervised changes at 6 months after testing.Genet Med advance online publication 22 September 2016.

  14. Self-reported responsiveness to direct-to-consumer drug advertising and medication use: results of a national survey

    Directory of Open Access Journals (Sweden)

    Somes Grant W

    2011-09-01

    Full Text Available Abstract Background Direct-to-consumer (DTC marketing of pharmaceuticals is controversial, yet effective. Little is known relating patterns of medication use to patient responsiveness to DTC. Methods We conducted a secondary analysis of data collected in national telephone survey on knowledge of and attitudes toward DTC advertisements. The survey of 1081 U.S. adults (response rate = 65% was conducted by the Food and Drug Administration (FDA. Responsiveness to DTC was defined as an affirmative response to the item: "Has an advertisement for a prescription drug ever caused you to ask a doctor about a medical condition or illness of your own that you had not talked to a doctor about before?" Patients reported number of prescription and over-the-counter (OTC medicines taken as well as demographic and personal health information. Results Of 771 respondents who met study criteria, 195 (25% were responsive to DTC. Only 7% respondents taking no prescription were responsive, whereas 45% of respondents taking 5 or more prescription medications were responsive. This trend remained significant (p trend .0009 even when controlling for age, gender, race, educational attainment, income, self-reported health status, and whether respondents "liked" DTC advertising. There was no relationship between the number of OTC medications taken and the propensity to discuss health-related problems in response to DTC advertisements (p = .4. Conclusion There is a strong cross-sectional relationship between the number of prescription, but not OTC, drugs used and responsiveness to DTC advertising. Although this relationship could be explained by physician compliance with patient requests for medications, it is also plausible that DTC advertisements have a particular appeal to patients prone to taking multiple medications. Outpatients motivated to discuss medical conditions based on their exposure to DTC advertising may require a careful medication history to evaluate for

  15. Improving medication practices for persons with intellectual and developmental disability: Educating direct support staff using simulation, debriefing, and reflection.

    Science.gov (United States)

    Auberry, Kathy; Wills, Katherine; Shaver, Carrie

    2017-01-01

    Direct support professionals (DSPs) are increasingly active in medication administration for people with intellectual and developmental disabilities, thus supplementing nursing and family caretakers. Providing workplace training for DSPs is often the duty of nursing personnel. This article presents empirical data and design suggestions for including simulations, debriefing, and written reflective practice during in-service training for DSPs in order to improve DSPs' skills and confidence related to medication administration. Quantitative study results demonstrate that DSPs acknowledge that their skill level and confidence rose significantly after hands-on simulations. The skill-level effect was statistically significant for general medication management -4.5 ( p debriefing with written reflective practice in DSP continuing education.

  16. Direct-to-consumer genetic testing: a revised position statement of the American College of Medical Genetics and Genomics.

    Science.gov (United States)

    2016-02-01

    These recommendations are designed primarily as an educational resource for medical geneticists and other health-care providers to help them provide quality medical genetics services. Adherence to these recommendations does not necessarily assure a successful medical outcome. These recommendations should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, geneticists and other clinicians should apply their own professional judgment to the specific clinical circumstances presented by the individual patient or specimen. It may be prudent, however, to document in the patient's record the rationale for any significant deviation from the recommendations.

  17. [Factorial structure and reliability of Fisher, King & Tague's self-directed learning readiness scale in Chilean medical students].

    Science.gov (United States)

    Fasce H, Eduardo; Pérez V, Cristhian; Ortiz M, Liliana; Parra P, Paula; Matus B, Olga

    2011-11-01

    Continuous education is crucial among physicians. Therefore, medical schools must teach self-directed learning skills to their students. To evaluate the factorial structure and reliability of the Spanish version of the Self-Directed Learning Readiness Scale of Fisher, King & Tague, applied to medical students. The survey was answered by 330 students aged between 17 and 26years (58% men, with 10 missing cases). Factorial structure, internal reliability and temporary stability of scale was evaluated. The Exploratory Factorial Analysis, conducted using a principal factor method, identified five factors in the structure of the survey. Internal consistency was adequate with a Cronbach's alpha between 0.66 and 0.88. Test retest reliability, comparing the results of the survey applied six months after the first application, showed Pearson correlation coefficients that fluctuated between 0.399 and 0.68. These results show a defined factorial structure with adequate reliability of the survey.

  18. [Direct costs involved in providing medical attention associated with traffic accidents in Bogotá].

    Science.gov (United States)

    Gómez-Restrepo, Carlos; Quitian, Hoover; Maldonado, Patricia; Naranjo-Lujan, Salomé; Rondón, Martín; Acosta, Andrés; Arango-Villegas, Carlos; Hurtado, Jaime; Hernández, Juan C; Angarita, María Del Pilar; Peña, Marcela; Saavedra, Miguel Á

    2014-01-01

    To determine the cost of medical attention associated with traffic accidents in Bogotá, Colombia. Prospective observational study with data from adult patients attended to in the emergency centers of 6 hospitals. Average total cost per patient was $1'112.000 COP. Average daily cost of hospitalized patients was $1'200.000 COP. Average cost of ambulatory treated patients ascended to $247.400 COP. Cost per accident calculated was $2'333.700 COP. In the whole city during study period, total medical costs were around $2.301'028.200 COP. All data was expressed in 2011 Colombian pesos. The medical cost of transit accidents is a significant economic burden.

  19. Use of POHEM to Estimate Direct Medical Costs of Current Practice and New Treatments Associated with Lung Cancer in Canada

    OpenAIRE

    Houle, Christian; Berthelot, Jean-Marie; Evans, William K.; Will, Phyllis

    1997-01-01

    Context : Lung cancer has been the leading cause of cancer deaths in Canadian males for many years, and since 1994, this has been the case for Canadian femalesas well. It is therefore important to evaluate the resources required for its diagnosis and treatment. This article presents an estimate of the direct medical costsassociated with the diagnosis and treatment of lung cancer calculated through the use of a micro-simulation model. For disease incidence, 1992 was chosen as thereference year...

  20. [Analysis of direct medical costs of type 2 diabetes in Mali].

    Science.gov (United States)

    Alouki, K; Delisle, H; Besançon, S

    2017-02-01

    Type 2 Diabetes (T2D) is rapidly increasing in Africa, but it is still rather neglected. Demonstrating the medical costs for treating type 2 diabetes would be useful for improving awareness and proposing solutions. The purpose of this study was to compare the estimated medical costs for basic chronic treatment and the actual expenditures of diabetic patients, and to identify determinants of these expenditures. The estimated medical costs were based on price data collected from three public hospitals and their pharmacies (one university and two district hospitals), as well as from three private clinics and three private pharmacies, in Bamako. A standard treatment protocol for diabetes care, with and without complications, was first established by a working group prior to pricing of consultations, medication, care devices and specialized tests and treatments. Costs were computed using an Excel® software program. We calculated actual expenditures for medical care and examined some determinants using the data from a cross-sectional survey on 500 adult diabetic subjects in Mali. Participants were randomly selected from registries of known diabetics. The estimated costs for basic medical care of uncomplicated diabetes ranged from 108 to 298 € per year in the public sector, and 325 to 756 € in the private sector. Median annual expenditures of survey subjects without complications for chronic care amounted to 178 € (range: 98-331) and were therefore in the estimated range in the public sector. Total median expenditures of all survey subjects, including 78% with complications, reached 241 € per year (142-386). Additional expenditures for the treatment of complications were lower than the estimated costs, except for retinopathy. Independent predictors of higher expenditures were insulin treatment, residence in Bamako, and the number of complications. The minimum estimated cost of medical treatment for uncomplicated diabetes in the public sector represented 29

  1. Visual servoing in medical robotics: a survey. Part I: endoscopic and direct vision imaging - techniques and applications.

    Science.gov (United States)

    Azizian, Mahdi; Khoshnam, Mahta; Najmaei, Nima; Patel, Rajni V

    2014-09-01

    Intra-operative imaging is widely used to provide visual feedback to a clinician when he/she performs a procedure. In visual servoing, surgical instruments and parts of tissue/body are tracked by processing the acquired images. This information is then used within a control loop to manoeuvre a robotic manipulator during a procedure. A comprehensive search of electronic databases was completed for the period 2000-2013 to provide a survey of the visual servoing applications in medical robotics. The focus is on medical applications where image-based tracking is used for closed-loop control of a robotic system. Detailed classification and comparative study of various contributions in visual servoing using endoscopic or direct visual images are presented and summarized in tables and diagrams. The main challenges in using visual servoing for medical robotic applications are identified and potential future directions are suggested. 'Supervised automation of medical robotics' is found to be a major trend in this field. Copyright © 2013 John Wiley & Sons, Ltd.

  2. Effect of Workshop Training on Self-Directed Learning Skills of Students at Shiraz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Rita Rezaee

    2015-12-01

    Full Text Available Introduction: Self-directed learning (SDL is the most important factor in the future success of students in medical schools. In self-directed learning, each student takes responsibility for his/ her own learning activities. The main purpose of this study was first to determine students’ most common learning problems and then familiarize them with the concept of self-directed learning in a teaching workshop. Teaching emphasized SDL skills and processes. Methods: This study used a pre-post interventional design and was conducted in Shiraz Medical School. The first step of the study was a self-administrated questionnaire to investigate the students’ study problems and in the second step all first year medical students (90 students were involved in a teaching workshop. It is worth mentioning that inclusion criteria of the study included participants’ willingness to participate in the study, and exclusion criteria included unwillingness of participants to continue the study or not completing the questionnaires. Descriptive data analysis was performed by SPSS version 18. Results: The findings showed that the most important study problem was related to the amount of materials and content, according to 68 students (75.8%, and teaching SDL skills could increase their motivation to learn, according to 83 students (92%. Conclusion: Teaching SDL skills to students can motivate their willingness to learn and could be used as a strategic approach to teaching. It seems universities should invest on students’ learning skills.

  3. Future Directions in Personality, Occupational and Medical Selection: Myths, Misunderstandings, Measurement, and Suggestions

    Science.gov (United States)

    Ferguson, Eamonn; Lievens, Filip

    2017-01-01

    This paper has two objectives: (1) presenting recent advances in personality theory whereby personality traits are conceptualized within a framework that focuses on the dynamic interactions of behaviour, biology, context, and states, and (2) discussing the implications of these developments for measurement and medical selection. We start by…

  4. Medical Student Preferences for Self-Directed Study Resources in Gross Anatomy

    Science.gov (United States)

    Choi-Lundberg, Derek L.; Low, Tze Feng; Patman, Phillip; Turner, Paul; Sinha, Sankar N.

    2016-01-01

    Gross anatomy instruction in medical curricula involve a range of resources and activities including dissection, prosected specimens, anatomical models, radiological images, surface anatomy, textbooks, atlases, and computer-assisted learning (CAL). These resources and activities are underpinned by the expectation that students will actively engage…

  5. Topiramate Induced Excessive Sialorrhea

    Directory of Open Access Journals (Sweden)

    Ersel Dag

    2015-11-01

    Full Text Available It is well-known that drugs such as clozapine and lithium can cause sialorrhea. On the other hand, topiramate has not been reported to induce sialorrhea. We report a case of a patient aged 26 who was given antiepileptic and antipsychotic drugs due to severe mental retardation and intractable epilepsy and developed excessive sialorrhea complaint after the addition of topiramate for the control of seizures. His complaints continued for 1,5 years and ended after giving up topiramate. We presented this case since it was a rare sialorrhea case induced by topiramate. Clinicians should be aware of the possibility of sialorrhea development which causes serious hygiene and social problems when they want to give topiramate to the patients using multiple drugs.

  6. Direct production of 99mTc using a small medical cyclotron

    Energy Technology Data Exchange (ETDEWEB)

    Lapi, Suzanne [Washington Univ., St. Louis, MO (United States)

    2017-10-03

    This project describes an investigation towards the production of 99mTc with a small medical cyclotron. This endeavor addresses the current urgent problem of availability of 99mTc due to the ongoing production reactor failures and the upcoming Canadian reactor shut down. Currently, 99mTc is produced via nuclear fission using highly enriched uranium which is a concern due to nuclear proliferation risks. In addition to this, the United States is dependent solely on currently unreliable foreign sources of this important medical isotope. Clearly, a need exists to probe alternative production routes of 99mTc. In the first year, this project measured cross-sections and production yields of potential pathways to 99mTc and associated radionuclidic impurities produced via these pathways using a small 15 MeV medical cyclotron. During the second and third years target systems for the production of 99mTc via the most promising reaction routes were developed and separation techniques for the isolation of 99mTc from the irradiated target material will be investigated. Systems for the recycling of the enriched target isotopes as well as automated target processing systems were examined in years four and five. This project has the potential to alleviate some of the current crisis in the medical community by developing a technique to produce 99mTc on location at a university hospital. This technology will be applicable at many other sites in the United States as many other similar, low energy (<20 MeV) cyclotrons (currently used for a few hours per day for the production of [18F]fluorodeoxyglucose) are available for production of 99mTc though this method, thus leading to job creation and preservation.

  7. Detection of strep throat causing bacterium directly from medical swabs by touch spray - mass spectrometry

    OpenAIRE

    Jarmusch, Alan K.; Pirro, Valentina; Kerian, Kevin S.; Cooks, Graham

    2014-01-01

    Strep throat causing Streptococcus pyogenes was detected in vitro and in simulated clinical samples by performing touch spray ionization - mass spectrometry. MS analysis took only seconds to reveal characteristic bacterial and human lipids. Medical swabs were used as the substrate for ambient ionization. This work constitutes the initial step in developing a noninvasive MS-based test for clinical diagnosis of strep throat. It is limited to the single species, S. pyogenes, which is responsible...

  8. Future Directions in Medical Physics: Models, Technology, and Translation to Medicine

    Science.gov (United States)

    Siewerdsen, Jeffrey

    The application of physics in medicine has been integral to major advances in diagnostic and therapeutic medicine. Two primary areas represent the mainstay of medical physics research in the last century: in radiation therapy, physicists have propelled advances in conformal radiation treatment and high-precision image guidance; and in diagnostic imaging, physicists have advanced an arsenal of multi-modality imaging that includes CT, MRI, ultrasound, and PET as indispensible tools for noninvasive screening, diagnosis, and assessment of treatment response. In addition to their role in building such technologically rich fields of medicine, physicists have also become integral to daily clinical practice in these areas. The future suggests new opportunities for multi-disciplinary research bridging physics, biology, engineering, and computer science, and collaboration in medical physics carries a strong capacity for identification of significant clinical needs, access to clinical data, and translation of technologies to clinical studies. In radiation therapy, for example, the extraction of knowledge from large datasets on treatment delivery, image-based phenotypes, genomic profile, and treatment outcome will require innovation in computational modeling and connection with medical physics for the curation of large datasets. Similarly in imaging physics, the demand for new imaging technology capable of measuring physical and biological processes over orders of magnitude in scale (from molecules to whole organ systems) and exploiting new contrast mechanisms for greater sensitivity to molecular agents and subtle functional / morphological change will benefit from multi-disciplinary collaboration in physics, biology, and engineering. Also in surgery and interventional radiology, where needs for increased precision and patient safety meet constraints in cost and workflow, development of new technologies for imaging, image registration, and robotic assistance can leverage

  9. Excessive daytime sleepiness, nocturnal sleep duration and ...

    African Journals Online (AJOL)

    Background and objectives. Short nocturnal sleep duration resulting in sleep debt may be a cause of excessive daytime sleepiness (EDS). Severity of depression (psychopathology) has been found to be directly related to EDS. There is an association between sleep duration and mental health, so there may therefore be an ...

  10. Detection of strep throat causing bacterium directly from medical swabs by touch spray-mass spectrometry.

    Science.gov (United States)

    Jarmusch, Alan K; Pirro, Valentina; Kerian, Kevin S; Cooks, R Graham

    2014-10-07

    Strep throat causing Streptococcus pyogenes was detected in vitro and in simulated clinical samples by performing touch spray ionization-mass spectrometry. MS analysis took only seconds to reveal characteristic bacterial and human lipids. Medical swabs were used as the substrate for ambient ionization. This work constitutes the initial step in developing a non-invasive MS-based test for clinical diagnosis of strep throat. It is limited to the single species, S. pyogenes, which is responsible for the vast majority of cases. The method is complementary to and, with further testing, a potential alternative to current methods of point-of-care detection of S. pyogenes.

  11. Can Individualized Learning Plans in an advanced clinical experience course for fourth year medical students foster Self-Directed Learning?

    Science.gov (United States)

    Chitkara, Maribeth B; Satnick, Daniel; Lu, Wei-Hsin; Fleit, Howard; Go, Roderick A; Chandran, Latha

    2016-09-01

    Residency programs have utilized Individualized Learning Plans (ILPs) to customize resident education while undergraduate medical education has not done so in a meaningful way. We discuss the use of ILPs within a fourth year medical school course to facilitate self-directed learning (SDL). At Stony Brook University School of Medicine, an ILP component was added to the Advanced Clinical Experience (ACE) course for fourth year students. Each completed an ILP outlining personal learning goals and strategies to achieve them. An adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ) (Duncan T and McKeachie W, Educ Psych 40(2):117-128, 2005 and Cook DA et al., Med Ed 45:1230-1240, 2011) was used to measure success of ILPs in improving SDL. Qualitative data analysis was conducted on the ILPs and self-reflections. Forty-eight students participated. Two of the four SDL sub-domains identified on the MSLQ showed improvement; self-efficacy (p = .001) and self-regulation (p = .002). 'Medical Knowledge' was the competency most frequently identified as an area of concentration (90 %) and professionalism was selected least frequently (4 %). A higher percentage (83 %) of students who reported complete achievement of their ILP goals also reported feeling better prepared for entering residency. ILPs improve SDL strategies among medical students and may serve as useful tools to help shape future learning goals as they transition to residency training.

  12. Exposure to Direct-to-Consumer Pharmaceutical Advertising and Medication Nonadherence Among Patients With Serious Mental Illness.

    Science.gov (United States)

    Green, Charee E; Mojtabai, Ramin; Cullen, Bernadette A; Spivak, Amethyst; Mitchell, Melissa; Spivak, Stanislav

    2017-09-15

    This study explored the association of exposure to direct-to-consumer advertising (DTCA) with medication nonadherence among individuals with serious mental disorders. Results of an anonymous survey administered at an inner-city mental health clinic were examined by using logistic regression. Nonadherence was defined as not taking prescribed medications for at least two out of seven days. Of 246 respondents, 48% reported DTCA exposure and 43% reported nonadherence. Sixty-one percent of those exposed to DTCA reported nonadherence, compared with 26% of those not exposed (adjusted odds ratio=4.96, 95% confidence interval=2.64-9.33, padvertisements and reporting nonadherence, 59% reported changing medication-taking behaviors or stopping prescribed medications because of side effect information in advertisements. Only a minority communicated with providers before becoming nonadherent. This study found an association between self-report of DTCA exposure and self-reported nonadherence. These results support further research on DTCA as a possible risk factor for nonadherence.

  13. Episodic Excessive Blinking in Children.

    Science.gov (United States)

    Mali, Yasmin Poustchi; Simon, John W; Chaudhri, Imran; Zobal-Ratner, Jitka; Barry, Gerard P

    2016-01-01

    Many children present with excessive blinking. Categorization, associated conditions, and prognosis are controversial. All children with excessive blinking were reviewed, excluding those with known uveitis, glaucoma, or obvious eyelid abnormalities. Parents were telephoned for follow-up. No ocular pathology was identified in 31 of 34 children with excessive blinking (91%). Parents were able to report a specific cause of blinking in 7 (21%). In 24 of 34 (71%), parents reported complete resolution of excessive blinking. No new ophthalmologic diagnoses were uncovered on follow-up. Episodes of excessive blinking rarely indicate neurologic disorders and frequently resolve spontaneously. Copyright 2016, SLACK Incorporated.

  14. Matching fundus photographs of classmates. An informal competition to promote learning and practice of direct ophthalmoscopy among medical students.

    Science.gov (United States)

    Krohn, Jørgen; Kjersem, Bård; Høvding, Gunnar

    2014-05-01

    To present a new approach for teaching direct ophthalmoscopy to medical students. At the University of Bergen, four consecutive classes of fourth-year medical students complete a required 9-week ophthalmology course every year. In the present project, one fundus photograph was taken of each student. The photographs were randomly numbered, printed on A4 glossy photo paper, and displayed on the classroom wall. Each student was given a form to fill in the fellow students' names matching the number of the fundus photographs. They were encouraged to practise direct ophthalmoscopy on their classmates outside formal teaching hours. At the end of the course, they returned the filled-in forms, and those with the highest number of correct matches between the fundus photographs and fellow students received a reward. Between 2011 and 2013, 239 students completed their ophthalmology course. Of these, 220 students (92%) voluntarily participated in the project. The mean score was 70% correct matches between fundus photographs and fellow students (range 7 - 100%). The students' course evaluations were overall positive. We recommend the use of peer fundus photographs in the context of a learning competition as a simple, inexpensive, and effective way to improve teaching of direct ophthalmoscopy.

  15. Surgical procedures and pediatric medical traumatic stress (PMTS) syndrome: Assessment and future directions.

    Science.gov (United States)

    Ari, Amichai Ben; Peri, Tuvia; Margalit, Daniella; Galili-Weisstub, Esti; Udassin, Raphael; Benarroch, Fortu

    2017-10-16

    Surgical procedures involve traumatic stress. Children may develop chronic psychological distress and dysfunction after surgery, with consequent reluctance to comply with medical follow-up care. A literature review of this topic shows that it has been understudied. Our study aims to assess the frequency and characteristics of symptoms of persistent psychological distress in children following surgery, which have not been documented before, in order to promote its awareness and its early identification. Parents of 79 children (aged 1-6) that were hospitalized in a pediatric surgical ward, comprising a representative sample, completed three validated questionnaires assessing their children's psychological symptoms 3-5months after the hospitalization. A significant portion of children suffer from psychological distress 3-5months after hospitalization. Moreover, 10.39% of the children exhibited symptoms of PTSD, and 28.6% of parents reported that the child's distress causes dysfunction. Additionally, our findings emphasize the parents' concerns regarding the child's behavior, function, and health following hospitalization. Since a significant prevalence of hospitalization-related traumatic stress is documented, the awareness to it has to be improved, in order to reduce its frequency and increase adherence to medical follow-up care. Prognosis study. 1. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students.

    Science.gov (United States)

    Pai, Kirtana M; Rao, K Raghavendra; Punja, Dhiren; Kamath, Asha

    2014-01-01

    Self-directed learning (SDL) has become popular in medical curricula and has been advocated as an effective learning strategy for medical students to develop competence in knowledge acquisition. The primary aim was to find out if there was any benefit of supplementing self-directed learning activity with a traditional lecture on two different topics in physiology for first-year medical students. Two batches of first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) (Batch A and Batch B) comprising 125 students each, received an SDL session on Morphological classification of anaemia. The students belonging to Batch A received a one-hour lecture on the same topic three days prior to the SDL session. The students were given a 10 multiple choice questions (MCQ) test for a maximum of 10 marks immediately following the SDL session. The next topic, Conducting system of the heart, disorders and conduction blocks was taught to both batches in traditional lecture format. This was followed by an SDL session on the same topic for Batch A only. The students were evaluated with a MCQ test for a maximum of 10 marks. The mean test scores on the first topic were 4.38±2.06 (n=119) and 4.17±1.71 (n=118) for Batch A and Batch B, respectively. The mean test scores on the second topic were 5.4± 1.54 (n=112) and 5.15±1.37 (n=107) for Batch A and Batch B, respectively. There was no significant difference between the groups. For first-year medical students, SDL is an effective teaching strategy for learning physiology. However, no additional benefit is gained by supplementing SDL with a lecture to facilitate learning physiology.

  17. Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

    Directory of Open Access Journals (Sweden)

    Westaby Daniel T

    2012-09-01

    Full Text Available Abstract Background There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP, especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate. Methods We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1 investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2 to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1 those who had initial medical management with methotrexate, (2 those who were eligible for initial medical management but chose surgery (‘elected’ surgery and (3 those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method. Results Methotrexate was £1179 (CI 819–1550 per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures. Conclusions Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.

  18. Impact of Integrated Care Model (ICM) on Direct Medical Costs in Management of Advanced Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Bandurska, Ewa; Damps-Konstańska, Iwona; Popowski, Piotr; Jędrzejczyk, Tadeusz; Janowiak, Piotr; Świętnicka, Katarzyna; Zarzeczna-Baran, Marzena; Jassem, Ewa

    2017-06-12

    BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly diagnosed condition in people older than 50 years of age. In advanced stage of this disease, integrated care (IC) is recommended as an optimal approach. IC allows for holistic and patient-focused care carried out at the patient's home. The aim of this study was to analyze the impact of IC on costs of care and on demand for medical services among patients included in IC. MATERIAL AND METHODS The study included 154 patients diagnosed with advanced COPD. Costs of care (general, COPD, and exacerbations-related) were evaluated for 1 year, including 6-months before and after implementing IC. The analysis included assessment of the number of medical procedures of various types before and after entering IC and changes in medical services providers. RESULTS Direct medical costs of standard care in advanced COPD were 886.78 EUR per 6 months. Costs of care of all types decreased after introducing IC. Changes in COPD and exacerbation-related costs were statistically significant (p=0.012492 and p=0.017023, respectively). Patients less frequently used medical services for respiratory system and cardiovascular diseases. Similarly, the number of hospitalizations and visits to emergency medicine departments decreased (by 40.24% and 8.5%, respectively). The number of GP visits increased after introducing IC (by 7.14%). CONCLUSIONS The high costs of care in advanced COPD indicate the need for new forms of effective care. IC caused a decrease in costs and in the number of hospitalization, with a simultaneous increase in the number of GP visits.

  19. Sleepiness or excessive daytime somnolence.

    Science.gov (United States)

    Edd, Ethel Mitty; Flores, Sandi

    2009-01-01

    Excessive daytime somnolence (EDS) is associated with age-related changes, environment, circadian rhythm or sleep pattern disorder, insomnia, medications, lifestyle factors, depression, pain, and illness. The notion of "sleep architecture" connotes a structure that describes the sleep cycle (i.e., stages) and wakefulness during a single sleep period-that is, rapid eye movement (REM) and non-REM sleep. Circadian rhythms perform a variety of functions including regulation of the quality and distribution of the stages of sleep. Insomnia includes delayed sleep onset as well as premature wakening; sleep is nonrestorative. Comorbidities associated with insomnia are Alzheimer's disease and other dementias, delirium, depression, congestive heart failure, chronic obstructive pulmonary disease, gastroesophageal reflux disease, pain, degenerative diseases of the neurological system, and sleep apnea. Continuous inadequate sleep affects cognitive function, physical performance, overall well-being, and quality of life. There is a greater risk of falls from insomnia than is the use of hypnotics to manage it. Sleep disruption among older adults is underrecognized and undertreated. Assessment using valid tools can be performed rapidly. There are a variety of treatment options, including sleep hygiene and pharmacological and alternative modalities.

  20. Optical fiber monitored by a directional coupler for delivering laser radiation in medical treatments.

    Science.gov (United States)

    Sottini, S; Lombardo, S; Russo, V

    1995-05-01

    The safety of therapeutic laser treatments could be strongly improved by introducing real-time monitoring to the fiber delivery system. Since any fiber damage leads to a significant variation of the backscatter, its detection could be exploited to monitor the system, in particular the fiber trip. To assess this potential, the backscattered modal power distribution (BMPD) from flat, bulb, and damaged fiber tips were investigated. The BMPD detection was accomplished by using a conventional beam-splitter method and two directional couplers: a prism-fiber and a fiber-fiber lapped coupler. Unlike the conventional method, use of the couplers allows for the separate detection of backscattered and forward transmitted signals. Therefore variations in the backscatter that are due to only a change in the laser pulse can be determined. Moreover, the directional couplers, because of the amplification of high-index modes, allow for an increase in sensitivity of the method. This was particularly evident in our tests on fiber tips that had been dipped into water to obtain a better simulation of the real working conditions. Finally, the influence of the target on the BMPD was investigated as a function of its distance from the fiber tip. All the tests confirm that the target must be taken into account if the distance is <1 mm, but the monitoring system can also be used when the fiber tip works in contact with the tissue wall provided that one can ensure contact by pushing the tip against the target wall.

  1. [Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis].

    Science.gov (United States)

    Rodríguez Bolaños, Rosibel de Los Ángeles; Reynales Shigematsu, Luz Myriam; Jiménez Ruíz, Jorge Alberto; Juárez Márquezy, Sergio Arturo; Hernández Ávila, Mauricio

    2010-12-01

    Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) for patients with type 2 diabetes mellitus (DM2). The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA) from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. Total IMSS DM2 annual costs were US$452 064 988, or 3.1% of operating expenses. The annual average cost per patient was US$3 193.75, with US$2 740.34 per patient without complications and US$3 550.17 per patient with complications. Hospitalization and intensive care bed-days generated the greatest expenses. The high cost of providing medical care to patients with DM2 and its complications represents an economic burden that health institutions should consider in their budgets to enable them to offer quality service that is both adequate and timely. Using the micro-costing methodology allows an approximation to real data on utilization and management of the disease.

  2. Development of prostate cancer research database with the clinical data warehouse technology for direct linkage with electronic medical record system.

    Science.gov (United States)

    Choi, In Young; Park, Seungho; Park, Bumjoon; Chung, Byung Ha; Kim, Choung-Soo; Lee, Hyun Moo; Byun, Seok-Soo; Lee, Ji Youl

    2013-01-01

    In spite of increased prostate cancer patients, little is known about the impact of treatments for prostate cancer patients and outcome of different treatments based on nationwide data. In order to obtain more comprehensive information for Korean prostate cancer patients, many professionals urged to have national system to monitor the quality of prostate cancer care. To gain its objective, the prostate cancer database system was planned and cautiously accommodated different views from various professions. This prostate cancer research database system incorporates information about a prostate cancer research including demographics, medical history, operation information, laboratory, and quality of life surveys. And, this system includes three different ways of clinical data collection to produce a comprehensive data base; direct data extraction from electronic medical record (EMR) system, manual data entry after linking EMR documents like magnetic resonance imaging findings and paper-based data collection for survey from patients. We implemented clinical data warehouse technology to test direct EMR link method with St. Mary's Hospital system. Using this method, total number of eligible patients were 2,300 from 1997 until 2012. Among them, 538 patients conducted surgery and others have different treatments. Our database system could provide the infrastructure for collecting error free data to support various retrospective and prospective studies.

  3. Medical applications of wireless sensor networks – current status and future directions

    Directory of Open Access Journals (Sweden)

    Krešimir Grgić

    2012-02-01

    Full Text Available In recent years a significant development of BASN (Body AreaSensor Networks as a special subclass of WSN (Wireless SensorNetworks has emerged. These networks have enabled a rapiddevelopment of telemedicine systems, which provide remote monitoringof patients and their vital parameters. The article givesa short overview of the BASN networks. Furthermore, a generalsystem architecture of telemedicine systems is proposed. The proposedarchitecture includes a local sensory area, a communicationnetwork area and an institutional network area. It also providesthe security and privacy of patient-related data. Furthermore, thearticle surveys some existing telemedicine systems. Finally, somecurrent problems are explained and the directions for the futuredevelopment of the telemedicine systems are given.

  4. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India.

    Science.gov (United States)

    Lindquist, Benjamin; Strehlow, Matthew C; Rao, G V Ramana; Newberry, Jennifer A

    2016-07-08

    Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.

  5. Recent achievements in Tc-99m radiopharmaceutical direct production by medical cyclotrons.

    Science.gov (United States)

    Boschi, Alessandra; Martini, Petra; Pasquali, Micol; Uccelli, Licia

    2017-09-01

    99mTc is the most commonly used radionuclide in the field of diagnostic imaging, a noninvasive method intended to diagnose a disease, assess the disease state and monitor the effects of treatments. Annually, the use of 99mTc, covers about 85% of nuclear medicine applications. This isotope releases gamma rays at about the same wavelength as conventional X-ray diagnostic equipment, and owing to its short half-life (t½ = 6 h) is ideal for diagnostic nuclear imaging. A patient can be injected with a small amount of 99mTc and within 24 h almost 94% of the injected radionuclide would have decayed and left the body, limiting the patient's radiation exposure. 99mTc is usually supplied to hospitals through a 99Mo/99mTc radionuclide generator system where it is produced from the β decay of the parent nuclide 99Mo (t½ = 66 h), which is produced in nuclear reactors via neutron fission. Recently, the interruption of the global supply chain of reactor-produced 99Mo, has forced the scientific community to investigate alternative production routes for 99mTc. One solution was to consider cyclotron-based methods as potential replacement of reactor-based technology and the nuclear reaction 100Mo(p,2n)99mTc emerged as the most worthwhile approach. This review reports some achievements about 99mTc produced by medical cyclotrons. In particular, the available technologies for target design, the most efficient extraction and separation procedure developed for the purification of 99mTc from the irradiated targets, the preparation of high purity 99mTc radiopharmaceuticals and the first clinical studies carried out with cyclotron produced 99mTc are described.

  6. Directly compressible medicated chewing gum formulation for quick relief from common cold.

    Science.gov (United States)

    Chaudhary, Shivang A; Shahiwala, Aliasgar F

    2012-07-01

    Common cold is the most frequently recurring disease in the world and is a leading cause of doctor visits and missed days from school and work. Cold reliever medicated chewing gum (MCG) will be a definitive patient acceptable solution for this condition. Anti-allergic, cetirizine (CTZ) is a BCS class-I (highly soluble and highly permeable) non-sedating antihistaminic drug and this study was based on the hypothesis that CTZ as a BCS class I drug will be easily released from chewing gum into the salivary fluid within few minutes of chewing and can be easily permeated from oral mucosa by the pressure created by the chewing action and absorbed to a larger extent into the systemic circulation. Therefore, ultimately patients will get quick relief from symptoms of common cold with greater compliance compared to other conventional dosage forms. This study mainly focuses on taste masking of CTZ by inclusion complexation method, its formulation development in the MCG form and its quality and performance evaluation with the study of potential factors affecting drug release by 3(2) full factorial experimental design. A "chew out" study is carried out to assess in vivo drug release from MCG, in which residual amount is extracted from the chewed sample. Formulation ingredients, such as elastomers, softeners, bulking agents, play an important role in the feel of the final product and its consistency; while sweeteners and flavors play a very essential character in its sensory properties. Interindividual variation in chewing frequency and chewing intensity is the main factor which affects release of active ingredient from MCG; while salivary dilution and involuntary swallowing are main reasons for variability in the absorption site, i.e., either from buccal mucosa or from gastrointestinal tract.

  7. Moral Distress in Nurses Providing Direct Patient Care at an Academic Medical Center.

    Science.gov (United States)

    Sirilla, Janet; Thompson, Kathrynn; Yamokoski, Todd; Risser, Mark D; Chipps, Esther

    2017-04-01

    Moral distress is the psychological response to knowing the appropriate action but not being able to act due to constraints. Previous authors reported moral distress among nurses, especially those that work in critical care units. The aims of this study were: (1) to examine the level of moral distress among nurses who work at an academic health system, (2) to compare the level of moral distress in nurses who work across specialty units at an academic health system, (3) to compare moral distress by the demographic characteristics of nurses and work experience variables, and (4) to identify demographic characteristics and type of clinical setting that may predict which nurses are at high risk for moral distress. A cross-sectional survey design was used with staff nurses who work on inpatient units and ambulatory units at an academic medical center. The moral distress scale-revised (MDS-R) was used to assess the intensity and frequency of moral distress. The overall mean MDS-R score in this project was low at 94.97 with mean scores in the low to moderate range (44.57 to 134.58). Nurses who work in critical care, perioperative services, and procedure areas had the highest mean MDS-R scores. There have been no previous reports of higher scores for nurses working in perioperative and procedure areas. There was weak positive correlation between MDS-R scores and years of experience (Rho = .17, p = .003) but no correlation between age (Rho = .02, p = .78) or education (Rho = .05, p = .802) and moral distress. Three variables were found useful in predicting moral distress: the type of unit and responses to two qualitative questions related to quitting their job. Identification of these variables allows organizations to focus their interventions. © 2017 Sigma Theta Tau International.

  8. A prospective study of direct medical costs in a large cohort of consecutively enrolled patients with refractory epilepsy in Italy.

    Science.gov (United States)

    Luoni, Chiara; Canevini, Maria Paola; Capovilla, Giuseppe; De Sarro, Giovambattista; Galimberti, Carlo Andrea; Gatti, Giuliana; Guerrini, Renzo; La Neve, Angela; Mazzucchelli, Iolanda; Rosati, Eleonora; Specchio, Luigi Maria; Striano, Salvatore; Tinuper, Paolo; Perucca, Emilio

    2015-07-01

    To evaluate direct medical costs and their predictors in patients with refractory epilepsy enrolled into the SOPHIE study (Study of Outcomes of PHarmacoresistance In Epilepsy) in Italy. Adults and children with refractory epilepsy were enrolled consecutively at 11 tertiary referral centers and followed for 18 months. At entry, all subjects underwent a structured interview and a medical examination, and were asked to keep records of diagnostic examinations, laboratory tests, specialist consultations, treatments, hospital admissions, and day-hospital days during follow-up. Study visits included assessments every 6 months of seizure frequency, health-related quality of life (Quality of Life in Epilepsy Inventory 31), medication-related adverse events (Adverse Event Profile) and mood state (Beck Depression Inventory-II). Cost items were priced by applying Italian tariffs. Cost estimates were adjusted to 2013 values. Of 1,124 enrolled individuals, 1,040 completed follow-up. Average annual cost per patient was € 4,677. The highest cost was for antiepileptic drug (AED) treatment (50%), followed by hospital admissions (29% of overall costs). AED polytherapy, seizure frequency during follow-up, grade III pharmacoresistance, medical and psychiatric comorbidities, and occurrence of status epilepticus during follow-up were identified as significant predictors of higher costs. Age between 6 and 11 years, and genetic (idiopathic) generalized epilepsies were associated with the lowest costs. Costs showed prominent variation across centers, largely due to differences in the clinical characteristics of cohorts enrolled at each center and the prescribing of second-generation AEDs. Individual outliers associated with high costs related to hospital admissions had a major influence on costs in many centers. Refractory epilepsy is associated with high costs that affect individuals and society. Costs differ across centers in relation to the characteristics of patients and the extent of

  9. Medical consequences of obesity.

    Science.gov (United States)

    Lawrence, Victor J; Kopelman, Peter G

    2004-01-01

    The obese are subject to health problems directly relating to the carriage of excess adipose tissue. These problems range from arthritis, aches and pains, sleep disturbance, dyspnea on mild exertion, and excessive sweating to social stigmatization and discrimination, all of which may contribute to low quality of life and depression (Table 1). The most serious medical consequences of obesity are a result of endocrine and metabolic changes, most notably type 2 diabetes mellitus, cardiovascular disease, and increased risk of cancer. Not all obesity comorbidities are fully reversed by weight loss. The degree and duration of weight loss required may not be achievable by an individual patient. Furthermore, "weight cycling" may be more detrimental to both physical and mental health than failure to achieve weight loss targets with medical and lifestyle advice.

  10. The relationship of medical, demographic and psychosocial factors to direct and indirect health utility instruments in rheumatoid arthritis.

    Science.gov (United States)

    Witney, A G; Treharne, G J; Tavakoli, M; Lyons, A C; Vincent, K; Scott, D L; Kitas, G D

    2006-08-01

    Cost-effectiveness analysis (CEA) is essential for the comparison of treatments for rheumatoid arthritis (RA). CEA centres on accurate measurement of health utility (HU) preferences. Direct measures of HU in RA patients demonstrate weaker correlations with health status (functional disability and pain) than indirect measures. We examined whether demographic and psychosocial factors relate to HU in RA patients. HU was measured for 142 RA patients (76% women; mean age 58.75 yr) directly through standard gamble (SG) and time trade-off (TTO), and indirectly on the EuroQol (EQ-5D). Current pain (100 mm visual analogue scale) and recent functional disability (Health Assessment Questionnaire; HAQ) were assessed. A subsample of 48 provided demographic and psychosocial information (education, employment, marital/family status, knowledge about RA, medication beliefs, desirable responding, social support, optimism, and the Hospital Anxiety and Depression Scale; HADS). Direct HU had higher means (SG = 0.88, TTO = 0.86) than indirect HU (EQ-5D = 0.52). HAQ functional disability correlated with SG (r = - 0.28), TTO (r = - 0.31) and EQ-5D (r = - 0.67). Current pain correlated with TTO (r = - 0.19) and EQ-5D (r = - 0.36). HADS depression correlated with TTO (r = - 0.35) and EQ-5D (r = - 0.64); HADS anxiety also correlated with EQ-5D (r = - 0.46). Demographic and psychosocial factors cannot completely explain either the significant differences between direct and indirect HUs in RA patients or the moderate correlations of direct HUs with health status. Characteristics of the SG and TTO may make them inappropriate for HU assessment and CEA among RA patients.

  11. Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Wu J

    2015-04-01

    Full Text Available Jing Wu,1 Xiaoning He,1 Li Liu,2 Wenyu Ye,2 William Montgomery,3 Haibo Xue,2 Jeffery S McCombs41School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, People’s Republic of China; 2Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, People’s Republic of China; 3Eli Lilly and Company, Sydney, Australia; 4Departments of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USAObjective: Information concerning the treatment costs of schizophrenia is scarce in People’s Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People’s Republic of China.Methods: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated.Results: A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median length of stay of 112.1 (71 days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median number of visits of 6.2 (4 and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication

  12. The importance of Guthrie cards and other medical samples for the direct matching of disaster victims using DNA profiling.

    Science.gov (United States)

    Hartman, D; Benton, L; Morenos, L; Beyer, J; Spiden, M; Stock, A

    2011-02-25

    The identification of disaster victims through the use of DNA analysis is an integral part of any Disaster Victim Identification (DVI) response, regardless of the scale and nature of the disaster. As part of the DVI response to the 2009 Victorian Bushfires Disaster, DNA analysis was performed to assist in the identification of victims through kinship (familial matching to relatives) or direct (self source sample) matching of DNA profiles. Although most of the DNA identifications achieved were to reference samples from relatives, there were a number of DNA identifications (12) made through direct matching. Guthrie cards, which have been collected in Australia over the past 30 years, were used to provide direct reference samples. Of the 236 ante-mortem (AM) samples received, 21 were Guthrie cards and one was a biopsy specimen; all yielding complete DNA profiles when genotyped. This publication describes the use of such Biobanks and medical specimens as a sample source for the recovery of good quality DNA for comparisons to post-mortem (PM) samples. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  13. Measuring Excess Noise in SDL's

    Science.gov (United States)

    Katzberg, S. J.; Kowitz, H. R.; Rowland, C. W.; Shull, T. A.; Ruggles, S. L.; Matthews, L. F.

    1983-01-01

    New instrument gives quantitive information on "excess noise" in semiconductor-diode laser (SDL's). By proper selection of detector, instrument tests any SDL from visible wavelengths through thermal infrared. Lasers determine excess noise in SKL source by measuring photocurrent generated in photodetector exposed first to reference laser then to SKL under test.

  14. The direct medical costs of colorectal cancer in Iran; analyzing the patient′s level data from a cancer specific hospital in Isfahan

    Directory of Open Access Journals (Sweden)

    Majid Davari

    2012-01-01

    Conclusion: CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million $. Screening programs could reduce the economic cost of CRC significantly.

  15. Does Excessive Pronation Cause Pain?

    DEFF Research Database (Denmark)

    Olesen, Christian Gammelgaard; Nielsen, RG; Rathleff, M

    Excessive pronation could be an inborn abnormality or an acquired foot disorder caused by overuse, inadequate supported shoes or inadequate foot training. When the muscles and ligaments of the foot are insufficient it can cause an excessive pronation of the foot. The current treatment consist...... of antipronation shoes or insoles, which latest was studied by Kulce DG., et al (2007). So far there have been no randomized controlled studies showing methods that can measure the effect of treatments with insoles. Some of the excessive pronation patients recieve antipronation training often if the patient...

  16. Excessive sleep duration and quality of life.

    Science.gov (United States)

    Ohayon, Maurice M; Reynolds, Charles F; Dauvilliers, Yves

    2013-06-01

    Using population-based data, we document the comorbidities (medical, neurologic, and psychiatric) and consequences for daily functioning of excessive quantity of sleep (EQS), defined as a main sleep period or 24-hour sleep duration ≥ 9 hours accompanied by complaints of impaired functioning or distress due to excessive sleep, and its links to excessive sleepiness. A cross-sectional telephone study using a representative sample of 19,136 noninstitutionalized individuals living in the United States, aged ≥ 18 years (participation rate = 83.2%). The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision; International Classification of Sleep Disorders: Diagnostic and Coding Manual II, International Classification of Diseases and Related Health Problems, 10th edition). Sleeping at least 9 hours per 24-hour period was reported by 8.4% (95% confidence interval = 8.0-8.8%) of participants; EQS (prolonged sleep episode with distress/impairment) was observed in 1.6% (1.4-1.8%) of the sample. The likelihood of EQS was 3 to 12× higher among individuals with a mood disorder. EQS individuals were 2 to 4× more likely to report poor quality of life than non-EQS individuals as well as interference with socioprofessional activities and relationships. Although between 33 and 66% of individuals with prolonged sleep perceived it as a major problem, only 6.3 to 27.5% of them reported having sought medical attention. EQS is widespread in the general population, co-occurring with a broad spectrum of sleep, medical, neurologic, and psychiatric disorders. Therefore, physicians must recognize EQS as a mixed clinical entity indicating careful assessment and specific treatment planning. © 2013 American Neurological Association.

  17. Does Excessive Pronation Cause Pain?

    DEFF Research Database (Denmark)

    Mølgaard, Carsten Møller; Olesen Gammelgaard, Christian; Nielsen, R. G.

    2008-01-01

    Excessive pronation could be an inborn abnormality or an acquired foot disorder caused by overuse, inadequate supported shoes or inadequate foot training. When the muscles and ligaments of the foot are insufficient it can cause an excessive pronation of the foot. The current treatment consist of ...... pronation patients recieve antipronation training often if the patient is in pain but wanted to investigate if it was possible to measure a change in foot posture after af given treatment....

  18. A comparison of the direct medical costs for individuals with or without basal or squamous cell skin cancer: A study from Australia

    Directory of Open Access Journals (Sweden)

    David Rowell

    2016-05-01

    Full Text Available Objectives: The composition of the medical costs incurred by people treated for basal cell and squamous cell carcinomas (hereafter keratinocyte cancers is not adequately understood. We sought to compare the medical costs of individuals with or without keratinocyte cancers. Methods: We used national health insurance data to analyze the direct medical costs of 2000 cases and 2000 controls nested within the QSkin prospective cohort study (n = 43,794 conducted in Australia. We reconstructed the medical history of patients using medical and pharmaceutical item codes and then compared the health service costs of individuals treated for keratinocyte cancers with those not treated for keratinocyte cancers. Results: Individuals treated for keratinocyte cancers consumed on average AUD$1320 per annum more in medical services than those without keratinocyte cancers. Only 23.2% of costs were attributed to the explicit treatment of keratinocyte cancers. The principal drivers of the residual costs were medical attendances, surgical procedures on the skin, and histopathology services. We found significant positive associations between history of treatment for keratinocyte cancers with treatments for other health conditions, including melanoma, cardiovascular disease, lipidemia, osteoporosis, rheumatoid arthritis, colorectal cancer, prostate cancer, and tuberculosis. Conclusion: Individuals treated for keratinocyte cancers have substantially higher medical costs overall than individuals without keratinocyte cancers. The direct costs of skin cancer excision account for only one-fifth of this difference.

  19. Airflow-directed in situ electrospinning of a medical glue of cyanoacrylate for rapid hemostasis in liver resection

    Science.gov (United States)

    Jiang, Kai; Long, Yun-Ze; Chen, Zhao-Jun; Liu, Shu-Liang; Huang, Yuan-Yuan; Jiang, Xingyu; Huang, Zhi-Qiang

    2014-06-01

    Rapid hemostasis of solitary organs is still a big challenge in surgical procedures or after major trauma in both civilians and on the battlefield. Here, we report the first use of an airflow-directed in situ electrospinning method to precisely and homogeneously deposit a medical glue of n-octyl-2-cyanoacrylate (OCA) ultrathin fibers onto a wound surface to realize rapid hemostasis in dozens of seconds. In vivo and in vitro experiments on pig liver resection demonstrate that the self-assembled electrospun OCA membrane with high strength, good flexibility and integrity is very compact and no fluid seeping is observed even under a pressure of 147 mm Hg. A similar effect has been achieved in an in vivo experiment on pig lung resection. The results provide a very promising alternative for rapid hemostasis of solitary organs as well as other traumas, providing evidence that the postoperative drainage tube may not be always necessary for surgery in the near future.Rapid hemostasis of solitary organs is still a big challenge in surgical procedures or after major trauma in both civilians and on the battlefield. Here, we report the first use of an airflow-directed in situ electrospinning method to precisely and homogeneously deposit a medical glue of n-octyl-2-cyanoacrylate (OCA) ultrathin fibers onto a wound surface to realize rapid hemostasis in dozens of seconds. In vivo and in vitro experiments on pig liver resection demonstrate that the self-assembled electrospun OCA membrane with high strength, good flexibility and integrity is very compact and no fluid seeping is observed even under a pressure of 147 mm Hg. A similar effect has been achieved in an in vivo experiment on pig lung resection. The results provide a very promising alternative for rapid hemostasis of solitary organs as well as other traumas, providing evidence that the postoperative drainage tube may not be always necessary for surgery in the near future. Electronic supplementary information (ESI) available

  20. Direct medical costs of COPD diagnosis and treatment, Eastern vs Western European country – examples of Serbia and Belgium

    Directory of Open Access Journals (Sweden)

    Mihajlo B Jakovljevic

    2013-12-01

    Full Text Available OBJECTIVE: Comparison of COPD financial burden and underlying factors, between Eastern upper middle income and a Western European high income, healthcare settings.METHODS: The patient sample was 433 in Belgium and 322 in Serbia, age ≥ 40, with spirometry and clinically confirmed COPD diagnosis. Belgian trial followed patients prospectively during 2006, using structured survey of clinicians in charge. Serbian trial conducted in 2008, retrieved data from clinical invoice database. Time horizon was one year and perspective of third party payers was taken into account for both studies. Clinical outcomes of interest were disease exacerbation, hospital admission and death. Economic inputs referred to COPD-attributable medical services consumption value during observed period of time.RESULTS: Average annual cost was 1,812.84 € for the Serbian patients and 1,738.13 €/year for the Belgian patients (not including the value of laboratory diagnostics or imaging techniques. Severity grade and duration of hospital admissions significantly directly correlated with overall cost in both populations. Pattern of diagnostic procedures requested and ATC classes of drug consumed to treat COPD remains similar and comparable in both countries. GDP per capita ratio in respective years (10.4: 37.4, exhibits the paradox of patient being much less affordable to treat in a less developed society.CONCLUSIONS: Burden of COPD in Europe is huge and, due to contemporary life style expected to grow further. We compared cost of illness structures between two societies with different macroeconomic past in healthcare financing and management. According to our findings, direct medical costs were driven by exacerbations and hospital admissions. Significantly cheaper human labor caused higher relative relevance of drug acquisition expenses in the East and higher portion of hospital admission costs in the West. More in-depth research of indirect COPD attributable costs (e.g. lost

  1. The impact of the European Working Time Directive 10 years on: views of the UK medical graduates of 2002 surveyed in 2013–2014

    Science.gov (United States)

    Lambert, Trevor W; Goldacre, Michael J

    2016-01-01

    Objectives To report doctors’ views about the European Working Time Directive (‘the Directive’). Design Survey of the medical graduates of 2002 (surveyed in 2013–2014). Participants Medical graduates. Setting UK. Main outcome measures Questions on views about the Directive. Results The response rate was 64% (2056/3196). Twelve per cent of respondents agreed that the Directive had benefited senior doctors, 39% that it benefited junior doctors, and 17% that it had benefited the NHS. More women (41%) than men (35%) agreed that the Directive had benefited junior doctors. Surgeons (6%) and adult medical specialists (8%) were least likely to agree that the Directive had benefited senior doctors. Surgeons (20%) were less likely than others to agree that the Directive had benefited junior doctors, whilst specialists in emergency medicine (57%) and psychiatry (52%) were more likely to agree. Surgeons (7%) were least likely to agree that the Directive had benefited the NHS. Most respondents (62%) reported a positive effect upon work–life balance. With regard to quality of patient care, 45% reported a neutral effect, 40% reported a negative effect, and 15% a positive effect. Most respondents (71%) reported a negative effect of the Directive on continuity of patient care, and 71% felt that the Directive had a negative effect upon junior doctors’ training opportunities. Fifty-two per cent reported a negative effect on efficiency in managing patient care. Conclusions Senior doctors agreed that the Directive benefited doctors’ work–life balance. In other respects, they were more negative about it. Surgeons were the least positive about aspects of the Directive. PMID:26981257

  2. Direct non-medical and indirect costs for families with children with congenital cardiac defects in Germany: a survey from a university centre.

    Science.gov (United States)

    Gerber, Andreas U; Torre, Agnieszka Hompanera; Büscher, Guido; Stock, Stephanie A K; Graf, Christine; Schickendantz, Sabine; Brockmeier, Konrad; Lüngen, Markus

    2010-04-01

    Parents of children with congenital cardiac disease suffer from psychological stress and financial burdens. These costs have not yet been quantified. In cooperation with paediatricians, social workers, and parents, a questionnaire was devised to calculate direct non-medical and indirect costs. Direct non-medical costs include all costs not directly related to medical services such as transportation. Indirect costs include lost productivity measured in lost income from wages. Parents were retrospectively queried on costs and refunds incurred during the child's first and sixth year of life. The questionnaire was sent out to 198 families with children born between 1980 and 2000. Costs were adjusted for inflation to the year 2006. Children were stratified into five groups according to the severity of their current health status. Fifty-four families responded and could be included into the analysis (27.7%). Depending on severity, total direct non-medical and indirect costs in the first year of life ranged between an average of euro1654 in children with no or mild (remaining) cardiac defects and an average euro2881 in children with clinically significant (residual/remaining) findings. Mean expenses in the sixth year of life were as low as euro562 (no or mild (remaining) cardiac defects) and as high as euro5213 (potentially life-threatening findings). At both points in time, the highest costs were lost income and transportation; and day care/ babysitting for siblings was third. Families of children with congenital cardiac disease and major sequelae face direct non-medical and indirect costs adding up to euro3000 per year on average. We should consider compensating families from low socioeconomic backgrounds to minimise under-use of non-medical services of assistance for their children.

  3. Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

    Science.gov (United States)

    Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

    2016-11-19

    Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Crying - excessive (0-6 months)

    Science.gov (United States)

    ... provider will check the infant's growth and development. Antibiotics may be prescribed if the baby has a bacterial infection. Alternative Names Infants - excessive crying; Well child - excessive crying ...

  5. Integrating Public Health and Health Promotion Practice in the Medical Curriculum: A Self-Directed Team-Based Project Approach

    Directory of Open Access Journals (Sweden)

    Geraldine Kershaw

    2017-08-01

    Full Text Available Preparing health professionals in health promotion (HP and disease prevention is essential for improvement of population health, community HP, and better health care for individuals. The aim of this article is to describe an HP project in the form of a major self-directed project-based learning task integrated within the curriculum in the second year of the medical degree program at United Arab Emirates University. The project introduces students to public health and HP practice and develops students’ literature searching, writing, presentation skills, and team work. Students learn the principles underlying behavioral change, and the design of HP programs and materials, through a lecture format. Small groups of students each choose a specific health topic for their project. Over 11 weeks, students obtain information about their topic from appropriate sources (library, PubMed, Google Scholar, credible health sources such as World Health Organization. Using the principles learned in the lectures, they develop appropriate materials for their target audience: for example, posters, a pamphlet, social media content, or a video or radio message. Students seek advice from specialist faculty as needed. In week 12, each team presents their project background, rationale, and materials to their colleagues in a seminar format open to all faculty. They then submit the materials they developed for assessment. Group marks are assigned for presentations and materials. Key concepts are assessed by multiple choice questions in comprehensive course examinations. By participation in the HP project, many students develop a solid background in prevention. The information retrieval, writing, and presentation skills, as well as experience of team work, are valuable both for the remaining years of their training and their future careers.

  6. Integrating Public Health and Health Promotion Practice in the Medical Curriculum: A Self-Directed Team-Based Project Approach.

    Science.gov (United States)

    Kershaw, Geraldine; Grivna, Michal; Elbarazi, Iffat; AliHassan, Souheila; Aziz, Faisal; Al Dhaheri, Aysha Ibrahim

    2017-01-01

    Preparing health professionals in health promotion (HP) and disease prevention is essential for improvement of population health, community HP, and better health care for individuals. The aim of this article is to describe an HP project in the form of a major self-directed project-based learning task integrated within the curriculum in the second year of the medical degree program at United Arab Emirates University. The project introduces students to public health and HP practice and develops students' literature searching, writing, presentation skills, and team work. Students learn the principles underlying behavioral change, and the design of HP programs and materials, through a lecture format. Small groups of students each choose a specific health topic for their project. Over 11 weeks, students obtain information about their topic from appropriate sources (library, PubMed, Google Scholar, credible health sources such as World Health Organization). Using the principles learned in the lectures, they develop appropriate materials for their target audience: for example, posters, a pamphlet, social media content, or a video or radio message. Students seek advice from specialist faculty as needed. In week 12, each team presents their project background, rationale, and materials to their colleagues in a seminar format open to all faculty. They then submit the materials they developed for assessment. Group marks are assigned for presentations and materials. Key concepts are assessed by multiple choice questions in comprehensive course examinations. By participation in the HP project, many students develop a solid background in prevention. The information retrieval, writing, and presentation skills, as well as experience of team work, are valuable both for the remaining years of their training and their future careers.

  7. Case-Based Learning in Endocrine Physiology: An Approach toward Self-Directed Learning and the Development of Soft Skills in Medical Students

    Science.gov (United States)

    Gade, Shubhada; Chari, Suresh

    2013-01-01

    The Medical Council of India, in the recent "Vision 2015" document, recommended curricular reforms for undergraduates. Case-based learning (CBL) is one method where students are motivated toward self-directed learning and to develop analytic and problem-solving skills. An overview of thyroid physiology was given in a didactic lecture. A…

  8. Prospective Multicenter Evaluation of the Direct Flow Medical Transcatheter Aortic Valve System: 12-Month Outcomes of the Evaluation of the Direct Flow Medical Percutaneous Aortic Valve 18F System for the Treatment of Patients With Severe Aortic Stenosis (DISCOVER) Study.

    Science.gov (United States)

    Lefèvre, Thierry; Colombo, Antonio; Tchétché, Didier; Latib, Azeem; Klugmann, Silvio; Fajadet, Jean; De Marco, Federico; Maisano, Francesco; Bruschi, Giuseppe; Bijuklic, Klaudija; Nava, Stefano; Weissman, Neil; Low, Reginald; Thomas, Martyn; Young, Christopher; Redwood, Simon; Mullen, Michael; Yap, John; Grube, Eberhard; Nickenig, Georg; Sinning, Jan-Malte; Hauptmann, Karl Eugen; Friedrich, Ivar; Lauterbach, Michael; Schmoeckel, Michael; Davidson, Charles; Schofer, Joachim

    2016-01-11

    The aim of this study was to assess the 1-year outcome after transcatheter aortic valve replacement (TAVR) of the Direct Flow Medical (DFM) valve in patients with severe symptomatic aortic stenosis who were contraindicated or high risk for surgery. The DFM transcatheter heart valve is a new-generation, nonmetallic aortic valve with a pressurized support structure and conformable double-ring annular sealing delivered through an 18-F sheath. The device allows repositioning, retrieval, and assessment of valve performance before permanent implantation. A prospective multicenter European registry was set up to determine the safety and performance of the valve in 100 consecutive patients (10 centers). Echocardiographic and angiographic data were evaluated by an independent core laboratory, and adverse events were adjudicated by a clinical events committee using Valve Academic Research Consortium criteria. Patients were 83.1 ± 5.9 years of age and had a logistic EuroSCORE of 22.5 ± 11.3% and a Society of Thoracic Surgeons score of 9.7 ± 8.7%. Correct valve positioning was obtained in 99% of cases with a combined 30-day safety endpoint at 10%, including major stroke in 5.0%, major vascular complications in 2.0%, and death in 1%. At 12 months, 95% of patients were in New York Heart Association functional class I or II. Freedom from any death was 90%, and freedom from any death or major stroke was 85%. Echocardiography demonstrated none/trace to mild aortic regurgitation in 100% of patients and an unchanged mean aortic gradient of 12.2 ± 6.6 mm Hg and effective orifice area of 1.6 ± 0.4 cm(2). At 1 year, the DFM transcatheter heart valve had durable hemodynamics. This study demonstrates that the low rate of early complications and the low risk of significant aortic regurgitation translated into midterm clinical benefit. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. The Use of Psychotropic Medication for People with Severe Disabilities and Challenging Behavior: Current Status and Future Directions.

    Science.gov (United States)

    Kennedy, Craig H.; Meyer, Kim A.

    1998-01-01

    This article reviews basic literature on behavioral pharmacology and integrates these findings with existing applied research regarding psychotropic medication. Suggestions are provided for improving research practices, increasing the diversity of people in decision-making regarding medication use, and developing consumer-friendly strategies for…

  10. Effects of differences in problem-based learning course length on academic motivation and self-directed learning readiness in medical school students.

    Science.gov (United States)

    Yune, So Jung; Im, Sun Ju; Lee, Sun Hee; Baek, Sun Yong; Lee, Sang Yeoup

    2010-03-01

    Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

  11. Do differentials in the support and advice available at UK schools and colleges influence candidate performance in the medical school admissions interview? A survey of direct school leaver applicants to a UK medical school.

    Science.gov (United States)

    Lambe, Paul; Waters, Catherine; Bristow, David

    2013-09-01

    To our knowledge, nothing is known about whether differentials in support and advice during preparation for the interview influence candidate performance and thereby contribute to bias in selection for medical school. To assess if differences in advice and support with preparation for the medical school admissions interview given type of school last attended influence interview score achieved by direct school leaver applicants to study on an undergraduate UK medical degree course. Confidential self-completed on-line questionnaire survey. Interview performance was positively related to whether a teacher, tutor or career advisors at the School or College last attended had advised a respondent to prepare for the interview, had advised about the various styles of medical interview used and the types of questions asked, and what resources were available to help in preparation. Respondents from Private/Independent schools were more likely than those from State schools to have received such advice and support. Differentials in access to advice on and support with preparation for the medical school interview may advantage some candidates over others. This inequity would likely be ameliorated by the provision of an authoritative and comprehensive guide to applying to medical school outlining admission requirements and the preparation strategy applicants should use in order to best meet those requirements. The guide could be disseminated to the Principals of all UK schools and colleges and freely available electronic versions signposted in medical school prospectuses and the course descriptor on the Universities and Colleges Admissions Service.

  12. Severe rhabdomyolysis after excessive bodybuilding.

    Science.gov (United States)

    Finsterer, J; Zuntner, G; Fuchs, M; Weinberger, A

    2007-12-01

    A 46-year-old male subject performed excessive physical exertion during 4-6 h in a studio for body builders during 5 days. He was not practicing sport prior to this training and denied the use of any aiding substances. Despite muscle aching already after 1 day, he continued the exercises. After the last day, he recognized tiredness and cessation of urine production. Two days after discontinuation of the training, a Herpes simplex infection occurred. Because of acute renal failure, he required hemodialysis. There were absent tendon reflexes and creatine kinase (CK) values up to 208 274 U/L (normal: <170 U/L). After 2 weeks, CK had almost normalized and, after 4 weeks, hemodialysis was discontinued. Excessive muscle training may result in severe, hemodialysis-dependent rhabdomyolysis. Triggering factors may be prior low fitness level, viral infection, or subclinical metabolic myopathy.

  13. [Direct medical costs and influencing factors in severe hand, foot and mouth disease in children aged between six months and five years old].

    Science.gov (United States)

    Zheng, Y M; Yang, J; Liao, Q H

    2017-01-06

    Objective: To estimate the direct medical cost of severe hand, foot and mouth disease (HFMD) in patients aged less than five years. Methods: A stratified sampling method was used to collect data on severe HFMD cases reported in the National HFMD surveillance database between Jan 1, 2012, and Dec 31, 2013. The sampling was referenced with the national aetiologic distribution of Enterovirus A71 (EV-A71), Coxsackievirus A16 (CV-A16) and other Enteroviruses (OEV) for severe HFMD cases and the included cases were distributed among seven geographic regions (Northeast, North China, Northwest, Central China, Southwest, East China and South China). A nationwide telephone interview using a structured questionnaire was conducted to obtain the direct medical cost and any complications that occurred in patients during the outbreak of laboratory-confirmed HFMD. After excluding the cases who could not recall their medical expenses or complications, a total of 685 cases were included in the analysis. Kruskal-Wallis H test was used to analyze the differences among patients who reported different complications. Multiple linear regression with bootstrap analysis of 500 replicates was used to explore the factors that influenced the direct medical costs. Results: Of 685 patients analyzed, 456 (66.6%) were male and 229 (33.4%) were female. The direct medical costs P50 (P25, P75) were 14 250 (10 301, 20 600) Yuan. In total, 127 (18.5%) patients were diagnosed with severe HFMD patients with respiratory disease, 38 (5.5%) patients were diagnosed with aseptic meningitis, and 378 (55.2%) with encephalitis/brainstem encephalitis/acute flaccid paralysis. Furthermore, 53 (18.5%) patients were diagnosed with myocarditis, 39 (5.7%) with pulmonary hemorrhage/pulmonary edema and 50 (7.3%) with cardiopulmonary failure. The median (interquartile range) direct medical costs were 12 360 (7 313, 16 480) Yuan for severe HFMD patients with respiratory disease, 13 803 (9 064, 19 930) Yuan for aseptic

  14. Direct medical costs and their predictors in patients with rheumatoid arthritis: a three-year study of 7,527 patients.

    Science.gov (United States)

    Michaud, Kaleb; Messer, Jodi; Choi, Hyon K; Wolfe, Frederick

    2003-10-01

    To estimate total direct medical costs in persons with rheumatoid arthritis (RA) and to characterize predictors of these costs. Patients (n = 7,527) participating in a longitudinal study of outcome in RA completed 25,050 semiannual questionnaires from January 1999 through December 2001. From these we determined direct medical care costs converted to 2001 US dollars using the consumer price index. We used generalized estimating equations to examine potential predictors of the costs. Monte Carlo simulations and sensitivity analyses were performed to evaluate the varying prevalence and cost of biologic therapy. The mean total annual direct medical care cost in 2001 for a patient with RA was 9,519 US dollars. Drug costs were 6,324 US dollars (66% of the total), while hospitalization costs were only 1,573 US dollars (17%). Approximately 25% of patients received biologic therapy. The mean total annual direct cost for patients receiving biologic agents was 19,016 US dollars per year, while the cost for those not receiving biologic therapy was 6,164 US dollars. RA patients who were in the worst quartile of functional status, as measured by the Health Assessment Questionnaire, experienced direct medical costs for the subsequent year that were 5,022 US dollars more than the costs incurred by those in the best quartile. Physical status as determined by the Short Form 36 physical component scale had a similar large effect on RA costs, as did comorbidity. Medical insurance type played a more limited role. However, those without insurance had substantially lower service utilization and costs, and health maintenance organization patients had lower drug costs and total medical costs. Increased years of education, increased income, and majority ethnic status were all associated with increased drug costs but not hospitalization costs. Costs in all categories decreased after age 65 years. Estimates of direct medical costs for patients with RA are substantially higher than cost

  15. Behavioral Management of Excessive Caffeine Consumption: Three Case Studies.

    Science.gov (United States)

    Johnson-Greene, Douglas; And Others

    Although caffeine is seemingly harmless in ordinary daily intake, there has been increasing concern about the possible side effects of habitual caffeine ingestion. The excessive daily ingestion of caffeine in the form of coffee, soda pop, tea, and various medications may lead to a chronic disorder known as caffeinism. This study tested the…

  16. 10 CFR 904.9 - Excess capacity.

    Science.gov (United States)

    2010-01-01

    ... Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall be entitled to such Excess Capacity to integrate the operation of the Boulder City Area Projects and other... 10 Energy 4 2010-01-01 2010-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF...

  17. 12 CFR 925.23 - Excess stock.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Excess stock. 925.23 Section 925.23 Banks and... BANKS Stock Requirements § 925.23 Excess stock. (a) Sale of excess stock. Subject to the restriction in paragraph (b) of this section, a member may purchase excess stock as long as the purchase is approved by the...

  18. Propylene Glycol Poisoning From Excess Whiskey Ingestion

    Directory of Open Access Journals (Sweden)

    Courtney A. Cunningham MD

    2015-09-01

    Full Text Available In this report, we describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol. Recently, several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication. Our patient endorsed drinking large volumes of cinnamon flavored whiskey, which was likely Fireball Cinnamon Whisky. To our knowledge, this is the first case of propylene glycol toxicity from an intentional ingestion of liquor containing propylene glycol.

  19. Japanese citizens' attitude toward end-of-life care and advance directives: A qualitative study for members of medical cooperatives.

    Science.gov (United States)

    Hirayama, Yoko; Otani, Takashi; Matsushima, Masato

    2017-12-01

    Japanese citizens are interested in choosing their own end-of-life care, but few have created their own advance directive. This study examined changes among Japanese citizens' attitudes toward end-of-life care and advance directives and explored factors that affected these attitudes. We conducted five focus groups with 48 participants in 2009 and 2010. All participants were members of health cooperatives in Tokyo. We identified many barriers and reasons for creating and writing down advance directives. Experience caring for dying people and having a serious disease affected attitudes toward advance directives. Some participants changed their attitude toward end-of-life care by writing their own advance directive. When someone is writing advance directives, asking about his/her past experience of caring may be helpful. And learning about or filling out advance directives may help to break down resistance to using these documents.

  20. Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions.

    Science.gov (United States)

    Akeroyd, Julia M; Chan, Winston J; Kamal, Ayeesha K; Palaniappan, Latha; Virani, Salim S

    2015-12-26

    To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients. We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate. These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence. The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence.

  1. Diphoton excess through dark mediators

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chien-Yi [Department of Physics and Astronomy, University of Victoria,Victoria, BC V8P 5C2 (Canada); Perimeter Institute for Theoretical Physics,Waterloo, ON N2J 2W9 (Canada); Lefebvre, Michel [Department of Physics and Astronomy, University of Victoria,Victoria, BC V8P 5C2 (Canada); Pospelov, Maxim [Department of Physics and Astronomy, University of Victoria,Victoria, BC V8P 5C2 (Canada); Perimeter Institute for Theoretical Physics,Waterloo, ON N2J 2W9 (Canada); Zhong, Yi-Ming [C.N. Yang Institute for Theoretical Physics, Stony Brook University,Stony Brook, New York 11794 (United States)

    2016-07-12

    Preliminary ATLAS and CMS results from the first 13 TeV LHC run have encountered an intriguing excess of events in the diphoton channel around the invariant mass of 750 GeV. We investigate a possibility that the current excess is due to a heavy resonance decaying to light metastable states, which in turn give displaced decays to very highly collimated e{sup +}e{sup −} pairs. Such decays may pass the photon selection criteria, and successfully mimic the diphoton events, especially at low counts. We investigate two classes of such models, characterized by the following underlying production and decay chains: gg→S→A{sup ′}A{sup ′}→(e{sup +}e{sup −})(e{sup +}e{sup −}) and qq̄→Z{sup ′}→sa→(e{sup +}e{sup −})(e{sup +}e{sup −}), where at the first step a heavy scalar, S, or vector, Z{sup ′}, resonances are produced that decay to light metastable vectors, A{sup ′}, or (pseudo-)scalars, s and a. Setting the parameters of the models to explain the existing excess, and taking the ATLAS detector geometry into account, we marginalize over the properties of heavy resonances in order to derive the expected lifetimes and couplings of metastable light resonances. We observe that in the case of A{sup ′}, the suggested range of masses and mixing angles ϵ is within reach of several new-generation intensity frontier experiments.

  2. Excess Early Mortality in Schizophrenia

    DEFF Research Database (Denmark)

    Laursen, Thomas Munk; Nordentoft, Merete; Mortensen, Preben Bo

    2014-01-01

    Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality...... as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may...

  3. Influence on consumer behavior: the impact of direct-to-consumer advertising on medication requests for gastroesophageal reflux disease and social anxiety disorder.

    Science.gov (United States)

    Khanfar, Nile M; Polen, Hyla H; Clauson, Kevin A

    2009-01-01

    A 68-question Internet survey was used to determine the impact of televised direct-to-consumer advertising (DTCA) on consumer-initiated medication changes for the treatment of gastroesophageal reflux disease (GERD) and social anxiety disorder (SAD). Of the 427 respondents, 10% that viewed DTCA for GERD and 6% that viewed DTCA for SAD reported that they subsequently initiated a conversation with their physician. Nearly half of respondents, 47.4% for GERD and 40% for SAD, reported that a change in therapy occurred as a direct result of these discussions. Televised DTCA for these two drug classes can have a significant impact on patient-initiated prescription requests.

  4. Excess zinc ions are a competitive inhibitor for carboxypeptidase A

    Energy Technology Data Exchange (ETDEWEB)

    Hirose, J.; Ando, S.; Kidani, Y.

    1987-10-06

    The mechanism for inhibition of enzyme activity by excess zinc ions has been studied by kinetic and equilibrium dialysis methods at pH 8.2, I = 0.5 M. With carboxypeptidase A (bovine pancreas), peptide (carbobenzoxyglycyl-L-phenylalanine and hippuryl-L-phenylalanine) and ester (hippuryl-L-phenyl lactate) substrates were inhibited competitively by excess zinc ions. The K/sub i/ values for excess zinc ions with carboxypeptidase A at pH 8.2 are all similar. The apparent constant for dissociation of excess zinc ions from carboxypeptidase A was also obtained by equilibrium dialysis at pH 8.2 and was 2.4 x 10/sup -5/ M, very close to the K/sub i/ values above. With arsanilazotyrosine-248 carboxypeptidase A ((Azo-CPD)Zn)), hippuryl-L-phenylalanine, carbobenzoxyglycyl-L-phenylalanine, and hippuryl-L-phenyl lactate were also inhibited with a competitive pattern by excess zinc ions, and the K/sub i/ values were (3.0-3.5) x 10/sup -5/ M. The apparent constant for dissociation of excess zinc ions from arsanilazotyrosine-248 carboxypeptidase A, which was obtained from absorption changes at 510 nm, was 3.2 x 10/sup -5/ M and is similar to the K/sub i/ values for ((Azo-CPD)Zn). The apparent dissociation and inhibition constants, which were obtained by inhibition of enzyme activity and spectrophotometric and equilibrium dialysis methods with native carboxypeptidase A and arsanilazotyrosine-248 carboxypeptidase A, were almost the same. This agreement between the apparent dissociation and inhibition constants indicates that the zinc binding to the enzymes directly relates to the inhibition of enzyme activity by excess zinc ions. Excess zinc ions were competitive inhibitors for both peptide and ester substrates. This behavior is believed to arise by the excess zinc ions fixing the enzyme in a conformation to which the substrates cannot bind.

  5. Legalising medical use of cannabis in South Africa: Is the empirical evidence sufficient to support policy shifts in this direction?

    Science.gov (United States)

    Parry, Charles D H; Myers, Bronwyn J

    2014-03-12

    Inkatha Freedom Party MP Mario Oriani-Ambrosini's impassioned plea to legalise the medical use of cannabis must be understood in the context of his own condition as well as legislative changes in at least ten countries. This article argues that any decisions to shift policy must be based on a consideration of the evidence on the risks and benefits associated with the medical use of cannabis for the individual and broader society. It concludes that there are important gaps in the evidence base, particularly in human trials supporting the efficacy of cannabis use for treating and preventing medical conditions and alleviating negative symptoms associated with these conditions. South African researchers should be enabled actively to support development of the necessary evidence base actively by conducting preclinical and clinical research in this area. Human trials to establish the efficacy of the use of cannabis/cannabinoids in addressing AIDS wasting syndrome and other negative sequelae of HIV and AIDS are especially needed.

  6. Excessive hoarding in Parkinson's disease.

    Science.gov (United States)

    O'Sullivan, Sean S; Djamshidian, Atbin; Evans, Andrew H; Loane, Clare M; Lees, Andrew J; Lawrence, Andrew D

    2010-06-15

    Hoarding is seen in several psychiatric conditions, but has not been specifically assessed in Parkinson's disease (PD). This study investigates hoarding tendency amongst patients with PD, and its association with impulsive-compulsive spectrum behaviors (ICBs). We compare clinical features, measures of hoarding, impulse buying, self-control, obsessive-compulsive symptoms, depression, and anxiety in 39 patients with PD with ICBs (PD + ICB), 61 patients with PD without ICBs (PD - ICB), and 50 healthy controls. A much higher proportion of PD + ICB (27.8%) than PD - ICB (3.5%) were hoarders (P = 0.001). 6% of healthy controls were hoarders. Compulsive shoppers scored higher than other varieties of ICB on excessive acquisition measures. Hoarding correlated positively with impulsive buying, obsessive-compulsive symptoms, PD duration, and negatively with self-control measures. Using multivariate regression analyzes, the presence of ICBs and measures of impulsive buying were the only variables independently associated with hoarding in PD. The association of hoarding with other ICBs and low trait impulse control suggests that excessive hoarding is related to the spectrum of impulsive behaviors in PD. (c) 2010 Movement Disorder Society.

  7. Effective interpretations of a diphoton excess

    Energy Technology Data Exchange (ETDEWEB)

    Berthier, Laure [Niels Bohr International Academy & Discovery Center,Niels Bohr Institute, University of Copenhagen,Blegdamsvej 17, DK-2100, Copenhagen (Denmark); Cline, James M. [Niels Bohr International Academy & Discovery Center,Niels Bohr Institute, University of Copenhagen,Blegdamsvej 17, DK-2100, Copenhagen (Denmark); Department of Physics, McGill University,3600 Rue University, Montréal, Québec, H3A 2T8 (Canada); Shepherd, William; Trott, Michael [Niels Bohr International Academy & Discovery Center,Niels Bohr Institute, University of Copenhagen,Blegdamsvej 17, DK-2100, Copenhagen (Denmark)

    2016-04-14

    We discuss some consistency tests that must be passed for a successful explanation of a diphoton excess at larger mass scales, generated by a scalar or pseudoscalar state, possibly of a composite nature, decaying to two photons. Scalar states at mass scales above the electroweak scale decaying significantly into photon final states generically lead to modifications of Standard Model Higgs phenomenology. We characterise this effect using the formalism of Effective Field Theory (EFT) and study the modification of the effective couplings to photons and gluons of the Higgs. The modification of Higgs phenomenology comes about in a variety of ways. For scalar 0{sup +} states, a component of the Higgs and the heavy boson can mix. Lower energy phenomenology gives a limit on the mixing angle, which gets generated at one loop in any theory explaining the diphoton excess. Even if the mixing angle is set to zero, we demonstrate that a relation exists between lower energy Higgs data and a massive scalar decaying to diphoton final states. If the new boson is a pseudoscalar, we note that if it is composite, it is generic to have an excited scalar partner that can mix with a component of the Higgs, which has a stronger coupling to photons. In the case of a pseudoscalar, we also characterize how lower energy Higgs phenomenology is directly modified using EFT, even without assuming a scalar partner of the pseudoscalar state. We find that naturalness concerns can be accommodated, and that pseudoscalar models are more protected from lower energy constraints.

  8. Gestational weight gain and medical outcomes of pregnancy.

    Science.gov (United States)

    Ferraro, Zachary M; Contador, Fernanda; Tawfiq, Afaf; Adamo, Kristi B; Gaudet, Laura

    2015-09-01

    This narrative review discusses gestational weight gain (GWG) and medical outcomes of pregnancy, including metabolic, cardiovascular, respiratory, musculoskeletal and psychiatric systems. Taken as a whole, the available evidence shows that excessive GWG increases the risk of all medical complications of pregnancy, and negatively impacts the long-term health and weight of both mothers and their offspring. Briefly, interventions to encourage appropriate GWG are discussed and readers are directed to resources to facilitate discussion of pregnancy weight.

  9. Extragalactic Gamma Ray Excess from Coma Supercluster Direction

    Indian Academy of Sciences (India)

    Author Affiliations. Pantea Davoudifar1 S. Jalil Fatemi2. Research Institute for Astronomy and Astrophysics of Maragha, Maragha 55177-36698, Iran. Physics Department, Shahid Bahonar University of Kerman, Kerman 76175-132, Iran.

  10. Central Gas Entropy Excess as Direct Evidence for AGN Feedback ...

    Indian Academy of Sciences (India)

    The possible mechanisms of the X-ray emission is synchrotron radiation of relativistic electrons, powered by the central AGN, and inverse-Compton scattering of relativistic electrons on ambient low-energy photons. In the X-ray images of galaxies, galaxy groups and clusters, a number of X-ray cavities have been observed.

  11. Standard of care and direct medical costs of the treatment of chronic lymphocytic leukemia among the adult population in Ukraine, Russia, and Kazakhstan: data from the LEUKOSPECT study

    Directory of Open Access Journals (Sweden)

    Vasylyev A

    2017-09-01

    Full Text Available Averyan Vasylyev,1 Valentina Molostvova,2 Boris A Rebrov,3 Janina Makarova,4 Andrey Zaritskey,5 Vadim Ptushkin,6 Raigul Ramazanova,7 Yuriy Popovych,8 Orest Tsyapka,9 Evgeny Pashanov10 1CIS Medical, GlaxoSmithKline, Kiev, Ukraine; 2Regional Clinical Hospital No. 1, Khabarovsk, Russia; 3Lugansk Regional Clinical Hospital, Lugansk, Ukraine; 4Russia Medical Department, GlaxoSmithKline, Moscow, Russia; 5Oncohaematology Department, Almazov Federal Heart, Blood and Endocrinology Centre, Saint Petersburg, Russia; 6S.P. Botkin Hospital, Moscow, Russia; 7Kazakh Scientific Research Institute of Oncology and Radiology, Almaty, Kazakhstan; 8Zakarpatskaya Regional Clinical Hospital, Zakarpatskaya, Ukraine; 9Institute of Blood Pathology and Transfusion Medicine, Lviv, Ukraine; 10Novartis Pharma LLC, Moscow, Russia Purpose: The LEUKOSPECT study aimed to describe health service utilization and to estimate the direct medical costs (DMCs of chronic lymphocytic leukemia (CLL in 2013 in the adult population of three post-Soviet countries – Russia, Ukraine, and Kazakhstan. As oncologic medical care is provided by federal state-owned, specialized medical institutions, the cost estimation in this study primarily informs from a state budget perspective. Patients’ contributions to medical costs were not included in the cost evaluation.Patients and methods: This was a multinational, multicenter, retrospective study conducted in eight specialized centers (four in Russia, three in Ukraine, and one in Kazakhstan. The investigators captured data from the medical documents of all adult patients with an established CLL diagnosis before December 31, 2013, and who made at least one visit to their respective center between January 1 and December 31, 2013.Results: A total of 319 adult CLL patients were enrolled (124 in Kazakhstan, 106 in Russia, and 89 in Ukraine. In 2013, the DMCs of CLL management (without CLL therapy were €215.40 in Kazakhstan, €1,342.20 in Russia, and

  12. Self-directed learning can outperform direct instruction in the course of a modern German medical curriculum - results of a mixed methods trial.

    Science.gov (United States)

    Peine, Arne; Kabino, Klaus; Spreckelsen, Cord

    2016-06-03

    Modernised medical curricula in Germany (so called "reformed study programs") rely increasingly on alternative self-instructed learning forms such as e-learning and curriculum-guided self-study. However, there is a lack of evidence that these methods can outperform conventional teaching methods such as lectures and seminars. This study was conducted in order to compare extant traditional teaching methods with new instruction forms in terms of learning effect and student satisfaction. In a randomised trial, 244 students of medicine in their third academic year were assigned to one of four study branches representing self-instructed learning forms (e-learning and curriculum-based self-study) and instructed learning forms (lectures and seminars). All groups participated in their respective learning module with standardised materials and instructions. Learning effect was measured with pre-test and post-test multiple-choice questionnaires. Student satisfaction and learning style were examined via self-assessment. Of 244 initial participants, 223 completed the respective module and were included in the study. In the pre-test, the groups showed relatively homogenous scores. All students showed notable improvements compared with the pre-test results. Participants in the non-self-instructed learning groups reached scores of 14.71 (seminar) and 14.37 (lecture), while the groups of self-instructed learners reached higher scores with 17.23 (e-learning) and 15.81 (self-study). All groups improved significantly (p learning group, whose self-assessment improved by 2.36. The study shows that students in modern study curricula learn better through modern self-instructed methods than through conventional methods. These methods should be used more, as they also show good levels of student acceptance and higher scores in personal self-assessment of knowledge.

  13. Excessive visceral fat accumulation in advanced chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Furutate R

    2011-08-01

    Full Text Available Ryuko Furutate1, Takeo Ishii1,2, Ritsuko Wakabayashi1, Takashi Motegi1,2, Kouichi Yamada1,2, Akihiko Gemma2, Kozui Kida1,21Respiratory Care Clinic, Nippon Medical School, Kudan-Minami, Chiyoda-ku, Tokyo, Japan; 2Department of Internal Medicine, Division of Pulmonary Medicine, Infectious Diseases and Oncology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, JapanBackground: Previous studies have suggested links between chronic obstructive pulmonary disease (COPD, cardiovascular disease, and abdominal obesity. Although abdominal visceral fat is thought to be associated with cardiovascular risk factors, the degree of visceral fat accumulation in patients with COPD has not been directly studied. The aim of this study was to investigate the abdominal visceral fat accumulation and the association between visceral fat and the severity and changes in emphysema in COPD patients.Methods: We performed clinical and laboratory tests, including pulmonary function, dyspnea score, and the six-minute walking test in COPD patients (n = 101 and control, which included subjects with a smoking history but without airflow obstruction (n = 62. We used computed tomography to evaluate the abdominal visceral fat area (VFA, subcutaneous fat area (SFA, and the extent of emphysema.Results: The COPD group had a larger VFA than the control group. The prevalence of non-obese subjects with an increased VFA was greater in the Global Initiative for Chronic Obstructive Lung Disease Stages III and IV than in the other stages of COPD. The extent of emphysema was inversely correlated with waist circumference and SFA. However, VFA did not decrease with the severity of emphysema. VFA was positively correlated with the degree of dyspnea.Conclusion: COPD patients have excessive visceral fat, which is retained in patients with more advanced stages of COPD or severe emphysema despite the absence of obesity.Keywords: abdominal obesity, chronic obstructive pulmonary disease, emphysema

  14. [Managed care--an example for future structural developments in health care. Reflections on a informational visit on direction and administration of medical centers in east USA].

    Science.gov (United States)

    Kraus, T; Weber, W; Funk, H; Klar, E; Herfarth, C

    1998-04-01

    While the different national health systems merge structurally, cost expansion in health care is a global challenge. Structural reforms have been developed during recent years in the USA which can be summarized as "managed care". They are characterized by the evolution of an economically orientated system, in which units of medical therapy are generally handled like conventional economically goods. In managed-care models, patients are deliberately directed to the most economic forms of therapy. The spectrum of medical interventions as well as diagnostic or therapeutic patterns are predefined by a system of contracted guidelines, which lead to a standardization of processes. Financing and medical executive responsibilities fuse. The autonomy of medical decisions is clearly reduced to enforce and integrated and economically oriented steering of the health system. Leadership is no longer primarily confined to doctors or scientists. It is progressively shifting to financing institutions, managing directors or insurance companies. Structural changes currently are expanding rapidly in the U.S. and have meanwhile led to marked regional reductions of medical costs. Nevertheless, the US model is still far more expensive compared to the German system. Historical development, current concepts of US-managed care, its potential influence and general applicability to the German situation are discussed in an overview.

  15. Attitudes and self-reported behavior of patients, doctors, and pharmacists in New Zealand and Belgium toward direct-to-consumer advertising of medication.

    Science.gov (United States)

    Dens, Nathalie; Eagle, Lynne C; De Pelsmacker, Patrick

    2008-01-01

    Patients', doctors', and pharmacists' attitudes toward direct-to-consumer advertising (DTCA) for medication and their perceptions of its impact on patient self-reported behavior in terms of request for, and consumption of, advertised medication were investigated. Data were obtained in New Zealand, 1 of only 2 countries that allow mass-media DTCA for prescription medication, and in Belgium, which does not. Attitudes were relatively negative in both countries, but significantly more positive in New Zealand than in Belgium. The impact of DTCA (both in a positive and a negative sense) on self-reported patient behavior and patient interaction with doctors and pharmacists was limited in both countries. Although -- as already established in previous work -- the informativeness and reliability of DTCA can be much improved, and the attitude of medical professionals toward DTCA is negative in both countries, from the point of view of medical professionals and patients, DTCA does not harm the self-reported relationship between doctors, pharmacists, and patients.

  16. Self-directed learning: Status of final-year students and perceptions of selected faculty leadership in a Nigerian medical school – a mixed analysis study

    Directory of Open Access Journals (Sweden)

    T E Nottidge

    2017-03-01

    Full Text Available Background. Self-directed learning (SDL is the essential mechanism of lifelong learning, which, in turn, is required for medical professionals to maintain competency because of advancing technology and constantly evolving disease care and contexts. Yet, most Nigerian medical schools do not actively promote SDL skills for medical students. Objective. To evaluate the status of SDL behaviour among final-year students, and the perceptions of faculty leadership towards SDL in a Nigerian medical school. Methods. A mixed research method was used, with a survey consisting of a validated Likert-based self-rating scale for SDL (SRSSDL to assess students’ SDL behaviour. Focus group discussions with selected faculty leaders were thematically analysed to assess their perceptions of SDL. Results. The medical students reported moderate SDL behaviour, contrary to faculty, who considered their students’ SDL behaviour to be low. Faculty leadership further defined SDL as the self-motivated student demonstrating initiative in learning under the guidance of teachers, who use interactive forums for teaching. Furthermore, teachers and students should partner towards the goal of ensuring that student learning takes place. Teachers expressed concerns about SDL methods in medical schools owing to the fear that this will require medical students to teach themselves medicine without expert guidance from teachers. Conclusion. This study suggests that final-year students have a low to moderate level of SDL behaviour. The index faculty are willing to develop teacherguided self-motivated learning for their students, rather than strict SDL. Faculty should be concerned about this behaviour and should encourage SDL in such a way that students realise its benefits to become lifelong learners. Further study of the perceptions about self-regulated learning are recommended.

  17. The effects of excessive humidity.

    Science.gov (United States)

    Williams, R B

    1998-06-01

    Humidification devices and techniques can expose the airway mucosa to a wide range of gas temperatures and humidities, some of which are excessive and may cause injury. Humidified gas is a carrier of both water and energy. The volume of water in the gas stream depends on whether the water is in a molecular form (vapor), particulate form (aerosol), or bulk form (liquid). The energy content of gas stream is the sum of the sensible heat (temperature) of the air and any water droplets in it and the heat of vaporization (latent energy) of any water vapor present. Latent heat energy is much larger than sensible heat energy, so saturated air contains much more energy than dry air. Thus every breath contains a water volume and energy (thermal) challenge to the airway mucosa. When the challenge exceeds the homeostatic mechanisms airway dysfunction begins, starting at the cellular and secretion level and progressing to whole airway function. A large challenge will result in quick progression of dysfunction. Early dysfunction is generally reversible, however, so large challenges with short exposure times may not cause irreversible injury. The mechanisms of airway injury owing to excess water are not well studied. The observation of its effects lends itself to some general conclusions, however. Alterations in the ventilation-perfusion ratio, decrease in vital capacity and compilance, and atelectasis are suggestive of partial or full occlusion of small airways. Changes in surface tension and alveolar-arterial oxygen gradient are consistent with flooding of alveoli. There also may be osmotic challenges to mucosal cell function as evidenced by the different reaction rates with hyper- and hypotonic saline. The reaction to nonisotonic saline also may partly explain increases in specific airway resistance. Aerosolized water and instilled water may be hazardous because of their demonstrated potential for delivering excessive water to the airway. Their use for airway humidification or

  18. Estimation of the prevalence and direct medical costs of chronic myeloid leukemia in the I.R. of Iran in the era of tyrosine kinase inhibitors.

    Science.gov (United States)

    Daroudi, Rajabali; Mirzania, Mehrzad; Nikravanfard, Nazila; Sadighi, Sanambar; Sedighi, Zahra; Zendehdel, Kazem

    2017-10-01

    After the introduction of tyrosine kinase inhibitors for chronic myeloid leukemia (CML), the survival of these patients has increased significantly. However, these new drugs are expensive and impose considerable expense to patients and governments. Epidemiologic and economic evaluation studies provide good information for resource allocation and decision making. We estimated the incidence, prevalence and direct medical cost of CML in Iran. We used the National Cancer Registry (NCR) data from 2006 to 2009 to estimate the incidence rate of CML (ICD-10 code C92.1). After adjustment for the underestimation of incidence rates, we used survival rates of CML and estimated the 5-year prevalence for these patients. In addition, we used clinical practice guideline, expert opinions and medical tariffs to estimate the direct medical costs through the prevalence approach. After an adjustment for the underestimation, the incidence rate of CML was 0.5 per 100 000 in the I.R. of Iran. The 5-year prevalence was about 2263 cases (2.98 per 100 000). The total direct medical cost of CML was $23 089 323 and the majority of the cost (97%) was related to drug costs. The total cost will increase considerably to $40 728 869 if all patients use the new drug nilotinib (800 mg/day) as a second-line treatment. The increased survival of CML patients and a possible increase in incidence of CML in Iran will most likely lead to a considerable rise in its prevalence and economic burden. © 2016 John Wiley & Sons Australia, Ltd.

  19. Patient-directed intelligent and interactive computer medical history-gathering systems: a utility and feasibility study in the emergency department.

    Science.gov (United States)

    Benaroia, Mark; Elinson, Roman; Zarnke, Kelly

    2007-04-01

    Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED). Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer's ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements. Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5 min and 32s +/- 1 min and 21s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90+/-7%, and the emergency physician asked 55+/-18%, of the important historical elements. These groups were statistically different with a p-value of computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient.

  20. Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools.

    Science.gov (United States)

    Widyahening, Indah S; van der Heijden, Geert J M G; Moy, Foong Ming; van der Graaf, Yolanda; Sastroasmoro, Sudigdo; Bulgiba, Awang

    2012-10-31

    We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM). We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), pstudents (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools. EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.

  1. Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain.

    Science.gov (United States)

    Mata-Cases, Manel; Casajuana, Marc; Franch-Nadal, Josep; Casellas, Aina; Castell, Conxa; Vinagre, Irene; Mauricio, Dídac; Bolíbar, Bonaventura

    2016-11-01

    We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population-based primary care database through a retrospective analysis of economic impact during 2011, including 126,811 patients with type 2 diabetes in Catalonia, Spain. Total annual costs included primary care visits, hospitalizations, referrals, diagnostic tests, self-monitoring test strips, medication, and dialysis. For each patient, one control matched for age, gender and managing physician was randomly selected from a population database. The annual average cost per patient was €3110.1 and €1803.6 for diabetic and non-diabetic subjects, respectively (difference €1306.6; i.e., 72.4 % increased cost). The costs of hospitalizations were €1303.1 and €801.6 (62.0 % increase), and medication costs were €925.0 and €489.2 (89.1 % increase) in diabetic and non-diabetic subjects, respectively. In type 2 diabetic patients, hospitalizations and medications had the greatest impact on the overall cost (41.9 and 29.7 %, respectively), generating approximately 70 % of the difference between diabetic and non-diabetic subjects. Patients with poor glycaemic control (glycated haemoglobin >7 %; >53 mmol/mol) had average costs of €3296.5 versus €2848.5 for patients with good control. In the absence of macrovascular complications, average costs were €3008.1 for diabetic and €1612.4 for non-diabetic subjects, while its presence increased costs to €4814.6 and €3306.8, respectively. In conclusion, the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications, and are higher among diabetic patients with poor glycaemic control and macrovascular complications.

  2. A Business Case Analysis of the Direct Health Care Provider Program Womack Army Medical Center, Fort Bragg, N.C.

    Science.gov (United States)

    2001-05-01

    hired for a specific amount of time to do one thing—see patients. Provider productivity has become an increasingly important issue within the managed...Postmenopausal Bleeding (627.1) Insect Bite (919.4) Tachycardia NOS (785.0) Postmenopausal Hormone Replacement (v07.4) Lipoma (214.9) Tobacco Use Disorder...plastic surgery that Dr. Mike performed was medically indicated. Authorized procedures include post- cancer reconstruction, breast reductions, and

  3. Medication Errors in an Internal Intensive Care Unit of a Large Teaching Hospital: A Direct Observation Study

    Directory of Open Access Journals (Sweden)

    Saadat Delfani

    2012-06-01

    Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

  4. 10 CFR 904.10 - Excess energy.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Excess energy. 904.10 Section 904.10 Energy DEPARTMENT OF ENERGY GENERAL REGULATIONS FOR THE CHARGES FOR THE SALE OF POWER FROM THE BOULDER CANYON PROJECT Power Marketing § 904.10 Excess energy. (a) If excess Energy is determined by the United States to be available...

  5. 7 CFR 985.56 - Excess oil.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Excess oil. 985.56 Section 985.56 Agriculture... HANDLING OF SPEARMINT OIL PRODUCED IN THE FAR WEST Order Regulating Handling Volume Limitations § 985.56 Excess oil. Oil of any class in excess of a producer's applicable annual allotment shall be identified as...

  6. 43 CFR 426.12 - Excess land.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Excess land. 426.12 Section 426.12 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR ACREAGE LIMITATION RULES AND REGULATIONS § 426.12 Excess land. (a) The process of designating excess and...

  7. Excess water dynamics in hydrotalcite: QENS study

    Indian Academy of Sciences (India)

    Abstract. Results of the quasi-elastic neutron scattering (QENS) measurements on the dynamics of excess water in hydrotalcite sample with varied content of excess water are reported. Translational motion of excess water can be best described by random transla- tional jump diffusion model. The observed increase in ...

  8. Standard of care and direct medical costs of the treatment of chronic lymphocytic leukemia among the adult population in Ukraine, Russia, and Kazakhstan: data from the LEUKOSPECT study.

    Science.gov (United States)

    Vasylyev, Averyan; Molostvova, Valentina; Rebrov, Boris A; Makarova, Janina; Zaritskey, Andrey; Ptushkin, Vadim; Ramazanova, Raigul; Popovych, Yuriy; Tsyapka, Orest; Pashanov, Evgeny

    2017-01-01

    The LEUKOSPECT study aimed to describe health service utilization and to estimate the direct medical costs (DMCs) of chronic lymphocytic leukemia (CLL) in 2013 in the adult population of three post-Soviet countries - Russia, Ukraine, and Kazakhstan. As oncologic medical care is provided by federal state-owned, specialized medical institutions, the cost estimation in this study primarily informs from a state budget perspective. Patients' contributions to medical costs were not included in the cost evaluation. This was a multinational, multicenter, retrospective study conducted in eight specialized centers (four in Russia, three in Ukraine, and one in Kazakhstan). The investigators captured data from the medical documents of all adult patients with an established CLL diagnosis before December 31, 2013, and who made at least one visit to their respective center between January 1 and December 31, 2013. A total of 319 adult CLL patients were enrolled (124 in Kazakhstan, 106 in Russia, and 89 in Ukraine). In 2013, the DMCs of CLL management (without CLL therapy) were €215.40 in Kazakhstan, €1,342.20 in Russia, and €13,260.70 in Ukraine. Hospitalizations formed the largest proportion of total cost: 18.1%, 23.1%, and 40.4%, respectively. The mean cost of CLL medical treatment was €13,580.60 (Russia), €399.40 (Kazakhstan), and €7,453.00 (Ukraine). CLL treatment standards varied across the selected countries; higher usage of biologic therapy was noted in Russia. Future research is needed to assess DMCs which include CLL treatment, which is another essential factor contributing to CLL DMCs.

  9. Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system - An activity theory analysis.

    Science.gov (United States)

    Heeneman, Sylvia; de Grave, Willem

    2017-04-01

    In medical education, students need to acquire skills to self-direct(ed) learning (SDL), to enable their development into self-directing and reflective professionals. This study addressed the mentor perspective on how processes in the mentor-student interaction influenced development of SDL. n = 22 mentors of a graduate-entry medical school with a problem-based curriculum and longitudinal mentoring system were interviewed (n = 1 recording failed). Using activity theory (AT) as a theoretical framework, thematic analysis was applied to the interview data to identify important themes. Four themes emerged: centered around the role of the portfolio, guiding of students' SDL in the context of assessment procedures, mentor-role boundaries and longitudinal development of skills by both the mentor and mentee. Application of AT showed that in the interactions between themes tensions or supportive factors could emerge for activities in the mentoring process. The mentors' perspective on coaching and development of reflection and SDL of medical students yielded important insights into factors that can hinder or support students' SDL, during a longitudinal mentor-student interaction. Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor-student interaction that can translate to students' SDL skills.

  10. EXCESSIVE INTERNET USE AND PSYCHOPATHOLOGY: THE ROLE OF COPING

    Directory of Open Access Journals (Sweden)

    Daria J. Kuss

    2017-02-01

    Full Text Available Objective: In 2013, the American Psychiatric Association included Internet Gaming Disorder in the diagnostic manual as a condition which requires further research, indicating the scientific and clinical community are aware of potential health concerns as a consequence of excessive Internet use. From a clinical point of view, it appears that excessive/addictive Internet use is often comorbid with further psychopathologies and assessing comorbidity is relevant in clinical practice, treatment outcome and prevention as the probability to become addicted to using the Internet accelerates with additional (subclinical symptoms. Moreover, research indicates individuals play computer games excessively to cope with everyday stressors and to regulate their emotions by applying media-focused coping strategies, suggesting pathological computer game players play in order to relieve stress and to avoid daily hassles. The aims of this research were to replicate and extend previous findings and explanations of the complexities of the relationships between excessive Internet use and Internet addiction, psychopathology and dysfunctional coping strategies. Method: Participants included 681 Polish university students sampled using an online battery of validated psychometric instruments. Results: Results of structural equation models revealed dysfunctional coping strategies (i.e., distraction, denial, self-blame, substance use, venting, media use, and behavioural disengagement significantly predict excessive Internet use, and the data fit the theoretical model well. A second SEM showed media-focused coping and substance use coping significantly mediate the relationship between psychopathology (operationalised via the Global Severity Index and excessive Internet use. Conclusions: The findings lend support to the self-medication hypothesis of addictive disorders, and suggest psychopathology and dysfunctional coping have additive effects on excessive Internet use.

  11. 77 FR 24403 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Science.gov (United States)

    2012-04-24

    ... rule was adopted by the Illinois Pollution Control Board on September 22, 2011 and became effective on... for Designated Facilities and Pollutants: Illinois AGENCY: Environmental Protection Agency (EPA). ACTION: Direct final rule. SUMMARY: EPA is approving Illinois' revised State Plan to control air...

  12. Investigation of excess thyroid cancer incidence in Los Alamos County

    Energy Technology Data Exchange (ETDEWEB)

    Athas, W.F.

    1996-04-01

    Los Alamos County (LAC) is home to the Los Alamos National Laboratory, a U.S. Department of Energy (DOE) nuclear research and design facility. In 1991, the DOE funded the New Mexico Department of Health to conduct a review of cancer incidence rates in LAC in response to citizen concerns over what was perceived as a large excess of brain tumors and a possible relationship to radiological contaminants from the Laboratory. The study found no unusual or alarming pattern in the incidence of brain cancer, however, a fourfold excess of thyroid cancer was observed during the late-1980`s. A rapid review of the medical records for cases diagnosed between 1986 and 1990 failed to demonstrate that the thyroid cancer excess had resulted from enhanced detection. Surveillance activities subsequently undertaken to monitor the trend revealed that the excess persisted into 1993. A feasibility assessment of further studies was made, and ultimately, an investigation was conducted to document the epidemiologic characteristics of the excess in detail and to explore possible causes through a case-series records review. Findings from the investigation are the subject of this report.

  13. Management of endocrine disease: GH excess: diagnosis and medical therapy

    DEFF Research Database (Denmark)

    Andersen, Marianne

    2014-01-01

    be discordant, especially during somatostatin analogue therapy. This discordance usually takes the form of high GH levels and an IGF-I level towards the upper limit of the normal range.Pasireotide, a new somatostatin analogue, may be more efficacious in some patients, but the drug has not yet been registered...... analogue. Dopamine-D2-agonists may be effective as monotherapy in a few patients, but it may prove necessary to apply combination therapy involving a somatostatin analogue and/or pegvisomant....

  14. Simplified Production of Organic Compounds Containing High Enantiomer Excesses

    Science.gov (United States)

    Cooper, George W. (Inventor)

    2015-01-01

    The present invention is directed to a method for making an enantiomeric organic compound having a high amount of enantiomer excesses including the steps of a) providing an aqueous solution including an initial reactant and a catalyst; and b) subjecting said aqueous solution simultaneously to a magnetic field and photolysis radiation such that said photolysis radiation produces light rays that run substantially parallel or anti-parallel to the magnetic field passing through said aqueous solution, wherein said catalyst reacts with said initial reactant to form the enantiomeric organic compound having a high amount of enantiomer excesses.

  15. Self-reported influence of television-based direct-to-consumer advertising on patient seasonal allergy and asthma medication use: An internet survey.

    Science.gov (United States)

    Khanfar, Nile M; Clauson, Kevin A; Polen, Hyla H; Shields, Kelly M

    2008-04-01

    Direct-to-consumer advertising (DDTCA) of medications, a marketing tool used by the pharmaceutical industry to increase patient awareness of products, affects both consumer behavior and, ultimately, physician prescribing practices. Billions of dollars are budgeted each year for DTCA, and its influence is far-reaching. However, little information is available about patient-initiated physician interactions in which television-bbased DTCA has played a role in consumer behavior. The objective of this study was to explore the influence of television-based DTCA on treatment changes in patient-initiated medication use. A 68-item survey instrument consisting of dichotomous, multiple-choice, and open-ended questions was constructed and sent to a convenience sample of US residents during 3 consecutive months ending in February 2005. The survey, which was accessed through an Internet link provided in the e-mail, was designed to capture data about patient perceptions and behaviors regarding television-based DTCA of prescription medications used for seasonal allergy and asthma as well as demographic information. Inferential and descriptive analyses were performed. Key tests included Crosstabs analysis and normal approximation to the binomial test with the z score. Surveys were sent to 2500 individuals. A total of 427 valid surveys were returned for a 17.1% response rate. Of the 402 respondents (94.1%) who stated that they had seen DTCA for seasonal allergy medication, 50 (12.4%) said they had discussed the advertised medication with their physician and 22 of those discussions (44.0%) resulted in a change in treatment. Three hundred forty-two respondents (80.1%) stated that they had viewed DTCA for prescription asthma medications, and 23 of those respondents (6.7%) said that they had discussed the brand of asthma medication viewed on television with their physician. Those discussions resulted in a change in treatment for 9 respondents (39.1%). Within th his limited, self

  16. A systematic literature review assessing the directional impact of managed care formulary restrictions on medication adherence, clinical outcomes, economic outcomes, and health care resource utilization.

    Science.gov (United States)

    Happe, Laura E; Clark, Deanna; Holliday, Edana; Young, Tramaine

    2014-07-01

    There is extensive literature demonstrating that formulary restrictions reduce the pharmacy costs and utilization of restricted drugs. However, some research suggests that there may be unintended consequences of formulary restrictions on other patient outcomes. While several literature reviews have assessed the relationship between formulary restrictions and medication adherence, clinical outcomes, economic outcomes, or health care resource utilization, these reviews were either not systematic, were conducted more than 5 years ago, or did not assess the aggregate directional impact of the relationships. To conduct a systematic literature review assessing the direction (positive, negative, or neutral) of the relationship between managed care formulary restrictions (including step therapy, cost sharing, prior authorization, preferred drug lists, and quantity limits) on medication adherence, clinical outcomes, economic outcomes, and health care resource utilization.  Articles published in 1993 or later were identified from PubMed using 2 lists of search terms. List A included 12 formulary restriction terms and List B included 12 patient outcomes terms, resulting in 144 unique search term combinations. Each article was evaluated by 2 investigators against the following exclusion criteria using a stepwise approach: (a) the article was a commentary or review article; (b) the article did not assess the impact of managed care formulary restrictions on outcomes; and (c) the study was conducted outside the United States. The total number of studies was reported by formulary restriction type. Next, the total number of outcomes reported in each study was summed to conduct an outcomes-level analysis. The outcomes were categorized by type of outcome (medication adherence, clinical, economic, or health care resource utilization) and direction of association (positive, negative, or neutral/not significant) based on the relationship reported in each study. The frequencies of each

  17. A prospective, randomized crossover study comparing direct inspection by light microscopy versus projected images for teaching of hematopathology to medical students.

    Science.gov (United States)

    Carlson, Aaron M; McPhail, Ellen D; Rodriguez, Vilmarie; Schroeder, Georgene; Wolanskyj, Alexandra P

    2014-01-01

    Instruction in hematopathology at Mayo Medical School has evolved from instructor-guided direct inspection under the light microscope (laboratory method), to photomicrographs of glass slides with classroom projection (projection method). These methods have not been compared directly to date. Forty-one second-year medical students participated in this pilot study, a prospective, randomized, crossover study measuring educational performance during a hematology pathophysiology course. The students were randomized to one of two groups. All students received the same didactic lectures in the classroom and subsequent case-based review of peripheral blood smears using either laboratory or projection methods, on day one with a crossover to the other method on day two. Pre- and post-test examinations centered on morphology recognition measured educational performance on each day, followed by a questionnaire identifying the student's favored method. There was no significant difference in the pre-test and post-test scores between the two teaching methods (rank-sum P = 0.43). Students overwhelmingly preferred the projection method and perceived it as superior (76%), although post-test scores were not significantly different. Student's recommended method was split with 50% favoring the projection method, 43% favoring a combined approach, and 23% noting logistical challenges to the laboratory. In this study, the laboratory and projection method were equivalent in terms of educational performance for hematopathology among medicals students. A classroom-based approach such as the projection method is favored, given the large class sizes in undergraduate medical education, as well as the ergonomic challenges and additional resources required for large group instruction in a laboratory setting. © 2013 American Association of Anatomists.

  18. Comorbidities as a driver of the excess costs of community-acquired pneumonia in U.S. commercially-insured working age adults

    Directory of Open Access Journals (Sweden)

    Polsky Daniel

    2012-10-01

    Full Text Available Abstract Background Adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention. We estimate the economic impact of community-acquired pneumonia (CAP for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD and congestive heart failure (CHF in a large U.S. commercially-insured working age population. Methods Data sources consisted of 2003 through 2007 Thomson Reuters MarketScan Commercial Claims and Encounters and Thomson Reuters Health Productivity and Management (HPM databases. Pneumonia episodes and selected comorbidities were identified by ICD-9-CM diagnosis codes. By propensity score matching, controls were identified for pneumonia patients. Excess direct medical costs and excess productivity cost were estimated by generalized linear models (GLM. Results We identified 402,831 patients with CAP between 2003 through 2007, with 25,560, 32,677, 16,343, and 5,062 episodes occurring in patients with asthma, diabetes, COPD and CHF, respectively. Mean excess costs (and standard error, SE of CAP were $14,429 (SE=44 overall. Mean excess costs by comorbidity subgroup were lowest for asthma ($13,307 (SE=123, followed by diabetes ($21,395 (SE=171 and COPD ($23,493 (SE=197; mean excess costs were highest for patients with CHF ($34,436 (SE=549. On average, indirect costs comprised 21% of total excess costs, ranging from 8% for CHF patients to 27% for COPD patients. Conclusions Compared to patients without asthma, diabetes, COPD, or CHF, the excess cost of CAP is nearly twice as high for patients with diabetes and COPD and nearly three times as high for patients with CHF. Indirect costs made up a significant but varying portion of excess CAP costs. Returns on prevention of pneumonia would therefore be higher in adults with these comorbidities.

  19. Direct medical costs and their predictors in the EMAR-II cohort: "Variability in the management of rheumatoid arthritis and spondyloarthritis in Spain".

    Science.gov (United States)

    Leon, Leticia; Abasolo, Lydia; Fernandez-Gutierrez, Benjamin; Jover, Juan Angel; Hernandez-Garcia, Cesar

    To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naïve. A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naïve, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models. We included 1,095 RA patients, 26% male, mean age of 62±14 years. Mean of direct medical costs per patient was €24,291±€45,382. Excluding biological drugs, the average cost per patient was €3,742±€3,711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P=.02) and disease activity (P=.004). In the biologic-naïve group, the predictor of direct medical costs was comorbidity (P<.001). In the biologic treatment group predictors were follow-up length of the disease (P=.04), age (P=.02) and disease activity (P=.007). Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. Management of mydriasis and pain in cataract and intraocular lens surgery: review of current medications and future directions

    Directory of Open Access Journals (Sweden)

    Grob SR

    2014-07-01

    Full Text Available Seanna R Grob,1–3 Luis A Gonzalez-Gonzalez,1–3 Mary K Daly1,2,4 1Department of Ophthalmology, Veterans Administration Boston Healthcare System, Boston, MA, USA; 2Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; 4Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA Abstract: The maintenance of mydriasis and the control of postoperative pain and ­inflammation are critical to the safety and success of cataract and intraocular lens replacement surgery. Appropriate mydriasis is usually achieved by topical and/or intracameral administration of anticholinergic agents, sympathomimetic agents, or both, with the most commonly used being cyclopentolate, tropicamide, and phenylephrine. Ocular inflammation is common after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drugs are widely used because they have been proved effective to control postsurgical inflammation and decrease pain. Topical nonsteroidal anti-inflammatory drugs have also been shown to help maintain dilation. However, use of multiple preoperative drops for pupil dilation, inflammation, and pain control have been shown to be time consuming, resulting in delays to the operating room, and they cause dissatisfaction among perioperative personnel; their use can also be associated with systemic side effects. Therefore, ophthalmologists have been in search of new options to streamline this process. This article will review the current medications commonly used for intraoperative mydriasis, as well as pain and inflammation control. In addition, a new combination of ketorolac, an anti-inflammatory agent, and phenylephrine, a mydriatic agent has recently been designed to maintain intraoperative mydriasis and to reduce postoperative pain and irritation from intraocular lens replacement surgery. Two Phase III clinical trials evaluating this

  1. 75 FR 27572 - Monthly Report of Excess Income and Annual Report of Uses of Excess Income

    Science.gov (United States)

    2010-05-17

    ... URBAN DEVELOPMENT Monthly Report of Excess Income and Annual Report of Uses of Excess Income AGENCY... subject proposal. Project owners are permitted to retain Excess Income for projects under terms and conditions established by HUD. Owners must request to retain some or all of their Excess Income. The request...

  2. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.

    Science.gov (United States)

    Galiczewski, Janet M; Shurpin, Kathleen M

    2017-06-01

    Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Pleural Touch Preparations and Direct Visualization of the Pleura during Medical Thoracoscopy for the Diagnosis of Malignancy.

    Science.gov (United States)

    Grosu, Horiana B; Vial-Rodriguez, Macarena; Vakil, Erik; Casal, Roberto F; Eapen, George A; Morice, Rodolfo; Stewart, John; Sarkiss, Mona G; Ost, David E

    2017-08-01

    During diagnostic thoracoscopy, talc pleurodesis after biopsy is appropriate if the probability of malignancy is sufficiently high. Findings on direct visual assessment of the pleura during thoracoscopy, rapid onsite evaluation (ROSE) of touch preparations (touch preps) of thoracoscopic biopsy specimens, and preoperative imaging may help predict the likelihood of malignancy; however, data on the performance of these methods are limited. To assess the performance of ROSE of touch preps, direct visual assessment of the pleura during thoracoscopy, and preoperative imaging in diagnosing malignancy. Patients who underwent ROSE of touch preps during thoracoscopy for suspected malignancy were retrospectively reviewed. Malignancy was diagnosed on the basis of final pathologic examination of pleural biopsy specimens. ROSE results were categorized as malignant, benign, or atypical cells. Visual assessment results were categorized as tumor studding present or absent. Positron emission tomography (PET) and computed tomography (CT) findings were categorized as abnormal or normal pleura. Likelihood ratios were calculated for each category of test result. The study included 44 patients, 26 (59%) with a final pathologic diagnosis of malignancy. Likelihood ratios were as follows: for ROSE of touch preps: malignant, 1.97 (95% confidence interval [CI], 0.90-4.34); atypical cells, 0.69 (95% CI, 0.21-2.27); benign, 0.11 (95% CI, 0.01-0.93); for direct visual assessment: tumor studding present, 3.63 (95% CI, 1.32-9.99); tumor studding absent, 0.24 (95% CI, 0.09-0.64); for PET: abnormal pleura, 9.39 (95% CI, 1.42-62); normal pleura, 0.24 (95% CI, 0.11-0.52); and for CT: abnormal pleura, 13.15 (95% CI, 1.93-89.63); normal pleura, 0.28 (95% CI, 0.15-0.54). A finding of no malignant cells on ROSE of touch preps during thoracoscopy lowers the likelihood of malignancy significantly, whereas finding of tumor studding on direct visual assessment during thoracoscopy only moderately increases the

  4. Eficacia del consejo médico para la reducción del consumo excesivo de alcohol: Metaanálisis de estudios españoles en atención primaria Effectiveness of medical advice for reducing excessive alcohol conssumption: Meta-analysis of Spanish studies in primary care

    Directory of Open Access Journals (Sweden)

    J. Ballesteros

    2003-04-01

    Full Text Available Introducción: Revisiones sistemáticas previas han apoyado la eficacia del consejo médico, como intervención breve, en el abordaje de bebedores excesivos detectados en la asistencia primaria. Sin embargo, estos resultados no pueden extrapolarse directamente a poblaciones que, como las mediterráneas, no están representadas en dichas revisiones. El objetivo de este estudio fue actualizar la evidencia sobre la eficacia de la intervención breve en consumidores excesivos de alcohol según estudios españoles. Métodos: Búsqueda de estudios en bases bibliográficas y consultas a expertos para localizar estudios no publicados. Se calcularon las estimaciones combinadas para dos variables de resultado, la reducción del consumo de alcohol y la disminución de la frecuencia de bebedores excesivos. Resultados: Dos de los 5 estudios localizados no estaban incluidos en una revisión previa. La eficacia de la intervención breve fue moderada para la disminución del consumo de alcohol (d = - 0,46; intervalo de confianza (IC del 95%, - 0,29 a - 0,63; p Introduction: Former systematic reviews have backed the efficacy of medical counselling, a form of brief intervention, on the treatment of excessive drinkers detected in primary care settings. Nevertheless, these results cannot be applied without criticism to Mediterranean populations which, so far, have not been represented in the aforementioned studies. The aim of the present study was to update the results on the efficacy of brief interventions in primary care by pooling Spanish studies. Methods: Studies were searched for by using appropriate databases and also by consulting to experts in the field to retrieve grey literature. Pooled estimations of effect sizes were calculated for two outcomes, the reduction in the amount of alcohol consumption and the decrease in the number of excessive drinkers. Results: Two over the 5 retrieved studies were not included in a former review. The effect size regarding

  5. The importance of social and collaborative learning for online continuing medical education (OCME): directions for future development and research.

    Science.gov (United States)

    Sandars, John; Kokotailo, Patricia; Singh, Gurmit

    2012-01-01

    There is an increasing use of online continuing medical education (OCME), but the potential use of social and collaborative learning to change professional performance and improve patient care has yet to be fully realised. The integration of the main themes from the presentations and comments from participants at a symposium at AMEE 2011. Sociological perspectives on change in professional performance highlight the need for social and collaborative learning in OCME so that learners can share information (explicit knowledge) and opinion (tacit knowledge). The educational topic should be relevant to the complexity of professional practice and use iterative cycles of implementation and critical reflection in social networks so that proposed solutions can be tested in actual practice. The challenge of developing effective online discussions for collaborative learning is recognised. The provision of OCME requires a shift in both policy and practice to emphasise the importance of social and collaborative learning. Further research is recommended, especially to evaluate the implementation and impact of social and collaborative learning for OCME on patient care and the use of newer Web 2.0 approaches.

  6. Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools

    Directory of Open Access Journals (Sweden)

    Indah S. Widyahening

    2012-10-01

    Full Text Available Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU, Universitas Indonesia (UI, and University of Malaya (UM. Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP. The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD score as the following: knowledge 5.04 (0.4 vs. 4.73 (0.69 and 4.24 (0.74, p<0.001; attitude 4.52 (0.64 vs. 3.85 (0.68 and 3.55 (0.63, p<0.001; behavior 2.62 (0.55 vs. 2.35 (0.71 and 2.39 (0.92, p=0.016; and future use of EBP 4.32 (0.59 vs. 4.08 (0.62 and 3.7 (0.71, p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001 and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001 but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their

  7. Statistical characteristics of excess fiber length in loose tubes of optical cable

    Science.gov (United States)

    Andreev, Vladimir A.; Gavryushin, Sergey A.; Popov, Boris V.; Popov, Victor B.; Vazhdaev, Michael A.

    2017-04-01

    This paper presents an analysis of the data measurements of excess fiber length in the loose tubes of optical cable during the post-process quality control of ready-made products. At determining estimates of numerical characteristics of excess fiber length method of results processing of direct multiple equally accurate measurements has been used. The results of experimental research of the excess length value at the manufacturing technology of loose tube remains constant.

  8. The clinical characteristics and direct medical cost of influenza in hospitalized children: a five-year retrospective study in Suzhou, China.

    Directory of Open Access Journals (Sweden)

    Tao Zhang

    Full Text Available BACKGROUND: There have been few studies on children hospitalized with influenza published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven influenza hospitalized children in Suzhou, China. METHODS: Retrospective study on children with documented influenza infection hospitalized at Suzhou Children Hospital during 2005-2009 was conducted using a structured chart review instrument. RESULTS: A total of 480 children were positive by immuno-fluorescent assay for influenza during 2005-2009. The hospitalizations for influenza occurred in 8-12 months of the year, most commonly in the winter with a second late summer peak (August-September. Influenza A accounted for 86.3%, and of these 286 (59.6% were male, and 87.2% were 60 months old had shorter hospital stay (OR = 0.45; children with oxygen treatment tended to have longer hospital stays than those without oxygen treatment (OR = 2.14. The mean cost of each influenza-related hospitalization was US$ 624 (US$ 1323 for children referred to ICU and US$ 617 for those cared for on the wards. High risk children had higher total cost than low-risk patients. CONCLUSION: Compared to other countries, in Suzhou, children hospitalized with influenza have longer hospital stay and higher percentage of pneumonia. The direct medical cost is high relative to family income. Effective strategies of influenza immunization of young children in China may be beneficial in addressing this disease burden.

  9. Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites.

    Science.gov (United States)

    Wilkinson, Jack; Vail, Andy; Roberts, Stephen A

    2017-01-12

    To establish how medically assisted reproduction (MAR) clinics report success rates on their websites. Websites of private and NHS clinics offering in vitro fertilisation (IVF) in the UK. We identified clinics offering IVF using the Choose a Fertility Clinic facility on the website of the Human Fertilisation and Embryology Authority (HFEA). Of 81 clinics identified, a website could not be found for 2, leaving 79 for inclusion in the analysis. Outcome measures reported by clinic websites. The numerator and denominator included in the outcome measure were of interest. 53 (67%) websites reported their performance using 51 different outcome measures. It was most common to report pregnancy (83% of these clinics) or live birth rates (51%). 31 different ways of reporting pregnancy and 9 different ways of reporting live birth were identified. 11 (21%) reported multiple birth or pregnancy rates. 1 clinic provided information on adverse events. It was usual for clinics to present results without relevant contextual information such as sample size, reporting period, the characteristics of patients and particular details of treatments. Many combinations of numerator and denominator are available for the purpose of reporting success rates for MAR. The range of reporting options available to clinics is further increased by the possibility of presenting results for subgroups of patients and for different time periods. Given the status of these websites as advertisements to patients, the risk of selective reporting is considerable. Binding guidance is required to ensure consistent, informative reporting. 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/.

  10. Sonolência excessiva Excessive daytime sleepiness

    Directory of Open Access Journals (Sweden)

    Lia Rita Azeredo Bittencourt

    2005-05-01

    Full Text Available A sonolência é uma função biológica, definida como uma probabilidade aumentada para dormir. Já a sonolência excessiva (SE, ou hipersonia, refere-se a uma propensão aumentada ao sono com uma compulsão subjetiva para dormir, tirar cochilos involuntários e ataques de sono, quando o sono é inapropriado. As principais causas de sonolência excessiva são a privação crônica de sono (sono insuficiente, a Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS, a narcolepsia, a Síndrome das Pernas Inquietas/Movimentos Periódicos de Membros (SPI/MPM, Distúrbios do Ritmo Circadiano, uso de drogas e medicações e a hipersonia idiopática. As principais conseqüências são prejuízo no desempenho nos estudos, no trabalho, nas relações familiares e sociais, alterações neuropsicológicas e cognitivas e risco aumentado de acidentes. O tratamento da sonolência excessiva deve estar voltado para as causas específicas. Na privação voluntária do sono, aumentar o tempo de sono e higiene do sono, o uso do CPAP (Continuous Positive Airway Pressure na Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono, exercícios e agentes dopaminérgicos na Síndrome das Pernas Inquietas/Movimentos Periódicos de Membros, fototerapia e melatonina nos Distúrbios do Ritmo Circadiano, retiradas de drogas que causam sonolência excessiva e uso de estimulantes da vigília.Sleepiness is a physiological function, and can be defined as increased propension to fall asleep. However, excessive sleepiness (ES or hypersomnia refer to an abnormal increase in the probability to fall asleep, to take involuntary naps, or to have sleep atacks, when sleep is not desired. The main causes of excessive sleepiness is chronic sleep deprivation, sleep apnea syndrome, narcolepsy, movement disorders during sleep, circadian sleep disorders, use of drugs and medications, or idiopathic hypersomnia. Social, familial, work, and cognitive impairment are among the consequences of

  11. Cool WISPs for stellar cooling excesses

    Science.gov (United States)

    Giannotti, Maurizio; Irastorza, Igor; Redondo, Javier; Ringwald, Andreas

    2016-05-01

    Several stellar systems (white dwarfs, red giants, horizontal branch stars and possibly the neutron star in the supernova remnant Cassiopeia A) show a mild preference for a non-standard cooling mechanism when compared with theoretical models. This exotic cooling could be provided by Weakly Interacting Slim Particles (WISPs), produced in the hot cores and abandoning the star unimpeded, contributing directly to the energy loss. Taken individually, these excesses do not show a strong statistical weight. However, if one mechanism could consistently explain several of them, the hint could be significant. We analyze the hints in terms of neutrino anomalous magnetic moments, minicharged particles, hidden photons and axion-like particles (ALPs). Among them, the ALP or a massless HP represent the best solution. Interestingly, the hinted ALP parameter space is accessible to the next generation proposed ALP searches, such as ALPS II and IAXO and the massless HP requires a multi TeV energy scale of new physics that might be accessible at the LHC.

  12. What controls deuterium excess in global precipitation?

    Directory of Open Access Journals (Sweden)

    S. Pfahl

    2014-04-01

    Full Text Available The deuterium excess (d of precipitation is widely used in the reconstruction of past climatic changes from ice cores. However, its most common interpretation as moisture source temperature cannot directly be inferred from present-day water isotope observations. Here, we use a new empirical relation between d and near-surface relative humidity (RH together with reanalysis data to globally predict d of surface evaporation from the ocean. The very good quantitative agreement of the predicted hemispherically averaged seasonal cycle with observed d in precipitation indicates that moisture source relative humidity, and not sea surface temperature, is the main driver of d variability on seasonal timescales. Furthermore, we review arguments for an interpretation of long-term palaeoclimatic d changes in terms of moisture source temperature, and we conclude that there remains no sufficient evidence that would justify to neglect the influence of RH on such palaeoclimatic d variations. Hence, we suggest that either the interpretation of d variations in palaeorecords should be adapted to reflect climatic influences on RH during evaporation, in particular atmospheric circulation changes, or new arguments for an interpretation in terms of moisture source temperature will have to be provided based on future research.

  13. Excessive libido in a woman with rabies.

    OpenAIRE

    Dutta, J. K.

    1996-01-01

    Rabies is endemic in India in both wildlife and humans. Human rabies kills 25,000 to 30,000 persons every year. Several types of sexual manifestations including excessive libido may develop in cases of human rabies. A laboratory proven case of rabies in an Indian woman who manifested excessive libido is presented below. She later developed hydrophobia and died.

  14. Understand Your Risk for Excessive Blood Clotting

    Science.gov (United States)

    ... Vascular Health Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Understand Your Risk for Excessive Blood Clotting Updated:Nov 2,2015 Many factors can lead to excessive blood clotting, leading to limited or blocked blood flow. Blood clots can travel to the arteries or ...

  15. Bladder calculus presenting as excessive masturbation.

    Science.gov (United States)

    De Alwis, A C D; Senaratne, A M R D; De Silva, S M P D; Rodrigo, V S D

    2006-09-01

    Masturbation in childhood is a normal behaviour which most commonly begins at 2 months of age, and peaks at 4 years and in adolescence. However excessive masturbation causes anxiety in parents. We describe a boy with a bladder calculus presenting as excessive masturbation.

  16. 30 CFR 57.6902 - Excessive temperatures.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Excessive temperatures. 57.6902 Section 57.6902... Requirements-Surface and Underground § 57.6902 Excessive temperatures. (a) Where heat could cause premature... shall— (1) Measure an appropriate number of blasthole temperatures in order to assess the specific mine...

  17. 30 CFR 56.6902 - Excessive temperatures.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Excessive temperatures. 56.6902 Section 56.6902... Requirements § 56.6902 Excessive temperatures. (a) Where heat could cause premature detonation, explosive... an appropriate number of blasthole temperatures in order to assess the specific mine conditions prior...

  18. Excess Based Allocation of Risk Capital

    NARCIS (Netherlands)

    van Gulick, G.; De Waegenaere, A.M.B.; Norde, H.W.

    2010-01-01

    In this paper we propose a new rule to allocate risk capital to portfolios or divisions within a firm. Specifically, we determine the capital allocation that minimizes the excesses of sets of portfolios in lexicographical sense. The excess of a set of portfolios is defined as the expected loss of

  19. The excessively crying infant : etiology and treatment

    NARCIS (Netherlands)

    Akhnikh, S.; Engelberts, A.C.; Sleuwen, B.E. van; Hoir, M.P. L’; Benninga, M.A.

    2014-01-01

    Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and selflimiting, excessive crying is associated with parental exhaustion and stress. However, and underlying organic cause

  20. Triboson interpretations of the ATLAS diboson excess

    CERN Document Server

    Aguilar-Saavedra, J.A.

    2015-01-01

    The ATLAS excess in fat jet pair production is kinematically compatible with the decay of a heavy resonance into two gauge bosons plus an extra particle. This possibility would explain the absence of such a localised excess in the analogous CMS analysis of fat dijet final states, as well as the negative results of diboson resonance searches in the semi-leptonic decay modes.

  1. Excess length of stay and economic consequences of adverse events in Dutch hospital patients.

    NARCIS (Netherlands)

    Hoogervorst-Schilp, J.; Langelaan, M.; Spreeuwenberg, P.; Bruijne, M.C. de; Wagner, C.

    2015-01-01

    Background: To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Methods: Data of a large retrospective patient

  2. Associations of Pass-Fail Outcomes with Psychological Health of First-Year Medical Students in a Malaysian Medical School

    National Research Council Canada - National Science Library

    Yusoff , Muhamad S. B

    2013-01-01

    The demanding and intense environment of medical training can create excessive pressures on medical students that eventually lead to unfavorable consequences, either at a personal or professional level...

  3. Forming of educational motivation of students to direction of preparation «Health of a man» in the process of study of medical and biological disciplines

    Directory of Open Access Journals (Sweden)

    Babich N.L.

    2012-12-01

    Full Text Available The features of forming of educational motivation of students are considered in the process of study of disciplines of medical and biological disciplines. 73 students took part in research. The analysis of publications is resulted in relation to determination of category vehicle of the probed problem, classification of educational reasons; motivational technologies of studies; correlation of reasons of educational activity of students. It is certain and grounded pedagogical terms of forming positive educational motivation of students on the example of study of discipline «Anatomy of timber-toe by bases of sporting morphology». It is recommended in the process of study of the rich in content modules of discipline to make examples of widespread diseases of the different systems and organs. It is set that the noted examples allow directly to influence on forming of educational motivation of students.

  4. 26 CFR 54.4979-1 - Excise tax on certain excess contributions and excess aggregate contributions.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Excise tax on certain excess contributions and excess aggregate contributions. 54.4979-1 Section 54.4979-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) MISCELLANEOUS EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4979-1 Excise tax on certain excess...

  5. Medical student knowledge regarding radiology before and after a radiological anatomy module: implications for vertical integration and self-directed learning.

    Science.gov (United States)

    Murphy, Kevin P; Crush, Lee; O'Malley, Eoin; Daly, Fergus E; O'Tuathaigh, Colm M P; O'Connor, Owen J; Cryan, John F; Maher, Michael M

    2014-10-01

    To examine the impact that anatomy-focused radiology teaching has on non-examined knowledge regarding radiation safety and radiology as a specialty. First-year undergraduate medical students completed surveys prior to and after undertaking the first-year anatomy programme that incorporates radiological anatomy. Students were asked opinions on preferred learning methodology and tested on understanding of radiology as a specialty and radiation safety. Pre-module and post-module response rates were 93 % (157/168) and 85 % (136/160), respectively. Pre-module and post-module, self-directed learning (SDL) ranked eighth (of 11) for preferred gross-anatomy teaching formats. Correct responses regarding radiologist/radiographer roles varied from 28-94 % on 16 questions with 4/16 significantly improving post-module. Identification of modalities that utilise radiation significantly improved for five of eight modalities post-module but knowledge regarding relative amount of modality-specific radiation use was variable pre-module and post-module. SDL is not favoured as an anatomy teaching method. Exposure of students to a radiological anatomy module delivered by senior clinical radiologists improved basic knowledge regarding ionising radiation use, but there was no improvement in knowledge regarding radiation exposure relative per modality. A possible explanation is that students recall knowledge imparted in didactic lectures but do little reading around the subject when the content is not examined. • Self-directed learning is not favoured as a gross anatomy teaching format amongst medical students. • An imaging anatomy-focused module improved basic knowledge regarding ionising radiation use. • Detailed knowledge of modality-specific radiation exposure remained suboptimal post-module. • Knowledge of roles within a clinical radiology department showed little change post-module.

  6. The learning environment as a mediating variable between self-directed learning readiness and academic performance of a sample of saudi nursing and medical emergency students.

    Science.gov (United States)

    Alotaibi, Khaled N

    2016-01-01

    There has been some ground-breaking research on self-directed learning (SDL) in nursing education which reveals the superiority of SDL to traditional learning methods in terms of students' academic performance and the development of positive attitudes toward the learning process on the part of both students and teachers. The relationship between students' self-directed learning readiness (SDLR) and students' academic performance, and the mediating role of students' perceptions of the learning environment needs further investigation. In this study, it is proposed that students' perceptions of their learning environment could enhance their SDLR and thus boost their academic performance (in terms of their GPA). A descriptive design was used to examine the relationships between the domains of SDLR, which are self-management, desire to learn and self-control and students' perceptions of the learning environment (SPLE) and students' GPA. A survey involving 342 [Corrected] Saudi students from nursing and emergency medical services undergraduate programs in King Saud University was used for this research. The results showed that SDLR level positively influenced students' academic performance positively, and that students' perceptions of their learning environment played a significant role in determining their level of SDLR and academic performance. It is recommended that nursing and emergency medical services educators provide a supportive learning environment in terms of good teaching, clear goals and standards, appropriate assessment, appropriate workload, and emphasis on independence to encourage students to engage in the process of SDL which can, in turn, enhance their academic performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Impact of medication adherence to disease-modifying drugs on severe relapse, and direct and indirect costs among employees with multiple sclerosis in the US.

    Science.gov (United States)

    Ivanova, J I; Bergman, R E; Birnbaum, H G; Phillips, A L; Stewart, M; Meletiche, D M

    2012-01-01

    To compare rates of severe relapse and total direct and indirect costs over a 2-year period between US-based employees with multiple sclerosis (MS) who were adherent and non-adherent to disease-modifying drugs (DMDs). Employees with ≥1 MS diagnosis (ICD-9-CM: 340.x) and ≥1 DMD pharmacy claim between 1/1/2002-12/31/2007 were identified from a large US administrative claims database. Patients had continuous coverage ≥6 months before (baseline) and ≥24 months after (study period) their index date (first DMD claim). Adherence was measured using medication possession ratio (MPR) over the study period. Patients with MPR ≥80% were considered adherent (n = 448) and those with MPR Indirect costs included disability and medically-related absenteeism costs. DMD adherent patients were on average older (43.5 vs 41.8 years, p = 0.015) and more likely to be male (38.6% vs 26.0%, p = 0.002) compared with non-adherent patients. Adherent patients had lower rates of depression, higher rates of previous DMD use, and higher baseline MS-related costs. After adjusting for differences in baseline characteristics, DMD adherent patients had a lower rate of severe relapse (12.4% vs 19.9%, p = 0.013) and lower total (direct and indirect) costs ($14,095 vs $16,638, p = 0.048) over the 2-year study period. In this study, DMD adherence was associated with a significantly lower rate of severe relapse and lower total costs over 2 years. Causality cannot be inferred because adherence and outcomes were measured over the same period. The study was subject to limitations associated with use of claims data and the absence of clinical measures.

  8. Polymorphism of Irganox 1076: Discovery of new forms and direct characterization of the polymorphs on a medical device by Raman microspectroscopy.

    Science.gov (United States)

    Saunier, Johanna; Mazel, Vincent; Paris, Céline; Yagoubi, Najet

    2010-08-01

    Irganox 1076(R) (octadecyl-3,5-di-tert-butyl-4-hydroxyhydrocinnamate) is a common phenolic antioxidant used in many polymer-based medical devices. As with many organic compounds, several polymorphs exist. However, in literature, only two forms of Irganox 1076(R) have been mentioned. In this study, we were able to produce, by crystallization in different solvents, three distinct polymorphs, which were characterized by DSC, FTIR and PXRD. Moreover, the three polymorphs have long-time stability at ambient pressure and temperature, meaning that they can potentially be present in or on polymeric devices. During DSC measurements, a fourth polymorph, which was only stable at low temperature, was evidenced. Thanks to Raman microspectroscopy, Irganox 1076(R) was identified directly on commercial polyurethane catheters which exhibited a blooming phenomenon. This study proves that the polymorph identified on the surface is different from the commercially available Irganox 1076(R). These results emphasize the importance of the screening of polymorphs before any study of the biocompatibility of antioxidants used in medical devices.

  9. Case-based learning in endocrine physiology: an approach toward self-directed learning and the development of soft skills in medical students.

    Science.gov (United States)

    Gade, Shubhada; Chari, Suresh

    2013-12-01

    The Medical Council of India, in the recent Vision 2015 document, recommended curricular reforms for undergraduates. Case-based learning (CBL) is one method where students are motivated toward self-directed learning and to develop analytic and problem-solving skills. An overview of thyroid physiology was given in a didactic lecture. A paper-based case scenario of multinodular goiter was given to phase I Bachelor of Medicine, Bachelor of Surgery students in two sessions. An attitude survey of the students and teachers was done using a Likert scale ranging from strongly disagrees to strongly agree. A pretest and posttest were conducted. The students opined that CBL helped them to better their understanding of a particular topic, gave them better retention of knowledge, helped them to relate clinical conditions to basic sciences, improved soft skills such as communication skills and group dynamics, and promoted a better teacher-student relationship. There was significant improvement in student's performance when pre- and posttest scores were compared (P = 0.018). Furthermore, faculty members opined that CBL promoted self-study and problem-solving abilities of the students. In conclusion, CBL motivates students toward self-directed learning and to develop analytic and problem-solving skills; thus, CBL could be beneficial for students' entry into clinical departments and, finally, in managing patients.

  10. Predictors of excessive use of social media and excessive online gaming in Czech teenagers.

    Science.gov (United States)

    Spilková, Jana; Chomynová, Pavla; Csémy, Ladislav

    2017-12-01

    Background and aims Young people's involvement in online gaming and the use of social media are increasing rapidly, resulting in a high number of excessive Internet users in recent years. The objective of this paper is to analyze the situation of excessive Internet use among adolescents in the Czech Republic and to reveal determinants of excessive use of social media and excessive online gaming. Methods Data from secondary school students (N = 4,887) were collected within the 2015 European School Survey Project on Alcohol and Other Drugs. Logistic regression models were constructed to describe the individual and familial discriminative factors and the impact of the health risk behavior of (a) excessive users of social media and (b) excessive players of online games. Results The models confirmed important gender-specific distinctions - while girls are more prone to online communication and social media use, online gaming is far more prevalent among boys. The analysis did not indicate an influence of family composition on both the excessive use of social media and on excessive online gaming, and only marginal effects for the type of school attended. We found a connection between the excessive use of social media and binge drinking and an inverse relation between excessive online gaming and daily smoking. Discussion and conclusion The non-existence of significant associations between family environment and excessive Internet use confirmed the general, widespread of this phenomenon across the social and economic strata of the teenage population, indicating a need for further studies on the topic.

  11. Explaining CMS lepton excesses with supersymmetry

    CERN Multimedia

    CERN. Geneva; Prof. Allanach, Benjamin

    2014-01-01

    1) Kostas Theofilatos will give an introduction to CMS result 2) Ben Allanach: Several CMS analyses involving di-leptons have recently reported small 2.4-2.8 sigma local excesses: nothing to get too excited about, but worth keeping an eye on nonetheless. In particular, a search in the $lljj p_T$(miss) channel, a search for $W_R$ in the $lljj$ channel and a di-leptoquark search in the $lljj$ channel and $ljj p_T$(miss) channel have all yielded small excesses. We interpret the first excess in the MSSM, showing that the interpretation is viable in terms of other constraints, despite only having squark masses of around 1 TeV. We can explain the last three excesses with a single R-parity violating coupling that predicts a non-zero contribution to the neutrinoless double beta decay rate.

  12. Genetics Home Reference: aromatase excess syndrome

    Science.gov (United States)

    ... Ogata T. Genomic basis of aromatase excess syndrome: recombination- and replication-mediated rearrangements leading to CYP19A1 overexpression. ... 2013 Oct 18. Citation on PubMed More from Genetics Home Reference Bulletins Rare Disease Day 2018 Darwin ...

  13. Prevention of modern teenager's computer excessive gambling

    OpenAIRE

    Shamsutdinova, D.

    2011-01-01

    This article is devoted to the prevention of young people's excessive gambling. The article organized and convincingly derived the prevention strategies dependent gaming behavior among young people and teenagers.

  14. Excessive deforestation of Gishwati Mountainous forest ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    sigp1. Excessive deforestation of Gishwati. Mountainous forest & biodiversity changes. Introduction. The Change in Forest cover in. Rwanda is result of the high growth of population density. The latter has doubled between 1978 and 2002. Over.

  15. Phospholipids as Biomarkers for Excessive Alcohol Use

    Science.gov (United States)

    2017-03-01

    of SM and LPC and the amount of alcohol consumption during the past month. The proposal has both scientific and practical significance in... alcohol use (EAU). Drinking becomes excessive when it causes or elevates the risk for alcohol -related problems or complicates the management of other...the quantity of alcohol consumption during the past month. 2. KEYWORDS: Excessive alcohol use, lipidomics, timeline follow back 3. ACCOMPLISHMENTS

  16. Romanian welfare state between excess and failure

    Directory of Open Access Journals (Sweden)

    Cristina Ciuraru-Andrica

    2012-12-01

    Full Text Available Timely or not, our issue can bring back to life some prolific discussions, sometimes diametrical. We strike the social assistance, where, at this moment, is still uncertain if, once unleashed the excess, the failure will come inevitably or there is a “Salvation Ark”. However, the difference between the excess and the failure of the welfare state is almost intangible, the reason of his potential failure being actually the abuses made until the start of depression.

  17. Organizational Inertia and Excessive Product Proliferation

    OpenAIRE

    Sakuraki, Rie

    2015-01-01

    This study investigates the internal factors of excessive product proliferation. Since empirical literature on product over-proliferation focused on how to optimize existing product portfolio, the causes of excessive product proliferation have so far attracted little attention. This study employs a case study of Shiseido, a famous Japanese cosmetics company, with particular attention to product proliferation in the Shiseido chain store channel, because external factors are mostly absent from ...

  18. Medulloblastoma with Excessive Nodularity: Radiographic Features and Pathologic Correlate

    Directory of Open Access Journals (Sweden)

    L. A. Yeh-Nayre

    2012-01-01

    Full Text Available Medulloblastoma with extensive nodularity is a rare subtype of the most common malignant childhood brain tumor and has been associated with more favorable prognosis. The authors report the case of a 10-month-old girl with a posterior fossa tumor of excessive nodularity with decreased diffusivity on diffusion-weighted magnetic resonance imaging sequences and robust grape-like postgadolinium contrast enhancing features. The unique neuroradiographic features were confirmed by histopathology and a diagnosis of medulloblastoma with extensive nodularity was made. This case highlights the importance of recognizing this unique medulloblastoma subtype preoperatively, as the more favorable outcome may preclude less aggressive medical management.

  19. Excess Weapons Plutonium Immobilization in Russia

    Energy Technology Data Exchange (ETDEWEB)

    Jardine, L.; Borisov, G.B.

    2000-04-15

    The joint goal of the Russian work is to establish a full-scale plutonium immobilization facility at a Russian industrial site by 2005. To achieve this requires that the necessary engineering and technical basis be developed in these Russian projects and the needed Russian approvals be obtained to conduct industrial-scale immobilization of plutonium-containing materials at a Russian industrial site by the 2005 date. This meeting and future work will provide the basis for joint decisions. Supporting R&D projects are being carried out at Russian Institutes that directly support the technical needs of Russian industrial sites to immobilize plutonium-containing materials. Special R&D on plutonium materials is also being carried out to support excess weapons disposition in Russia and the US, including nonproliferation studies of plutonium recovery from immobilization forms and accelerated radiation damage studies of the US-specified plutonium ceramic for immobilizing plutonium. This intriguing and extraordinary cooperation on certain aspects of the weapons plutonium problem is now progressing well and much work with plutonium has been completed in the past two years. Because much excellent and unique scientific and engineering technical work has now been completed in Russia in many aspects of plutonium immobilization, this meeting in St. Petersburg was both timely and necessary to summarize, review, and discuss these efforts among those who performed the actual work. The results of this meeting will help the US and Russia jointly define the future direction of the Russian plutonium immobilization program, and make it an even stronger and more integrated Russian program. The two objectives for the meeting were to: (1) Bring together the Russian organizations, experts, and managers performing the work into one place for four days to review and discuss their work with each other; and (2) Publish a meeting summary and a proceedings to compile reports of all the excellent

  20. Physiological and genetic basis of plant tolerance to excess boron

    Directory of Open Access Journals (Sweden)

    Kastori Rudolf R.

    2008-01-01

    Full Text Available Boron (B deficit as well as excess may significantly limit the organic production in plants. In extreme cases they may kill the affected plants. Boron excess occurs primarily in arid and semiarid regions, in saline soils or in consequence to human action. Excessive boron concentrations retard plant growth and cause physiological and morphological changes (chlorosis and necrosis first of all in leaf tips and then in marginal or intercostal parts of the lamina. Physiological mechanisms of plant tolerance to boron excess have not been studied in sufficient detail. The predominant opinion holds that they are based on restricted uptake and accumulation of boron in the root and aboveground plant parts. Significant differences in boron excess tolerance have been observed not only between different crops but even between different genotypes of the same crop. This has enabled the breeding of crop genotypes and crops adapted to growing on soils rich in available boron and intensified the research on the inheritance of plant tolerance to high B concentration. Sources of tolerance to high B concentration have been found in many crops (wheat, mustard, pea, lentil, eucalypt. Using different molecular techniques based on PCR (RAPD, SRAP, plant parents and progenies have been analyzed in an attempt to map as precisely as possible the position of B-tolerant genes. Small grains have been studied in greatest detail for inheritance of B tolerance. B tolerance in wheat is controlled by at least four additive genes, Bo1, Bo2, Bo3 and Bo4. Consequently, there exists a broad range of tolerance levels. Studies of Arabidopsis have broadened our understanding of regulation mechanisms of B transport from roots to above ground parts, allowing more direct genetic manipulations.

  1. Development of Electronic Medical Record-Based "Rounds Report" Results in Improved Resident Efficiency, More Time for Direct Patient Care and Education, and Less Resident Duty Hour Violations.

    Science.gov (United States)

    Ham, Phillip B; Anderton, Toby; Gallaher, Ryan; Hyrman, Mike; Simmerman, Erika; Ramanathan, Annamalai; Fallaw, David; Holsten, Steven; Howell, Charles Gordon

    2016-09-01

    Surgeons frequently report frustration and loss of efficiency with electronic medical record (EMR) systems. Together, surgery residents and a programmer at Augusta University created a rounds report (RR) summarizing 24 hours of vitals, intake/output, labs, and other values for each inpatient that were previously transcribed by hand. The objective of this study was to evaluate the RR's effect on surgery residents. Surgery residents were queried to assess the RR's impact. Outcome measures were time spent preparing for rounds, direct patient care time, educational activity time, rates of incorrect/incomplete data on rounds, and rate of duty hour violations. Hospital wide, 17,200 RRs were generated in the 1-month study. Twenty-three surgery residents participated. Time spent preparing for rounds decreased per floor patient (15.6 ± 3.0 vs 6.0 ± 1.2, P time increased from 35.2 ± 5.4 to 54.7 ± 7.1 minutes per resident per day (P = 0.0004). Reported duty hour violations decreased 58 per cent (P < 0.0001). American Board of Surgery in Training exam scores trended up, and estimates of departmental annual financial savings range from $66,598 to $273,141 per year. Significant improvements occur with surgeon designed EMR tools like the RR. Hospitals and EMR companies should pair interested surgeons with health information technology developers to facilitate EMR enhancements. Improvements like RRs can have broad ranging, multidisciplinary impact and should be standard in all EMRs used for inpatient care at academic medical centers.

  2. Characterising the 750 GeV diphoton excess

    Energy Technology Data Exchange (ETDEWEB)

    Bernon, Jérémy [Laboratoire de Physique Subatomique et de Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3,53 Avenue des Martyrs, Grenoble, F-38026 (France); Goudelis, Andreas [Institute of High Energy Physics, Austrian Academy of Sciences,Nikolsdorfergasse 18, Vienna, 1050 (Austria); Kraml, Sabine [Laboratoire de Physique Subatomique et de Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3,53 Avenue des Martyrs, Grenoble, F-38026 (France); Mawatari, Kentarou [Laboratoire de Physique Subatomique et de Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3,53 Avenue des Martyrs, Grenoble, F-38026 (France); Theoretische Natuurkunde and IIHE/ELEM, Vrije Universiteit Brussel, and International Solvay Institutes, Pleinlaan 2, Brussels, B-1050 (Belgium); Sengupta, Dipan [Laboratoire de Physique Subatomique et de Cosmologie, Université Grenoble-Alpes, CNRS/IN2P3,53 Avenue des Martyrs, Grenoble, F-38026 (France)

    2016-05-23

    We study kinematic distributions that may help characterise the recently observed excess in diphoton events at 750 GeV at the LHC Run 2. Several scenarios are considered, including spin-0 and spin-2 750 GeV resonances that decay directly into photon pairs as well as heavier parent resonances that undergo three-body or cascade decays. We find that combinations of the distributions of the diphoton system and the leading photon can distinguish the topology and mass spectra of the different scenarios, while patterns of QCD radiation can help differentiate the production mechanisms. Moreover, missing energy is a powerful discriminator for the heavy parent scenarios if they involve (effectively) invisible particles. While our study concentrates on the current excess at 750 GeV, the analysis is general and can also be useful for characterising other potential diphoton signals in the future.

  3. Dark matter for excess of AMS-02 positrons and antiprotons

    Directory of Open Access Journals (Sweden)

    Chuan-Hung Chen

    2015-07-01

    Full Text Available We propose a dark matter explanation to simultaneously account for the excess of antiproton-to-proton and positron power spectra observed in the AMS-02 experiment while having the right dark matter relic abundance and satisfying the current direct search bounds. We extend the Higgs triplet model with a hidden gauge symmetry of SU(2X that is broken to Z3 by a quadruplet scalar field, rendering the associated gauge bosons stable weakly-interacting massive particle dark matter candidates. By coupling the complex Higgs triplet and the SU(2X quadruplet, the dark matter candidates can annihilate into triplet Higgs bosons each of which in turn decays into lepton or gauge boson final states. Such a mechanism gives rise to correct excess of positrons and antiprotons with an appropriate choice of the triplet vacuum expectation value. Besides, the model provides a link between neutrino mass and dark matter phenomenology.

  4. [What nosographic framework for excessive tanning?].

    Science.gov (United States)

    Petit, A; Karila, L; Lejoyeux, M

    2014-04-01

    Socially valorised tanning, like other forms of behaviour, can take on an addictive aspect. Excessive tanning, defined by the presence of impulsivity and repetition of tanning that leads to personal distress, is a psychiatric disorder that has only recently been recognized. This finding is based on the observations of many dermatologists who report an addictive relationship in their patients with tanning cabins despite announcement of the diagnosis of malignant melanoma. This article attempts to synthesize the existing literature on excessive tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, aetiology, and treatment of this disorder. The literature review was conducted from 1983 to 2012, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following keywords alone or combined: Tanning, Addiction, Sunbeds, Skin cancer prevention, and Treatment. We investigated different models to determine how excessive tanning met these criteria. Excessive Tanning was described in the 2000s by an American dermatologist, Carolyn Heckman. Wartham et al. were the first to have proposed a theoretical framework for addiction to sunbathing, as well as two scales (m CAGE and m DSM IV) for the diagnosis and to assess the degree of addiction. These diagnostic criteria describe the craving like-symptoms, the feeling of losing control, or the continuation of the behavior despite knowledge of negative consequences. Excessive Tanning is not present in the classifications of the DSM or ICD, but may be related to Addiction, Obsessive-Compulsive Disorder, Impulse control disorders, Anorexia, or Body Dysmorphic Disorder. Excessive tanning can be included in the spectrum of behavioural addictions due its clinical characteristics in common with classics addictive disorders. They are a variety of other models, which may offer an explanation for or insight into tanning behaviour. Further studies must be controlled, notably on

  5. Has time come for the use of direct oral anticoagulants in the extended prophylaxis of venous thromboembolism in acutely ill medical patients? Yes.

    Science.gov (United States)

    Ageno, Walter

    2017-08-14

    Betrixaban is a direct factor Xa inhibitor with a renal excretion of only approximately 5-7%. On June 23rd 2017, it became the first direct oral anticoagulant to receive Food and Drug Administration approval for the prevention of venous thromboembolism in acutely ill medical patients, and the first anticoagulant agent to be approved for extended-duration thromboprophylaxis after hospital discharge in this setting. Approval followed the results of the APEX trial, a phase III clinical trial comparing betrixaban (80 mg) administered for 35-42 days with enoxaparin (40 mg) administered for 10 ± 4 days. This study for the first time applied a risk assessment model, integrating clinical factors and a laboratory marker to identify high risk patients. To improve safety, a dose reduction was used for patients with creatinine clearance between 15 and 30 mL/min (betrixaban 40 mg and enoxaparin 20 mg) and for patients receiving concomitant treatment with potent P-glycoprotein inhibitors (betrixaban 40 mg). The primary prespecified analysis tested the hypothesis that the benefit of extended thromboprophylaxis with betrixaban was greatest in patients with elevated D-dimer, but the 21% relative risk reduction failed to meet the prespecified threshold for statistical significance. However, the analysis of the overall study population showed a favorable net clinical benefit with betrixaban, with a statistically significant reduction in all efficacy outcomes and no increase in major bleeding rates. An ongoing trial, MARINER, is also assessing a combined approach for risk stratification comparing extended-duration rivaroxaban with standard duration low molecular weight heparin.

  6. Antidepressant induced excessive yawning and indifference

    Directory of Open Access Journals (Sweden)

    Bruno Palazzo Nazar

    2015-03-01

    Full Text Available Introduction Antidepressant induced excessive yawning has been described as a possible side effect of pharmacotherapy. A syndrome of indifference has also been described as another possible side effect. The frequency of those phenomena and their physiopathology are unknown. They are both considered benign and reversible after antidepressant discontinuation but severe cases with complications as temporomandibular lesions, have been described. Methods We report two unprecedented cases in which excessive yawning and indifference occurred simultaneously as side effects of antidepressant therapy, discussing possible physiopathological mechanisms for this co-occurrence. Case 1: A male patient presented excessive yawning (approximately 80/day and apathy after venlafaxine XR treatment. Symptoms reduced after a switch to escitalopram, with a reduction to 50 yawns/day. Case 2: A female patient presented excessive yawning (approximately 25/day and inability to react to environmental stressors with desvenlafaxine. Conclusion Induction of indifference and excessive yawning may be modulated by serotonergic and noradrenergic mechanisms. One proposal to unify these side effects would be enhancement of serotonin in midbrain, especially paraventricular and raphe nucleus.

  7. High excess costs of infections caused by carbapenem-resistant gram-negative bacilli in an endemic region.

    Science.gov (United States)

    Vargas-Alzate, Carlos Andrés; Higuita-Gutiérrez, Luis Felipe; López López, Lucelly; Cienfuegos Gallet, Astrid Vanessa; Jiménez Quiceno, Judy Natalia

    2017-12-22

    The financial burden of antibiotic resistance is a serious concern worldwide. The aim of this study is to describe the excess costs associated with pneumonia, bacteremia, surgical site infections and intra-abdominal infections caused by carbapenem-resistant gram-negative bacilli in Medellín, Colombia, an endemic region for carbapenem resistance. A cohort study was conducted in a third level hospital from 2014 to 2015. All patients with carbapenem-resistant and carbapenem-susceptible gram-negative bacteria infections were included. Pharmaceutical, medical and surgical direct costs were described from the health system perspective. The excess costs were estimated from generalized linear models using a gamma distribution and adjusted for variables that could affect the cost difference. A total of 218 patients were enrolled, 22% of whom were infected with carbapenem-resistant bacteria. Intra-abdominal infections were the most frequent. The adjusted total excess costs was USD $3,966 (95%CI, 1,684-6,249) with a significantly higher cost for antibiotics, followed by hospital stays, laboratory tests and inter-consultation. The highest excess cost was attributed mainly to the use of broad-spectrum antibiotics (USD $1,827, 95%CI, 1,005-2,648) and followed by length of hospital stay (USD $1,015, 95%CI, 163-1867). The results of this study highlight the importance of designing antimicrobial stewardship programs and infection control strategies in endemic regions to reduce the financial threat of antimicrobial resistance to health systems. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  8. Subcapital fracture of the femoral neck in medically unwell patients: technique for fixation using direct infiltration local anaesthetic rather than regional blockade.

    Science.gov (United States)

    Sher, Doron; Biant, Leela C

    2007-10-01

    Patients presenting with fracture of the femoral neck are usually elderly, and often have extensive co-morbidity. Patients who are considered able to survive an operation under general or regional anaesthesia usually undergo surgical stabilisation of the fracture or hemiarthroplasty of the hip for pain relief, to facilitate mobilisation and minimise the risk of developing the sequelae of bed rest. Patients who are considered too unwell for surgery are often treated non-operatively. These patients have a high morbidity and mortality and present significant nursing difficulties. We describe a technique for fixation of subcapital fracture of the femoral neck under local anaesthesia direct infiltration only which is suitable for the medically unwell patient who may otherwise be treated non-operatively. A case series of patients on whom it was performed is presented. None of the patients required a supplementary anaesthetic technique, all survived to discharge from hospital. We recommend all patients with a subcapital fracture of the femoral neck are offered surgery to optimise their chance of survival and avoid the morbidity associated with bed rest.

  9. CaPOW! Using Problem Sets in a Capstone Course to Improve Fourth-Year Medical Students' Confidence in Self-Directed Learning.

    Science.gov (United States)

    Clay, Alison S; Ming, David Y; Knudsen, Nancy W; Engle, Deborah L; Grochowski, Colleen O'Connor; Andolsek, Kathryn M; Chudgar, Saumil M

    2017-03-01

    Despite the importance of self-directed learning (SDL) in the field of medicine, individuals are rarely taught how to perform SDL or receive feedback on it. Trainee skill in SDL is limited by difficulties with self-assessment and goal setting. Ninety-two graduating fourth-year medical students from Duke University School of Medicine completed an individualized learning plan (ILP) for a transition-to-residency Capstone course in spring 2015 to help foster their skills in SDL. Students completed the ILP after receiving a personalized report from a designated faculty coach detailing strengths and weaknesses on specific topics (e.g., pulmonary medicine) and clinical skills (e.g., generating a differential diagnosis). These were determined by their performance on 12 Capstone Problem Sets of the Week (CaPOWs) compared with their peers. Students used transitional-year milestones to self-assess their confidence in SDL. SDL was successfully implemented in a Capstone course through the development of required clinically oriented problem sets. Coaches provided guided feedback on students' performance to help them identify knowledge deficits. Students' self-assessment of their confidence in SDL increased following course completion. However, students often chose Capstone didactic sessions according to factors other than their CaPOW performance, including perceived relevance to planned specialty and session timing. Future Capstone curriculum changes may further enhance SDL skills of graduating students. Students will receive increased formative feedback on their CaPOW performance and be incentivized to attend sessions in areas of personal weakness.

  10. Limiting law excess sum rule for polyelectrolytes.

    Science.gov (United States)

    Landy, Jonathan; Lee, YongJin; Jho, YongSeok

    2013-11-01

    We revisit the mean-field limiting law screening excess sum rule that holds for rodlike polyelectrolytes. We present an efficient derivation of this law that clarifies its region of applicability: The law holds in the limit of small polymer radius, measured relative to the Debye screening length. From the limiting law, we determine the individual ion excess values for single-salt electrolytes. We also consider the mean-field excess sum away from the limiting region, and we relate this quantity to the osmotic pressure of a dilute polyelectrolyte solution. Finally, we consider numerical simulations of many-body polymer-electrolyte solutions. We conclude that the limiting law often accurately describes the screening of physical charged polymers of interest, such as extended DNA.

  11. Nordic working group on x-ray diagnostics - Practical implementation of the directive on medical exposures in the Nordic EU countries

    Energy Technology Data Exchange (ETDEWEB)

    Waltenburg, H.N.; Groen, P. [National Institute of Radiation Hygiene, Herlev (Denmark); Leitz, W. [Swedish Radiation Protection Authority, Stockholm (Sweden); Servomaa, A. [Finnish Centre for Radiation and Nuclear Safety, Helsinki (Finland); Einarsson, G. [Icelandic Radiation Protection Institute, Reykjavik (Iceland); Olerud, H. [Norwegian Radiation Protection Authority, Oslo (Norway)

    2003-06-01

    The EU directive on medical exposure, 97/43/EURATOM (referred to in the following as MED) imposes new requirements on hospital departments using ionising radiation for either diagnostics or treatment of illnesses. The directive was approved on 30 June 1997, and the member states were obliged to implement the requirements into national legislation before 13 May 2000. The implementation of a directive of this kind is a complicated process requiring time as well as other resources. The Nordic EU countries (Sweden, Finland and Denmark) must comply with the rules in MED, while this is not the case for Norway and Iceland as EFTA (European Free Trade Association) members, since the agreements between EFTA and EU does not cover the EURATOM treaty. The issues that have to be addressed in the national legislation are justification, optimisation, responsibilities, procedures, training, equipment, special protection during pregnancy and breast-feeding, and potential exposure. A central aspect in MED is the requirement for quality assurance programmes to be established in radiological departments (and in other departments employing ionising radiation). A change of this magnitude in legislation requires adjustments in the routines of the individual departments. The staff in each department needs to prepare and follow procedures and instructions for daily work and also participate in day-to-day quality assurance. A considerable burden has also been laid on the radiation protection authorities in the member states, first in the process of transposing MED into national law or regulations, and secondly in guiding the process of practical implementation. Here we will describe how the individual Nordic EU countries have chosen to implement MED in national legislation and how far the process of complying with the requirements has come so far. Although Norway and Iceland are not required to follow MED, it is still interesting for comparison to include the situation in these countries

  12. The High Price of Excessive Alcohol Consumption

    Centers for Disease Control (CDC) Podcasts

    2011-10-17

    This podcast is based on the October 2011 release of a report estimating the economic cost of excessive drinking. Excessive alcohol consumption cost the U. S. $223.5 billion in 2006, or about $1.90 per drink. Over three-quarters (76%) of these costs were due to binge drinking, defined as consuming 4 or more alcoholic beverages per occasion for women or 5 or more drinks per occasion for men.  Created: 10/17/2011 by National Center for Chronic Disease Prevention and Health Promotion.   Date Released: 10/17/2011.

  13. Contrast induced hyperthyroidism due to iodine excess

    Science.gov (United States)

    Mushtaq, Usman; Price, Timothy; Laddipeerla, Narsing; Townsend, Amanda; Broadbridge, Vy

    2009-01-01

    Iodine induced hyperthyroidism is a thyrotoxic condition caused by exposure to excessive iodine. Historically this type of hyperthyroidism has been described in areas of iodine deficiency. With advances in medicine, iodine induced hyperthyroidism has been observed following the use of drugs containing iodine—for example, amiodarone, and contrast agents used in radiological imaging. In elderly patients it is frequently difficult to diagnose and control contrast related hyperthyroidism, as most of these patients do not always present with typical signs and symptoms of hyperthyroidism. Treatment can be very challenging as drugs commonly used to treat hyperthyroidism have little effect on already formed thyroid hormone due to iodine excess. PMID:22053166

  14. Conciliating SUSY with the Z-peaked excess

    Directory of Open Access Journals (Sweden)

    Mitsou Vasiliki A.

    2016-01-01

    Full Text Available The ATLAS experiment observed an excess at the 3σ level in the channel of Z boson, jets and high missing transverse momentum in the full 2012 dataset at 8 TeV while searching for SUSY. The question arises whether the abundance and the kinematical features of this excess are compatible with the yet unconstrained supersymmetric realm, respecting at the same time the measured Higgs boson properties and dark matter density. By trying to explain this signal with SUSY we find that only relatively light gluinos together with a heavy neutralino NLSP decaying predominantly to a Z boson plus a light gravitino could reproduce the excess. We construct an explicit general gauge mediation model able to match the observed signal. More sophisticated models could also reproduce the signal, as long as it features light gluinos, or heavy particles with a strong production cross section, producing at least one Z boson in its decay chain. The implications of our findings for the Run II at LHC with the scaling on the Z peak, as well as for the direct search of gluinos and other SUSY particles, are also discussed.

  15. Bridges, Lights, and Hubris: Examples of Excessive Light Pollution

    Science.gov (United States)

    Upgren, A. R.

    2000-12-01

    Recently many new lighting projects have been planned, frequently for the purpose of bringing attention to a tower or bridge, with the intent of promoting it as a tourist attraction. Examples of this form of light pollution are illustrated here. Many proceed with plans to mount new floodlights pointed upward with most of the light shining directly up into the sky. At least three of the more excessive among them have been tabled or aborted upon objections by members of the International Dark-Sky Association and other environmental groups. Opposition to the most ill-conceived of these plans centers on waste of money and energy, excessive fatalities among migratory birds, damage to the aesthetic beauty and study of the night sky, and (near seacoasts) damage to the nesting and hatching of sea turtles. Constructive opposition to lighting excess and glare may include the substitution of tracer lights, such as the ones that adorn the great suspension bridges of New York and San Francisco. Tracer lights using full-cutoff shielding outline a structure much as lights on a Christmas tree delineate its shape, but floodlights in the mix render a washed-out effect similar to a Christmas tree in broad daylight. The AAS Committee on Light Pollution, Radio Interference, and Space Debris encourages a greater role for the Society in coordinating opposition to such projects, which is too often local and inexperienced.

  16. 34 CFR 300.16 - Excess costs.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Excess costs. 300.16 Section 300.16 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

  17. Excessive Positivism in Person-Centered Planning

    Science.gov (United States)

    Holburn, Steve; Cea, Christine D.

    2007-01-01

    This paper illustrates the positivistic nature of person-centered planning (PCP) that is evident in the planning methods employed, the way that individuals with disabilities are described, and in portrayal of the outcomes of PCP. However, a confluence of factors can lead to manifestation of excessive positivism that does not serve PCP…

  18. Excessive prices as abuse of dominance?

    DEFF Research Database (Denmark)

    la Cour, Lisbeth; Møllgaard, Peter

    2007-01-01

    firm abused its position by charging excessive prices. We also test whether tightening of the Danish competition act has altered the pricing behaviour on the market. We discuss our results in the light of a Danish competition case against the dominant cement producer that was abandoned by the authority...

  19. Surface temperature excess in heterogeneous catalysis

    NARCIS (Netherlands)

    Zhu, L.

    2005-01-01

    In this dissertation we study the surface temperature excess in heterogeneous catalysis. For heterogeneous reactions, such as gas-solid catalytic reactions, the reactions take place at the interfaces between the two phases: the gas and the solid catalyst. Large amount of reaction heats are released

  20. Origin of excess 176Hf in meteorites

    DEFF Research Database (Denmark)

    Thrane, Kristine; Connelly, James; Bizzarro, Martin

    2010-01-01

    with Lu/Hf elemental ratios in meteorites older than similar to 4.56 Ga meteorites unresolved. We attribute (176)Hf excess in older meteorites to an accelerated decay of (176)Lu caused by excitation of the long-lived (176)Lu ground state to a short-lived (176m)Lu isomer. The energy needed to cause...

  1. Excessive nitrogen and phosphorus in European rivers

    NARCIS (Netherlands)

    Blaas, Harry; Kroeze, Carolien

    2016-01-01

    Rivers export nutrients to coastal waters. Excess nutrient export may result in harmful algal blooms and hypoxia, affecting biodiversity, fisheries, and recreation. The purpose of this study is to quantify for European rivers (1) the extent to which N and P loads exceed levels that minimize the

  2. Excessive infant crying : definitions determine risk groups

    NARCIS (Netherlands)

    Reijneveld, SA; Brugman, E; Hirasing, RA

    We assessed risk groups for excessive infant crying using 10 published definitions, in 3179 children aged 1-6 months (response: 96.5%). Risk groups regarding parental employment, living area, lifestyle, and obstetric history varied by definition. This may explain the existence of conflicting

  3. Low excess air operations of oil boilers

    Energy Technology Data Exchange (ETDEWEB)

    Butcher, T.A.; Celebi, Y.; Litzke, Wai Lin [Brookhaven National Labs., Upton, NY (United States)

    1997-09-01

    To quantify the benefits which operation at very low excess air operation may have on heat exchanger fouling BNL has recently started a test project. The test allows simultaneous measurement of fouling rate, flue gas filterable soot, flue gas sulfuric acid content, and flue gas sulfur dioxide.

  4. Productivity or discrimination? An economic analysis of excess-weight penalty in the Swedish labor market.

    OpenAIRE

    Dackehag, Margareta; Gerdtham, Ulf; Nordin, Martin

    2015-01-01

    Using longitudinal data, this paper investigates the penalty for excess weight in the Swedish labor market, distinguishing between the productivity and the discrimination hypotheses. We analyze employment, income, and sickness absence , using the latter as a direct measure of productivity. We find that excess weight women, but not men, experience a significant employment penalty. Both genders experience a significant income penalty for obesity. We conclude that the penalties are associated wi...

  5. Personalized Recommendation via Suppressing Excessive Diffusion

    Directory of Open Access Journals (Sweden)

    Guilin Chen

    2017-01-01

    Full Text Available Efficient recommendation algorithms are fundamental to solve the problem of information overload in modern society. In physical dynamics, mass diffusion is a powerful tool to alleviate the long-standing problems of recommendation systems. However, popularity bias and redundant similarity have not been adequately studied in the literature, which are essentially caused by excessive diffusion and will lead to similarity estimation deviation and recommendation performance degradation. In this paper, we penalize the popular objects by appropriately dividing the popularity of objects and then leverage the second-order similarity to suppress excessive diffusion. Evaluation on three real benchmark datasets (MovieLens, Amazon, and RYM by 10-fold cross-validation demonstrates that our method outperforms the mainstream baselines in accuracy, diversity, and novelty.

  6. ILLUSION OF EXCESSIVE CONSUMPTION AND ITS EFFECTS

    Directory of Open Access Journals (Sweden)

    MUNGIU-PUPĂZAN MARIANA CLAUDIA

    2015-12-01

    Full Text Available The aim is to explore, explain and describe this phenomenon to a better understanding of it and also the relationship between advertising and the consumer society members. This paper aims to present an analysis of excessive and unsustainable consumption, the evolution of a phenomenon, and the ability to find a way to combat. Unfortunately, studies show that this tendency to accumulate more than we need to consume excess means that almost all civilizations fined and placed dogmatic among the values that children learn early in life. This has been perpetuated since the time when the goods or products does not get so easy as today. Anti-consumerism has emerged in response to this economic system, not on the long term. We are witnessing the last two decades to establish a new phase of consumer capitalism: society hiperconsumtion.

  7. Conservative treatment of excessive anterior pelvic tilt

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    , DK-5000 Odense C, Denmark ABSTRACT (1795 anslag) Background: Excessive anterior pelvic tilt has been linked to pain and dysfunction of the hip and pelvic region. Conservative treatment (e.g. manual therapy and physical training) is suggested in correcting the tilt and eventually related symptoms...... demonstrated a significant reduction in anterior pelvic tilt. The two studies intervening on symptomatic subjects demonstrated a significant reduction in pain and disability, respectively. Conclusions: Very low quality of evidence suggests that further studies are needed to clarify whether conservative......Conservative treatment of excessive anterior pelvic tilt: A systematic review Anders Falk Brekke1,2,3, Søren Overgaard1,2, Asbjørn Hróbjartsson4, Anders Holsgaard-Larsen1,2 1Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital 2Department...

  8. Neurological manifestations of excessive alcohol consumption.

    Science.gov (United States)

    Planas-Ballvé, Anna; Grau-López, Laia; Morillas, Rosa María; Planas, Ramón

    2017-12-01

    This article reviews the different acute and chronic neurological manifestations of excessive alcohol consumption that affect the central or peripheral nervous system. Several mechanisms can be implicated depending on the disorder, ranging from nutritional factors, alcohol-related toxicity, metabolic changes and immune-mediated mechanisms. Recognition and early treatment of these manifestations is essential given their association with high morbidity and significantly increased mortality. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  9. Fertilizing nature: a tragedy of excess in the commons.

    Directory of Open Access Journals (Sweden)

    Allen G Good

    2011-08-01

    Full Text Available Globally, we are applying excessive nitrogen (N fertilizers to our agricultural crops, which ultimately causes nitrogen pollution to our ecosphere. The atmosphere is polluted by N₂O and NO(x gases that directly and indirectly increase atmospheric warming and climate change. Nitrogen is also leached from agricultural lands as the water-soluble form NO₃⁻, which increases nutrient overload in rivers, lakes, and oceans, causing "dead zones", reducing property values and the diversity of aquatic life, and damaging our drinking water and aquatic-associated industries such as fishing and tourism. Why do some countries show reductions in fertilizer use while others show increasing use? What N fertilizer application reductions could occur, without compromising crop yields? And what are the economic and environmental benefits of using directed nutrient management strategies?

  10. Concurrent use of tramadol and oral vitamin K antagonists and the risk of excessive anticoagulation

    DEFF Research Database (Denmark)

    Pottegård, Anton; Meegaard, P. M.; Holck, L. H.

    2013-01-01

    .9-5.2). This corresponds to, on average, one excess case per 250 treatment years (CI 125-584). The result is potentially confounded by concomitant paracetamol use and the presence of acute illness. CONCLUSION: Caution is advised when using tramadol in patients using VKA, and if possible, an alternative pain-medication...

  11. Tendon rupture associated with excessive smartphone gaming.

    Science.gov (United States)

    Gilman, Luke; Cage, Dori N; Horn, Adam; Bishop, Frank; Klam, Warren P; Doan, Andrew P

    2015-06-01

    Excessive use of smartphones has been associated with injuries. A 29-year-old, right hand-dominant man presented with chronic left thumb pain and loss of active motion from playing a Match-3 puzzle video game on his smartphone all day for 6 to 8 weeks. On physical examination, the left extensor pollicis longus tendon was not palpable, and no tendon motion was noted with wrist tenodesis. The thumb metacarpophalangeal range of motion was 10° to 80°, and thumb interphalangeal range of motion was 30° to 70°. The clinical diagnosis was rupture of the left extensor pollicis longus tendon. The patient subsequently underwent an extensor indicis proprius (1 of 2 tendons that extend the index finger) to extensor pollicis longus tendon transfer. During surgery, rupture of the extensor pollicis longus tendon was seen between the metacarpophalangeal and wrist joints. The potential for video games to reduce pain perception raises clinical and social considerations about excessive use, abuse, and addiction. Future research should consider whether pain reduction is a reason some individuals play video games excessively, manifest addiction, or sustain injuries associated with video gaming.

  12. [Mortality attributable to excess weight in Spain].

    Science.gov (United States)

    Martín-Ramiro, José Javier; Álvarez-Martín, Elena; Gil-Prieto, Ruth

    2014-06-16

    Estimate the mortality attributable to higher than optimal body mass index in the Spanish population in 2006. Excess body weight prevalence data were obtained from the 2006 National Health Survey, while data on associated mortality were extracted from the National Statistic Institute. Population attributable fractions were applied and mortality attributable to higher than optimal body mass index was calculated for people between 35 and 79 years. In 2006, among the Spanish population aged 35-79 years, 25,671 lives (16,405 males and 9,266 women) were lost due to higher than optimal body mass index. Mortality attributable was 15.8% of total deaths in males and 14.8% in women, but if we refer to those causes where excess body weight is a risk factor, it is about a 30% of mortality (31.6% in men and 28% in women). The most important individual cause was cardiovascular disease (58%), followed by cancer. The individual cause with a major contribution to deaths was type 2 diabetes; nearly 70% in males and 80% in women. Overweight accounted for 54.9% deaths in men and 48.6% in women. Excess body weight is a major public health problem, with an important associated mortality. Attributable deaths are a useful tool to know the real situation and to monitor for disease control interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Earnings Quality Measures and Excess Returns.

    Science.gov (United States)

    Perotti, Pietro; Wagenhofer, Alfred

    2014-06-01

    This paper examines how commonly used earnings quality measures fulfill a key objective of financial reporting, i.e., improving decision usefulness for investors. We propose a stock-price-based measure for assessing the quality of earnings quality measures. We predict that firms with higher earnings quality will be less mispriced than other firms. Mispricing is measured by the difference of the mean absolute excess returns of portfolios formed on high and low values of a measure. We examine persistence, predictability, two measures of smoothness, abnormal accruals, accruals quality, earnings response coefficient and value relevance. For a large sample of US non-financial firms over the period 1988-2007, we show that all measures except for smoothness are negatively associated with absolute excess returns, suggesting that smoothness is generally a favorable attribute of earnings. Accruals measures generate the largest spread in absolute excess returns, followed by smoothness and market-based measures. These results lend support to the widespread use of accruals measures as overall measures of earnings quality in the literature.

  14. User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation

    Directory of Open Access Journals (Sweden)

    Ameur Amal

    2012-11-01

    Full Text Available Abstract Background In 2006, the Parliament of Burkina Faso passed a policy to reduce the direct costs of obstetric services and neonatal care in the country’s health centres, aiming to lower the country’s high national maternal mortality and morbidity rates. Implementation was via a “partial exemption” covering 80% of the costs. In 2008 the German NGO HELP launched a pilot project in two health districts to eliminate the remaining 20% of user fees. Regardless of any exemptions, women giving birth in Burkina Faso’s health centres face additional expenses that often represent an additional barrier to accessing health services. We compared the total cost of giving birth in health centres offering partial exemption versus those with full exemption to assess the impact on additional out-of-pocket fees. Methods A case–control study was performed to compare medical expenses. Case subjects were women who gave birth in 12 health centres located in the Dori and Sebba districts, where HELP provided full fee exemption for obstetric services and neonatal care. Controls were from six health centres in the neighbouring Djibo district where a partial fee exemption was in place. A random sample of approximately 50 women per health centre was selected for a total of 870 women. Results There was an implementation gap regarding the full exemption for obstetric services and neonatal care. Only 1.1% of the sample from Sebba but 17.5% of the group from Dori had excessive spending on birth related costs, indicating that women who delivered in Sebba were much less exposed to excessive medical expenses than women from Dori. Additional out-of-pocket fees in the full exemption health districts took into account household ability to pay, with poorer women generally paying less. Conclusions We found that the elimination of fees for facility-based births benefits especially the poorest households. The existence of excessive spending related to direct costs of

  15. 78 FR 42072 - Application for Final Commitment for a Long-Term Loan or Financial Guarantee in Excess of $100...

    Science.gov (United States)

    2013-07-15

    ... UNITED STATES Application for Final Commitment for a Long-Term Loan or Financial Guarantee in Excess of... commitment for a long-term loan or financial guarantee in excess of $100 million (as calculated in accordance.... Reference: AP087586XX. Purpose and Use Brief description of the purpose of the transaction: A direct loan to...

  16. Risk factors for opioid-induced excessive respiratory depression.

    Science.gov (United States)

    Jungquist, Carla R; Karan, Suzanne; Perlis, Michael L

    2011-09-01

    Opioid use has increased significantly over the past ten years and so has the incidence of reportable adverse events, such as respiratory depression and/or arrest. It is important for nurses to understand and know how to assess patients for risk factors for respiratory depression secondary to opioid therapy. This paper presents the pharmacodynamics of opioids, the risk factors for excessive respiratory depression, recommendations for identifying patients at high risk, and interventions to prevent adverse effects. After reading this paper, nurses will have the knowledge to provide safe administration of opioid medications for the management of acute pain. Copyright © 2011 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  17. Excessive Profits of German Defense Contractors

    Science.gov (United States)

    2014-09-01

    aesthetic aspects; customer service; follow-on costs; life cycle costs)” (“Regulations on contract,” 2009, p. 44). Further, “the most economically...3840 Surgical, Medical, and Dental Instruments and Supplies 1 3841 Surgical and Medical Instruments and Apparatus 1 7300 Business Services 2

  18. Profilometric and SEM analyses of composite surfaces after excess cement removal

    Directory of Open Access Journals (Sweden)

    Jevremović Danimir P.

    2012-01-01

    Full Text Available Composite cements are widely used in dentistry, due to their positive characteristics (bond strength, color, low solubility etc.. However, removal of the cement presents one of the drawbacks of their use, since incomplete removal might cause bacterial adhesion, gingival irritation and subsequent inflammation. The aim of this study was to investigate surface characteristics of the composite cements after different ways of excess removal, by means of profilometric and SEM analysis. Thirty leucite reinforced ceramic specimens were divided into three groups, based on the manner of excess cement removal: Group 1 (polished: excess was fully polymerized for 40 s, then removed; Group 2 (cleaned: excess was removed with a cotton roll, after which cement was fully polymerized for 40 s; Group 3 (pre-polymerized: excess was light cured for 5 s, after which cement excess was broken with an instrument and then fully polymerized for 40 s. Surface roughness was measured using a surface profilometer. Subsequently, specimens were inspected by a scanning electron microscope. The data were statistically analyzed. The examination of variants of average values proved the statistically significant difference in the height of average values per group, p<0.0001; the statistically significantly highest values were for the pre-polymerized group, whereas the statistically significantly lowest values were for the polished group. Results of this study show that utmost attention has to be paid to the excess removal procedure, since surface roughness parameters directly depend on the choice of the applied technique.

  19. Analysis of Microbiome Data in the Presence of Excess Zeros

    Science.gov (United States)

    Kaul, Abhishek; Mandal, Siddhartha; Davidov, Ori; Peddada, Shyamal D.

    2017-01-01

    Motivation: An important feature of microbiome count data is the presence of a large number of zeros. A common strategy to handle these excess zeros is to add a small number called pseudo-count (e.g., 1). Other strategies include using various probability models to model the excess zero counts. Although adding a pseudo-count is simple and widely used, as demonstrated in this paper, it is not ideal. On the other hand, methods that model excess zeros using a probability model often make an implicit assumption that all zeros can be explained by a common probability models. As described in this article, this is not always recommended as there are potentially three types/sources of zeros in a microbiome data. The purpose of this paper is to develop a simple methodology to identify and accomodate three different types of zeros and to test hypotheses regarding the relative abundance of taxa in two or more experimental groups. Another major contribution of this paper is to perform constrained (directional or ordered) inference when there are more than two ordered experimental groups (e.g., subjects ordered by diet or age groups or environmental exposure groups). As far as we know this is the first paper that addresses such problems in the analysis of microbiome data. Results: Using extensive simulation studies, we demonstrate that the proposed methodology not only controls the false discovery rate at a desired level of significance while competing well in terms of power with DESeq2, a popular procedure derived from RNASeq literature. As expected, the method using pseudo-counts tends to be very conservative and the classical t-test that ignores the underlying simplex structure in the data has an inflated FDR. PMID:29163406

  20. Analysis of Microbiome Data in the Presence of Excess Zeros

    Directory of Open Access Journals (Sweden)

    Abhishek Kaul

    2017-11-01

    Full Text Available Motivation: An important feature of microbiome count data is the presence of a large number of zeros. A common strategy to handle these excess zeros is to add a small number called pseudo-count (e.g., 1. Other strategies include using various probability models to model the excess zero counts. Although adding a pseudo-count is simple and widely used, as demonstrated in this paper, it is not ideal. On the other hand, methods that model excess zeros using a probability model often make an implicit assumption that all zeros can be explained by a common probability models. As described in this article, this is not always recommended as there are potentially three types/sources of zeros in a microbiome data. The purpose of this paper is to develop a simple methodology to identify and accomodate three different types of zeros and to test hypotheses regarding the relative abundance of taxa in two or more experimental groups. Another major contribution of this paper is to perform constrained (directional or ordered inference when there are more than two ordered experimental groups (e.g., subjects ordered by diet or age groups or environmental exposure groups. As far as we know this is the first paper that addresses such problems in the analysis of microbiome data.Results: Using extensive simulation studies, we demonstrate that the proposed methodology not only controls the false discovery rate at a desired level of significance while competing well in terms of power with DESeq2, a popular procedure derived from RNASeq literature. As expected, the method using pseudo-counts tends to be very conservative and the classical t-test that ignores the underlying simplex structure in the data has an inflated FDR.

  1. First excess levels of vector processes

    Directory of Open Access Journals (Sweden)

    Jewgeni H. Dshalalow

    1994-01-01

    Full Text Available This paper analyzes the behavior of a point process marked by a two-dimensional renewal process with dependent components about some fixed (two-dimensional level. The compound process evolves until one of its marks hits (i.e. reaches or exceeds its associated level for the first time. The author targets a joint transformation of the first excess level, first passage time, and the index of the point process which labels the first passage time. The cases when both marks are either discrete or continuous or mixed are treated. For each of them, an explicit and compact formula is derived. Various applications to stochastic models are discussed.

  2. Excessive or unwanted hair in women

    Science.gov (United States)

    ... Most of the time, hirsutism does not cause health problems. But many women find it bothersome or embarrassing. When to Contact a Medical Professional Call your health care provider if: The hair ...

  3. A case-control study on excessive daytime sleepiness in chronic migraine.

    Science.gov (United States)

    Barbanti, Piero; Aurilia, Cinzia; Egeo, Gabriella; Fofi, Luisa; Vanacore, Nicola

    2013-03-01

    Excessive daytime sleepiness is a major clinical and health concern that can have varied and sometimes harmful consequences. Findings from uncontrolled studies suggest a high prevalence in patients with chronic migraine. In a case-control study, we compared frequency data for excessive daytime sleepiness in 100 patients with chronic migraine and 100 healthy controls paired for sex and age, and assessed risk factors including lifestyle, sleep quality, anxiety, depression, concomitant disease and medications. The frequency of excessive daytime sleepiness was higher in migraineurs (especially in those with medication overuse) than in controls (20% versus 6%; odds ratio 3.92, 95% CI 1.5-10.22), but was lower than previously reported and correlated with poor quality sleep and anxiolytic and antidepressant use. Again confirming that disability in chronic migraine is multifactorial in origin, excessive daytime sleepiness, especially in migraineurs who overuse medications, adds to the multiple factors known to impair social and working function. Patients with chronic migraine might benefit from diagnostic interviews focussing also on sleep problems and from targeted psychoactive drug prescribing. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. [Disability attributable to excess weight in Spain].

    Science.gov (United States)

    Martín-Ramiro, José Javier; Alvarez-Martín, Elena; Gil-Prieto, Ruth

    2014-08-19

    To estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006. Excess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD). In 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37%. Excess body weight is a health risk related to the development of various diseases with an important associated disability burden and social and economical cost. YLD analysis is a useful monitor tool for disease control interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  5. Nonintrusive verification attributes for excess fissile materials

    Energy Technology Data Exchange (ETDEWEB)

    Nicholas, N.J.; Eccleston, G.W.; Fearey, B.L. [and others

    1997-10-01

    Under US initiatives, over two hundred metric tons of fissile materials have been declared to be excess to national defense needs. These excess materials are in both classified and unclassified forms. The US has expressed the intent to place these materials under international inspections as soon as practicable. To support these commitments, members of the US technical community are examining a variety of nonintrusive approaches (i.e., those that would not reveal classified or sensitive information) for verification of a range of potential declarations for these classified and unclassified materials. The most troublesome and potentially difficult issues involve approaches for international inspection of classified materials. The primary focus of the work to date has been on the measurement of signatures of relevant materials attributes (e.g., element, identification number, isotopic ratios, etc.), especially those related to classified materials and items. The authors are examining potential attributes and related measurement technologies in the context of possible verification approaches. The paper will discuss the current status of these activities, including their development, assessment, and benchmarking status.

  6. Metabolic acclimation to excess light intensity in Chlamydomonas reinhardtii.

    Science.gov (United States)

    Davis, Maria C; Fiehn, Oliver; Durnford, Dion G

    2013-07-01

    There are several well-described acclimation responses to excess light in green algae but the effect on metabolism has not been thoroughly investigated. This study examines the metabolic changes during photoacclimation to high-light (HL) stress in Chlamydomonas reinhardtii using nuclear magnetic resonance and mass spectrometry. Using principal component analysis, a clear metabolic response to HL intensity was observed on global metabolite pools, with major changes in the levels of amino acids and related nitrogen metabolites. Amino acid pools increased during short-term photoacclimation, but were especially prominent in HL-acclimated cultures. Unexpectedly, we observed an increase in mitochondrial metabolism through downstream photorespiratory pathways. The expression of two genes encoding key enzymes in the photorespiratory pathway, glycolate dehydrogenase and malate synthase, were highly responsive to the HL stress. We propose that this pathway contributes to metabolite pools involved in nitrogen assimilation and may play a direct role in photoacclimation. Our results suggest that primary and secondary metabolism is highly pliable and plays a critical role in coping with the energetic imbalance during HL exposure and a necessary adjustment to support an increased growth rate that is an effective energy sink for the excess reducing power generated during HL stress. © 2013 John Wiley & Sons Ltd.

  7. Efficacy and efficiency of psychological, psychiatric, sociomedical and complementary medical interventions for excessive crying in primary care services (“Schreiambulanzen” [Effektivität und Effizienz von psychologischen, psychiatrischen, sozialmedizinischen und komplementärmedizinischen Interventionen bei Schreibabys (z. B. regulative Störung in Schreiambulanzen

    Directory of Open Access Journals (Sweden)

    Korczak, Dieter

    2013-04-01

    Full Text Available [english] There are different approaches to reduce excessive crying of babies. Studies prove positive effects of single measures, e. g. certain diets, acupuncture or psychological approaches improve the crying behaviour. No evaluation data support the effectiveness of the examined crying ambulances.[german] Es gibt verschiedene Ansätze, die exzessives Schreien bei Kindern verringern sollen. Für einzelne Maßnahmen jedoch belegen Studien positive Effekte: so können bestimmte Ernährungsveränderungen, Akupunktur oder psychologische Ansätze das Schreiverhalten verbessern. Zu den betrachteten Schreiambulanzen finden sich keine Studiendaten, die deren Wirksamkeit nachweisen.

  8. Molecular simulation of excess isotherm and excess enthalpy change in gas-phase adsorption.

    Science.gov (United States)

    Do, D D; Do, H D; Nicholson, D

    2009-01-29

    We present a new approach to calculating excess isotherm and differential enthalpy of adsorption on surfaces or in confined spaces by the Monte Carlo molecular simulation method. The approach is very general and, most importantly, is unambiguous in its application to any configuration of solid structure (crystalline, graphite layer or disordered porous glass), to any type of fluid (simple or complex molecule), and to any operating conditions (subcritical or supercritical). The behavior of the adsorbed phase is studied using the partial molar energy of the simulation box. However, to characterize adsorption for comparison with experimental data, the isotherm is best described by the excess amount, and the enthalpy of adsorption is defined as the change in the total enthalpy of the simulation box with the change in the excess amount, keeping the total number (gas + adsorbed phases) constant. The excess quantities (capacity and energy) require a choice of a reference gaseous phase, which is defined as the adsorptive gas phase occupying the accessible volume and having a density equal to the bulk gas density. The accessible volume is defined as the mean volume space accessible to the center of mass of the adsorbate under consideration. With this choice, the excess isotherm passes through a maximum but always remains positive. This is in stark contrast to the literature where helium void volume is used (which is always greater than the accessible volume) and the resulting excess can be negative. Our definition of enthalpy change is equivalent to the difference between the partial molar enthalpy of the gas phase and the partial molar enthalpy of the adsorbed phase. There is no need to assume ideal gas or negligible molar volume of the adsorbed phase as is traditionally done in the literature. We illustrate this new approach with adsorption of argon, nitrogen, and carbon dioxide under subcritical and supercritical conditions.

  9. Minimal Composite Dynamics versus Axion Origin of the Diphoton excess

    DEFF Research Database (Denmark)

    Molinaro, Emiliano; Sannino, Francesco; Vignaroli, Natascia

    2016-01-01

    ATLAS and CMS observe deviations from the expected background in the diphoton invariant mass searches of new resonances around 750 GeV. We show that a simple realization in terms of a new pseudoscalar state can accommodate the observations. The model leads to further footprints that can be soon o...... that it is possible to directly test and constrain composite dynamics via processes stemming from its distinctive topological sector....... observed. The new state can be interpreted both as an axion or as a {highly natural} composite state arising from minimal models of dynamical electroweak symmetry breaking. We further show how to disentangle the two scenarios. Beyond the possible explanation of the diphoton excess the results show...

  10. Variables associated with seeking information from doctors and the internet after exposure to direct-to-consumer advertisements for prescription medications.

    Science.gov (United States)

    Fogel, Joshua; Teichman, Chaim

    2014-01-01

    This study examines variables associated with seeking information from doctors, the Internet, and a combination of both doctors and Internet after exposure to direct-to-consumer advertisements. Data were analyzed from 462 college students. Younger age, women, and health insurance were associated with greater odds for doctor; women, subjective norms, intentions, and greater time since seen doctor were associated with greater odds for Internet; and African American, Hispanic, subjective norms, intentions, and health insurance were associated with greater odds for both doctor and Internet. Marketers of direct-to-consumer advertisements can use these findings for tailoring and targeting direct-to-consumer advertisements.

  11. Excessive anticoagulation with warfarin or phenprocoumon may have multiple causes

    DEFF Research Database (Denmark)

    Meegaard, Peter Martin; Holck, Line H V; Pottegård, Anton

    2012-01-01

    Excessive anticoagulation with vitamin K antagonists is a serious condition with a substantial risk of an adverse outcome. We thus found it of interest to review a large case series to characterize the underlying causes of excessive anticoagulation....

  12. Modeling excessive nutrient loading in the environment.

    Science.gov (United States)

    Reckhow, K H; Chapra, S C

    1999-01-01

    Models addressing excessive nutrient loading in the environment originated over 50 years ago with the simple nutrient concentration thresholds proposed by Sawyer (1947. Fertilization of lakes by agricultural and urban drainage. New Engl. Water Works Assoc. 61, 109-127). Since then, models have improved due to progress in modeling techniques and technology as well as enhancements in scientific knowledge. Several of these advances are examined here. Among the recent approaches in modeling techniques we review are error propagation, model confirmation, generalized sensitivity analysis, and Bayesian analysis. In the scientific arena and process characterization, we focus on advances in surface water modeling, discussing enhanced modeling of organic carbon, improved hydrodynamics, and refined characterization of sediment diagenesis. We conclude with some observations on future needs and anticipated developments.

  13. Managing a patient with excessive belching.

    Science.gov (United States)

    Disney, Benjamin; Trudgill, Nigel

    2014-04-01

    A 50-year-old man with end-stage renal failure was referred by his general practitioner with dyspeptic symptoms. On further questioning the patient complained of a 10-year history of frequent belching. This was noticeably worse after meals and during times of stress. He did not have nocturnal belching and episodes of belching were less frequent when the patient was talking or distracted. There was no history of gastro-oesophageal reflux, vomiting, dysphagia, loss of appetite or weight loss. He was diagnosed with excessive, probably supragastric, belching. Further investigation was not deemed necessary. His symptoms have since settled with simple reassurance and explanation of their origin provided during the clinic visit.

  14. Production of ethanol from excess ethylene

    DEFF Research Database (Denmark)

    Kadhim, Adam S.; Carlsen, Kim B.; Bisgaard, Thomas

    2012-01-01

    Ethyl alcohol is one of the most important and used chemicals. Two common routes exist for the production: synthetic route typically based on petroleum feedstock and a fermentation route. The fermentation route comprises the majority of the produced ethyl alcohol. In this work, however, we...... alcohol (azeotropic mixture) is produced from excess ethylene containing propylene and methane as impurities. The design work is based on a systematic approach consisting of 12 tasks performed in a specified hierarchy. According to this 12-tasks design procedure, information about the product and process...... is obtained in tasks 1-2. A preliminary process flowsheet is obtained in task 3 using a modified Douglas hierarchical process synthesis method. The next tasks involves making design decisions and then further refining them in tasks 4-7 related to separation factors, reactor operating conditions, product...

  15. Excessive Fragmentary Myoclonus: What Do We Know?

    Directory of Open Access Journals (Sweden)

    Jiří Nepožitek

    2017-03-01

    Full Text Available Excessive fragmentary myoclonus (EFM is a polysomnographic finding registered by the surface electromyography (EMG and characterized as a result of the muscle activity consisting of sudden, isolated, arrhythmic, asynchronous and asymmetric brief twitches. The EMG potentials are defined by the exact criteria in The International Classification of the Sleep Disorders, 3rd edition and they appear with high intensity in all sleep stages. Clinical significance of EFM is unclear. It was observed in combination with other diseases and features such as obstructive and central sleep apnea, narcolepsy, periodic limb movements, insomnia, neurodegenerative disorders and peripheral nerve dysfunction. Relation to such wide range of diseases supports the opinion that EFM is nor a specific sleep disorder nor a specific polysomnographic sign. The option that EFM is a normal variant has also not been ruled out so far.

  16. Desaturation of excess intramyocellular triacylglycerol in obesity

    DEFF Research Database (Denmark)

    Haugaard, S B; Madsbad, S; Mu, Huiling

    2010-01-01

    OBJECTIVE: Excess intramyocellular triacylglycerol (IMTG), found especially in obese women, is slowly metabolized and, therefore, prone to longer exposure to intracellular desaturases. Accordingly, it was hypothesized that IMTG content correlates inversely with IMTG fatty acid (FA) saturation...... in sedentary subjects. In addition, it was validated if IMTG palmitic acid is associated with insulin resistance as suggested earlier. DESIGN: Cross-sectional human study. SUBJECTS: In skeletal muscle biopsies, which were obtained from sedentary subjects (34 women, age 48+/-2 years (27 obese including 7 type 2...... diabetes (T2DM), body mass index (BMI)=35.5+/-0.8 kg m(-2)) and 25 men, age 49+/-2 years (20 obese including 6 T2DM, BMI=35.8+/-0.8 kg m(-2))), IMTG FA composition was determined by gas-liquid chromatography after separation from phospholipids by thin-layer chromatography. RESULTS: Independently of gender...

  17. Excess plutonium disposition using ALWR technology

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, A. (ed.); Buckner, M.R.; Radder, J.A.; Angelos, J.G.; Inhaber, H.

    1993-02-01

    The Office of Nuclear Energy of the Department of Energy chartered the Plutonium Disposition Task Force in August 1992. The Task Force was created to assess the range of practicable means of disposition of excess weapons-grade plutonium. Within the Task Force, working groups were formed to consider: (1) storage, (2) disposal,and(3) fission options for this disposition,and a separate group to evaluate nonproliferation concerns of each of the alternatives. As a member of the Fission Working Group, the Savannah River Technology Center acted as a sponsor for light water reactor (LWR) technology. The information contained in this report details the submittal that was made to the Fission Working Group of the technical assessment of LWR technology for plutonium disposition. The following aspects were considered: (1) proliferation issues, (2) technical feasibility, (3) technical availability, (4) economics, (5) regulatory issues, and (6) political acceptance.

  18. Invisible excess of sense in social interaction.

    Science.gov (United States)

    Koubová, Alice

    2014-01-01

    The question of visibility and invisibility in social understanding is examined here. First, the phenomenological account of expressive phenomena and key ideas of the participatory sense-making theory are presented with regard to the issue of visibility. These accounts plead for the principal visibility of agents in interaction. Although participatory sense-making does not completely rule out the existence of opacity and invisible aspects of agents in interaction, it assumes the capacity of agents to integrate disruptions, opacity and misunderstandings in mutual modulation. Invisibility is classified as the dialectical counterpart of visibility, i.e., as a lack of sense whereby the dynamics of perpetual asking, of coping with each other and of improvements in interpretation are brought into play. By means of empirical exemplification this article aims at demonstrating aspects of invisibility in social interaction which complement the enactive interpretation. Without falling back into Cartesianism, it shows through dramaturgical analysis of a practice called "(Inter)acting with the inner partner" that social interaction includes elements of opacity and invisibility whose role is performative. This means that opacity is neither an obstacle to be overcome with more precise understanding nor a lack of meaning, but rather an excess of sense, a "hiddenness" of something real that has an "active power" (Merleau-Ponty). In this way it contributes to on-going social understanding as a hidden potentiality that naturally enriches, amplifies and in part constitutes human participation in social interactions. It is also shown here that this invisible excess of sense already functions on the level of self-relationship due to the essential self-opacity and self-alterity of each agent of social interaction. The analysis consequently raises two issues: the question of the enactive ethical stance toward the alterity of the other and the question of the autonomy of the self

  19. Invisible excess of sense in social interaction.

    Directory of Open Access Journals (Sweden)

    Alice eKoubová

    2014-09-01

    Full Text Available The question of visibility and invisibility in social understanding is examined here. First, the phenomenological account of expressive phenomena and key ideas of the participatory sense-making theory are presented with regard to the issue of visibility. These accounts plead for the principal visibility of agents in interaction. Although participatory sense-making does not completely rule out the existence of opacity and invisible aspects of agents in interaction, it assumes the capacity of agents to integrate disruptions, opacity and misunderstandings in mutual modulation. Invisibility is classified as the dialectical counterpart of visibility, i.e. as a lack of sense whereby the dynamics of perpetual asking, of coping with each other and of improvements in interpretation are brought into play. By means of empirical exemplification this article aims at demonstrating aspects of invisibility in social interaction which complement the enactive interpretation. Without falling back into Cartesianism, it shows through dramaturgical analysis of a practice called ‘(Interacting with the inner partner’ that social interaction includes elements of opacity and invisibility whose role is performative. This means that opacity is neither an obstacle to be overcome with more precise understanding nor a lack of meaning, but rather an excess of sense, a hiddenness of something real that has an active power (Merleau-Ponty. In this way it contributes to on-going social understanding as a hidden potentiality that naturally enriches, amplifies and in part constitutes human participation in social interactions. It is also shown here that this invisible excess of sense already functions on the level of self-relationship due to the essential self-opacity and self-alterity of each agent of social interaction. The analysis consequently raises two issues: the question of the enactive ethical stance towards the alterity of the other and the question of the autonomy of

  20. The lifetime of excess atmospheric carbon dioxide

    Science.gov (United States)

    Moore, Berrien; Braswell, B. H.

    1994-03-01

    We explore the effects of a changing terrestrial biosphere on the atmospheric residence time of CO2 using three simple ocean carbon cycle models and a model of global terrestrial carbon cycling. We find differences in model behavior associated with the assumption of an active terrestrial biosphere (forest regrowth) and significant differences if we assume a donor-dependent flux from the atmosphere to the terrestrial component (e.g., a hypothetical terrestrial fertilization flux). To avoid numerical difficulties associated with treating the atmospheric CO2 decay (relaxation) curve as being well approximated by a weighted sum of exponential functions, we define the single half-life as the time it takes for a model atmosphere to relax from its present-day value half way to its equilibrium pCO2 value. This scenario-based approach also avoids the use of unit pulse (Dirac Delta) functions which can prove troublesome or unrealistic in the context of a terrestrial fertilization assumption. We also discuss some of the numerical problems associated with a conventional lifetime calculation which is based on an exponential model. We connect our analysis of the residence time of CO2 and the concept of single half-life to the residence time calculations which are based on using weighted sums of exponentials. We note that the single half-life concept focuses upon the early decline of CO2 under a cutoff/decay scenario. If one assumes a terrestrial biosphere with a fertilization flux, then our best estimate is that the single half-life for excess CO2 lies within the range of 19 to 49 years, with a reasonable average being 31 years. If we assume only regrowth, then the average value for the single half-life for excess CO2 increases to 72 years, and if we remove the terrestrial component completely, then it increases further to 92 years.

  1. Direct ELISA.

    Science.gov (United States)

    Lin, Alice V

    2015-01-01

    First described by Engvall and Perlmann, the enzyme-linked immunosorbent assay (ELISA) is a rapid and sensitive method for detection and quantitation of an antigen using an enzyme-labeled antibody. Besides routine laboratory usage, ELISA has been utilized in medical field and food industry as diagnostic and quality control tools. Traditionally performed in 96-well or 384-well polystyrene plates, the technology has expanded to other platforms with increase in automation. Depending on the antigen epitope and availability of specific antibody, there are variations in ELISA setup. The four basic formats are direct, indirect, sandwich, and competitive ELISAs. Direct ELISA is the simplest format requiring an antigen and an enzyme-conjugated antibody specific to the antigen. This chapter describes the individual steps for detection of a plate-bound antigen using a horseradish peroxidase (HRP)-conjugated antibody and luminol-based enhanced chemiluminescence (ECL) substrate. The methodological approach to optimize the assay by chessboard titration is also provided.

  2. Bayesian time-series analysis of a repeated-measures poisson outcome with excess zeroes.

    Science.gov (United States)

    Murphy, Terrence E; Van Ness, Peter H; Araujo, Katy L B; Pisani, Margaret A

    2011-12-01

    In this article, the authors demonstrate a time-series analysis based on a hierarchical Bayesian model of a Poisson outcome with an excessive number of zeroes. The motivating example for this analysis comes from the intensive care unit (ICU) of an urban university teaching hospital (New Haven, Connecticut, 2002-2004). Studies of medication use among older patients in the ICU are complicated by statistical factors such as an excessive number of zero doses, periodicity, and within-person autocorrelation. Whereas time-series techniques adjust for autocorrelation and periodicity in outcome measurements, Bayesian analysis provides greater precision for small samples and the flexibility to conduct posterior predictive simulations. By applying elements of time-series analysis within both frequentist and Bayesian frameworks, the authors evaluate differences in shift-based dosing of medication in a medical ICU. From a small sample and with adjustment for excess zeroes, linear trend, autocorrelation, and clinical covariates, both frequentist and Bayesian models provide evidence of a significant association between a specific nursing shift and dosing level of a sedative medication. Furthermore, the posterior distributions from a Bayesian random-effects Poisson model permit posterior predictive simulations of related results that are potentially difficult to model.

  3. 32 CFR 644.385 - Record of excess classification.

    Science.gov (United States)

    2010-07-01

    ... PROPERTY REAL ESTATE HANDBOOK Disposal Predisposal Action § 644.385 Record of excess classification. The DE will establish a record on ENG Form 836A, Real Property Disposal Report, of the excess classification... 32 National Defense 4 2010-07-01 2010-07-01 true Record of excess classification. 644.385 Section...

  4. 46 CFR 154.546 - Excess flow valve: Closing flow.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Excess flow valve: Closing flow. 154.546 Section 154.546... and Process Piping Systems § 154.546 Excess flow valve: Closing flow. (a) The rated closing flow of vapor or liquid cargo for an excess flow valve must be specially approved by the Commandant (CG-522). (b...

  5. Excessive Testing and Pupils in the Public Schools

    Science.gov (United States)

    Ediger, Marlow

    2017-01-01

    This article explores the question of excessive testing in public schools, its value in the educational process, and the impact that excessive testing may have on the student and the family unit. While assessments are valuable when used properly, excessive testing may lead to problems with unforeseen consequences.

  6. Excess molar volumes, and refractive index of binary mixtures of ...

    African Journals Online (AJOL)

    Excess molar volumes (VE) viscosities and refractive index have been evaluated for binary mixtures of glycerol + water, and glycerol + methanol at 298.15 K and 303.15 K. Excess molar volumes (VE) have been calculated from density. The excess molar volume (VE) results were fitted to the Redlich and Kister type ...

  7. The effects of implementation of guideline-directed medical therapy on relief of angina in patients with stable coronary artery disease in Serbia

    Directory of Open Access Journals (Sweden)

    Ilić Ivan

    2016-01-01

    Full Text Available Introduction. Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD is poor. Objective. We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG, history of myocardial infarction (MI, positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results. Most patients were included based on abnormal ECG (48.4%. At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ± 1.29 to 4.63 ± 1.57 (p < 0.001. At the follow-up, the patients had significantly lower blood pressure (141 ± 19 / 85 ± 11 vs. 130 ± 12 / 80 ± 8 mmHg; p < 0.001 and most of them reported CCS class I (63.3%. The average weekly number of angina attacks was reduced from 2.82 ± 2.50 at Visit 1 to 1.72 0 ± 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ± 2.53 to 1.74 ± 1.47 tablets; p < 0.001 for all. Conclusion. Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina.

  8. Projections of temperature-related excess mortality under climate change scenarios.

    Science.gov (United States)

    Gasparrini, Antonio; Guo, Yuming; Sera, Francesco; Vicedo-Cabrera, Ana Maria; Huber, Veronika; Tong, Shilu; de Sousa Zanotti Stagliorio Coelho, Micheline; Nascimento Saldiva, Paulo Hilario; Lavigne, Eric; Matus Correa, Patricia; Valdes Ortega, Nicolas; Kan, Haidong; Osorio, Samuel; Kyselý, Jan; Urban, Aleš; Jaakkola, Jouni J K; Ryti, Niilo R I; Pascal, Mathilde; Goodman, Patrick G; Zeka, Ariana; Michelozzi, Paola; Scortichini, Matteo; Hashizume, Masahiro; Honda, Yasushi; Hurtado-Diaz, Magali; Cesar Cruz, Julio; Seposo, Xerxes; Kim, Ho; Tobias, Aurelio; Iñiguez, Carmen; Forsberg, Bertil; Åström, Daniel Oudin; Ragettli, Martina S; Guo, Yue Leon; Wu, Chang-Fu; Zanobetti, Antonella; Schwartz, Joel; Bell, Michelle L; Dang, Tran Ngoc; Van, Dung Do; Heaviside, Clare; Vardoulakis, Sotiris; Hajat, Shakoor; Haines, Andy; Armstrong, Ben

    2017-12-01

    Climate change can directly affect human health by varying exposure to non-optimal outdoor temperature. However, evidence on this direct impact at a global scale is limited, mainly due to issues in modelling and projecting complex and highly heterogeneous epidemiological relationships across different populations and climates. We collected observed daily time series of mean temperature and mortality counts for all causes or non-external causes only, in periods ranging from Jan 1, 1984, to Dec 31, 2015, from various locations across the globe through the Multi-Country Multi-City Collaborative Research Network. We estimated temperature-mortality relationships through a two-stage time series design. We generated current and future daily mean temperature series under four scenarios of climate change, determined by varying trajectories of greenhouse gas emissions, using five general circulation models. We projected excess mortality for cold and heat and their net change in 1990-2099 under each scenario of climate change, assuming no adaptation or population changes. Our dataset comprised 451 locations in 23 countries across nine regions of the world, including 85 879 895 deaths. Results indicate, on average, a net increase in temperature-related excess mortality under high-emission scenarios, although with important geographical differences. In temperate areas such as northern Europe, east Asia, and Australia, the less intense warming and large decrease in cold-related excess would induce a null or marginally negative net effect, with the net change in 2090-99 compared with 2010-19 ranging from -1·2% (empirical 95% CI -3·6 to 1·4) in Australia to -0·1% (-2·1 to 1·6) in east Asia under the highest emission scenario, although the decreasing trends would reverse during the course of the century. Conversely, warmer regions, such as the central and southern parts of America or Europe, and especially southeast Asia, would experience a sharp surge in heat

  9. Psychosocial risk factors for excessive gestational weight gain: A systematic review.

    Science.gov (United States)

    Hartley, Eliza; McPhie, Skye; Skouteris, Helen; Fuller-Tyszkiewicz, Matthew; Hill, Briony

    2015-12-01

    Excessive weight gain during pregnancy can have adverse health outcomes for mother and infant throughout pregnancy. However, few studies have identified the psychosocial factors that contribute to women gaining excessive weight during pregnancy. To review the existing literature that explores the impact of psychosocial risk factors (psychological distress, body image dissatisfaction, social support, self-efficacy and self-esteem) on excessive gestational weight gain. A systematic review of peer-reviewed English articles using Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, MEDLINE Complete, PsycINFO, Informit, Web of Science, and Scopus was conducted. Quantitative studies that investigated psychosocial factors of excessive GWG, published between 2000 and 2014 were included. Studies investigating mothers with a low risk of mental health issues and normally-developing foetuses were eligible for inclusion. From the total of 474 articles located, 12 articles were identified as relevant and were subsequently reviewed in full. Significant associations were found between depression, body image dissatisfaction, and social support with excessive gestational weight gain. No significant relationships were reported between anxiety, stress, self-efficacy, or self-esteem and excessive gestational weight gain. The relationship between psychosocial factors and weight gain in pregnancy is complex; however depression, body dissatisfaction and social support appear to have a direct relationship with excessive gestational weight gain. Further research is needed to identify how screening for, and responding to, psychosocial risk factors for excessive gestational weight gain can be successfully incorporated into current antenatal care. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  10. Medical treatment of male infertility

    OpenAIRE

    Ali A Dabaja; Schlegel, Peter N

    2014-01-01

    The majority of male infertility is idiopathic. However, there are multiple known causes of male infertility, and some of these causes can be treated medically with high success rates. In cases of idiopathic or genetic causes of male infertility, medical management is typically empirical; in most instances medical therapy represents off-label use that is not specifically approved by the FDA. Understanding the hypothalamic-pituitary-gonadal (HPG) axis and the effect of estrogen excess is criti...

  11. [Prevalence of hepatitis C virus and excessive consumption of alcohol in a nonhospital worker population].

    Science.gov (United States)

    Prieto Domingo, J J; Carrión Bolaños, J A; Bandrés Moya, F

    1997-12-01

    The aim of the study was to know the prevalence of the hepatitis C virus (HCV) in a non hospital work population by ELISA 3.0 and PCR-Amplicor, as well as its relationship with excessive alcohol intake (more than 280 g/week in men and 168 g/week in women). A transversal seroepidemiologic study was carried out in 1,109 workers of the Empresa Nacional de Electricidad, S.A. (ENDESA). During the annual medical examinations (April 1993-October 1994) the amount of alcoholic beverages each worker had consumed over the 7 days prior to the medical examination was obtained by anamnesis together with a blood sample for different laboratory tests. Sixteen percent of the workers had had excessive alcohol intake. The prevalence of anti HCV antibodies in the study population was 2.4% being up to 4.6% in the workers declaring excessive alcohol consumption and 10.4% if they also presented an elevation in any of the transaminases. The prevalence of the potentially ineffective workers was 1.46%. The prevalence of anti C antibodies by ELISA 3.0 was greater than expected (2.4%) significantly increasing in the population group which declared excessive alcohol intake, thereby demonstrating the relationship between alcohol and hepatitis C.

  12. Energy potential of the modified excess sludge

    Directory of Open Access Journals (Sweden)

    Zawieja Iwona

    2017-01-01

    Full Text Available On the basis of the SCOD value of excess sludge it is possible to estimate an amount of energy potentially obtained during the methane fermentation process. Based on a literature review, it has been estimated that from 1 kg of SCOD it is possible to obtain 3.48 kWh of energy. Taking into account the above methane and energy ratio (i.e. 10 kWh/1Nm3 CH4, it is possible to determine the volume of methane obtained from the tested sludge. Determination of potential energy of sludge is necessary for the use of biogas as a source of power generators as cogeneration and ensure the stability of this type of system. Therefore, the aim of the study was to determine the energy potential of excess sludge subjected to the thermal and chemical disintegration. In the case of thermal disintegration, test was conducted in the low temperature 80°C. The reagent used for the chemical modification was a peracetic acid, which in an aqueous medium having strong oxidizing properties. The time of chemical modification was 6 hours. Applied dose of the reagent was 1.0 ml CH3COOOH/L of sludge. By subjecting the sludge disintegration by the test methods achieved an increase in the SCOD value of modified sludge, indicating the improvement of biodegradability along with a concomitant increase in their energy potential. The obtained experimental production of biogas from disintegrated sludge confirmed that it is possible to estimate potential intensity of its production. The SCOD value of 2576 mg O2/L, in the case of chemical disintegration, was obtained for a dose of 1.0 ml CH3COOH/L. For this dose the pH value was equal 6.85. In the case of thermal disintegration maximum SCOD value was 2246 mg O2/L obtained at 80°C and the time of preparation 6 h. It was estimated that in case of thermal disintegration as well as for the chemical disintegration for selected parameters, the potential energy for model digester of active volume of 5L was, respectively, 0.193 and 0,118 kWh.

  13. Energy potential of the modified excess sludge

    Science.gov (United States)

    Zawieja, Iwona

    2017-11-01

    On the basis of the SCOD value of excess sludge it is possible to estimate an amount of energy potentially obtained during the methane fermentation process. Based on a literature review, it has been estimated that from 1 kg of SCOD it is possible to obtain 3.48 kWh of energy. Taking into account the above methane and energy ratio (i.e. 10 kWh/1Nm3 CH4), it is possible to determine the volume of methane obtained from the tested sludge. Determination of potential energy of sludge is necessary for the use of biogas as a source of power generators as cogeneration and ensure the stability of this type of system. Therefore, the aim of the study was to determine the energy potential of excess sludge subjected to the thermal and chemical disintegration. In the case of thermal disintegration, test was conducted in the low temperature 80°C. The reagent used for the chemical modification was a peracetic acid, which in an aqueous medium having strong oxidizing properties. The time of chemical modification was 6 hours. Applied dose of the reagent was 1.0 ml CH3COOOH/L of sludge. By subjecting the sludge disintegration by the test methods achieved an increase in the SCOD value of modified sludge, indicating the improvement of biodegradability along with a concomitant increase in their energy potential. The obtained experimental production of biogas from disintegrated sludge confirmed that it is possible to estimate potential intensity of its production. The SCOD value of 2576 mg O2/L, in the case of chemical disintegration, was obtained for a dose of 1.0 ml CH3COOH/L. For this dose the pH value was equal 6.85. In the case of thermal disintegration maximum SCOD value was 2246 mg O2/L obtained at 80°C and the time of preparation 6 h. It was estimated that in case of thermal disintegration as well as for the chemical disintegration for selected parameters, the potential energy for model digester of active volume of 5L was, respectively, 0.193 and 0,118 kWh.

  14. Symmetrical excessive pectus excavatum in children.

    Science.gov (United States)

    Balci, Akin Eraslan; Eren, Sevval; Ozyurtkan, Mehmet Oguzhan

    2013-12-01

    The indications for repair of pectus excavatum are controversial. We present our surgical results in children with severe pectus excavatum. 27 children aged 6-15-years were included in the study. Pulmonary function tests and chest measurements were performed pre- and postoperatively. Deformed cartilages were resected subperichondrially, and a Kirchner wire was used to support the chest cage; it was removed 5 days after the operation. Fourteen children with restricted pulmonary function were considered to have excessive pectus excavatum. 3 patients had asthma-like symptoms that resolved postoperatively. None suffered chest pain postoperatively. Postoperative hospital stay was 7.1 days. Only minor complications occurred postoperatively. The mean pectus severity index was 0.27 ± 0.2 preoperatively and 0.41 ± 0.1 postoperatively (p pectus severity index pectus severity index (r = 0.8). After 6 and 13 months, a minor decrease in pulmonary function was noted. Significant increases in right and left ventricular function occurred in cases of severe deformity. Surgery is recommended not only for cosmetic reasons but also to increase cardiorespiratory functional capacity and alleviate symptoms. Kirchner wires can be used safely.

  15. [Base excess. Parameter with exceptional clinical significance].

    Science.gov (United States)

    Schaffartzik, W

    2007-05-01

    The base excess of blood (BE) plays an important role in the description of the acid-base status of a patient and is gaining in clinical interest. Apart from the Quick test, the age, the injury severity score and the Glasgow coma scale, the BE is becoming more and more important to identify, e. g. the risk of mortality for patients with multiple injuries. According to Zander the BE is calculated using the pH, pCO(2), haemoglobin concentration and the oxygen saturation of haemoglobin (sO(2)). The use of sO(2 )allows the blood gas analyser to determine only one value of BE, independent of the type of blood sample analyzed: arterial, mixed venous or venous. The BE and measurement of the lactate concentration (cLac) play an important role in diagnosing critically ill patients. In general, the change in BE corresponds to the change in cLac. If DeltaBE is smaller than DeltacLac the reason could be therapy with HCO(3)(-) but also with infusion solutions containing lactate. Physician are very familiar with the term BE, therefore, knowledge about an alkalizing or acidifying effect of an infusion solution would be very helpful in the treatment of patients, especially critically ill patients. Unfortunately, at present the description of an infusion solution with respect to BE has not yet been accepted by the manufacturers.

  16. Light pollution: the possible consequences of excessive illumination on retina.

    Science.gov (United States)

    Contín, M A; Benedetto, M M; Quinteros-Quintana, M L; Guido, M E

    2016-02-01

    Light is the visible part of the electromagnetic radiation within a range of 380-780 nm; (400-700 on primates retina). In vertebrates, the retina is adapted to capturing light photons and transmitting this information to other structures in the central nervous system. In mammals, light acts directly on the retina to fulfill two important roles: (1) the visual function through rod and cone photoreceptor cells and (2) non-image forming tasks, such as the synchronization of circadian rhythms to a 24 h solar cycle, pineal melatonin suppression and pupil light reflexes. However, the excess of illumination may cause retinal degeneration or accelerate genetic retinal diseases. In the last century human society has increased its exposure to artificial illumination, producing changes in the Light/Dark cycle, as well as in light wavelengths and intensities. Although, the consequences of unnatural illumination or light pollution have been underestimated by modern society in its way of life, light pollution may have a strong impact on people's health. The effects of artificial light sources could have direct consequences on retinal health. Constant exposure to different wavelengths and intensities of light promoted by light pollution may produce retinal degeneration as a consequence of photoreceptor or retinal pigment epithelium cells death. In this review we summarize the different mechanisms of retinal damage related to the light exposure, which generates light pollution.

  17. Abortion - medical

    Science.gov (United States)

    ... womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman has ... Therapeutic medical abortion; Elective medical abortion; Induced abortion; Nonsurgical abortion

  18. Clinical and polysomnographic characteristics of excessive daytime sleepiness in children.

    Science.gov (United States)

    Lee, Jiwon; Na, Geonyoub; Joo, Eun Yeon; Lee, Munhyang; Lee, Jeehun

    2017-08-18

    This study aimed to delineate the clinical and polysomnography (PSG) characteristics of sleep disorders in children with excessive daytime sleepiness (EDS). Between February 2002 and June 2015, 622 pediatric patients with EDS were evaluated with overnight PSG and the Multiple Sleep Latency Test at the Samsung Medical Center. The medical records; questionnaire responses about depression, sleepiness, sleep habits; and sleep study data of 133 patients without obstructive sleep apnea (OSA) were reviewed retrospectively. The patients (63 girls, 70 boys) slept for an average of 7 h 30 min and 8 h 44 min on weekdays and weekends, respectively. The mean Epworth Sleepiness Scale score was 11.01 ± 4.09 and did not differ significantly among sleep disorders. Among the 102 patients who completed the depression questionnaire, 53 showed depressive feelings, which were moderate or severe in 39, with no significant differences among specific sleep disorders. Thirty-four patients exhibited normal PSG results. Seventeen of them were concluded as not having any sleep disorders, and the others as having delayed sleep phase disorder (DSPD). Narcolepsy (n = 78) was the most common disorder, followed by DSPD (n = 17) and idiopathic hypersomnia (n = 12). Pediatric patients with EDS had various sleep disorders and some did not have any sleep disorder despite EDS. More than half the patients with EDS showed depressive feelings affecting their daily lives. For pediatric patients with EDS, a systematic diagnostic approach including questionnaires for sleep habits and emotion and PSG is essential for accurate diagnosis and treatment.

  19. Excessive sleepiness is predictive of cognitive decline in the elderly.

    Science.gov (United States)

    Jaussent, Isabelle; Bouyer, Jean; Ancelin, Marie-Laure; Berr, Claudine; Foubert-Samier, Alexandra; Ritchie, Karen; Ohayon, Maurice M; Besset, Alain; Dauvilliers, Yves

    2012-09-01

    To examine the association of sleep complaints reported at baseline (insomnia complaints and excessive daytime sleepiness (EDS)) and medication, with cognitive decline in community-dwelling elderly. An 8-yr longitudinal study. The French Three-City Study. There were 4,894 patients without dementia recruited from 3 French cities and having a Mini-Mental Status Examination (MMSE) score ≥ 24 points at baseline. Questionnaires were used to evaluate insomnia complaints (poor sleep quality (SQ), difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA)), EDS, and sleep medication at baseline. Cognitive decline was defined as a 4-point reduction in MMSE score during follow-up at 2, 4, and 8 yr. Logistic regression models were adjusted for sociodemographic, behavioral, physical, and mental health variables, and apolipoprotein E genotype. EDS independently increased the risk of cognitive decline (odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.02-1.56), especially for those patients who also developed dementia during the follow-up period (OR = 1.39, 95% CI = 1.00-1.97). The number of insomnia complaints and DMS were negatively associated with MMSE cognitive decline (OR = 0.77, 95% CI = 0.60-0.98 for 3-4 complaints, OR = 0.81, 95% CI = 0.68-0.96, respectively). The 3 other components of insomnia (SQ, DIS, EMA) were not significantly associated with MMSE cognitive decline. Our results suggest that EDS may be associated independently with the risk of cognitive decline in the elderly population. Such results could have important public health implications because EDS may be an early marker and potentially reversible risk factor of cognitive decline and onset of dementia.

  20. Millisecond Pulsars and the Galactic Center Excess

    Science.gov (United States)

    Gonthier, Peter L.; Koh, Yew-Meng; Kust Harding, Alice; Ferrara, Elizabeth C.

    2017-08-01

    Various groups including the Fermi team have confirmed the spectrum of the gamma- ray excess in the Galactic Center (GCE). While some authors interpret the GCE as evidence for the annihilation of dark matter (DM), others have pointed out that the GCE spectrum is nearly identical to the average spectrum of Fermi millisecond pul- sars (MSP). Assuming the Galactic Center (GC) is populated by a yet unobserved source of MSPs that has similar properties to that of MSPs in the Galactic Disk (GD), we present results of a population synthesis of MSPs from the GC. We establish parameters of various models implemented in the simulation code by matching characteristics of 54 detected Fermi MSPs in the first point source catalog and 92 detected radio MSPs in a select group of thirteen radio surveys and targeting a birth rate of 45 MSPs per mega-year. As a check of our simulation, we find excellent agreement with the estimated numbers of MSPs in eight globular clusters. In order to reproduce the gamma-ray spectrum of the GCE, we need to populate the GC with 10,000 MSPs having a Navarro-Frenk-White distribution suggested by the halo density of DM. It may be possible for Fermi to detect some of these MSPs in the near future; the simulation also predicts that many GC MSPs have radio fluxes S1400above 10 �μJy observable by future pointed radio observations. We express our gratitude for the generous support of the National Science Foundation (RUI: AST-1009731), Fermi Guest Investigator Program and the NASA Astrophysics Theory and Fundamental Program (NNX09AQ71G).

  1. Factors influencing excessive daytime sleepiness in adolescents

    Directory of Open Access Journals (Sweden)

    Thiago de Souza Vilela

    2016-04-01

    Full Text Available Abstract Objective: Sleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents' bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. Methods: The cross-sectional study analyzed 531 adolescents aged 10–18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. Results: Sleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p < 0.001, and there was a positive correlation between age and sleep deficit (p < 0.001; r = 0.337. Logistic regression showed that older age (p = 0.002; PR: 1.21 [CI: 1.07–1.36] and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p = 0.02; PR: 1.16 [CI: 1.02–1.32] were risk factors for worse degree of sleepiness. Conclusions: Sleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.

  2. Implication of zinc excess on soil health.

    Science.gov (United States)

    Wyszkowska, Jadwiga; Boros-Lajszner, Edyta; Borowik, Agata; Baćmaga, Małgorzata; Kucharski, Jan; Tomkiel, Monika

    2016-01-01

    This study was undertaken to evaluate zinc's influence on the resistance of organotrophic bacteria, actinomyces, fungi, dehydrogenases, catalase and urease. The experiment was conducted in a greenhouse of the University of Warmia and Mazury (UWM) in Olsztyn, Poland. Plastic pots were filled with 3 kg of sandy loam with pHKCl - 7.0 each. The experimental variables were: zinc applied to soil at six doses: 100, 300, 600, 1,200, 2,400 and 4,800 mg of Zn(2+) kg(-1) in the form of ZnCl2 (zinc chloride), and species of plant: oat (Avena sativa L.) cv. Chwat and white mustard (Sinapis alba) cv. Rota. Soil without the addition of zinc served as the control. During the growing season, soil samples were subjected to microbiological analyses on experimental days 25 and 50 to determine the abundance of organotrophic bacteria, actinomyces and fungi, and the activity of dehydrogenases, catalase and urease, which provided a basis for determining the soil resistance index (RS). The physicochemical properties of soil were determined after harvest. The results of this study indicate that excessive concentrations of zinc have an adverse impact on microbial growth and the activity of soil enzymes. The resistance of organotrophic bacteria, actinomyces, fungi, dehydrogenases, catalase and urease decreased with an increase in the degree of soil contamination with zinc. Dehydrogenases were most sensitive and urease was least sensitive to soil contamination with zinc. Zinc also exerted an adverse influence on the physicochemical properties of soil and plant development. The growth of oat and white mustard plants was almost completely inhibited in response to the highest zinc doses of 2,400 and 4,800 mg Zn(2+) kg(-1).

  3. Excess crude protein for nongravid gilts.

    Science.gov (United States)

    Fox, M C; Watkins, K L; Craig, W M; Stewart, T B; Clawson, A J; Southern, L L

    1988-04-01

    Twenty-five nongravid crossbred gilts (avg initial wt, 126 kg) were placed on either a high (38%) or a low (13%) crude protein (CP) diet and fed either at the rate of 1.82 kg/d or had ad libitum access to feed. In addition, a fifth group was pair-fed the 13% CP diet to the average intake of the gilts fed high CP ad libitum. The experimental period lasted 30 d. Corn-soybean meal diets were used and CP levels were varied by altering the corn:soybean meal ratio. Gain and gain/feed were reduced (P less than .01) in gilts fed 1.82 kg/d compared with the gilts fed ad libitum or pair-fed gilts. Gain (P less than .03) and feed intake (P less than .01) of gilts with ad libitum access to the 13% CP diet were higher than those of gilts with ad libitum access to the 38% CP diet. Gain/feed was not different (P greater than .10) between the two groups, however. Rate of gain and feed efficiency of gilts pair-fed the 13% CP diet were similar (P greater than .10) to those of gilts with ad libitum access to the 38% CP diet. Plasma total free amino acids, NH3 and total protein were not (P greater than .10) affected by treatment. Plasma urea-N and urinary total N, urea-N and orotic acid were increased (P less than .01) in gilts fed the high CP diet regardless of feed intake level. However, urinary NH3 was higher (P less than .01) in gilts fed the low-protein diet. These results indicate that excess dietary CP for nongravid gilts decreases gain and feed intake and has no effect on efficiency of feed utilization, but it increases plasma urea-N and urinary total N, urea-N and orotic acid.

  4. Iron excess in recreational marathon runners.

    Science.gov (United States)

    Mettler, S; Zimmermann, M B

    2010-05-01

    Iron deficiency and anemia may impair athletic performance, and iron supplements are commonly consumed by athletes. However, iron overload should be avoided because of the possible long-term adverse health effects. We investigated the iron status of 170 male and female recreational runners participating in the Zürich marathon. Iron deficiency was defined either as a plasma ferritin (PF) concentration or =4.5 (functional iron deficiency). After excluding subjects with elevated C-reactive protein concentrations, iron overload was defined as PF >200 microg/l. Iron depletion was found in only 2 out of 127 men (1.6% of the male study population) and in 12 out of 43 (28.0%) women. Functional iron deficiency was found in 5 (3.9%) and 11 (25.5%) male and female athletes, respectively. Body iron stores, calculated from the sTfR/PF ratio, were significantly higher (Prunners. Median PF among males was 104 microg/l, and the upper limit of the PF distribution in males was 628 microg/l. Iron overload was found in 19 out of 127 (15.0%) men but only 2 out of 43 in women (4.7%). Gender (male sex), but not age, was a predictor of higher PF (Prunners but in runners had signs of iron overload. Although iron supplements are widely used by athletes in an effort to increase performance, our findings indicate excess body iron may be common in male recreational runners and suggest supplements should only be used if tests of iron status indicate deficiency.

  5. Consistency between the luminosity function of resolved millisecond pulsars and the galactic center excess

    Science.gov (United States)

    Ploeg, Harrison; Gordon, Chris; Crocker, Roland; Macias, Oscar

    2017-08-01

    Fermi Large Area Telescope data reveal an excess of GeV gamma rays from the direction of the Galactic Center and bulge. Several explanations have been proposed for this excess including an unresolved population of millisecond pulsars (MSPs) and self-annihilating dark matter. It has been claimed that a key discriminant for or against the MSP explanation can be extracted from the properties of the luminosity function describing this source population. Specifically, is the luminosity function of the putative MSPs in the Galactic Center consistent with that characterizing the resolved MSPs in the Galactic disk? To investigate this we have used a Bayesian Markov Chain Monte Carlo to evaluate the posterior distribution of the parameters of the MSP luminosity function describing both resolved MSPs and the Galactic Center excess. At variance with some other claims, our analysis reveals that, within current uncertainties, both data sets can be well fit with the same luminosity function.

  6. Association between maternal depressive symptoms with child malnutrition or child excess weight

    Directory of Open Access Journals (Sweden)

    Thais Feres Moreira Lima

    Full Text Available Abstract Objectives: to verify associations between maternal depressive symptoms with child malnutrition or child excess weight. Methods: prospective study with data from the BRISA prenatal cohort in São Luís, Brazil, obtained from the 22nd to the 25th week of gestation (in 2009 and 2010 and, later, when children were aged 12 to 32 months (in 2010 and 2012. Maternal depressive symptoms were identified using the Center for Epidemiologic Studies Depression Scale (CES-D and the Edinburgh Postnatal Depression Scale (EPDS. For the excess weight evaluation, BMI z-score for age > +2 was used. For measuring child malnutrition, height z-score for age < -2 was used. The confounding factors were identified using a directed acyclic graph in DAGitty software. Results: we did not find associations between maternal depressive symptoms with child malnutrition or child excess weight. The prevalence of maternal depressive symptoms was 27.6% during gestation and 19.8% in the second or third year of the child's life. The malnutrition rate was 6% and the excess weight rate was 10.9%. Conclusions: no associations between maternal depressive symptoms in prenatal or in the second or third year of the child's life and child malnutrition or excess weight were detected.

  7. Phospholipids as Biomarkers for Excessive Alcohol Use

    Science.gov (United States)

    2015-10-01

    protein enhances hepatic insulin sensitivity by direct activation of the mTORC2-Akt signaling. Diabetes . 2015 Apr;64(4):1211-23. doi: 10.2337/db14-0539...cardiomyopathy: review of pathophysiology and treatment. Hepatol Int. 2014 Jul;8(3):308-15. doi: 10.1007/s12072- 014-9531-y. PubMed PMID: 25221635; PubMed

  8. A real-time assessment of factors influencing medication events.

    Science.gov (United States)

    Dollarhide, Adrian W; Rutledge, Thomas; Weinger, Matthew B; Fisher, Erin Stucky; Jain, Sonia; Wolfson, Tanya; Dresselhaus, Timothy R

    2014-01-01

    Reducing medical error is critical to improving the safety and quality of healthcare. Physician stress, fatigue, and excessive workload are performance-shaping factors (PSFs) that may influence medical events (actual administration errors and near misses), but direct relationships between these factors and patient safety have not been clearly defined. This study assessed the real-time influence of emotional stress, workload, and sleep deprivation on self-reported medication events by physicians in academic hospitals. During an 18-month study period, 185 physician participants working at four university-affiliated teaching hospitals reported medication events using a confidential reporting application on handheld computers. Emotional stress scores, perceived workload, patient case volume, clinical experience, total sleep, and demographic variables were also captured via the handheld computers. Medication event reports (n = 11) were then correlated with these demographic and PSFs. Medication events were associated with 36.1% higher perceived workload (p stress scores (p effect of factors influencing medication events, and support attention to both provider and hospital environmental characteristics for improving patient safety. © 2013 National Association for Healthcare Quality.

  9. Excess Demand and Cost Relationships Among Kentucky Nursing Homes

    OpenAIRE

    Davis, Mark A.; Freeman, James W.

    1994-01-01

    This article examines the influence of excess demand on nursing home costs. Previous work indicates that excess demand, reflected in a pervasive shortage of nursing home beds, constrains market competition and patient care expenditures. According to this view, nursing homes located in under-bedded markets can reduce costs and quality with impunity because there is no pressure to compete for residents. Predictions based on the excess demand argument were tested using 1989 data from a sample of...

  10. Excess morbidity and mortality in patients with craniopharyngioma: a hospital-based retrospective cohort study.

    Science.gov (United States)

    Wijnen, Mark; Olsson, Daniel S; van den Heuvel-Eibrink, Marry M; Hammarstrand, Casper; Janssen, Joseph A M J L; van der Lely, Aart J; Johannsson, Gudmundur; Neggers, Sebastian J C M M

    2018-01-01

    Most studies in patients with craniopharyngioma did not investigate morbidity and mortality relative to the general population nor evaluated risk factors for excess morbidity and mortality. Therefore, the objective of this study was to examine excess morbidity and mortality, as well as their determinants in patients with craniopharyngioma. Hospital-based retrospective cohort study conducted between 1987 and 2014. We included 144 Dutch and 80 Swedish patients with craniopharyngioma identified by a computer-based search in the medical records (105 females (47%), 112 patients with childhood-onset craniopharyngioma (50%), 3153 person-years of follow-up). Excess morbidity and mortality were analysed using standardized incidence and mortality ratios (SIRs and SMRs). Risk factors were evaluated univariably by comparing SIRs and SMRs between non-overlapping subgroups. Patients with craniopharyngioma experienced excess morbidity due to type 2 diabetes mellitus (T2DM) (SIR: 4.4, 95% confidence interval (CI): 2.8-6.8) and cerebral infarction (SIR: 4.9, 95% CI: 3.1-8.0) compared to the general population. Risks for malignant neoplasms, myocardial infarctions and fractures were not increased. Patients with craniopharyngioma also had excessive total mortality (SMR: 2.7, 95% CI: 2.0-3.8), and mortality due to circulatory (SMR: 2.3, 95% CI: 1.1-4.5) and respiratory (SMR: 6.0, 95% CI: 2.5-14.5) diseases. Female sex, childhood-onset craniopharyngioma, hydrocephalus and tumour recurrence were identified as risk factors for excess T2DM, cerebral infarction and total mortality. Patients with craniopharyngioma are at an increased risk for T2DM, cerebral infarction, total mortality and mortality due to circulatory and respiratory diseases. Female sex, childhood-onset craniopharyngioma, hydrocephalus and tumour recurrence are important risk factors. © 2018 European Society of Endocrinology.

  11. Reference limits of plasma and serum creatinine concentrations from intra-laboratory data bases of several German and Italian medical centres: Comparison between direct and indirect procedures.

    Science.gov (United States)

    Arzideh, Farhad; Wosniok, Werner; Haeckel, Rainer

    2010-02-01

    The current dogma of establishing intra-laboratory reference limits (RLs) and their periodical reviewing cannot be fulfilled by most laboratories due to the expenses involved. Thus, most laboratories adopt external sources for their RLs often neglecting the problems of transferability. Therefore, several attempts were undertaken to derive RLs from the large data pools stored in modern laboratory information systems. These attempts were further developed to a more sophisticated indirect procedure. The new model can be considered a combined approach because it pre-excludes some subjects by direct criteria. In the current study, the new concept was applied to estimate RLs for serum and plasma creatinine from several German and Italian laboratories. A smoothed kernel density function was estimated for the distribution of the total mixed data of the sample group (combined data of non-diseased and diseased subjects). It was assumed that the "central" part of the distribution of all data represents the non-diseased ("healthy") population. The central part was defined by truncation points using an optimisation method, and was used to estimate a Gaussian distribution of the values of presumably non-diseased subjects after Box-Cox transformation of the empirical data. This distribution was now considered as the distribution of the non-diseased subgroup. The percentiles of this parametrical distribution were calculated to obtain RLs. RLs determined by the indirect combined decomposition technique led to similar RLs as the classical direct method. Furthermore, the RLs obtained from 14 laboratories in 2 different European regions reflected the well-known differences of various analytical procedures. Stratification for gender and age was necessary. With rising age, an increase of the upper RL and of the reference range was observed. Hospitalization appeared also to affect the RLs. The new approach led to RLs in an artificially mixed population of diseased and non

  12. The Direct Cost of Managing a Rare Disease: Assessing Medical and Pharmacy Costs Associated with Duchenne Muscular Dystrophy in the United States.

    Science.gov (United States)

    Thayer, Sarah; Bell, Christopher; McDonald, Craig M

    2017-06-01

    A Duchenne muscular dystrophy (DMD) cohort was identified using a claims-based algorithm to estimate health care utilization and costs for commercially insured DMD patients in the United States. Previous analyses have used broad diagnosis codes that include a range of muscular dystrophy types as a proxy to estimate the burden of DMD. To estimate DMD-associated resource utilization and costs in a sample of patients identified via a claims-based algorithm using diagnosis codes, pharmacy prescriptions, and procedure codes unique to DMD management based on DMD clinical milestones. DMD patients were selected from a commercially insured claims database (2000-2009). Patients with claims suggestive of a non-DMD diagnosis or who were aged 30 years or older were excluded. Each DMD patient was matched by age, gender, and region to controls without DMD in a 1:10 ratio (DMD patients n = 75; controls n = 750). All-cause health care resource utilization, including emergency department, inpatient, outpatient, and physician office visits, and all-cause health care costs were examined over a minimum 1-year period. Costs were computed as total health-plan and patient-paid amounts of adjudicated medical claims (in annualized U.S. dollars). The average age of the DMD cohort was 13 years. Patients in the DMD cohort had a 10-fold increase in health care costs compared with controls ($23,005 vs. $2,277, P Therapeutics, Biomarin, and Catabasis on clinical trials regarding Duchenne muscular dystrophy clinical trial design, endpoint selection, and data analysis; Mitobridge for drug development; and Eli Lilly as part of a steering committee for clinical trials. Study concept and design were contributed primarily by Bell, along with Thayer and McDonald. Thayer collected the data, and data interpretation was performed by Thayer and Bell, along with McDonald. The manuscript was written by Thayer and Bell, along with McDonald, and revised by all the authors.

  13. Dis-appearance and dys-appearance anew: living with excess skin and intestinal changes following weight loss surgery.

    Science.gov (United States)

    Groven, Karen Synne; Råheim, Målfrid; Engelsrud, Gunn

    2013-08-01

    The aim of this article is to explore bodily changes following weight loss surgery. Our empirical material is based on individual interviews with 22 Norwegian women. To further analyze their experiences, we build primarily on the phenomenologist Drew Leder`s distinction between bodily dis-appearance and dys-appearance. Additionally, our analysis is inspired by Simone de Beauvoir, Merleau-Ponty and Julia Kristeva. Although these scholars have not directed their attention to obesity operations, they occupy a prime framework for shedding light on different dimensions of bodily change. In doing so, we were able to identify two main themes: The felt "inner" body versus the visible "surface" body and the "old" body versus the "new" body. In different, though interconnected ways, these main themes encompass tensions between changes the women experienced as contributing to a more "normal" and active life, feeling more accepted, and changes that generated ambivalence. In particular, their skin became increasingly problematic because it did not "shrink" like the rest of the body. On the contrary, it became looser and looser. Moreover, badsmelling folds of skin that wobbled, sweated and chafed at the smallest movement, aprons of fat hanging in front of their stomachs, batwing arms, thick flabby thighs and sagging breasts were described as a huge contrast to the positive response they received to their changed body shape when they were out and about with their clothes on. At the same time, they expressed ambivalence with regards to removing the excess skin by means of plastic surgery. Through their own and other women`s experiences they learned removing the excess skin by means of surgery could be a double-edged sword. By illuminating the experiences of the ones undergoing such changes our article offers new insight in a scholarly debate predominated by medical research documenting the positive outcomes of weight loss surgery.

  14. Clinical and ultrasound parameters in prediction of excessive hemorrhage during management of cesarean scar pregnancy

    Directory of Open Access Journals (Sweden)

    Gui T

    2017-06-01

    Full Text Available Ting Gui, Ping Peng, Xinyan Liu, Li Jin, Weilin Chen Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Precis: During the management of cesarean scar pregnancy, gestational mass size >6 cm, uterine scar thickness <0.2 cm, peak systolic velocity >70 cm/s, and resistance index <0.35 are independent risk factors for excessive hemorrhage.Objective: The objective of this study was to investigate risk factors associated with excessive hemorrhage during the management of cesarean scar pregnancy (CSP.Patients and methods: A retrospective case–control study was conducted, including 40 patients who experienced excessive bleeding and 80 controls without severe hemorrhage.Results: Six parameters (two clinical and four ultrasound parameters potentially related to excessive hemorrhage were analyzed. Single-variable statistical analyses showed that the case group had higher gestational age (74.1±23.6 days, higher pretreatment serum β-human chorionic gonadotropin (HCG level (46,201±32,294 mIU/mL, larger gestational mass size (6.5±2.2 cm, thinner uterine scar thickness (0.17±0.12 cm, and richer peritrophoblastic perfusion (peak systolic velocity [PSV] 72.8±33.7 cm/s, resistance index [RI] 0.35±0.12, showing statistical significance compared with the control group. Further multivariable logistic regression analysis of the association between each of the risk factors and hemorrhage confirmed that increased gestational mass size and PSV were risk factors for hemorrhage (odds ratio [OR] 3.624, 95% confidence interval [CI] [1.179–11.138] and OR 1.062, 95% CI [1.007–1.121] and increased uterine scar thickness and RI were protective factors against hemorrhage (OR 0.181, 95% CI [0.034–0.957] and OR 0.851, 95% CI [0.729–0.994]; however, there was no statistical significance between the two clinical parameters

  15. A Study of the Management of Patients Taking Novel Oral Antiplatelet or Direct Oral Anticoagulant Medication Undergoing Dental Surgery in a Rural Setting

    Directory of Open Access Journals (Sweden)

    Steven Johnston

    2015-10-01

    Full Text Available Purpose: Novel oral antiplatelet (NOAP (prasugrel and ticagrelor and direct oral anticoagulant drugs (DOAC (dabigatran, rivaroxaban and apixaban have emerged in the last decade. This study was undertaken to determine current approaches taken to the management of patients taking these agents in dental practice in a remote and rural setting. Methods: A small retrospective study was carried out in a small island population that identified patients taking one of the above drugs. All national health service and private dental records were examined to determine the type of treatment carried out and whether drug therapy, treatment plans or actual treatment were modified as a result of NOAP or DOAC therapy. In addition other outcomes such as referral to another service for advice or treatment and any adverse bleeding events were noted. Results: 156 dental encounters for 95 patients taking one of the drugs were identified. Significant events were identified in sixteen encounters and the management of patients taking each drug type differed significantly between cases but no patients returned with troublesome post-operative bleeding. Conclusions: The approaches taken by dental surgeons in Orkney in the management of the NOAPs and DOACs varied and this is likely to be a reflection of the limited literature available.

  16. Psychological Factors, Beliefs About Medication, and Adherence of Youth with HIV-1 in a Multisite Directly Observed Therapy (DOT) Pilot Study

    Science.gov (United States)

    Garvie, Patricia A.; Flynn, Patricia M.; Belzer, Marvin; Britto, Paula; Hu, Chengcheng; Graham, Bobbie; Neely, Michael; McSherry, George D.; Spector, Stephen A.; Gaur, Aditya H.

    2010-01-01

    Introduction Examine psychological functioning and beliefs about medicine in adolescents with HIV-1 on HAART in a community-based directly observed therapy (DOT) pilot feasibility study. Methods Youth with behaviorally-acquired HIV (n=20; 65% female; median age 21 years) with adherence problems, received once-daily DOT. Youth were assessed at baseline, week 12 (post-DOT) and week 24 (follow-up). Results Baseline to week 12 comparisons: 55% of youth reported clinical depressive symptoms compared to 27% at week 12 with sustained improvements at week 24. Substance use: Borderline clinical range (Tscore=68), with clinical but statistically non-significant improvement (Tscore=61). Hopelessness scores reflected optimism for the future. Coping strategies showed significantly decreased Cognitive Avoidance (p=0.02), Emotional Discharge (p=0.004), and Acceptance/Resignation (“nothing I can do,” p=0.004); Positive Reappraisal and Seeking Support emerged. Aside from depressive symptoms, week 12 improvements were not sustained at week 24. DOT adherence was predicted by higher baseline depression (p=0.05), Beliefs About Medicine (p=0.006) and Perceived Threat of illness scores (p=0.03). Discussion Youth with behaviorally-acquired HIV and adherence problems who participated in a community-based DOT intervention reported clinically improved depressive symptoms, and temporarily reduced substance use and negative coping strategies. Depressive symptoms, Beliefs About Medicine and viewing HIV as a threat predicted better DOT adherence. PMID:21575827

  17. Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery.

    Science.gov (United States)

    Shourie, Swati; Conigrave, Katherine M; Proude, Elizabeth M; Ward, Jeanette E; Wutzke, Sonia E; Haber, Paul S

    2007-03-01

    Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation.

  18. Is the Epworth Sleepiness Scale a useful tool for screening excessive daytime sleepiness in commercial drivers?

    Science.gov (United States)

    Baiardi, Simone; La Morgia, Chiara; Sciamanna, Lucia; Gerosa, Alberto; Cirignotta, Fabio; Mondini, Susanna

    2018-01-01

    The significant social and economic impact of excessive daytime sleepiness makes sleep evaluation a primary medical need in commercial drivers. However, the best screening tool is still matter of debate. In our cohort of 221 commercial drivers, only ten (4.5%) had Epworth Sleepiness Scale scores indicative of excessive daytime sleepiness. These findings and the lack of concordance in estimating excessive daytime sleepiness among commercial drivers in previous studies using the same psychometric measure indicate that the Epworth Sleepiness Scale is not a reliable tool. This may be due to the low internal consistency of the scale in non-clinical samples and the possible intentional underscoring of sleepiness due to a perceived threat of driver's license suspension. Moreover, the reliability of the Epworth Sleepiness Scale results may be strongly influenced by the administration setting. The clinical application of inexpensive less time-consuming new tools like performance tests should be considered for the objective evaluation of excessive daytime sleepiness in commercial drivers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Necroptosis Promotes Staphylococcus aureus Clearance by Inhibiting Excessive Inflammatory Signaling

    Directory of Open Access Journals (Sweden)

    Kipyegon Kitur

    2016-08-01

    Full Text Available Staphylococcus aureus triggers inflammation through inflammasome activation and recruitment of neutrophils, responses that are critical for pathogen clearance but are associated with substantial tissue damage. We postulated that necroptosis, cell death mediated by the RIPK1/RIPK3/MLKL pathway, would function to limit pathological inflammation. In models of skin infection or sepsis, Mlkl−/− mice had high bacterial loads, an inability to limit interleukin-1b (IL-1b production, and excessive inflammation. Similarly, mice treated with RIPK1 or RIPK3 inhibitors had increased bacterial loads in a model of sepsis. Ripk3−/− mice exhibited increased staphylococcal clearance and decreased inflammation in skin and systemic infection, due to direct effects of RIPK3 on IL-1b activation and apoptosis. In contrast to Casp1/4−/− mice with defective S. aureus killing, the poor outcomes of Mlkl−/− mice could not be attributed to impaired phagocytic function. We conclude that necroptotic cell death limits the pathological inflammation induced by S. aureus.

  20. [Reflections on the excessive rates of cesareans in Brazil and the empowerment of women].

    Science.gov (United States)

    Leão, Míriam Rêgo de Castro; Riesco, Maria Luiza Gonzalez; Schneck, Camilla Alexsandra; Angelo, Margareth

    2013-08-01

    The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.

  1. A Practical Approach For Excess Bandwidth Distribution for EPONs

    KAUST Repository

    Elrasad, Amr

    2014-03-09

    This paper introduces a novel approach called Delayed Excess Scheduling (DES), which practically reuse the excess bandwidth in EPONs system. DES is suitable for the industrial deployment as it requires no timing constraint and achieves better performance compared to the previously reported schemes.

  2. Excess isentropic compressibility and speed of sound of the ternary ...

    Indian Academy of Sciences (India)

    These excess properties of the binary mixtures were fitted to Redlich-Kister equation, while the Cibulka's equation was used to fit the values related to the values to the ternary system. These excess properties have been used to discuss the presence of significant interactions between the component molecules in the binary ...

  3. excess molar volumes, and refractive index of binary mixtures of ...

    African Journals Online (AJOL)

    Preferred Customer

    mixtures of glycerol + water, and glycerol + methanol at 298.15 K and 303.15 K. Excess molar volumes (VE) have been calculated ... KEY WORDS: Excess molar, Density, Refractive index, Glycerol, Water, Methanol ... Biodiesel, defined as “a substitute for, or a additive to diesel fuel that is derived from the oils and fats of ...

  4. 5 CFR 530.204 - Payment of excess amounts.

    Science.gov (United States)

    2010-01-01

    ... Section 530.204 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY RATES AND SYSTEMS (GENERAL) Aggregate Limitation on Pay § 530.204 Payment of excess amounts. (a) An agency must pay the amounts that were deferred because they were in excess of the aggregate limitation...

  5. Alternative search strategies to explore ATLAS diboson excess

    Indian Academy of Sciences (India)

    2017-10-05

    Oct 5, 2017 ... We consider the s-channel resonance to fit the 2 TeV ATLAS diboson excess.We address the production mechanism of the resonance, its decay and coupling measurement. In order to explain only the hadronic channel excess, we consider the scenario where resonance decays to two new beyond ...

  6. Teachers' Knowledge of Anxiety and Identification of Excessive Anxiety in

    Science.gov (United States)

    Headley, Clea; Campbell, Marilyn A.

    2013-01-01

    This study examined primary school teachers' knowledge of anxiety and excessive anxiety symptoms in children. Three hundred and fifteen primary school teachers completed a questionnaire exploring their definitions of anxiety and the indications they associated with excessive anxiety in primary school children. Results showed that teachers had an…

  7. Management of excessive movable tissue: a modified impression technique.

    Science.gov (United States)

    Shum, Michael H C; Pow, Edmond H N

    2014-08-01

    Excessive movable tissue is a challenge in complete denture prosthetics. A modified impression technique is presented with polyvinyl siloxane impression material and a custom tray with relief areas and perforations in the area of the excessive movable tissue. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  8. Resonant excess quantum noise in lasers with mixed guiding

    NARCIS (Netherlands)

    Lien, Y.; van der Togt, E.; van Exter, M.P.; Woerdman, J.P.; van Druten, N.J.

    2003-01-01

    We show experimentally that the combination of soft-edged gain and index guiding can lead to resonant excess quantum noise. Resonances with excess noise factors close to 100 are observed in end-pumped Nd 3+ YVO 4 lasers for cavity lengths in which two modes experience similar gain. An associated

  9. 30 CFR 75.401-1 - Excessive amounts of dust.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Excessive amounts of dust. 75.401-1 Section 75.401-1 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Combustible Materials and Rock Dusting § 75.401-1 Excessive amounts of dust. The term ...

  10. Excess Molar Volumes and Partial Molar Volumes of Binary Systems ...

    African Journals Online (AJOL)

    NJD

    Excess molar volumes have been evaluated from density measurements over the entire composition range for binary systems of an ionic liquid ... was used to fit the excess molar volume data and the partial molar volumes were determined from the Redlich-Kister coefficients. ... ture below the boiling point of water. Most of ...

  11. 43 CFR 426.13 - Excess land appraisals.

    Science.gov (United States)

    2010-10-01

    ... discretion, can initiate the appraisal. (b) Procedures Reclamation uses to determine the sale price of excess... determine the sale price of excess land and land burdened by a deed covenant, except if a landholder owns land subject to a recordable contract that was in force on October 12, 1982, or other pertinent...

  12. Excess molar volumes and isentropic compressibilities of binary ...

    Indian Academy of Sciences (India)

    Remaining five binary mixtures, n-heptane + toluene, cyclohexane + n-heptane, cyclohexane + n-hexane, toluene + nhexane and n-decane + n-hexane show negative excess molar volumes over the whole composition range. However, the large negative values of excess molar volume becomes dominant in toluene + ...

  13. Goodwill, Excess Returns, and Determinants of Value Creation and Overpayment

    NARCIS (Netherlands)

    Lycklama a Nijeholt, M.; Grift, Y.K.

    2007-01-01

    In this article we have investigated whether the determinants of excess returns (especially of target excess returns) are valid for purchased goodwill as well. Among them are acquirer’s and target’s Tobin’s q, and debt assets ratio, that explain value creation of acquisitions, and relative size,

  14. 19 CFR 10.625 - Refunds of excess customs duties.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Refunds of excess customs duties. 10.625 Section 10.625 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT... and Apparel Goods § 10.625 Refunds of excess customs duties. (a) Applicability. Section 205 of the...

  15. Iodine Excess is a Risk Factor for Goiter Formation | Washington ...

    African Journals Online (AJOL)

    Iodine Excess is a Risk Factor for Goiter Formation. ... Iodine Excess is a Risk Factor for Goiter Formation. L Washington, T Makumbi, OJ Fualal, M Galukande. Abstract. Background: Goiters have been associated with iodine deficiency. Although universal salt iodization in Uganda achieved a household coverage of 95%

  16. 30 CFR 75.323 - Actions for excessive methane.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Actions for excessive methane. 75.323 Section... excessive methane. (a) Location of tests. Tests for methane concentrations under this section shall be made.... (1) When 1.0 percent or more methane is present in a working place or an intake air course, including...

  17. 12 CFR 740.3 - Advertising of excess insurance.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Advertising of excess insurance. 740.3 Section... ACCURACY OF ADVERTISING AND NOTICE OF INSURED STATUS § 740.3 Advertising of excess insurance. Any advertising that mentions share or savings account insurance provided by a party other than the NCUA must...

  18. Evaluation of the Effects of Direct Observation of Procedural Skills (DOPS on Clinical Externship Students’ Learning Level in Obstetrics Ward of Kurdistan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Shahgheibi Sh

    2009-01-01

    Full Text Available Background and purpose: Importance of clinical skills learning in medicine cannot be overemphasized but it seems that due attention is not paid to this issue. This study is an attempt to examine the effectiveness of direct observation of procedural skills (DOPS in this regard. Methods: In this study all externs passing the obstetrics ward rotation in 2005 and 2006for the first time participated. In this study, at first, 7 fundamental skills were selected and checklists for skill evaluation was prepared. Student’s skills was evaluated before and after traditional education(control group and before and after intervention which added DOPS. Examiners were requested to also provde a global judement of students performance. The data was analysed with paired T- test, T- test by SPSS software. Results: In this study 73 students participated of whom 42 students (57.5% were in control group, and 31(42.5% were in intervention group. In control group 47.6% and in interventional group 58.1% were male. Comparing students’ scores for each skill, the intervention group had significantly improved more than control group (p=0.0001. Comparing the interventions means of students’ averages for all skills before and after intervention (49.49 vs 86.03, p<0.0001 with those of control group(49.99 vs 77.43, p<0.0001 showed that the intervention group performed significantly better than control group (36.54 vs 27.44, p<0.0001. The examiner teacher’s opinion about doing each skill by the student correctly showed that the students’ skills in interventional group was more correct than control group. T-test showed a significant difference between groups in improvement of all skills (p=0.000. Conclusion: Using DOPS can be very useful in increasing student’s skill learning. Key words: DOPS , Skill Training

  19. Psychological factors, beliefs about medication, and adherence of youth with human immunodeficiency virus in a multisite directly observed therapy pilot study.

    Science.gov (United States)

    Garvie, Patricia A; Flynn, Patricia M; Belzer, Marvin; Britto, Paula; Hu, Chengcheng; Graham, Bobbie; Neely, Michael; McSherry, George D; Spector, Stephen A; Gaur, Aditya H

    2011-06-01

    This study examined psychological functioning and beliefs about medicine in adolescents with human immunodeficiency virus (HIV) on highly active antiretroviral therapy in a community-based directly observed therapy (DOT) pilot feasibility study. Participants were youth with behaviorally acquired HIV (n = 20; 65% female; median age, 21 years) with adherence problems, who received once-daily DOT. Youth were assessed at baseline, week 12 (post-DOT), and week 24 (follow-up). At baseline, 55% of youth reported having clinical depressive symptoms compared to 27% at week 12 with sustained improvements at week 24. At baseline, substance use was reported within the borderline clinical range (T(score) = 68), with clinical but statistically nonsignificant improvement (T(score) = 61) at week 12. Hopelessness scores reflected optimism for the future. Coping strategies showed significantly decreased cognitive avoidance (p = .02), emotional discharge (p = .004), and acceptance/resignation ("nothing I can do," p = .004), whereas positive reappraisal and seeking support emerged. With the exception of depressive symptoms, week 12 improvements were not sustained at week 24. DOT adherence was predicted by higher baseline depression (p = .05), beliefs about medicine (p = .006) and perceived threat of illness scores (p = .03). Youth with behaviorally acquired HIV and adherence problems who participated in a community-based DOT intervention reported clinically improved depressive symptoms, and temporarily reduced substance use and negative coping strategies. Depressive symptoms, beliefs about medicine, and viewing HIV as a potential threat predicted better DOT adherence. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. On Infrared Excesses Associated with Li-Rich K Giants

    Science.gov (United States)

    Rebull, Luisa M.; Carlberg, Joleen K.; Gibbs, John C.; Deeb, J. Elin; Larsen, Estefania; Black, David V.; Altepeter, Shailyn; Bucksbee, Ethan; Cashen, Sarah; Clarke, Matthew; hide

    2015-01-01

    Infrared (IR) excesses around K-type red giants (RGs) have previously been discovered using Infrared Astronomy Satellite (IRAS) data, and past studies have suggested a link between RGs with overabundant lithium and IR excesses, implying the ejection of circumstellar shells or disks. We revisit the question of IR excesses around RGs using higher spatial resolution IR data, primarily from the Wide-field Infrared Survey Explorer. Our goal was to elucidate the link between three unusual RG properties: fast rotation, enriched lithium, and IR excess. Our sample of RGs includes those with previous IR detections, a sample with well-defined rotation and lithium abundance measurements with no previous IR measurements, and a large sample of RGs asserted to be lithium-rich in the literature; we have 316 targets thought to be K giants, about 40% of which we take to be Li-rich. In 24 cases with previous detections of IR excess at low spatial resolution, we believe that source confusion is playing a role, in that either (a) the source that is bright in the optical is not responsible for the IR flux, or (b) there is more than one source responsible for the IR flux as measured in IRAS. We looked for IR excesses in the remaining sources, identifying 28 that have significant IR excesses by approximately 20 micrometers (with possible excesses for 2 additional sources). There appears to be an intriguing correlation in that the largest IR excesses are all in Li-rich K giants, though very few lithium-rich K giants have IR excesses (large or small). These largest IR excesses also tend to be found in the fastest rotators. There is no correlation of IR excess with the carbon isotopic ratio, 12C/13C. IR excesses by 20 micrometers, though relatively rare, are at least twice as common among our sample of lithium-rich K giants. If dust shell production is a common by-product of Li enrichment mechanisms, these observations suggest that the IR excess stage is very short-lived, which is supported

  1. ON INFRARED EXCESSES ASSOCIATED WITH Li-RICH K GIANTS

    Energy Technology Data Exchange (ETDEWEB)

    Rebull, Luisa M. [Spitzer Science Center (SSC) and Infrared Science Archive (IRSA), Infrared Processing and Analysis Center - IPAC, 1200 E. California Blvd., California Institute of Technology, Pasadena, CA 91125 (United States); Carlberg, Joleen K. [NASA Goddard Space Flight Center, Code 667, Greenbelt, MD 20771 (United States); Gibbs, John C.; Cashen, Sarah; Datta, Ashwin; Hodgson, Emily; Lince, Megan [Glencoe High School, 2700 NW Glencoe Rd., Hillsboro, OR 97124 (United States); Deeb, J. Elin [Bear Creek High School, 9800 W. Dartmouth Pl., Lakewood, CO 80227 (United States); Larsen, Estefania; Altepeter, Shailyn; Bucksbee, Ethan; Clarke, Matthew [Millard South High School, 14905 Q St., Omaha, NE 68137 (United States); Black, David V., E-mail: rebull@ipac.caltech.edu [Walden School of Liberal Arts, 4230 N. University Ave., Provo, UT 84604 (United States)

    2015-10-15

    Infrared (IR) excesses around K-type red giants (RGs) have previously been discovered using Infrared Astronomy Satellite (IRAS) data, and past studies have suggested a link between RGs with overabundant Li and IR excesses, implying the ejection of circumstellar shells or disks. We revisit the question of IR excesses around RGs using higher spatial resolution IR data, primarily from the Wide-field Infrared Survey Explorer. Our goal was to elucidate the link between three unusual RG properties: fast rotation, enriched Li, and IR excess. Our sample of RGs includes those with previous IR detections, a sample with well-defined rotation and Li abundance measurements with no previous IR measurements, and a large sample of RGs asserted to be Li-rich in the literature; we have 316 targets thought to be K giants, about 40% of which we take to be Li-rich. In 24 cases with previous detections of IR excess at low spatial resolution, we believe that source confusion is playing a role, in that either (a) the source that is bright in the optical is not responsible for the IR flux, or (b) there is more than one source responsible for the IR flux as measured in IRAS. We looked for IR excesses in the remaining sources, identifying 28 that have significant IR excesses by ∼20 μm (with possible excesses for 2 additional sources). There appears to be an intriguing correlation in that the largest IR excesses are all in Li-rich K giants, though very few Li-rich K giants have IR excesses (large or small). These largest IR excesses also tend to be found in the fastest rotators. There is no correlation of IR excess with the carbon isotopic ratio, {sup 12}C/{sup 13}C. IR excesses by 20 μm, though relatively rare, are at least twice as common among our sample of Li-rich K giants. If dust shell production is a common by-product of Li enrichment mechanisms, these observations suggest that the IR excess stage is very short-lived, which is supported by theoretical calculations. Conversely, the

  2. Crítica social e idéias médicas nos excessos do desejo: uma análise dos "romances para homens" de finais do século XIX e início do XX Social criticism and medical ideas on desires' excesses: a study of "novels for men" from late nineteenth to early twentieth century

    Directory of Open Access Journals (Sweden)

    Alessandra El Far

    2007-06-01

    Full Text Available Este artigo procura analisar a produção literária pornográfica desde a segunda metade do século XIX até o início do XX no Brasil. Também conhecidos como "leitura para homens" ou "romances para homens", esses enredos alcançaram uma repercussão singular naquele período. Se, em um primeiro momento, essas narrativas, repletas de fantasias e desejos, tratavam de questões sociais e políticas, com a chegada do novo século, de modo evidente, elas passaram a estabelecer um estreito diálogo com as teorias médicas e científicas da época.This article analyses the pornographic literature from the second half of the nineteenth century until the beginning of the twentieth century in Brazil. Also known as "reading for men" or "novels for men", these plots reached a singular repercussion at the time. If at first these stories, full of fantasies and desires, talked about both social and political issues, with the coming of the new century they clearly started to establish a close dialogue with current medical and scientific theories.

  3. 26 CFR 54.4979-0 - Excise tax on certain excess contributions and excess aggregate contributions; table of contents.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Excise tax on certain excess contributions and excess aggregate contributions; table of contents. 54.4979-0 Section 54.4979-0 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) MISCELLANEOUS EXCISE TAXES (CONTINUED) PENSION EXCISE TAXES § 54.4979-0 Excise tax on...

  4. Low energy gamma ray excess confronting a singlet scalar extended inert doublet dark matter model

    Directory of Open Access Journals (Sweden)

    Amit Dutta Banik

    2015-04-01

    Full Text Available Recent study of gamma rays originating from the region of galactic centre has confirmed an anomalous γ-ray excess within the energy range 1–3 GeV. This can be explained as the consequence of pair annihilation of a 31–40 GeV dark matter into bb¯ with thermal annihilation cross-section σv∼1.4–2.0×10−26 cm3/s. In this work we revisit the Inert Doublet Model (IDM in order to explain this gamma ray excess. Taking the lightest inert particle (LIP as a stable DM candidate we show that a 31–40 GeV dark matter derived from IDM will fail to satisfy experimental limits on dark matter direct detection cross-section obtained from ongoing direct detection experiments and is also inconsistent with LHC findings. We show that a singlet extended inert doublet model can easily explain the reported γ-ray excess which is as well in agreement with Higgs search results at LHC and other observed results like DM relic density and direct detection constraints.

  5. Prevalence of excessive screen time and associated factors in adolescents

    Directory of Open Access Journals (Sweden)

    Joana Marcela Sales de Lucena

    2015-12-01

    Full Text Available Objective: To determine the prevalence of excessive screen time and to analyze associated factors among adolescents. Methods: This was a cross-sectional school-based epidemiological study with 2874 high school adolescents with age 14-19 years (57.8% female from public and private schools in the city of João Pessoa, PB, Northeast Brazil. Excessive screen time was defined as watching television and playing video games or using the computer for more than 2 h/day. The associated factors analyzed were: sociodemographic (gender, age, economic class, and skin color, physical activity and nutritional status of adolescents. Results: The prevalence of excessive screen time was 79.5% (95%CI 78.1-81.1 and it was higher in males (84.3% compared to females (76.1%; p<0.001. In multivariate analysis, adolescent males, those aged 14-15 year old and the highest economic class had higher chances of exposure to excessive screen time. The level of physical activity and nutritional status of adolescents were not associated with excessive screen time. Conclusions: The prevalence of excessive screen time was high and varied according to sociodemographic characteristics of adolescents. It is necessary to develop interventions to reduce the excessive screen time among adolescents, particularly in subgroups with higher exposure.

  6. Advanced Capabilities for Combat Medics

    National Research Council Canada - National Science Library

    Convertino, Victor A; Cooke, William H; Salinas, Jose; Holcomb, John B

    2004-01-01

    The US Army Institute of Surgical Research (USAISR) has the lead for directing the Research Program Area for Advanced Triage Capabilities for Combat Medics in the Medical Research and Materiel Command (MRMC...

  7. Excess chemical potential of small solutes across water--membrane and water--hexane interfaces

    Science.gov (United States)

    Pohorille, A.; Wilson, M. A.

    1996-01-01

    The excess chemical potentials of five small, structurally related solutes, CH4, CH3F, CH2F2, CHF3, and CF4, across the water-glycerol 1-monooleate bilayer and water-hexane interfaces were calculated at 300, 310, and 340 K using the particle insertion method. The excess chemical potentials of nonpolar molecules (CH4 and CF4) decrease monotonically or nearly monotonically from water to a nonpolar phase. In contrast, for molecules that possess permanent dipole moments (CH3F, CH2F, and CHF3), the excess chemical potentials exhibit an interfacial minimum that arises from superposition of two monotonically and oppositely changing contributions: electrostatic and nonelectrostatic. The nonelectrostatic term, dominated by the reversible work of creating a cavity that accommodates the solute, decreases, whereas the electrostatic term increases across the interface from water to the membrane interior. In water, the dependence of this term on the dipole moment is accurately described by second order perturbation theory. To achieve the same accuracy at the interface, third order terms must also be included. In the interfacial region, the molecular structure of the solvent influences both the excess chemical potential and solute orientations. The excess chemical potential across the interface increases with temperature, but this effect is rather small. Our analysis indicates that a broad range of small, moderately polar molecules should be surface active at the water-membrane and water-oil interfaces. The biological and medical significance of this result, especially in relation to the mechanism of anesthetic action, is discussed.

  8. Medical marijuana

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000899.htm Medical marijuana To use the sharing features on this ... have legalized marijuana for medical use. How Does Medical Marijuana Work? Medical marijuana may be: Smoked Vaporized ...

  9. Excess winter cardiovascular morbidity in Ivanovo Region in 2009-2013 years

    Directory of Open Access Journals (Sweden)

    A. V. Kontsevaya

    2015-11-01

    Full Text Available Chronic non-infectious diseases are characterized by irregular morbidity and mortality throughout a year. Aim. To study excess cardiovascular morbidity during winter in Ivanovo Region in 2009-2013 years. Material and methods. Excess winter morbidity index (EWMI was calculated using special formula. The incidence of cardiovascular diseases (CVDs was determined according to the data from the medical information-analytic center of Ivanovo Region. The index was calculated for CVDs in general, for arterial hypertension (HT and for acute forms of CVDs (acute myocardial infarction and stroke. Results. The mean EWMI for CVDs for 5 years of the follow-up made up to 77.2% and was higher in women than in men (80% vs 69.5%, respectively. People of working age had lower excess winter morbidity than the population older than working age (53.1% and 88%, respectively. EWMI for CVDs had significant variability and ranged from 29.0% (2013 year to 81.1% (2010 year in men and from 25.2% to 82.9% in women in the same years. In general, the 5-year mean EWMI for HT was 72.7%; it was higher in men than in women in most of the analyzed years of follow-up. We had revealed the heterogeneity of the EWMI for HT during the analyzed period in each analyzed group (the minimal values were found in 2011 after the heat wave in 2010. EWMI for myocardial infarction demonstrated excess winter morbidity, men and women had in general similar indices (31.0% and 28.4%, respectively, but it was higher in people of working age as compared with the older ones. This index had a wide range of values. In case of stroke we had revealed no excess winter morbidity; this index was equal throughout a year. Conclusion. The influence on excess winter morbidity can result in the reduction of cardiovascular morbidity and mortality due to the decreased effect of risk factors; it would also optimize a load on healthcare system, the season irregularity of which must be taken into account when planning a

  10. Excess winter cardiovascular morbidity in Ivanovo Region in 2009-2013 years

    Directory of Open Access Journals (Sweden)

    A. V. Kontsevaya

    2015-01-01

    Full Text Available Chronic non-infectious diseases are characterized by irregular morbidity and mortality throughout a year. Aim. To study excess cardiovascular morbidity during winter in Ivanovo Region in 2009-2013 years. Material and methods. Excess winter morbidity index (EWMI was calculated using special formula. The incidence of cardiovascular diseases (CVDs was determined according to the data from the medical information-analytic center of Ivanovo Region. The index was calculated for CVDs in general, for arterial hypertension (HT and for acute forms of CVDs (acute myocardial infarction and stroke. Results. The mean EWMI for CVDs for 5 years of the follow-up made up to 77.2% and was higher in women than in men (80% vs 69.5%, respectively. People of working age had lower excess winter morbidity than the population older than working age (53.1% and 88%, respectively. EWMI for CVDs had significant variability and ranged from 29.0% (2013 year to 81.1% (2010 year in men and from 25.2% to 82.9% in women in the same years. In general, the 5-year mean EWMI for HT was 72.7%; it was higher in men than in women in most of the analyzed years of follow-up. We had revealed the heterogeneity of the EWMI for HT during the analyzed period in each analyzed group (the minimal values were found in 2011 after the heat wave in 2010. EWMI for myocardial infarction demonstrated excess winter morbidity, men and women had in general similar indices (31.0% and 28.4%, respectively, but it was higher in people of working age as compared with the older ones. This index had a wide range of values. In case of stroke we had revealed no excess winter morbidity; this index was equal throughout a year. Conclusion. The influence on excess winter morbidity can result in the reduction of cardiovascular morbidity and mortality due to the decreased effect of risk factors; it would also optimize a load on healthcare system, the season irregularity of which must be taken into account when planning a

  11. Survival as medical registrar on call: remember the doughnut.

    Science.gov (United States)

    Blayney, Sarah; Crowe, Alexander; Bray, Dominic

    2014-10-01

    Life as a medical registrar presents many challenges and concern is growing that a downwards trend in recruitment to General Medicine is the direct result of a perception by junior doctors that the role of the medical registrar is excessively demanding and results in poor work-life balance. A solution-focused approach (SFA) can be used successfully to find a satisfying outcome for both registrar and patient in many of the situations encountered during an on-call, as well as carrying over benefits into life outside of work. We explore the origins of SFA and the ways in which it can be successfully applied to clinical medicine, providing case studies from the author's own experience to illustrate the principles of this way of thinking. © 2014 Royal College of Physicians.

  12. Alternative search strategies to explore ATLAS diboson excess

    Science.gov (United States)

    Khosa, Charanjit K.

    2017-10-01

    We consider the s-channel resonance to fit the 2 TeV ATLAS diboson excess. We address the production mechanism of the resonance, its decay and coupling measurement. In order to explain only the hadronic channel excess, we consider the scenario where resonance decays to two new beyond Standard Model (BSM) particles (in the mass range of W / Z boson) and also explore the possibility of three-particle BSM final state mimicking diboson excess. Techniques suggested in this work are generic and could be used for heavy BSM resonance searches.

  13. Timing of Excessive Weight Gain During Pregnancy Modulates Newborn Anthropometry.

    Science.gov (United States)

    Ruchat, Stephanie-May; Allard, Catherine; Doyon, Myriam; Lacroix, Marilyn; Guillemette, Laetitia; Patenaude, Julie; Battista, Marie-Claude; Ardilouze, Jean-Luc; Perron, Patrice; Bouchard, Luigi; Hivert, Marie-France

    2016-02-01

    Excessive gestational weight gain (GWG) is associated with increased birth weight and neonatal adiposity. However, timing of excessive GWG may have a differential impact on birth outcomes. The objective of this study was to compare the effect of early and mid/late excessive GWG on newborn anthropometry in the context of the Canadian clinical recommendations that are specific for first trimester and for second/third trimesters based on maternal pre-pregnancy BMI. We included 607 glucose-tolerant women in our main analyses, after excluding women who had less than the recommended total GWG. Maternal body weight was measured in early pregnancy, mid-pregnancy, and late pregnancy. Maternal and fetal clinical outcomes were collected, including newborn anthropometry. Women were divided into four groups according to the Canadian guidelines for GWG in the first and in the second/third trimesters: (1) "overall non-excessive" (reference group); (2) "early excessive GWG"; (3) "mid/late excessive GWG"; and (4) "overall excessive GWG." Differences in newborn anthropometry were tested across GWG categories. Women had a mean (±SD) pre-pregnancy BMI of 24.7 ± 5.2 kg/m(2) and total GWG of 15.3 ± 4.4 kg. Women with mid/late excessive GWG gave birth to heavier babies (gestational age-adjusted birth weight z-score 0.33 ± 0.91) compared with women in the reference group (0.00 ± 0.77, P = 0.007), whereas women with early excessive GWG gave birth to babies of similar weight (gestational age-adjusted z-score 0.01 ± 0.86) to the reference group (0.00 ± 0.77, P = 0.84). When we stratified our analyses and investigated women who gained within the recommendations for total GWG, mid/late excessive GWG specifically was associated with greater newborn size, similar to our main analyses. Excessive GWG in mid/late pregnancy in women who did not gain weight excessively in early pregnancy is associated with increased birth size, even in those who gained within the Canadian recommendations

  14. Ring polymer molecular dynamics beyond the linear response regime: Excess electron injection and trapping in liquids.

    Science.gov (United States)

    Menzeleev, Artur R; Miller, Thomas F

    2010-01-21

    Ring polymer molecular dynamics (RPMD) is used to directly simulate the injection and relaxation of excess electrons into supercritical helium fluid and ambient liquid water. A method for modulating the initial energy of the excess electron in the RPMD model is presented and used to study both low-energy (cold) and high-energy (hot) electron injections. For cold injection into both solvents, the RPMD model recovers electronically adiabatic dynamics with the excess electron in its ground state, whereas for hot electron injection, the model predicts slower relaxation dynamics associated with electronic transitions between solvent cavities. The analysis of solvent dynamics during electron localization reveals the formation of an outgoing solvent compression wave in helium that travels for over 2 nm and the delayed formation of water solvation shells on the timescale of 300 fs. Various system-size effects that are intrinsic to the simulation of excess electron injection are discussed. Comparison of the RPMD simulations with previous mixed quantum-classical dynamics simulations finds general agreement for both the mechanisms and timescales for electron localization, although the electron localization dynamics in the RPMD model is essentially completed within 400 fs in helium and 150 fs in water.

  15. The semi-Hooperon: Gamma-ray and anti-proton excesses in the Galactic Center

    Science.gov (United States)

    Arcadi, Giorgio; Queiroz, Farinaldo S.; Siqueira, Clarissa

    2017-12-01

    A puzzling excess in gamma-rays at GeV energies has been observed in the center of our galaxy using Fermi-LAT data. Its origin is still unknown, but it is well fitted by Weakly Interacting Massive Particles (WIMPs) annihilations into quarks with a cross section around 10-26 cm3s-1 with masses of 20-50 GeV, scenario which is promptly revisited. An excess favoring similar WIMP properties has also been seen in anti-protons with AMS-02 data potentially coming from the Galactic Center as well. In this work, we explore the possibility of fitting these excesses in terms of semi-annihilating dark matter, dubbed as semi-Hooperon, with the process WIMP WIMP → WIMP X being responsible for the gamma-ray excess, where X = h , Z. An interesting feature of semi-annihilations is the change in the relic density prediction compared to the standard case, and the possibility to alleviate stringent limits stemming from direct detection searches. Moreover, we discuss which models might give rise to a successful semi-Hooperon setup in the context of Z3,Z4 and extra ;dark; gauge symmetries.

  16. Excessive anterior cervical muscle tone affects hyoid bone kinetics during swallowing in healthy individuals

    Directory of Open Access Journals (Sweden)

    Yamazaki Y

    2017-11-01

    Full Text Available Yasuhiro Yamazaki, Haruka Tohara, Koji Hara, Ayako Nakane, Yoko Wakasugi, Kohei Yamaguchi, Shunsuke Minakuchi Department of Gerodontology, Tokyo Medical and Dental University, Tokyo, Japan Purpose: This study aimed to determine whether excessive neck muscle tone affects hyoid bone kinetics during swallowing using videofluorography (VF in an unnatural posture in healthy individuals. Subjects and methods: Subjects were 28 healthy adults (12 men, 16 women; mean age, 39.75±9.50 years without any history or present complaints of swallowing disorders. We first established the participant’s posture a reclining wheelchair that was adjusted to a 30-degree angle with the headrest (without excessive neck muscle tone or without headrest (with excessive neck muscle tone, used an electromyogram above the mylohyoid muscle to represent the suprahyoid muscles and above the sternohyoid muscle to represent the infrahyoid muscles to confirm neck muscle tone, and then conducted VF of swallowing measurements. Videofluorographic images were obtained when 5 mL of 50% (w/v barium sulfate was being swallowed, and hyoid bone coordinate (the resting position and the elevated position, extent of horizontal and vertical hyoid bone elevation, as well as duration and velocity of hyoid bone elevation were evaluated (x-axis and y-axis coordinates for the resting position of hyoid bone are referred to as Xr and Yr, respectively; those for the elevated hyoid bone position induced during swallowing are referred to as Xs and Ys, respectively. Results: In the resting position of the hyoid bone, the Yr coordinates in those with excessive neck muscle tone were significantly lower than in those without excessive neck muscle tone. Vertical hyoid bone elevation and hyoid bone elevation velocity were significantly higher with excessive neck muscle tone than without excessive neck muscle tone, whereas horizontal elevation showed no significant differences. Conclusion: Our findings

  17. Mitochondrial and cellular mechanisms for managing lipid excess

    Directory of Open Access Journals (Sweden)

    Miguel A Aon

    2014-07-01

    Full Text Available Current scientific debates center on the impact of lipids and mitochondrial function on diverse aspects of human health, nutrition and disease, among them the association of lipotoxicity with the onset of insulin resistance in skeletal muscle, and with heart dysfunction in obesity and diabetes. Mitochondria play a fundamental role in aging and in prevalent acute or chronic diseases. Lipids are main mitochondrial fuels however these molecules can also behave as uncouplers and inhibitors of oxidative phosphorylation. Knowledge about the functional composition of these contradictory effects and their impact on mitochondrial-cellular energetics/redox status is incomplete.Cells store fatty acids (FAs as triacylglycerol and package them into cytoplasmic lipid droplets (LDs. New emerging data shows the LD as a highly dynamic storage pool of FAs that can be used for energy reserve. Lipid excess packaging into LDs can be seen as an adaptive response to fulfilling energy supply without hindering mitochondrial or cellular redox status and keeping low concentration of lipotoxic intermediates.Herein we review the mechanisms of action and utilization of lipids by mitochondria reported in liver, heart and skeletal muscle under relevant physiological situations, e.g. exercise. We report on perilipins, a family of proteins that associate with LDs in response to loading of cells with lipids. Evidence showing that in addition to physical contact, mitochondria and LDs exhibit metabolic interactions is presented and discussed. A hypothetical model of channeled lipid utilization by mitochondria is proposed. Direct delivery and channeled processing of lipids in mitochondria could represent a reliable and efficient way to maintain ROS within levels compatible with signaling while ensuring robust and reliable energy supply.

  18. Characteristics of adolescent excessive drinkers compared with consumers and abstainers

    NARCIS (Netherlands)

    Tomcikova, Zuzana; Geckova, Andrea Madarasova; van Dijk, Jitse P.; Reijneveld, Sijmen A.

    Introduction and Aims. This study aimed at comparing adolescent abstainers, consumers and excessive drinkers in terms of family characteristics (structure of family, socioeconomic factors), perceived social support, personality characteristics (extraversion, self-esteem, aggression) and well-being.

  19. Alpha molecular epidemiological analysis of adenoviruses from excess conjunctivitis cases

    National Research Council Canada - National Science Library

    A Balasopoulou; P Κokkinos; D Pagoulatos; P Plotas; O E Makri; C D Georgakopoulos; A Vantarakis

    2017-01-01

    Background Τo perform a molecular epidemiological analysis of viral conjunctivitis among excess conjunctivitis cases recorded at the University Hospital of Patras, Greece, for the period March to June 2012...

  20. Excess Molar Volume of Binary Systems Containing Mesitylene

    Directory of Open Access Journals (Sweden)

    Morávková, L.

    2013-05-01

    Full Text Available This paper presents a review of density measurements for binary systems containing 1,3,5-trimethylbenzene (mesitylene with a variety of organic compounds at atmospheric pressure. Literature data of the binary systems were divided into nine basic groups by the type of contained organic compound with mesitylene. The excess molar volumes calculated from the experimental density values have been compared with literature data. Densities were measured by a few experimental methods, namely using a pycnometer, a dilatometer or a commercial apparatus. The overview of the experimental data and shape of the excess molar volume curve versus mole fraction is presented in this paper. The excess molar volumes were correlated by Redlich–Kister equation. The standard deviations for fitting of excess molar volume versus mole fraction are compared. Found literature data cover a huge temperature range from (288.15 to 343.15 K.

  1. Parenting Emerging Adults Who Game Excessively: Parents' Lived Experiences.

    Science.gov (United States)

    Russell, Linda L H; Johnson, Elizabeth I

    2017-01-01

    Excessive gaming among emerging adults is a growing concern, especially in cases where it interferes with key developmental milestones such as gaining an education or establishing a career. Although researchers have begun to understand the effects of excessive gaming on young people themselves, we know remarkably little about how emerging adults' gaming may affect family relationships. Utilizing phenomenological interviewing of parents of emerging adult sons who game excessively, this study presents a rich description of the experience of parenting a young adult who games excessively. In-depth interviews were conducted with two fathers and two mothers. Findings suggested that parents felt their sons were missing out on aspects of their life due to their gaming and were not meeting their full potential. They also felt their sons were different from other people their age and found it difficult to talk to them about their gaming. Finally, they believed their sons were addicted to gaming.

  2. Antigen excess in modern immunoassays: to anticipate on the unexpected.

    Science.gov (United States)

    Jacobs, Joannes F M; van der Molen, Renate G; Bossuyt, Xavier; Damoiseaux, Jan

    2015-02-01

    Immunoassays measuring sera with high analyte concentration may be prone to an artifact that causes underestimation of the analyte concentration. This phenomenon is generally described as antigen excess or the prozone effect. Characteristically, serum with high concentrations of a certain analyte can give a false negative/low result when tested at the recommended dilution, but reacts strongly positive upon further dilution. Increased insight of the antigen excess mechanisms and tools to prevent it has reduced the analytical problems caused by prozone effects in daily laboratory practice. However, misinterpretation of laboratory results caused by antigen excess does still occur, in virtually any type of immunoassay. Awareness by the laboratory specialist of the mechanisms underlying antigen excess in the different immunoassays, strategies to detect it, and adequate communication with clinicians can help to avoid reporting false negative test-results. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Modelling of excess noise attnuation by grass and forest | Onuu ...

    African Journals Online (AJOL)

    , guinea grass (panicum maximum) and forest which comprises iroko (milicia ezcelea) and white afara (terminalia superba) trees in the ratio of 2:1 approximately. Excess noise attenuation spectra have been plotted for the grass and forest for ...

  4. Iodine deficiency and iodine excess in Jiangsu Province, China

    NARCIS (Netherlands)

    Zhao, J.

    2001-01-01

    Keywords:
    iodine deficiency, iodine excess, endemic goiter, drinking water, iodine intake, thyroid function, thyroid size, iodized salt, iodized oil, IQ, physical development, hearing capacity, epidemiology, meta-analysis, IDD, randomized trial, intervention, USA, Bangladesh,

  5. Generic switching of warfarin and risk of excessive anticoagulation

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Rathe, Jette; Stage, Tore Bjerregaard

    2015-01-01

    PURPOSE: Generic switching of warfarin was recently repealed in Denmark, as adverse drug reaction (ADR) reports suggested risk of excessive anticoagulation following switches from branded to generic warfarin. We investigated this putative association in a formalized pharmacoepidemiological analysis......). This constituted 89.0% of all warfarin prescriptions in Denmark during the study period. We observed 19,362 switches to generic warfarin during the study period. The adjusted hazard ratio for excessive anticoagulation following a recent switch from branded to generic warfarin was 1.1 (95%CI, 0.8-1.4). The result...... was robust within subgroups and several sensitivity analyses. CONCLUSION: Switching from branded to generic warfarin is not associated with an increased risk of hospitalization with excessive anticoagulation. However, a minor excess risk of transient INR increase cannot be excluded. Pharmacoepidemiological...

  6. Gene Linked to Excess Male Hormones in Female Infertility Disorder

    Science.gov (United States)

    ... April 15, 2014 Gene linked to excess male hormones in female infertility disorder Discovery by NIH-supported ... may lead to the overproduction of androgens — male hormones similar to testosterone — occurring in women with polycystic ...

  7. Internet Addiction and Excessive Social Networks Use: What About Facebook?

    National Research Council Canada - National Science Library

    Guedes, Eduardo; Sancassiani, Federica; Carta, Mauro Giovani; Campos, Carlos; Machado, Sergio; King, Anna Lucia Spear; Nardi, Antonio Egidio

    2016-01-01

    ... world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths...

  8. Predictive factors for intraoperative excessive bleeding in Graves’ disease

    Directory of Open Access Journals (Sweden)

    Kosho Yamanouchi

    2015-01-01

    Conclusion: A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves’ disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g.

  9. Excess Alcohol May Speed Muscle Loss in Older Women

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_166348.html Excess Alcohol May Speed Muscle Loss in Older Women After ... risk drinking was defined as frequent and significant alcohol use, along with a lack of control over ...

  10. A Portable Burn Pan for the Disposal of Excess Propellants

    Science.gov (United States)

    2016-06-01

    Measuring energetic contaminant deposition rates on snow. Water Air Soil Pollut (2012) 223:3689–3699. [25] Rasemann, W (2000) Industrial waste dumps...2013 - 06/01/2016 A Portable Burn Pan for the Disposal of Excess Propellants Michael Walsh USA CRREL USA CRREL 72 Lyme Road Hanover, NH 03755...detected in surface waters . Local regulations also require the transportation of excess charges to remote burn facilities, which results in the absence of

  11. Asymmetric Dark Matter Models and the LHC Diphoton Excess

    DEFF Research Database (Denmark)

    Frandsen, Mads T.; Shoemaker, Ian M.

    2016-01-01

    The existence of dark matter (DM) and the origin of the baryon asymmetry are persistent indications that the SM is incomplete. More recently, the ATLAS and CMS experiments have observed an excess of diphoton events with invariant mass of about 750 GeV. One interpretation of this excess is decays...... have for models of asymmetric DM that attempt to account for the similarity of the dark and visible matter abundances....

  12. Excessive computer game playing : evidence for addiction and aggression?

    OpenAIRE

    Grüsser, SM; Thalemann, R; Griffiths, MD

    2007-01-01

    Computer games have become an ever-increasing part of many adolescents’ day-to-day lives. Coupled with this phenomenon, reports of excessive gaming (computer game playing) denominated as “computer/video game addiction” have been discussed in the popular press as well as in recent scientific research. The aim of the present study was the investigation of the addictive potential of gaming as well as the relationship between excessive gaming and aggressive attitudes and behavior. A sample compri...

  13. Variables of excessive computer internet use in childhood and adolescence

    OpenAIRE

    Thalemann, Ralf

    2010-01-01

    The aim of this doctoral thesis is the characterization of excessive computer and video gaming in terms of a behavioral addiction. Therefore, the development of a diagnostic psychometric instrument was central to differentiate between normal and pathological computer gaming in adolescence. In study 1, 323 children were asked about their video game playing behavior to assess the prevalence of pathological computer gaming. Data suggest that excessive computer and video game players use thei...

  14. Searching For Infrared Excesses Around White Dwarf Stars

    Science.gov (United States)

    Deeb Wilson, Elin; Rebull, Luisa M.; Debes, John H.; Stark, Chris

    2017-01-01

    Many WDs have been found to be “polluted,” meaning they contain heavier elements in their atmospheres. Either an active process that counters gravitational settling is taking place, or an external mechanism is the cause. One proposed external mechanism for atmospheric pollution of WDs is the disintegration and accretion of rocky bodies, which would result in a circumstellar (CS) disk. As CS disks are heated, they emit excess infrared (IR) emission. WDs with IR excesses indicative of a CS disk are known as dusty WDs. Statistical studies are still needed to determine how numerous dusty, polluted WDs are, along with trends and correlations regarding rate of planetary accretion, the lifetimes of CS disks, and the structure and evolution of CS disks. These findings will allow for a better understanding of the fates of planets along with potential habitability of surviving planets.In this work, we are trying to confirm IR excesses around a sample of 69 WD stars selected as part of the WISE InfraRed Excesses around Degenerates (WIRED) Survey (Debes et al. 2011). We have archival data from WISE, Spitzer, 2MASS, DENIS, and SDSS. The targets were initially selected from the Sloan Digital Sky Survey (SDSS), and identified as containing IR excesses based on WISE data. We also have data from the Four Star Infrared Camera array, which is part of Carnegie Institution’s Magellan 6.5 meter Baade Telescope located at Las Campanas Observatory in Chile. These Four Star data are much higher spatial resolution than the WISE data that were used to determine if each WD has an IR excess. There are often not many bands delineating the IR excess portion of the SED; therefore, we are using the Four Star data to check if there is another source in the WISE beam affecting the IR excess.

  15. Excessive maps, "arrival times" and perturbation of dynamical semigroups

    Science.gov (United States)

    Holevo, A. S.

    1995-12-01

    The notion of excessive map for dynamical semigroup is introduced, and it is shown that an excessive map defines an operation-valued measure describing the measurement of an "arrival time" related to the irreversible dynamics described by the semigroup. Any such arrival time determines a positive perturbation of the dynamical semigroup describing the dynamics after "arrivals". Generators of the relevant perturbations are characterized, and several examples, both commutative and a non-commutative, are discussed, elucidating the problem of standard representation.

  16. Animal models of excessive alcohol consumption in rodents.

    Science.gov (United States)

    Becker, Howard C

    2013-01-01

    Numerous animal models have been developed to study excessive alcohol consumption in rodents. Use of such models has played a valuable role in elucidating biological underpinnings and environmental factors that mediate/promote excessive levels of alcohol drinking. A major obstacle in this work has been the need to overcome the natural tendency of rodents to either avoid alcohol or consume it in limited amounts that typically do not produce overt signs of intoxication. A variety of experimental approaches that entail modifying genetic and/or environmental factors have been employed to address this general problem and demonstrate excessive levels of alcohol consumption. Five different approaches that characterize animal models of excessive alcohol consumption are described: models that involve (a) scheduled access to alcohol; (b) scheduled periods of alcohol deprivation; (c) scheduled intermittent access to alcohol; (d) scheduled-induced polydipsia; and (e) dependence and withdrawal experience. Each of the models possesses unique experimental features that engender excessive levels of alcohol consumption. Both advantages and disadvantages for each model are described along with discussion of future challenges to be considered in developing more optimal models. Ultimately, the validity and usefulness of these models will lie in their ability to serve as a platform for studying biological underpinnings and environmental influences that drive increased motivation for alcohol seeking and consumption, as well as evaluation of treatment strategies that effectively reduce excessive levels of alcohol consumption.

  17. Acquisition: Direct Care Medical Services Contracts

    Science.gov (United States)

    2004-06-24

    implementation of a management structure for the procurement of services . National Defense Authorization Act for FY 2001. The National Defense...and implement a management structure for the procurement of services for DoD. The management structure was to include a designated official for each...Military Department, Defense agency, and DoD Component. The designated official would be responsible for managing the procurement of services and

  18. Propylene Glycol Poisoning From Excess Whiskey Ingestion: A Case of High Osmolal Gap Metabolic Acidosis.

    Science.gov (United States)

    Cunningham, Courtney A; Ku, Kevin; Sue, Gloria R

    2015-01-01

    In this report, we describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol. Recently, several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication. Our patient endorsed drinking large volumes of cinnamon flavored whiskey, which was likely Fireball Cinnamon Whisky. To our knowledge, this is the first case of propylene glycol toxicity from an intentional ingestion of liquor containing propylene glycol.

  19. Artificial Dietotherapy in a Patient with an Excess Neck Enteric Graft Loop

    Directory of Open Access Journals (Sweden)

    G. N. Shcherbakova

    2006-01-01

    Full Text Available Postoperative complications have been a cardinal problem of reparative operations on the esophagus for many years. Attempts to make an artificial esophagus have frequently ended with anastomotic failure or pyoseptic complications, which is largely associated with significant metabolic disturbances in patients. The adequate preoperative and postoperative parenteral and enteral feeding programs developed at the Russian Surgery Research Center, Russian Academy of Medical Sciences, show their considerable impact on the results of surgical activities. The paper gives a clinical example of the specific features of management of a female patient with an excess neck enteric graft loop after retrosternal enteric esophagoplasty.

  20. Hostility among adolescents in Switzerland? multivariate relations between excessive media use and forms of violence.

    Science.gov (United States)

    Kuntsche, Emmanuel N

    2004-03-01

    To determine what kind of violence-related behavior or opinion is directly related to excessive media use among adolescents in Switzerland. A national representative sample of 4222 schoolchildren (7th- and 8th-graders; mean age 13.9 years) answered questions on the frequency of television-viewing, electronic game-playing, feeling unsafe at school, bullying others, hitting others, and fighting with others, as part of the Health Behaviour in School-Aged Children (HBSC) international collaborative study protocol. The Chi-square tests and multiple logistic regression analyses were applied to high-risk groups of adolescents. For the total sample, all bivariate relationships between television-viewing/electronic game-playing and each violence-related variable are significant. In the multivariate comparison, physical violence among boys ceases to be significant. For girls, only television-viewing is linked to indirect violence. Against the hypothesis, females' electronic game-playing only had a bearing on hitting others. Experimental designs are needed that take into account gender, different forms of media, and violence to answer the question of whether excessive media use leads to violent behavior. With the exception of excessive electronic game-playing among girls, this study found that electronic media are not thought to lead directly to real-life violence but to hostility and indirect violence.

  1. [Career preferences among medical students].

    Science.gov (United States)

    Soethout, Marc B M; ten Cate, Olle Th J

    2014-01-01

    Research on the preference of medical specialty among medical students in the Netherlands and the attractiveness of aspects of the medical profession during the period 2009-2013. Retrospective, descriptive research. Data from medical students in the Netherlands who participated in the computer programme Inventory Medical Professionals Choice (IMBK) were analyzed with respect to their preference of medical specialty and the attractiveness of various aspects of the medical profession. The IMBK programme was available free of charge through the Royal Dutch Medical Association (KNMG) website 'Arts in Spe' (Future Physician) during the period 2009-2013. The content of the IMBK programme was based on the questionnaire from the medical profile book developed by the pharmaceutical company GlaxoSmithKline (GSK). General practice was the most popular specialty, particularly among female medical students, with interest increasing during the undergraduate medical curriculum. Hardly any students were interested in insurance medicine, occupational medicine and elderly medicine. Direct patient care was the most attractive professional aspect for medical students. Female students were more attracted to direct and prolonged patient contact than their male counterparts. The number of hours students wished to work in future declined during the course of the undergraduate curriculum, and women were more inclined to prefer regular working hours with adequate leisure time than men. During the course of the undergraduate medical curriculum, medical students changed their preference for medical specialty. Major differences exist between male and female students in terms of preference of medical specialty and attractiveness of aspects of the medical profession.

  2. Excess Readmission vs Excess Penalties: Maximum Readmission Penalties as a Function of Socioeconomics and Geography.

    Science.gov (United States)

    Caracciolo, Chris; Parker, Devin; Marshall, Emily; Brown, Jeremiah

    2017-08-01

    The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with "excess" readmissions up to 3% of Medicare reimbursement. Approximately 75% of eligible hospitals received penalties, worth an estimated $428 million, in fiscal year 2015. To identify demographic and socioeconomic disparities between matched and localized maximum-penalty and no-penalty hospitals. A case-control study in which cases included were hospitals to receive the maximum 3% penalty under the HRRP during the 2015 fiscal year. Controls were drawn from no-penalty hospitals and matched to cases by hospital characteristics (primary analysis) or geographic proximity (secondary analysis). A selectiion of 3383 US hospitals eligible for HRRP. Thirty-nine case and 39 control hospitals from the HRRP cohort. Socioeconomic status variables were collected by the American Community Survey. Hospital and health system characteristics were drawn from Centers for Medicare and Medicaid Services, American Hospital Association, and Dartmouth Atlas of Health Care. The statistical analysis was conducted using Student t tests. Thirty-nine hospitals received a maximum penalty. Relative to controls, maximum-penalty hospitals in counties with lower SES profiles are defined by increased poverty rates (19.1% vs 15.5%, = 0.015) and lower rates of high school graduation (82.2% vs 87.5%, = 0.001). County level age, sex, and ethnicity distributions were similar between cohorts. Cases were more likely than controls to be in counties with low socioeconomic status; highlighting potential unintended consequences of national benchmarks for phenomena underpinned by environmental factors; specifically, whether maximum penalties under the HRRP are a consequence of underperforming hospitals or a manifestation of underserved communities.

  3. Isomorphic classical molecular dynamics model for an excess electronin a supercritical fluid

    Energy Technology Data Exchange (ETDEWEB)

    Miller III, Thomas F.

    2008-08-04

    Ring polymer molecular dynamics (RPMD) is used to directly simulate the dynamics of an excess electron in a supercritical fluid over a broad range of densities. The accuracy of the RPMD model is tested against numerically exact path integral statistics through the use of analytical continuation techniques. At low fluid densities, the RPMD model substantially underestimates the contribution of delocalized states to the dynamics of the excess electron. However, with increasing solvent density, the RPMD model improves, nearly satisfying analytical continuation constraints at densities approaching those of typical liquids. In the high density regime, quantum dispersion substantially decreases the self-diffusion of the solvated electron. In this regime where the dynamics of the electron is strongly coupled to the dynamics of the atoms in the fluid, trajectories that can reveal diffusive motion of the electron are long in comparison to {beta}{h_bar}.

  4. Flavored Dark Matter and the Galactic Center Gamma-Ray Excess

    Energy Technology Data Exchange (ETDEWEB)

    Agrawal, Prateek; Batell, Brian; Hooper, Dan; Lin, Tongyan

    2014-09-01

    Thermal relic dark matter particles with a mass of 31-40 GeV and that dominantly annihilate to bottom quarks have been shown to provide an excellent description of the excess gamma rays observed from the center of the Milky Way. Flavored dark matter provides a well-motivated framework in which the dark matter can dominantly couple to bottom quarks in a flavor-safe manner. We propose a phenomenologically viable model of bottom flavored dark matter that can account for the spectral shape and normalization of the gamma-ray excess while naturally suppressing the elastic scattering cross sections probed by direct detection experiments. This model will be definitively tested with increased exposure at LUX and with data from the upcoming high-energy run of the Large Hadron Collider (LHC).

  5. The 750 GeV diphoton excess as a first light on supersymmetry breaking

    Directory of Open Access Journals (Sweden)

    J.A. Casas

    2016-08-01

    Full Text Available One of the most exciting explanations advanced for the recent diphoton excess found by ATLAS and CMS is in terms of sgoldstino decays: a signal of low-energy supersymmetry-breaking scenarios. The sgoldstino, a scalar, couples directly to gluons and photons, with strength related to gaugino masses, that can be of the right magnitude to explain the excess. However, fitting the suggested resonance width, Γ≃45 GeV, is not so easy. In this paper we explore efficient possibilities to enhance the sgoldstino width, via the decay into two Higgses, two Higgsinos and through mixing between the sgoldstino and the Higgs boson. In addition, we present an alternative and more efficient mechanism to generate a mass splitting between the scalar and pseudoscalar components of the sgoldstino, which has been suggested as an interesting alternative explanation to the apparent width of the resonance.

  6. Galactic center GeV gamma-ray excess, from dark matter with gauged lepton numbers

    Directory of Open Access Journals (Sweden)

    Jong-Chul Park

    2016-01-01

    Full Text Available The recently observed excess in gamma-ray signal near the Galactic center suggests that dark matter particles may annihilate into charged fermions that produce gamma-ray to be observed. In this paper, we consider a leptonic dark matter, which annihilates into the standard model leptons, μ+μ− and τ+τ−, by the interaction of the gauged lepton number U(1Lμ−Lτ and fits the observed excess. Interestingly, the necessary annihilation cross section for the observed gamma-ray flux provides a good fit to the value for the relic abundance of dark matter. We identify the preferred parameter space of the model after taking the existing experimental constraints from the precision measurements including the muon (g−2, tau decay, neutrino trident production, dark matter direct detection, LHC, and LEP experiments.

  7. Excess Gestational Weight Gain in Pregnancy and the Role of Lifestyle Intervention.

    Science.gov (United States)

    Goldstein, Rebecca; Teede, Helena; Thangaratinam, Shakila; Boyle, Jacqueline

    2016-03-01

    With increasingly adverse lifestyles, young women in many countries have rapid weight gain and rising obesity. In keeping with this, most pregnant women exceed recommended gestational weight gain (GWG) and then retain weight postpartum. The consequences of excess GWG include maternal risks during pregnancy, neonatal risks and maternal obesity and chronic disease longer term, presenting a significant public health and economic burden worldwide. This article discusses the adverse maternal and infant risks with excess GWG apparent from observational studies, summarizes the existing guidelines for optimal GWG and highlights the need for further research to identify optimal GWG recommendations across the different ethnicities and weight ranges.We also review the evidence for lifestyle interventions in pregnancy to prevent excess GWG and highlighting the work underway to integrate large scale meta-analyses of individual patient data from lifestyle intervention studies to inform clinical practice beyond current observational data. Finally, we address the need to implement lifestyle interventions into routine pregnancy care to improve short and long term maternal health outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Excess electrons in ice: a density functional theory study.

    Science.gov (United States)

    Bhattacharya, Somesh Kr; Inam, Fakharul; Scandolo, Sandro

    2014-02-21

    We present a density functional theory study of the localization of excess electrons in the bulk and on the surface of crystalline and amorphous water ice. We analyze the initial stages of electron solvation in crystalline and amorphous ice. In the case of crystalline ice we find that excess electrons favor surface states over bulk states, even when the latter are localized at defect sites. In contrast, in amorphous ice excess electrons find it equally favorable to localize in bulk and in surface states which we attribute to the preexisting precursor states in the disordered structure. In all cases excess electrons are found to occupy the vacuum regions of the molecular network. The electron localization in the bulk of amorphous ice is assisted by its distorted hydrogen bonding network as opposed to the crystalline phase. Although qualitative, our results provide a simple interpretation of the large differences observed in the dynamics and localization of excess electrons in crystalline and amorphous ice films on metals.

  9. Twentieth century surge of excess adult male mortality

    Science.gov (United States)

    Beltrán-Sánchez, Hiram; Finch, Caleb E.; Crimmins, Eileen M.

    2015-01-01

    Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal—a large excess of female life expectancy in adulthood—is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50–70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50–70 for cohorts born in 1900–1935. However, after accounting for smoking, substantial excess male mortality at ages 50–70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors. PMID:26150507

  10. Excess healthcare costs of a large waterborne outbreak in Finland.

    Science.gov (United States)

    Huovinen, Elisa; Laine, Janne; Virtanen, Mikko J; Snellman, Marja; Hujanen, Timo; Kiiskinen, Urpo; Kujansuu, Eila; Lumio, Jukka; Ruutu, Petri; Kuusi, Markku

    2013-11-01

    The economic effects of waterborne outbreaks have rarely been reported. A large waterborne outbreak occurred in the town of Nokia in Finland in 2007 with half of the population in the contaminated area suffering from gastroenteritis. We studied the healthcare costs of this outbreak. Healthcare costs were studied using register data from the Nokia Health Care Centre, data collected in the regional university hospital, and data from laboratory register on stool samples. Total excess healthcare costs were EUR 354,496, which is approximately EUR 10 per resident of Nokia. There were 2052 excess visits because of gastroenteritis in Nokia Health Care Centre, 403 excess episodes in the university hospital, and altogether over 2000 excess stool samples due to the outbreak. Care in the Nokia Health Care Centre accounted for 44% and care in the university hospital for 42% of the excess healthcare costs while stool samples accounted for only 10%. Despite the high morbidity, the total cost was low because most patients had a relatively mild illness. The situation would have been worse if the microbes involved had been more hazardous or if the financial situation of the community had been worse. Prevention of waterborne outbreaks is important, as there is a risk of severe short- and long-term health effects and substantial health-economic costs.

  11. Patient-specific electronic decision support reduces prescription of excessive doses.

    Science.gov (United States)

    Seidling, H M; Schmitt, S P W; Bruckner, T; Kaltschmidt, J; Pruszydlo, M G; Senger, C; Bertsche, T; Walter-Sack, I; Haefeli, W E

    2010-10-01

    Prescription of excessive doses is the most common prescription error, provoking dose-dependent adverse drug reactions. Clinical decision support systems (CDSS) can prevent prescription errors especially when mainly clinically relevant warnings are issued. We have built and evaluated a CDSS providing upper dose limits personalised to individual patient characteristics thus guaranteeing for specific warnings. For 170 compounds, detailed information on upper dose limits (according to the drug label) was compiled. A comprehensive software-algorithm extracted relevant patient information from the electronic chart (eg, age, renal function, comedication). The CDSS was integrated into the local prescribing platform for outpatients and patients at discharge, providing immediate dosage feedback. Its impact was evaluated in a 90-day intervention study (phase 1: baseline; phase 2: intervention). Outcome measures were frequency of excessive doses before and after intervention considering potential induction of new medication errors. Moreover, predictors for alert adherence were analysed. In phase 1, 552 of 12,197 (4.5%) prescriptions exceeded upper dose limits. In phase 2, initially 559 warnings were triggered (4.8%, p=0.37). Physicians were responsive to one in four warnings mostly adjusting dosages. Thus, the final prescription rate of excessive doses was reduced to 3.6%, with 20% less excessive doses compared with baseline (pprescription errors were induced. Physicians' alert adherence correlated with patients' age, prescribed drug class, and reason for the alert. During the 90-day study, implementation of a highly specific algorithm-based CDSS substantially improved prescribing quality with a high acceptance rate compared with previous studies.

  12. EXCESSIVE WEIGHT – MUSCLE DEPLETION PARADOX AND CARDIOVASCULAR RISK FACTORS IN OUTPATIENTS WITH INFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Maria Izabel Siqueira de ANDRADE

    2015-03-01

    Full Text Available Background Evidence suggests a nutritional transition process in patients with inflammatory bowel disease. Obesity, which was once an uncommon occurrence in such patients, has grown in this population at the same prevalence rate as that found in the general population, bringing with it an increased risk of cardiovascular disease. Objective The aim of the present study was to determine the nutritional status and occurrence of cardiovascular risk factors in patients with inflammatory bowel disease. Methods A case-series cross-sectional study was conducted involving male and female adult outpatients with inflammatory bowel disease. Data were collected on demographic, socioeconomic, clinical and anthropometric variables as well as the following cardiovascular risk factors: sedentary lifestyle, excess weight, abdominal obesity, medications in use, comorbidities, alcohol intake and smoking habits. The significance level for all statistical tests was set to 5% (P< 0.05. Results The sample comprised 80 patients with inflammatory bowel disease, 56 of whom (70.0% had ulcerative colitis and 24 of whom (30.0% had Crohn's disease. Mean age was 40.3±11 years and the female genre accounted for 66.2% of the sample. High frequencies of excess weight (48.8% and abdominal obesity (52.5% were identified based on the body mass index and waist circumference, respectively, in both groups, especially among those with ulcerative colitis. Muscle depletion was found in 52.5% of the sample based on arm muscle circumference, with greater depletion among patients with Crohn’s disease (P=0.008. The most frequent risk factors for cardiovascular disease were a sedentary lifestyle (83.8%, abdominal obesity (52.5% and excess weight (48.8%. Conclusion The results of the complete anthropometric evaluation draw one’s attention to a nutritional paradox, with high frequencies of both - muscle depletion, as well as excess weight and abdominal obesity.

  13. Can standardized sleep questionnaires be used to identify excessive daytime sleeping in older post-acute rehabilitation patients?

    Science.gov (United States)

    Skibitsky, Megan; Edelen, Maria Orlando; Martin, Jennifer L; Harker, Judith; Alessi, Cathy; Saliba, Debra

    2012-02-01

    Excessive daytime sleeping is associated with poorer functional outcomes in rehabilitation populations and may be improved with targeted interventions. The purpose of this study was to test simple methods of screening for excessive daytime sleeping among older adults admitted for postacute rehabilitation. Secondary analysis of data from 2 clinical samples. Two postacute rehabilitation (PAR) units in southern California. Two hundred twenty-six patients older than 65 years with Mini-Mental State Examination (MMSE) score higher than 11 undergoing rehabilitation. The primary outcome was excessive daytime sleeping, defined as greater than 15% (1.8 hours) of daytime hours (8 am to 8 pm) sleeping as measured by actigraphy. Participants spent, on average, 16.2% (SD 12.5%) of daytime hours sleeping as measured by actigraphy. Thirty-nine percent of participants had excessive daytime sleeping. The Pittsburgh Sleep Quality Index (PSQI) was significantly associated with actigraphically measured daytime sleeping (P = .0038), but the Epworth Sleepiness Scale (ESS) was not (P = .49). Neither the ESS nor the PSQI achieved sufficient sensitivity and specificity to be used as a screening tool for excessive daytime sleeping. Two additional models using items from these questionnaires were not significantly associated with the outcome. In an older PAR population, self-report items from existing sleep questionnaires do not identify excessive daytime sleeping. Therefore we recommend objective measures for the evaluation of excessive daytime sleeping as well as further research to identify new self-report items that may be more applicable in PAR populations. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  14. Recent advances in the treatment and management of excessive daytime sleepiness.

    Science.gov (United States)

    Black, Jed; Duntley, Stephen P; Bogan, Richard K; O'Malley, Mary B

    2007-02-01

    Excessive daytime sleepiness (EDS) is a prevalent complaint among patients in psychiatric care. Patients with conditions of EDS have often been misdiagnosed with depression due to their complaints of lack of energy, poor concentration, memory disturbance, and a reduced interest in life. Impaired alertness associated with EDS can be detrimental to a person's quality of life by causing decreased work performance, self-consciousness, low self esteem, and social isolation. Excessive sleepiness is also associated with various health problems, comorbid medical and psychiatric conditions, and fatal accidents occurring after the driver has fallen asleep at the wheel. Contributing factors leading to EDS range from insufficient sleep hours to central nervous system-mediated debilitating hypersomnolence. Circadian rhythm disorders, sleep disorders such as obstructive sleep apnea and narcolepsy, and medications that cause sleepiness may also contribute to symptoms of EDS. Recognition of the symptoms of sleep deprivation is essential, as many such patients do not have a clear awareness of their own sleepiness. Treatment options, depending upon the condition, include light therapy or appropriate airway management techniques such as nasal continuous positive airway pressure (CPAP). Occasionally, wakefulness-promoting medications are necessary, particularly in patients with narcolepsy. In this expert roundtable supplement, Stephen P. Duntley, MD, reviews the definition and prevalence of EDS and discusses the contributing factors and consequences of daytime sleepiness. Next, Richard K. Bogan, MD, FCCP, gives an overview of the differential diagnosis of EDS and the assessment tools available for identifying sleepiness in symptomatic patients. Finally, Mary B. O'Malley, MD, PhD, reviews treatment of EDS, including counseling on sleep hygiene and duration of sleep, mechanical treatments, bright-light therapy, and wake-promoting medications.

  15. The Directed Case Method.

    Science.gov (United States)

    Cliff, William H.; Curtin, Leslie Nesbitt

    2000-01-01

    Provides an example of a directed case on human anatomy and physiology. Uses brief real life newspaper articles and clinical descriptions of medical reference texts to describe an actual, fictitious, or composite event. Includes interrelated human anatomy and physiology topics in the scenario. (YDS)

  16. Excess body weight during pregnancy and offspring obesity: potential mechanisms.

    Science.gov (United States)

    Paliy, Oleg; Piyathilake, Chandrika J; Kozyrskyj, Anita; Celep, Gulcin; Marotta, Francesco; Rastmanesh, Reza

    2014-03-01

    The rates of child and adult obesity have increased in most developed countries over the past several decades. The health consequences of obesity affect both physical and mental health, and the excess body weight can be linked to an elevated risk for developing type 2 diabetes, cardiovascular problems, and depression. Among the factors that can influence the development of obesity are higher infant weights and increased weight gain, which are associated with higher risk for excess body weight later in life. In turn, mother's excess body weight during and after pregnancy can be linked to the risk for offspring overweight and obesity through dietary habits, mode of delivery and feeding, breast milk composition, and through the influence on infant gut microbiota. This review considers current knowledge of these potential mechanisms that threaten to create an intergenerational cycle of obesity. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. The excess in the hate discourse of the haters

    Directory of Open Access Journals (Sweden)

    Rebeca Recuero Rebs

    2017-11-01

    Full Text Available The article aims to identify and comprehend the marks of the excess present in the hate discourse of the haters. By using the power of social media’s information diffusion on the internet, the haters appropriate of such spaces to disseminate ideologies related to violence, intending to generate more hate. Among the strategies utilized by this group, there is the excess. However, it is necessary to understand the subject’s social and historical contexts and the meanings of their discourse in these environments. As the corpus, we start off the analysis from the attacks towards the actress Taís Araújo occurred on Facebook. As shown by the results, the excess is perceived on authority demonstrations, on the repetition of ideals and onto the search of values such as visibility, popularity (among participants of the networks and the media, authority and reputation (inside the hater’s group of belonging.elonging.

  18. ATLAS diboson excess from low scale supersymmetry breaking

    Energy Technology Data Exchange (ETDEWEB)

    Petersson, Christoffer [Department of Fundamental Physics, Chalmers University of Technology,412 96 Göteborg (Sweden); Physique Théorique et Mathématique, Université Libre de Bruxelles,C.P. 231, 1050 Brussels (Belgium); International Solvay Institutes,1050 Brussels (Belgium); Torre, Riccardo [Dipartimento di Fisica e Astronomia, Università di Padova and INFN Sezione di Padova,Via Marzolo 8, I-35131 Padova (Italy)

    2016-01-18

    We provide an interpretation of the recent ATLAS diboson excess in terms of a class of supersymmetric models in which the scale of supersymmetry (SUSY) breaking is in the few TeV range. The particle responsible for the excess is the scalar superpartner of the Goldstone fermion associated with SUSY breaking, the sgoldstino. This scalar couples strongly to the Standard Model vector bosons and weakly to the fermions, with all coupling strengths determined by ratios of soft SUSY breaking parameters over the SUSY breaking scale. Explaining the ATLAS excess selects particular relations and ranges for the gaugino masses, while imposing no constraints on the other superpartner masses. Moreover, this signal hypothesis predicts a rate in the Zγ final state that is expected to be observable at the LHC Run II already with a few fb{sup −1} of integrated luminosity.

  19. Internet Addiction and Excessive Social Networks Use: What About Facebook?

    Science.gov (United States)

    Guedes, Eduardo; Sancassiani, Federica; Carta, Mauro Giovani; Campos, Carlos; Machado, Sergio; King, Anna Lucia Spear; Nardi, Antonio Egidio

    2016-01-01

    Facebook is notably the most widely known and used social network worldwide. It has been described as a valuable tool for leisure and communication between people all over the world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype. PMID:27418940

  20. Internet Addiction and Excessive Social Networks Use: What About Facebook?

    Science.gov (United States)

    Guedes, Eduardo; Sancassiani, Federica; Carta, Mauro Giovani; Campos, Carlos; Machado, Sergio; King, Anna Lucia Spear; Nardi, Antonio Egidio

    2016-01-01

    Facebook is notably the most widely known and used social network worldwide. It has been described as a valuable tool for leisure and communication between people all over the world. However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.

  1. Merits of excess bagasse as fuel for generating electricity. [Florida

    Energy Technology Data Exchange (ETDEWEB)

    Perea, P.

    1981-05-01

    The rising cost of fuel oil improves the economics for sugar factories of using excess bagasse to produce more electricity than they require for sale to the public utility companies. Recently, the United States Sugar Corporation, in Florida, initiated the operation of a 20 MW plant fueled with excess bagasse only, and the electricity it generates is sold to a local utility. This constitutes a saving of 10 million liters of oil per year. The operating cycle is described of a system of high-pressure boilers and automatically controlled turbogenerator for the production of energy from bagasse. This system is a pre-engineered design which is very simple to install and operate and can be fitted in with the electric-generating installations which are normally found in practically any sugar factory without making significant modifications to the factory. An economic analysis is presented of power generation using excess bagasse for a 3MW unit and a 4MW unit.

  2. Paradoxical hypomagnesemia caused by excessive ingestion of magnesium hydroxide.

    Science.gov (United States)

    Joo Suk, Oh

    2008-09-01

    Excessive ingestion of magnesium may lead to hypermagnesemia even without kidney dysfunction. Several cases of development of hypermagnesemia after overdose of magnesium hydroxide have been reported. Although magnesium hydroxide is widely used as laxative, its overdose may induce diarrhea, which is followed by excessive magnesium loss. I report a case of paradoxical hypomagnesemia developed after excessive ingestion of magnesium hydroxide. A 39-year-old woman was presented to the emergency department complaining of severe watery diarrhea and carpopedal spasm after ingesting a handful of magnesium hydroxide tablets. The laboratory tests detected hypomagnesemia, hypocalcemia, and normokalemia. Calcium gluconate was given to the patient, but her symptom did not improve shortly. The symptom disappeared spontaneously 2 days after the watery diarrhea subsided. This case shows that overdose of magnesium hydroxide, which leads to massive diarrhea, might induce hypomagnesemia unexpectedly. This case also suggests that it should be treated, as well as typical magnesium deficiency.

  3. Excessive computer game playing: evidence for addiction and aggression?

    Science.gov (United States)

    Grüsser, S M; Thalemann, R; Griffiths, M D

    2007-04-01

    Computer games have become an ever-increasing part of many adolescents' day-to-day lives. Coupled with this phenomenon, reports of excessive gaming (computer game playing) denominated as "computer/video game addiction" have been discussed in the popular press as well as in recent scientific research. The aim of the present study was the investigation of the addictive potential of gaming as well as the relationship between excessive gaming and aggressive attitudes and behavior. A sample comprising of 7069 gamers answered two questionnaires online. Data revealed that 11.9% of participants (840 gamers) fulfilled diagnostic criteria of addiction concerning their gaming behavior, while there is only weak evidence for the assumption that aggressive behavior is interrelated with excessive gaming in general. Results of this study contribute to the assumption that also playing games without monetary reward meets criteria of addiction. Hence, an addictive potential of gaming should be taken into consideration regarding prevention and intervention.

  4. Fetal Programming of Obesity: Maternal Obesity and Excessive Weight Gain

    Directory of Open Access Journals (Sweden)

    Seray Kabaran

    2014-10-01

    Full Text Available The prevalence of obesity is an increasing health problem throughout the world. Maternal pre-pregnancy weight, maternal nutrition and maternal weight gain are among the factors that can cause childhood obesity. Both maternal obesity and excessive weight gain increase the risks of excessive fetal weight gain and high birth weight. Rapid weight gain during fetal period leads to changes in the newborn body composition. Specifically, the increase in body fat ratio in the early periods is associated with an increased risk of obesity in the later periods. It was reported that over-nutrition during fetal period could cause excessive food intake during postpartum period as a result of metabolic programming. By influencing the fetal metabolism and tissue development, maternal obesity and excessive weight gain change the amounts of nutrients and metabolites that pass to the fetus, thus causing excessive fetal weight gain which in turn increases the risk of obesity. Fetal over-nutrition and excessive weight gain cause permanent metabolic and physiologic changes in developing organs. While mechanisms that affect these organs are not fully understood, it is thought that the changes may occur as a result of the changes in fetal energy metabolism, appetite control, neuroendocrine functions, adipose tissue mass, epigenetic mechanisms and gene expression. In this review article, the effects of maternal body weight and weight gain on fetal development, newborn birth weight and risk of obesity were evaluated, and additionally potential mechanisms that can explain the effects of fetal over-nutrition on the risk of obesity were investigated [TAF Prev Med Bull 2014; 13(5.000: 427-434

  5. Excessive recreational computer use and food consumption behaviour among adolescents

    Directory of Open Access Journals (Sweden)

    Mao Yuping

    2010-08-01

    Full Text Available Abstract Introduction Using the 2005 California Health Interview Survey (CHIS data, we explore the association between excessive recreational computer use and specific food consumption behavior among California's adolescents aged 12-17. Method The adolescent component of CHIS 2005 measured the respondents' average number of hours spent on viewing TV on a weekday, the average number of hours spent on viewing TV on a weekend day, the average number of hours spent on playing with a computer on a weekday, and the average number of hours spent on playing with computers on a weekend day. We recode these four continuous variables into four variables of "excessive media use," and define more than three hours of using a medium per day as "excessive." These four variables are then used in logistic regressions to predict different food consumption behaviors on the previous day: having fast food, eating sugary food more than once, drinking sugary drinks more than once, and eating more than five servings of fruits and vegetables. We use the following variables as covariates in the logistic regressions: age, gender, race/ethnicity, parental education, household poverty status, whether born in the U.S., and whether living with two parents. Results Having fast food on the previous day is associated with excessive weekday TV viewing (O.R. = 1.38, p Conclusion Excessive recreational computer use independently predicts undesirable eating behaviors that could lead to overweight and obesity. Preventive measures ranging from parental/youth counseling to content regulations might be addressing the potential undesirable influence from excessive computer use on eating behaviors among children and adolescents.

  6. Minimal Coleman-Weinberg theory explains the diphoton excess

    DEFF Research Database (Denmark)

    Antipin, Oleg; Mojaza, Matin; Sannino, Francesco

    2016-01-01

    the introduction of an extra singlet scalar further coupled to new fermions. In this constrained setup the Higgs mass was close to the observed value and the new scalar mass was below a TeV scale. Here we first extend the previous analysis by taking into account the important difference between running mass...... and pole mass of the scalar states. We then investigate whether these theories can account for the 750 GeV excess in diphotons observed by the LHC collaborations. New QCD-colored fermions in the TeV mass range coupled to the new scalar state are needed to describe the excess. We further show, by explicit...

  7. Excess mortality in persons with severe mental disorders

    DEFF Research Database (Denmark)

    Liu, Nancy H; Daumit, Gail L; Dua, Tarun

    2017-01-01

    Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base...... by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions...

  8. Real exchange rate persistence and the excess return puzzle

    DEFF Research Database (Denmark)

    Juselius, Katarina; Assenmacher, Katrin

    2017-01-01

    The PPP puzzle refers to the wide swings of nominal exchange rates around their long-run equilibrium values whereas the excess return puzzle represents the persistent deviation of the domestic-foreign interest rate differential from the expected change in the nominal exchange rate. Using the I(2)...... knowledge based expectations rather than so-called "rational expectations".......The PPP puzzle refers to the wide swings of nominal exchange rates around their long-run equilibrium values whereas the excess return puzzle represents the persistent deviation of the domestic-foreign interest rate differential from the expected change in the nominal exchange rate. Using the I(2...

  9. Management of excessive gingival display: Lip repositioning technique

    Directory of Open Access Journals (Sweden)

    Upasana Sthapak

    2015-01-01

    Full Text Available The lips form the frame of a smile and define the esthetic zone. Excessive gingival display during smile is often referred to as "gummy smile". A successful management of excessive gingival display with lip repositioning procedure has shown excellent results. The procedure involves removing a strip of partial thickness mucosa from maxillary vestibule, then suturing it back to the lip mucosa at the level of mucogingival junction. This technique results in restricted muscle pull and a narrow vestibule, thereby reducing the gingival display. In this case gummy smile was treated by modification of Rubinstein and Kostianovsky′s surgical lip repositioning technique which resulted in a harmonious smile.

  10. Excess europium content in Precambrian sedimentary rocks and continental evolution

    Science.gov (United States)

    Jakes, P.; Taylor, S. R.

    1974-01-01

    It is proposed that the europium excess in Precambrian sedimentary rocks, relative to those of younger age, is derived from volcanic rocks of ancient island arcs, which were the source materials for the sediments. Precambrian sedimentary rocks and present-day volcanic rocks of island arcs have similar REE patterns, total REE abundances, and excess Eu, relative to the North American shale composite. The present upper crustal REE pattern, as exemplified by that of sediments, is depleted in Eu, relative to chondrites. This depletion is considered to be a consequence of development of a granodioritic upper crust by partial melting in the lower crust, which selectively retains europium.

  11. Medical therapy in acromegaly.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2011-05-01

    Acromegaly is a rare disease characterized by excess secretion of growth hormone (GH) and increased circulating insulin-like growth factor 1 (IGF-1) concentrations. The disease is associated with increased morbidity and premature mortality, but these effects can be reduced if GH levels are decreased to <2.5 μg\\/l and IGF-1 levels are normalized. Therapy for acromegaly is targeted at decreasing GH and IGF-1 levels, ameliorating patients\\' symptoms and decreasing any local compressive effects of the pituitary adenoma. The therapeutic options for acromegaly include surgery, radiotherapy and medical therapies, such as dopamine agonists, somatostatin receptor ligands and the GH receptor antagonist pegvisomant. Medical therapy is currently most widely used as secondary treatment for persistent or recurrent acromegaly following noncurative surgery, although it is increasingly used as primary therapy. This Review provides an overview of current and future pharmacological therapies for patients with acromegaly.

  12. Medical error

    African Journals Online (AJOL)

    QuickSilver

    Studies in the USA have shown that medical error is the 8th most common cause of death.2,3. The most common causes of medical error are:- administration of the wrong medication or wrong dose of the correct medication, using the wrong route of administration, giving a treatment to the wrong patient or at the wrong time.4 ...

  13. Drinking Patterns of Older Adults with Chronic Medical Conditions

    National Research Council Canada - National Science Library

    Ryan, Marian; Merrick, Elizabeth L; Hodgkin, Dominic; Horgan, Constance M; Garnick, Deborah W; Panas, Lee; Ritter, Grant; Blow, Frederic C; Saitz, Richard

    2013-01-01

    ... medication use, and the potential consequences of excessive drinking in this population.To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic...

  14. Evidence for an excess of soft photons in hadronic decays of $Z^{0}$

    CERN Document Server

    Abdallah, J; Adam, W; Adzic, P; Albrecht, T; Alderweireld, T; Alemany-Fernandez, R; Allmendinger, T; Allport, P P; Amaldi, Ugo; Amapane, N; Amato, S; Anashkin, E; Andreazza, A; Andringa, S; Anjos, N; Antilogus, P; Apel, W D; Arnoud, Y; Ask, S; Åsman, B; Augustin, J E; Augustinus, A; Baillon, Paul; Ballestrero, A; Bambade, P; Barbier, R; Bardin, D; Barker, G J; Baroncelli, A; Battaglia, M; Baubillier, M; Becks, K H; Begalli, M; Behrmann, A; Ben-Haim, E; Benekos, N; Benvenuti, A C; Bérat, C; Berggren, M; Berntzon, L; Bertrand, D; Besançon, M; Besson, N; Bloch, D; Blom, M; Bluj, M; Bonesini, M; Boonekamp, M; Booth, P S L; Borisov, G; Botner, O; Bouquet, B; Bowcock, T J V; Boyko, I; Bracko, M; Brenner, R; Brodet, E; Brückman, P; Brunet, J M; Buschbeck, Brigitte; Buschmann, P; Calvi, M; Camporesi, T; Canale, V; Carena, F; Castro, N; Cavallo, F; Chapkin, M; Charpentier, P; Checchia, P; Chierici, R; Shlyapnikov, P; Chudoba, J; Chung, S U; Cieslik, K; Collins, P; Contri, R; Cosme, G; Cossutti, F; Costa, M J; Crennell, D J; Cuevas-Maestro, J; D'Hondt, J; Dalmau, J; Da Silva, T; Da Silva, W; Della Ricca, G; De Angelis, A; de Boer, Wim; De Clercq, C; De Lotto, B; De Maria, N; De Min, A; De Paula, L; Di Ciaccio, L; Di Simone, A; Doroba, K; Drees, J; Eigen, G; Ekelöf, T J C; Ellert, M; Elsing, M; Espirito-Santo, M C; Fanourakis, G K; Fassouliotis, D; Feindt, M; Fernández, J; Ferrer, A; Ferro, F; Flagmeyer, U; Föth, H; Fokitis, E; Fulda-Quenzer, F; Fuster, J; Gandelman, M; García, C; Gavillet, P; Gazis, E; Gokieli, R; Golob, B; Gómez-Ceballos, G; Gonçalves, P; Graziani, E; Grosdidier, G; Grzelak, K; Guy, J; Haag, C; Hallgren, A; Hamacher, K; Hamilton, K; Haug, S; Hauler, F; Hedberg, V; Hennecke, M; Herr, H; Hoffman, J; Holmgren, S O; Holt, P J; Houlden, M A; Hultqvist, K; Jackson, J N; Jarlskog, G; Jarry, P; Jeans, D; Johansson, E K; Johansson, P D; Jonsson, P; Joram, C; Jungermann, L; Kapusta, F; Katsanevas, S; Katsoufis, E; Kernel, G; Kersevan, B P; Kerzel, U; King, B T; Kjaer, N J; Kluit, P; Kokkinias, P; Kourkoumelis, C; Kuznetsov, O; Krumshtein, Z; Kucharczyk, M; Lamsa, J; Leder, G; Ledroit, F; Leinonen, L; Leitner, R; Lemonne, J; Lepeltier, V; Lesiak, T; Liebig, W; Liko, D; Lipniacka, A; Lopes, J H; López, J M; Loukas, D; Lutz, P; Lyons, L; MacNaughton, J; Malek, A; Maltezos, S; Mandl, F; Marco, J; Marco, R; Maréchal, B; Margoni, M; Marin, J C; Mariotti, C; Markou, A; Martínez-Rivero, C; Masik, J; Mastroyiannopoulos, N; Matorras, F; Matteuzzi, C; Mazzucato, F; Mazzucato, M; McNulty, R; Meroni, C; Migliore, E; Mitaroff, W A; Mjörnmark, U; Moa, T; Moch, M; Mönig, K; Monge, R; Montenegro, J; Moraes, D; Moreno, S; Morettini, P; Müller, U; Münich, K; Mulders, M; Mundim, L; Murray, W; Muryn, B; Myatt, G; Myklebust, T; Nassiakou, M; Navarria, Francesco Luigi; Nawrocki, K; Nicolaidou, R; Nikolenko, M; Oblakowska-Mucha, A; Obraztsov, V F; Olshevskii, A G; Onofre, A; Orava, R; Österberg, K; Ouraou, A; Oyanguren, A; Paganoni, M; Paiano, S; Palacios, J P; Palka, H; Papadopoulou, T D; Pape, L; Parkes, C; Parodi, F; Parzefall, U; Passeri, A; Passon, O; Peralta, L; Perepelitsa, V F; Perrotta, A; Petrolini, A; Piedra, J; Pieri, L; Pierre, F; Pimenta, M; Piotto, E; Podobnik, T; Poireau, V; Pol, M E; Polok, G; Pozdnyakov, V; Pukhaeva, N; Pullia, A; Rames, J; Read, A; Rebecchi, P; Rehn, J; Reid, D; Reinhardt, R; Renton, P B; Richard, F; Rídky, J; Rivero, M; Rodríguez, D; Romero, A; Ronchese, P; Roudeau, P; Rovelli, T; Ruhlmann-Kleider, V; Ryabtchikov, D; Sadovskii, A; Salmi, L; Salt, J; Sander, C; Savoy-Navarro, A; Schwickerath, U; Segar, A; Sekulin, R L; Siebel, M; Sisakian, A; Smadja, G; Smirnova, O; Sokolov, A; Sopczak, A; Sosnowski, R; Spassoff, Tz; Stanitzki, M; Stocchi, A; Strauss, J; Stugu, B; Szczekowski, M; Szeptycka, M; Szumlak, T; Tabarelli de Fatis, T; Taffard, A C; Tegenfeldt, F; Timmermans, J; Tkatchev, L G; Tobin, M; Todorovova, S; Tomé, B; Tonazzo, A; Tortosa, P; Travnicek, P; Treille, D; Tristram, G; Trochimczuk, M; Troncon, C; Turluer, M L; Tyapkin, I A; Tyapkin, P; Tzamarias, S; Uvarov, V; Valenti, G; van Dam, P; Van Eldik, J; Van Remortel, N; Van Vulpen, I; Vegni, G; Veloso, F; Venus, W; Verdier, P; Verzi, V; Vilanova, D; Vitale, L; Vrba, V; Wahlen, H; Washbrook, A J; Weiser, C; Wicke, D; Wickens, J; Wilkinson, G; Winter, M; Witek, M; Yushchenko, O P; Zalewska-Bak, A; Zalewski, P; Zavrtanik, D; Zhuravlov, V; Zimin, N I; Zintchenko, A; Zupan, M

    2006-01-01

    Soft photons inside hadronic jets converted in front of the DELPHI main tracker (TPC) in events of qqbar disintegrations of the Z^0 were studied in the kinematic range 0.2 < E_gamma < 1 GeV and transverse momentum with respect to the closest jet direction p_T < 80 MeV/c. A clear excess of photons in the experimental data as compared to the Monte Carlo predictions is observed. This excess (uncorrected for the photon detection efficiency) is (1.17 +/- 0.06 +/- 0.27) x 10^{-3} gamma/jet in the specified kinematic region, while the expected level of the inner hadronic bremsstrahlung (which is not included in the Monte Carlo) is (0.340 +/- 0.001 +/- 0.038) x 10^{-3} gamma/jet. The ratio of the excess to the predicted bremsstrahlung rate is then (3.4 +/- 0.2 +/- 0.8), which is similar in strength to the anomalous soft photon signal observed in fixed target experiments with hadronic beams.

  15. On the Issue of Excess Lower Stratospheric Subtropical Transport in GEOS-DAS

    Science.gov (United States)

    Tan, Wei-Wu; Geller, Marvin; Pawson, Steven

    2002-01-01

    In recent years, data assimilation has become an indispensable tool for our understanding of the global features of meteorological variables. However, assessments of transport characteristics using trajectory related methods as well as chemical transport models (CTMs) show that results derived from assimilated (or analyzed) winds exhibit significantly larger mixing and entrainment rates compared to results derived from GCM winds, which are closer to results derived from observations (e.g., Douglass et al., 2002; Schoeberl et al., 2002). This discrepancy presents a serious challenge to our ability to understand and model global trace gas transport and distribution. We use the GEOS-DAS to explore this issue by examining how the process of data assimilation alters the dynamics of the underlying GCM and how this leads to the excess of lower stratospheric mixing and transport in the subtropics. In particular, we show that significant model biases in tropical winds necessitate large analysis increments. These increments directly force large subtropical regions of instability with negative PV gradient on the one hand, and generate excessive noise in the tropical wind fields on the other. The result is an excess of transport in the lower stratospheric subtropics.

  16. 78 FR 73817 - Information Collection; Federal Excess Personal Property (FEPP) and Firefighter Property (FFP...

    Science.gov (United States)

    2013-12-09

    ... Forest Service Information Collection; Federal Excess Personal Property (FEPP) and Firefighter Property... currently approved information collection, Federal Excess Personal Property (FEPP) and Firefighter Property... Friday. SUPPLEMENTARY INFORMATION: Title: Federal Excess Personal Property (FEPP) and Firefighter...

  17. Directed homology

    DEFF Research Database (Denmark)

    Fahrenberg, Uli

    2004-01-01

    We introduce a new notion of directed homology for semicubical sets. We show that it respects directed homotopy and is functorial, and that it appears to enjoy some good algebraic properties. Our work has applications to higher-dimensional automata.......We introduce a new notion of directed homology for semicubical sets. We show that it respects directed homotopy and is functorial, and that it appears to enjoy some good algebraic properties. Our work has applications to higher-dimensional automata....

  18. [Medical Devices Law for anesthesiologists].

    Science.gov (United States)

    Regner, M

    2015-09-01

    The Medical Devices Law is a relatively new legal system, which has replaced the still well-known medical devices regulations in Germany. The Medical Devices Law in Germany is based on European directives, which have been translated into national law with the Medical Devices Act. The Medical Devices Act is a framework of regulations and incorporates a number of decrees that address specific topics within the medical devices directives and in turn individual regulations refer to guidelines and recommendations from other sources which provide detailed technical information on specific topics. Overall, the Medical Devices Act represents a very complex legal system, which needs to be permanently observed with respect to continuous updating and adjustment. In this article the design and the structure are described but most of all the article filters significant problem areas that need to be considered when using and operating medical devices, especially for anesthesiologists.

  19. Defense Innovation Unit Experimental (DIUX): Innovative or Excessive

    Science.gov (United States)

    2017-04-06

    AIR WAR COLLEGE AIR UNIVERSITY DEFENSE INNOVATION UNIT EXPERIMENTAL (DIUX): INNOVATIVE OR EXCESSIVE? by Roger Kuykendall, COL...technological superiority to near-peer competitors, Secretary of Defense Ashton Carter announced the establishment of the Defense Innovation Unit...or simply another layer of bureaucracy compensating for shortcomings in other areas. When viewed through the lens of innovation , DIUx is

  20. Densities and Excess Molar Volume for the Ternary Systems (1 ...

    African Journals Online (AJOL)

    methylimidazolium methyl sulphate ([BMIM]+[MeSO4]-) were determined. The ternary systems studied were ([BMIM]+[MeSO4]-+ nitromethane + methanol or ethanol or 1-propanol) at the temperatures (303.15 and 313.15) K. The ternary excess molar ...

  1. Excess Molar Volumes and Partial Molar Volumes of Binary Systems ...

    African Journals Online (AJOL)

    Excess molar volumes have been evaluated from density measurements over the entire composition range for binary systems of an ionic liquid (IL) and an alcohol at T = (298.15, 303.15 and 313.15) K. The IL is 1-butyl-3-methylimidazolium methylsulphate [BMIM]+[MeSO4]– and the alcohols are methanol, ethanol or ...

  2. On the excess attenuation of sound in the atmosphere

    Science.gov (United States)

    Deloach, R.

    1975-01-01

    The attenuation suffered by an acoustic plane wave propagating from an elevated source to the ground, in excess of absorption losses, was studied. Reported discrepancies between attenuation measurements made in the field and theories which only account for absorption losses are discussed. It was concluded that the scattering of sound by turbulence results in a nonnegligible contribution to the total attenuation.

  3. Financial Instability - a Result of Excess Liquidity or Credit Cycles?

    DEFF Research Database (Denmark)

    Heebøll-Christensen, Christian

    , a prolonged credit cycle starting in the mid-1990s - and possibly initiated subprime mortgage innovations - appears to have created a long-run housing bubble. Further fuelled by expansionary monetary policy and excess liquidity, the bubble accelerated in period following the dot-com crash, until it finally...

  4. Excess mortality following hip fracture: a systematic epidemiological review

    DEFF Research Database (Denmark)

    Abrahamsen, B; van Staa, T; Ariely, R

    2009-01-01

    the need for interventions to reduce this risk.Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess...

  5. Decaying Dark Atom Constituents and Cosmic Positron Excess

    Directory of Open Access Journals (Sweden)

    K. Belotsky

    2014-01-01

    μ+μ+ and τ+τ+ produces the observed positron excess. These decays can naturally take place via GUT interactions. If it exists, such a metastable particle can be found in the next run of LHC. The model predicts also the ratio of leptons over baryons in the universe to be close to -3.

  6. High‑risk of obstructive sleep apnea and excessive daytime ...

    African Journals Online (AJOL)

    Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra‑city commercial drivers. Setting and Design: A descriptive cross‑sectional study in three ...

  7. Additive effects of dietary glycotoxins and androgen excess on the ...

    African Journals Online (AJOL)

    Sotiria Palimeri

    2015-08-08

    Aug 8, 2015 ... PCOS. Abstract Background: Dietary glycotoxins and androgen excess have been independently associ- ated with a negative influence on the kidney. There are no data concerning the additive effects of these two factors on the kidney function and structure, in females. The present study aims to inves-.

  8. Searching for Excess Rotation Measures in Galaxy Clusters with the ...

    Indian Academy of Sciences (India)

    2016-01-27

    Jan 27, 2016 ... We present a statistical analysis of the rotation measure (RM) catalogue from the NVSS in search for a statistical excess of rotation measure through Abell clusters. After excluding the data known to be affected by the large-scale magnetic field of the Galaxy ( ≤ |30|), we consider RMs as a function of ...

  9. Stringy origin of diboson and dijet excesses at the LHC

    Directory of Open Access Journals (Sweden)

    Luis A. Anchordoqui

    2015-10-01

    Full Text Available Very recently, the ATLAS and CMS Collaborations reported diboson and dijet excesses above standard model expectations in the invariant mass region of 1.8–2.0 TeV. Interpreting the diboson excess of events in a model independent fashion suggests that the vector boson pair production searches are best described by WZ or ZZ topologies, because states decaying into W+W− pairs are strongly constrained by semileptonic searches. Under the assumption of a low string scale, we show that both the diboson and dijet excesses can be steered by an anomalous U(1 field with very small coupling to leptons. The Drell–Yan bounds are then readily avoided because of the leptophobic nature of the massive Z′ gauge boson. The non-negligible decay into ZZ required to accommodate the data is a characteristic footprint of intersecting D-brane models, wherein the Landau–Yang theorem can be evaded by anomaly-induced operators involving a longitudinal Z. The model presented herein can be viewed purely field-theoretically, although it is particularly well motivated from string theory. Should the excesses become statistically significant at the LHC13, the associated Zγ topology would become a signature consistent only with a stringy origin.

  10. An extended rational thermodynamics model for surface excess fluxes

    NARCIS (Netherlands)

    Sagis, L.M.C.

    2012-01-01

    In this paper, we derive constitutive equations for the surface excess fluxes in multiphase systems, in the context of an extended rational thermodynamics formalism. This formalism allows us to derive Maxwell–Cattaneo type constitutive laws for the surface extra stress tensor, the surface thermal

  11. Excessive recreational computer use and food consumption behaviour among adolescents.

    NARCIS (Netherlands)

    L. Shi (Lu); Y. Mao (Yuping)

    2010-01-01

    textabstractINTRODUCTION: Using the 2005 California Health Interview Survey (CHIS) data, we explore the association between excessive recreational computer use and specific food consumption behavior among California's adolescents aged 12-17. METHOD: The adolescent component of CHIS 2005 measured the

  12. Excessive Internet Use and Loneliness among Secondary School Students

    Science.gov (United States)

    Deniz, Levent

    2010-01-01

    The association between loneliness and excessive internet use among secondary school students was examined. One hundred and sixty seven secondary school students were administered a questionnaire for some demographic questions and UCLA for determining their loneliness levels. The results showed that the secondary school students who reported…

  13. Excess Entropy Production in Quantum System: Quantum Master Equation Approach

    Science.gov (United States)

    Nakajima, Satoshi; Tokura, Yasuhiro

    2017-10-01

    For open systems described by the quantum master equation (QME), we investigate the excess entropy production under quasistatic operations between nonequilibrium steady states. The average entropy production is composed of the time integral of the instantaneous steady entropy production rate and the excess entropy production. We propose to define average entropy production rate using the average energy and particle currents, which are calculated by using the full counting statistics with QME. The excess entropy production is given by a line integral in the control parameter space and its integrand is called the Berry-Sinitsyn-Nemenman (BSN) vector. In the weakly nonequilibrium regime, we show that BSN vector is described by ln \\breve{ρ }_0 and ρ _0 where ρ _0 is the instantaneous steady state of the QME and \\breve{ρ }_0 is that of the QME which is given by reversing the sign of the Lamb shift term. If the system Hamiltonian is non-degenerate or the Lamb shift term is negligible, the excess entropy production approximately reduces to the difference between the von Neumann entropies of the system. Additionally, we point out that the expression of the entropy production obtained in the classical Markov jump process is different from our result and show that these are approximately equivalent only in the weakly nonequilibrium regime.

  14. evaluation of radiological hazard indices and excess lifetime cancer ...

    African Journals Online (AJOL)

    Sowole & Ehindero

    Associated With the Use of Ogun River Sediment as Building Material ... effective dose rate. 10 sediment samples were collected from the river. The values of the radiological indicators and excess lifetime cancer risk were found to be within the limits ... the mean values were calculated to be 0.594 Bqkg-1 and 0.658. Bqkg-1 ...

  15. Hjertestop associeret med syndrome of apparent mineralocorticoid excess

    DEFF Research Database (Denmark)

    Meldgaard-Nielsen, Anne; Laugesen, Esben; Poulsen, Per Løgstrup

    2014-01-01

    Ventricular fibrillation is an unknown complication to the syndrome of apparent mineralocorticoid excess (SAME). This case report describes a young woman admitted with hypo-kalaemia and hypertension. Concentrations of both P-renin and P-aldosterone were low and urinary steroid metabolites revealed...

  16. An analysis of the excess mortality profile during the 2006 ...

    African Journals Online (AJOL)

    The Island of Mauritius was affected by a large scale epidemic outbreak of. Chikungunya Fever (CHIKF) from February to April 2006. It was observed that this epidemic was associated with an excess mortality during the months of March to May 2006 in Mauritius. This study was aimed to analyze the gender and age group ...

  17. Excess molar volumes and isentropic compressibilities of binary ...

    Indian Academy of Sciences (India)

    However, the large negative values of excess molar volume becomes dominant in toluene. · n-hexane mixture. Deviation in isentropic compressibility is negative over the whole range of composition in the case of all the six binary mixtures. Existence of specific intermolecular interac- tions in the mixtures has been analyzed ...

  18. Excess isentropic compressibility and speed of sound of the ternary ...

    Indian Academy of Sciences (India)

    relation (NR), Van Deal's ideal mixing relation (IMR) and Junjie's relation (JR). The results are used to ... The compounds used were 2-propanol (>99 mass%), diethyl ether (>99.5 mass%) and n-hexane (>99 .... The excess speed of sound, uE, is estimated in binary and ternary mixtures using the following expression:.

  19. Excess Molar Volume Of Binarymixtures From Iso-Propyl Alcohol ...

    African Journals Online (AJOL)

    In this work, binary mixtures from Tertiary-Butyl alcohol (TBA), Toluene (TOL) and Iso-Propyl alcohol (IPA) were prepared at 298K. The mixtures physical properties which includes densities of mixtures (ρ) and pure components (ρI) and mole fractions of components (x) were equally measured at 298K. Excess molar volumes ...

  20. Diffuse neutron scattering from anion-excess strontium chloride

    DEFF Research Database (Denmark)

    Goff, J.P.; Clausen, K.N.; Fåk, B.

    1992-01-01

    The defect structure and diffusional processes have been studied in the anion-excess fluorite (Sr, Y)Cl2.03 by diffuse neutron scattering techniques. Static cuboctahedral clusters found at ambient temperature break up at temperatures below 1050 K, where the anion disorder is highly dynamic. The a...

  1. Opportunities to reduce children's excessive consumption of calories from beverages.

    Science.gov (United States)

    Rader, Ryan K; Mullen, Kathy B; Sterkel, Randall; Strunk, Robert C; Garbutt, Jane M

    2014-10-01

    To describe children's consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice (FJ), and identify factors that may reduce excessive consumption. A total of 830 parents of young children completed a 36-item questionnaire at the pediatricians' office. Children consumed soda (62.2%), other SSBs (61.6%), and FJ (88.2%): 26.9% exceeded the American Academy of Pediatrics' recommended daily FJ intake. 157 (18.9%) children consumed excessive calories (>200 kcal/d) from beverages (median = 292.2 kcal/d, range 203.8-2177.0 kcal/d). Risk factors for excessive calorie consumption from beverages were exceeding recommendations for FJ (odds ratio [OR] = 119.7, 95% confidence interval [CI] = 52.2-274.7), being 7 to 12 years old (OR = 4.3, 95%CI = 1.9-9.9), and having Medicaid insurance (OR = 2.6, 95%CI = 1.1-6.0). Parents would likely reduce beverage consumption if recommended by the physician (65.6%). About 1 in 5 children consumes excessive calories from soda, other SSBs and FJ, with FJ the major contributor. © The Author(s) 2014.

  2. Excess post hypoxic oxygen consumption in Atlantic cod (Gadus morhua)

    DEFF Research Database (Denmark)

    Plambech, Marie; Deurs, Mikael van; Steffensen, J.F.

    2013-01-01

    Atlantic cod Gadus morhua experienced oxygen deficit (DO2 ) when exposed to oxygen levels below their critical level (c. 73% of pcrit) and subsequent excess post-hypoxic oxygen consumption (CEPHO) upon return to normoxic conditions, indicative of an oxygen debt. The mean±s.e. CEPHO:DO2 was 6...

  3. The Pathophysiology, Diagnosis and Treatment of Excessive Belching Symptoms

    NARCIS (Netherlands)

    Kessing, Boudewijn F.; Bredenoord, Albert J.; Smout, André J. P. M.

    2014-01-01

    Excessive belching is a commonly observed complaint in clinical practice that can occur not only as an isolated symptom but also as a concomitant symptom in patients with gastroesophageal reflux disease (GERD) or functional dyspepsia. Impedance monitoring has revealed that there are two mechanisms

  4. Infinite Excess Entropy Processes with Countable-State Generators

    Directory of Open Access Journals (Sweden)

    Nicholas F. Travers

    2014-03-01

    Full Text Available We present two examples of finite-alphabet, infinite excess entropy processes generated by stationary hidden Markov models (HMMs with countable state sets. The first, simpler example is not ergodic, but the second is. These are the first explicit constructions of processes of this type.

  5. The patient with excessive worry | Shearer | South African Family ...

    African Journals Online (AJOL)

    Worry is a normal response to uncertainty. Education, empathetic support, reassurance, and passage of time usually ameliorate ordinary worries. However, these common-sense strategies for dealing with transient worries often prove ineffective for patients with excessive worry, many of whom meet the criteria for disorders ...

  6. Iodine Excess is a Risk Factor for Goiter Formation

    African Journals Online (AJOL)

    iodine deficiency. Although universal salt iodization in Uganda achieved a household coverage of 95% by 2005, goiter rates are still high. This study investigated the association between iodine excess and goiter. Methods: In a case control study, urinary iodine levels, complete blood count, T3, T4 and TSH levels were ...

  7. Effect of Excess Gravitational Force on Cultured Myotubes in Vitro

    Directory of Open Access Journals (Sweden)

    Shigehiro Hashimoto

    2013-06-01

    Full Text Available An effect of an excess gravitational force on cultured myoblasts has been studied in an experimental system with centrifugal force in vitro. Mouse myoblasts (C2C12 were seeded on a culture dish of 35 mm diameter, and cultured in the Dulbecco's Modified Eagle's Medium until the sub-confluent condition. To apply the excess gravitational force on the cultured cells, the dish was set in a conventional centrifugal machine. Constant gravitational force was applied to the cultured cells for three hours. Variations were made on the gravitational force (6 G, 10 G, 100 G, 500 G, and 800 G with control of the rotational speed of the rotator in the centrifugal machine. Morphology of the cells was observed with a phasecontrast microscope for eight days. The experimental results show that the myotube thickens day by day after the exposure to the excess gravitational force field. The results also show that the higher excess gravitational force thickens myotubes. The microscopic study shows that myotubes thicken with fusion each other.

  8. Excess Entropy Production in Quantum System: Quantum Master Equation Approach

    Science.gov (United States)

    Nakajima, Satoshi; Tokura, Yasuhiro

    2017-12-01

    For open systems described by the quantum master equation (QME), we investigate the excess entropy production under quasistatic operations between nonequilibrium steady states. The average entropy production is composed of the time integral of the instantaneous steady entropy production rate and the excess entropy production. We propose to define average entropy production rate using the average energy and particle currents, which are calculated by using the full counting statistics with QME. The excess entropy production is given by a line integral in the control parameter space and its integrand is called the Berry-Sinitsyn-Nemenman (BSN) vector. In the weakly nonequilibrium regime, we show that BSN vector is described by ln \\breve{ρ }_0 and ρ _0 where ρ _0 is the instantaneous steady state of the QME and \\breve{ρ }_0 is that of the QME which is given by reversing the sign of the Lamb shift term. If the system Hamiltonian is non-degenerate or the Lamb shift term is negligible, the excess entropy production approximately reduces to the difference between the von Neumann entropies of the system. Additionally, we point out that the expression of the entropy production obtained in the classical Markov jump process is different from our result and show that these are approximately equivalent only in the weakly nonequilibrium regime.

  9. Excess of counterclockwise scalp hair-whorl rotation in homosexual ...

    Indian Academy of Sciences (India)

    Unknown

    Journal of Genetics, Vol. 83, No. 3, December 2004. 251. Excess of counterclockwise scalp hair- ... on genes and/or prenatal hormone environments influenc- ing the neuronal circuitry on which sexual preference is ... This assessment was reinforced by the dearth of females and children on the beach. More importantly,.

  10. Alternative search strategies to explore ATLAS diboson excess

    Indian Academy of Sciences (India)

    Charanjit K Khosa

    Alternative search strategies to explore ATLAS diboson excess. CHARANJIT K KHOSA. Centre for High Energy Physics, Indian Institute of Science, Bengaluru 560 012, India. E-mail: khosacharanjit@chep.iisc.ernet.in. Published online 5 October 2017. Abstract. We consider the s-channel resonance to fit the 2 TeV ATLAS ...

  11. Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study)

    NARCIS (Netherlands)

    Moreno-Lopez, C.; Santamaria, J.; Salamero, M.; Del Sorbo, F.; Albanese, A.; Pellecchia, M.T.; Barone, P.; Overeem, S.; Bloem, B.R.; Aarden, W.C.C.A.; Canesi, M.; Antonini, A.; Duerr, S.; Wenning, G.K.; Poewe, W.; Rubino, A.; Meco, G.; Schneider, S.A.; Bhatia, K.P.; Djaldetti, R.; Coelho, M.; Sampaio, C.; Cochen, V.; Hellriegel, H.; Deuschl, G.; Colosimo, C.; Marsili, L.; Gasser, T.; Tolosa, E.

    2011-01-01

    BACKGROUND: Sleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known. OBJECTIVE: To assess the frequency and associations of EDS in MSA. DESIGN: Survey of EDS in consecutive patients with MSA and comparison with patients

  12. excess molar volumes, and refractive index of binary mixtures of ...

    African Journals Online (AJOL)

    Preferred Customer

    product of biodiesel and used in many wide industrial applications. Glycerol can be obtained by ... binary mixtures of glycerol + water and glycerol + methanol covering the whole composition range and at 298.15 K .... 114 the mixture. Excess molar volumes on mixing of the binary systems were fitted to Redlich–. Kister [12 ...

  13. The poignant, the excessive and the enigmatic in sexuality.

    Science.gov (United States)

    Stein, R

    1998-04-01

    The author offers a contribution to redressing a certain lack of theorization concerning the specific power and meaning of sexuality. This begins with George Klein's suggestion that it is the quality of a specific, poignant sensuality that characterizes sexuality. Bataille's ideas about the violent and excessive aspects of eroticism provide some answers to the question of what makes for this special poignant quality. Bataille captures a profound link between the sacred and the erotic with regard to their both being linked with taboos and their transgression as opposed to habitual 'work mentality' and established order. The excessive dimension highlighted by Bataille is complemented in the work of Laplanche about sexuality as opposed to 'functional', self-preservative ego needs, and the excess of the 'enigmatic message' transmitted by the mother while satisfying the infant's ego needs that establishes the infant's unconscious and sexuality. Losing the nutritive object, a process of fantasizing sets in; the influx of strong sensations that cannot yet be integrated spills over into libidinal excitement. The gap between the other's excess and the child's limited resources can then be sexualized. A picture emerges of non-procreative sexuality as foreign to ordinary experience and as transcending one's limits.

  14. 7 CFR 929.104 - Outlets for excess cranberries.

    Science.gov (United States)

    2010-01-01

    ... nonhuman food use. (4) Research and development projects approved by the committee dealing with the development of foreign and domestic markets, including, but not limited to dehydration, radiation, freeze drying, or freezing of cranberries. (b) Excess cranberries may not be converted into canned, frozen, or...

  15. Excessive crying: behavioral and emotional regulation disorder in infancy

    Directory of Open Access Journals (Sweden)

    Joon Sik Kim

    2011-06-01

    Full Text Available In the pediatric literature, excessive crying has been reported solely in association with 3-month colic and is described, if at all, as unexplained crying and fussing during the first 3 months of life. The bouts of crying are generally thought to be triggered by abdominal colic (over-inflation of the still immature gastrointestinal tract, and treatment is prescribed accordingly. According to this line of reasoning, excessive crying is harmless and resolves by the end of the third month without long-term consequences. However, there is evidence that it may cause tremendous distress in the mother&#8211;infant relationship, and can lead to disorders of behavioral and emotional regulation at the toddler stage (such as sleep and feeding disorders, chronic fussiness, excessive clinginess, and temper tantrums. Early treatment of excessive crying focuses on parent&#8211;infant communication, and parent-infant interaction in the context of soothing and settling the infant to sleep is a promising approach that may prevent later behavioral and emotional disorders in infancy.

  16. Feasibility of recycling excess agricultural nitrate with electrodialysis

    Science.gov (United States)

    One of the most serious environmental problems associated with agriculture is excessive nitrate-N in waters leaving fields. It is a local health hazard in drinking water and a primary cause of hypoxia in continental ocean waters receiving drainage from agricultural regions. Many of the recent miti...

  17. Industrial excess heat for district heating in Denmark

    DEFF Research Database (Denmark)

    Bühler, Fabian; Petrovic, Stefan; Karlsson, Kenneth Bernard

    2017-01-01

    Excess heat is available from various sources and its utilisation could reduce the primary energy use. The accessibility of this heat is however dependent amongst others on the source and sink temperature, amount and potential users in its vicinity. In this work a new method is developed which...

  18. Interventions for preventing excessive weight gain during pregnancy

    Science.gov (United States)

    Muktabhant, Benja; Lumbiganon, Pisake; Ngamjarus, Chetta; Dowswell, Therese

    2014-01-01

    Background Excessive weight gain during pregnancy is associated with multiple maternal and neonatal complications. However, interventions to prevent excessive weight gain during pregnancy have not been adequately evaluated. Objectives To evaluate the effectiveness of interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (20 October 2011) and MEDLINE (1966 to 20 October 2011). Selection criteria All randomised controlled trials and quasi-randomised trials of interventions for preventing excessive weight gain during pregnancy. Data collection and analysis We assessed for inclusion all potential studies we identified as a result of the search strategy. At least two review authors independently assessed trial quality and extracted data. We resolved discrepancies through discussion. We have presented results using risk ratio (RR) for categorical data and mean difference for continuous data. We analysed data using a fixed-effect model. Main results We included 28 studies involving 3976 women; 27 of these studies with 3964 women contributed data to the analyses. Interventions focused on a broad range of interventions. However, for most outcomes we could not combine data in a meta-analysis, and where we did pool data, no more than two or three studies could be combined for a particular intervention and outcome. Overall, results from this review were mainly not statistically significant, and where there did appear to be differences between intervention and control groups, results were not consistent. For women in general clinic populations one (behavioural counselling versus standard care) of three interventions examined was associated with a reduction in the rate of excessive weight gain (RR 0.72, 95% confidence interval 0.54 to 0.95); for women in high-risk groups no intervention appeared to reduce excess weight gain. There were

  19. Excess cardiovascular mortality associated with cold spells in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Kyncl Jan

    2009-01-01

    Full Text Available Abstract Background The association between cardiovascular mortality and winter cold spells was evaluated in the population of the Czech Republic over 21-yr period 1986–2006. No comprehensive study on cold-related mortality in central Europe has been carried out despite the fact that cold air invasions are more frequent and severe in this region than in western and southern Europe. Methods Cold spells were defined as periods of days on which air temperature does not exceed -3.5°C. Days on which mortality was affected by epidemics of influenza/acute respiratory infections were identified and omitted from the analysis. Excess cardiovascular mortality was determined after the long-term changes and the seasonal cycle in mortality had been removed. Excess mortality during and after cold spells was examined in individual age groups and genders. Results Cold spells were associated with positive mean excess cardiovascular mortality in all age groups (25–59, 60–69, 70–79 and 80+ years and in both men and women. The relative mortality effects were most pronounced and most direct in middle-aged men (25–59 years, which contrasts with majority of studies on cold-related mortality in other regions. The estimated excess mortality during the severe cold spells in January 1987 (+274 cardiovascular deaths is comparable to that attributed to the most severe heat wave in this region in 1994. Conclusion The results show that cold stress has a considerable impact on mortality in central Europe, representing a public health threat of an importance similar to heat waves. The elevated mortality risks in men aged 25–59 years may be related to occupational exposure of large numbers of men working outdoors in winter. Early warnings and preventive measures based on weather forecast and targeted on the susceptible parts of the population may help mitigate the effects of cold spells and save lives.

  20. Excess cardiovascular mortality associated with cold spells in the Czech Republic.

    Science.gov (United States)

    Kysely, Jan; Pokorna, Lucie; Kyncl, Jan; Kriz, Bohumir

    2009-01-15

    The association between cardiovascular mortality and winter cold spells was evaluated in the population of the Czech Republic over 21-yr period 1986-2006. No comprehensive study on cold-related mortality in central Europe has been carried out despite the fact that cold air invasions are more frequent and severe in this region than in western and southern Europe. Cold spells were defined as periods of days on which air temperature does not exceed -3.5 degrees C. Days on which mortality was affected by epidemics of influenza/acute respiratory infections were identified and omitted from the analysis. Excess cardiovascular mortality was determined after the long-term changes and the seasonal cycle in mortality had been removed. Excess mortality during and after cold spells was examined in individual age groups and genders. Cold spells were associated with positive mean excess cardiovascular mortality in all age groups (25-59, 60-69, 70-79 and 80+ years) and in both men and women. The relative mortality effects were most pronounced and most direct in middle-aged men (25-59 years), which contrasts with majority of studies on cold-related mortality in other regions. The estimated excess mortality during the severe cold spells in January 1987 (+274 cardiovascular deaths) is comparable to that attributed to the most severe heat wave in this region in 1994. The results show that cold stress has a considerable impact on mortality in central Europe, representing a public health threat of an importance similar to heat waves. The elevated mortality risks in men aged 25-59 years may be related to occupational exposure of large numbers of men working outdoors in winter. Early warnings and preventive measures based on weather forecast and targeted on the susceptible parts of the population may help mitigate the effects of cold spells and save lives.