WorldWideScience

Sample records for inappropriate material offensive

  1. Offensive

    African Journals Online (AJOL)

    R.B. Ruthven

    For purposes of discussion in this arti- cle, offensive and/or taboo words will be taken to refer to a variety of words that may be considered vulgar, obscene, impolite, insulting and derogatory, those referring to the physically deformed or mentally impaired and all those usually being avoided or normally found unacceptable in ...

  2. Offensive Speech in Educational Materials: Changing Words without Censorship

    Science.gov (United States)

    McGough, Sarah M.

    2007-01-01

    Background/Context: Diane Ravitch has focused on the extensive censorship occurring within the publication of school textbook and testing materials in her book, "The Language Police" (2003). This book, indicative of conservative frustrations with minority special interest groups, raises several key issues echoed throughout the larger educational…

  3. The Constitutive Content of the Offense of not Complying with the Regime of Explosive Materials in the Romanian Criminal Law

    Directory of Open Access Journals (Sweden)

    Ion Rusu

    2014-08-01

    Full Text Available In the present work we examined the constitutive content of the offense of not complying with the regime of explosive materials, according to the new provisions of the new Criminal Code. The paper can be helpful both to theorists and those who carry their activity in preventing and combating crime of this kind. The innovations consist of the objective and subjective side examination of the crime, focusing on the changes in its legal content.

  4. No Offense!

    DEFF Research Database (Denmark)

    Petersen, Thomas Søbirk

    2016-01-01

    A central aim within criminal justice ethics is to give a plausible justification concerning which type of acts ought to be criminalized by the state. One of the principles of criminalization which has been presented and critically discussed in the philosophical literature is the Offense Principl....... The primary aim of this paper is to argue that unless a rather special and implausible objective list theory of well-being is accepted, the Offense Principle should be subsumed in the Harm Principle....

  5. The material element in the basic form of the offense of abusive behavior

    Directory of Open Access Journals (Sweden)

    Mihaela ROTARU

    2012-06-01

    Full Text Available Legal rules are dynamic, meaning that they change depending on the evolution of the society at a certain time, in order to successfully meet the needs of regulation of social relations. The Criminal Code is no exception to this rule. Insult and slander have been decriminalized by the Law no. 278/2006, a situation which has led to changing legal content of other crimes, such as outrage, referred to in Art. 239 Criminal Code, by repealing its basic variant, relative to insult and slander. Instead, at the offense of abusive behavior, referred to in Art. 250 Criminal Code, the basic variant, represented by ,,the use of offensive language”, remained in force.

  6. Offensive Threats

    Directory of Open Access Journals (Sweden)

    Alaa A. Mahdi

    2017-02-01

    Full Text Available This paper try to give us more details about the meaning of directory, and which type of security involved within the intended with each type of the specified directory. The security threats pose a significant and increasing problem for organizations. This is shown by the regular stories of fraud and data loss reported daily in the media in anywhere in the world. There is a need to provide systematic protection from insider attacks because of their privileged access. Moreover, we should provide a systematic protection from the outside attacks, as well. It is worthy to separate the duty of directory by indentifying the main two duties: the duty of the system administrator and the database administrator, and we have to recognize the difference between them. We will provide the researchers with four main threats that might be offensive to the security of directory. Moreover, we will address the nature of attack and the purpose of this attack that may encounter the directory or network assets. Finally, we will show the relation between Active Directory Security and Server Security.

  7. Nontechnical Strategies To Reduce Children's Exposure to Inappropriate Material on the Internet. Summary of a Workshop (December 13, 2000).

    Science.gov (United States)

    Iannotta, Joah G., Ed.

    In response to a Congressional mandate in conjunction with the Protection of Children from Sexual Predators Act of 1998, a committee of experts was formed to explore both technical and nontechnical strategies for protecting children from pornography and other inappropriate Internet content. This book summarizes a workshop held in December 2000 to…

  8. Offensive Rolling in Sambo

    Directory of Open Access Journals (Sweden)

    Stephen Koepfer

    2012-07-01

    Full Text Available In recent years the Soviet born martial art of sambo has become increasingly well known in martial art circles. This is largely due to the success of sambo fighters in various mixed martial art venues. Offered here is a brief description of sambo’s development as well as a delineation of one of sambo’s hallmark strategies: offensive rolling. Examples of proper forward rolling and three related offensive techniques are presented. This paper provides a brief introduction to sambo’s history and one of its key tactical philosophies.

  9. The evolution of offensive realism.

    Science.gov (United States)

    Johnson, Dominic D P; Phil, D; Thayer, Bradley A

    Offensive realism, a theory of international relations, holds that states are disposed to competition and conflict because they are self-interested, power maximizing, and fearful of other states. Moreover, it argues that states are obliged to behave this way because doing so favors survival in the international system. Debate continues as to whether modern states actually do, or should, behave in this way, but we are struck by a different question. In this article, we ask whether the three core assumptions about behavior in offensive realism-self-help, power maximization, and outgroup fear-have any basis in scientific knowledge about human behavioral evolution. We find that these precise traits are not only evolutionarily adaptive but also empirically common across the animal kingdom, especially in primate and human societies. Based on these findings, we hypothesize that states behave as offensive realists predict not just because of anarchy in the modern international system but also because of the legacy of our evolution. In short, offensive realism may really be describing the nature of the human species more than the nature of the international system. If our hypothesis is correct, then evolutionary theory offers the following: (1) a novel ultimate cause of offensive realist behavior; (2) an extension of offensive realism to any domain in which humans compete for power; and (3) an explanation for why individual leaders themselves, and not just states, seek power. However, a key insight from evolution is that the primacy of self-help, power maximization, and outgroup fear does not necessarily condemn individuals or groups to competition and conflict; rather, these traits can in themselves give rise to cooperation and alliances.

  10. Airpower and the Cult of the Offensive

    National Research Council Canada - National Science Library

    Carter, John

    1998-01-01

    ... I. Termed the cult of the offensive by scholars of the Great War, faith in the offense became so unshakable in pre-1914 Europe that military organizations dismissed as irrelevant numerous indications...

  11. Airpower and the Cult of the Offensive

    National Research Council Canada - National Science Library

    Carter, John

    1998-01-01

    .... Termed the cult of the offensive by scholars, faith in offense became so unshakable in pre-1914 Europe that military organizations dismissed as irrelevant the numerous indications of the waning power...

  12. The use of pornography during the commission of sexual offenses.

    Science.gov (United States)

    Langevin, Ron; Curnoe, Suzanne

    2004-10-01

    The goal of this study was to examine the use of pornographic materials by sex offenders during the commission of their crimes. A sample of 561 sex offenders was examined. There were 181 offenders against children, 144 offenders against adults, 223 incest offenders, 8 exhibitionists, and 5 miscellaneous cases. All but four cases were men. A total of 96 (17%) offenders had used pornography at the time of their offenses. More offenders against children than against adults used pornography in the offenses. Of the users, 55% showed pornographic materials to their victims and 36% took pictures, mostly of child victims. Nine cases were involved in the distribution of pornography. Results showed that pornography plays only a minor role in the commission of sexual offenses, however the current findings raise a major concern that pornography use in the commission of sexual crimes primarily involved child victims.

  13. Understanding Online Child Sexual Exploitation Offenses.

    Science.gov (United States)

    Ly, Thanh; Murphy, Lisa; Fedoroff, J Paul

    2016-08-01

    In the past three decades, there has been an exponential increase in the worldwide availability of Internet access and devices that are able to access online materials. This literature review investigated whether increased accessibility of Internet child pornography (CP) increases the risk of in-person child sexual exploitation. The current review found little to no evidence that availability of the Internet has increased the worldwide incidence or prevalence of in-person child sexual abuse. In fact, during the time period in which the Internet has flourished, international crime statistics have shown a steady decrease of in-person child sexual abuse. The only exception to this trend is an increase in Internet child pornography or luring offenses (e.g., Stats Can, 2014), which involves child abuse by definition. This article reviews the impact of the Internet on child sexual abuse. It also reviews the characteristics of online CP offenders. Treatment of these offenders and prevention of such offenses is also discussed.

  14. Physicians disciplined for sex-related offenses.

    Science.gov (United States)

    Dehlendorf, C E; Wolfe, S M

    1998-06-17

    Physicians who abuse their patients sexually cause immense harm, and, therefore, the discipline of physicians who commit any sex-related offenses is an important public health issue that should be examined. To determine the frequency and severity of discipline against physicians who commit sex-related offenses and to describe the characteristics of these physicians. Analysis of sex-related orders from a national database of disciplinary orders taken by state medical boards and federal agencies. A total of 761 physicians disciplined for sex-related offenses from 1981 through 1996. Rate and severity of discipline over time for sex-related offenses and specialty, age, and board certification status of disciplined physicians. The number of physicians disciplined per year for sex-related offenses increased from 42 in 1989 to 147 in 1996, and the proportion of all disciplinary orders that were sex related increased from 2.1% in 1989 to 4.4% in 1996 (Psex-related offenses was significantly more severe (Psex-related offenses, with 71.9% of sex-related orders involving revocation, surrender, or suspension of medical license. Of 761 physicians disciplined, the offenses committed by 567 (75%) involved patients, including sexual intercourse, rape, sexual molestation, and sexual favors for drugs. As of March 1997, 216 physicians (39.9%) disciplined for sex-related offenses between 1981 and 1994 were licensed to practice. Compared with all physicians, physicians disciplined for sex-related offenses were more likely to practice in the specialties of psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice (all Psex-related offenses is increasing over time and is relatively severe, although few physicians are disciplined for sexual offenses each year. In addition, a substantial proportion of physicians disciplined for these offenses are allowed to either continue to practice or return to practice.

  15. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  16. Offensive language in the general hospital.

    Science.gov (United States)

    Zimmerman, Daniel J; Stern, Theodore A

    2010-01-01

    Offensive language (spoken by medical staff and by patients and their families) is often heard in the general hospital, but its manifestations and clinical implications have not been previously examined. The authors sought to facilitate an understanding of the effects and treatment of offensive utterances and their downstream consequences. The authors present a sampling of clinical vignettes that illustrate a variety of examples of hospital-based events in which offensive language was used and discuss differential diagnoses and management strategies. Swearing can also be used as a psychological tool in the service of helping. Swearing may provide a channel of catharsis for aggressive drives and affects that have been building in either the doctor or the patient. Placing offensive behaviors, for example, use of profane language, in a biopsychosocial context can facilitate an understanding of the causes, effects, and treatment of these events.

  17. Are Latinos Who Commit Sexual Offenses Different? A Closer Examination of Characteristics and Offense Patterns.

    Science.gov (United States)

    Fraga Dominguez, Silvia; Jeglic, Elizabeth L; Calkins, Cynthia; Leguizamo, Alejandro

    2017-06-01

    Research examining ethnic and cultural differences among individuals who commit sex offenses remains limited. Specifically, literature focusing on sex offenses committed by Latinos is scarce. Using archival data from a large sample of individuals who committed sex offenses, this study explored differences between Latino, White, and African American individuals related to their characteristics, the offenses, and the victims. Latinos in the sample were more likely to have a lower educational level, and to be living with the victim, than either their White or African American counterparts. To further understand the influence of cultural background, the study also examined differences within the Latino group based on their country of origin. Within the Latino sample, differences emerged in their educational level, criminal background, and psychiatric history. These findings are discussed as they pertain to future research and current practices related to the management and treatment of Latinos who commit sexual offenses.

  18. Legislative Proposals To Protect Children from Inappropriate Materials on the Internet. Hearing on H.R. 3783, H.R. 774, H.R. 1180, H.R. 1964, H.R. 3177, and H.R. 3442 before the Subcommittee on Telecommunications, Trade, and Consumer Protection of the Committee on Commerce, House of Representatives, One Hundred Fifth Congress, Second Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Committee on Commerce.

    This hearing addresses legislative proposals to protect children from inappropriate materials on the Internet. Among the issues discussed are federal investments and information access, defining standards for protection, child pornography and marketing to children, filtering technology and adult verification services, and freedom of speech.…

  19. Signal Security in the Ardennes Offensive: 1944-1945

    National Research Council Canada - National Science Library

    Moe

    1997-01-01

    ...) during the Ardennes Offensive of 1944-1945. The work includes a brief introduction to the offensive and to the history of SIGSEC, and examines how the American and German armies safeguarded communications from the enemy...

  20. Comparing models of offensive cyber operations

    CSIR Research Space (South Africa)

    Grant, T

    2015-10-01

    Full Text Available would be needed by a Cyber Security Operations Centre in order to perform offensive cyber operations?". The analysis was performed, using as a springboard seven models of cyber-attack, and resulted in the development of what is described as a canonical...

  1. 28 CFR Appendix A to Part 811 - Listing of Sex Offender Registration Offenses by Class

    Science.gov (United States)

    2010-07-01

    ... sexual offense; (q) First or second degree burglary with intent to commit sex offense; (r) Kidnapping... degree burglary with intent to commit sex offense; (d) Kidnapping with intent to commit sex offense; (e...

  2. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  3. Environmental offenses in 1999. An evaluation of statistics; Umweltdelikte 1999. Eine Auswertung der Statistiken

    Energy Technology Data Exchange (ETDEWEB)

    Goertz, M.; Werner, J.; Heinrich, M.

    2000-11-01

    A total of 43,382 known environmental offenses was recorded in 1999 as compared to 47,900 in 1998. There were 36,663 penal offenses (section 29 StGB), 48 penal offenses (section 28 StGB) and 6,671 offenses against other laws (BNatSchG, ChemG, etc.). This statistics covers chemical pollutants, radioactive materials, ionizing and non-ionizing radiation, noise and explosions. It is estimated that a much higher number of offenses went unnoticed. [German] Mit insgesamt 43 382 bekannt gewordenen umweltrelevanten Straftaten ist die Umweltkriminalitaet im Jahre 1999 gegenueber 47 900 im Jahre 1998 gesunken. Die 43 382 Taten verteilen sich auf 36 663 Taten nach dem 29. Abschnitt des StGB (Straftaten gegen die Umwelt), 48 umweltrelevante Taten nach dem 28. Abschnitt des StGB (gemeingefaehrliche Straftaten) und 6 671 Straftaten nach dem Umweltnebenstrafrecht (BNatSchG, ChemG u.a.). Erfasst wurden alle Delikte bezueglich chemischer Schadstoffe, radioaktiver Stoffe, ionisierender und nichtionisierender Strahlen, Laerm und Erschuetterungen. Das Dunkelfeld bei Umweltstraftaten wird von den mit ihnen befassten Personen im Vergleich zu tatsaechlich angezeigten Umweltdelikten ueberwiegend als bedeutend groesser eingeschaetzt. (orig.)

  4. Pedophilia and sexual offenses against children.

    Science.gov (United States)

    Seto, Michael C

    2004-01-01

    This article reviews the definition and assessment of pedophilia, describes the relationship between pedophilia and sexual offenses against children, and provides an overview of our current theoretical understanding of the etiology of pedophilia. A great deal is known about the assessment of pedophilia--attributable to public and professional concerns regarding the empirical association between pedophilia and sexual offenses against children--but much remains to be learned about pedophilia, including its prevalence in the general population, cross-cultural manifestations, developmental trajectories, and causes. Recent research suggests that neurodevelopmental problems and childhood sexual abuse play a role in the etiology of pedophilia, but the mechanisms that are involved are unknown. Future directions for research on assessment methods and etiology are highlighted.

  5. Offensive Cybersecurity in the NIST Cybersecurity Framework

    Energy Technology Data Exchange (ETDEWEB)

    Bulyk, Mykhaylo; Evans, Dr. Nathaniel

    2015-02-01

    Government and corporate computer systems are attacked, networks are penetrated by hackers, and enterprises are protected by demilitarized zones. Language that until recently was used to describe security and warfare in military settings has now become common-place in cybersecurity discussions. The concepts of pre-emptive attack, counterattack and offensive defense fit the linguistic cultural thread of security in cyberspace, at least in part due to the taxonomy adopted by cybersecurity as a discipline.

  6. [Inappropriate test methods in allergy].

    Science.gov (United States)

    Kleine-Tebbe, J; Herold, D A

    2010-11-01

    Inappropriate test methods are increasingly utilized to diagnose allergy. They fall into two categories: I. Tests with obscure theoretical basis, missing validity and lacking reproducibility, such as bioresonance, electroacupuncture, applied kinesiology and the ALCAT-test. These methods lack both the technical and clinical validation needed to justify their use. II. Tests with real data, but misleading interpretation: Detection of IgG or IgG4-antibodies or lymphocyte proliferation tests to foods do not allow to separate healthy from diseased subjects, neither in case of food intolerance, allergy or other diagnoses. The absence of diagnostic specificity induces many false positive findings in healthy subjects. As a result unjustified diets might limit quality of life and lead to malnutrition. Proliferation of lymphocytes in response to foods can show elevated rates in patients with allergies. These values do not allow individual diagnosis of hypersensitivity due to their broad variation. Successful internet marketing, infiltration of academic programs and superficial reporting by the media promote the popularity of unqualified diagnostic tests; also in allergy. Therefore, critical observation and quick analysis of and clear comments to unqualified methods by the scientific medical societies are more important than ever.

  7. Intergroup forgiveness of race-related offenses.

    Science.gov (United States)

    Davis, Don E; DeBlaere, Cirleen; Hook, Joshua N; Burnette, Jeni; Van Tongeren, Daryl R; Rice, Kenneth G; Worthington, Everett L

    2015-07-01

    We developed a new intergroup forgiveness measure in the context of identity-related offenses, with a focus on racial conflicts. In Study 1 (N = 384), we adapted a widely used measure of interpersonal forgiveness to develop the Group Forgiveness Scale (GFS) within the context of an identity-related offense. In Study 2, we replicated the 3-factor structure of the GFS (i.e., Avoidance, Revenge, Decision to Forgive) and examined evidence for its construct validity in a sample of African American/Black university students (N = 225). As evidence of convergent validity, intergroup forgiveness correlated with appraising greater relationship value as well as appraising lower likelihood of being exploited in the future. As evidence of discriminant validity, the newly developed intergroup forgiveness scale (i.e., the GFS) correlated only moderately with interpersonal forgiveness and perceived microaggressions. In Study 3, in another sample of racial/ethnic minority individuals (N = 352), we examined the predictive validity of the scale. More specifically, we examined relations of the GFS subscales with religious commitment and racial/ethnic identity. The Decision to Forgive subscale uniquely correlated with religious commitment controlling for the Avoidance and Revenge subscales. Lower revenge correlated with stronger racial/ethnic identity. We conclude with implications of the current findings for the development of intergroup forgiveness measurement and for understanding the nature of forgiveness within marginalized groups. (c) 2015 APA, all rights reserved).

  8. Three Cases With Inappropriate TSH Syndrome

    Directory of Open Access Journals (Sweden)

    Hatice Sebila Dökmetaş

    2012-12-01

    Full Text Available Inappropriate thyroid-stimulating hormone (TSH syndrome or central hyperthyroidism is a rare disorder characterized by inappropriately normal or elevated levels of TSH and elevated levels of T3 and T4. The syndrome is associated with TSH-secreting pituitary adenoma (TSHoma or thyroid hormone resistance (THR. Thyroid-releasing hormone stimulation test and T3 suppression test can be useful for the differential diagnosis of central hyperthyroidism. In the present study, we report three cases of inappropriate TSH syndrome diagnosed after TRH stimulation and T3 suppression tests. Turk Jem 2012; 16: 105-8

  9. Criminal offenses in gamblers anonymous and hospital treated pathological gamblers.

    Science.gov (United States)

    Blaszczynski, A P; McConaghy, N

    1994-06-01

    The purpose of this study was to compare the nature and prevalence of gambling and non-gambling related offenses in samples of pathological gamblers seeking behavioural treatment from a hospital-based program and those attending Gamblers Anonymous. A semi-structured interview schedule obtaining demographic data and details of the nature, frequency, and consequent legal action of criminal offenses committed was administered to 152 consecutive hospital treated pathological gamblers, and 154 Gamblers Anonymous attendees who volunteered to participate in the study. Of the total sample, 59% admitted a gambling-related offense, and 23% to a conviction. There was no difference in the proportion of hospital treated and Gamblers Anonymous subjects who offended. The most common gambling-related offenses were larceny, embezzlement and misappropriation. Gamblers committed a median of ten offenses over an average ten year period of pathological gambling with a median value of $ A 300(1) per offense. The median value for each non-gambling-related offense was $ A 130. Except for the significantly older mean age of Gamblers Anonymous subjects, hospital treated gamblers did not differ from Gamblers Anonymous attenders on relevant demographic features or parameters of gambling behaviour. Findings were interpreted to suggest a possible causal link between pathological gambling and the commission of non-violent property offenses.

  10. Primary Sjogren's syndrome associated with inappropriate ...

    African Journals Online (AJOL)

    A patient in whom primary Sjogren's syndrome and inappropriate antiduretic hormone secretion were associated is reported. This is the first report of such an association. The possible pathophysiological mechanisms are discussed and vasculitis proposed as the underlying pathogenetic mechanism.

  11. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  12. Drug Utilization and Inappropriate Prescribing in Centenarians.

    Science.gov (United States)

    Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C

    2016-05-01

    To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  13. Prejudice and Presupposition in Offensive Language

    Directory of Open Access Journals (Sweden)

    Carlo Penco

    2017-08-01

    Full Text Available In this paper I give a short introduction to the standard way to treat offensive language in contemporary philosophy of language, without giving details on the very rich contemporary literature on the problem. My aim here is to connect what is called a “presuppositional point of view” on pejoratives to the topic of prejudice. At the same time, I want to develop some hints given by Flavio Baroncelli, a political philosopher and colleague who offered some provocative suggestions on the educative role of politically correct language. I will show that some of his ideas are still workable, and at the same time I eventually will try to show what is really new in the diffusion of prejudice through social networks and which kinds of reactions can be foreseen.

  14. Offense Characteristics of Incompetent to Stand Trial Defendants Charged With Violent Offenses.

    Science.gov (United States)

    Schreiber, Jeremy; Green, Debbie; Kunz, Michal; Belfi, Brian; Pequeno, Gabriela

    2015-06-01

    The current study compared offender and offense characteristics of pretrial defendants found incompetent to stand trial (IST) against those described as general offenders by victims in the 2008 Bureau of Justice Statistics (BJS) survey and evaluated factors that differentiated IST defendants who allegedly used weapons from those who did not during the course of a violent offense. IST defendants were older and used "weapons" more frequently than those reported in the BJS survey; however, other characteristics, including use of firearms, did not differ. No demographic, clinical, or legal factors differentiated pretrial defendants who used weapons from those who did not. Overall, pretrial defendants were frequently diagnosed with a comorbid substance use disorder, and were homeless, unemployed, and had an extensive history of psychiatric hospitalizations and prior arrests at the time of their alleged offenses. Such results indicate that models for comprehensive discharge planning may have utility in addressing the unique needs of this subgroup of mentally disordered offenders. The findings also raise questions about the federal and state prohibition of gun rights to all IST defendants. Copyright © 2015 John Wiley & Sons, Ltd.

  15. Chemistry for preserving the global environment. Part 5. Offensive odor; its present condition and control technique; Kankyo sozai no kagaku. 5. Akushu no genjo to taisaku gijutsu

    Energy Technology Data Exchange (ETDEWEB)

    Saiki, Y.

    1996-07-01

    Offensive odor substances belongs to a quite different field from the perfume inspire of the same sense of smell, and is a substance forming a lot of troubles which is formed in intimate resident environments such as manufacturing factories of the chemicals, incineration and decomposition treatment process of living body relating substances, stock raising facilities, restaurants and others. A material called the offensive odor substance is generally in very low concentration in the atmosphere, most of which is ppm order in its detection limit. And, the offensive odor intensity is proportional to logarithm of its concentration. For example, even removing 99.9% of the offensive odor substance from its forming source, there is remained its difficult countermeasuring problem of no removing as its offensive odor. At present, the offensive odor is severely regulated by means of laws and acts, research on its relating field is active, and its relating publications have become plenty. In this paper, outline on recent state of the offensive odor and its measuring technique was summarized. 14 refs., 6 figs., 8 tabs.

  16. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig

    2015-01-01

    shocks have been reported. METHODS: We analyzed the incidence, predictors and management of inappropriate shocks in the EFFORTLESS S-ICD Registry, which collects S-ICD implantation information and follow-up data from clinical centers in Europe and New Zealand. RESULTS: During a follow-up of 21 ± 13...... months, 48 out of 581 S-ICD patients (71% male, age 49 ± 18 years) experienced 101 inappropriate shocks (8.3%). The most common cause was cardiac signal oversensing (73%), such as T-wave oversensing. Eighteen shocks (18%) were due to supraventricular tachycardias (SVT), of which 15 occurred in the shock......-only zone. Cox-proportional hazard modeling using time-dependent covariates demonstrated that patients with a history of atrial fibrillation (HR 2.4) and patients with hypertrophic cardiomyopathy (HR 4.6) had an increased risk for inappropriate shocks, while programming the primary vector for sensing (from...

  17. Offense related characteristics and psychosexual development of juvenile sex offenders

    NARCIS (Netherlands)

    Doreleijers, T.A.H.; Jansen, L.M.C.; Bullens, R.A.R.

    2009-01-01

    ABSTRACT: OBJECTIVE:: This article reports on offense related characteristics and the psychosexual development in subgroups of juvenile sex offenders as measured by the Global Assessment Instrument for Juvenile Sex Offenders (GAIJSO). The predictive validity of these characteristics for persistent

  18. The elderly offender: relative frequency and pattern of offenses.

    Science.gov (United States)

    Wilbanks, W

    There is considerable literature on the elderly victim but almost none on the elderly offender. This study presents data on the relative frequency of felonies and misdemeanors by age and patterns of offenses for one jurisdiction, Dade County (Miami), Florida in 1980 and 1982. The pattern of offenses by the elderly was found to be varied with no concentration in the expected areas (shoplifting and child molesting). Age was found to be a better predictor of offense rates than sex or race. Persons aged eighteen to twenty-four were 138 times as likely to be charged with a felony as persons aged sixty-five and over. The highest offense rate for any age/sex/race subgroup (non-white male, eighteen to twenty-four) was 3,089 times the rate for the subgroup (white females, sixty-five and over) with the lowest felony rate.

  19. Inappropriate Intensive Care Unit admissions: Nigerian doctors ...

    African Journals Online (AJOL)

    2015-12-04

    Dec 4, 2015 ... Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is ..... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. References. 1.

  20. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  1. Bullying and Inappropriate Behaviour among Faculty Personnel

    Science.gov (United States)

    Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka

    2016-01-01

    This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…

  2. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...

  3. Missed opportunities and inappropriately given vaccines reduce ...

    African Journals Online (AJOL)

    Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate ...

  4. American Offensive Funny Riddles: A Critical Metaphor Analysis

    Directory of Open Access Journals (Sweden)

    Ahmed Sahib Jabir Mubarak

    2018-01-01

    Full Text Available The paradox in the offensive humor lies in the assumption that what evokes laughter can be harmful for someone. Linguistically, the offense can be expressed directly and indirectly, additionally, humor, including riddles is one of the most effective ways to show offense or aggression toward someone. Humor, on the other hand, is mostly expressed indirectly. Metaphoric forms are said to be one of the most appealing strategies of humor language. The present study aims at applying a critical metaphor analysis of some randomly selected American offensive humorous riddles related to various aspects of offense like race and nation. In this approach to critical discourse analysis, the cognitive aspect is added for the sake of analyzing figurative forms like metaphor which is considered as an important part of ideology. Thus, critical metaphor analysis covers both social and cognitive aspects. It is concluded that offensive jokes (namely funny riddles can be used as a tool to measure the aggressiveness towards certain social aspects like race; on the other hand, metaphors afford indications of facets of power, inequality and people ideologies in American society.

  5. Comparison of intellectually disabled offenders with a combined history of sexual offenses and other offenses versus intellectually disabled offenders without a history of sexual offenses on dynamic client and environmental factors

    NARCIS (Netherlands)

    van den Bogaard, K.J.H.M.; Embregts, P.J.C.M.; Hendriks, A.H.C.; Heestermans, M.C.

    2013-01-01

    Sexually offensive behavior is prevalent among individuals with intellectual disabilities (ID) and many sex offenders also commit other offenses such as vandalism or assault. We examined the differences between sex offenders with ID and a history of combined sex and other types of offenses (mixed

  6. Offense related characteristics and psychosexual development of juvenile sex offenders

    Directory of Open Access Journals (Sweden)

    van Wijk Anton PH

    2009-07-01

    Full Text Available Abstract Objective: This article reports on offense related characteristics and the psychosexual development in subgroups of juvenile sex offenders as measured by the Global Assessment Instrument for Juvenile Sex Offenders (GAIJSO. The predictive validity of these characteristics for persistent (sexual offensive behavior in subgroups of juvenile sex offenders was investigated. Methods: One hundred seventy four sex offenders (mean age 14.9 SD 1.4 referred by the police to the Dutch Child Protection Board were examined. Offense related characteristics were assessed by means of the GAIJSO and the BARO (a global assessment tool for juvenile delinquents, and criminal careers of the subjects were ascertained from official judicial records. Results: Serious need for comprehensive diagnostics were found on the domains sexual offense and psychosexual development in juvenile sex offenders, especially in the group of child molesters. These youngsters displayed more internalizing and (psychosexual developmental problems and their sexual offense was more alarming as compared to the other juvenile sex offender subgroups. Although one third of the juveniles had already committed one or more sex offenses prior to the index offense, at follow up (mean follow up period: 36 months SD 18 months almost no sexual recidivism was found (0.6% of the entire sample. However, a substantial proportion of the entire sample of juvenile sex offenders showed non-sexual (55.6% and violent recidivism (32.1%. Several predictors for a history of multiple sex offending and non-sexual recidivism were identified. Conclusion: This study revealed numerous problems in juvenile sex offenders. Assessment using the GAIJSO is helpful in order to identify indicators for extensive diagnostic assessment. In order to investigate the predictive validity for sexual reoffending a longer follow up period is necessary.

  7. Offense related characteristics and psychosexual development of juvenile sex offenders

    Science.gov (United States)

    Hart-Kerkhoffs, Lisette 't A; Doreleijers, Theo AH; Jansen, Lucres MC; van Wijk, Anton PH; Bullens, Ruud AR

    2009-01-01

    Objective: This article reports on offense related characteristics and the psychosexual development in subgroups of juvenile sex offenders as measured by the Global Assessment Instrument for Juvenile Sex Offenders (GAIJSO). The predictive validity of these characteristics for persistent (sexual) offensive behavior in subgroups of juvenile sex offenders was investigated. Methods: One hundred seventy four sex offenders (mean age 14.9 SD 1.4) referred by the police to the Dutch Child Protection Board were examined. Offense related characteristics were assessed by means of the GAIJSO and the BARO (a global assessment tool for juvenile delinquents), and criminal careers of the subjects were ascertained from official judicial records. Results: Serious need for comprehensive diagnostics were found on the domains sexual offense and psychosexual development in juvenile sex offenders, especially in the group of child molesters. These youngsters displayed more internalizing and (psychosexual) developmental problems and their sexual offense was more alarming as compared to the other juvenile sex offender subgroups. Although one third of the juveniles had already committed one or more sex offenses prior to the index offense, at follow up (mean follow up period: 36 months SD 18 months) almost no sexual recidivism was found (0.6% of the entire sample). However, a substantial proportion of the entire sample of juvenile sex offenders showed non-sexual (55.6%) and violent recidivism (32.1%). Several predictors for a history of multiple sex offending and non-sexual recidivism were identified. Conclusion: This study revealed numerous problems in juvenile sex offenders. Assessment using the GAIJSO is helpful in order to identify indicators for extensive diagnostic assessment. In order to investigate the predictive validity for sexual reoffending a longer follow up period is necessary. PMID:19594889

  8. Present of offensive odor problems. Shuki mondaino genjo

    Energy Technology Data Exchange (ETDEWEB)

    Ishiguro, T.

    1991-06-01

    As of 1991, full 20 years have elapsed since the Offensive Odor Control Law was promulgated in June, 1971 at the opportunity of public offensive odor nuisance raised as an issue from fish meat bone feather blood mills. Past livestock breeding agriculture and industrial factory type claim started changing to urban life and livelihood type claim around FY 1980, and which also started increasing the production of odor-destroyer and deodorant, then added with microbiological deodorant, to form an industry of Yen 100 billions, as so called at present. 'Odor boom'is said to have started coming around 1985 when utilization started being positively tried of effect given by the odor. The rule to execute the present Offensive Odor Control Law is said to have its most important defect that the stipulated time be only five minutes to collect odor, which has its mere average of concentration felt. As problematic in dispersed data of measurement and detecting sensitivity, it is of a very difficult condition. Initiation has been also made of propagating propulsion of preventive measures from offensive odor, study of countermeasures against urban type offensive odor sources, etc. 2 refs., 5 figs., 2 tabs.

  9. Reducing offensiveness of STD prevention advertisements in China.

    Science.gov (United States)

    Waller, David S; Fam, Kim-Shyan

    2011-01-01

    The issue of sexually transmitted diseases is a socially sensitive one in Asian communities, with governments being criticized for not doing enough to reduce AIDS transmission, and the advertising of such issues potentially causing offense to people. This article surveys 630 people in China to determine their level of offense toward the advertising of condoms and STD prevention and analyzes the qualitative responses to how they would reduce the offensiveness of such advertising. The results found that generally women are more offended by the advertising of these products than men, and in terms of creative execution, women prefer implicit, prevention or effects messages, whereas men suggested a scientific message, or a focus on the creative strategy or media/location of the advertisement. It is recommended that traditional Chinese Confucian values are important for public policy makers to keep in mind when wanting to advertise socially sensitive issues in China and wider Asia.

  10. [Offenses related to alcohol consumption in Mexico (1964-1984)].

    Science.gov (United States)

    Mas Condés, C

    1991-06-01

    Existing data series related to sentences pronounced upon offenders in Mexican courts of law are presented in this paper: Offenses committed were either of a misdemeanour nature, or of a federal criminal nature. In both types of offenses, magistrates discovered that offenders had been under the influence of alcohol when committing the misdemeanour or crime involved. Regression and correlation analysis were carried out upon such data series, and other variables of an economic nature as well. Results show that there exists an almost perfect correlation (.90, .96, .97) between both factors.

  11. POPI (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions: development of a tool to identify inappropriate prescribing.

    Directory of Open Access Journals (Sweden)

    Sonia Prot-Labarthe

    Full Text Available INTRODUCTION: Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. METHODS: A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. RESULTS: 108 explicit criteria (80 inappropriate prescriptions and 28 omissions were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based -50%- or working in community -50%-. Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous. Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references. Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions. DISCUSSION CONCLUSION: POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary.

  12. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  13. Psychosocial and developmental characteristics of female adolescents who have committed sexual offenses

    NARCIS (Netherlands)

    van der Put, C.; van Vugt, E.S.; Stams, G.J.J.M.; Hendriks, J.

    2014-01-01

    The present study aimed to examine differences in psychosocial and developmental characteristics between Adolescent Females who have committed Sexual Offenses (AFSOs; n = 40), Adolescent Females who have committed nonsexual Violent Offenses (AFVOs; n = 533), and Adolescent Males who have committed

  14. Psychosocial and developmental characteristics of female adolescents who have committed sexual offenses.

    NARCIS (Netherlands)

    van der Put, C; van Vugt, E.S.; Stams, G.J.J.M.; Hendriks, J.

    2013-01-01

    The present study aimed to examine differences in psychosocial and developmental characteristics between Adolescent Females who have committed Sexual Offenses (AFSOs; n = 40), Adolescent Females who have committed nonsexual Violent Offenses (AFVOs; n = 533), and Adolescent Males who have committed

  15. American Leadership and Decision-Making Failures in the Tet Offensive

    National Research Council Canada - National Science Library

    Turner, Charles

    2003-01-01

    .... This thesis will address the question of how the American leadership failed to correctly assess the indications of an impending offensive in the months preceding the 1968 Tet Offensive in Vietnam...

  16. Automatic recognition of offensive team formation in american football plays

    KAUST Repository

    Atmosukarto, Indriyati

    2013-06-01

    Compared to security surveillance and military applications, where automated action analysis is prevalent, the sports domain is extremely under-served. Most existing software packages for sports video analysis require manual annotation of important events in the video. American football is the most popular sport in the United States, however most game analysis is still done manually. Line of scrimmage and offensive team formation recognition are two statistics that must be tagged by American Football coaches when watching and evaluating past play video clips, a process which takes many man hours per week. These two statistics are also the building blocks for more high-level analysis such as play strategy inference and automatic statistic generation. In this paper, we propose a novel framework where given an American football play clip, we automatically identify the video frame in which the offensive team lines in formation (formation frame), the line of scrimmage for that play, and the type of player formation the offensive team takes on. The proposed framework achieves 95% accuracy in detecting the formation frame, 98% accuracy in detecting the line of scrimmage, and up to 67% accuracy in classifying the offensive team\\'s formation. To validate our framework, we compiled a large dataset comprising more than 800 play-clips of standard and high definition resolution from real-world football games. This dataset will be made publicly available for future comparison. © 2013 IEEE.

  17. Criminal law. [Propositions for the inclusion of nuclear offenses

    Energy Technology Data Exchange (ETDEWEB)

    da Silva, J.M.

    1979-07-01

    Facts concerning the application of atomic energy are presented and those aspects which should be under tutelage, the nature and guilt of the nuclear offenses and the agent's peril are presented. The need of a specific chapter in criminal law with adequate legislation concerning the principles of atomic energy is inferred. The basis for the future elaboration this legislation are fixed.

  18. 14 CFR 61.15 - Offenses involving alcohol or drugs.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Offenses involving alcohol or drugs. 61.15... involving alcohol or drugs. (a) A conviction for the violation of any Federal or State statute relating to... vehicle while intoxicated by alcohol or a drug, while impaired by alcohol or a drug, or while under the...

  19. 14 CFR 65.12 - Offenses involving alcohol or drugs.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Offenses involving alcohol or drugs. 65.12... alcohol or drugs. (a) A conviction for the violation of any Federal or state statute relating to the... narcotic drugs, marihuana, or depressant or stimulant drugs or substances is grounds for— (1) Denial of an...

  20. 14 CFR 63.12 - Offenses involving alcohol or drugs.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Offenses involving alcohol or drugs. 63.12... alcohol or drugs. (a) A conviction for the violation of any Federal or state statute relating to the... narcotic drugs, marihuana, or depressant or stimulant drugs or substances is grounds for— (1) Denial of an...

  1. Inappropriate colonoscopic surveillance of hyperplastic polyps.

    LENUS (Irish Health Repository)

    Keane, R A

    2011-11-15

    Colonoscopic surveillance of hyperplastic polyps alone is controversial and may be inappropriate. The colonoscopy surveillance register at a university teaching hospital was audited to determine the extent of such hyperplastic polyp surveillance. The surveillance endoscopy records were reviewed, those patients with hyperplastic polyps were identified, their clinical records were examined and contact was made with each patient. Of the 483 patients undergoing surveillance for colonic polyps 113 (23%) had hyperplastic polyps alone on last colonoscopy. 104 patients remained after exclusion of those under appropriate surveillance. 87 of the 104 patients (84%) were successfully contacted. 37 patients (8%) were under appropriate colonoscopic surveillance for a significant family history of colorectal carcinoma. 50 (10%) patients with hyperplastic polyps alone and no other clinical indication for colonoscopic surveillance were booked for follow up colonoscopy. This represents not only a budgetary but more importantly a clinical opportunity cost the removal of which could liberate valuable colonoscopy time for more appropriate indications.

  2. Comparison of intellectually disabled offenders with a combined history of sexual offenses and other offenses versus intellectually disabled offenders without a history of sexual offenses on dynamic client and environmental factors.

    Science.gov (United States)

    van den Bogaard, K J H M; Embregts, P J C M; Hendriks, A H C; Heestermans, M

    2013-10-01

    Sexually offensive behavior is prevalent among individuals with intellectual disabilities (ID) and many sex offenders also commit other offenses such as vandalism or assault. We examined the differences between sex offenders with ID and a history of combined sex and other types of offenses (mixed sex offenders) versus offenders with no history of sexual offenses (non-sex offenders). Dynamic client and environmental factors were measured using the Adult Behaviour Checklist (ABCL) and the Risk Inventarization Scale on Sexually Offensive Behavior of Clients with intellectual disabilities (RISC-V). Item, subscale, and total scores were then compared for the two groups. Most of the comparisons did not reveal significant differences between the two groups. The findings call for a general theory of offending behavior to explain the absence of differences between the mixed sex offenders and non-sex offenders with ID. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses' Perspectives.

    Science.gov (United States)

    Askola, Riitta; Nikkonen, Merja; Putkonen, Hanna; Kylmä, Jari; Louheranta, Olavi

    2017-07-01

    The purpose of this study is to describe the therapeutic approach to a patient's criminal offense in a forensic mental health nurse-patient relationship from the nurse's perspective. Eight nurses in a Finnish forensic psychiatric hospital were interviewed, and the resultant research material was analyzed by inductive content analysis. The results revealed the process of the therapeutic approach to a patient's offense, which comprises numerous steps and various phases. For the nurse, the process of working through the offense can be divided into stages in which an attempt is made to respond to the patient's behavior and interaction in a manner that leads to working through the criminal act. © 2016 Wiley Periodicals, Inc.

  4. Criminal and offensive behavior involving multiuser virtual worlds

    OpenAIRE

    Jungman, Heikki

    2009-01-01

    This thesis is a study about criminal and offensive activity involving virtual worlds. It will cover cases purely taking place inside virtual worlds, as well as cases connected to them in some other way. The thesis will also discuss about the problems that current legislature and enforcement of norms have in virtual worlds, and find out solutions to those problems. An overall look on the state of virtual worlds of today is also made. The issues of real world are increasingly influencing v...

  5. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah

    2017-03-01

    Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  6. Sex Offenses Against Minors in China: An Empirical Comparison.

    Science.gov (United States)

    Hu, Ming; Liang, Bin; Huang, Siwen

    2017-08-01

    In recent years, due to a number of notorious sex offense cases against minors, a new punitive public attitude emerged in China and pressed for harsher crackdown and punishment against sex offenders. In particular, an "engagement in prostitution with a minor" law (Article 360 of the Criminal Law) was targeted as "unjust" based on the belief that offenders of such crimes often received "lenient" punishment, and many called for its abolition. In this study, based on 440 adjudicated sex offense cases, we examine potential differences across three sex offenses (including rape, child molestation, and engagement in prostitution with a minor) in the demographics of defendants and victims, offending characteristics, and trials and sentences of convicted offenders. Our empirical inquiry pointed to the unique nature of engagement in prostitution with a minor. Offenders of such crimes seemingly carried a different profile, compared with offenders of the other two sex crimes. Moreover, our data casted some doubt on the "lenient" punishment received by offenders of engagement in prostitution with a minor. Policy implications were also drawn based on our findings.

  7. [Patients with hyperlipidemia: inappropriate nutritional intake].

    Science.gov (United States)

    Lecerf, Jean-Michel; Hottin, Delphine Mastin

    2004-10-23

    Gather knowledge on nutritional supplementation in patients with hyperlipidemia. In an observational study on patients with hyperlipidemia, nutritional intake was assessed using a 7-day dietary questionnaire, provided on the first visit to a lipid clinic. 291 patients (201 men and 90 women) were studied. Calorie intake and proportion of energetic nutrients revealed low carbohydrate intake, low intake of dietary fibres, and excessive lipid and saturated fatty acid intakes. Patients with isolated hypercholesterolemia had nutritional intake very similar to the daily allowances recommended in France. Men with type III hyperlipidemia had the highest calorie intake and those with type IV dyslipidemia had the highest alcohol intake. Triglycerides increased with total energy intake and with fat intake (%). Body mass index was inversely correlated to carbohydrate intake. The duration of dyslipidemia was related to low vitamin C and B9 intake. The existence of risk factors (type 2 diabetes, hypertension, smoking or inactivity) was associated with less well-balanced diet and low protective micronutrient status. In the case of atherosclerosis, vitamin B9, C, E and beta-carotene intake was insufficient. Interactions existed between nutrient intake with correlations between fibres, vitamin B9, C and beta-carotene, suggesting that nutritional education should favour foodstuffs that provide them simultaneously. Nutritional intake in patients with hyperlipidemia is often far from that recommended and does not greatly differ from that in large non-selected populations. It can be considered as inappropriate because of the metabolic and cardiovascular risks in these patients. Adapted nutritional management is crucial.

  8. Accommodating Presuppositions Is Inappropriate in Implausible Contexts.

    Science.gov (United States)

    Singh, Raj; Fedorenko, Evelina; Mahowald, Kyle; Gibson, Edward

    2016-04-01

    According to one view of linguistic information (Karttunen, 1974; Stalnaker, 1974), a speaker can convey contextually new information in one of two ways: (a) by asserting the content as new information; or (b) by presupposing the content as given information which would then have to be accommodated. This distinction predicts that it is conversationally more appropriate to assert implausible information rather than presuppose it (e.g., von Fintel, 2008; Heim, 1992; Stalnaker, 2002). A second view rejects the assumption that presuppositions are accommodated; instead, presuppositions are assimilated into asserted content and both are correspondingly open to challenge (e.g., Gazdar, 1979; van der Sandt, 1992). Under this view, we should not expect to find a difference in conversational appropriateness between asserting implausible information and presupposing it. To distinguish between these two views of linguistic information, we performed two self-paced reading experiments with an on-line stops-making-sense judgment. The results of the two experiments-using the presupposition triggers the and too-show that accommodation is inappropriate (makes less sense) relative to non-presuppositional controls when the presupposed information is implausible but not when it is plausible. These results provide support for the first view of linguistic information: the contrast in implausible contexts can only be explained if there is a presupposition-assertion distinction and accommodation is a mechanism dedicated to reasoning about presuppositions. Copyright © 2015 Cognitive Science Society, Inc.

  9. Electoral Offenses in The Common Law System

    Directory of Open Access Journals (Sweden)

    Vladimir Mulaj

    2013-07-01

    Full Text Available Electoral behavior is a new element in the political analysis of democracy in Albania. Distinctive features of the Albanian transition distinguish other models of the former communist countries, as well as significantly differ with Western models and electoral behavior analysis of the relations between political actors and citizens voting. Penal Code of the Republic of Albania remains the basis of criminal law to sanction criminal acts in the election. The object of criminal misconduct are directly related to the normal criminal and legal protection and free elections as well as the Albanian Constitution provides all these obstacles to electoral subjects committed by force or by any other means which directly affect the normal performance electoral system. Barriers can be done with physical or psychological, and consists in blocking commissioners election materials, election materials decay affecting decay electoral system unfairly supported a particular political party or a coalition of political parties that present list candidacy according to the rules defined in the electoral code. Albanian Constitution as the fundamental law of the Albanian state provides for the rightness of the equality of the vote for all Albanian citizens The vote is the democratic way that every citizen expressing the opinion and its political will but to have democratic value ratings should be personal equal, free and secret. The right to vote is a political right provided by the Albanian Constitution and the Universal Declaration of Human Rights and as such is closely linked to democracy, the sovereignty of the people and citizens. Total vote, or the right to get to the polls all Albanian citizens, men and women, and in fact is the greatest achievement of the twentieth century. According to the Electoral Code of the Republic of Albania every citizen exercises his right to vote at his polling station, where placed under citizen’s location criteria. Voting centers

  10. To the 100th Anniversary of Storming of the Erzerum: the Offensive Operationand Its Significance

    Directory of Open Access Journals (Sweden)

    Vladimir B. Karataev

    2016-12-01

    Full Text Available The article is considered the Erzurum offensive and its significance for Russian society due to the 100th anniversary.There were used the published materials – the collections of documents, scientific research, as well as private sources: memoirs and diaries. The methodological basis of the study were the principles of objectivity and historicism, suggesting an unbiased approach to the analysis of the studied problems, a critical attitude to the sources, making judgments under result of the analysis of set of facts and the screening phenomena in the development and the context of the historical situation. The authors conclude that the Erzurum offensive was the result of the efficient conduct tactical and strategic planning of the Russian command. Despite the considerable force of the enemy and his strong defensive positions, the operation has been a success with relatively small losses of the Russian army. The victory inspired not only the army, but also the Russian rear, which had a positive impact on the mood in society.

  11. Offense Trajectories, the Unfolding of Sexual and Non-Sexual Criminal Activity, and Sex Offense Characteristics of Adolescent Sex Offenders.

    Science.gov (United States)

    Cale, Jesse; Smallbone, Stephen; Rayment-McHugh, Sue; Dowling, Chris

    2016-12-01

    The current study examines offending trajectories of adolescent sexual offenders (ASOs). Until recently, classification frameworks have not been designed to account for the heterogeneity of offending patterns in adolescence, how these are associated with the unfolding of sexual and non-sexual criminal activity, and whether and to what extent they are related to the characteristics of sex offenses in adolescence. The current study takes a longitudinal view of offending in adolescence by examining retrospective longitudinal data of 217 ASOs referred for treatment to a clinical service between 2001 and 2009 in Australia. General offending trajectories in adolescence were examined using semi-parametric group-based modeling, and compared according to non-violent non-sexual, violent-non-sexual, and sex offending criminal activity parameters (e.g., participation, onset, frequency, specialization/versatility) and the characteristics of the referral sexual offense. The results show distinct differences in the unfolding of sexual and non-sexual criminal activity along different offending trajectories of ASOs, and further, that these trajectories were differentially associated with the characteristics of the sexual offenses they committed. © The Author(s) 2015.

  12. Inappropriate treatments for patients with cognitive decline.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F

    2014-01-01

    Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population. Copyright © 2012 Sociedad Española de Neurolog

  13. Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior

    Science.gov (United States)

    Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.

    2009-01-01

    Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

  14. Prescribing Patterns and Inappropriate Use of Medications in Elderly ...

    African Journals Online (AJOL)

    Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria. ... Tropical Journal of Pharmaceutical Research ... Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary ...

  15. Correlates of offense severity and recidivism probability in a Canadian sample.

    Science.gov (United States)

    Mandelzys, N

    1979-10-01

    Related the severity of the most recent offense (Offense Severity Scale) and the probability of recidivism (California Base Expectancy Scale) to a number of social/background and psychometric variables in a sample of inmates incarcerated in a Canadian federal institution (N = 457). Multpile regression indicated that when the group was considered as a totality the most consistent relationships with both offense severity and probability of recidivism centered on the background variables, in particular, the total number of arrests and first offense variables (age, type of offense, and sentence). Further analyses were performed by classifying the group along the offense severity dimension, and the results of these analyses clearly demonstrated the heterogeneity of the groups in question.

  16. Offensive Cyber Operations: The Need for a Policy to Contend with the Future

    Science.gov (United States)

    2016-06-10

    policy document, language detailing that the United States will conduct offensive cyber operations to protect the country and its national interests...06-2016 4. TITLE AND SUBTITLE Ga. CONTRACT NUMBER OFFENSIVE CYBER OPERATIONS: Sb. GRANT NUMBER THE NEED FOR A POLICY TO CONTEND WITH THE FUTURE 5c...States. An excellent example ofan offensive cyber operation is the Stuxnet malicious virus which attacked the Iranian nuclear program. Stuxnet

  17. Inappropriate urinary catheter reinsertion in hospitalized older patients.

    Science.gov (United States)

    Hu, Fang-Wen; Tsai, Chuan-Hsiu; Lin, Huey-Shyan; Chen, Ching-Huey; Chang, Chia-Ming

    2017-01-01

    We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  18. Autism spectrum disorder symptoms in juvenile suspects of sex offenses.

    Science.gov (United States)

    't Hart-Kerkhoffs, Lisette A; Jansen, Lucres M; Doreleijers, Theo A; Vermeiren, Robert; Minderaa, Ruud B; Hartman, Catharina A

    2009-02-01

    To investigate autism spectrum disorder (ASD) symptoms in juvenile suspects of sex offenses. A group of 175 juvenile suspected sex offenders (all males, mean +/- SD age = 14.9 +/- 1.4 years) was compared with a matched healthy control group (N = 500, mean +/- SD age = 14.0 +/- 1.4 years) and a group of children with DSM-IV-diagnosed ASD (N = 114, mean +/- SD age = 14.2 +/- 1.9 years) with respect to autistic symptoms as measured by means of a standardized questionnaire, the Children's Social Behavior Questionnaire. Furthermore, specific subgroups of sexual offenders, i.e., child molesters, solo peer offenders, and group offenders, were compared with regard to levels of ASD symptoms. The study was conducted from May 2003 to December 2006. Significantly higher levels of ASD symptoms were found in juvenile sex offenders than in healthy controls, while levels were lower than in the ASD group (F = 148.259, p sex offenses as compared to the healthy population, which argues for considering specific diagnostic assessment in this population, especially in solo offenders and child molesters. Copyright 2009 Physicians Postgraduate Press, Inc.

  19. Women accused of sex offenses: a gender-based comparison.

    Science.gov (United States)

    West, Sara G; Friedman, Susan Hatters; Kim, Ki Dan

    2011-01-01

    Sexual offenses committed by women are likely underestimated and under-reported. This exploratory study compares and contrasts women accused of sexual offenses and their male counterparts. Data were retrospectively compiled on all alleged female and age-matched male sex offenders who were referred for psychiatric evaluation to a large Midwestern city's court psychiatric clinic over a six-year period. Data were abstracted regarding their crimes, charges, demographics, social history, medical history, legal history, violence history, substance use, sexual history, psychiatric history and their victims. Like the men, women were most frequently referred for sexual predator classification evaluations. Ages ranged from 19 to 62 years, and the majority had children. Most had prior arrests. One-third had a past history of psychiatric hospitalization, and most were given a non-paraphilic psychiatric diagnosis. The majority of the women reported past histories of sexual or physical victimization. While there were many similarities between female and male sex offenders in this psychiatric sample, women more frequently had victims of both genders. Copyright © 2011 John Wiley & Sons, Ltd.

  20. Typography for Children May Be Inappropriately Designed

    Science.gov (United States)

    Wilkins, Arnold; Cleave, Roanna; Grayson, Nicola; Wilson, Louise

    2009-01-01

    We present four studies indicating that the size and design of the typeface in textual material for children aged 7-9 may impair speed of reading and comprehension, and measurement of reading attainment. The first study compared the speed with which sample sentences were comprehended. The sentences were printed in Arial font with an x-height of…

  1. OFFENSE ELEMENTS ANALYSIS IN BASKETBALL APPLIED BY WELL-KNOWN COACHES

    Directory of Open Access Journals (Sweden)

    Naid Kadušić

    2010-09-01

    Full Text Available Offense tatctics can be divided into indivdual, group and collective. This article deals with man to man offense, as well as with primary and secondary fast break. It deals with offense tactics consideration and analysis of well-known contemporary teams. Their tactics is presented through different simplified patterns. These patterns allow the teams to find more ideas how to outperform an oponent. The aim of each strategy is to bring a specific outcome, which may be positive or negative. A game outcome is the final product of a team and it shows whether any progress has been made. One of the important offense tactics is man to man, which is very demanding. There is secondary offense also, that represents a situation in which the oponent defense is outnumbered by the offense. These tactics are closely connected with primary and secondary fast break offense. Another interesting type of an offensive play is the pick and roll, one of the most common contemporary plays used in basketball.

  2. Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani

    2012-01-01

    Full Text Available Background: early diagnosis of left ventricular mass (LVM inappropriateness and left ventricular hypertrophy (LVH can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E/late diastolic peak velocity (A, deceleration time (DT, and E/early mitral annulus velocity (E′ were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P 0.05. Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025. Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

  3. Violent sex offenses: how are they best measured from official records?

    Science.gov (United States)

    Rice, Marnie E; Harris, Grant T; Lang, Carol; Cormier, Catherine

    2006-08-01

    In the United States, sexually violent predator (SVP) commitment statutes generally require assessment of an offender's risk of subsequent sexual violence. Current actuarial methods for predicting sexual reoffending were actually designed to predict something else-charges or convictions for offenses deemed sexual based on information obtained from police "rapsheets" alone. This study examined the referral and past offenses of 177 sex offenders. Results showed that police rapsheets (and data based on them) underestimated the number and severity of sexually motivated violent offenses for which sex offenders were actually apprehended. Rapsheet violent offenses seemed a more accurate index of the conduct addressed by SVP legislation than were rapsheet sex offenses. We suggest that, when evaluating sex offenders for SVP status, actuarial instruments designed to predict violent recidivism (as measured by rapsheet violent reoffenses) might be preferable to those designed to predict sexual recidivism (as measured by rapsheet sexual reoffenses).

  4. Discontinuing Inappropriate Medication Use in Nursing Home Residents : A Cluster Randomized Controlled Trial

    NARCIS (Netherlands)

    Wouters, Hans; Scheper, Jessica; Koning, Hedi; Brouwer, Chris; Twisk, Jos W.; van der Meer, Helene; Boersma, Froukje; Zuidema, Sytse U.; Taxis, Katja

    2017-01-01

    Background: Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. Objective: To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home

  5. Discontinuing Inappropriate Medication in Nursing Home Residents (DIM-NHR study): A cluster randomized controlled trial

    NARCIS (Netherlands)

    Wouters, H.; Scheper, J.; Koning, H.; Brouwer, C.; Twisk, J.; Van Der Meer, H.; Boersma, F.; Zuidema, S.; Taxis, K.

    2017-01-01

    Introduction: Inappropriate prescribing is a prevalent problem in nursing home residents that is associated with cognitive and physical impairment. Few interventions have been shown to reduce inappropriate prescribing. The aim was therefore to examine successful discontinuation of inappropriate

  6. Child pornography offenses are a valid diagnostic indicator of pedophilia.

    Science.gov (United States)

    Seto, Michael C; Cantor, James M; Blanchard, Ray

    2006-08-01

    This study investigated whether being charged with a child pornography offense is a valid diagnostic indicator of pedophilia, as represented by an index of phallometrically assessed sexual arousal to children. The sample of 685 male patients was referred between 1995 and 2004 for a sexological assessment of their sexual interests and behavior. As a group, child pornography offenders showed greater sexual arousal to children than to adults and differed from groups of sex offenders against children, sex offenders against adults, and general sexology patients. The results suggest child pornography offending is a stronger diagnostic indicator of pedophilia than is sexually offending against child victims. Theoretical and clinical implications are discussed. Copyright 2006 APA, all rights reserved.

  7. Inappropriate oophorectomy at time of benign premenopausal hysterectomy.

    Science.gov (United States)

    Mahal, Amandeep S; Rhoads, Kim F; Elliott, Christopher S; Sokol, Eric R

    2017-08-01

    We assessed rates of oophorectomy during benign hysterectomy around the release of the American College of Obstetricians and Gynecologists 2008 practice bulletin on prophylactic oophorectomy, and evaluated predictors of inappropriate premenopausal oophorectomy. A cross-sectional administrative database analysis was performed utilizing the California Office of Statewide Health Planning Development Patient Discharge Database for years 2005 to 2011. After identifying all premenopausal women undergoing hysterectomy for benign conditions, International Classification of Diseases (ICD)-9 diagnosis codes were reviewed to create a master list of indications for oophorectomy. We defined appropriate oophorectomy as cases with concomitant coding for ovarian cyst, breast cancer susceptibility gene carrier status, and other diagnoses. Using patient demographics and hospital characteristics to predict inappropriate oophorectomy, a logistic regression model was created. We identified 57,776 benign premenopausal hysterectomies with oophorectomies during the period studied. Of the premenopausal oophorectomies, 37.7% (21,783) were deemed "inappropriate" with no documented reason for removal. The total number of premenopausal inpatient hysterectomies with oophorectomy decreased yearly (12,227/y in 2005 to 5,930/y in 2011). However, the percentage of inappropriate oophorectomies remained stable. In multivariate analysis, Hispanic and African American ethnicity/race associated with increased odds of inappropriate oophorectomy (P Urban and at low Medi-Cal utilization hospitals showed increased odds of inappropriate oophorectomy. In premenopausal women undergoing benign hysterectomy, over one-third undergo oophorectomy without an appropriate indication documented. The rate of inappropriate oophorectomy in California has not changed since the 2008 American College of Obstetricians and Gynecologists guidelines. Whereas the absolute number of inpatient hysterectomies for benign

  8. Prevalence and correlates of inappropriate use of benzodiazepines in Kosovo.

    Science.gov (United States)

    Tahiri, Zejdush; Kellici, Suela; Mone, Iris; Shabani, Driton; Qazimi, Musa; Burazeri, Genc

    2017-08-01

    In post-war Kosovo, the magnitude of inappropriate use of benzodiazepines is unknown to date. The aim of this study was to assess the prevalence and correlates of continuation of intake of benzodiazepines beyond prescription (referred to as "inappropriate use") in the adult population of Gjilan region in Kosovo. A cross-sectional study was conducted in Gjilan region in 2015 including a representative sample of 780 individuals attending different pharmacies and reporting use of benzodiazepines (385 men and 395 women; age range 18-87 years; response rate: 90%). A structured questionnaire was administered to all participants inquiring about the use of benzodiazepines and socio-demographic characteristics. Overall, the prevalence of inappropriate use of benzodiazepines was 58%. In multivariable-adjusted models, inappropriate use of benzodiazepines was significantly associated with older age (OR 1.7, 95% CI 1.1-2.7), middle education (OR 1.8, 95% CI 1.2-2.7), daily use (OR 1.4, 95% CI 1.1-2.0) and addiction awareness (OR 2.7, 95% CI 2.0-3.8). Furthermore, there was evidence of a borderline relationship with rural residence (OR 1.2, 95% CI 0.9-1.7). Our study provides novel evidence about the prevalence and selected correlates of inappropriate use of benzodiazepines in Gjilan region of Kosovo. Health professionals and policymakers in Kosovo should be aware of the magnitude and determinants of drug misuse in this transitional society.

  9. Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.

    Science.gov (United States)

    Peces, R; Pobes, A; Díaz-Corte, C; Gago, E

    2000-08-01

    We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

  10. Inappropriate prescribing of proton pump inhibitors among patients ...

    African Journals Online (AJOL)

    updating physicians on the practice guidelines, participation of a clinical pharmacist in making therapeutic decisions and modifying hospital ... inappropriate overuse of PPIs include physician type, practice setting, formulary status and ... Well-trained assistants, using a structured questionnaire, recruited the study sample.

  11. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva

    2009-09-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  12. Inappropriate Practices in Fitness Testing and Reporting: Alternative Strategies

    Science.gov (United States)

    Zhu, Xihe; Davis, Summer; Kirk, T. Nicole; Haegele, Justin A.; Knott, Stephen E.

    2018-01-01

    Fitness education is becoming an integrated component for many physical education programs. As such, many physical educators conduct health-related fitness tests on a regular basis. Some states even mandate certain types of physical fitness tests to be administered and reported annually or by semester. Yet, inappropriate practices have been…

  13. Visual Reaction Time™ as a predictor of sexual offense recidivism.

    Science.gov (United States)

    Gray, Steven R; Abel, Gene G; Jordan, Alan; Garby, Tina; Wiegel, Markus; Harlow, Nora

    2015-04-01

    In this study, we investigated the use of Visual Reaction Time™ (VRT™) for sexual interest in children to predict recidivism of sexual offenses among men who sexually abused children and men with other sexually deviant behaviors. The authors hypothesized that study participants with a higher VRT™ to stimuli of children would be more likely to sexually reoffend compared with those with a lower VRT™ to stimuli of children. Participants included 621 adult males on parole or probation for acting on a range of sexual paraphilias who sought outpatient treatment or evaluation at two separate therapists' practices. Sample 1 consisted of 284 adult males followed up (by the lead author) during a 15-year period, while Sample 2 consisted of 337 adult males followed up (by the second author) during a 7-year period. A discrete-time hazard model found VRT™ to children to be significantly related to sexual recidivism. The researchers found that VRT™ to children measured at intake held up in its predictive ability over a 15-year period. When the participants were divided into three groups based on their VRT™, of the 97 participants who measured at least one standard deviation lower than the mean VRT™, 0% reoffended. The 432 participants in the medium-VRT™ group had an estimated recidivism rate of 7% after 15 years and the 92 participants who measured at least one standard deviation higher than the mean had an estimated recidivism rate of 27%. © The Author(s) 2013.

  14. Juveniles who have committed sexual offenses: a special group?

    Science.gov (United States)

    Fanniff, Amanda M; Kimonis, Eva R

    2014-01-01

    Juveniles who have committed sexual offenses (JSOs) are subject to specialized interventions and public policies based on the assumption that they constitute a unique group distinct from other delinquents. Previous research has demonstrated considerable similarities between these groups, though some consistent differences have been found and some theory-relevant constructs have been inadequately studied. The current study compares 119 delinquents and 108 JSOs on a number of theory-relevant constructs. Consistent with theories positing a unique etiology for sexual offending, JSOs reported higher rates of sexual abuse and anxiety as well as fewer consensual sexual partners, less delinquent activity, and lower callous-unemotional traits; however, there were no differences detected in the majority of characteristics examined (e.g., attachment, sensation-seeking). Physical and emotional abuse did not predict sex offending after controlling for sexual abuse, but lower callous-unemotional traits did predict sex offending after controlling for total delinquent behavior. Additional research on constructs little studied in previous research (e.g., sexual history and development, attachment) is needed, but evidence to date suggests considerable overlap between these populations. Perhaps subgroups of JSOs are distinct from generally delinquent youth; however, a focus on offender characteristics or trajectories of behavior problems may prove more fruitful than categorizing youth based on a single behavior. Copyright © 2014 John Wiley & Sons, Ltd.

  15. The transformation of the offensive system in Asobal Cup 2011

    Directory of Open Access Journals (Sweden)

    Alejandro Perira Ortega

    2012-11-01

    Full Text Available The aim of this study is to obtain information regarding time length, areas and distances of the attack end, specific positions from which the attack end can be executed and differences in effectiveness between system 3:3 with two pivots and system 2:4. Therefore three matches of the Asobal Cup 2011 have been analyzed. This analysis leads us to obtain time values, distribution of absolute and relative frequencies, and to calculate the effectiveness coefficients: absolute success (EA, relative success (ER, absolute failure (FA and relative failure (FR. There were no differences between average length of extreme and first line deployment circulation. Systems 3:3 with two pivots provide more options for the attack end than the System 2:4 for the first line of attack. Furthermore, with the players going to the second line, pivots get a higher attack end percentage, between six and nine meters. System 3:3 with two pivots shows a better ER and FA value than system 2:4Keywords: offensive system, transitions, effectiveness, areas, distance, attack end.

  16. The strategic offense initiative? The Soviets and Star Wars

    Energy Technology Data Exchange (ETDEWEB)

    Westwick, Peter J. [History Department, University of Southern California, Los Angles, California (United States)

    2014-05-09

    Historians of the Cold War have paid too little attention to Soviet fears of 'space-strike weapons' - that is, possible offensive uses of President Ronald Reagan's Strategic Defense Initiative. In fifteen years or so, soldiers will no longer shoot rifles but will use some kind of lightning, some sort of a machine emitting a holocaustal electrical beam. Tell me, what can we invent in this line so as to surprise our neighbors?... Alas, we are only capable of imitating and purchasing weapons from others, and we do well if we manage to repair them ourselves. --Fyodor Dostoevsky, A Writer's Diary, 1873. [Khlinov, a physicist]: 'I know that he has made an important discovery concerning the transmission of infra-red rays over a distance.... Heat waves at a temperature of a thousand degrees centigrade transmitted parallel to each other constitute a monstrous weapon of destruction and defense in time of war. The whole secret lies in the transmission of a ray that does not disperse. So far nobody has been able to do this. Judging by your story, Garin has constructed a machine that will do it. If so it is an extremely important discovery.' 'I've been thinking for a long time that this invention smells of higher politics,' said Shelga. --Aleksei Tolstoy, The Garin Death Ray, 1927 (translated by George Hanna)

  17. The strategic offense initiative? The Soviets and Star Wars

    Science.gov (United States)

    Westwick, Peter J.

    2014-05-01

    Historians of the Cold War have paid too little attention to Soviet fears of "space-strike weapons" - that is, possible offensive uses of President Ronald Reagan's Strategic Defense Initiative. In fifteen years or so, soldiers will no longer shoot rifles but will use some kind of lightning, some sort of a machine emitting a holocaustal electrical beam. Tell me, what can we invent in this line so as to surprise our neighbors?... Alas, we are only capable of imitating and purchasing weapons from others, and we do well if we manage to repair them ourselves. --Fyodor Dostoevsky, A Writer's Diary, 1873. [Khlinov, a physicist]: "I know that he has made an important discovery concerning the transmission of infra-red rays over a distance.... Heat waves at a temperature of a thousand degrees centigrade transmitted parallel to each other constitute a monstrous weapon of destruction and defense in time of war. The whole secret lies in the transmission of a ray that does not disperse. So far nobody has been able to do this. Judging by your story, Garin has constructed a machine that will do it. If so it is an extremely important discovery." "I've been thinking for a long time that this invention smells of higher politics," said Shelga. --Aleksei Tolstoy, The Garin Death Ray, 1927 (translated by George Hanna)

  18. The strategic offense initiative? The Soviets and Star Wars

    International Nuclear Information System (INIS)

    Westwick, Peter J.

    2014-01-01

    Historians of the Cold War have paid too little attention to Soviet fears of 'space-strike weapons' - that is, possible offensive uses of President Ronald Reagan's Strategic Defense Initiative. In fifteen years or so, soldiers will no longer shoot rifles but will use some kind of lightning, some sort of a machine emitting a holocaustal electrical beam. Tell me, what can we invent in this line so as to surprise our neighbors?... Alas, we are only capable of imitating and purchasing weapons from others, and we do well if we manage to repair them ourselves. --Fyodor Dostoevsky, A Writer's Diary, 1873. [Khlinov, a physicist]: 'I know that he has made an important discovery concerning the transmission of infra-red rays over a distance.... Heat waves at a temperature of a thousand degrees centigrade transmitted parallel to each other constitute a monstrous weapon of destruction and defense in time of war. The whole secret lies in the transmission of a ray that does not disperse. So far nobody has been able to do this. Judging by your story, Garin has constructed a machine that will do it. If so it is an extremely important discovery.' 'I've been thinking for a long time that this invention smells of higher politics,' said Shelga. --Aleksei Tolstoy, The Garin Death Ray, 1927 (translated by George Hanna)

  19. Offenses against the environment and their prevention: an international appraisal

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, G.O.W.

    1979-07-01

    While pollutants recognize no jurisdictional boundaries and, therefore, constitute a threat to people everywhere, there has been little effort to utilize criminal sanctions within the framework of international law to control them. A partial explanation for this may be the fact that there is really no effective enforcement mechanism for international criminal law; the United Nations International Criminal Court is still on the drawing board. Certain pollution offenses have become matters of international criminal law by being subjected to universal jurisdiction under national law. However, there are many problems that have inhibited the use of criminal sanctions for protecting the environment on a national level and these carry over into the international level. These include: qualification, quantification, strict liability, vicarious liability, corporate liability, proof, abuse of power, changing priorities, inadequate enforcement, and countervailing penalization policies and trends toward decriminalization. Even a cautious use of the criminal sanction to combat pollution will succeed only if there is a strong public awareness of the problem and a determination to control it; threats to the environment are not yet adequately perceived as posing a problem.

  20. Incorporating feminist theory and insights into a restorative justice response to sex offenses.

    Science.gov (United States)

    Hopkins, C Quince; Koss, Mary P

    2005-05-01

    Sex offenses, particularly nonpenetration sex offenses and acquaintance sexual assault, are all too common. Because these crimes reinforce women's fear of crime and restrict spatial and social freedom, it is paramount for the justice system to act affirmatively; however, it does not. This article identifies several failures in the current response to these sex offenses. We describe the research demonstration project, RESTORE, operating in Pima County, Arizona, which uses a restorative justice response as a way of remedying some of those failures. Identifying central feminist insights that guided the development of that project, the article addresses concerns raised by feminists about the use of restorative justice for gendered violence. We conclude that most if not all of these concerns apply to cases of on going domestic violence--cases specifically excluded from the RESTORE program--rather than to cases of acquaintance sexual assault or nonpenetration sex offenses.

  1. 25 CFR 11.907 - Transfer to Court of Indian Offenses.

    Science.gov (United States)

    2010-04-01

    ... presenting officer or the minor may file a petition requesting the children's court to transfer the minor to... transfer jurisdiction of the minor to the Court of Indian Offenses if the children's court finds clear and...

  2. Crime seriousness and participation in restorative justice: The role of time elapsed since the offense.

    Science.gov (United States)

    Zebel, Sven; Schreurs, Wendy; Ufkes, Elze G

    2017-08-01

    Restorative justice policies and programs aimed at facilitating victim-offender mediation (VOM) are part of many criminal justice systems around the world. Given its voluntary nature and potential for positive outcomes, the appropriateness and feasibility of VOM after serious offenses is subject to debate in the literature. In light of this discussion, this study first aimed to unravel the prevalence of serious offenses in cases registered for VOM and examined whether crime seriousness predicts whether mediated contact is reached between victims and offenders. Second, it tested the hypothesis that victims of increasingly serious, harmful crimes are more willing to participate when more time has elapsed since the offense-in contrast to victims of less serious, harmful crimes. We analyzed 199 cases registered for VOM in the Netherlands and coded the perceived wrongfulness, harmfulness, and average duration of incarceration of an offense as 3 distinct indicators of crime seriousness in these cases. The findings revealed that cases registered for VOM (a) are, in terms of the incarceration duration, on average more serious than all offenses in the population, and (b) resulted in mediated contact (or not) independently of the 3 seriousness indicators. In addition, empirical support was found for the hypothesis that victims' willingness to participate in VOM increased over time after more harmful offenses, whereas it decreased when offenses inflicted less harm. These findings suggest that when VOM programs operate irrespectively of the time elapsed after crime, mediated contact between parties may be as likely after minor and serious offenses. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  3. Inappropriate prescribing in the older population: need for new criteria.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2012-02-03

    Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers\\' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers\\' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.

  4. Factors associated with inappropriate utilisation of emergency department services.

    Science.gov (United States)

    Selasawati, H G; Naing, L; Wan Aasim, W A; Winn, T; Rusli, B N

    2007-01-01

    This study was carried out to determine the associated factors and the reasons for inappropriate utilisation of Emergency Department (ED) services at Universiti Sains Malaysia Hospital. A case-control study was conducted with 170 cases from ED and 170 controls from the Outpatient Department (OPD). A self-administered questionnaire was designed and used to obtain sociodemographic data, knowledge on the functions of ED and OPD, health seeking attitude and behaviour, and reasons for seeking treatment at ED. The study found that gender, marital status, family size, shift work, perceived illness, and knowledge on the role and functions of ED and OPD were significant associated factors. The three most common reasons for inappropriate utilisation of ED were as follows: "due to severity of illness" (85%), "can't go to OPD during office hours" (42%), and "ED near my house" (27%).

  5. The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences.

    LENUS (Irish Health Repository)

    Hannon, M J

    2010-06-01

    Hyponatraemia is the commonest electrolyte abnormality found in hospital inpatients, and is associated with a greatly increased morbidity and mortality. The syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent cause of hyponatraemia in hospital inpatients. SIADH is the clinical and biochemical manifestation of a wide range of disease processes, and every case warrants investigation of the underlying cause. In this review, we will examine the prevalence, pathophysiology, clinical characteristics and clinical consequences of hyponatraemia due to SIADH.

  6. Requests for "inappropriate" treatment based on religious beliefs.

    Science.gov (United States)

    Orr, R D; Genesen, L B

    1997-06-01

    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured.

  7. Potentially inappropriate medications among older adults in Pelotas, Southern Brazil.

    Science.gov (United States)

    Lutz, Bárbara Heather; Miranda, Vanessa Irribarem Avena; Bertoldi, Andréa Dâmaso

    2017-06-22

    To assess the use of potentially inappropriate medications among older adults. This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease. Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications. It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List. Avaliar o uso de medicamentos potencialmente inadequados entre idosos. Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença. Dentre os 5.700 medicamentos utilizados, 5

  8. The neurobiology of offensive aggression: Revealing a modular view.

    Science.gov (United States)

    de Boer, S F; Olivier, B; Veening, J; Koolhaas, J M

    2015-07-01

    Experimental studies aimed at understanding the neurobiology of aggression started in the early 20th century, and by employing increasingly sophisticated tools of functional neuroanatomy (i.e., from electric/chemical lesion and stimulation techniques to neurochemical mapping and manipulations) have provided the important framework for the functional brain circuit organization of aggressive behaviors. Recently, newly emerging technologies for mapping,measuring and manipulating neural circuitry at the level of molecular and genetically defined neuronal subtypes promise to further delineate the precise neural microcircuits mediating the initiation and termination of aggressive behavior, and characterize its dynamic neuromolecular functioning. This paper will review some of the behavioral, neuroanatomical and neurochemical evidence in support of a modular view of the neurobiology of offensive aggressive behavior. Although aggressive behavior likely arises from a specific concerted activity within a distributed neural network across multiple brain regions, emerging opto- and pharmacogenetic neuronal manipulation studies make it clear that manipulation of molecularly-defined neurons within a single node of this global interconnected network seems to be both necessary and sufficient to evoke aggressive attacks. However, the evidence so far also indicates that in addition to behavior-specific neurons there are neuronal systems that should be considered as more general behavioral control modules. The answer to the question of behavioral specificity of brain structures at the level of individual neurons requires a change of the traditional experimental setup. Studies using c-fos expression mapping usually compare the activation patterns induced by for example aggression with a home cage control. However, to reveal the behavioral specificity of this neuronal activation pattern, a comparison with other social and non-social related behaviors such as mating, defensive burying

  9. Risk and Outcomes: Are Adolescents Charged with Sex Offenses Different from Other Adolescent Offenders?

    Science.gov (United States)

    Fanniff, Amanda M; Schubert, Carol A; Mulvey, Edward P; Iselin, Anne-Marie R; Piquero, Alex R

    2017-07-01

    Juveniles who have committed sexual offenses are subject to specialized treatment and policies based on their assumed unique dangerousness, despite contradictory evidence. Limited information is available regarding risk factors and their relationships to outcomes in this population. The comparative frequency and predictive utility of empirically supported risk factors for general delinquency were examined using data from the Pathways to Desistance study. Adolescent males who committed sexual offenses (n = 127) were compared to adolescent males who committed non-sexual offenses (n = 1021). At the start of the study, the sample ranged in age from 14 to 18 (M = 16.00, SD = 1.12) and self-identified as primarily African American (44 %), Latino (29 %), or White (25 %). Outcomes were measured over 7 years and included general and sexual recidivism, involvement in school and work, and positive relationships with peers and adults. The results indicated a few small differences in the presence of risk factors and their relationship to outcomes, with many similarities. Juveniles who have committed sexual offenses had equivalent general recidivism but higher sexual recidivism, though this rate was low (7.87 %, or 10 of the 127 adolescents who had committed sexual offenses). New clinical and policy approaches may be needed given the similarities between groups.

  10. Childhood Sexual Abuse in Adolescents Adjudicated for Sexual Offenses: Mental Health Consequences and Sexual Offending Behaviors.

    Science.gov (United States)

    Morais, Hugo B; Alexander, Apryl A; Fix, Rebecca L; Burkhart, Barry R

    2018-02-01

    Most studies on the mental health consequences of childhood sexual abuse (CSA) focus predominantly on CSA survivors who do not commit sexual offenses. The current study examined the effects of CSA on 498 male adolescents adjudicated for sexual offenses who represent the small portion of CSA survivors who engage in sexual offenses. The prevalence of internalizing symptoms, parental attachment difficulties, specific sexual offending behaviors, and risk for sexually offending were compared among participants with and without a history of CSA. Results indicated that participants with a history of CSA were more likely to be diagnosed with major depression and posttraumatic stress disorder than those who did not report a history of CSA. A history of CSA was also positively correlated with risk for sexually offending and with specific offense patterns and consensual sexual behaviors. No significant differences emerged on parental attachment difficulties. These results highlight that adolescents adjudicated for sexual offenses with a history of CSA present with differences in sexual and psychological functioning as well as markedly different offending patterns when compared with those without a CSA history. Clinical implications and future directions are discussed.

  11. Efficacy of the “pick and roll” offense in top level European basketball teams

    Directory of Open Access Journals (Sweden)

    Marmarinos Christos

    2016-06-01

    Full Text Available Team offense in basketball games consists of a set of offensive actions carried out with the cooperation of two or more players. Of these actions, the most commonly used in the last decade is the on-ball screen called the “pick and roll.” The aim of this study was to analyze all of the pick and rolls conducted in the Euroleague championship from all of the 24 participating teams and to investigate the possible relationships between success in the pick and roll and overall success of the teams. For this purpose, 12,376 pick and rolls from 502 matches were analyzed and classified in categories according to the end result of the offensive possession. The results showed that the most effective type of pick and roll offense was when a shot was attempted after 2 passes from the pick and roll occurrence, followed by the screener’s shot when he rolled to the basket. Additionally, linear regression analysis confirmed that pick and roll effectiveness could predict the final classification of the teams. Conclusively, coaches of the high level European clubs should focus on training the players to the most efficient phases of the pick and roll offense, so that the chances of winning the championship to be maximized.

  12. Cost analysis of inappropriate treatments for suspected dermatomycoses

    Directory of Open Access Journals (Sweden)

    Emanuela Fiammenghi

    2015-06-01

    Full Text Available Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1 to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2 to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II” in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination were defined as inappropriate: (1 cortisone in a patient with at least one positive site; (2 antifungals in (a patients with all negative sites or (b ineffective antifungal treatment (in terms of drug chosen, dose or duration in those with all positive sites; or (3 antibiotics; (4 antivirals or (5 antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease

  13. Medically Inappropriate or Futile Treatment: Deliberation and Justification 1

    Science.gov (United States)

    Misak, Cheryl J.; White, Douglas B.; Truog, Robert D.

    2016-01-01

    This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. PMID:26681796

  14. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.

    2010-01-01

    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study.......7-10), thrombocytopenia (3.9, 1.6-9.3), chronic liver failure (3.3, 1.1-10) and age >/=60 years (2.2, 0.99-5.0). Antibiotics not appropriately covering enterococci are frequently administered empirically in suspected bloodstream infections. Inappropriate antibiotic therapy was an independent risk factor for mortality...

  15. Quetiapine-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone

    Directory of Open Access Journals (Sweden)

    Theocharis Koufakis

    2016-01-01

    Full Text Available The syndrome of inappropriate secretion of antidiuretic hormone (SIADH can be induced by various conditions, including malignant neoplasms, infections, central nervous system disorders, and numerous drugs. We here report a case of a 65-year-old female patient, treated with quetiapine for schizophrenia, who presented with generalized tonic-clonic seizures and was finally diagnosed with quetiapine-induced SIADH. Quetiapine-associated hyponatremia is extremely uncommon and only a few, relevant reports can be found in the literature. This case underlines the fact that patients on antipsychotic medication and more specifically on quetiapine should be closely monitored and routinely tested for electrolyte disorders.

  16. Diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone

    DEFF Research Database (Denmark)

    Holm, Ellen Astrid; Bie, Peter; Ottesen, Michael

    2009-01-01

    BACKGROUND: Hyponatremia is a frequent condition in elderly patients. In diagnostic workup, a 24-hour urine sample is used to measure urinary osmolality and urinary sodium concentration necessary to confirm the diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH...... peptide (P = 0.007), elevated mean arterial blood pressure (P = 0.03), and lower plasma levels of creatinine (P = 0.002) compared to the controls. CONCLUSION: A spot urine sample seems to be sufficient to confirm the diagnosis of SIADH....

  17. Psychosocial characteristics of criminals committing incest and other sex offenses: a survey in a Taiwanese prison.

    Science.gov (United States)

    Lung, For-Wey; Huang, Shu-Fen

    2004-10-01

    The purpose of this study was to investigate the psychosocial characteristics of criminals who had committed incest or other sexual offenses. The participants, 240 criminals serving sentences for sex offenses in a Taiwanese prison, were divided into two groups: incest offenders (20.4%) and other sex offenders (79.6%). The psychosocial characteristics taken into consideration included age, parental survival, education, marital status, previous crime records, drug and alcohol abuse, diagnosed mental disorders, and victim abuse at the time of the offense. After an analysis of the data, the authors concluded that even though incest offenders showed fewer mental disorders, they needed psychiatric treatment and that this treatment should be focused not only on their mental disorder and related symptoms but especially to correct their abnormal behavior. Also, attention should be given to their psychosocial characteristics.

  18. Psychosocial and developmental characteristics of female adolescents who have committed sexual offenses.

    Science.gov (United States)

    van der Put, Claudia; van Vugt, Eveline S; Stams, Geert Jan J M; Hendriks, Jan

    2014-08-01

    The present study aimed to examine differences in psychosocial and developmental characteristics between Adolescent Females who have committed Sexual Offenses (AFSOs; n = 40), Adolescent Females who have committed nonsexual Violent Offenses (AFVOs; n = 533), and Adolescent Males who have committed Sexual Offenses (AMSO, n = 743). Results showed that AFSOs and AMSOs were remarkably similar, whereas AFSOs and AFVOs were remarkably different on the measured variables. Compared to AFVOs, AFSOs less often had antisocial friends and problems in the domains of school (truancy, behavior problems, dropping out of school) and family (e.g., parental problems, poor authority and control, and run away from home). Victimization of sexual abuse outside the family and social isolation were found to be more common in AFSOs than in AFVOs. Victimization of sexual abuse outside the family was the only specific characteristic of female adolescent sexual offending, as this was more common in AFSOs than in both AMSOs and AFVOs. © The Author(s) 2013.

  19. Comparative Analysis of Personality Structures of the Perpetrators of Aggressive and Non-aggressive Offense

    Directory of Open Access Journals (Sweden)

    Kalashnikova A.S.,

    2014-11-01

    Full Text Available problem of the emergence of aggressive behavior is seen through the analysis of the relationship of proagressive and inhibiting aggression personality structures. The study involved 54 men serving sentences for criminal offenses, of which 24 were accused for violent offenses and 30 - for offenses without resorting to violence. We used questionnaires to study the proagressive and deterring aggression personality structures. Statistical analysis was performed to reveal significant differences between groups and to determine correlations. On this basis, the correlations were interpreted with the help of not only quantitative but also qualitative analysis. The results showed no significant differences in the level of expression of aggression and aggression inhibitors between treatment groups, but we identified qualitative differences in the structural analysis of data from individual psychological characteristics that are expected to distinguish aggressive offenders from the perpetrators without violence.

  20. Child Sexual Abuse in Protestant Christian Congregations: A Descriptive Analysis of Offense and Offender Characteristics

    Directory of Open Access Journals (Sweden)

    Andrew S. Denney

    2018-01-01

    Full Text Available Utilizing data from 326 cases of alleged child sexual abuse that occurred at or through activities provided by Protestant Christian congregations, this study examines demographic and contextual characteristics of alleged child sexual abuse that took place within the most prevalent religious environment in the United States. Research questions are addressed in this study. First, what type of child sexual abuse most commonly occurs at or through activities provided by Protestant Christian congregations? Second, where do such offenses physically take place? Third, who are the offenders and what role(s do they assume in the congregations? We find that the overwhelming majority of offenses were contact offenses that occurred on church premises or at the offender’s home, and that most offenders were white male pastors or youth ministers who were approximately 40 years in age. We conclude with policy implications and recommendations for future research.

  1. MMPL profiles of men referred for a pretrial psychiatric assessment as a function of offense type.

    Science.gov (United States)

    Quinsey, V L; Arnold, L S; Pruesse, M G

    1980-04-01

    Gathered MMPI and demographic data on six groups of 25 men each who had been remanded by the courts to a maximum security psychiatric hospital for pretrial assessment. The groups differed according to offense type: Murder or attempted murder of a family member or girlfriend, murder or attempted murder of an unrelated victim, rape, arson, child molesting, or property. The MMPI profiles of the groups were remarkably similar, and the prediction that the murder family group would have the highest Overcontrolled Hostility scores was not supported. Multiple discriminant analyses showed that the remand's age on admission and whether he had been in corrections before the current offense were the best discriminators among the groups. These data indicate that the MMPI is not related to the offense types of mentally disordered offenders referred by the courts for assessment, but does reflect their relatively high levels of psychopathology.

  2. Prediction of Adult Criminal Careers from Early Delinquency Offense Characteristics in the 1958 Philadelphia Birth Cohort

    Directory of Open Access Journals (Sweden)

    Danielle M. Carkin

    2018-03-01

    Full Text Available Objective to investigate the impact of delinquency conduct on adult criminal career by the example of delinquent boys in the 1958 Philadelphia Birth Cohort. Methods dialectical approach to cognition of social phenomena allowing to analyze them in historical development and functioning in the context of the totality of objective and subjective factors predetermined the following research methods formallogical comparativelegal and sociological. nbsp Results by the example of delinquent boys in the 1958 Philadelphia Birth Cohort the authors investigate the nature of delinquency conduct offensebyoffense and its relationship to adult crime status. Although it is convenient to think of an offender39s delinquency career as a whole such a career actually consists of one or more specific offenses and offense conduct can be worth studying in its own right. Thus it is necessary to determine whether the timing type severity court disposition and so on of these juvenile offenses can be used to predict adult career pathways. An extensive review of the literature revealed that investigations of early offense conduct and its connection to adult crime are exceedingly scarce. Scientific novelty for the first time the research proves that the facility disposition appears to have a criminogenic effect. The juvenile court dispositions are significantly predictive of the adult pathsmdashthe less severe the disposition the less adult crime. At the time of the second offense age is found significant in that the younger the individual is at the time of the second offense the greater the chances are that the individual will receive a higher score in the adult path variable. The younger the individual is at the time of the third offense the more likely he is to score higher in the adult paths. Thus to decrease the adult crime rates it is necessary to work with delinquent criminals before they commit their third crime. Besides it is substantiated that the strongest

  3. Sex Differences in the Regulation of Offensive Aggression and Dominance by Arginine-Vasopressin

    OpenAIRE

    Joseph I. Terranova; Craig F. Ferris; H. Elliott Albers

    2017-01-01

    Arginine-vasopressin (AVP) plays a critical role in the regulation of offensive aggression and social status in mammals. AVP is found in an extensive neural network in the brain. Here, we discuss the role of AVP in the regulation of aggression in the limbic system with an emphasis on the critical role of hypothalamic AVP in the control of aggression. In males, activation of AVP V1a receptors (V1aRs) in the hypothalamus stimulates offensive aggression, while in females activation of V1aRs inhi...

  4. Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion.

    Science.gov (United States)

    Shah, Neil; Baker, Steven A; Spain, David; Shieh, Lisa; Shepard, John; Hadhazy, Eric; Maggio, Paul; Goodnough, Lawrence T

    2017-08-01

    To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  5. [Prevalence of potentially inappropriate drug prescription in the elderly].

    Science.gov (United States)

    Fajreldines, A; Insua, J; Schnitzler, E

    2016-01-01

    One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. The influence of rules manipulation on offensive patterns during small-sided and conditioned games in football

    Directory of Open Access Journals (Sweden)

    João Cláudio Machado

    Full Text Available Abstract This study analyzed the influence of rules manipulation on offensive patterns in different Small-Sided and Conditioned Games (SSCGs. Fourteen young soccer players (13.82 ± 1.94 years performed two different SSCG formats (6v6+Gk: Maintenance of Ball Possession Game (MPG and Progression to the Target Game (PTG. Both games were played on a field 52 m long by 32 m wide. We used the Offensive Sequences Characterization System (OSCS and SoccerEye software to analyze offensive sequences. For statistical analysis, we used the Mann-Whitney test to compare variables that compose the OSCS between the two SSCGs, while the SDIS-GSEQ software allowed us to detect offensive patterns. We concluded that the rule manipulation of SSCGs influenced changes in teams' offensive patterns, in which they self-organized according to manipulation of key task constraints.

  7. Rates of inappropriate antiretroviral prescription among injection drug users

    Directory of Open Access Journals (Sweden)

    Bonner Simon

    2007-01-01

    Full Text Available Abstract Background Although the survival benefits of antiretroviral therapy (ART for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU. Methods In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs ART for patients with a CD4 cell count of 350 or less; Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less; Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL; Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment. Results Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5% individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53% in Era 1, 3 (12% in Era 2, 22 (28% in Era 3, and 23 (15% in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5 – 20. Conclusion The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple

  8. Behavioral Coaching to Improve Offensive Line Pass-Blocking Skills of High School Football Athletes

    Science.gov (United States)

    Stokes, John V.; Luiselli, James K.; Reed, Derek D.; Fleming, Richard K.

    2010-01-01

    We evaluated several behavioral coaching procedures for improving offensive line pass-blocking skills with 5 high school varsity football players. Pass blocking was measured during practice drills and games, and our intervention included descriptive feedback with and without video feedback and teaching with acoustical guidance (TAG). Intervention…

  9. The Employment-Crime Association for Individuals Convicted of a Sexual Offense in Their Youth

    NARCIS (Netherlands)

    van den Berg, C.J.W.; Mesters, Geert

    2017-01-01

    Objective We study the bi-directional relationship between employment and crime for individuals convicted for a sexual offense in their youth (JSO) and investigate the moderating influences of age and employment duration. Method A bi-variate dynamic binary choice model is developed to allow for

  10. The Dual Treatment of Political Offenses Within the Framework of Human Rights

    Directory of Open Access Journals (Sweden)

    Daniela Silva Fontoura de Barcellos

    2015-12-01

    Full Text Available In general, the expression political offense means every harmful act against the domestic or international public order and against national security. However, there is a double treatment for this behavior in the Brazilian system. On one hand, the expression was used especially during the era of Brazilian authoritarian regimes to designate any activity against the public order policy and national security. In these cases, the political nature of the offense served to justify the loss of rights and guarantees, such as the prohibition of habeas corpus, the trial of civilians by military personnel and the aggravation of penalties. On the other, the characterization of a crime as a political may prevent the extradition of foreigners by granting them the possibility of obtaining asylum in the country, which hinders the criminal persecution action from the other State. Hence, this paper aims to demonstrate this duplicity of treatment of political offenses in Brazilian law, as well as the criteria used for this categorization. The methodology consists of a historical analysis of the aforementioned concept and presents the current state of the art as to its uses in Brazil. In order to achieve our purposes, we have employed as sources the national and international norms that display the category political offense and their empiric interpretation in the rulings of the Brazilian Supreme Court, since the Vargas Era until today.

  11. Theoretical feasibility of suppressing offensive sports chants by means of delayed feedback of sound

    NARCIS (Netherlands)

    Wijngaarden, S.J. van; Balken, J.A. van

    2007-01-01

    A novel approach for disrupting offensive chants at sporting events is proposed, based on attacking synchronization between individuals. Since timing is crucial for coordination between chanters, disruption of timing is expected to be effective against undesired chants. Delayed auditory feedback is

  12. Dien Bien Phu 1954, TET Offensive 1968, and Clausewitz: An Analysis

    National Research Council Canada - National Science Library

    Combs, John R

    1995-01-01

    .... The analysis is in response to a request by President Lyndon B. Johnson to get some clarification on any linkage between Dien Bien Phu and the TET Offensive, and the role of Carl von Clausewitz's theories in explaining the two battles...

  13. Offense type as determinant of revenge and forgiveness after victimization : Adolescents’ responses to injustice and aggression

    NARCIS (Netherlands)

    Gerlsma, Coby; Lugtmeyer, Valerie

    2018-01-01

    Victims of injustice and aggression may have strong feelings about the perpetrator(s) that may impede their efforts to cope with the victimizing experience. We examined to what extent adolescents’ interpersonal responses to victimization in terms of revenge and forgiveness depend on offense type. Of

  14. Comparison of network processes between successful and unsuccessful offensive sequences in elite soccer

    Directory of Open Access Journals (Sweden)

    Peixoto Diogo

    2017-12-01

    Full Text Available Purpose. The study aimed to compare social network analysis (SNA general measures and centrality levels of successful and unsuccessful offensive sequences performed by elite national teams in 64 matches of the FIFA World Cup 2014 tournament and to compare the level of centrality between playing positions. Methods. Adjacency matrices of passing sequences within an offensive unit were built and treated in a dedicated SNA software. Results. The main results indicated significantly lower values of total links and network density in successful sequences in comparison with unsuccessful ones in the teams that achieved the round of 8, semifinals, and the final. The comparisons between playing positions revealed that forwards showed the highest values of indegree centrality (balls received and that midfielders presented the highest values of outdegree centrality (ball passed in both successful and unsuccessful offensive units. Midfielders also exhibited the highest values of betweenness centrality (intermediation between teammates in unsuccessful sequences and forwards in successful ones. Conclusions. Greater cooperation among teammates may not be determinant for successful sequences. Forwards are the prominent players to receive the ball and intermediate the passing sequence in offenses that end in a goal.

  15. Effects of Offense, Defense, and Ball Possession on Mobility Performance in Wheelchair Basketball

    NARCIS (Netherlands)

    de Witte, Annemarie M. H.; Berger, Monique A. M.; Hoozemans, Marco J. M.; Veeger, Dirkjan H. E. J.; van der Woude, Lucas H. V.

    2017-01-01

    The aim of this study was to determine to what extent mobility performance is influenced by offensive or defensive situations and ball possession and to what extent these actions are different for the field positions. From video analysis, the relative duration of the various wheelchair movements

  16. Effects of offense, defense, and ball possession on mobility performance in wheelchair basketball

    NARCIS (Netherlands)

    De Witte, Annemarie M.H.; Berger, Monique A.M.; Hoozemans, Marco J.M.; Veeger, H.E.J.; van der Woude, Lucas H.V.

    2017-01-01

    The aim of this study was to determine to what extent mobility performance is influenced by offensive or defensive situations and ball possession and to what extent these actions are different for the field positions. From video analysis, the relative duration of the various wheelchair movements

  17. Study of the effects of plea bargaining motor vehicle offenses : final report, December 2009.

    Science.gov (United States)

    2009-12-01

    The objectives of this study were to examine the impact of plea bargaining point-carrying moving violations to zero-point : offenses on roadway safety in New Jersey and to assess the impact of plea bargaining on New Jersey Motor Vehicle : Commission ...

  18. Race, Offense Type, and Suicide Ideation: Tests of the Interpersonal-Psychological Theory in Juvenile Offenders.

    Science.gov (United States)

    Cero, Ian; Zuromski, Kelly L; Witte, Tracy K; Fix, Rebecca L; Burkhart, Barry

    2017-08-22

    This study evaluated the synergy hypothesis of the Interpersonal-Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at-risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes. © 2017 The American Association of Suicidology.

  19. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    2016-01-01

    Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences...... and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish...... the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated...

  20. Inappropriate sexual behaviour experienced by speech-language therapists.

    Science.gov (United States)

    Williams, T H; de Seriere, J; Boddington, L

    1999-01-01

    Inappropriate sexual behaviour by clients or patients of health professionals has been noted as a considerable problem in a number of professions. Similarly, sexual harassment by colleagues or employers has been identified as causing stress and harm. The primary objective of this study was to investigate the experience of speech-language therapists in New Zealand of inappropriate sexual behaviour (ISB) by colleagues, clients, and care givers of clients. A questionnaire developed by McComas and colleagues to investigate ISB directed by patients at physical therapists in Canada was adapted to meet the broader requirements of this study. This questionnaire was sent to all members of the New Zealand Speech-Language Therapists' Association and to current third- and fourth-year students in the Bachelor of Speech and Language Therapy degree programme in 1994. The overall return rate was 70%. A large number of respondents (81%) reported experiencing some level of ISB. The number of incidents of ISB from clients and colleagues was identified with equal frequency; care givers less frequently. Fewer students than qualified therapists reported ISB as sexual harassment. ISB affects work performance (e.g. absenteeism) and causes psychological reactions (e.g. stress). A majority of respondents reported being satisfied with how they handled ISB but considered there would be value in having training for both qualified and student therapists in managing such behaviour. Conclusions drawn from the study are that colleagues as well as clients are a serious source of ISB for qualified and student speech-language therapists; that negative effects in this group are similar to those in other professions; that speech-language therapists experience less ISB from clients than some other professions; and that, despite legal steps to curb sexual harassment, it continues to be an issue that requires local administrative and educative attention.

  1. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH).

    Science.gov (United States)

    Hamilton, Mark G; Price, Angel V

    2012-01-01

    Most patients with acute hydrocephalus have ventriculomegaly and high intracranial pressure (ICP). However, there is a subset of patients who are symptomatic with acute ventriculomegaly and inappropriately low ICP. Two patient groups were defined. Each patient presented with clinical deterioration that included a significant decrease in level of consciousness with new and significant ventriculomegaly. Patients in group 1 (n = 10) were managed without endoscopic third ventriculostomy (ETV). Group 2 was a series of patients (n = 10) managed with ETV. Treatment for both groups involved insertion of an external ventricular drain (EVD) with ICP <5 cmH(2)O. Further treatment consisted of either neck wrapping with a tensor bandage and/or lowering the EVD to negative levels to facilitate drainage of cerebrospinal fluid (CSF), which resulted in clinical improvement and resolution of ventriculomegaly. All 20 patients had anatomical obstruction to CSF flow into the subarachnoid space (SAS) confirmed by magnetic resonance imaging (MRI) with cine MRI studies. Group 1 patients were treated until shunt revision/insertion was possible (n = 7), ICP normalized, and the EVD could be removed (n = 2), or death (n = 1) occurred. Patients in group 2 all underwent ETV, and ICP patterns normalized in all. Group 2 patients were managed with an EVD until shunt revision/insertion was required (n = 2), ICP normalized and the EVD could be removed (n = 7), or death (n = 1) occurred. The syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH) is an important entity in both children and adults. A possible hypothesis invokes loss of an effective SAS. ETV reestablishes communication between the SAS and ventricles, producing a rapid return of normal ICP dynamics and a significant decrease in the number of shunt-dependent patients.

  2. Patterns of drinking and driving offenses among nightclub patrons in Brazil.

    Science.gov (United States)

    Wagner, Gabriela A; Sanchez, Zila M

    2017-05-01

    Brazil has a strict drinking and driving law known as the Brazilian "Dry Law". The aim of the present study was to investigate characteristics associated with the breaking of the Brazilian traffic law, on drinking and driving, at nightclub exit among a representative sample of nightclub patrons in the city of São Paulo, Brazil. Portal survey realized with a two-stage cluster sampling survey design to collect data from 2422 patrons at the entrance and 1822 patrons at the exit of 31 nightclubs in the city of São Paulo, Brazil. Patrons' breath alcohol concentrations (BrACs) at the entrance and exit of the nightclubs were categorized according to the law as either a "traffic offense" or a "traffic offense and crime". Weighted multinomial logistic regression was used to analyze factors associated with different patterns of drinking and driving offenses. Of the subjects, 16.5% (n=369) were identified as driving patrons at the entrance and exit of the nightclubs. At entry, 80.1% of the patrons had a zero BrAC, 14.9% had a BrAC meeting the traffic offense criteria and 5.0% had a BrAC meeting the traffic offense and crime criteria. Women were less likely to have BrACs meeting the traffic offense criteria. At nightclub exit, 63.4% of patrons had maintained a zero BrAC, 24.7% had a BrAC that had increased and now met the traffic offense and crime criteria, and 11.9% had a decreased or stable BrAC. An increased BrAC was more frequently identified in patrons who were men, were single, and had used illicit drugs inside the nightclub. Despite the existence of a strict law regarding drinking and driving, a significant proportion of nightclub patrons in the city of São Paulo had violated this law, suggesting a perception of impunity and need for law enforcement. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. A study of clerics who commit sexual offenses: are they different from other sex offenders?

    Science.gov (United States)

    Langevin, R; Curnoe, S; Bain, J

    2000-04-01

    The goal of this study was to determine if cleric-sex offenders differed significantly from other sex offenders when compared to a control group and assessed with standard instruments that examine the major factors important in sexual offenses. Twenty-four male clerics accused of sexual offenses were compared to 24 male sex offender controls, matched on offense type, age, education, and marital status. Both groups were compared to a general sample of sex offenders (n = 2125) matched only for offense type. The three groups were compared on sexual history and preference, substance abuse, mental illness and personality, history of crime and violence, neuropsychological impairment, and endocrine abnormalities, using reliable and valid measures. The clerics in this study formed a statistically significant highly educated, older, and predominantly single subgroup of sex offenders. The majority of cleric-sex offenders suffered from a sexual disorder (70.8%), predominantly homosexual pedophilia, as measured by phallometric testing, but did not differ from the control groups in this respect. The clerics were comparable to the other two groups in most respects, but tended to show less antisocial personality disorders and somewhat more endocrine disorders. The most noteworthy features differentiating the clerics from highly educated matched controls were that clerics had a longer delay before criminal charges were laid, or lacked criminal charges altogether, and they tended to use force more often in their offenses. In spite of differences in age, education, and occupation between cleric-sex offenders and sex offenders in general, the same procedures should be used in the assessment of this group as for the sex offender population in general. Hypotheses about reduced sexual outlet and increased sexual abuse of clerics in childhood were not supported. Assessment and treatment of cleric-sex offenders should focus especially on sexual deviance, substance abuse, and endocrine

  4. Sanative Measures against Offensive Odour that Affect Indigenous ...

    African Journals Online (AJOL)

    The material and technical means refer to the use of sanding tool to sand off excess flesh from the fleshy side of leather; and soaking of leather in a soapy water made with perfume toilet-soap after which drying is done under room temperature. The experiments proved that the presence of excess flesh and fatty substances ...

  5. Potentially inappropriate medication use in a city of Southeast Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto

    2012-03-01

    Full Text Available Potentially inappropriate medication use by the Diamantina (Minas Gerais State population was investigated by analyzing medicine consumption, self-medication, polypharmacy and drug interactions of medicines prescribed among those interviewed. Level of knowledge about rational drug use and its relationship to socio-economic variables was also evaluated using a semi-structured questionnaire. This survey was based on stratified sampling of 423 individuals selected randomly. The prevalence of prescription drug consumption was 42.32% (n=179 and cardiovascular drugs were the most prescribed. Drug interactions were found in 45.81% (n=82 of prescriptions and 92.68% (n=76 of these interactions were moderate, with co-administration of cardiovascular drugs occurring in more than half of the cases. The inappropriate use of medication, according to Beers criteria, occurred in 44.73% of prescriptions to the elderly. The prevalence of self-medication was 63.34% (n=268 while 21.99% (n=91 of individuals administered medications to their children without formal prescriptions, where this practice was associated to analgesic/antipyretic consumption. The population showed a high prevalence of inappropriate use of drugs across all strata of society, representing an issue requiring effective actions to promote rational use of medicines.O consumo inapropriado de medicamentos pela população de Diamantina-MG foi investigado através da análise do consumo de medicamentos, automedicação, polifarmácia e interações medicamentosas prescritas aos entrevistados. Também foi avaliado o nível de conhecimento sobre uso racional de medicamentos e sua relação com variáveis sócio-econômicas através de um questionário semi-estruturado. Este estudo transversal foi baseado em amostragem estratificada e contou com a participação de 423 indivíduos selecionados aleatoriamente. A prevalência do consumo de medicamentos prescritos foi de 42,32% (n=179, sendo os

  6. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use

    OpenAIRE

    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung

    2017-01-01

    Background While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication. Method In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factor...

  7. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  8. Between two beds: inappropriately delayed discharges from hospitals.

    Science.gov (United States)

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

    2013-12-01

    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

  9. An inappropriate tool: criminal law and HIV in Asia.

    Science.gov (United States)

    Csete, Joanne; Dube, Siddharth

    2010-09-01

    Asian countries have applied criminal sanctions widely in areas directly relevant to national HIV programmes and policies, including criminalization of HIV transmission, sex work, homosexuality and drug injection. This criminalization may impede universal access to HIV prevention and treatment services in Asia and undermine vulnerable people's ability to be part of the HIV response. To review the status of application of criminal law in key HIV-related areas in Asia and analyze its impact. Review of literature and application of human rights norms to analysis of criminal law measures. Criminal laws in the areas considered here and their enforcement, while intended to reduce HIV transmission, are inappropriate and counterproductive with respect to health and human rights. Governments should remove punitive laws that impede the HIV response and should ensure meaningful participation of people living with HIV, people who use illicit drugs, sex workers and men who have sex with men in combating stigma and discrimination and developing rights-centered approaches to HIV.

  10. Inappropriate eating behavior: a longitudinal study with female adolescents

    Directory of Open Access Journals (Sweden)

    Leonardo de Sousa Fortes

    2014-03-01

    Full Text Available Objective: To evaluate the inappropriate eating behaviors (IEB of female adolescents over a one-year period. Methods: 290 adolescents aged between 11 and 14 years old participated in the three research stages (T1: first four months, T2: second four months and T3: third four months. The Eating Attitudes Test (EAT-26 was applied to assess the IEB. Weight and height were measured to calculate body mass index (BMI in the three study periods. Analysis of variance for repeated measures was used to analyze the data, adjusted for the scores of the Body Shape Questionnaire and the Brazil Economic Classification Criteria. Results: Girls at T1 showed a higher frequency of IEB compared to T2 (p=0.001 and T3 (p=0.001. The findings also indicated higher values for BMI in T3 in relation to T1 (p=0.04. The other comparisons did not show statistically significant differences. Conclusions: IEB scores of female adolescents declined over one year.

  11. Materials

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn V

    2009-02-01

    Full Text Available community. The construction industry is a significantly consumer of materials, using 50 per cent of all products produced globally. Building materials is any material which is used for a construction purpose. Many of these materials are sources from natural...

  12. Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital

    Directory of Open Access Journals (Sweden)

    Vishal Sehgal

    2013-01-01

    Full Text Available Background and Aim: Readmission to the hospital within 30 days of discharge from the hospital is a common occurrence. Congestive heart failure is the most common cause of readmissions in the hospital. We hypothesized that irrespective of the admission diagnosis polypharmacy and potentially inappropriate use of medications (PIM leads to readmissions within 30 days of discharge from the hospital. Materials and Methods: A retrospective study was carried out by reviewing the hospital records of 414 patients who were readmitted to the hospital within 30 days of discharge from the hospital between January 2008 and December 2009. The data was stratified to see which patients were on polypharmacy and/or on PIM. Polypharmacy was defined as use of more than 5 medications. PIM was defined as per the modified Beers criteria. Day 0 was defined as the day of discharge and day1 was defined as the day-after Admission to the hospital. Statistical analysis was carried out using a two-way analysis of variance (ANOVA on the data to see if polypharmacy and/or PIM was related to readmission within 30 days of discharge irrespective of admission diagnosis. Results: Polypharmacy was related to hospital readmission at day 1 and day 0, however inappropriate drug use was found to be not related at any day. Polypharmacy and PIM combined had a positive correlation to readmission only on days 1 and 0 and it was statistically significant. The use of minimal and appropriate use of drugs was statistically significant compared to polypharmacy and PIM use. Conclusions: Polypharmacy and PIM are under recognized cause of readmissions to the hospital.

  13. Skills and offensive tactics used in pick-up basketball games.

    Science.gov (United States)

    Wang, Jianyu; Liu, Wenhao; Moffit, Jeffrey

    2009-10-01

    The purpose of this study was to describe skills and offensive tactics frequently used in pick-up basketball games. 65 participants were recruited from public basketball courts. An observational instrument was developed to analyze the performances of pick-up games. Participants' performances were videotaped and coded. Results indicated that the passing skills most frequently observed in the games were chest pass, overhead pass, and bounce pass. For dribbling, crossover dribble and change-of-pace dribble were frequently observed. Jump shot, set shot, and layup were also frequently used. The offensive tactics frequently used included drive, cut, and set screen. The study may be beneficial for helping young people prepare to play pick-up basketball games.

  14. Preventing sexual violence: can examination of offense location inform sex crime policy?

    Science.gov (United States)

    Colombino, Nicole; Mercado, Cynthia Calkins; Levenson, Jill; Jeglic, Elizabeth

    2011-01-01

    Recently, legislative initiatives to prevent sex crime recidivism include the passage of child safety zones (also called loitering zones) that prohibit sex offenders from lingering near places where children congregate. The ability of policies such as these or residence restrictions to curb sexual recidivism depends on the empirical reality of sex offender perpetration patterns. As such, the current study sought to examine locations where sex offenders first come into contact with their victims and whether sex crime locations differ among those who perpetrate offenses against children as compared to those who perpetrate offenses against adults. Further, this study examined actuarial risk scores and recidivism rates among offenders who met victims in child-dense public locations to determine if these offenders are more at risk of re-offense. Descriptive analyses, based on archival sex offender file review (N=1557), revealed that offenders primarily cultivated their offenses in private residential locations (67.0%); relatively few offenders (4.4%) met their victims in child-dense public locations. Further, offenders who perpetrated crimes against children were more likely to meet victims within a residence, while those who perpetrate crimes against adults were more likely to encounter victims in a more public type of location (e.g., bar, workplace). Though only 3.7% of all offenders in this sample sexually recidivated, those who recidivated were more likely to have met their victim in a child-dense public location than those who did not recidivate. Current sex crime policies that focus only on where offenders live may fail to focus on where offenders go and, further, may misdirect efforts away from the place where sex crimes most often occur, namely, in the home. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. CONSIDERATIONS ABOUT OVERLAPPING CRIMINAL AND ADMINISTRATIVE LIABILITY FOR THE SAME OFFENSE

    Directory of Open Access Journals (Sweden)

    MIRELA GORUNESCU

    2011-04-01

    Full Text Available The ne bis in idem principle is one of the fundamental principles of a criminal trial in a state of law. This paper focuses on the question whether a possible overlapping between criminal and administrative liability for the same offense is or not a violation of this principle. Both the national and the European Court of Human Rights jurisprudence were investigated. By reporting to the European case we concluded that such a situation represents a case of bis in idem.

  16. Reliability of odor offensiveness quantification using the refined cloth swatch olfactometric technique

    OpenAIRE

    Gay, S. W.; Wheeler, E. F.; Kephart, K. B.

    2001-01-01

    The cloth swatch olfactometric technique uses flannel swatches to absorb odors for presentation to a trained human sensory panel. This study examined the reliability of the refined cloth swatch technique used to facilitate the quantification of odor offensiveness of swine facility wastewater treated in subsurface-flow constructed wetlands. Reliability was based on the consistency of ratings assigned by panelists to odor sample replicate pairs. Panelists assigned odor replicate pairs ratings t...

  17. Influence of playing style on the physiological responses of offensive players in table tennis.

    Science.gov (United States)

    Martin, C; Favier-Ambrosini, B; Mousset, K; Brault, S; Zouhal, H; Prioux, J

    2015-12-01

    The study aimed to analyse the influence of playing style on the physiological responses of offensive players and on match characteristics during table tennis matches. Eight table tennis players were involved in the study. Among them, six players with an offensive playing style (Off) played respectively two matches: one against an offensive player (Off vs. Off matches) and the other one against a defensive opponent (Off vs. Def matches). Duration of rally (DR), real playing time (RPT), effective playing time (EPT), frequency of shots by minutes, and shots per rally were measured. Heart rate (HR) was monitored continuously while rating of perceived exertion (RPE) was obtained after each match. Blood lactate concentrations ([La]) were measured both at the end of each set and at the end of the match. DR (5.4±0.7 s vs. 3.2±0.4 s), RPT, EPT (31.8±5.0% vs. 20.3±1.7%), shots per rally (6.6±0.9 vs. 4.6±0.9), HRmean (146.0±5.9 bpm vs. 139.9±9.0 bpm), HRmean relative to the predicted maximal HR (HRmax-p) (74.8±4.0% vs. 71.7±4.3%) and RPE (7.0±1.1 vs. 5.5±1.5) were significantly higher (P0.05) for HRpeak, [La]mean and [La]peak were noticed between Off vs. Def matches and Off vs. Off matches. Table tennis playing style influences match characteristics and the offensive player's physiological responses.

  18. Taking of hostages as an offense in international law and Serbian regulations

    Directory of Open Access Journals (Sweden)

    Cmiljanić Bajo M.

    2012-01-01

    Full Text Available In the development of international relations, hostage-taking was carried out as an insurance against fraud, not keeping obligations, or according to the rules of war law. Earlier taking hostages was more related to armed conflicts, and in modern times it is more related to terrorist acts in international terrorism. The taking of hostages is an international offense, which has its essential elements and characteristics. It is a crime punishable under the national legislation of many countries, and taking of hostages in armed conflicts is a war crime for which the International Criminal Court is responsible. International terrorism is manifested through a variety of terrorist acts, which, through fear and panic aim to achieve a political purpose. The range of these terrorist acts is wide and varied. One of these terrorist activities is the taking of hostages. As an offense established by the norms of international law, this unlawful act must be specifically investigated and clarified, which is the goal of this paper. This paper gives an overview of the features and elements of the offense in the light of international law and the laws of the Republic of Serbia.

  19. Women convicted for violent offenses: adverse childhood experiences, low level of education and poor mental health.

    Science.gov (United States)

    Rossegger, Astrid; Wetli, Nicole; Urbaniok, Frank; Elbert, Thomas; Cortoni, Franca; Endrass, Jérôme

    2009-12-22

    In past years, the female offender population has grown, leading to an increased interest in the characteristics of female offenders. The aim of this study was to assess the prevalence of female violent offending in a Swiss offender population and to compare possible socio-demographic and offense-related gender differences. Descriptive and bivariate logistic regression analyses were performed for a representative sample of N = 203 violent offenders convicted in Zurich, Switzerland. 7.9% (N = 16) of the sample were female. Significant gender differences were found: Female offenders were more likely to be married, less educated, to have suffered from adverse childhood experiences and to be in poor mental health. Female violent offending was less heterogeneous than male violent offending, in fact there were only three types of violent offenses females were convicted for in our sample: One third were convicted of murder, one third for arson and only one woman was convicted of a sex offense. The results of our study point toward a gender-specific theory of female offending, as well as toward the importance of developing models for explaining female criminal behavior, which need to be implemented in treatment plans and intervention strategies regarding female offenders.

  20. Accuracy of sexually violent person assessments of juveniles adjudicated for sexual offenses.

    Science.gov (United States)

    Caldwell, Michael F

    2013-10-01

    This study reviewed the records of 198 juveniles who were committed to secured custody after being adjudicated delinquent for a sexually violent offense that qualified them for possible commitment under a Sexually Violent Person's (SVP) civil commitment law. For an individual to be committed, the statute requires that the individual have a qualifying mental disorder and is "likely," to commit a future act of sexual violence. Each youth was screened by at least two expert examiners in a two-step process. Fifty-four of the youth were found to meet the commitment criteria in an initial examination and were subject to an SVP petition. The remaining 144 were screened out. Subsequent criminal charges were collected over a 4.97-year mean follow-up. The results showed that the prevalence rates for general sexual offending and felony sexual offending did not differ between youth who were screened out and those who were subject to a petition. Among petitioned youth, 11.76% were charged with a new sexual offense including 9.80% who were charged with a felony sexual assault. By comparison, 17.36% of the youth that were screened out were charged with a sexual offense including 13.19% who were charged with a felony sexual assault, a nonsignificant difference.

  1. Women convicted for violent offenses: Adverse childhood experiences, low level of education and poor mental health

    Directory of Open Access Journals (Sweden)

    Cortoni Franca

    2009-12-01

    Full Text Available Abstract Background In past years, the female offender population has grown, leading to an increased interest in the characteristics of female offenders. The aim of this study was to assess the prevalence of female violent offending in a Swiss offender population and to compare possible socio-demographic and offense-related gender differences. Methods Descriptive and bivariate logistic regression analyses were performed for a representative sample of N = 203 violent offenders convicted in Zurich, Switzerland. Results 7.9% (N = 16 of the sample were female. Significant gender differences were found: Female offenders were more likely to be married, less educated, to have suffered from adverse childhood experiences and to be in poor mental health. Female violent offending was less heterogeneous than male violent offending, in fact there were only three types of violent offenses females were convicted for in our sample: One third were convicted of murder, one third for arson and only one woman was convicted of a sex offense. Conclusions The results of our study point toward a gender-specific theory of female offending, as well as toward the importance of developing models for explaining female criminal behavior, which need to be implemented in treatment plans and intervention strategies regarding female offenders.

  2. Observational methodology in football: Development of an instrument to study the offensive game in football

    Directory of Open Access Journals (Sweden)

    H. Sarmento

    2009-01-01

    Full Text Available The following paper introduces a new approach to the analysis of offensive game in football. Therefore, the main aim of this study was to create an instrument for collecting information for the analysis of offensive action and interactions game. The observation instrument that was used to accomplish the main objective of this work consists of a combination of format fields (FC and systems of categories (SC. This methodology is a particular strategy of the scientific method that has as an objective to analyse the perceptible behaviour that occurs in habitual contexts, allowing them to be formally recorded and quantified and using an ad hoc instrument in order to obtain a behaviour systematic registration that, since they have been transformed in quantitative data with the necessary reliability and validity determined level, will allow analysis of the relations between these behaviours. The codifications undertaken to date in various games of football have shown that it serves the purposes for which it was developed, allowing more research into the offensive game methods in football.

  3. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  4. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  5. The Inappropriate Symmetries of Multivariate Statistical Analysis in Geometric Morphometrics.

    Science.gov (United States)

    Bookstein, Fred L

    In today's geometric morphometrics the commonest multivariate statistical procedures, such as principal component analysis or regressions of Procrustes shape coordinates on Centroid Size, embody a tacit roster of symmetries -axioms concerning the homogeneity of the multiple spatial domains or descriptor vectors involved-that do not correspond to actual biological fact. These techniques are hence inappropriate for any application regarding which we have a-priori biological knowledge to the contrary (e.g., genetic/morphogenetic processes common to multiple landmarks, the range of normal in anatomy atlases, the consequences of growth or function for form). But nearly every morphometric investigation is motivated by prior insights of this sort. We therefore need new tools that explicitly incorporate these elements of knowledge, should they be quantitative, to break the symmetries of the classic morphometric approaches. Some of these are already available in our literature but deserve to be known more widely: deflated (spatially adaptive) reference distributions of Procrustes coordinates, Sewall Wright's century-old variant of factor analysis, the geometric algebra of importing explicit biomechanical formulas into Procrustes space. Other methods, not yet fully formulated, might involve parameterized models for strain in idealized forms under load, principled approaches to the separation of functional from Brownian aspects of shape variation over time, and, in general, a better understanding of how the formalism of landmarks interacts with the many other approaches to quantification of anatomy. To more powerfully organize inferences from the high-dimensional measurements that characterize so much of today's organismal biology, tomorrow's toolkit must rely neither on principal component analysis nor on the Procrustes distance formula, but instead on sound prior biological knowledge as expressed in formulas whose coefficients are not all the same. I describe the problems

  6. Inappropriate shock: a failure of SVT discriminators in a dual chamber ICD?

    Science.gov (United States)

    Al-Ahmad, Amin; Tsiperfal, Angela; Hsia, Henry H; Wang, Paul J

    2006-12-01

    Inappropriate shock remains a major issue in patients with implantable cardioverter defibrillators. We examine an inappropriate shock delivered in a patient with atrial tachycardia that conducted 1:1. We reconstruct the device algorithms that led to therapy delivery and discuss programming changes that could be considered.

  7. Functional Analysis of Inappropriate Social Interactions in Students with Asperger's Syndrome

    Science.gov (United States)

    Roantree, Christina F.; Kennedy, Craig H.

    2012-01-01

    We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of…

  8. [Management of inappropriate shocks/T-wave-oversensing in S-ICD®-patients].

    Science.gov (United States)

    Larbig, Robert; Bettin, Markus; Motloch, Lukas J; Fischer, Alicia; Bode, Niklas; Frommeyer, Gerrit; Reinke, Florian; Loeher, Andreas; Eckardt, Lars; Köbe, Julia

    2018-02-12

    Inappropriate shocks are a feared complication after implantable cardioverter-defibrillator (ICD) implantation and have a tremendous impact on quality of life. Inappropriate shocks in patients with subcutaneous ICD (S-ICD®, Boston Scientific, Marlborough, MA, USA) have various underlying causes. This review summarizes the current literature on this topic and lists possible treatment options.

  9. What is inappropriate hospital use for elderly people near the end of life?

    DEFF Research Database (Denmark)

    Cardona-Morrell, Magnolia; Kim, James C H; Brabrand, Mikkel

    2017-01-01

    independently by two authors. RESULTS: The definition of 'Inappropriate admissions' near the end of life incorporated system factors, social and family factors. The prevalence of inappropriate admissions ranged widely depending largely on non-clinical reasons: poor availability of alternative sites of care...

  10. The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents.

    Science.gov (United States)

    Lee, Sang Ah; Jang, Suk Yong; Shin, Jaeyong; Ju, Yeong Jun; Nam, Jin Young; Park, Eun Cheol

    2016-10-01

    Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative.

  11. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

    Science.gov (United States)

    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung

    2017-01-01

    While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication. In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication. The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication. Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  12. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

    Directory of Open Access Journals (Sweden)

    Chun-Hsien Lee

    Full Text Available While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%, cold or cough medicines (prevalence = 21.6%, analgesics (prevalence = 19.3%, and antacids (prevalence = 17.3%. Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%, using excessive dosages (21.6%, and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy (30.3%. The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  13. Materialism.

    Science.gov (United States)

    Melnyk, Andrew

    2012-05-01

    Materialism is nearly universally assumed by cognitive scientists. Intuitively, materialism says that a person's mental states are nothing over and above his or her material states, while dualism denies this. Philosophers have introduced concepts (e.g., realization and supervenience) to assist in formulating the theses of materialism and dualism with more precision, and distinguished among importantly different versions of each view (e.g., eliminative materialism, substance dualism, and emergentism). They have also clarified the logic of arguments that use empirical findings to support materialism. Finally, they have devised various objections to materialism, objections that therefore serve also as arguments for dualism. These objections typically center around two features of mental states that materialism has had trouble in accommodating. The first feature is intentionality, the property of representing, or being about, objects, properties, and states of affairs external to the mental states. The second feature is phenomenal consciousness, the property possessed by many mental states of there being something it is like for the subject of the mental state to be in that mental state. WIREs Cogn Sci 2012, 3:281-292. doi: 10.1002/wcs.1174 For further resources related to this article, please visit the WIREs website. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    Directory of Open Access Journals (Sweden)

    Yamada Yukari

    2006-01-01

    Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

  15. Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients.

    Directory of Open Access Journals (Sweden)

    Chia-Chen Hsu

    Full Text Available Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings.Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as "special oral formulations". A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August. During the intervention period, prescription changes in response to a warning were logged and analyzed.A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23-0.31, P<0.001. In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%.The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system

  16. Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records.

    Science.gov (United States)

    Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo

    2016-11-01

    The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate

  17. Understanding Factors Contributing to Inappropriate Critical Care: A Mixed-Methods Analysis of Medical Record Documentation.

    Science.gov (United States)

    Neville, Thanh H; Tarn, Derjung M; Yamamoto, Myrtle; Garber, Bryan J; Wenger, Neil S

    2017-11-01

    Factors leading to inappropriate critical care, that is treatment that should not be provided because it does not offer the patient meaningful benefit, have not been rigorously characterized. We explored medical record documentation about patients who received inappropriate critical care and those who received appropriate critical care to examine factors associated with the provision of inappropriate treatment. Medical records were abstracted from 123 patients who were assessed as receiving inappropriate treatment and 66 patients who were assessed as receiving appropriate treatment but died within six months of intensive care unit (ICU) admission. We used mixed methods combining qualitative analysis of medical record documentation with multivariable analysis to examine the relationship between patient and communication factors and the receipt of inappropriate treatment, and present these within a conceptual model. One academic health system. Medical records revealed 21 themes pertaining to prognosis and factors influencing treatment aggressiveness. Four themes were independently associated with patients receiving inappropriate treatment according to physicians. When decision making was not guided by physicians (odds ratio [OR] 3.76, confidence interval [95% CI] 1.21-11.70) or was delayed by patient/family (OR 4.52, 95% CI 1.69-12.04), patients were more likely to receive inappropriate treatment. Documented communication about goals of care (OR 0.29, 95% CI 0.10-0.84) and patient's preferences driving decision making (OR 0.02, 95% CI 0.00-0.27) were associated with lower odds of receiving inappropriate treatment. Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.

  18. Knudsen-Like Scaling May Be Inappropriate for Gas Shales

    KAUST Repository

    Patzek, Tadeusz

    2017-10-02

    Summary We assert that a classification of gas flow regimes in shales that is widely accepted in the petroleum industry, may be inconsistent with the physics of high-pressure gas flow in capillaries. This classification follows from the 1946 work by Brown et al. (1946) that deals with the flow of gases in large industrial metal pipes, elbows and orifices under vacuum, with gas pressures of the order of 1 mm Hg or less. In another pioneering paper that year, Tsien (1946) analyzed the hypersonic flight of rockets in the thermosphere (above 50 miles of altitude), and established the widely accepted Knudsen flow regimes for the high-Reynolds, high-Mach flow of rarified gases. We show why both these papers are not quite applicable to flow of compressed gas in the hot, high-pressure shale pores with rough surfaces. In addition, it may be inappropriate to use the capillary tube metaphor to describe shale micropores or microcracks, simply because each is fed with gas by dozens or hundreds of intricately connected nanopores, which themselves may be slits rather than circular cylinders, and are charged with the dense, liquid-like gas. In the small-scale, low-velocity flows of gases, failure of the standard Navier-Stokes description (the standard Darcy law in petroleum engineering) can be quantified by the Knudsen number, ratio of the mean free path, λ, of gas molecules at the reservoir pressure and temperature to the characteristic pore radius, R. We carefully enumerate the multiple restrictive conditions that must hold for the slip-flow boundary condition to emerge. We also describe the dependence of the slip correction factor on the gas pressure and temperature, as well as the median pore size and rock roughness. In the derivation, we revisit the original approaches of Helmholtz and von Piotrowski (1860) and Maxwell, Niven (1890), which were somehow lost in the multiple translations from physics to petroleum engineering. For example, in Barnett mudrocks, naturally

  19. Judicial individualization of criminal penalties for corruption offenses committed by civil servants and/or dignitaries

    Directory of Open Access Journals (Sweden)

    Ion TIPA

    2017-06-01

    Full Text Available This article focuses on the study of judicial personalization of criminal penalties applied for corruption offenses of civil servants and / or dignitaries. At the same time, the following study shows the criteria and rules for the individualization of a criminal punishment, the attenuating and aggravating circumstances that influence the application of criminal penalties, with examples from practice, thus mentioning the errors made by some instances of Lower court judgment in the Republic of Moldova. The study also shows the process of individualization of criminal punishment in the light of exceptional circumstances and the way of calculating sentences and arrest computations.

  20. Taxing Guns vs. Taxing Crime: An Application of the "Market for Offenses Model"

    OpenAIRE

    Isaac Ehrlich; Tetsuya Saito

    2010-01-01

    The interaction between offenders and potential victims has so far received relatively little attention in the literature on the economics of crime. The main objective of this paper is twofold: to extend the “market for offenses model” to deal with both “product” and “factor” markets, and to apply it to the case where guns are used for crime commission by offenders and for self-protection by potential victims. Our analysis offers new insights about the association between crime and guns and t...

  1. Does the Future Engineer Force Transition Engineer Units between Offensive and Stability Operations in Ways That Achieve Responsiveness, Versatility, Agility, Effectiveness, and Efficiency?

    National Research Council Canada - National Science Library

    London, David T

    2005-01-01

    .... The main question is as follows: Does the FEF transition engineer units between offensive and stability operations in ways that achieve responsiveness, versatility, agility, effectiveness, and efficiency...

  2. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital.

    Science.gov (United States)

    Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María

    2013-10-01

    The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  3. Inappropriate antibiotic prescription for respiratory tract indications : most prominent in adult patients

    NARCIS (Netherlands)

    Dekker, Anne R. J.; Verheij, Theo J. M.; van der Velden, Alike W.

    Background. Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient

  4. Effects of Personality on Social Network Disclosure: Do Emotionally Intelligent Individuals Post Inappropriate Content?

    Directory of Open Access Journals (Sweden)

    Chockalingam Viswesvaran

    2012-12-01

    Full Text Available The prevalence of individuals using social networking sites to stay connected has increased considerably in only a few years and the information posted is now being used by organizations for employee selection. The purpose of the current study was to investigating how differences on the Big Five Personality traits, honesty-integrity, and emotional intelligence influence whether individuals post inappropriate social network content. Participants were 506 college students from a large metropolitan state university in the Southeastern United States. Results suggest individuals scoring high on emotional intelligence and honesty/integrity disclosed less inappropriate social network content. Emotional intelligence was not, however, predictive of inappropriate disclosure above and beyond the Big Five Personality traits. Honest and emotionally intelligent individuals seem to understand the negative implications of disclosing inappropriate social network content. Future research should examine how social network information is being used in employee selection and the predictive validity of this method.

  5. The frequency of agitation due to inappropriate use of naltrexone in addicts

    Directory of Open Access Journals (Sweden)

    Sima Siadat

    2014-01-01

    Conclusion: Considering the high prevalence of agitation in the poisoning emergency department due to inappropriate use of naltrexone, more accurate planning for administration of naltrexone in addicts seems necessary.

  6. Correlates of (inappropriate) benzodiazepine use : the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J.; Stoop, Jose E.; Neven, Arie Knuistingh; Penninx, Brenda W. J. H.; Zitman, Frans G.

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODS We

  7. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, L.; van Veen, T.; Giltay, E.J.; Stoop, J.E.; Neven, A.K.; Penninx, B.W.J.H.; Zitman, F.G.

    2011-01-01

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model.METHODS We

  8. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Abu-Zeitone, Abeer; Jons, Christian

    2013-01-01

    The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study.......The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study....

  9. Inappropriate Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

    Directory of Open Access Journals (Sweden)

    Ajit Thachil, MD, DM, CCDS

    2014-05-01

    Full Text Available Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.

  10. Correlation analysis between team communication characteristics and frequency of inappropriate communications

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Park, Jinkyun; Kang, Hyun Gook; Seong, Poong Hyun

    2013-01-01

    Highlights: • We proposed a method to evaluate team communication characteristics based on social network analysis. • We compare team communication characteristics with the frequency of inappropriate communications. • Frequency of inappropriate communications were decreased when more operators perform the same types of role as others. • Frequency of inappropriate communications were decreased for teams who provide more number of acknowledgment. - Abstract: The characteristics of team communications are important since large process systems such as nuclear power plants, airline, and railways are operated by operating teams. In such situation, inappropriate communications can cause a lack of situational information and lead to serious consequences for the systems. As a result, the communication characteristics of operating teams should be understood in order to extract meaningful insights to address the nature of inappropriate communications. The purpose of this study was to develop a method to evaluate the characteristics of team communications based on social network analysis and compare them with the frequency of inappropriate communications. In order to perform the analysis, verbal protocol data, which were audio-visual recorded under training sessions by operating teams, were used and interfacing system loss of coolant accident scenarios were selected. As a result of the study, it was found that the frequency of inappropriate communications decreased when more operators perform the same types of role as other operators, since they can easily and effectively back up each other. Also, the frequency of inappropriate communication is decreased for teams which provide a relatively large communication content that acknowledge or confirm another communication content

  11. Reduction in inappropriate hospital use based on analysis of the causes

    Directory of Open Access Journals (Sweden)

    Soria-Aledo Víctor

    2012-10-01

    Full Text Available Abstract Background To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement. Methods Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain. Results Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease. Conclusions It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.

  12. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study.

    Directory of Open Access Journals (Sweden)

    Giuseppe Colloca

    Full Text Available BACKGROUND: It has been estimated that Nursing Home (NH residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe. METHODS: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008. RESULTS: Mean age of participating residents was 84.2±8.9 years, 1087 (75.0% were women. Inappropriate drug use was observed in 643 (44.9% residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%, antiplatelet agents (excluding Acetylsalicylic Acid - ASA - (9.9%, acetylcholinesterase, inhibitors (7.2% and antispasmodics (6.9%. Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24, heart failure (OR 1.48; 95% CI 1.04-2.09, stroke (OR 1.43; 95% CI 1.06-1.93, and recent hospitalization (OR 1.69; 95% CI 1.20-2.39. An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77. CONCLUSION: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

  13. Heart failure severity, inappropriate ICD therapy, and novel ICD programming: a MADIT-RIT substudy.

    Science.gov (United States)

    Daimee, Usama A; Vermilye, Katherine; Rosero, Spencer; Schuger, Claudio D; Daubert, James P; Zareba, Wojciech; McNitt, Scott; Polonsky, Bronislava; Moss, Arthur J; Kutyifa, Valentina

    2017-12-01

    The effects of heart failure (HF) severity on risk of inappropriate implantable cardioverter-defibrillator (ICD) therapy have not been thoroughly investigated. We aimed to study the association between HF severity and inappropriate ICD therapy in MADIT-RIT. MADIT-RIT randomized 1,500 patients to three ICD programming arms: conventional (Arm A), high-rate cut-off (Arm B: ≥200 beats/min), and delayed therapy (Arm C: 60-second delay for ≥170 beats/min). We evaluated the association between New York Heart Association (NYHA) class III (n = 256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A patients with ICD-only and cardiac resynchronization therapy with defibrillator (CRT-D). We additionally assessed benefit of novel ICD programming in Arms B and C versus Arm A by NYHA classification. In Arm A, the risk of inappropriate therapy was significantly higher in those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] = 2.55, confidence interval [CI]: 1.51-4.30, P programming significantly reduced inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR = 0.08, P programming with high-rate cut-off or delayed detection reduces inappropriate ICD therapies in both mild and moderate HF. © 2017 Wiley Periodicals, Inc.

  14. Development and Validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II.

    Science.gov (United States)

    Epperson, Douglas L; Ralston, Christopher A

    2015-12-01

    This article describes the development and initial validation of the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (JSORRAT-II). Potential predictor variables were extracted from case file information for an exhaustive sample of 636 juveniles in Utah who sexually offended between 1990 and 1992. Simultaneous and hierarchical logistic regression analyses were used to identify the group of variables that was most predictive of subsequent juvenile sexual recidivism. A simple categorical scoring system was applied to these variables without meaningful loss of accuracy in the development sample for any sexual (area under the curve [AUC] = .89) and sexually violent (AUC = .89) juvenile recidivism. The JSORRAT-II was cross-validated on an exhaustive sample of 566 juveniles who had sexually offended in Utah in 1996 and 1997. Reliability of scoring the tool across five coders was quite high (intraclass correlation coefficient [ICC] = .96). Relative to the development sample, however, there was considerable shrinkage in the indices of predictive accuracy for any sexual (AUC = .65) and sexually violent (AUC = .65) juvenile recidivism. The reduced level of accuracy was not explained by severity of the index sexual offense, time at risk, or missing data. Capitalization on chance and other explanations for the possible reduction in predictive accuracy are explored, and potential uses and limitations of the tool are discussed. © The Author(s) 2014.

  15. Heat stress but not inbreeding affects offensive sperm competitiveness in Callosobruchus maculatus.

    Science.gov (United States)

    Lieshout, Emile; Tomkins, Joseph L; Simmons, Leigh W

    2013-09-01

    Environmental and genetic stress have well-known detrimental effects on ejaculate quality, but their concomitant effect on male fitness remains poorly understood. We used competitive fertilization assays to expose the effects of stress on offensive sperm competitive ability in the beetle Callosobruchus maculatus, a species where ejaculates make up more than 5% of male body mass. To examine the effects of environmental and genetic stress, males derived from outcrosses or sib matings were heat shocked at 50°C for 50 min during the pupal stage, while their siblings were maintained at a standard rearing temperature of 28°C. Heat-shocked males achieved only half the offensive paternity success of their siblings. While this population exhibited inbreeding depression in body size, sperm competitiveness was unaffected by inbreeding, nor did the effect of heat shock stress on sperm competitiveness depend on inbreeding status. In contrast, pupal emergence success was increased by 34% among heat-stressed individuals, regardless of their inbreeding status. Heat-shocked males' ejaculate size was 19% reduced, but they exhibited 25% increased mating duration in single mating trials. Our results highlight both the importance of stress in postcopulatory sexual selection, and the variability among stressors in affecting male fitness.

  16. South African serial rapists: the offenders, their victims, and their offenses.

    Science.gov (United States)

    Woodhams, Jessica; Labuschagne, Gérard

    2012-12-01

    Serial rapists have the propensity to cause harm to a significant number of victims, meaning that they are of concern to the police as well as to treatment providers. Despite the serious nature of their offending, there are surprisingly few studies that provide information regarding their characteristics, the types of victim they target, or the nature of the sexual offenses they commit, and those studies that do exist are varied in their findings. This study provides a descriptive analysis of serial rape in South Africa. One hundred and nineteen sexual offenses committed by 22 serial rapists were sampled. Information regarding the victims, the offenders, and the crimes they had committed were extracted from police files. The characteristics of victims and offenders are reported as well as the frequencies for 114 different crime scene behaviors. When compared with samples of serial sex offenders from other countries, differences emerged in victim characteristics and crime scene behaviors, including how the victims were targeted, the sexual behaviors engaged in, and the incidence of physical violence. The implications of these observed differences for practice are discussed.

  17. Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review.

    Science.gov (United States)

    Heerde, Jessica A; Scholes-Balog, Kirsty E; Hemphill, Sheryl A

    2015-01-01

    Homeless youth commonly report engaging in sexual risk behaviors. These vulnerable young people also frequently report being sexually victimized. This systematic review collates, summarizes, and appraises published studies of youth investigating relationships between homelessness, perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior. A systematic search of seventeen psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "offend*," "victimization," "crime," "rape," "victim*," and "sex crimes." Thirty-eight studies were identified that met the inclusion criteria. Findings showed homeless youth commonly report being raped and sexually assaulted, fear being sexually victimized, and engage in street prostitution and survival sex. Rates of victimization and sexual risk behavior were generally higher for females. Given the paucity of longitudinal studies and limitations of current studies, it is unclear whether homelessness is prospectively associated with sexual victimization or engagement in sexual risk behavior, and whether such associations vary cross nationally and as a function of time and place. Future prospective research examining the influence of the situational context of homelessness is necessary to develop a better understanding of how homelessness influences the perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior among homeless youth.

  18. Gun Violence Following Inpatient Psychiatric Treatment: Offense Characteristics, Sources of Guns, and Number of Victims.

    Science.gov (United States)

    Kivisto, Aaron J

    2017-10-01

    This study presents data on the relative contribution to gun violence by people with a history of inpatient psychiatric treatment and on federal efforts to deter presumptively dangerous persons from obtaining firearms, information useful for analyzing the potential public health benefits of gun policies targeting people with serious mental illness. The study also estimates the reduction in gun violence victims that would be expected if individuals with a previous psychiatric hospitalization were prohibited from purchasing firearms. Data from 838 violent gun offenders from a nationally representative sample of state prison inmates were analyzed. Those with and without a history of psychiatric hospitalization were compared on a range of offense characteristics, including relationship to the victim, number of victims, location of the offense, and source of firearms. Inmates with a history of hospitalization constituted 12% of all violent gun offenders and accounted for 13% of the sample's victims. They were less likely than those without a previous hospitalization to victimize strangers (odds ratio=.52) and were no more likely to commit gun violence in public or to have multiple victims. Among those with previous hospitalizations, 78% obtained guns from sources not subject to federal background checks. Of the total 1,041 victims of gun violence, only 3% were victimized by participants with a history of hospitalization who obtained guns from currently regulated sources. Prohibiting all individuals with a history of psychiatric hospitalization from purchasing firearms, absent expanded background checks, was estimated to reduce the number of gun violence victims by only 3%.

  19. Offensive Strategy in the 2D Soccer Simulation League Using Multi-Group Ant Colony Optimization

    Directory of Open Access Journals (Sweden)

    Shengbing Chen

    2016-02-01

    Full Text Available The 2D soccer simulation league is one of the best test beds for the research of artificial intelligence (AI. It has achieved great successes in the domain of multi-agent cooperation and machine learning. However, the problem of integral offensive strategy has not been solved because of the dynamic and unpredictable nature of the environment. In this paper, we present a novel offensive strategy based on multi-group ant colony optimization (MACO-OS. The strategy uses the pheromone evaporation mechanism to count the preference value of each attack action in different environments, and saves the values of success rate and preference in an attack information tree in the background. The decision module of the attacker then selects the best attack action according to the preference value. The MACO-OS approach has been successfully implemented in our 2D soccer simulation team in RoboCup competitions. The experimental results have indicated that the agents developed with this strategy, along with related techniques, delivered outstanding performances.

  20. The Offense of Homicide by the Victim’s Request according to the Romanian Criminal Law

    Directory of Open Access Journals (Sweden)

    Minodora-Ioana RUSU

    2015-12-01

    Full Text Available In this paper we have examined the offense of homicide by the request of the victim, newly introduced in the Romanian Criminal Law. As it results from its legal content this incrimination envisages the exceptional situation of the person, suffering from an incurable illness or a permanent medically certified disability, causing permanent and unbearable sufferings, and in this situation, the person asks someone to end their life in order to put an end to the unbearable sufferings. The justification for sanctioning such acts is motivated also by the provisions of article 22 paragraph (2 Criminal Code, according to which the consent of the injured person does not take effect for the crimes against life and when the law excludes its justifying effect. We also appreciate that this act, due to its marginal title homicide at the request of the victim and not at murder at the request of the victim, it cannot be in the history of the person who committed the act in the case of qualified murder provided for in article 189 paragraph (1, letter e of the Criminal Code. The paper continues further examination carried out in connection to the offenses under the New Criminal Code. Given the novelty in the Romanian law, the study may be useful both to theorists and practitioners.

  1. Inappropriate and cloned clinical histories on radiology request forms for sick children.

    Science.gov (United States)

    Shah, Chetan Chandulal; Linam, Leann; Greenberg, S Bruce

    2013-10-01

    An appropriate clinical history improves the perception and interpretation of radiographic examinations in children and adults. However, clinical history provided on radiology request has not been studied for its appropriateness and frequency of cloned clinical history. The purpose of this study was to determine the frequency of inappropriate histories and cloned histories at a tertiary-care children's hospital. We analyzed radiology request forms of 388 outpatient and inpatient radiographic examinations obtained on 3 days during the same month at a tertiary-care children's hospital. Appropriateness of the clinical history was judged by its relevance to the examination ordered and appropriate associated billable ICD-9 code. Cloning was defined as identical clinical histories appearing on the radiology request on three consecutive days. Cloned histories were further subdivided as being appropriate or inappropriate. A total of 18% (70/388) of the requests for clinical history were either inappropriate, cloned or both. Neonatal intensive care unit (NICU) referrals constituted the majority (82%, 9/11) of combined inappropriate history and cloning. NICU referrals accounted for 52% (28/54) of all inappropriate clinical histories, a significantly higher percentage than other inpatient locations (P = 0.006). The cardiovascular intensive care unit (CVICU) was the second most common patient location for inappropriate clinical histories (11%, 6/54). About one-third of the radiographic requests from the NICU had inappropriate histories (35%, 28/79). Among the outpatient referrals, 50% (4/8) of the inappropriate histories were from the emergency department. The most common cloned histories included "hypoplastic left heart syndrome" (15%, 4/27), "endotracheal tube placement" (11%, 3/27) and "evaluate lung fields and bowel" (11%, 3/27). The most commonly cloned clinical history was seen on referrals from the NICU at 63% (17/27), a significantly higher percentage than other

  2. Analysis of Inappropriate Medication Use in Older Adults Discharged From Hospitals Affiliated With Tehran University of Medical Sciences (TUMS Using the Beers Criteria in 2010

    Directory of Open Access Journals (Sweden)

    Leila Vali

    2011-10-01

    Full Text Available Objectives: Studies demonstrate that chronic diseases are more frequent among the elderly than other age groups. Therefore, it is reasonable to assume that more pharmaceuticals are consumed by this age group than by others and that older patients are more prone to pharmaceutical side effects and complications due to such higher drug consumption rates. Changes in pharmacokinetics and pharmacodynamics, among others, are considered as major causes of medication related complications among the elderly. Another factor worth noting is the inappropriate choice of medications prescribed for such patients, who can benefit from the identification of such medications and better care in their prescription. These issues are among the well known factors discussed in recent and relevant literature and may inflict significant harm on the health and well-being of the elderly population. Methods & Materials: For the purpose of the present study 212 patients aged 60yr and over (mean age: 69.32 yr discharged from 4 (2 teaching and 2 non-teaching general hospitals affiliated with TUMS were selected. The Beers Criteria was employed to assess inappropriate use of pharmaceuticals by the sample population. Results: Findings reveal that there was a significant relation between the level of income and the inappropriate use of medications among the sample population (P=0.041. The most frequent inappropriate use of medications, in order of frequency, included alprazolam (16.66%, chlordiazepoxide (14.28%, fluoxetine (11.90%, and oxazepam (11.90%. The highest rate of drug interactions was observed for the drug clopidogrel (29.4%. Benzodiazepines were recognized as the most frequent class of pharmaceuticals consumed by the patients (49.98%. There was no significant relationship between income rates and the amount of inappropriate drug use (P=0.041. Conclusion: Inappropriate consumption of pharmaceuticals was relatively high among the study population, in comparison to similar

  3. A Cultural Resource Survey of the Offense Area of the Live Fire Maneuver Range, Fort Irwin, California.

    Science.gov (United States)

    1981-02-19

    ADA2 78 ACULTURAL RESOURCE SURVEY OF THE OFFENSE AREA 0F THE 3/ LIE FRE MANEUVER ANGE FORT IRWIN CA IFRNIA U RECON SAN DIEGO CA C S BULL 19 FEB 81 R...DESCRIPTION AND RESULTS 1 I B. RECOMMENDATIONS 2 * II. CULTURAL RESOURCE REVIEW 3 A. PROJECT AREA DESCRIPTION 3 1. Location 31 2. Geology 3 3. Biology 8 I...CULTURAL RESOURCE REVIEW I A. PROJECT AREA DESCRIPTION 1. Location. The offense area of the live fire maneu-I ver range is located at Fort Irwin, San

  4. Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms

    Directory of Open Access Journals (Sweden)

    Lee D

    2013-09-01

    Full Text Available INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3 years and 59% were women. The median number of medications used was 6 (range 1-21 medications. The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49% of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5 and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54. DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed.

  5. Using a social story intervention to decrease inappropriate behavior of preschool children with autism

    Directory of Open Access Journals (Sweden)

    Angkhana Khantreejitranon

    2018-01-01

    Full Text Available This research investigated the inappropriate behavior of preschool children with autism in a classroom and examined the effectiveness of the use of social stories to decrease inappropriate autistic behavior. An A-B-A-B single subject design was used across the five participants selected for the study. Investigating the problematic social skills and developing a social story intervention for the preschool autistic children was completed, followed by an examination of the effectiveness of the social story intervention. Ten common problematic social skills among the autistic children in preschool were identified—walking around, making loud noises, not sharing their toys with others, showing frustration when feeling unsatisfied, having no patience, not putting toys away when finished, taking other people's belongings without permission, not knowing how to greet others, destroying things when feeling frustrated, and giving a hug to other people at inappropriate times. It was found that the social story intervention helped to decrease inappropriate behavior in children with autism. The social story intervention consisted of five social story books and five e-books (one story per child using a single subject design with an A-B-A-B pattern. The autistic children preferred social stories from the hardcopy books compared with stories from the e-books. A fourth stage time trial was used over 6 weeks, five times per week, for a total of 30 times. The findings suggested that the use of properly constructed social stories can be effective in decreasing the inappropriate behavior of children with autism. However, each story intervention should be applied with caution because of individual differences between children. The social story intervention should be designed only for autistic children who exhibit specific inappropriate social behavior. Keywords: autistic child, inappropriate behavior, social skills, social story

  6. Potentially inappropriate prescriptions for older patients in long-term care

    Directory of Open Access Journals (Sweden)

    Laurin Danielle

    2004-10-01

    Full Text Available Abstract Background Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs in long-term care in metropolitan Quebec. Methods A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results Almost all residents (94.0% were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7% of treated patients had a potentially inappropriate prescription (PIP. Most common PIPs were drug interactions (33.9% of treated patients, followed by potentially inappropriate duration (23.6%, potentially inappropriate medication (14.7% and potentially inappropriate dosage (9.6%. PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication. The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43 and with the length of stay (OR: 1.78, CI: 1.43 – 2.20. On the other hand, the risk of receiving a PIP decreased with age. Conclusion Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

  7. Inappropriate implantable cardioverter defibrillator shocks-incidence, effect, and implications for driver licensing.

    Science.gov (United States)

    Watanabe, Eiichi; Okajima, Katsunori; Shimane, Akira; Ozawa, Tomoya; Manaka, Tetsuyuki; Morishima, Itsuro; Asai, Toru; Takagi, Masahiko; Honda, Toshihiro; Kasai, Atsunobu; Fujii, Eitaro; Yamashiro, Kohei; Kohno, Ritsuko; Abe, Haruhiko; Noda, Takashi; Kurita, Takashi; Watanabe, Shigeyuki; Ohmori, Hiroya; Nitta, Takashi; Aizawa, Yoshifusa; Kiyono, Ken; Okumura, Ken

    2017-09-01

    Patients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions. Inappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold. Of the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively. We found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits.

  8. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

    Directory of Open Access Journals (Sweden)

    Paolo Bifulco

    2014-01-01

    Full Text Available Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs. A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences. As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

  9. Healthcare providers attitudes and perceptions of 'inappropriate attendance' in the Emergency Department.

    Science.gov (United States)

    Breen, Bernadette M; McCann, Margaret

    2013-07-01

    Emergency Departments (EDs) worldwide are facing a crisis from overcrowding and a common perception exists that inappropriate use of the ED is a major contributing factor. Patients, who attend the ED with non-urgent problems, could be dealt with by a General Practitioner; such patients use time and resources that would otherwise be used for patients with more appropriate needs. To explore attitudes and perceptions of healthcare providers regarding 'inappropriate attendance' in the ED. Using a survey questionnaire, this descriptive quantitative study included ED nurses, doctors and paramedics from three regional hospitals in the Republic of Ireland. A total of 163 surveys were returned (59% response rate). There was an overwhelming agreement among respondents that inappropriate attendance in Irish ED exists and poses a considerable challenge for healthcare providers. Results suggest differences of opinion on what represents inappropriate ED use. Potential solutions to address the issue of inappropriate ED attendance include General Practitioners and Advanced Nurse Practitioners practicing within the ED setting; education and greater public awareness and faster access to a specialist opinion in the Out Patient Department. Copyright © 2012 Elsevier Ltd. All rights reserved.

  10. Inappropriate sexual behaviour in adolescents with autism spectrum disorder: what education is recommended and why.

    Science.gov (United States)

    Beddows, Nicola; Brooks, Rachel

    2016-08-01

    Autism spectrum disorder (ASD) is a neurodevelopmental disorder impairing social skills and communication. Adolescents with ASD have sexual needs, but may not understand their physical and emotional development resulting in inappropriate sexual behaviour. The aim of this review is to describe the type of inappropriate behaviour that presents in these adolescents, explain why such behaviours occur, suggest what education is suitable and identify current gaps in research. The databases EMBASE, OVID MEDLINE and PSYCINFO were searched for relevant articles. In total, 5241 articles were found, with an additional 15 sources found via soft searches, of which 42 met inclusion criteria and were subsequently reviewed. Sexual behaviours that occur in these adolescents with ASD include hypermasturbation, public masturbation, inappropriate romantic gestures, inappropriate arousal and exhibitionism. Such behaviours are thought to be caused via a lack of understanding of normal puberty, the absence of appropriate sex education, the severity of their ASD and other associated problems. It is suggested that individualized, repetitive education should be started from an early age in an accessible form. Social skills development is also important before more technical aspects of sex education are taught. Despite being such a common problem for schools, institutions and families to manage, it is surprising how sparse literature is particularly regarding why inappropriate behaviour occurs and what education is effective. © 2015 Wiley Publishing Asia Pty Ltd.

  11. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes

    Directory of Open Access Journals (Sweden)

    Vivatkusol Y

    2017-05-01

    Full Text Available Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG.Results: Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001. The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different.Conclusion: More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes. Keywords: prevalence, pregnancy outcome, inappropriate gestational weight gain, teenage pregnancy

  12. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul F

    2012-02-03

    INTRODUCTION: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers\\' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers\\' Criteria applied. RESULTS: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers\\' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.

  13. Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

    International Nuclear Information System (INIS)

    Choi, Doo Ho; Kim, Eun Seog; Nam, Kae Hyun; Huh, Seung Jae

    1996-01-01

    Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Methods and Materials : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcioma in situ (38 cases), severe dysplasia(2), myoma(6), uterine bleeding (4), uterine prolapse (2), and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy form August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients reveived ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate were 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively. There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cncer (stage IA) had no treatment related failure. Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy. Survivals for patients with gross disease

  14. Offensive Counterterrorism Targeted killing in eliminating terrorist target: the case of the USA and Israel

    Directory of Open Access Journals (Sweden)

    Hermínio Matos

    2012-01-01

    Full Text Available Due to the "global terrorism project", some States have adopted offensive counterterrorism measures which, though within national strategies on security and defense, contemplate the use of military power and the use of lethal force against non-state actors - individuals, groups or terrorist organizations - beyond their national borders. Reformulating the security paradigm has led, in these cases, to policies against terrorism. This is the case of targeted killing - the killing of selected targets - by the USA and Israel. Targeted killing actions - using essentially but not only drones - in Pakistan and Yemen by the American administration, a well as the Israeli response to Palestinian terrorism, are under heated debate in terms of their efficiency and legality. Thus, this paper aims to not only provide an analytical framework on this theme but also analyze the scope and impact of these counter terrorist strategies by the two countries.

  15. Risk of future offense among probationers with co-occurring substance use and mental health disorders.

    Science.gov (United States)

    Balyakina, Elizabeth; Mann, Christopher; Ellison, Michael; Sivernell, Ron; Fulda, Kimberly G; Sarai, Simrat Kaur; Cardarelli, Roberto

    2014-04-01

    The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.

  16. Strategic Social Action Plan for MERCOSUR: Income transfer programs in the context of a neoliberal offensive

    Directory of Open Access Journals (Sweden)

    Rosilaine Coradini Guilherme

    2018-02-01

    Full Text Available This article analyzes the Strategic Social Action Plan for the Common Market of the South (MERCOSUR, based on its relationship with the Millennium Development Goals, which means articulating the reflection to the context of the neoliberal offensive in Latin America. Epistemologically the study is based on the dialectical-critical method, involving exploratory research, with a survey of documentary and bibliographic sources. This research revealed that the focus of the social agenda is the establishment of an exit door or the sustained emancipation of families, by means of individual training, based on the theory of human capital and neoliberal ideology. The scope of the study presupposes presenting the contents of the historic processes and the theoretical concepts that permeate the proposals contained in the Strategic Plan, to stimulate the debate about the issue.

  17. Chemical offense by means of toxicysts in the freshwater ciliate, Coleps hirtus.

    Science.gov (United States)

    Buonanno, Federico; Anesi, Andrea; Guella, Graziano; Kumar, Santosh; Bharti, Daizy; La Terza, Antonietta; Quassinti, Luana; Bramucci, Massimo; Ortenzi, Claudio

    2014-01-01

    Coleps hirtus is a small common freshwater ciliate belonging to the protostomatid group, its body covered by calcified plates assembled to form an armor. Coleps feeds on bacteria, algae, flagellates, living and dead ciliates, animal and plant tissues. To assist its carnivorous feeding the ciliate is equipped with offensive extrusomes (toxicysts), clustering mainly in and around its oral aperture. In this study, we isolated the discharge of the toxicysts from living cells, evaluating its cytotoxic effects against various ciliate species, and demonstrating that it is essential for the effectiveness of Coleps' predatory behavior. The analysis of the toxicyst discharge performed by liquid chromatography-electrospray-mass spectrometry and gas chromatography-mass spectrometry, revealed the presence of a mixture of 19 saturated, monounsaturated and polyunsaturated free fatty acids with the addition of a minor amount of a diterpenoid (phytanic acid). © 2014 The Author(s) Journal of Eukaryotic Microbiology © 2014 International Society of Protistologists.

  18. Trashing the System: Social Movement, Intersectional Rhetoric, and Collective Agency in the Young Lords Organization's Garbage Offensive

    Science.gov (United States)

    Enck-Wanzer, Darrel

    2006-01-01

    Examining the nascent rhetoric of the Young Lords Organization's (YLO) 1969 "garbage offensive," this essay argues that the long-standing constraints on agency to which they were responding demanded an inventive rhetoric that was decolonizing both in its aim and in its form. Blending diverse forms of discourse produced an intersectional rhetoric…

  19. "Stealing and Being Stolen From": Perpetration of Property Offenses and Property Victimization Among Homeless Youth--A Systematic Review

    Science.gov (United States)

    Heerde, Jessica A.; Hemphill, Sheryl A.

    2016-01-01

    Homelessness is purportedly a predictor of property offending and property victimization, yet published studies examining this occurrence are scarce. This systematic review collates, summarizes, and appraises published studies reporting the rates of perpetration of property offenses and property victimization, and associations between homelessness…

  20. Offense Type as Determinant of Revenge and Forgiveness after Victimization: Adolescents' Responses to Injustice and Aggression

    Science.gov (United States)

    Gerlsma, Coby; Lugtmeyer, Valerie

    2018-01-01

    Victims of injustice and aggression may have strong feelings about the perpetrator(s) that may impede their efforts to cope with the victimizing experience. We examined to what extent adolescents' interpersonal responses to victimization in terms of revenge and forgiveness depend on offense type. Of 455 Dutch students from various educational…

  1. Predictors of child pornography offenses and child sexual abuse in a community sample of pedophiles and hebephiles.

    Science.gov (United States)

    Neutze, Janina; Seto, Michael C; Schaefer, Gerard A; Mundt, Ingrid A; Beier, Klaus M

    2011-06-01

    Little is known about factors that distinguish men who act upon their self-identified sexual interest in prepubescent or pubescent children from those who do not. Even less is known about pedophiles or hebephiles who are not involved with the criminal justice system. In this study, a sample of 155 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia (or paraphilia not otherwise specified for those who were sexually attracted to pubescent children). Two sets of group comparisons were conducted on sociodemographic variables and measures of dynamic risk factors. The first set was based on recent activity and compared men who had committed child pornography only or child sexual abuse offenses in the past six months with men who remained offense-free during the same period. The second set was based on lifetime offense history (excluding the most recent six months) and compared child pornography offenders with child sexual abuse offenders and men who had committed both kinds of offenses. Overall, there were more similarities than differences between groups.

  2. Women who sexually offend display three main offense styles: a reexamination of the descriptive model of female sexual offending.

    Science.gov (United States)

    Gannon, Theresa A; Waugh, Greg; Taylor, Kelly; Blanchette, Kelly; O'Connor, Alisha; Blake, Emily; Ciardha, Caoilte Ó

    2014-06-01

    This study examined a theory constructed to describe the offense process of women who sexually offend-the Descriptive Model of Female Sexual Offending (DMFSO). In particular, this report sets out to establish whether the original three pathways (or offending styles) identified within United Kingdom convicted female sexual offenders and described within the DMFSO (i.e., Explicit-Approach, Directed-Avoidant, Implicit-Disorganized) were applicable to a small sample (N = 36) of North American women convicted of sexual offending. Two independent raters examined the offense narratives of the sample and-using the DMFSO-coded each script according to whether it fitted one of the three original pathways. Results suggested that the three existing pathways of the DMFSO represented a reasonable description of offense pathways for a sample of North American women convicted of sexual offending. No new pathways were identified. A new "Offense Pathway Checklist" devised to aid raters' decision making is described and future research and treatment implications explored.

  3. Correlates of admitted sexual interest in children among individuals convicted of child pornography offenses.

    Science.gov (United States)

    Seto, Michael C; Eke, Angela W

    2017-06-01

    Recent research on a risk assessment tool for child pornography offending suggests that admission of sexual interest in children is a risk factor for any sexual recidivism. Admission is easily vulnerable to lying, however, or to refusals to respond when asked about sexual interests. This may become a particular issue when individuals are concerned about the potential impact of admission of sexual interest on sentencing and other risk-related decisions. In this study, we identified the following behavioral correlates (coded yes/no) of admission of sexual interest in children in the risk tool development sample of 286 men convicted of child pornography offenses: (a) never married (54% of sample), (b) child pornography content included child sexual abuse videos (64%), (c) child pornography content included sex stories involving children (31%), (d) evidence of interest in child pornography spanned 2 or more years (55%), (e) volunteered in a role with high access to children (7%), and (f) engaged in online sexual communication with a minor or officer posing as a minor (10%). When summed, the average score on this Correlates of Admission of Sexual Interest in Children (CASIC) measure was 2.21 (SD = 1.22, range 0-6) out of a possible 6, and the CASIC score was significantly associated with admission of sexual interest in children, area under the curve (AUC) = .71, 95% CI [ .65, .77]. The CASIC had a stronger relationship with admission in a small cross-validation sample of 60 child pornography offenders, AUC = .81, 95% CI [.68, .95]. CASIC scores may substitute for admission of sexual interest in risk assessment involving those with child pornography offenses. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  4. Statin therapy reduces inappropriate shock in non-ischemic patients with mild heart failure

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H.; Zareba, Wojciech; Jons, Christian

    2013-01-01

    BACKGROUND: The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy...... tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative...... (hazard ratio, 4.17; 95% confidence interval, 1.52-11.40; P=0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06-5.87; P=0.037) compared with those who did not. CONCLUSIONS: Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate...

  5. The Effect of ICD Programming on Inappropriate and Appropriate ICD Therapies in Ischemic and Nonischemic Cardiomyopathy

    DEFF Research Database (Denmark)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina

    2015-01-01

    INTRODUCTION: The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT......-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy. METHODS AND RESULTS: First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic......-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P

  6. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki

    2006-01-01

    Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We...... conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC) facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified...... on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1%) of the patients were treated with potentially inappropriate medication independent of disease or condition...

  7. Dementia and inappropriate sexual behavior (ISB: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà

    2013-12-01

    Full Text Available Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high adaptive potential in old age.

  8. Dementia and inappropriate sexual behavior: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà

    2012-06-01

    Full Text Available Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high potential for adaptation in old age.

  9. Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD

    Directory of Open Access Journals (Sweden)

    Alessandro Corzani

    2015-01-01

    Full Text Available Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD. A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles.

  10. Elevator talk: observational study of inappropriate comments in a public space.

    Science.gov (United States)

    Ubel, P A; Zell, M M; Miller, D J; Fischer, G S; Peters-Stefani, D; Arnold, R M

    1995-08-01

    We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.

  11. The inappropriate use of lumbar magnetic resonance imaging in a health service area

    International Nuclear Information System (INIS)

    Rodriguez Recio, F. J.; Sanz, J. C.; Vera, S.; Peiro, S.

    1999-01-01

    To identify the percentage of inappropriate lumbar spine magnetic resonance imaging in the Soria Health Service, to quantify the costs and the possible association between inadequate use, the characteristics of the patient and the services requested. A descriptive study of the inappropriate use of MRI of the lumbar spine, taken from the retrospective examination, carried out by a radiologist, of the 233 MRI's requested between 1995 and 1998. For the valuation, the criteria of the American College of Radiology (ACR) and the Basque Agency for the Evaluation of Technologies (OSTEBA) were used. All the MRI's were carried out at an approved centre, the costs were calculated taken form the expenses paid by the Insalud, including the transport costs, calculated at prices applicable for the year in question. 11.7% of the studies were values as inappropriate, 2.1% debatable and the remainder adequate according to the ACR criteria, concentrating the inadequacy on studies for lumbago, that reached 80% of the inappropriate requests. The ACR and OSTEBA criteria coincided to a high degree (kappa statistics: 0.87). The expense related to the unnecessary studies was a litter higher than a million pesetas. No differences were found in the proportion of inappropriate studies according to the characteristics of the patient or the service requested, except the one already mentioned for the supposition diagnosis. Although the results of the study cannot be generalised to other environments, they suggest the possibility of a significant proportion of inappropriate use of lumbar spine MRI that could have an important repercussion on health care expenses. (Author) 11 refs

  12. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA).

    Science.gov (United States)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J; Stoop, José E; Neven, Arie Knuistingh; Penninx, Brenda W J H; Zitman, Frans G

    2011-02-01

    Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. We included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. BZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%). BZD use was independently associated with older age, singleness, unemployment, treatment in secondary care, higher medical consumption (more severe) anxiety, depression (OR [95% CI]=1.95 [1.29, 2.93]), comorbidity, insomnia, SSRI (OR [95% CI]=2.05 [1.55, 2.70]), TCA and other antidepressant (OR [95% CI]=2.44 [1.64, 3.62]) use. Overall, BZD use was rarely in accordance with all guidelines, mainly because most users (82.5%) exceeded the recommended duration of safe use. Inappropriate use was independently associated with older age (β=0.130) and chronic illnesses (β=0.120). Higher scores on agreeableness were associated with less inappropriate use. Mentally or physically vulnerable subjects were most likely to use BZDs. The most vulnerable (i.e. the old and physically ill) BZD users were at highest risk of inappropriate BZD use. Without further evidence of the effectiveness of BZDs in long-term use, caution in initiating BZD prescriptions is recommended, particularly when patients are chronically ill and old, as those are most likely to display inappropriate use. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  13. Reducing inappropriate testing in the diagnosis of the menopause and peri-menopause.

    Science.gov (United States)

    Williams, Jac; Currie, Heather; Foster, Adele; Anderson, Julia

    2016-09-01

    The menopause should be diagnosed based on age, menstrual history and clinical symptoms, and as such, follicle stimulating hormone testing may be considered inappropriate when diagnosing the menopause or peri-menopause in women aged 45 and over. As part of a demand optimisation programme, the number of follicle stimulating hormone tests requested to diagnose the menopause in this age group was quantified and educational interventions were implemented to reduce inappropriate testing. The number of follicle stimulating hormone tests requested to diagnose the menopause in women aged 45 and over was successfully and sustainably reduced. © The Author(s) 2016.

  14. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki

    2006-01-01

    Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We...... dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate...

  15. Development of new taxonomy of inappropriate communication and its application to operating teams in nuclear power plants

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Jang, In Seok; Kang, Hyun Gook; Seong, Poong Hyun; Park, Jin Kyun

    2012-01-01

    Inappropriate communications can cause a lack of necessary information exchange between operators and lead to serious consequences in large process systems such as nuclear power plants (NPPs). In this regard, various kinds of taxonomies of inappropriate communications have been developed to prevent inappropriate communications. However, there seems to be difficult to identify inappropriate communications from verbal protocol data between operators. Because the existing taxonomies were developed for use in report analysis, there is a problem of 'uncertainty'. In consequence, this paper proposes a new taxonomy of inappropriate communications and provides some insights to prevent inappropriate communications. In order to develop the taxonomy, existing taxonomies for four industries from 1980 to 2010 were collected and a new taxonomy is developed based on the simplified one-way communication model. In addition, the ratio of inappropriate communications from 8 samples of audio-visual format verbal protocol data recorded during emergency training sessions by operating teams is compared with performance scores calculated based on the task analysis. As a result, inappropriate communications can be easily identified from the verbal protocol data using the suggested taxonomy, and teams with a higher ratio of inappropriate communications tend to have a lower performance score.

  16. Using an Electronic Highlighter to Eliminate the Negative Effects of Pre-Existing, Inappropriate Highlighting

    Science.gov (United States)

    Gier, Vicki; Kreiner, David; Hudnell, Jason; Montoya, Jodi; Herring, Daniel

    2011-01-01

    The purpose of the present experiment was to determine whether using an active learning technique, electronic highlighting, can eliminate the negative effects of pre-existing, poor highlighting on reading comprehension. Participants read passages containing no highlighting, appropriate highlighting, or inappropriate highlighting. We hypothesized…

  17. [Characteristics of potentially inappropriate prescribing of drugs in elderly polypathological patients].

    Science.gov (United States)

    Rivas-Cobas, Paula Carlota; Ramírez-Duque, Nieves; Gómez Hernández, Mercedes; García, Juana; Agustí, Antonia; Vidal, Xavier; Formiga, Francesc; López-Soto, Alfonso; Torres, Olga H; San-José, Antonio

    To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Inappropriate implantable cardioverter-defibrillator shocks in Brugada syndrome: Pattern in primary and secondary prevention

    Directory of Open Access Journals (Sweden)

    Aimé Bonny

    2017-01-01

    Conclusion: Inappropriate shock is common in Brugada syndrome during the early periods after an ICD implantation, and seems to be more likely in asymptomatic patients. This finding may warrant a review of the indications for ICD implantation, especially in the young and apparently healthy population of patients with Brugada syndrome.

  19. Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe

    Czech Academy of Sciences Publication Activity Database

    Fialová, D.; Topinková, E.; Gambassi, G.; Finne-Soveri, H.; Jónsson, P.; Carpenter, I.; Schroll, M.; Onder, G.; Sorbye, L.W.; Wagner, C.; Reissigová, Jindra; Bernabei, R.

    2005-01-01

    Roč. 293, č. 11 (2005), s. 1348-1358 ISSN 0098-7484 Institutional research plan: CEZ:AV0Z10300504 Keywords : potentially inappropriate medication * prevalence * independent correlates Subject RIV: FQ - Public Health Care, Social Medicine Impact factor: 23.332, year: 2005 http://jama.ama-assn.org/cgi/content/abstract/293/11/1348

  20. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

    Directory of Open Access Journals (Sweden)

    Maria Carlota eVaz Patto

    2014-11-01

    Full Text Available Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus and two inappropriate (U. viciae-fabae and U. lupinicolus rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However responses to different inappropriate rust species also showed some specificity, suggesting a combination of non specific and specific responses underlying this legume nonhost resistance to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and nonhost resistance mechanisms to breed for broad-spectrum resistance to rust in legume species.

  1. Inappropriate use of urinary catheters and its common complications in different hospital wards

    Directory of Open Access Journals (Sweden)

    Parivash Davoodian

    2012-01-01

    Full Text Available Inappropriate use of indwelling urinary catheters (IUCs and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6% had IUCs used appropriately while 42 of them (20.6% were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%, 16 (19.0% and 14 patients (24.6%, respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2% and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

  2. Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto

    2013-12-01

    Full Text Available In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO. Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

  3. College Student Perceptions of the (In)Appropriateness and Functions of Teacher Disclosure

    Science.gov (United States)

    Hosek, Angela M.; Presley, Rachel

    2018-01-01

    This study investigated college student perceptions of the (in)appropriateness of instructor disclosures and perceived functions of instructor disclosures. An interpretive analysis of 35 college students identified that family relationships, life experiences and background, and everyday talk and activities were forms of appropriate disclosures;…

  4. Inappropriate Care in European ICUs Confronting Views From Nurses and Junior and Senior Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Meert, Anne-Pascale; Reyners, Anna K.; Decruyenaere, Johan; Benoit, Dominique D.

    BACKGROUND: ICU care providers oft en feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of

  5. Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges

    Directory of Open Access Journals (Sweden)

    Edward Samuel Roberto

    2017-01-01

    Full Text Available Electromagnetic interference (EMI includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

  6. Improving Inappropriate Social Behavior of Autistic Students Using the LISTEN Intervention Strategy

    Science.gov (United States)

    Al-Shammari, Zaid; Daniel, Cathy; Faulkner, Paula; Yawkey, Thomas D.

    2010-01-01

    A case study was conducted on the development of the LISTEN intervention strategy for use with autistic students to improve inappropriate social behaviors. The study was conducted in a special education classroom in an autism school in Kuwait. Examination of LISTEN Intervention Strategy applications included: duration of targeted behavior; methods…

  7. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes.

    Science.gov (United States)

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

    2017-01-01

    To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m 2 . The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.

  8. Age-Related Differences in Judgments of Inappropriate Behavior are Related to Humor Style Preferences

    Science.gov (United States)

    Stanley, Jennifer Tehan; Lohani, Monika; Isaacowitz, Derek M.

    2014-01-01

    Identifying social gaffes is important for maintaining relationships. Older adults are less able than young to discriminate between socially appropriate and inappropriate behavior in video clips. One open question is how these social appropriateness ratings relate to potential age differences in the perception of what is actually funny or not. In the present study, young, middle-aged, and older adults were equally able to discriminate between appropriate and inappropriate social behavior in a diverse set of clips relevant to both age groups. However, young and middle-aged adults rated the gaffe clips as funnier than control clips and young adults smiled more during the inappropriate clips than the control clips. Older adults did not show this pattern, suggesting that they did not find the inappropriate clips funny. Additionally, young adults endorsed a more aggressive humor style than middle-aged and older adults and aggressive humor style endorsement mediated age differences in social appropriateness ratings. Results are discussed in terms of possible mechanisms such as cohort differences in humor and developmental prioritization of certain humor styles, as well as the importance of investigating age differences in both abilities and preferences. PMID:25244473

  9. Performance Costs when Emotion Tunes Inappropriate Cognitive Abilities: Implications for Mental Resources and Behavior

    Science.gov (United States)

    Storbeck, Justin

    2012-01-01

    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency.…

  10. Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue.

    Science.gov (United States)

    Torrisi, Michele; Cacciola, Alberto; Marra, Angela; De Luca, Rosaria; Bramanti, Placido; Calabrò, Rocco Salvatore

    2017-06-01

    Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non-pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work-up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865-874. © 2016 Japan Geriatrics Society.

  11. Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator Shocks.

    Science.gov (United States)

    Turakhia, Mintu P; Zweibel, Steven; Swain, Andrea L; Mollenkopf, Sarah A; Reynolds, Matthew R

    2017-02-01

    In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified. We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different. After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings. © 2017 American Heart Association, Inc.

  12. [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital].

    Science.gov (United States)

    Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa

    2011-12-01

    Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

  13. Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study.

    Science.gov (United States)

    Márquez, Paola H Ponte; Torres, Olga H; San-José, Anonio; Vidal, Xavier; Agustí, Antonia; Formiga, Francesc; López-Soto, Alfonso; Ramírez-Duque, Nieves; Fernández-Moyano, Antonio; Garcia-Moreno, Juana; Arroyo, Juan A; Ruiz, Domingo

    2017-06-01

    Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce. The aim of the study was to assess inappropriate antihypertensive prescriptions to older patients. An observational, prospective multicentric study was conducted to assess potentially inappropriate prescription of antihypertensive drugs, in patients aged 75 years and older with arterial hypertension (HTN), in the month prior to hospital admission, using four instruments: Beers, Screening Tool of Older Person's Prescriptions (STOPP), Screening Tool to Alert Doctors to the Right Treatment (START) and Assessing Care of Vulnerable Elders 3 (ACOVE-3). Primary care and hospital electronic records were reviewed for HTN diagnoses, antihypertensive treatment and blood pressure readings. Of 672 patients, 532 (median age 85 years, 56% female) had HTN. 21.6% received antihypertensive monotherapy, 4.7% received no hypertensive treatment, and the remainder received a combination of antihypertensive therapies. The most frequently prescribed antihypertensive drugs were diuretics (53.5%), angiotensin-converting enzyme inhibitors (ACEIs) (41%), calcium antagonists (32.2%), angiotensin receptor blockers (29.7%) and beta-blockers (29.7%). Potentially inappropriate prescription was observed in 51.3% of patients (27.8% overprescription and 35% underprescription). The most frequent inappropriately prescribed drugs were calcium antagonists (overprescribed), ACEIs and beta-blockers (underprescribed). ACEI and beta-blocker underprescriptions were independently associated with heart failure admissions [beta-blockers odds ratio (OR) 0.53, 95% confidence interval (CI) 0.39-0.71, p treatment. Underprescription was more frequent than overprescription. ACEIs and beta-blockers were frequently underprescribed and were associated with heart failure admissions.

  14. Sex Differences in the Regulation of Offensive Aggression and Dominance by Arginine-Vasopressin.

    Science.gov (United States)

    Terranova, Joseph I; Ferris, Craig F; Albers, H Elliott

    2017-01-01

    Arginine-vasopressin (AVP) plays a critical role in the regulation of offensive aggression and social status in mammals. AVP is found in an extensive neural network in the brain. Here, we discuss the role of AVP in the regulation of aggression in the limbic system with an emphasis on the critical role of hypothalamic AVP in the control of aggression. In males, activation of AVP V1a receptors (V1aRs) in the hypothalamus stimulates offensive aggression, while in females activation of V1aRs inhibits aggression. Serotonin (5-HT) also acts within the hypothalamus to modulate the effects of AVP on aggression in a sex-dependent manner. Activation of 5-HT1a receptors (5-HT1aRs) inhibits aggression in males and stimulates aggression in females. There are also striking sex differences in the mechanisms underlying the acquisition of dominance. In males, the acquisition of dominance is associated with the activation of AVP-containing neurons in the hypothalamus. By contrast, in females, the acquisition of dominance is associated with the activation of 5-HT-containing neurons in the dorsal raphe. AVP and 5-HT also play critical roles in the regulation of a form of social communication that is important for the maintenance of dominance relationships. In both male and female hamsters, AVP acts via V1aRs in the hypothalamus, as well as in other limbic structures, to communicate social status through the stimulation of a form of scent marking called flank marking. 5-HT acts on 5-HT1aRs as well as other 5-HT receptors within the hypothalamus to inhibit flank marking induced by AVP in both males and females. Interestingly, while AVP and 5-HT influence the expression of aggression in opposite ways in males and females, there are no sex differences in the effects of AVP and 5-HT on the expression of social communication. Given the profound sex differences in the incidence of many psychiatric disorders and the increasing evidence for a relationship between aggressiveness/dominance and

  15. Sex Differences in the Regulation of Offensive Aggression and Dominance by Arginine-Vasopressin

    Directory of Open Access Journals (Sweden)

    Joseph I. Terranova

    2017-11-01

    Full Text Available Arginine-vasopressin (AVP plays a critical role in the regulation of offensive aggression and social status in mammals. AVP is found in an extensive neural network in the brain. Here, we discuss the role of AVP in the regulation of aggression in the limbic system with an emphasis on the critical role of hypothalamic AVP in the control of aggression. In males, activation of AVP V1a receptors (V1aRs in the hypothalamus stimulates offensive aggression, while in females activation of V1aRs inhibits aggression. Serotonin (5-HT also acts within the hypothalamus to modulate the effects of AVP on aggression in a sex-dependent manner. Activation of 5-HT1a receptors (5-HT1aRs inhibits aggression in males and stimulates aggression in females. There are also striking sex differences in the mechanisms underlying the acquisition of dominance. In males, the acquisition of dominance is associated with the activation of AVP-containing neurons in the hypothalamus. By contrast, in females, the acquisition of dominance is associated with the activation of 5-HT-containing neurons in the dorsal raphe. AVP and 5-HT also play critical roles in the regulation of a form of social communication that is important for the maintenance of dominance relationships. In both male and female hamsters, AVP acts via V1aRs in the hypothalamus, as well as in other limbic structures, to communicate social status through the stimulation of a form of scent marking called flank marking. 5-HT acts on 5-HT1aRs as well as other 5-HT receptors within the hypothalamus to inhibit flank marking induced by AVP in both males and females. Interestingly, while AVP and 5-HT influence the expression of aggression in opposite ways in males and females, there are no sex differences in the effects of AVP and 5-HT on the expression of social communication. Given the profound sex differences in the incidence of many psychiatric disorders and the increasing evidence for a relationship between aggressiveness

  16. Exercises to improve the tactical thought to the offensive in the basketball players of the school category

    Directory of Open Access Journals (Sweden)

    Roberto Crespo Contreras

    2016-12-01

    Full Text Available The following research offers the opportunity to overcome the deficiencies in the actions, during the offensive game against the defence for zones in the Basketball game, performed by the players of 15-16 years old category of Pinar del Río Sport Initiation School (EIDE. As main research methods, they stand out the observation in a hidden way, the interview and the approach of Pinar del Río basketball specialists, which allowed to get to the final results and to arrive at important conclusions. Through the work, the author demonstrates that the preparation process can and should be improved. Activities directed to tactical thought formation during the offensive position against defense for zones are offered, relating the practice with the theory, essential elements to comprehend and interpret the game, so the practical answers have relation with the players’ though.

  17. Suicide outside of prison settings among males under investigation for sex offenses in Ireland during 1990 to 1999.

    Science.gov (United States)

    Brophy, Justin

    2003-01-01

    Thirty-two cases of suicide outside prison were identified among 7008 Irish men under investigation for sexual offenses between 1990 and 1999. Previously this risk category has not been identified. Risk ratios of 1/1644 for those accused of offenses against adults, and 1/24 for those accused of offending against minors, respectively, were estimated based on the conservative estimates found here. The increase in the base rate of suicide in Ireland during the study period is an insufficient explanation. The frequency is comparable to prison suicides for the period, and the population of risk may overlap. The incidence increases over the study period. It outpaces increases in prosecutions and may reflect responses to the changing social environment of these investigations. These men use community psychiatric services that may need to become aware of the increased risk of suicide they pose.

  18. The 2nd Guards Tank Army in the Berlin Strategic Offensive Operation

    Directory of Open Access Journals (Sweden)

    Vladimir Ottovich Daynes

    2015-01-01

    Full Text Available One of the greatest battles of the Great Patriotic and also the World War II took place on the outskirts of the capital of Nazi Germany on April 16, 1945. Three magor fronts - 1st Belorussian, 2nd Byelorussian, 1st Ukrainian - and four tank armies were involved. They were not used as highly mobile groups to enter Berlin from the north and north-west, they were sent first to break powerful enemy defenses, and then to wage battles on the streets. The Supreme Command and the commanders of the 1st Byelorussian and 1st Ukrainian fronts understood the inevitability of heavy losses in tanks and troops, but deliberately took this step. The aim was not only a speedy capture of the German capital and the end of the war, but also to be ahead of allies on their way to Berlin. The article deals with the planning and preparation for the Berlin Strategic Offensive Operation, the use of 2nd Guards Tank Army, who played along with other tank divisions a magor role in the success of this operation.

  19. Is the creation of admixed embryos "an offense against human dignity"?

    Science.gov (United States)

    Jones, David Albert

    2010-01-01

    The controversy over the creation of admixed human-nonhuman embryos, and specifically of what have been termed "cybrids," involves a range of ethical and political issues. It is not reducible to a single question. This paper focuses on one question raised by that controversy, whether creating admixed human-nonhuman entities is "an offense against human dignity. "In the last decade there has been sustained criticism of the use of the concept of human dignity within bioethics. The concept has been criticized as "vague" and "useless." Nevertheless, the concept continues to be invoked in bioethical discussion and in international instruments. This paper defends a concept of human dignity that is coherent but that is wider than contemporary post-Kantian approaches. "Human dignity" is best regarded as having a set of analogically related meanings, more than one of which is relevant to the field of bioethics. A more subtle understanding of the concept of human dignity can help identify what is ethically problematic in human-nonhuman combinations and so shed light on one aspect of the admixed embryo debate.

  20. 'Offensive' snakes: cultural beliefs and practices related to snakebites in a Brazilian rural settlement

    Science.gov (United States)

    2010-01-01

    This paper records the meaning of the term 'offense' and the folk knowledge related to local beliefs and practices of folk medicine that prevent and treat snake bites, as well as the implications for the conservation of snakes in the county of Pedra Branca, Bahia State, Brazil. The data was recorded from September to November 2006 by means of open-ended interviews performed with 74 individuals of both genders, whose ages ranged from 4 to 89 years old. The results show that the local terms biting, stinging and pricking are synonymous and used as equivalent to offending. All these terms mean to attack. A total of 23 types of 'snakes' were recorded, based on their local names. Four of them are Viperidae, which were considered the most dangerous to humans, besides causing more aversion and fear in the population. In general, local people have strong negative behavior towards snakes, killing them whenever possible. Until the antivenom was present and available, the locals used only charms, prayers and homemade remedies to treat or protect themselves and others from snake bites. Nowadays, people do not pay attention to these things because, basically, the antivenom is now easily obtained at regional hospitals. It is understood that the ethnozoological knowledge, customs and popular practices of the Pedra Branca inhabitants result in a valuable cultural resource which should be considered in every discussion regarding public health, sanitation and practices of traditional medicine, as well as in faunistic studies and conservation strategies for local biological diversity. PMID:20346120

  1. The Joint Force Air Component Commander and the Integration of Offensive Cyberspace Effects: Power Projection through Cyberspace

    Science.gov (United States)

    2016-06-14

    86 | Air & Space Power Journal The Joint Force Air Component Commander and the Integration of Offensive Cyberspace Effects Power Projection through... Cyberspace Capt Jason M. Gargan, USAF Disclaimer: The views and opinions expressed or implied in the Journal are those of the authors and should not...and Space Power Journal requests a courtesy line. Cyberspace can provide great opportunities to assist the joint force air compo-nent commander (JFACC

  2. Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria.

    Science.gov (United States)

    Nyborg, Gunhild; Brekke, Mette; Straand, Jørund; Gjelstad, Svein; Romøren, Maria

    2017-09-19

    Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand. 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially

  3. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

    LENUS (Irish Health Repository)

    Hamilton, Hilary

    2011-06-13

    Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

  4. Parsing apart the persisters: Etiological mechanisms and criminal offense patterns of moderate- and high-level persistent offenders.

    Science.gov (United States)

    Amemiya, Jamie; Vanderhei, Susan; Monahan, Kathryn C

    2017-08-01

    Longitudinal investigations that have applied Moffitt's dual taxonomic framework to criminal offending have provided support for the existence of adolescent-limited and life-course persistent antisocial individuals, but have also identified additional trajectories. For instance, rather than a single persistent trajectory, studies have found both high-level and moderate-level persistent offenders. To inform theory and progress our understanding of chronic antisocial behavior, the present study used a sample of serious adolescent offenders (N =1,088) followed from middle adolescence to early adulthood (14-25 years), and examined how moderate-level persistent offenders differed from low-rate, desisting, and high-level persistent offenders. Results indicated that moderate-level persisters' etiology and criminal offense patterns were most similar to high-level persisters, but there were notable differences. Specifically, increasing levels of contextual adversity characterized both moderate-level and high-level persisting trajectories, but moderate-level persisters reported consistently lower levels of environmental risk. While both high- and moderate-level persisters committed more drug-related offenses in early adulthood compared to adolescence, moderate-level persisters engaged in lower levels of antisocial behavior across all types of criminal offenses. Taken cumulatively, the findings of this study suggest that sociocontextual interventions may be powerful in reducing both moderate- and high-level persistence in crime.

  5. Subtitling Tarantino’s offensive and taboo dialogue exchanges into european spanish: the case of Pulp Fiction

    Directory of Open Access Journals (Sweden)

    José Javier Ávila-Cabrera

    2015-07-01

    Full Text Available The manner offensive and taboo language is subtitled becomes a delicate and controversial practice given that this type of language functions as a lexical vehicle that provides information on the characters’ personality, social class, and setting and can provoke a strong reaction on viewers (Díaz Cintas, 2001. The omission of offensive/taboo words can therefore be said to entail a loss in their communicative function. From a Descriptive Translation Studies approach, the goals of this paper attempt to shed some light on the way the film Pulp Fiction (Quentin Tarantino, 1994 was subtitled into European Spanish by delving into diverse matters such as: (1 the translation strategies utilised by the subtitler; (2 the way offensive/taboo dialogue exchanges were transferred on the screen; and (3 proving whether the cases of neutralisation and omission of the load of these terms might have been justified by the technical constraints of subtitling.

  6. Clinical analysis of asthenopia caused by wearing inappropriate glasses in college students

    Directory of Open Access Journals (Sweden)

    Li Wang

    2015-01-01

    Full Text Available AIM: To proposed control measures by exploring visual fatigue caused by college students wearing inappropriate glasses.METHODS: A total of 124 cases of asthenopia patients underwent optometry students audition, checked the original spectacles; TOPCON-CL100 computer center was used to checked the original mirror glasses(glasses, the distance between the optical center; with near vision as the standard examination table nearly with vergence and regulation near point, and checked the visual function. RESULTS: All 124 cases(248 eyeshad refractive errors, 77% were spherical mirror and 69% column mirror with error ≥±0.50D, and the pupil center distance from the lens had significant difference(U=5.27, PCONCLUSION: Students wearing inappropriate spectacle asthenopia is caused by one of the main scientific wearing glasses can effectively control asthenopia.

  7. Collecting duct renal cell carcinoma with the syndrome of inappropriate antidiuresis: An autopsy case report

    Directory of Open Access Journals (Sweden)

    Emi Yasuda

    2013-01-01

    Full Text Available A 57-year-old Japanese man visited our hospital with a moist cough. Chest radiographic imaging showed a left hilar shadow. Adenocarcinoma cells were found on cytologic screening of fresh sputum. Although multiple metastases including brain were detected, no tumor was observed in the kidneys. The patient underwent whole-brain irradiation and chemotherapy for advanced-stage lung cancer. One month before his death, carcinomatous meningitis was detected. Hyponatremia, hypo-osmolality, and hypertonic urine suggested the syndrome of inappropriate antidiuresis. Restricting water intake improved the hyponatremia; however, he developed fever and hematuria. Despite systemic administration of an antibacterial drug, he died. Primary tumor in the lung was absent, but adenocarcinoma of the right kidney was evident on autopsy. Lectin histochemical analysis of the carcinoma revealed its distal nephron origin, confirming collecting duct carcinoma. Severe carcinomatous meningitis, which is possibly caused the syndrome of inappropriate antidiuresis, was observed, with no cancer involvement of the pituitary gland and hypothalamus.

  8. Women convicted of promoting prostitution of a minor are different from women convicted of traditional sexual offenses: a brief research report.

    Science.gov (United States)

    Cortoni, Franca; Sandler, Jeffrey C; Freeman, Naomi J

    2015-06-01

    Some jurisdictions have legally decreed that certain nonsexual offenses (e.g., promoting prostitution of a minor, arson, burglary) can be considered sexual offenses. Offenders convicted of these crimes can be subjected to sexual offender-specific social control policies such as registration, as well as be included in sexual offender research such as recidivism studies. No studies, however, have systematically examined differences and similarities between this new class of sexual offenders and more traditional sexual offenders. The current study used a sample of 94 women convicted of sexual offenses to investigate whether women convicted of promoting prostitution of a minor differed on demographic and criminogenic features from those convicted of more traditional sexual offenses. Results show that women convicted of promoting prostitution offenses have criminal histories more consistent with general criminality and exhibit more general antisocial features than women convicted of traditional sexual offenses. These results support the notion that the inclusion of legally defined sexual offenders with traditional ones obscures important differences in criminogenic features among these women. © The Author(s) 2014.

  9. Meaning Of The Term "Corruption Offense" As A Feature Of The Public Prosecutor's Supervision Over The Legislation On The Corruption Counteraction In The Municipal Governments Execution

    Directory of Open Access Journals (Sweden)

    Kseniya D. Okuneva

    2014-12-01

    Full Text Available In the present article theoretical and practical aspects of the corruption offense definition, which are being characteristic features of the methodology of prosecutorial supervision over the legislation on counteraction to corruption in local government are analyzed. Federal Law of Jan. 17, 1992 No. 2202-1 "On the Procuracy of the Russian Federation" (Article 21 establishes the public prosecutor's supervision over the legislation on combating corruption in local government execution, which is a special sub-cluster. On general terms of theoretical techniques of the prosecutor's supervision, taking into account its specific and complex nature of corruption prosecutors based activities in this area. Author emphasizes attention on characteristics of the corruption offense, as well as aspects of legal responsibility, which lie in the fact that it is applied in accordance with law to offender as measures of state coercion of personal, financial or organizational nature for the offense committed; responsibilities of the person, who committed the offense, to be subject to measures of state coercion. In the conclusion author notes that specifics of corruption offenses that are subject of prosecutorial supervision over the execution of legislation on combating corruption in local government is determined by the special status of the offense subjects, as well as the content of legal prohibitions and legal responsibilities in the field of ​​anti-corruption at the municipal level.

  10. Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions.

    Science.gov (United States)

    Abel, Gregory A; Chen, Kun; Taback, Nathan; Hassett, Michael J; Schrag, Deborah; Weeks, Jane C

    2013-03-01

    Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness. Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate. Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months. DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes. Copyright © 2012 American Cancer Society.

  11. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    Science.gov (United States)

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    OpenAIRE

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T ...

  13. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2010-05-01

    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  14. An automated technique to identify potential inappropriate traditional Chinese medicine (TCM) prescriptions.

    Science.gov (United States)

    Yang, Hsuan-Chia; Iqbal, Usman; Nguyen, Phung Anh; Lin, Shen-Hsien; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan

    2016-04-01

    Medication errors such as potential inappropriate prescriptions would induce serious adverse drug events to patients. Information technology has the ability to prevent medication errors; however, the pharmacology of traditional Chinese medicine (TCM) is not as clear as in western medicine. The aim of this study was to apply the appropriateness of prescription (AOP) model to identify potential inappropriate TCM prescriptions. We used the association rule of mining techniques to analyze 14.5 million prescriptions from the Taiwan National Health Insurance Research Database. The disease and TCM (DTCM) and traditional Chinese medicine-traditional Chinese medicine (TCMM) associations are computed by their co-occurrence, and the associations' strength was measured as Q-values, which often referred to as interestingness or life values. By considering the number of Q-values, the AOP model was applied to identify the inappropriate prescriptions. Afterwards, three traditional Chinese physicians evaluated 1920 prescriptions and validated the detected outcomes from the AOP model. Out of 1920 prescriptions, 97.1% of positive predictive value and 19.5% of negative predictive value were shown by the system as compared with those by experts. The sensitivity analysis indicated that the negative predictive value could improve up to 27.5% when the model's threshold changed to 0.4. We successfully applied the AOP model to automatically identify potential inappropriate TCM prescriptions. This model could be a potential TCM clinical decision support system in order to improve drug safety and quality of care. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults

    Science.gov (United States)

    Lund, Brian C; Steinman, Michael A; Chrischilles, Elizabeth A; Kaboli, Peter J

    2014-01-01

    BACKGROUND The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, and widely used a prescribing quality indicator. OBJECTIVE To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. METHODS Data for patients 65 years and older were obtained from the VA Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications (non-Beers MAI) were contrasted between patients who did and did not receive a Beers criteria medication. RESULTS Beers criteria medications accounted for 12.9% and 14.0% of total MAI scores in the two studies. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs. 12.4, p = 0.02; PCM: 11.1 vs. 8.7, p = 0.04), after adjusting for important confounding factors. CONCLUSIONS Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators. PMID:21972251

  16. Syndrome of inappropriate antidiuretic hormone caused by continuous lumbar spinal fluid drainage after transphenoidal surgery.

    Science.gov (United States)

    Norlela, S; Azmi, K N; Khalid, B A K

    2006-01-01

    A 53-year-old acromegalic woman had cerebrospinal fluid rhinorrhoea following transphenoidal surgery for a pituitary microadenoma. A continuous lumbar spinal fluid drainage catheter was inserted and on the sixth postoperative day, she developed hyponatremia with features of syndrome of inappropriate antidiuretic hormone (SIADH) requiring hypertonic saline administration. Over-drainage is potentially hazardous and close biochemical monitoring is required. To our knowledge, this is the first reported case of SIADH caused by continuous lumbar drainage in an adult.

  17. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes

    OpenAIRE

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

    2017-01-01

    Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse preg...

  18. Short notes and reviews Simplifying hydrozoan classification: inappropriateness of the group Hydroidomedusae in a phylogenetic context

    OpenAIRE

    Marques, Antonio C.

    2001-01-01

    The systematics of Hydrozoa is considered from the viewpoint of logical consistency between phylogeny and classification. The validity of the nominal taxon Hydroidomedusae (including all groups of Hydrozoa except the Siphonophorae) is discussed with regard to its distinctness and inclusive relationships. In general, phylogenetic systematic evidence suggest that the use of the term Hydroidomedusae is inappropriate given our current level of understanding. It is concluded that no new, or resurr...

  19. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes.

    Science.gov (United States)

    Chen, Li Li; Tangiisuran, Balamurugan; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad

    2012-08-01

    There is an increasing evidence of medicines related issues such as inappropriate prescribing among older people. Inappropriate prescribing is an important risk factor for adverse drug reactions and hospitalizations in the older people. To assess and characterize the prevalence of Potentially Inappropriate Medications (PIMs) in nursing home care in Malaysia as defined by Screening Tool of Older Peoples Prescriptions (STOPP) and Beers criteria. Four Nursing Homes situated in Penang, Malaysia. A multicenter and cross-sectional study was conducted over 2 months period at four large non-governmental organizations nursing homes in Penang, Malaysia. The study population included older residents (≥65 years old) taking at least one medication. Residents who had been diagnosed with dementia or taking anti dementia drugs, delirium, too frail or refused to give consent were excluded. Demographic, clinical data and concurrent medications were collected through direct interview and also by reviewing medical records. STOPP and Beers criteria were applied in the medical review to screen for PIMs. Potentially Inappropriate Medication using STOPP and Beers criteria. Two hundred eleven residents were included in the study with the median age of 77 (inter quartile range (IQR) 72-82) years. Median number of prescription medicines was 4 (IQR 1-14). STOPP identified less residents (50 residents, 23.7 %) being prescribed on PIMs compared with Beers criteria (69 residents, 32.7 %) (p older residents living in the nursing homes and are associated with number of medications and longer nursing home stay. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  20. Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm.

    Science.gov (United States)

    Lewandowski, Michał; Przybylski, Andrzej; Kuźmicz, Wiesław; Szwed, Hanna

    2013-09-01

    The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced. On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients. All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.

  1. Congenital short QT syndrome and implantable cardioverter defibrillator treatment: inherent risk for inappropriate shock delivery.

    Science.gov (United States)

    Schimpf, Rainer; Wolpert, Christian; Bianchi, Francesca; Giustetto, Carla; Gaita, Florenzo; Bauersfeld, Urs; Borggrefe, Martin

    2003-12-01

    A congenital short QT interval constitutes a new primary electrical abnormality associated with syncope and/or sudden cardiac death. We report on the initial use of implantable cardioverter defibrillator (ICD) therapy in patients with inherited short QT interval and discuss sensing abnormalities and detection issues. In five consecutive patients from two unrelated European families who had structurally normal hearts, excessively shortened QT intervals, and a strong positive family history of sudden cardiac death, ICDs were placed for primary and secondary prevention. Mean QT intervals were 252 +/- 13 ms (QTc 287 +/- 13 ms). Despite normal sensing behavior during intraoperative and postoperative device testing, 3 of 5 patients experienced inappropriate shock therapies for T wave oversensing 30 +/- 26 days after implantation. Programming lower sensitivities and decay delays prevented further inappropriate discharges. The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option. In patients with short QT interval and implanted ICD, increased risk for inappropriate therapy is inherent due to the detection of short-coupled and prominent T waves. Careful testing of ICD function and adaptation of sensing levels and decay delays without sacrificing correct arrhythmia detection are essential.

  2. Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report.

    Science.gov (United States)

    Haslam, Nicholas R; Garth, Rachel; Kelly, Nicola

    2017-12-01

    We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  3. Phantom movements from physiologically inappropriate muscles: A case study with a high transhumeral amputee.

    Science.gov (United States)

    Gade, Julie; Hugosdottir, Rosa; Kamavuako, Ernest N

    2015-08-01

    Individuals with high-level amputation have a great need for functional prostheses because of their vast functional deficits. Conventional techniques are considered inappropriate for high-level amputees due to the lack of physiologically appropriate muscles. This study investigates how accurate phantom movements (PMs) can be classified from physiologically inappropriate muscles. The study involves a case study of a 42-year-old transhumeral amputee. Suitable PMs and best electrode configuration were identified using the sequential forward selection method and brute-force technique. Using linear discriminant analysis, the best PMs (elbow extension/flexion, wrist supination/pronation) and rest were classified with error ranging from 3% to 0.18% when using 3 to 8 EMG channels respectively. A completion rate of 93 % was obtained during a targeted achievement control test in a virtual reality environment. This case indicates that a proximal transhumeral amputee can generate muscle activation patterns related to distinct PMs; and these PMs can be decoded from physiologically inappropriate muscles.

  4. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension.

    Science.gov (United States)

    Jiang, Cunmei; Hamm, Jeff P; Lim, Vanessa K; Kirk, Ian J; Chen, Xuhai; Yang, Yufang

    2012-01-01

    Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  5. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension.

    Directory of Open Access Journals (Sweden)

    Cunmei Jiang

    Full Text Available Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  6. The Impact of a Computerized Clinical Decision Support Tool on Inappropriate Clostridium difficile Testing.

    Science.gov (United States)

    White, Duncan R; Hamilton, Keith W; Pegues, David A; Hanish, Asaf; Umscheid, Craig A

    2017-10-01

    OBJECTIVE To evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testing DESIGN Retrospective cohort study SETTING University of Pennsylvania Health System, comprised of 3 large tertiary-care hospitals PATIENTS All adult patients admitted over a 2-year period INTERVENTION Providers were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives. RESULTS Compared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; Ptesting (5.4% vs 35.2%; Ptesting and improving the timely discontinuation of laxatives. Infect Control Hosp Epidemiol 2017;38:1204-1208.

  7. Beyond the cold war nuclear legacy: offense-defense and the role of nuclear deterrence

    International Nuclear Information System (INIS)

    Dunn, L.A.

    2001-01-01

    Since the September 11 terrorist attacks on the World Trade Center and the Pentagon, the defense community of the United States focused overwhelmingly on countering the threat of global terrorism. This focus rightly reflects the danger of additional terrorist attacks against the American homeland, including conceivably even with nuclear weapons or radiological devices. At the same time, the December, 2001 announcement of the U.S. decision to withdraw from the 1972 Anti-Ballistic Missile (ABM) Treaty after the six month waiting period serves as a reminder that there still is considerable other outstanding 'defense business' confronting the United States and its European allies. In particular, it is increasingly essential to re-craft the Cold War nuclear weapons legacy, not only in its own right but because doing so can also have important payoffs for the success of the U.S.-led global anti-terrorist campaign. The following paper first describes some of the main features of the Cold War nuclear legacy. It then sketches a number of different schools of thought or camps that exist within the U.S. defense community in answer to the question, 'what next with nuclear weaponry?' In light of those contending positions, it then sets out a possible way ahead - moving to re-craft U.S. strategic dealings with Russia toward a non-adversary relationship, to avoid a new Cold War with China, and to put in place the right mix of offensive and defensive, nuclear and non-nuclear capabilities to contain 21. century proliferation dangers. (author)

  8. Goal Format in Small-Sided Soccer Games: Technical Actions and Offensive Scenarios of Prepubescent Players

    Directory of Open Access Journals (Sweden)

    Craig Pulling

    2016-11-01

    Full Text Available The aim of this study was to investigate the influence of the number of goal-posts and the positioning of goal-posts used within small-sided games on the frequency of technical actions and offensive scenarios performed by prepubescent players within soccer. The participants were eight male prepubescent soccer players (12.1 ± 0.5 years. The participants were video recorded for 20 min playing four different formats of 4v4 small-sided games: (1 standard two goal game; (2 four goal game, one goal in each corner; (3 two goal game with goal-posts positioned 9.14 m/10 yd infield, scoring only through the back of the goal; (4 four goal-game, one goal positioned 9.14 m/10 yd infield in each corner, scoring through either the front or back of each goal. Chi-squared tests of independence were utilized to statistically explore the impact of the different small-sided game formats. There were significant associations (p < 0.05 observed between the different small-sided game formats and the frequency of turns, dribbles, shots, goals and overlaps performed. For example, players performed more turns in small-sided game format two and more shots during small-sided game format four. It is suggested coaches should consider using a variation of the number and positioning of goal-posts in small-sided games as an effective training tool in the development of prepubescent soccer players. This will enable coaches to vary the focus of sessions, and develop specific technical and tactical actions within a situation similar to that of real match-play.

  9. Beyond the cold war nuclear legacy: offense-defense and the role of nuclear deterrence

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, L.A

    2001-07-01

    Since the September 11 terrorist attacks on the World Trade Center and the Pentagon, the defense community of the United States focused overwhelmingly on countering the threat of global terrorism. This focus rightly reflects the danger of additional terrorist attacks against the American homeland, including conceivably even with nuclear weapons or radiological devices. At the same time, the December, 2001 announcement of the U.S. decision to withdraw from the 1972 Anti-Ballistic Missile (ABM) Treaty after the six month waiting period serves as a reminder that there still is considerable other outstanding 'defense business' confronting the United States and its European allies. In particular, it is increasingly essential to re-craft the Cold War nuclear weapons legacy, not only in its own right but because doing so can also have important payoffs for the success of the U.S.-led global anti-terrorist campaign. The following paper first describes some of the main features of the Cold War nuclear legacy. It then sketches a number of different schools of thought or camps that exist within the U.S. defense community in answer to the question, 'what next with nuclear weaponry?' In light of those contending positions, it then sets out a possible way ahead - moving to re-craft U.S. strategic dealings with Russia toward a non-adversary relationship, to avoid a new Cold War with China, and to put in place the right mix of offensive and defensive, nuclear and non-nuclear capabilities to contain 21. century proliferation dangers. (author)

  10. Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial

    DEFF Research Database (Denmark)

    Ruwald, Martin H.; Zareba, Wojciech; Jons, Christian

    2013-01-01

    The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery...

  11. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators

    Directory of Open Access Journals (Sweden)

    Lucenteforte E

    2017-10-01

    Full Text Available Ersilia Lucenteforte,1 Niccolò Lombardi,1,* Davide Liborio Vetrano,2,* Domenico La Carpia,2,* Zuzana Mitrova,3 Ursula Kirchmayer,3 Giovanni Corrao,4 Francesco Lapi,5 Alessandro Mugelli,1 Alfredo Vannacci1 On behalf of the Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE 1Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA, University of Florence, Florence, Italy; 2Department of Geriatrics Catholic University, Rome, Italy; 3Department of Epidemiology, ASL 1 Rome, Italy; 4Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; 5Epidemiology Unit, ARS Toscana, Florence, Italy *These authors contributed equally to this work Abstract: Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator “and”. The first regarded “prescriptions”, the second “adverse events”, the third “cardiovascular conditions”, and the last was planned to identify studies on “older people”. Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects

  12. Combined evaluations of competency to stand trial and mental state at the time of the offense: An overlooked methodological consideration?

    Science.gov (United States)

    Kois, Lauren; Wellbeloved-Stone, James M; Chauhan, Preeti; Warren, Janet I

    2017-06-01

    Combined evaluations of competency to stand trial (CST; competency) and mental state at the time of the offense (MSO; sanity) frequently co-occur. However, most research examines the 2 as discrete constructs without considering 4 potential combined evaluation outcomes: competent-sane, incompetent-sane, competent-insane, and incompetent-insane. External validity can be improved if research more closely mirrored practice. It may be incorrect to assume incompetent defendants are similar across CST-only and combined evaluations, and insane defendants are similar across MSO-only and combined evaluations. Using a sample of 2,751 combined evaluations, we examined demographic, clinical, offense, evaluation, and psycholegal characteristics associated with evaluators' combined evaluation opinions. Multinomial regression analyses revealed older defendants were more likely to be opined incompetent-insane. Defendants with psychotic disorders were more often opined insane, regardless of competency status. Affective diagnoses predicted competent-insane opinions. Developmental disorders were closely related to incompetence, regardless of sanity status. Defendants with organic disorders tended to have global psycholegal impairment, in that they were more often opined incompetent-insane, incompetent-sane, or competent-insane, relative to competent-sane. Prior hospitalization predicted competent-insane relative to competent-sane opinions. Defendants not under the influence of a substance during the offense or with no prior convictions were more likely to be opined insane, regardless of competency status. We interpret these findings in light of psycholegal theory and provide recommendations for research and practice. Collectively, results suggest incorporation of combined evaluations into CST and MSO research is an important methodological consideration not to be overlooked. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Charlson Comorbidity Index, inappropriate medication use and cognitive impairment : Bermuda Triangle.

    Science.gov (United States)

    Silay, Kamile; Yalcin, Ahmet; Akinci, Sema; Gursoy, Fatma Gul; Sener Dede, Didem

    2017-11-01

    The aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients. A cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People's Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ 2 , Pearson correlation, Fisher exact, and Mann-Whitney U test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis. A significant difference was found between gender, CCI and cognitive impairment (p = 0.038, p = 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1 fold (95% CI = 1.8-5.4, p < 0.001), hypertension increases the risk 12 fold (95% CI = 2.5-67.8, p = 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (p = 0.015), the correlation between MMSE and IDU was insignificant (p = 0.739). The association of urogenital system drugs and dementia was significant (p = 0.044). Comorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered a risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

  14. Failed Attempts to Reduce Inappropriate Laboratory Utilization in an Emergency Department Setting in Cyprus: Lessons Learned.

    Science.gov (United States)

    Petrou, Panagiotis

    2016-03-01

    Laboratory test ordering is a significant part of the diagnosis definition and disease treatment monitoring process. Inappropriate laboratory test ordering wastes scarce resources, places unnecessary burden on the health care delivery system, and exposes patients to unnecessary discomfort. Inappropriate ordering is caused by many factors, such as lack of guidelines, defensive medicine, thoughtless ordering, and lack of awareness of costs incurred to the system. The purpose of this study is to assess two successive measures, which were introduced in a Cyprus emergency department (ED) for the purpose of synergistically reducing inappropriate laboratory ordering: the introduction of a copayment fee to reduce nonemergent visits, and the development of a Web-based protocol defining the tests emergency physicians could order. An autoregressive integrated moving average model for interrupted time series analysis was constructed. Data include number and type of tests ordered, along with number of visits for a period of 4 years from an ED in Cyprus. Copayment fee and introduction of a revised Web-based protocol for a test ordering form did not reduce the number of ordered tests in the ED unit. Copayment fee alone resulted in a statistically significant reduction in ED visits. The implementation of two consecutive measures resulted in an increase of ordered tests per patient. Laboratory ordering is a multidimensional process that is primarily supplier induced, therefore, all underlying possible causes must be scrutinized by health authorities. These include lack of guidelines, defensive medicine and thoughtless prescribing. To attain significant gains, an integrated approach must be implemented. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Reducing inappropriate accident and emergency department attendances: a systematic review of primary care service interventions.

    Science.gov (United States)

    Ismail, Sharif A; Gibbons, Daniel C; Gnani, Shamini

    2013-12-01

    Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Systematic review of UK and international primary care interventions. Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance.

  16. A qualitative examination of inappropriate hospital admissions and lengths of stay

    Directory of Open Access Journals (Sweden)

    Hammond Christina L

    2009-03-01

    Full Text Available Abstract Background Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions. We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. Methods Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. Results The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS, including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. Conclusion Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.

  17. Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

    Science.gov (United States)

    Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

    2017-10-01

    To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

  18. Effect of nurse practitioner and pharmacist counseling on inappropriate medication use in family practice.

    Science.gov (United States)

    Fletcher, John; Hogg, William; Farrell, Barbara; Woodend, Kirsten; Dahrouge, Simone; Lemelin, Jacques; Dalziel, William

    2012-08-01

    To measure the effect of nurse practitioner and pharmacist consultations on the appropriate use of medications by patients. We studied patients in the intervention arm of a randomized controlled trial. The main trial intervention was provision of multidisciplinary team care and the main outcome was quality and processes of care for chronic disease management. Patients were recruited from a single publicly funded family health network practice of 8 family physicians and associated staff serving 10 000 patients in a rural area near Ottawa, Ont. A total of 120 patients 50 years of age or older who were on the practice roster and who were considered by their family physicians to be at risk of experiencing adverse health outcomes. A pharmacist and 1 of 3 nurse practitioners visited each patient at his or her home, conducted a comprehensive medication review, and developed a tailored plan to optimize medication use. The plan was developed in consultation with the patient and the patient's doctor. We assessed medication appropriateness at the study baseline and again 12 to 18 months later. We used the medication appropriateness index to assess medication use. We examined associations between personal characteristics and inappropriate use at baseline and with improvements in medication use at the follow-up assessment. We recorded all drug problems encountered during the trial. At baseline, 27.2% of medications were inappropriate in some way and 77.7% of patients were receiving at least 1 medication that was inappropriate in some way. At the follow-up assessments these percentages had dropped to 8.9% and 38.6%, respectively (P trial. This might provide a mechanism to explain some of the reductions in mortality and morbidity observed in other trials of counseling and advice provided by pharmacists and nurses. NCT00238836 (ClinicalTrials.gov).

  19. Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs.

    Science.gov (United States)

    Prakash, Ravi; Pathak, Amit; Munda, Sanjay; Bagati, Dhruv

    2009-01-01

    Dementia of Lewy body disease is the second most common degenerative cause of dementia after Alzheimer's disease, among all the dementias. The core features are a progressive dementia, fluctuations in cognitive functions, visual hallucinations, and spontaneous parkinsonism. Rapid eye movement sleep behavior disorder, severe neuroleptic sensitivity, and low dopamine transporter uptake in basal ganglia are other suggestive features. Behavioral abnormalities are commonly present in the form of aggressive behavior, irritability, and uninhibited behaviors. These are mostly seen in the advanced stages of dementia. However, inappropriate sexual behavior is uncommonly seen in such cases. Three types of inappropriate sexual behaviors commonly found in cases of dementia are sex talks, sexual acts, and implied sexual acts. Such inappropriate sexual behaviors have not been described adequately in dementia of Lewy body disease. We report inappropriate sexual behaviors in a case of dementia of Lewy body disease, which improved rapidly after treatment with quetiapine.

  20. Appeal of inappropriate technologies: self-inflicted wages, ethnic pride and corruption

    Energy Technology Data Exchange (ETDEWEB)

    Winston, G.C.

    1979-08-01

    A survey of manufacturing firms in Nigeria produced a set of useful clues to why firms in poor countries so often choose inappropriate production technologies. Some of their explanations do and some do not fit neatly in the neoclassical modelling of production by which economists have judged technological appropriateness. Much of what the firms described affect their real costs and do so in ways that escape economists' notice; technology is appropriate to the managers' view of costs. Often they were responding to more complicated goals than simple profit maximization for the firm; defense of ethnic identity or the goal of increasing their own incomes by stealing from the firm.

  1. Urea for management of the syndrome of inappropriate secretion of ADH: A systematic review.

    Science.gov (United States)

    de Solà-Morales, Oriol; Riera, Maribel

    2014-11-01

    Urea has been recently proposed for the management of hyponatremia linked to the syndrome of inappropriate secretion of ADH (SIADH). The objective of the study was to review the levels of evidence for treatment of hyponatremia associated with SIADH with urea. We performed a: systematic review of experimental trials and grading according to SIGN. No clinical trials were found. The 6 studies analysed had methodological limitations and were prone to biases. In conclusion, there is no evidence to support the efficacy of urea for the treatment of hyponatremia following SIADH. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  2. Adrenal insufficiency secondary to inappropriate oral administration of topical exogenous steroids presenting with hypercalcaemia.

    Science.gov (United States)

    Bhatti, Rahila Sarwar; Flynn, Michael D

    2012-06-21

    A 59-year-old Caucasian gentleman presented with malaise, fatigue and proximal muscle weakness. He had history of long-standing roseate psoriasis treated with topical clobetasol propionate (dermovate). On admission, he had significant postural hypotension, and hypercalcaemia. Endocrinological investigation revealed hypercalcaemia, a serum cortisol of <30 nmol/l, a flat short synacthen test and undetectable adrenocorticotropic hormone. He was treated with hydrocortisone. The abrupt withdrawal of the topical steroids by the patient precipitated the addisonian crisis. Further enquiry documented inappropriate oral administration of clobetasol for more than 10 years in addition to prescribed topical usage.

  3. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich

    2013-05-01

    Full Text Available BACKGROUND The laboratory overuse is widely prevalent in hospital practice, mostly in the emergency care. Reasons for excessive and inappropriate test-ordering include defensive behaviour and fear or uncertainty, lack of experience, the misuse of protocols and guidelines, “routine” and local attitudes, inadequate educational feedback and clinician’s unawareness about the cost of examinations and their related implications. AIM OF THE STUDY AND METHODS The primary target of our working group was to reduce inappropriate ordering on a urgent basis test, implementing further examinations not yet previewed in the hospital panel of the available urgencies, according to the evidence based diagnosis concept. The secondary goal was to indicate strategies of re-engineering of the processes, improving turnaround time in the laboratory management of emergencies. After evaluating, as first intervention, the more reliable sources for practice guidelines, systematic reviews and RCTs, the committee further discussed main topics with in-hospital stakeholders, selected from Emergency, Internal Medicine and Surgery Depts. The working group, in many subsequent audits, tried to obtain a systematic feed back with all involved professionals. RESULTS After reviewing literature’s evidence, the board constrained testing options by defining the basic emergency laboratory panel tests (blood type, hemogram, blood urea nitrogen, plasma creatinine, glucose, sodium, potassium, chloride, osmolarity, CRP, bicarbonate, CPK, creatine phosphokinase-MB, myoglobin, troponin, BNP and NT-proBNP, PT-INR, PTT, D-dimer, beta- HCG, biochemical urinalysis etc.. As final result, the proposed tests reduced the overall number of inappropriate investigations and increased, with newer and updated tests, the available panel for critical patients. DISCUSSION A collegiate review of data reporting, in-hospital deepening of problems and the inter- professional discussion of the evidences

  4. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  5. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD

    2014-01-01

    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  6. Minor Theft: Problems of the Initiation of a Case on an Administrative Offense and Conducting an Administrative Investigation

    Directory of Open Access Journals (Sweden)

    Oleg Y. Filippov

    2016-11-01

    Full Text Available The paper defines the problem of the initiation of an administrative case and conducting an administrative investigation on cases of identifying signs of minor theft under Art. 7.27 of the Code of Administrative Offences of the Russian Federation in cases where the identity of the offender at the time of committing minor theft is not established, this person is not detained. Guidance on the application of this provision under the existing legislation and on amendments and supplements to the law on administrative offenses is offered.

  7. The use of offensive public relations during a conflict: Hamas's efforts to damage Israel's image during the 2010 flotilla

    Directory of Open Access Journals (Sweden)

    Tomer Mozes-Sadeh

    2014-10-01

    Full Text Available Crisis communication models contain strategies to rehabilitate an organization's image, but do not deal with strategies used to damage the image of another player or competitor. Using qualitative content analysis of 178 items published by Palestinian Information Center (PIC, the Hamas's leading website, the purpose of this manuscript is to examine Hamas's efforts to run offensive PR and to harm Israel's image restoration efforts at the time of the flotilla crisis in May 2010. We discover that Hamas deployed a strategy that consisted of five elements: evidence of existence of the crisis event, damages, victims, performance history and undermining the competitor's response.

  8. Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.

    Science.gov (United States)

    Winchester, David E; Kitchen, Andrew; Brandt, John C; Dusaj, Raman S; Virani, Salim S; Bradley, Steven M; Shaw, Leslee J; Beyth, Rebecca J

    2015-04-01

    Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known. Inappropriate MPI will be associated with low achievement of quality care metrics. We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved. Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics. Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem. © 2015 Wiley Periodicals, Inc.

  9. SOME APPROACHES ON THE OFFENSE OF MURDER OR INJURY OF THE NEWBORN COMMITTED BY THE MOTHER, PROVIDED IN ARTICLE 200 OF THE NEW CRIMINAL CODE

    Directory of Open Access Journals (Sweden)

    MIHAELA ROTARU

    2013-05-01

    Full Text Available In addition to the innovations included in the new Criminal Code, the legislator of this legal act makes a number of amendments to the existing institutions and offenses in the criminal law. Such a situation is encountered for the offense of murder or injury of the newborn committed by the mother provided in Art. 200 N.C.C., offense that partly corresponds to the offense of infanticide described in Art. 177 of the Criminal Code in force. The legislator considered it necessary to also criminalize in the new Criminal Code the act of injury of the newborn committed by the mother, along with the action of killing, a situation that rightly caused the change of the marginal name of the offense. Moreover, another interesting aspect that also constitutes the focus of our approach is represented by the two phrases which are different from those in the legal text in force, i.e. ,,immediately after birth but not later than 24 hours" and ,,state of mental disorder”, which are designed to equalize the views expressed in the criminal literature regarding the analyzed crime and the practice in the field.

  10. Excess Baggage for Birds: Inappropriate Placement of Tags on Gannets Changes Flight Patterns

    Science.gov (United States)

    Vandenabeele, Sylvie P.; Grundy, Edward; Friswell, Michael I.; Grogan, Adam; Votier, Stephen C.; Wilson, Rory P.

    2014-01-01

    Devices attached to flying birds can hugely enhance our understanding of their behavioural ecology for periods when they cannot be observed directly. For this, scientists routinely attach units to either birds' backs or their tails. However, inappropriate payload distribution is critical in aircraft and, since birds and planes are subject to the same laws of physics during flight, we considered aircraft aerodynamic constraints to explain flight patterns displayed by northern gannets Sula bassana equipped with (small ca. 14 g) tail- and back-mounted accelerometers and (larger ca. 30 g) tail-mounted GPS units. Tail-mounted GPS-fitted birds showed significantly higher cumulative numbers of flap-glide cycles and a higher pitch angle of the tail than accelerometer-equipped birds, indicating problems with balancing inappropriately placed weights with knock-on consequences relating to energy expenditure. These problems can be addressed by carefully choosing where to place tags on birds according to the mass of the tags and the lifestyle of the subject species. PMID:24671007

  11. Lean Methodology Reduces Inappropriate Use of Antipsychotics for Agitation at a Psychiatric Hospital.

    Science.gov (United States)

    Goga, Joshana K; Depaolo, Antonio; Khushalani, Sunil; Walters, J Ken; Roca, Robert; Zisselman, Marc; Borleis, Christopher

    2017-01-01

    To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. Historically Controlled Study. Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit. All Patients Admitted on the Dementia Unit Were 65 Years of Age and Older with a Primary Diagnosis of Dementia. our Multidisciplinary Team Used Lean Methodology to Identify the Root Causes and Interventions Necessary to Reduce Inappropriate Antipsychotic Use. The Primary Outcome Was Rate of Inappropriately Indicating Agitation as the Rationale When Prescribing Antipsychotic Medications. There Was a 90% (P Agitation. The Lean Methodology Interventions Led To A 90% (P Agitation and a 10% Rate Reduction in Overall Antipsychotic Prescribing. Key Words: Agitation Alzheimer's Antipsychotics Behavioral and Psychological Symptoms of Dementia Centers For Medicare & Medicaid Services Dementia Root-cause Analysis. BPSD = Behavioral and Psychological Symptoms of Dementia CATIE-AD = Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease EMR = Electronic Medical Records GAO = Government Accountability Office GNCIS = Geriatric Neuropsychiatric Clinical Indicator Scale.

  12. Rooting out institutional corruption to manage inappropriate off-label drug use.

    Science.gov (United States)

    Rodwin, Marc A

    2013-01-01

    Prescribing drugs for uses that the FDA has not approved - off-label drug use - can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers' conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. © 2013 American Society of Law, Medicine & Ethics, Inc.

  13. How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

    Science.gov (United States)

    Buri, L; Bersani, G; Hassan, C; Anti, M; Bianco, M A; Cipolletta, L; Di Giulio, E; Di Matteo, G; Familiari, L; Ficano, L; Loriga, P; Morini, S; Pietropaolo, V; Zambelli, A; Grossi, E; Intraligi, M; Tessari, F; Buscema, M

    2010-09-01

    Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs. Copyright (c) 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  14. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients.

    Science.gov (United States)

    Dekker, Anne R J; Verheij, Theo J M; van der Velden, Alike W

    2015-08-01

    Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available. The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs. This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined. The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Voluntary Rehabilitation? On Neurotechnological Behavioural Treatment, Valid Consent and (In)appropriate Offers.

    Science.gov (United States)

    Bomann-Larsen, Lene

    2013-04-01

    Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a consent to be normatively valid ("take the wronging out of the act") under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation.

  16. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments.

    Science.gov (United States)

    Stewart, Derek; Mair, Alpana; Wilson, Martin; Kardas, Przemyslaw; Lewek, Pawel; Alonso, Albert; McIntosh, Jennifer; MacLure, Katie

    2017-02-01

    Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.

  17. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

    Directory of Open Access Journals (Sweden)

    Naomi Yagi

    2017-09-01

    Full Text Available Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood.Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system.Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow, pause duration (duration of respiratory pause for swallowing, and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination.Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.

  18. [Severe nutritional deficiencies in young infants with inappropriate plant milk consumption].

    Science.gov (United States)

    Le Louer, B; Lemale, J; Garcette, K; Orzechowski, C; Chalvon, A; Girardet, J-P; Tounian, P

    2014-05-01

    Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (slow down the progress of this social trend. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    Directory of Open Access Journals (Sweden)

    Lott Alison

    2007-06-01

    Full Text Available Abstract Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1 prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2 initiation of anticoagulation for patients with atrial fibrillation (AF, where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2 to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be

  20. Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms.

    Science.gov (United States)

    Bhatia, R Sacha; Ivers, Noah; Yin, Cindy X; Myers, Dorothy; Nesbitt, Gillian; Edwards, Jeremy; Yared, Kibar; Wadhera, Rishi; Wu, Justina C; Wong, Brian; Hansen, Mark; Weinerman, Adina; Shadowitz, Steven; Johri, Amer; Farkouh, Michael; Thavendiranathan, Paaladinesh; Udell, Jacob A; Rambihar, Sherryn; Chow, Chi-Ming; Hall, Judith; Thorpe, Kevin E; Rakowski, Harry; Weiner, Rory B

    2015-08-01

    Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings. The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment. In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice. The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101). Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use.

    Science.gov (United States)

    Heerde, Jessica A; Hemphill, Sheryl A

    2016-12-01

    The use of substances among youth experiencing homelessness is an important issue in the context of addressing the developing burden of morbidities arising due to illness, injury, physical and mental health concerns, and low rates of health care utilization among this population group. Youth experiencing homelessness report engaging in and being victimized by various forms of sexual behavior. Of interest in this systematic review were published studies investigating substance use in its association with perpetration of sexual offenses, engagement in sexual risk behavior, or experience of sexual victimization among homeless youth. A systematic search of 12 psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "sex crimes," "sexual victimization," "survival sex," "rape," "drugs," and "substance abuse." Twenty-three studies were identified that met the inclusion criteria. No studies statistically examining substance use in its association with perpetrating sexual offenses were located. Findings showed substance use was generally associated with sexual risk behavior or sexual victimization; however, it remains unclear whether substance use precedes or follows these behaviors and experiences. It is possible substances are used by homeless youth as a means of coping with sexual risk behavior and victimization. Implications of the review findings in relation to prevention and intervention approaches aimed to decrease the incidence and severity of health concerns among homeless youth are discussed. © The Author(s) 2015.

  2. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Yang P

    2016-10-01

    Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of

  3. [Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients].

    Science.gov (United States)

    Terán-Álvarez, L; González-García, M J; Rivero-Pérez, A L; Alonso-Lorenzo, J C; Tarrazo-Suárez, J A

    2016-01-01

    Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]). PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP. Copyright © 2014 Sociedad Española de Médicos de

  4. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    Science.gov (United States)

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T wave oversensing, leading to ventricular oversensing with resultant detection in the ventricular fibrillation rate zone. This was followed by shock therapy, even though the ventricular tachycardia rate was below the programmed detection rate of the ICD. The subsequent emergency treatment of the hyperkalemia normalized the electrogram, corrected the ventricular oversensing and arrhythmia, and restored rate-adaptive single-chamber ventricular pacing. PMID:18340383

  5. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, L; Thirstrup, S; Kristensen, M

    2009-01-01

    PURPOSE: To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI). METHODS: General practitioners were...... to polypharmacy (>/=5 medications) were identified and approached for inclusion. Data on medications prescribed over a 3-month period were collected, and the GPs provided detailed information on their patients before and after the intervention. A pre- and post-MAI were scored for all medications. RESULTS......: Of the 277 GPs invited to participate; 41 (14.8%) volunteered. Data were obtained from 166 patients before and after the intervention. Medication appropriateness improved in the combined intervention group but not in the single intervention group. The mean change in MAI and number of medications was -5 [95...

  6. Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder

    Directory of Open Access Journals (Sweden)

    Binu P Pillai

    2011-01-01

    Full Text Available Hyponatremia occurs in about 30% of hospitalized patients and syndrome of inappropriate antidiuretic hormone secretion (SIADH is a common cause of hyponatremia. SIADH should be differentiated from other causes of hyponatremia like diuretic therapy, hypothyroidism and hypocortisolism. Where possible, all attempts should be made to identify and rectify the cause of SIADH. The main problem in SIADH is fluid excess, and hyponatremia is dilutional in nature. Fluid restriction is the main stay in the treatment of SIADH; however, cerebral salt wasting should be excluded in the clinical setting of brain surgeries, subarachnoid hemorrhage, etc. Fluid restriction in cerebral salt wasting can be hazardous. Sodium correction in chronic hyponatremia (onset >48 hours should be done slowly to avoid deleterious effects in brain.

  7. Vancomycin intoxication in a patient with inappropriate antidiuretic hormone syndrome and diarrhea

    Directory of Open Access Journals (Sweden)

    Patricia Hidalgo-Collazos

    2015-07-01

    Full Text Available Vancomycin is an antibiotic used for infections by gram-positive bacteria with a two-compartment pharmacokinetic model. Its monitoring has an established therapeutic range (10-20 mg/L to prevent nephrotoxicity and ototoxicity due to supratherapeutic levels, and inefficiency and development of resistance by subtherapeutic levels. Nephrotoxicity for vancomycin monotherapy at standard doses according to pathogen and typical regimens (usual dose: 15-20 mg/kg/12 h is rare and usually reversible. Moreover, monitoring plasma concentrations allows to achieve concentrations within therapeutic range to allow safe and effective drug use. The renal hypoperfusion can cause pre-renal damage, resulting in elevated levels of serum creatinine, resulting in decreased antibiotic elimination and nephrotoxicity. We report a case of unexpected vancomycin nephrotoxicity in a patient with syndrome Inappropriate antidiuretic hormone secretion associated paraneoplastic

  8. The syndrome of inappropriate antidiuretic hormone: current and future management options.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2010-06-01

    Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.

  9. Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America

    DEFF Research Database (Denmark)

    Urbiztondo, Inés; Bjerrum, Lars; Caballero, Lidia

    2017-01-01

    High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed...... limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs...... in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced...

  10. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH in Strongyloides stercoralis hyperinfection

    Directory of Open Access Journals (Sweden)

    Deepshikha Nag Chowdhury

    2014-01-01

    Full Text Available Strongyloides stercoralis (S. stercoralis is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH. The patient′s symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.

  11. [Validity of the protocol for evaluating the inappropriate use of hospitalization].

    Science.gov (United States)

    Peiró, S; Meneu, R; Roselló, M L; Portella, E; Carbonell-Sanchís, R; Fernández, C; Lázaro, G; Llorens, M A; Martínez-Mas, E; Moreno, E; Ruano, M; Rincón, A; Vila, M

    1996-06-22

    The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services

  12. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review.

    Science.gov (United States)

    Tommelein, Eline; Mehuys, Els; Petrovic, Mirko; Somers, Annemie; Colin, Pieter; Boussery, Koen

    2015-12-01

    Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.

  13. High-dose oral medroxyprogesterone for inappropriate hypersexuality in elderly men with dementia: a case series.

    Science.gov (United States)

    Cross, Bethany S; DeYoung, G Robert; Furmaga, Kevin M

    2013-01-01

    To retrospectively examine the utility of high-dose oral medroxyprogesterone (MPA) for the treatment of inappropriate hypersexuality (IH) in elderly men with dementia. Ten men aged 65 years or older (median 79.5 years, range 65-93 years) were identified from all admissions at a 170-bed tertiary referral psychiatric hospital between December 2005 and January 2011. Admission records were used to identify subjects who received at least 100 mg daily of oral MPA. The primary outcome of successful treatment was chart documentation of a substantial decline in IH, such that subjects could return to preadmission residence. Data were collected to assess trends in dose, adverse effects, use of other symptom-modifying medications prior to MPA initiation, and successful return to preadmission placement. A trial serotoneric agent was used in 70% of subjects prior to MPA initiation. Sixty percent of subjects failed a trial of an antipsychotic, while 40% did not have response to the use of both a serotonergic agent and an antipsychotic before MPA was initiated. The average daily dose of MPA was 300 mg (range 100-400 mg/day). No adverse effects were documented from physician, nursing, or behavioral health rounding notes; however, adverse effects may not have been systematically assessed at the time of MPA administration. Seventy percent of subjects experienced favorable changes in target behaviors from MPA. Few data exist on effective therapy options for treatment of IH. The minimum concentration of MPA needed to suppress IH in the male body is unknown. MPA was titrated upward, with the efficacy measure being a decrease in inappropriate behaviors. Use of MPA likely contributed to decreased IH; however, other factors involved in hospitalization could have contributed to improved behavior. While requiring further study, high-dose (100-400 mg/day) oral MPA may represent an effective and well-tolerated treatment option for subjects displaying IH.

  14. Legal and Political Implications of Offensive Actions from and Against the Space Segment

    Science.gov (United States)

    de Angelis, Iole M.

    2002-01-01

    deployment of strategic weapons, kinetic energy weapons and directed energy weapons are already contained within existing rules and such issues are being actively addressed by the international community. At the same time, the use of cyberwar and electronic warfare to counter space technology not only encounters a void of international rules, but it is a question that is very rarely taken into consideration while addressing to the issues of preventing space warfare. Finally, these techniques are easily available to non-state organisations - terrorist organisations and commercial companies - and individuals. In conclusion, the issues related to offensive actions towards and from space shall be taken into consideration not only in a military perspective, but also in a political perspective - terrorist actions against the space segment - and from an economical point of view.

  15. Failure to register as a predictor of sex offense recidivism: the big bad wolf or a red herring?

    Science.gov (United States)

    Zgoba, Kristen M; Levenson, Jill

    2012-08-01

    This quasi-experimental study analyzed the recidivism outcomes of 1,125 sexual offenders in two groups. The first group comprised 644 registered sex offenders who were convicted of a sex crime and at some point failed to register after release from prison. The comparison group contained 481 registered sex offenders released from prison during a similar time frame who did not fail to register after their release. The groups were then tracked for both sexual and nonsexual offenses to determine whether failure to register under Megan's Law is predictive of reoffending. Failure to register was not a significant predictor of sexual recidivism, casting doubt on the belief that sex offenders who are noncompliant with registration are especially sexually dangerous. Few differences between groups were detected, but FTR offenders were more likely to have sexually assaulted a stranger and to have adult female victims, further challenging the stereotype of the child predator who absconds to evade detection. Potential policy implications are discussed.

  16. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

    Directory of Open Access Journals (Sweden)

    Bonet M

    2012-06-01

    Full Text Available Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people.Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more by pharmacists in a nursing home in the Lleida region (Spain.Results: The mean patients’ age was 84 (SD=8 years, with an average of 5 drugs per resident (total prescriptions: 416 medicines. The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%, but omissions corresponding to the cardiovascular system implied 23% of patients.Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes.

  17. Diccionario de palabras equivocas o malsonantes en Espana, Hispanoamerica y Filipinas: Continuacion. (Dictionary of Ambiguous or Offensive Words in Spain, Spanish America and the Philippines: Continued)

    Science.gov (United States)

    Criado de Val, Manuel

    1976-01-01

    This list of obscene, ambiguous, or offensive Spanish words indicates their off-color meaning in various Spanish-speaking countries. The list comprises words beginning with letters H-M, and is intended to protect the traveller or non-native speaker from embarrassment. It is a continuation of a previous article. (Text is in Spanish.) (CHK)

  18. PRE-EXISTING ELEMENTS OF CUSTOMS OFFENSES IN ACCORDANCE WITH THE LEGISLATION OF THE REPUBLIC OF MOLDOVA AND THESE OF ROMANIA

    Directory of Open Access Journals (Sweden)

    Aurel Octavian Pasat

    2017-12-01

    Full Text Available Our scientific approach will include, to a considerable extent, the analysis of smuggling offenses. We will analyze the pre-existing elements of customs offenses in accordance with the legislation of the Republic of Moldova and that of Romania, our focus being on the investigation of the object of customs offenses. The analysis carried out aims at: highlighting the generic legal object and the special legal object of customs offenses. Different research methods were used to carry out the study, including: analysis, synthesis, deduction, induction. However, the most used method was comparative considering the specifics of the subject under investigation. In the customs sphere, the Romanian legislator has incriminated: simple smuggling, skilled smuggling, the use of unrealistic acts and the use of falsified documents. The analysis of smuggling (simple and qualified will make an incursion both in the legislation of the Republic of Moldova and in Romania; analysis of using false documents and use of forged documents will refer to the rules of the Customs Code of Romania, while the analysis evade customs payments will make use of the Criminal Code rules.

  19. Relationship Between Selected Strength and Power Assessments to Peak and Average Velocity of the Drive Block in Offensive Line Play.

    Science.gov (United States)

    Jacobson, Bert H; Conchola, Eric C; Smith, Doug B; Akehi, Kazuma; Glass, Rob G

    2016-08-01

    Jacobson, BH, Conchola, EC, Smith, DB, Akehi, K, and Glass, RG. Relationship between selected strength and power assessments to peak and average velocity of the drive block in offensive line play. J Strength Cond Res 30(8): 2202-2205, 2016-Typical strength training for football includes the squat and power clean (PC) and routinely measured variables include 1 repetition maximum (1RM) squat and 1RM PC along with the vertical jump (VJ) for power. However, little research exists regarding the association between the strength exercises and velocity of an actual on-the-field performance. The purpose of this study was to investigate the relationship of peak velocity (PV) and average velocity (AV) of the offensive line drive block to 1RM squat, 1RM PC, the VJ, body mass (BM), and body composition. One repetition maximum assessments for the squat and PC were recorded along with VJ height, BM, and percent body fat. These data were correlated with PV and AV while performing the drive block. Peal velocity and AV were assessed using a Tendo Power and Speed Analyzer as the linemen fired, from a 3-point stance into a stationary blocking dummy. Pearson product analysis yielded significant (p ≤ 0.05) correlations between PV and AV and the VJ, the squat, and the PC. A significant inverse association was found for both PV and AV and body fat. These data help to confirm that the typical exercises recommended for American football linemen is positively associated with both PV and AV needed for the drive block effectiveness. It is recommended that these exercises remain the focus of a weight room protocol and that ancillary exercises be built around these exercises. Additionally, efforts to reduce body fat are recommended.

  20. A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior.

    Science.gov (United States)

    Davis, Tonya N; Machalicek, Wendy; Scalzo, Rachel; Kobylecky, Alicia; Campbell, Vincent; Pinkelman, Sarah; Chan, Jeffrey Michael; Sigafoos, Jeff

    2016-12-01

    Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

  1. Good Bugs, Bad Bugs: A Modern Approach for Detecting Offensive Biological Weapons Research

    National Research Council Canada - National Science Library

    Moodie, Michael; Loeb, Cheryl; Armstrong, Robert; Purkitt, Helen

    2008-01-01

    ... crude and sophisticated biological weapons around the world. Unlike nuclear programs, a well-defined and limited set of equipment and material that can be controlled through various import/export controls does not exist...

  2. "Normal" and "Inappropriate" Childhood Sexual Behaviours: Findings from a Delphi Study of Professionals in the United Kingdom

    Science.gov (United States)

    Vosmer, Susanne; Hackett, Simon; Callanan, Margie

    2009-01-01

    This paper presents the results of a three-stage Delphi study examining the current level of consensus among 24 professionals in the United Kingdom regarding definitions of and distinctions between normal, inappropriate and sexually abusive behaviours in children under 10 years, as well as factors influencing their views. Although firm conclusions…

  3. Group Contingencies, Randomization of Reinforcers, and Criteria for Reinforcement, Self-Monitoring, and Peer Feedback on Reducing Inappropriate Classroom Behavior

    Science.gov (United States)

    Coogan, Brenda Anne; Kehle, Thomas J.; Bray, Melissa A.; Chafouleas, Sandra M.

    2007-01-01

    Considerable research has demonstrated the effectiveness of interdependent and unknown dependent group contingencies on reducing inappropriate classroom behavior. Several investigators have focused on the addition of self-monitoring and peer feedback to these interdependent and unknown dependent group contingencies in order to further improve…

  4. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2011-11-01

    Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

  5. Teachers' Self-Reported Beliefs on Developmentally Appropriate and Inappropriate Practices in Grade K-4 EFL Classrooms

    Science.gov (United States)

    Mede, Enisa

    2017-01-01

    This study investigated the perceived beliefs and reported practices of fourth-grade English teachers in primary (elementary) public schools in Turkey. Significantly, it aimed to examine the participating K-4 English as a foreign language (EFL) teachers' beliefs about the developmentally appropriate and inappropriate practices, discover the…

  6. Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil.

    Science.gov (United States)

    Lucena-Silva, Norma; Assunção, Maria Elisa Lucena Sales de Melo; Ramos, Frederico Antônio Pereira; Azevedo, Fernanda; Lessa, Ronaldo; Cordeiro, Marli Tenório; Brito, Carlos Alexandre Antunes de

    2017-01-01

    The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

  7. Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Norma Lucena-Silva

    Full Text Available Abstract The symptoms of chikungunya virus (CHIKV infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

  8. Evaluation of electrical aversion therapy for inappropriate sexual behaviour after traumatic brain injury: a single case experimental design study.

    Science.gov (United States)

    Ter Mors, Bert Jan; van Heugten, Caroline M; van Harten, Peter N

    2012-08-24

    Inappropriate sexual behaviour after acquired brain injury is a severe complication. Evidence for effective treatment is not available. Electrical aversion therapy (EAT) is a behavioural therapeutic option used in persons with intellectual disabilities, which might be suitable for brain-injured individuals for whom other therapies are not effective. The effect of EAT in brain injury has not been investigated previously. A single case experimental design was used. In an ABBA (baseline-treatment-treatment-withdrawal) design the frequency of the target behaviour (ie, inappropriate sexual behaviour) in a 40-year-old man was measured daily. A total of 551 measurements were recorded. A significant reduction of the target behaviour was seen after the first treatment phase (baseline 12.18 (2.59) vs 3.15 (3.19) mean target behaviours daily); this reduction remained stable over time. We conclude that EAT was effective in this patient with inappropriate sexual behaviour due to severe brain injury. EAT can therefore be considered in therapy resistant inappropriate sexual behaviour in brain-injured patients.

  9. Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Ana Fajreldines

    2018-01-01

    Full Text Available Together, potentially inappropriate prescribing of medications (PIP and appropriate prescribing omission (APO constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE. This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment. The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

  10. Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report

    Directory of Open Access Journals (Sweden)

    Renata Reis Carvalho

    Full Text Available Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH is the inability of antidiuretic hormone (ADH suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

  11. [Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)].

    Science.gov (United States)

    Cruz-Esteve, Inés; Marsal-Mora, Josep Ramón; Galindo-Ortego, Gisela; Galván-Santiago, Leonardo; Serrano-Godoy, Marcos; Ribes-Murillo, Esther; Real-Gatius, Jordi

    2017-03-01

    Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. Cross-sectional population study. Primary Care, Lleida Health Region, Spain. 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  12. Inappropriate Use of Psychotropic Drugs in People Aged 60 and over

    Directory of Open Access Journals (Sweden)

    María Magdalena Caro Mantilla

    2013-03-01

    Full Text Available Background: indiscriminate use of psychoactive medication can provoke multiple disorders to the elderly system. Furthermore, it can also result in drug abuse. Objective: to characterize the inappropriate use of psychotropic drugs in people aged 60 and over. Methods: a descriptive, cross-sectional and prospective study was conducted in two consultations of Health Area # II in the municipality of Cienfuegos from June to December 2006. The sample consisted of 93 adults aged over 60. The variables analyzed were age, sex, educational level, prescribed medication and its application, symptoms leading to the indication, duration of the treatment according to the prescription, follow-up, therapeutic alternatives, tolerance and abstinence. We applied a functional assessment scale: the Lawton and Brody Scale. For the statistical processing, descriptive statistics tests were performed. For computational processing, a database was created in the SPSS 11.0 program for Windows. Results: it is mostly women who consume these types of drugs. The most consumed psychoactive drugs were benzodiazepines and mainly through self-medication. Elderly presented tolerance and abstinence. There was a misuse of these drugs in relation to the time of consumption, prescription, follow-up and treatment options such as natural and traditional medicine. Conclusions: high rates of medical prescription, failures in patient’s follow-up, self-medication and non-use of therapeutic alternatives are some of the many causes of the indiscriminate use of psychoactive drugs in people aged over 60.

  13. Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Jaspinder Kaur

    2016-01-01

    Full Text Available Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH, neuroleptic malignant syndrome (NMS, and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

  14. Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

    Directory of Open Access Journals (Sweden)

    Kyle Richard G

    2013-01-01

    Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

  15. Adult female with symptomatic AVPR2-related nephrogenic syndrome of inappropriate antidiuresis (NSIAD

    Directory of Open Access Journals (Sweden)

    Jennifer Hague

    2018-01-01

    Full Text Available Activating mutations in AVPR2 are associated with nephrogenic syndrome of inappropriate antidiuresis (NSIAD. NSIAD causes hyponatremia, decreased serum osmolality and clinical symptoms, which may present from birth or in infancy and include hypotonia, irritability, vomiting and/or seizures. Symptoms in later life are often less specific and include malaise, dizziness, confusion, tiredness and headache. NSIAD is a rare X-linked condition, which is associated with a variable phenotype in males, of whom some present in infancy but others do not become symptomatic until adulthood, or occasionally, never. Female carriers may present with episodes of hyponatremia, usually found incidentally. Literature in this field is limited; namely, two clinical reports describing a female proband, both diagnosed in infancy. We describe, for the first time, the case of an adult female proband with NSIAD, who had longstanding associated symptoms of tiredness, headache, temporary memory loss and mood changes as well as hyponatremia and decreased serum osmolality. A water load test demonstrated an inability to dilute urine and gene sequencing confirmed a recurrent activating mutation in AVPR2. The variant was inherited from the proband’s mother who had had longstanding episodes of transient asymptomatic hyponatremia. This is the third report of a female proband with NSIAD and is the first female reported who sought medical treatment for chronic symptoms from adulthood. This case acts as a reminder of the importance of considering NSIAD as a diagnosis in females of all ages with unexplained hyponatremia.

  16. Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases.

    Science.gov (United States)

    Pérez-Jover, Virtudes; Mira, José J; Carratala-Munuera, Concepción; Gil-Guillen, Vicente F; Basora, Josep; López-Pineda, Adriana; Orozco-Beltrán, Domingo

    2018-02-10

    The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

  17. Factors underlying students’ appropriate or inappropriate use of scholarly sources in academic writing, and instructors’ responses

    Directory of Open Access Journals (Sweden)

    John Sivell

    2013-07-01

    Full Text Available At first glance it is surprising that – in remarkable contrast to grammatical or lexical failings which, while certainly not viewed as insignificant, are rarely greeted with outright anger or hostility – inappropriate documentation of scholarly sources so frequently provokes very harsh penalties. Rather than the constructively pedagogical approach that one would expect with regard to other defects in writing, why do we so often witness a rush to negative evaluation of what may, after all, be evidence of nothing more culpable than misinformation, confusion, or oversight? Much has of course been written about possible remedies for ineffective use of scholarly sources and, on the other hand, about available monitoring and punishment for deliberate plagiarism; so, in a sense, the alternatives appear quite simple. However, decisions about when to adopt a more pedagogical or a more disciplinary viewpoint are complicated by difficult and potentially emotional factors that can disrupt calm, confident and well-reasoned judgment. Thus, this paper will focus not on pedagogical or disciplinary strategies, whichever may be considered suitable in a given case, but on a framework for thorough reflection earlier in the thinking process. It will explore multiple perspectives on possible origins for the innocent if maladroit mishandling of scholarly sources, with a view to highlighting a number of informative but potentially neglected reference points – a cognitive psychological perspective on human error and error management, plausible ambiguities in determining what actually constitutes plagiarism, and communication challenges – that may enter into the instructor’s final determination.

  18. Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

    Directory of Open Access Journals (Sweden)

    Mario Visconti

    2015-09-01

    Full Text Available Proton pump inhibitors (PPIs are the most potent drugs for reducing gastric acid secretion; so, since their release in the late 1980s, they have been recommended as the first therapeutic choice for many gastroesophageal diseases, risk reduction in or healing of non-steroidal anti-inflammatory drugs-associated ulcer disease and stress ulcer prophylaxis in intensive care unit patients. Thus PPIs account for a significant proportion of pharmaceutical health-care expenditure. Much of this high expenditure results from overuse of PPIs in account of inappropriate indications or prolongation of therapies for excessive time compared to real need. PPIs overutilization occurs in all medical care settings: in the majority of hospitalized patients with low risks for gastrointestinal bleeding, in patients healed at discharge from hospital, in outpatients in ambulatory practice. However potential adverse effects associated with PPIs therapy have been described, including enteric (especially by Clostridium difficile in elderly patients and pneumonia infections, nutritional deficiencies, rebound acid hypersecretion, acute interstitial nephritis, gastric neoplasms, bone fractures. Caution is required for some coprescription, particularly with clopidogrel.

  19. [The treament of hyponatremia secundary to the syndrome of inappropriate antidiuretic hormone secretion].

    Science.gov (United States)

    Runkle, Isabelle; Villabona, Carles; Navarro, Andrés; Pose, Antonio; Formiga, Francesc; Tejedor, Alberto; Poch, Esteban

    2013-12-07

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most frequent cause of hyponatremia in a hospital setting. However, detailed protocols and algorithms for its management are lacking. Our objective was to develop 2 consensus algorithms for the therapy of hyponatremia due to SIADH in hospitalized patients. A multidisciplinary group made up of 2 endocrinologists, 2 nephrologists, 2 internists, and one hospital pharmacist held meetings over the period of a year. The group worked under the auspices of the European Hyponatremia Network and the corresponding Spanish medical societies. Therapeutic proposals were based on widely-accepted recommendations, expert opinion and consensus guidelines, as well as on the authors' personal experience. Two algorithms were developed. Algorithm 1 addresses acute correction of hyponatremia posing as a medical emergency, and is applicable to both severe euvolemic and hypovolemic hyponatremia. The mainstay of this algorithm is the iv use of 3% hypertonic saline solution. Specific infusion rates are proposed, as are steps to avoid or reverse overcorrection of serum sodium levels. Algorithm 2 is directed to the therapy of SIADH-induced mild or moderate, non-acute hyponatremia. It addresses when and how to use fluid restriction, solute, furosemide, and tolvaptan to achieve eunatremia in patients with SIADH. Two complementary strategies were elaborated to treat SIADH-induced hyponatremia in an attempt to increase awareness of its importance, simplify its therapy, and improve prognosis. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  20. Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil.

    Science.gov (United States)

    Carneiro, Jackelyne Faierstein; Valongueiro, Sandra; Ludermir, Ana Bernarda; Araújo, Thália Velho Barreto de

    2016-01-01

    To analyze the association between physical violence by an intimate partner (PVIP) and the inappropriate use of prenatal care services. A nested cross-sectional study was conducted with 1,026 women, based on data from a prospective cohort study designed to investigate intimate partner violence among pregnant women enrolled in the Family Health Program (PSF) in Recife, Northeastern Brazil. The use of prenatal care services was assessed with basis on the guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and considered the time of the first prenatal care visit and the total number of visits during the pregnancy. Data were collected through two face-to-face interviews (one in the last pregnancy trimester and the other in the postpartum period), using standardized questionnaires and data on Pregnancy Card records. An unconditional logistic regression was performed to estimate the odds ratio (OR) and the 95% confidence intervals to measure the association between an PVIP and the inappropriate use of prenatal care services, using the stepwise method. The prevalence of the inappropriate use of prenatal care services was 44.1% and of an PVIP, 25.6%. In the logistic regression analysis, an intimatePVIP was associated with inappropriate prenatal care (OR = 1.37; 95%CI 1.01 - 1.85; p = 0.04) after adjustment by variables confirmed as confounders (parity, alcohol use in pregnancy, and education level). Women who are victims of an PVIP have more chance of receiving inappropriate prenatal care due to late onset of prenatal care, fewer prenatal care visits, or both.

  1. Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals.

    Science.gov (United States)

    Appari, Ajit; Johnson, M Eric; Anthony, Denise L

    2018-01-01

    To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of outpatient imaging. Copyright © 2017

  2. Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit.

    Science.gov (United States)

    Swan, Joshua T

    2014-01-01

    The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings. To compare the incidence of inappropriate UTA ratings before and after an educational campaign. An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment. The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001). The educational campaign decreased the incidence of inappropriate UTA ratings.

  3. Freedom of Religion and Freedom of Expression: Religiously Offensive Speech and International Human Rights

    Directory of Open Access Journals (Sweden)

    Jack Donnelly

    2015-11-01

    Full Text Available May the state prohibit speech that deeply offends religious sensibilities? This issue has recently been a matter of intense controversy in both the Islamic and Western world. Much of the discussion, on both sides, has been inflammatory and deeply unhelpful, even counterproductive. This paper seeks to advance the discussion by analyzing and defending the approach suggested by international human rights law. Although international human rights law is explicitly silent on the question of speech that is intended to be or is perceived as hostile to a religion, there is a clear body of law dealing with speech that fosters racial discrimination that can be used as a model. On this basis, prohibiting speech that provokes or incites religious discrimination, religious hatred, or religious violence is clearly within the bounds of international human rights law. Prohibiting speech because that speech is offensive to adherents of a religion is not. If speech is to be free, it must be regulated only to prevent demonstrable serious harm to others that outweighs the harm to those whose speech is restricted. Crying fire in a crowded theater is a classic example. Prohibiting speech that incites religious violence clearly meets this test. The fact that some people find the speech offensive clearly does not. The human right to freedom of religion does not guarantee that others respect one’s religion. States are obliged to permit the free choice and public exercise of one’s religion and to protect that choice and exercise. States are at liberty to give support to religion, either in general or to particular religions – so long as that support does not violate the human rights of others. To prohibit some speech on the basis of the religious sensibilities of one, some, or all religions restricts a fundamental human right for a non-human rights reason of insufficient weight. آیا دولتها اجازه دارند سخنرانیهایی را که

  4. The offensive efficiency of the high-level handball players of the front and the rear lines.

    Science.gov (United States)

    Moncef, Cherif; Dagbaji, Gomri; Abdallah, Aouidet; Mohamed, Said

    2011-12-01

    The aim of this study was to investigat the offensive efficiency of the professional handball players forming the front and rear lines. Our investigation was carried out on four matches (final, semi-finals and classifying match) at the 19(th) male Handball World Championship "Tunisia 2005". Finalist teams were Tunisia, France, Croatia, and Spain. Matches were recorded using 5 digital camcorders (SONY, DCL, and TRV 130E). Number of passes and the length of the attacks were determined by software "STUDIO 9". Speed of the ball at the different shootings was calculated by REGAVI software, version 2.57, 2004. Work was dissociated according to 2 variables namely axes and lines. Players of lateral axes (A4) and front basis (L1) were shorter and thinner than those of the central axis (A3) and rear basis (L2). No differences were observed between lines and axes in age. The analysis of the total shootings to the goal shows that the players of lines and axes present very close values in each team, excepting the Croatian L2 compared to the Tunisian L2. Players of the rear Croatian basis present also a number of attacks concluded by a non-successfully cadred shooting greater than all other groups. In the Spanish group, a significant difference among number of passes concluded by a non-successfully cadred shooting between lines, and front basis vs central axis was noted. No significant difference was found between lines and axes in the Croatian team. Regarding the velocity of shooting, excepting the Croatian team, no differences were found between lines and axes of the other teams. No differences were also noted in the attack duration between lines and axes in Croatian and Tunisian teams. In the Spanish team, duration of attacks concluded by a cadred shooting was most important when finished by an L2 or an A3 player. The present results demonstrate that finalist teams were found to be clearly characterized by L2 and A3 players taller and weightier than those of L1 and A4

  5. Empagliflozin Increases Short-Term Urinary Volume Output in Artificially Induced Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Julie Refardt

    2017-01-01

    Full Text Available Objective. Syndrome of inappropriate antidiuresis (SIADH is the predominant cause of hyponatremia, but treatment options are unsatisfying. SGLT2 inhibitors increase urinary glucose excretion with concomitant osmotic diuresis. We therefore hypothesized SGLT2-inhibitors as a novel treatment for SIADH. Design. Double-blind placebo-controlled randomised crossover study in 14 healthy volunteers. Methods. We induced an artificial SIADH model by administration of desmopressin and overhydration. Afterwards, empagliflozin 25 mg or placebo was given in random order. The main outcomes were total urinary excretion, glucosuria, and the area under the curve (AUC of serum sodium concentration. Outcome measures were obtained 2–8 hours after administration of study drug. Results. 14 participants (64% males, BMI 23 kg/m2 (±2.4, aged 28.6 years (±9, completed the study. Empagliflozin led to significantly increased total urinary excretion (579.3 ml (±194.8 versus 367.3 ml (±158.8; treatment effect 158 ml (CI 48.29, 267.74, p=0.017 due to glucosuria (74.18 mmol (±22.3 versus 0.12 mmol (±0.04; treatment effect (log scale 2.85 (CI 2.75, 2.96, p<0.001. There was no difference in the AUC of serum sodium concentration (treatment effect 0.2 (CI −7.38, 6.98, p=0.96. Conclusion. In our SIADH model, empagliflozin increased urinary excretion due to osmotic diuresis. Due to the short treatment duration, serum sodium levels remained unchanged. Real-live studies are needed to further examine empagliflozin as a new treatment for SIADH.

  6. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals?

    Science.gov (United States)

    Silver, Samuel A; Baillie, Laura; Simor, Andrew E

    2009-01-01

    Urine specimens are among the most common samples submitted for culture to microbiology laboratories. The objectives of the present study were to describe the indications for obtaining urine cultures in a cohort of hospitalized patients, and to determine the appropriateness of antimicrobial therapy in response to urine culture results. The study was performed at a teaching hospital with an adjoining long-term care facility from June 1 to July 31, 2006. The medical records of nonpregnant adult patients with and without bacteriuria were reviewed. A symptomatic urinary tract infection was defined as the presence of bacteriuria in a patient with fever or urinary symptoms; asymptomatic bacteriuria was defined as bacteriuria without urinary symptoms and no infection evident at another site. Medical records of 335 eligible patients (64% male; mean age 68 years) were reviewed, including all 137 with bacteriuria, and 198 with negative urine cultures. In total, 51% of the urine specimens were obtained from an indwelling urinary catheter, and 28% were voided urine samples. Confusion (57%) and fever (36%) were the most common indications noted for obtaining the urine cultures. Only 34 patients (25% of those with positive urine cultures) met the criteria for a symptomatic urinary tract infection; 67 (49%) had asymptomatic bacteriuria and 36 (26%) had infection at a nonurinary site. Of those with asymptomatic bacteriuria, 64% received antimicrobial therapy for a total of 347 days. Confused patients with asymptomatic bacteriuria were more likely to be treated than were bacteriuric patients without altered mental status (OR 1.8, 95% CI 1.2 to 4.1; P=0.03). Urine cultures are frequently obtained from hospitalizedpatients,evenintheabsenceofurinarysymptoms.Asymptomatic bacteriuria is often treated in these patients, and accounts for a substantial burden of inappropriate antimicrobial use in hospitals. Effective strategies to improve urine culture ordering and antimicrobial

  7. Carbon dioxide narcosis due to inappropriate oxygen delivery: a case report.

    Science.gov (United States)

    Herren, Thomas; Achermann, Eva; Hegi, Thomas; Reber, Adrian; Stäubli, Max

    2017-07-28

    Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry. Oxygen was administered using a non-rebreathing mask with an oxygen reservoir bag attached. For fear of removing the hypoxic stimulus to respiration the oxygen flow was inappropriately limited to 4L/minute. The patient developed carbon dioxide narcosis and had to be intubated and mechanically ventilated. Non-rebreathing masks with oxygen reservoir bags must be fed with an oxygen flow exceeding the patient's minute ventilation (>6-10 L/minute.). If not, the amount of oxygen delivered will be too small to effectively increase the arterial oxygen saturation. Moreover, the risk of carbon dioxide rebreathing dramatically increases if the flow of oxygen to a non-rebreathing mask is lower than the minute ventilation, especially in patients with chronic obstructive pulmonary disease and low tidal volumes. Non-rebreathing masks (with oxygen reservoir bags) must be used cautiously by experienced medical staff and with an appropriately high oxygen flow of 10-15 L/minute. Nevertheless, arterial blood gases must be analyzed regularly for early detection of a rise in partial pressure of carbon dioxide in arterial blood in patients with chronic obstructive pulmonary disease and a hypoxic ventilatory drive. These patients are more safely managed using a nasal cannula with an oxygen flow of 1-2L/minute or a simple face mask with an oxygen flow of 5L/minute.

  8. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem

    Science.gov (United States)

    Parsons, Carole

    2016-01-01

    Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to

  9. [Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers].

    Science.gov (United States)

    Machado-Alba, J E; Giraldo-Giraldo, C; Aguirre Novoa, A

    2016-01-01

    To determine the frequency of simultaneous prescription of β-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them. Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a β-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months. A total of 535 patients, with a mean age 75.8±6.7 years received concomitant β-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription. An improved adherence to recommendations for appropriate use of β-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  10. Independent review of inappropriate identification, storage and treatment methods of polychlorinated biphenyl waste streams

    International Nuclear Information System (INIS)

    1997-07-01

    The purpose of the review was to evaluate incidents involving the inappropriate identification, storage, and treatment methods associated with polychlorinated biphenyl (PCB) waste streams originating from the V-tank system at the Test Area North (TAN). The team was instructed to perform a comprehensive review of Lockheed Martin Idaho Technologies Company (LMITCO's) compliance programs related to these incidents to assess the adequacy and effectiveness of the management program in all respects including: adequacy of the waste management program in meeting all LMITCO requirements and regulations; adequacy of policies, plans, and procedures in addressing and implementing all federal and state requirements and regulations; and compliance status of LMITCO, LMITCO contract team members, and LMITCO contract/team member subcontractor personnel with established PCB management policies, plans, and procedures. The V-Tanks are part of an intermediate waste disposal system and are located at the Technical Support Facility (TSF) at TAN at the Idaho National Engineering and Environmental Laboratory (INEEL). The IRT evaluated how a waste was characterized, managed, and information was documented; however, they did not take control of wastes or ensure followup was performed on all waste streams that may have been generated from the V-Tanks. The team has also subsequently learned that the Environmental Restoration (ER) program is revising the plans for the decontamination and decommissioning of the intermediate waste disposal system based on new information listed and PCB wastes. The team has not reviewed those in-process changes. The source of PCB in the V-Tank is suspected to be a spill of hydraulic fluid in 1968

  11. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.

    Science.gov (United States)

    O'Mahony, Denis; O'Sullivan, David; Byrne, Stephen; O'Connor, Marie Noelle; Ryan, Cristin; Gallagher, Paul

    2015-03-01

    Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. We reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. The expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

  12. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list.

    Science.gov (United States)

    Pohl-Dernick, Katharina; Meier, Florian; Maas, Renke; Schöffski, Oliver; Emmert, Martin

    2016-04-01

    Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.

  13. Addressing the Issue of Chronic, Inappropriate Benzodiazepine Use: How Can Pharmacists Play a Role?

    Directory of Open Access Journals (Sweden)

    Helen C. Gallagher

    2013-09-01

    Full Text Available Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is out-weighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Despite these guidelines, historical data points to an increasing proportion of inappropriate, repeat prescribing of benzodiazepines in Ireland and elsewhere, with up to 33% of patients who use these drugs doing so long-term. The typical long-term benzodiazepine user is an older, socio-economically disadvantaged patient who has been prescribed these medicines by their general practitioner (GP and dispensed them by their community pharmacist. Misuse of benzodiazepines in nursing homes and psychiatric institutions is also of concern, with one Irish study indicating that almost half of all admissions to a psychiatric hospital were prescribed these drugs, usually despite a lack of clear clinical need. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. It is obvious that an inter-professional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes. Here, this evidence is reviewed and the potential for pharmacists to play an expanded role in ensuring the appropriate use of benzodiazepines is discussed.

  14. Establishing the offense of non-consensual genetic testing in Australia: a call for action.

    Science.gov (United States)

    Otlowski, Margaret

    2013-12-01

    A criminal offence should be created in Australia for non-consensual genetic testing. This has been recommended in several law reform inquiries due to the sensitive and personal nature of genetic information, and the real potential for harm that non-consensual genetic testing can cause. Since those recommendations were made, the potential for misuse of genetic information has increased, with new methods to easily access large quantities of genetic material and information, such as whole genome sequencing and the increasing availability of direct-to-consumer genetic testing. Some countries have already created an offence of non-consensual genetic testing and their provisions are considered and compared.

  15. Prospective evaluation of inappropriate unable-to-assess CAM-ICU documentations of critically ill adult patients.

    Science.gov (United States)

    Terry, Kimberly J; Anger, Kevin E; Szumita, Paul M

    2015-01-01

    Delirium occurs in the intensive care unit and identification is often performed using a validated assessment tool such as the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) patients. The CAM-ICU has three ratings: positive, negative, and unable to assess (UTA). Patients may often be assigned UTA when it is inappropriate given the level of sedation or medical condition. The purpose of this study is to evaluate the rate of inappropriate UTA CAM-ICU documentations. A single-center prospective observational analysis was performed evaluating CAM-ICU documentations from October 27, 2014, to December 26, 2014. Patients admitted to the medical and surgical ICU were included and excluded if admitted to the ICU for less than 24 h. CAM-ICU assessments were performed per institutional guidelines using CAM-ICU scoring as validated in literature. CAM-ICU patient documentations were recorded as positive, negative, UTA, or not assessed. Patients with an appropriate UTA documentation were deeply sedated, non-English speaking, or not medically able to participate in the assessment. The major endpoint assessed rates of inappropriate UTA CAM-ICU documentations. Minor endpoints evaluated adherence to CAM-ICU documentations and use of pharmacologic agents for symptoms of delirium. Sixty-one patients were identified with 45 (74 %) medical, 16 (26 %) surgical, of which 27 (44.3 %) were mechanically ventilated. There were 116 UTA documentations with 35 (30.2 %) identified as inappropriate. Of the 906 identified CAM-ICU documentation opportunities, adherence was 439 (48.5 %). Overall, 18 (29.5 %) of the 61 patients were administered pharmacologic agents for delirium management and 5 (27.7 %) had a positive CAM-ICU documented within 24 h. Rates of inappropriate UTA CAM-ICU documentations may be significantly higher than reported in literature. Additional research is needed to identify an acceptable rate of inappropriate UTA CAM-ICU assessments and its clinical impact

  16. Prevalence and factors associated with inappropriate use of treadmill exercise stress test for coronary artery disease: a cross-sectional study.

    Science.gov (United States)

    Silva, Antônio M L; Armstrong, Anderson C; Silveira, Fernando J C; Cavalcanti, Marcelo D; França, Fernando M F; Correia, Luis C L

    2015-06-16

    In some countries, the public health system has less availability when compared to the population covered by health insurance. In addition, inappropriate referrals for treadmill exercise stress test increase spending and lead to unnecessary interventions. We aim to determine the prevalence and characteristics of inappropriate referrals for treadmill exercise stress tests in the assessment of coronary artery disease (CAD), considering public and private health systems scenarios. A cross-sectional design was used to describe the frequency of inappropriate use of exercise testing in the diagnosis of CAD and to determine its predictors. We consecutively enrolled 191 patients from two outpatient facilities in Northeast Brazil. For inclusion, the exercise testing should be referred for the assessment of CAD. We performed logistic regression models to identify independent predictors of inappropriate use. Treadmill exercise stress tests were rated as inappropriate in 150 (78 %) patients. The majority of patients had low or very low pre-test probability of CAD. Presence of hypertension, diabetes and dyslipidemia were more frequent in the appropriate than inappropriate indications (71 %, 19 % and 29 % versus 43 %, 8 % and 16 %, respectively). Tests performed both at the public and private system showed high prevalence of inappropriate examinations, higher in the latter (57 % versus 87 %, P test referrals in the assessment of CAD were inappropriate. The availability of the method and not the estimate probability of CAD appear to be the underlying condition for a treadmill test referral.

  17. Women born preterm or with inappropriate weight for gestational age are at risk of subsequent gestational diabetes and pre-eclampsia

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter

    2012-01-01

    Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain....

  18. Inadequate drug prescribing: comparison of inappropriate drug rates at the end of a geriatric short-stay service with three prescribing tools.

    Science.gov (United States)

    Fanon, Jean-Luc; Dechavigny, Sandra; Dramé, Moustapha; Godaert, Lidvine

    2017-12-01

    To compare the proportion of prescriptions containing at least one inappropriate drug, as identified using three tools for optimizing drug prescriptions in the elderly. Cross-sectional, observational study based on the analysis of prescriptions of patients discharged between 1 September and 31 October 2014 in a short-stay geriatrics unit at the Louis Domergue de Trinité Hospital in Martinique (France). Each prescription was analysed using 3 tools, namely one for general medicine (Vidal © drug dictionary) and two tools specifically designed for geriatrics (the Laroche list of potentially inappropriate medications, and the STOPP-START toolkit). The number of prescriptions containing at least one inappropriate medication was recorded as evaluated with each tool. These prescriptions were then compared to investigate whether the two geriatric tools identified the same prescriptions as being inappropriate. In total, 53 prescriptions were analysed. The male-female sex ratio was 0.70. The average age of the patients was 84.5±6.2 years. Analysis according to the Vidal © drug dictionary identified the greatest number of inappropriate prescriptions (28.3% of all prescriptions). The proportion of prescriptions containing at least one inappropriate drug was lower with the two tools specific to geriatrics (11% for the Laroche list and 7.5% for the STOPP-START method). The general medicine Vidal © drug dictionary identified more inappropriate prescriptions than the tools specifically designed for geriatrics. The tools for aiding drug prescriptions in the elderly identified different drugs as being inappropriate.

  19. A beam of "chimeric" darkness: presence, interconnectedness, and transformation in the psychoanalytic treatment of a patient convicted of sex offenses.

    Science.gov (United States)

    Eshel, Ofra

    2012-04-01

    The paper puts forward the dimension created by analytic presence and the ensuing patient-analyst interconnectedness in the process of psychoanalytic treatment and change, particularly with more disturbed patients. Working within this dimension, at a fundamental level of contact and impact, opens up new possibilities of extending the reach of psychoanalytic treatment. The analyst's "presencing" and interconnectedness with the patient forge a living therapeutic entity that is not a one-person or two-person psychology, but an emergent two-in-one new entity that goes beyond the confines of the separate subjectivities of patient and analyst and the simple summation of the two. The paper describes the kind of knowledge, experience, and powerful therapeutic potential that comes into being through analytic "presencing" and patient-analyst interconnectedness, and particularly focuses on the chimeric element, or quality, of this interconnectedness. The term "chimera/chimerism"-chosen here for its wealth of mythological, genetic, biological, biomedicinal (chimeric proteins), and psychoanalytical associations-is used in this paper to highlight the complex quality of patient-analyst interconnectedness, especially in difficult, psychotic, psychically foreclosed, dissociative and perverse states. The author offers an extensive clinical account of psychoanalytic treatment of a patient convicted of sex offenses in order to illustrate "presencing," interconnectedness, and the extent and intricate emotional meaning of the extreme chimerism that this kind of (difficult) treatment entailed.

  20. Adverse Childhood Experiences, Commitment Offense, and Race/Ethnicity: Are the Effects Crime-, Race-, and Ethnicity-Specific?

    Directory of Open Access Journals (Sweden)

    Matt DeLisi

    2017-03-01

    Full Text Available Adverse childhood experiences are associated with an array of health, psychiatric, and behavioral problems including antisocial behavior. Criminologists have recently utilized adverse childhood experiences as an organizing research framework and shown that adverse childhood experiences are associated with delinquency, violence, and more chronic/severe criminal careers. However, much less is known about adverse childhood experiences vis-à-vis specific forms of crime and whether the effects vary across race and ethnicity. Using a sample of 2520 male confined juvenile delinquents, the current study used epidemiological tables of odds (both unadjusted and adjusted for onset, total adjudications, and total out of home placements to evaluate the significance of the number of adverse childhood experiences on commitment for homicide, sexual assault, and serious persons/property offending. The effects of adverse childhood experiences vary considerably across racial and ethnic groups and across offense types. Adverse childhood experiences are strongly and positively associated with sexual offending, but negatively associated with homicide and serious person/property offending. Differential effects of adverse childhood experiences were also seen among African Americans, Hispanics, and whites. Suggestions for future research to clarify the mechanisms by which adverse childhood experiences manifest in specific forms of criminal behavior are offered.

  1. Parental and Peer Attachment Characteristics: Differentiating Between Youth Sexual and Non-Sexual Offenders and Associations With Sexual Offense Profiles.

    Science.gov (United States)

    Yoder, Jamie R; Leibowitz, George S; Peterson, Leanne

    2016-02-12

    Attachment deficits have been suggested as an etiological explanation underlying the development of sexually abusive behaviors and general delinquency among youth. Yet, few researchers have explored the discriminating functions of attachment characteristics or investigated attachments as a stand-alone risk/protective factor explaining offending profiles among youth sexual offenders. This article explored the differences in characteristics of parental and peer attachments between youth sexual (n = 355) and non-sexual offenders (n = 150). Furthermore, associations between family and peer attachments and criminal profiles of sexual offenders were tested. The t-test results revealed that the groups of youth differed on various mother and father attachment characteristics, with youth sexual offenders exhibiting greater deficits. Regression models revealed lower levels of mother and peer trust and communication were associated with more severe sexual offenses; low levels of mother trust were associated with more victims; and low levels of mother trust and high father alienation were associated with more non-sexual criminality. Practice implications suggest the need to amalgamate families more consistently into treatment and addressing peer dynamics within groups and community contexts. © The Author(s) 2016.

  2. Faktor-Faktor yang Menyebabkan Wajib Pajak Melakukan Tax Offenses, Tax Fraud, dan Tax Evasion (Studi Empiris di KPP Pratama Medan-Polonia)

    OpenAIRE

    Amalia, Gita

    2016-01-01

    This research aims to analyze the influence of tax fairness, tax compliance, tax knowledge, tax system, and discrimination against taxpayer perception about the ethical of tax offenses, tax fraud, and tax evasion. This research was conducted at the tax service office Pratama MedanPolonia, with a sampling technique is convenience sampling and distributing the questionnaires until fifty questionnaires. All of the questionnaires given to the taxpayer who listed on tax service office Pratama Meda...

  3. Zabezpečení webových aplikací s využitím metod offensive security

    OpenAIRE

    Avdeev, Vadim

    2017-01-01

    This bachelors thesis focuses on the topic of securing web applications using the offensive security methods. The first part aims to present the terminology of the topic, introduce the top ten most critical web application security risks according to OWASP Top 10 2017, then present Kali Linux, its tools and used methods. The practical part aims to perform penetration testing on authors own web application in Kali Linux environment with the use of available automated tools. Results of performe...

  4. Symptomatic Hypoglycemia Related to Inappropriately High IGF-II Serum Levels in a Patient with Desmoplastic Small Round Cell Tumor

    Directory of Open Access Journals (Sweden)

    Williams Fernandes Barra

    2010-01-01

    Full Text Available A 45-year old man was diagnosed with desmoplastic small round cell tumor (DSRCT with involvement of the peritoneum and pelvis. Disease progression was observed despite systemic chemotherapy. Six months after diagnosis, he developed severe hypoglycemia presented with seizures. He received intravenous glucose infusion and hydrocortisone with poor glycemic control, but with seizures resolution. The investigation excluded insulinoma, adrenal, liver and GH deficiencies. Laboratory showed slight rise of IGF-II and significant increase of the ratio IGF-II : IGF-I, which is pathognomonic of non-islet cell tumor hypoglycemia (NICTH. He received the diagnoses of NICTH related to IGF-II inappropriate production by DSRCT. Despite the attempt to control tumor mass and hypoglycemia, the patient died 9 months after diagnosis. NICTH related to inappropriate IGF-II secretion should be investigated in all cancer patients with refractory hypoglycemia whom insulinoma and other metabolic abnormalities were excluded from.

  5. Fungal suppression of resistance against inappropriate ¤Blumeria graminis formae speciales¤ in barley, oat and wheat

    DEFF Research Database (Denmark)

    Olesen, K.L.; Carver, T.L.W.; Lyngkjær, Michael Foged

    2003-01-01

    When barley, wheat or oat leaf epidermal cells were attacked by their appropriate forma specialis (f.sp.) of Blumeria graminis DC. Speer (f.sp. hordei, tritici and avenae, respectively), many attempted penetrations succeeded, functional haustoria were formed and very few plant cells died. When...... attacked by either of the two possible inappropriate ff.spp., penetration attempts failed in association with papilla deposition by epidermal cells, attacked cells died, or if visible haustoria were formed the plant cell died very soon afterwards. Double inoculation experiments were performed where each...... the inducer haustorium, evident to some extent in adjacent cells, but undetectable at two cells distance. Suppression of penetration resistance allowed most challenger attacks, even by inappropriate ff.spp., to form a haustorium. Furthermore, death of penetrated epidermal cells was also suppressed so...

  6. A Systems Biology Approach to the Coordination of Defensive and Offensive Molecular Mechanisms in the Innate and Adaptive Host-Pathogen Interaction Networks.

    Science.gov (United States)

    Wu, Chia-Chou; Chen, Bor-Sen

    2016-01-01

    Infected zebrafish coordinates defensive and offensive molecular mechanisms in response to Candida albicans infections, and invasive C. albicans coordinates corresponding molecular mechanisms to interact with the host. However, knowledge of the ensuing infection-activated signaling networks in both host and pathogen and their interspecific crosstalk during the innate and adaptive phases of the infection processes remains incomplete. In the present study, dynamic network modeling, protein interaction databases, and dual transcriptome data from zebrafish and C. albicans during infection were used to infer infection-activated host-pathogen dynamic interaction networks. The consideration of host-pathogen dynamic interaction systems as innate and adaptive loops and subsequent comparisons of inferred innate and adaptive networks indicated previously unrecognized crosstalk between known pathways and suggested roles of immunological memory in the coordination of host defensive and offensive molecular mechanisms to achieve specific and powerful defense against pathogens. Moreover, pathogens enhance intraspecific crosstalk and abrogate host apoptosis to accommodate enhanced host defense mechanisms during the adaptive phase. Accordingly, links between physiological phenomena and changes in the coordination of defensive and offensive molecular mechanisms highlight the importance of host-pathogen molecular interaction networks, and consequent inferences of the host-pathogen relationship could be translated into biomedical applications.

  7. [Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments].

    Science.gov (United States)

    Toledo del Castillo, B; González Ruiz de León, E; Rivas García, A; Vázquez López, P; Miguez Navarro, M C; Marañón Pardillo, R

    2016-01-01

    To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  8. Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis.

    Science.gov (United States)

    Jha, Sujeet; Waghdhare, Swati; Reddi, Rajashekar; Bhattacharya, Priyanka

    2012-12-01

    Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS. A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL). Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state. The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably

  9. Inappropriate Use of Proton Pump Inhibitors in Elderly Patients Discharged from Acute Care Hospitals.

    Science.gov (United States)

    Schepisi, R; Fusco, S; Sganga, F; Falcone, B; Vetrano, D L; Abbatecola, A; Corica, F; Maggio, M; Ruggiero, C; Fabbietti, P; Corsonello, A; Onder, G; Lattanzio, F

    2016-01-01

    Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of

  10. Impact of potential inappropriate NSAIDs use in chronic pain

    Directory of Open Access Journals (Sweden)

    Ussai S

    2015-04-01

    Full Text Available S Ussai,1,2 L Miceli,3 F E Pisa,4 R Bednarova,5 A Giordano,1,2 G Della Rocca,3 R Petelin6 1Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; 2Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA; 3Department of Anesthesiology and Intensive Care Medicine, 4Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, 5Department of Palliative Care and Pain Medicine, Health Company n.5, Bassa Friulana, Italy; 6School of Management, Santa Clara University, Santa Clara, CA, USA Abstract: Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1 the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2 potential inappropriate use. A retrospective 18-months systematic analysis on patients’ pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical

  11. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  12. Novel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients: A MADIT-RIT Sub-Study.

    Science.gov (United States)

    Kutyifa, Valentina; Daubert, James P; Schuger, Claudio; Goldenberg, Ilan; Klein, Helmut; Aktas, Mehmet K; McNitt, Scott; Stockburger, Martin; Merkely, Bela; Zareba, Wojciech; Moss, Arthur J

    2016-01-01

    The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT. The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; Pprogramming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; Pprogramming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients. http://clinicaltrials.gov; Unique identifier: NCT00947310. © 2016 American Heart Association, Inc.

  13. Arabidopsis PEN3/PDR8, an ATP binding cassette transporter, contributes to nonhost resistance to inappropriate pathogens that enter by direct penetration.

    Science.gov (United States)

    Stein, Mónica; Dittgen, Jan; Sánchez-Rodríguez, Clara; Hou, Bi-Huei; Molina, Antonio; Schulze-Lefert, Paul; Lipka, Volker; Somerville, Shauna

    2006-03-01

    Arabidopsis thaliana is a host to the powdery mildew Erysiphe cichoracearum and nonhost to Blumeria graminis f. sp hordei, the powdery mildew pathogenic on barley (Hordeum vulgare). Screening for Arabidopsis mutants deficient in resistance to barley powdery mildew identified PENETRATION3 (PEN3). pen3 plants permitted both increased invasion into epidermal cells and initiation of hyphae by B. g. hordei, suggesting that PEN3 contributes to defenses at the cell wall and intracellularly. pen3 mutants were compromised in resistance to the necrotroph Plectosphaerella cucumerina and to two additional inappropriate biotrophs, pea powdery mildew (Erysiphe pisi) and potato late blight (Phytophthora infestans). Unexpectedly, pen3 mutants were resistant to E. cichoracearum. This resistance was salicylic acid-dependent and correlated with chlorotic patches. Consistent with this observation, salicylic acid pathway genes were hyperinduced in pen3 relative to the wild type. The phenotypes conferred by pen3 result from the loss of function of PLEIOTROPIC DRUG RESISTANCE8 (PDR8), a highly expressed putative ATP binding cassette transporter. PEN3/PDR8 tagged with green fluorescent protein localized to the plasma membrane in uninfected cells. In infected leaves, the protein concentrated at infection sites. PEN3/PDR8 may be involved in exporting toxic materials to attempted invasion sites, and intracellular accumulation of these toxins in pen3 may secondarily activate the salicylic acid pathway.

  14. Arabidopsis PEN3/PDR8, an ATP Binding Cassette Transporter, Contributes to Nonhost Resistance to Inappropriate Pathogens That Enter by Direct Penetration[W][OA

    Science.gov (United States)

    Stein, Mónica; Dittgen, Jan; Sánchez-Rodríguez, Clara; Hou, Bi-Huei; Molina, Antonio; Schulze-Lefert, Paul; Lipka, Volker; Somerville, Shauna

    2006-01-01

    Arabidopsis thaliana is a host to the powdery mildew Erysiphe cichoracearum and nonhost to Blumeria graminis f. sp hordei, the powdery mildew pathogenic on barley (Hordeum vulgare). Screening for Arabidopsis mutants deficient in resistance to barley powdery mildew identified PENETRATION3 (PEN3). pen3 plants permitted both increased invasion into epidermal cells and initiation of hyphae by B. g. hordei, suggesting that PEN3 contributes to defenses at the cell wall and intracellularly. pen3 mutants were compromised in resistance to the necrotroph Plectosphaerella cucumerina and to two additional inappropriate biotrophs, pea powdery mildew (Erysiphe pisi) and potato late blight (Phytophthora infestans). Unexpectedly, pen3 mutants were resistant to E. cichoracearum. This resistance was salicylic acid–dependent and correlated with chlorotic patches. Consistent with this observation, salicylic acid pathway genes were hyperinduced in pen3 relative to the wild type. The phenotypes conferred by pen3 result from the loss of function of PLEIOTROPIC DRUG RESISTANCE8 (PDR8), a highly expressed putative ATP binding cassette transporter. PEN3/PDR8 tagged with green fluorescent protein localized to the plasma membrane in uninfected cells. In infected leaves, the protein concentrated at infection sites. PEN3/PDR8 may be involved in exporting toxic materials to attempted invasion sites, and intracellular accumulation of these toxins in pen3 may secondarily activate the salicylic acid pathway. PMID:16473969

  15. Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients.

    Science.gov (United States)

    Sager, Solomon J; Healy, Chris; Ramireddy, Archana; Rivner, Harold; Viles Gonzalez, Juan F; Coffey, James O; Rossin, Natalia; Lo, Ka M; Goldberger, Jeffrey J; Myerburg, Robert J; Mitrani, Raul D

    2017-02-15

    Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured). Shock frequencies were analyzed before and after a uniform follow-up pattern was implemented regardless of insurance profile. Uninsured patients were more likely to present with an inappropriate shock (63% vs 40%, p = 0.01), and they were more likely to present with atrial fibrillation (AF) as the shock trigger (37% vs 19%, p = 0.04). Uninsured patients had a longer interval between previous physician contact and index ICD shock (147 ± 167 vs 83 ± 124 days, p = 0.04). Patients were followed for a mean of 521 ± 458 days after being enrolled in a uniform follow-up protocol, and there were no differences in the rate of recurrent shocks based on insurance status. In conclusion, among patients presenting with an ICD shock, underinsured/uninsured patients had significantly longer intervals since previous physician contact and were more likely to present with inappropriate shocks and AF, compared to those with private/Medicare coverage. After the index shock, both groups were followed uniformly, and the differences in rates of inappropriate shocks were mitigated. This observation confirms the importance of regular postimplant follow-up as part of the overall ICD management standard. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Prevalence and Risk of Inappropriate Sexual Behavior of Patients Toward Physical Therapist Clinicians and Students in the United States.

    Science.gov (United States)

    Boissonnault, Jill S; Cambier, Ziádee; Hetzel, Scott J; Plack, Margaret M

    2017-11-01

    For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. This was a retrospective and observational study. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Self-report, clinician memory, and convenience sampling are

  17. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics

    Directory of Open Access Journals (Sweden)

    Diane M. Parente

    2017-03-01

    Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.

  18. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatraemia associated with valproic Acid : four case reports from the Netherlands and a case/non-case analysis of vigibase

    NARCIS (Netherlands)

    Beers, Erna; van Puijenbroek, Eugène P; Bartelink, Imke H; van der Linden, Carolien M J; Jansen, Paul A F

    The Netherlands Pharmacovigilance Centre Lareb received four cases of severe symptomatic hyponatraemia or syndrome of inappropriate antidiuretic hormone secretion (SIADH) in association with valproic acid use, in which a causal relationship was suspected. This study describes these cases and gives

  19. Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery.

    Science.gov (United States)

    Lamas, Cristina; del Pozo, Carlos; Villabona, Carles

    2014-04-01

    Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  20. Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Amyotrophic Lateral Sclerosis in a Patient Developing Carbon Dioxide Narcosis.

    Science.gov (United States)

    Inoue, Yui; Murakami, Takaaki; Nakamura, Takeshi; Morita, Kyohei; Kaneda, Daita; Nishino, Ichizo; Hayashi, Tetsuya; Shinoto, Yuya; Hatoko, Tomonobu; Kato, Tomoko; Yonemitsu, Shin; Muro, Seiji; Oki, Shogo

    2017-01-01

    We report a rare case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with amyotrophic lateral sclerosis (ALS). A 69-year-old man was admitted to our hospital with sustained hyponatremia. Hyposmolality with elevated urinary osmolality and sodium excretion was observed, which indicated SIADH. The treatment for SIADH was challenging; the patient developed carbon dioxide narcosis, which led to the diagnosis of ALS. After the initiation of noninvasive positive-pressure ventilation, the patient's serum sodium concentration normalized and became stable. Thus, ALS should be recognized as a possible cause of SIADH in the clinical setting.

  1. Inappropriate Shock Delivered By Implantable Cardioverter Defibrillator - Cardiac Resynchronization Therapy (ICD-CRT Due To Myopotential Oversensing

    Directory of Open Access Journals (Sweden)

    Hamid Barakpour

    2009-01-01

    Full Text Available The clinical efficacy of ICD-CRT therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We report the occurrence of sensing abnormality in a patient with ICD-CRT. In this patient, oversensing of myopotentials during strenuous muscular activity resulted in an inappropriate ICD-CRT discharge. Although modern ICDs are highly effective in detecting and terminating malignant tachyarrhythmias, their detection specificity must be improved. It is possible to find the mechanism of arrhythmia by EGM. Simple device reprogramming make it possible to avoid the oversensing of myopotentials.

  2. Erroneous Magnet Positioning Leads to Failure of Inhibition of Inappropriate Shock during Fast Conducting Atrial Fibrillation Episodes.

    Science.gov (United States)

    Römers, Hans; VAN Dijk, Vincent; Balt, Jippe

    2017-06-01

    We present the case of a 75-year-old patient with a single-chamber St. Jude Medical internal cardioverter defibrillator (ICD; St. Jude Medical, St. Paul, MN, USA) for primary prevention, who was admitted with 39 inappropriate ICD shocks because of atrial fibrillation with rapid ventricular frequention, despite magnet placement. Review of the device manual and literature revealed that apart from different responses to magnet placement programmed for the various manufacturers, the type of magnet and the positioning can be of specific interest. In the case presented, the donut-shaped magnet should have been placed off-center instead of directly over the device. © 2017 Wiley Periodicals, Inc.

  3. Offensive Words, Lethal Weapons

    Science.gov (United States)

    Jacoby, Russell

    2007-01-01

    The old childhood ditty "sticks and stones may break my bones, but words will never hurt me" has proved wiser than the avalanche of commentary provoked by the recent insults by Don Imus and the killings at Virginia Tech. Our society forbids public name-calling but allows sticks and stones. Anyone can acquire a gun, but everyone must be…

  4. An exploratory study of Internet-initiated sexual offenses and the chat room sex offender: has the Internet enabled a new typology of sex offender?

    Science.gov (United States)

    Briggs, Peter; Simon, Walter T; Simonsen, Stacy

    2011-03-01

    This exploratory study examined 51 participants convicted of an Internet-initiated sex offense in which they attempted to entice an adolescent into a sexual relationship using an Internet chat room. All participants were convicted of a sex offense and subject to an evaluation as a part of sentencing requirements in Colorado. Clinical and behavioral data were obtained from each subject's offense-specific evaluation and chat room transcripts. The results of the study found that 90% of the participants were apprehended as a result of an Internet sex sting. The authors conclude that Internet chat room sex offenders constitute a separate group characterized by less severe criminogenic factors than other sex offenders (rapists, child molesters). It can be hypothesized that chat room sex offenders avoid relationships and spend a significant amount of time in online chat rooms as a primary social and sexual outlet, and engage in other sexually compulsive behaviors. Within this offender group, it was discovered that two subgroups exist: a contact-driven group motivated to engage in offline sexual behavior with an adolescent and a fantasy-driven group motivated to engage an adolescent in online cybersex without an express intent to meet offline. The chat room sex offender presents a significant clinical issue to treatment providers as a live victim does not exist. Thus, it is unclear if Internet sex stings prevent incidents of child sexual exploitation and may result in convictions of individuals who may never have abused a child. The data suggest a tentative sex offender typology, including subtypes, which need to be replicated in future studies.

  5. The interpretation of forensic biochemical expert test made in human body fluids: scientific - legal analysis in the research on sexual offenses

    International Nuclear Information System (INIS)

    Chaves Carballo, Diana

    2014-01-01

    The contributions of science and technology have covered the whole of human life, and relationships of coexistence are even found in the various disciplines of knowledge through legal forensics. Therefore, it is increasingly imperative that the law enforcement agents are interdisciplinary professionals, with knowledge beyond the legal knowledge to enable them make the most of the scientific knowledge in judicial proceedings. Among the natural sciences applied to right, forensic biochemistry has contributed an extremely relevant test for the investigation of various sexual offenses, much has been so, that the Organismo de Investigacion Judicial of Costa Rica has in its Departamento de Laboratorios de Ciencias Forenses with specialized sections in this discipline. A diversity of skills are performed of presumptive and confirmatory character for the presence of biological fluids, sexually transmitted diseases and identification of DNA by genetic markers. Updated information is given with respect to the correct interpretation of forensic biochemical expertises achievable for identification of semen, blood and human saliva in the investigation of sexual offenses. A scientific and legal language is used allowing the most of this information in the criminal process. The main objective has been to interpret, legal and scientifically, forensic biochemical expert evidence performed in human body fluids during the investigation of sexual offenses. A legal, doctrinal and scientific review is presented with compilation of related jurisprudence and criminology reports analysis of Seccion de Bioquimica of the Departamento de Laboratorios Forenses of the Organismo de Investigacion Juridica issued during the investigation of sexual offenses. Two types of attainable skills have existed for the identification of biological fluids, each with a different binding. In addition, it has been clear, due to the lexicon employed when making a forensic biochemist opinion, that to make a proper

  6. [Eight-step structured decision-making process to assign criminal responsibility and seven focal points for describing relationship between psychopathology and offense].

    Science.gov (United States)

    Okada, Takayuki

    2013-01-01

    The author suggested that it is essential for lawyers and psychiatrists to have a common understanding of the mutual division of roles between them when determining criminal responsibility (CR) and, for this purpose, proposed an 8-step structured CR decision-making process. The 8 steps are: (1) gathering of information related to mental function and condition, (2) recognition of mental function and condition,(3) psychiatric diagnosis, (4) description of the relationship between psychiatric symptom or psychopathology and index offense, (5) focus on capacities of differentiation between right and wrong and behavioral control, (6) specification of elements of cognitive/volitional prong in legal context, (7) legal evaluation of degree of cognitive/volitional prong, and (8) final interpretation of CR as a legal conclusion. The author suggested that the CR decision-making process should proceed not in a step-like pattern from (1) to (2) to (3) to (8), but in a step-like pattern from (1) to (2) to (4) to (5) to (6) to (7) to (8), and that not steps after (5), which require the interpretation or the application of section 39 of the Penal Code, but Step (4), must be the core of psychiatric expert evidence. When explaining the relationship between the mental disorder and offense described in Step (4), the Seven Focal Points (7FP) are often used. The author urged basic precautions to prevent the misuse of 7FP, which are: (a) the priority of each item is not equal and the relative importance differs from case to case; (b) each item is not exclusively independent, there may be overlap between items; (c) the criminal responsibility shall not be judged because one item is applicable or because a number of items are applicable, i. e., 7FP are not "criteria," for example, the aim is not to decide such things as 'the motive is understandable' or 'the conduct is appropriate', but should be to describe how psychopathological factors affected the offense specifically in the context of

  7. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study.

    Science.gov (United States)

    Rognstad, Sture; Brekke, Mette; Fetveit, Arne; Spigset, Olav; Wyller, Torgeir Bruun; Straand, Jørund

    2009-01-01

    To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people > or =70 years. A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients. A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures. The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups' scores was seen for only one of the 36 criteria. The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs' prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions.

  8. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2012-02-03

    Introduction: STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers\\' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers\\' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers\\' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers\\' criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers\\' criteria. This finding has significant implications for hospital geriatric practice.

  9. Can attribution theory explain carers' propensity to help men with intellectual disabilities who display inappropriate sexual behaviour?

    Science.gov (United States)

    Willner, P; Smith, M

    2008-01-01

    This study examined the responses of care managers and direct care staff to vignettes of inappropriate sexual behaviour by a man with an intellectual disability. The aim was to test the theory that helping behaviour is determined by emotional responses (positive and negative emotional reactions, and optimism), which in turn are determined by causal attributions (respectively: controllability and stability of the incident depicted in the vignette). The vignettes varied in response topography and the age of the victim. Regression analysis was used to examine the relationships between causal attributions, emotional responses, and willingness to invest extra time and effort in the service user's care. No support was found for the pathway: low controllability --> increased sympathy and/or decreased negative emotions --> increased helping. However, strong support was found for the pathway: low stability --> high optimism --> increased helping, particularly in direct care staff. High levels of sympathy were also associated with increased helping, the effect again being mediated by feelings of optimism. The data provide support for one (but not the other) strand of attribution theory as applied to inappropriate sexual behaviour. The discussion considers the discrepancy between the present data and the far less encouraging literature on attribution theory as applied to challenging behaviour.

  10. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns.

    Science.gov (United States)

    Borg, Michael A

    2012-03-01

    European countries exhibit significant geographical differences in antibiotic consumption per capita within ambulatory care, especially inappropriate use for colds/flu/sore throat (CFSt). One potential explanation could be national cultural differences resulting in varying perceptions and, therefore, influences. Publicly available data on the proportions of respondents in the 2009 Eurobarometer survey who had taken antibiotics for CFSt were tested for association against country scores derived from the Hofstede cultural dimension model. They were also correlated with knowledge of respondents about various key antibiotic facts. The Eurobarometer dataset incorporated 26,259 responses from all European Union (EU) countries except Cyprus. Using multiple regression, uncertainty avoidance and masculinity were identified as the two national cultural dimensions significantly associated with the use of antibiotics for CFSt (R-adjusted = 0.45; PCFSt was found to be inversely correlated with respondents' knowledge that antibiotics are ineffective against viruses (r=-0.724; P<0.001) and that misuse will render them ineffective in the longer term (r=-0.775; P<0.001). National cultural dimensions, especially uncertainty avoidance and masculinity, appear to have a very significant impact on inappropriate antibiotic use within European countries. Nevertheless, their influence can be reduced by making EU citizens more knowledgeable about antibiotics through appropriate messages and targeted campaigns.

  11. Obesity is more strongly associated with inappropriate eating behaviors than with mental health in older adults receiving congregate meals.

    Science.gov (United States)

    Porter, Kathryn N; Johnson, Mary Ann

    2011-01-01

    This study explored the relationships of inappropriate eating behaviors and mental health with obesity in congregate meal participants in Georgia (N = 120, mean age = 75 years, 75% female, 43% African American). Inappropriate eating behaviors were evaluated with the Three-Factor Eating Questionnaire (18 questions); mental health was assessed with the Depression Anxiety Stress Scale (21 questions); history of depression was assessed with the Behavioral Risk Factor Surveillance Survey; and height and weight were measured to calculate body mass index (BMI) and obesity (52% ≥ 30 kg/m(2)). In bivariate analyses, obesity was associated with cognitive restraint (rho = 0.49, p eating (rho = 0.22; p emotional eating (rho = 0.32, p eating behavior and mental health indices, only cognitive restraint and emotional eating were consistently associated with obesity (p eating behaviors, particularly cognitive restraint and emotional eating, may be important targets for future research and intervention. Additional research is needed to better understand how cognitive restraint and emotional eating contribute to obesity in this population so that interdisciplinary research and health care teams can appropriately prevent and manage obesity in congregate meal participants.

  12. Race and Victim Age Matter: Sexual Behaviors and Experiences Among Confined African American and European American Youth With Sexual and Nonsexual Offenses.

    Science.gov (United States)

    Fix, Rebecca L; Falligant, John Michael; Alexander, Apryl A; Burkhart, Barry R

    2017-07-01

    Previous research has found differences in sexual behavior and types of sexual offending by offense category and racial/ethnic group. The present study examined effects of offense category, victim age, and race/ethnicity on sexual behavior. Data from 561 confined adolescents adjudicated for illegal sexual behavior (AISBs) and adolescents adjudicated for illegal nonsexual behavior (AINBs) were included in the present study. A hierarchical multinomial logistic regression was run to test whether sexual experiences and behaviors differentially predicted AINBs, AISBs with child victims, and AISBs with peer/adult victims. Results supported the utility of distinguishing AISBs by victim age. Comparisons between AISBs and AINBs indicated AISBs had more sexual abuse and were more sexually restricted, whereas AINBs reported more sexual behavior, reflecting a finding potentially mirroring sexual development, sexual experiences, and caregiver approaches to discussing sexuality. Over 60% of AINBs and 30% of AISBs reported behaviors that could be classified as distribution of child pornography. Within the group of AISBs, select racial/ethnic group differences emerged such that European American participants were more likely to have had intrafamilial sexual experiences and were far less likely to have had vaginal intercourse than African American AISBs. Future directions and implications regarding policies related to sexual education and sexting are discussed.

  13. Identification of (E,E)-2,4-undecadienal from coriander (Coriandrum sativum L.) as a highly effective deodorant compound against the offensive odor of porcine large intestine.

    Science.gov (United States)

    Ikeura, Hiromi; Kohara, Kaori; Li, Xin-Xian; Kobayashi, Fumiyuki; Hayata, Yasuyoshi

    2010-10-27

    The leaves of coriander ( Coriandrum sativum L.) exhibited a strong deodorizing effect against porcine internal organs (large intestine). The effective deodorizing compounds of coriander were identified by separating the volatile component of coriander, testing the effectiveness of each fraction against the offensive odor of porcine large intestine, and then identifying the compounds by GC-MS. The volatile component of coriander was first separated into six fractions (A-F) by preparative gas chromatography, and the deodorizing activity of each of these fractions against the offensive odor was measured. Fraction D, which showed the strongest deodorizing effect, was then separated into 12 subfractions by preparative GC. The deodorant activity of each subfraction was evaluated, and the deodorant compounds were identified by GC-MS. It was discovered that (E,E)-2,4-undecadienal was the most effective deodorizing compound. The deodorizing activity of (E,E)-2,4-undecadienal on the porcine large intestine increased as with concentration, reaching almost complete deodorizing ability at 10 ppb.

  14. Comparative analysis in the field of customs offenses and criminal regulations in certain states in relation to the legislation of the Republic of Moldova

    Directory of Open Access Journals (Sweden)

    Aurel Octavian Pasat

    2017-06-01

    Full Text Available The study tries to highlight the specificity of the criminal laws of foreign states in the area of customs criminalization. The author discusses the criminal regulations in the laws of some Western European, Central European, Asian states, as well as in the legislation of some ex-Soviet states. The analysis carried out aims at: investigating the incriminating framework in the field of criminal offenses in the criminal law of some foreign states; determining the similarities and differences between criminal laws under analysis; identifying the legal problems by comparing the incriminating framework registered in the Criminal Code of the Republic of Moldova with those included in the criminal laws analyzed; taking good practice. Different research methods were used in the study, including: analysis, synthesis, deduction, induction. However, the most used method was comparative considering the specifics of the subject under investigation. In order to intensify the fight against the phenomenon of crime in the customs sphere, some proposals have been advanced to improve the legal framework of incrimination. All this is a consequence of taking good practices from the comparative analysis of criminal regulations in the field of customs offenses.

  15. Potentially inappropriate liver transplantation in the era of the "sickest first" policy - A search for the upper limits.

    Science.gov (United States)

    Linecker, Michael; Krones, Tanja; Berg, Thomas; Niemann, Claus U; Steadman, Randolph H; Dutkowski, Philipp; Clavien, Pierre-Alain; Busuttil, Ronald W; Truog, Robert D; Petrowsky, Henrik

    2017-11-11

    Liver transplantation has emerged as a highly efficient treatment for a variety of acute and chronic liver diseases. However, organ shortage is becoming an increasing problem globally, limiting the applicability of liver transplantation. In addition, potential recipients are becoming sicker, thereby increasing the risk of losing the graft during transplantation or in the initial postoperative period after liver transplantation (three months). This trend is challenging the model for end-stage liver disease allocation system, where the sickest candidates are prioritised and no delisting criteria are given. The weighting of the deontological demand for "equity", trying to save every patient, regardless of the overall utility; and "efficiency", rooted in utilitarianism, trying to save as many patients as possible and increase the overall quality of life of patients facing the same problem, has to be reconsidered. In this article we are aiming to overcome the widespread concept of futility in liver transplantation, providing a definition of potentially inappropriate liver transplantation and giving guidance on situations where it is best not to proceed with liver transplantation, to decrease the mortality rate in the first three months after transplantation. We propose "absolute" and "relative" conditions, where early post-transplant mortality is highly probable, which are not usually captured in risk scores predicting post-transplant survival. Withholding liver transplantation for listed patients in cases where liver transplant is not deemed clearly futile, but is potentially inappropriate, is a far-reaching decision. Until now, this decision had to be discussed extensively on an individual basis, applying explicit communication and conflict resolution processes, since the model for end-stage liver disease score and most international allocation systems do not include explicit delisting criteria to support a fair delisting process. More work is needed to better

  16. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

    Directory of Open Access Journals (Sweden)

    Gjerberg Elisabeth

    2011-04-01

    Full Text Available Abstract Background Studies have shown that residents in nursing homes often are exposed to inappropriate medication. Particular concern has been raised about the consumption of psychoactive drugs, which are commonly prescribed for nursing home residents suffering from dementia. This review is an update of a Norwegian systematic review commissioned by the Norwegian Directorate of Health. The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes. Methods We searched for systematic reviews and randomised controlled trials in the Cochrane Library, MEDLINE, EMBASE, ISI Web of Knowledge, DARE and HTA, with the last update in April 2010. Two of the authors independently screened titles and abstracts for inclusion or exclusion. Data on interventions, participants, comparison intervention, and outcomes were extracted from the included studies. Risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Table and GRADE, respectively. Outcomes assessed were use of or prescribing of drugs (primary and the health-related outcomes falls, physical limitation, hospitalisation and mortality (secondary. Results Due to heterogeneity in interventions and outcomes, we employed a narrative approach. Twenty randomised controlled trials were included from 1631 evaluated references. Ten studies tested different kinds of educational interventions while seven studies tested medication reviews by pharmacists. Only one study was found for each of the interventions geriatric care teams, early psychiatric intervening or activities for the residents combined with education of health care personnel. Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews. Conclusions Interventions using educational outreach, on-site education given alone or as part of an

  17. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Micek Scott T

    2010-06-01

    Full Text Available Abstract Background Candida represents the most common cause of invasive fungal disease, and candidal blood stream infections (CBSI are prevalent in the ICU. Inappropriate antifungal therapy (IAT is known to increase a patient's risk for death. We hypothesized that in an ICU cohort it would also adversely affect resource utilization. Methods We retrospectively identified all patients with candidemia on or before hospital day 14 and requiring an ICU stay at Barnes-Jewish Hospital between 2004 and 2007. Hospital length of stay following culture-proven onset of CBSI (post-CBSI HLOS was primary and hospital costs secondary endpoints. IAT was defined as treatment delay of ≥24 hours from candidemia onset or inadequate dose of antifungal agent active against the pathogen. We developed generalized linear models (GLM to assess independent impact of inappropriate therapy on LOS and costs. Results Ninety patients met inclusion criteria. IAT was frequent (88.9%. In the IAT group antifungal delay ≥24 hours occurred in 95.0% and inappropriate dosage in 26.3%. Unadjusted hospital mortality was greater among IAT (28.8% than non-IAT (0% patients, p = 0.059. Both crude post-CBSI HLOS (18.4 ± 17.0 vs. 10.7 ± 9.4, p = 0.062 and total costs ($66,584 ± $49,120 vs. $33,526 ± $27,244, p = 0.006 were higher in IAT than in non-IAT. In GLMs adjusting for confounders IAT-attributable excess post-CBSI HLOS was 7.7 days (95% CI 0.6-13.5 and attributable total costs were $13,398 (95% CI $1,060-$26,736. Conclusions IAT of CBSI, such as delays and incorrect dosing, occurs commonly. In addition to its adverse impact on clinical outcomes, IAT results in substantial prolongation of hospital LOS and increase in hospital costs. Efforts to enhance rates of appropriate therapy for candidemia may improve resource use.

  18. An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription.

    Science.gov (United States)

    García-Gollarte, Fermín; Baleriola-Júlvez, José; Ferrero-López, Isabel; Cuenllas-Díaz, Álvaro; Cruz-Jentoft, Alfonso J

    2014-12-01

    Inappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilization. Prospective, randomized, multicenter study. A private organization of nursing homes in Spain. Sixty nursing home physicians caring for approximately 3900 nursing home residents in 37 centers were randomized to receive an educational intervention (30) or as a control group (30). 10 hours educational program, followed by on demand support by phone. Outcomes were assessed in 1018 randomly selected nursing home residents. Appropriateness of drug use [measured by the Screening Tool of Older Persons Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria], incidence of selected geriatric syndromes (falls, delirium) and health resource utilization (visits to physicians and nursing homes, visits to the emergency room, days of hospitalization) were recorded for 3 months before the intervention started and 3 months after the intervention finished. O total of 716 residents finished the study (344 cared for by the intervention group physicians, 372 cared for by control physicians). Mean age was 84.4 ± 12.7 years; 73% were women. The mean number of inappropriate drugs (STOPP criteria) was higher at the end of the study in the control than in the intervention group (1.29 ± 1.56 vs 0.81 ± 1.13), as was the number of residents on 6 or more drugs (76.5% vs.67.0%), using antipsychotics (9.1% vs 3.2%) or duplicate medications (32.5% vs 9.2%). The number of fallers increased in the control group (from 19.3% to 28%) and did not significantly change in the intervention group (from 25.3% to 23.9%); the number of residents with delirium increased in the control group (from 3.8% to 9.1%) and decreased in the intervention group (from 6

  19. Inverted hysteresis loops: Experimental artifacts arising from inappropriate or asymmetric sample positioning and the misinterpretation of experimental data

    Energy Technology Data Exchange (ETDEWEB)

    Jin Hanmin [Reserch Center for Advanced Magnetic Materials, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of) and Department of Physics, Jilin University, 119 Jiefang road, 130023, Changchun (China)]. E-mail: jinhanmin@jlu.edu.cn; Sun Dongsheng [Reserch Center for Advanced Magnetic Materials, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of); Gao Cunxu [Department of Materials Science and Engineering, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of); Kim, Hyojin [Department of Materials Science and Engineering, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of)

    2007-01-15

    Inverted hysteresis loops (IHL) of negative net area have been measured for some films using vibrating sample magnetometer (VSM), SQUID magnetometer or magneto-optic Kerr effect magnetometer. All of the IHL were observed in the field direction along the hard axis. An IHL violates the thermo-mechanical second law. This work points out that an IHL arises when |M{sub x}|-bar |M{sub z}| (M{sub x} and M{sub z}: the parallel and normal to the field direction components of magnetization vector) if the sample is set at certain inappropriate positions in VSM and SQUID magnetometer experiments, and the sense voltage is solely attributed to M{sub x} while it also relates to M{sub z}.

  20. Inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' in the peer-reviewed biomedical literature

    Directory of Open Access Journals (Sweden)

    Wenban Adrian B

    2006-08-01

    contact with the principal researcher revealed that the care provider was not a chiropractor, as defined by the World Federation of Chiropractic. The authors of the other two case reports did not respond to my communications. In the case series, which involved twenty relevant cases, the principal researcher conceded that the term chiropractor had been inappropriately used and that his case series did not relate to chiropractors who had undergone appropriate formal training. The author of the secondary report, a British Medical Journal editor, conceded that he had misused the title chiropractor. Letters to editors were accepted and published by all four journals to which they were sent. To date one of the four journals has published a correction. Conclusion The results of this year-long prospective review suggests that the words 'chiropractor' and 'chiropractic manipulation' are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. Finally, editors of peer-reviewed journals were amenable to publishing 'letters to editors', and to a lesser extent 'corrections', when authors had inappropriately used the title 'chiropractor' and/or term 'chiropractic manipulation'.

  1. The effect of ICD programming on inappropriate and appropriate ICD Therapies in ischemic and nonischemic cardiomyopathy: the MADIT-RIT trial.

    Science.gov (United States)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina; McNitt, Scott; Thomsen, Poul Erik Bloch; Klein, Helmut; Stockburger, Martin; Wichterle, Dan; Merkely, Bela; DE LA Concha, Joaquin Fernandez; Swissa, Moshe; Zareba, Wojciech; Moss, Arthur J; Kautzner, Josef; Ruwald, Martin H

    2015-04-01

    The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy. First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic cardiomyopathy. Patients with ischemic and nonischemic cardiomyopathy had similar incidence of first inappropriate (9% and 11%, P = 0.21) and first appropriate ICD therapy (11.6% and 14.1%, P = 0.15). Patients with ischemic cardiomyopathy had higher mortality rate (6.1% vs. 3.3%, P = 0.01). MADIT-RIT high-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P programming and delayed VT therapy ICD programming in both ischemic and nonischemic cardiomyopathy patients. High-rate cut-off and delayed VT therapy ICD programming are associated with significant reduction in first and total inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy. © 2014 Wiley Periodicals, Inc.

  2. Persistent nonmalignant pain management using nonsteroidal anti-inflammatory drugs in older patients and use of inappropriate adjuvant medications

    Directory of Open Access Journals (Sweden)

    Rianon N

    2015-01-01

    Full Text Available Nahid Rianon,1 Maureen E Knell,2 Walter Agbor-Bawa,3 Joan Thelen,4 Crystal Burkhardt,3 Rafia S Rasu3 1Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA; 2Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA; 3Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA; 4Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA Objective: Due to the high risk of life-threatening side effects, nonsteroidal anti-inflammatory drugs (NSAIDs are not favored for treating persistent nonmalignant pain in the elderly. We report national prescription trends with determinants of NSAIDs prescription for persistent nonmalignant pain among older patients (age 65 and over in the US outpatient setting. Methods: A cross-sectional analysis was performed using National Ambulatory Medical Care Survey data. Prescriptions for NSAIDs, opioids, and adjuvant agents were identified using five-digit National Ambulatory Medical Care Survey drug codes. Results: About 89% of the 206,879,848 weighted visits in the US from 2000 to 2007 recorded NSAIDs prescriptions in patients (mean age =75.4 years. Most NSAIDs users had Medicare (75%, and about 25% were prescribed with adjuvant medications considered inappropriate for their age. Compared to men, women were 1.79 times more likely to be prescribed NSAIDs. Conclusion: The high percentage of NSAIDs prescription in older patients is alarming. We recommend investigating the appropriateness of the high prevalence of NSAIDs use among older patients reported in our study. Keywords: pain management, NSAIDs, inappropriate adjuvant, AGS guideline, NAMCS

  3. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.

    Science.gov (United States)

    Piltcher, Otávio Bejzman; Kosugi, Eduardo Macoto; Sakano, Eulalia; Mion, Olavo; Testa, José Ricardo Gurgel; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Sá, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin

    2018-02-25

    Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. 'Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  4. A comparison of the effects of hard rock and easy listening on the frequency of observed inappropriate behaviors: control of environmental antecedents in a large public area.

    Science.gov (United States)

    Harris, C S; Bradley, R J; Titus, S K

    1992-01-01

    Observation of clients at a state mental health hospital by direct care staff indicated that they appeared to act in more inappropriate ways when "hard rock" or "rap" music was played in an open courtyard than when "easy listening" or "country" music was played. A study was conducted to compare the inappropriate behavior of clients when hard rock and rap music were played (21 days), followed by easy listening and country and western music (21 days). This comparison was followed by a reversal phase in which hard rock and rap music were again played (18 days). The behaviors of the clients were observed and recorded via a controlled methodology. The results demonstrated that more inappropriate behavior was observed under conditions in which hard rock and rap music were played than when easy listening and country western music were played. The implications of these findings are discussed.

  5. Antidiabetic and antiulcer effects of extract of Eugenia jambolana seed in mild diabetic rats: study on gastric mucosal offensive acid-pepsin secretion.

    Science.gov (United States)

    Chaturvedi, Aditi; Bhawani, G; Agarwal, P K; Goel, Shalini; Singh, A; Goel, R K

    2009-01-01

    Diabetes has been reported to increase propensity to peptic ulceration through its effect both on offensive and defensive mucosal factors. Seeds of Eugenia jambolana (EJ) have been reported to have both antidiabetic as well as ulcer protective effects. The present study evaluates the antidiabetic effects of ethanolic extract of dried seed kernel of Eugenia jambolana (EJE) and its comparative effect on gastric ulceration and acid-pepsin secretion with standard antisecretory FL-blocker. Ranitidine and antidiabetic glibenclamide with a premise that Eugenia jambolana may show better ulcer healing effects by promoting defensive or reducing offensive mucosal factors in mild diabetes (MD) rats. MD was produced in adult rats by administration of streptozotocin (45 mg/kg, ip). EJE was given orally in the doses of 100-400 mg/kg for 10 days and in the dose of 200 mg/kg for 30 days respectively to study its dose- and time-dependent effects on various diabetic parameters like blood glucose, serum cholesterol and triglycerides, insulin level and glycosylated hemoglobin. For ulcer protective and gastric secretion studies, EJE (200 mg/kg) was given orally for 10 days against 2 h cold restraint stress (CRS)-, 4 h pylorus ligation (PL), aspirin (ASP, 200 mg/kg, 4 h)--and 95% ethanol (EtOH, 1 ml/200 g, 1 h)-induced gastric ulcers and offensive acid-pepsin secretion after 4 h PL with co-occurring MD in rats. EJE showed dose-dependent decrease in blood glucose level in MD rats. Blood glucose level remained stable in mild diabetic rats from 3rd day onwards after streptozotocin administration (taken as 1st day for treatment) and EJE (200 mg/kg) showed anti-hyperglycemic effect on 10th day of its administration. Further, EJE in the above dose also decreased cholesterol level with little or no effect on triglycerides level and reversed the decrease and increase in insulin and glycosylated hemoglobin level near to the normal level as observed alter 30 days treatment in MD rats. MD rats

  6. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Science.gov (United States)

    Cusini, Alexia; Rampini, Silvana K; Bansal, Vineeta; Ledergerber, Bruno; Kuster, Stefan P; Ruef, Christian; Weber, Rainer

    2010-11-16

    Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. Experienced infectious diseases (ID) fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4%) had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4%) prescriptions were for therapy and 312 (24.6%) for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%); incorrect choice of antimicrobials (7.6%); incorrect application of drugs (9.3%); and divergence from institutional guidelines (8%). Characteristics of inappropriate prophylaxes were: No indication (9%); incorrect choice of antimicrobials (1%); duration too long or other inappropriate use (6.7%). Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial

  7. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Directory of Open Access Journals (Sweden)

    Alexia Cusini

    Full Text Available BACKGROUND: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. METHODOLOGY/PRINCIPAL FINDINGS: Experienced infectious diseases (ID fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4% had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4% prescriptions were for therapy and 312 (24.6% for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%; incorrect choice of antimicrobials (7.6%; incorrect application of drugs (9.3%; and divergence from institutional guidelines (8%. Characteristics of inappropriate prophylaxes were: No indication (9%; incorrect choice of antimicrobials (1%; duration too long or other inappropriate use (6.7%. Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. CONCLUSIONS/SIGNIFICANCE: Audits of individual patient care provide important data to identify local

  8. The inappropriate use of lumbar magnetic resonance imaging in a health service area; Utilizacion inapropiada de la resonancia magnetica lumbar en un area de salud

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Recio, F. J.; Sanz, J. C.; Vera, S. [Hospital General de Soria (Spain); Peiro, S. [Fundacion de Investigacion en Servicios de Salud Valencia (Spain)

    1999-07-01

    To identify the percentage of inappropriate lumbar spine magnetic resonance imaging in the Soria Health Service, to quantify the costs and the possible association between inadequate use, the characteristics of the patient and the services requested. A descriptive study of the inappropriate use of MRI of the lumbar spine, taken from the retrospective examination, carried out by a radiologist, of the 233 MRI's requested between 1995 and 1998. For the valuation, the criteria of the American College of Radiology (ACR) and the Basque Agency for the Evaluation of Technologies (OSTEBA) were used. All the MRI's were carried out at an approved centre, the costs were calculated taken form the expenses paid by the Insalud, including the transport costs, calculated at prices applicable for the year in question. 11.7% of the studies were values as inappropriate, 2.1% debatable and the remainder adequate according to the ACR criteria, concentrating the inadequacy on studies for lumbago, that reached 80% of the inappropriate requests. The ACR and OSTEBA criteria coincided to a high degree (kappa statistics: 0.87). The expense related to the unnecessary studies was a litter higher than a million pesetas. No differences were found in the proportion of inappropriate studies according to the characteristics of the patient or the service requested, except the one already mentioned for the supposition diagnosis. Although the results of the study cannot be generalised to other environments, they suggest the possibility of a significant proportion of inappropriate use of lumbar spine MRI that could have an important repercussion on health care expenses. (Author) 11 refs.

  9. Analysis of the association between isokinetic knee strength with offensive and defensive jumping capacity in high-level female volleyball athletes.

    Science.gov (United States)

    Sattler, Tine; Sekulic, Damir; Esco, Michael R; Mahmutovic, Ifet; Hadzic, Vedran

    2015-09-01

    Isokinetic-knee-strength was hypothesized to be an important factor related to jumping performance. However, studies examining this relation among elite female athletes and sport-specific jumps are lacking. This investigation determined the influence of isokinetic-knee flexor/extensor strength measures on spike-jump (offensive) and block-jump (defensive) performance among high-level female volleyball players. Cross-sectional laboratory study. Eighty-two female volleyball athletes (age = 21.3 ± 3.8 years, height = 175.4 ± 6.76 cm, and weight = 68.29 ± 8.53 kg) volunteered to participate in this study. The studied variables included spike-jump and block-jump performance and a set of isokinetic tests to evaluate the eccentric and concentric strength capacities of the knee extensors (quadriceps - Q), and flexors (hamstring - H) for both legs. Both jumping tests showed high intra-session reliability (ICC of 0.87 and 0.95 for spike-jump and block-jump, respectively). The athletes were clustered into three achievement-groups based on their spike-jump and block-jump performances. For the block-jump, ANOVA identified significant differences between achievement-groups for all isokinetic variables except the Right-Q-Eccentric-Strength. When observed for spike-jump, achievement-groups differed significantly in all tests but Right-H-Concentric-Strength. Discriminant canonical analysis showed that the isokinetic-strength variables were more associated with block-jump then spike-jump-performance. The eccentric isokinetic measures were relatively less important determinants of block-jump than for the spike-jump performance. Data support the hypothesis of the importance of isokinetic strength measures for the expression of rapid muscular performance in volleyball. The results point to the necessity of the differential approach in sport training for defensive and offensive duties. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. The Relationships Among Exposure to Violence, Psychological Distress, and Gun Carrying Among Male Adolescents Found Guilty of Serious Legal Offenses: A Longitudinal Cohort Study.

    Science.gov (United States)

    Reid, Joan A; Richards, Tara N; Loughran, Thomas A; Mulvey, Edward P

    2017-03-21

    Gun violence and psychological problems are often conflated in public discourse on gun safety. However, few studies have empirically assessed the effect of exposure to violence when exploring the association between gun carrying and psychological distress. To examine the potential effect of exposure to violence on the associations between gun carrying and psychological distress among vulnerable adolescents. Longitudinal cohort study. The Pathways to Desistance study, a study of youths found guilty of a serious criminal offense in Philadelphia County, Pennsylvania, or Maricopa County, Arizona. 1170 male youths aged 14 to 19 years who had been found guilty of a serious criminal offense. Youths were assessed at baseline and at four 6-month intervals with regard to gun carrying ("Have you carried a gun?"), psychological distress (Global Severity Index), and exposure to violence (modified version of the Exposure to Violence Inventory). At the bivariate level, gun carrying was consistently associated with higher levels of psychological distress. However, the association between psychological distress and gun carrying diminished or disappeared when exposure to violence was considered. Exposure to violence (as either a victim or a witness) was significantly related to gun carrying at all follow-up assessments, with increased odds of gun carrying ranging from 1.43 to 1.87 with each additional report of exposure to violence. The study sample was limited to justice-involved male youths. Precarrying distress and exposure to violence could not be fully captured because many participants had initiated gun carrying before baseline. In male youths involved in the criminal justice system, the relationship between psychological distress and gun carrying seems to be influenced by exposure to violence (either experiencing or witnessing it). Further study is warranted to explore whether interventions after exposure to violence could reduce gun carrying in this population. None.

  11. Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room.

    Science.gov (United States)

    Hirata, Kazuhito; Wake, Minoru; Takahashi, Takanori; Nakazato, Jun; Yagi, Nobuhito; Miyagi, Tadayoshi; Shimotakahara, Junichi; Mototake, Hidemitsu; Tengan, Toshiho; Takara, Tsuyoshi R; Yamaguchi, Yutaka

    2015-01-01

    Initial diagnosis of acute aortic dissection (AAD) in the emergency room (ER) is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD. We conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78). An inappropriate initial diagnosis (IID) was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD) was also evaluated. Delayed diagnosis (DD) was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile). In addition, TFD was compared with respect to each clinical variable using a rank sum test. An IID was determined for 37% of patients. Walk-in (WI) visit to the ER [odds ratio (OR) 2.6, 95% confidence interval (CI) = 1.01-6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14-36.82, P = 0.035) were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h). DD (>4.5 h) was observed in 27 cases (21.3%). TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003). Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39-9.9, P = 0.009). TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001). WI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

  12. Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room.

    Directory of Open Access Journals (Sweden)

    Kazuhito Hirata

    Full Text Available Initial diagnosis of acute aortic dissection (AAD in the emergency room (ER is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD.We conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78. An inappropriate initial diagnosis (IID was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD was also evaluated. Delayed diagnosis (DD was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile. In addition, TFD was compared with respect to each clinical variable using a rank sum test.An IID was determined for 37% of patients. Walk-in (WI visit to the ER [odds ratio (OR 2.6, 95% confidence interval (CI = 1.01-6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14-36.82, P = 0.035 were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h. DD (>4.5 h was observed in 27 cases (21.3%. TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003. Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39-9.9, P = 0.009. TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001.WI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

  13. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    LENUS (Irish Health Repository)

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  14. [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].

    Science.gov (United States)

    Gentes, Élodie; Hertzog, Maurice; Vogel, Thomas; Lang, Pierre Olivier

    2015-02-01

    Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria. A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed. Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure. Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing

  15. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.

    Science.gov (United States)

    Al Aqqad, Saná M H; Chen, Li Li; Shafie, Asrul Akmal; Hassali, Mohamed Azmi; Tangiisuran, Balamurugan

    2014-01-01

    Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and

  16. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

    Directory of Open Access Journals (Sweden)

    Al Aqqad S MH

    2014-01-01

    Full Text Available Sana’ MH Al Aqqad, Li Li Chen, Asrul Akmal Shafie, Mohamed Azmi Hassali, Balamurugan Tangiisuran Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Background: Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs and the changes observed in the HRQoL among older nursing home residents. Methods: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D and EuroQol-visual analog scale (EQ-VAS at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results: The median age of the 211 participants was 77 years (interquartile range 72–82 years and the median number of prescription medicines was four (interquartile range three to six. The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months

  17. Potential Teachers' Appropriate and Inappropriate Application of Pedagogical Resources in a Model-Based Physics Course: A "Knowledge in Pieces" Perspective on Teacher Learning

    Science.gov (United States)

    Harlow, Danielle B.; Bianchini, Julie A.; Swanson, Lauren H.; Dwyer, Hilary A.

    2013-01-01

    We used a "knowledge in pieces" perspective on teacher learning to document undergraduates' pedagogical resources in a model-based physics course for potential teachers. We defined pedagogical resources as small, discrete ideas about teaching science that are applied appropriately or inappropriately in specific contexts. Neither…

  18. An Evaluation of a High-Probability Instructional Sequence to Increase Acceptance of Food and Decrease Inappropriate Behavior in Children with Pediatric Feeding Disorders

    Science.gov (United States)

    Patel, Meeta R.; Reed, Gregory K.; Piazza, Cathleen C.; Bachmeyer, Melainie H.; Layer, Stacy A.; Pabico, Ryan S.

    2006-01-01

    We evaluated the effects of escape extinction with and without a high-probability (high-p) instructional sequence on food acceptance and inappropriate behavior for children diagnosed with feeding problems. The high-p sequence consisted of three presentations of a response that was similar topographically (i.e., presentations of an empty nuk[R],…

  19. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study.

    LENUS (Irish Health Repository)

    Moriarty, Frank

    2015-03-01

    To examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland.

  20. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria.

    LENUS (Irish Health Repository)

    Cooper, Janine A

    2016-01-28

    The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45-64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People\\'s Treatments) criteria.

  1. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H; Sood, Nitesh; Ruwald, Martin H

    2013-01-01

    The majority of implantable cardioverter defibrillators (ICDs) are dual-chamber devices, but studies on the frequency of inappropriate therapy in dual- versus single-chamber devices have shown conflicting results. The aim of this study is to determine whether implantation of dual-chamber ICD...

  2. [Point of view of older adults on the potentially inappropriate medications prescribing in primary care facilities in Bobo-Dioulasso, Burkina Faso].

    Science.gov (United States)

    Hien, H; Berthé, A; Drabo, M K; Konaté, B; Toé, N; Tou, F; Adiara, M; Badini-Kinda, F; Ouédraogo, M; Meda, N; Macq, J

    2016-02-01

    Little is known about the organization of primary care facilities in sub-Saharan Africa that might lead to potentially inappropriate prescribing. The aim of this study was to analyze the factors that could lead to potentially inappropriate prescribing in primary care facilities in Bobo-Dioulasso (Burkina Faso), taking into consideration the patient's perspective. A cross-sectional qualitative study was conducted in primary care facilities from November 2013 to February 2014. People aged 60 years or more with at least one chronic disease were included. Individual interviews were conducted. An analysis of the thematic content of the interviews was conducted. Our results showed that the patient referral system was insufficient. We also found many different prescribers for older people seeking care and poor communication between prescribers and patients. This caused some consequences such as the absence of review of drugs consumed before a new prescription, a lack of exchange on medication changes and repeated treatment change during hospitalization. Most of the persons who prescribed potentially inappropriate medications were nurses. The poor communication between prescribers and patients is a challenge for the prevention of prescribing potentially inappropriate medications. Teamwork is an important feature of the organizational care system, strengthening it could be a way to improve rational prescription. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  3. Inappropriate glucagon response after oral compared with isoglycemic intravenous glucose administration in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Hare, Kristine J; Vilsbøll, Tina; Holst, Jens Juul

    2010-01-01

    glucose infusion (IIGI) in patients with type 1 diabetes. Nine patients without residual beta-cell function [age: 25 +/- 9 yr; body mass index (BMI): 24 +/- 2 kg/m(2); fasting plasma glucose (FPG): 9.5 +/- 2.1 mM; Hb A(1c): 8.4 +/- 1.2% (mean +/- SD)] and eight healthy subjects (age: 28 +/- 5 yr; BMI: 24...... +/- 3 kg/m(2); FPG: 5.3 +/- 0.2 mM; Hb A(1c): 5.0 +/- 0.1%) were examined on two separate occasions: 4-h 50-g OGTT and IIGI. Isoglycemia during IIGIs was obtained using 53 +/- 5 g of glucose in patients with type 1 diabetes and 30 +/- 3 g in control subjects (P gastrointestinal...... that the inappropriate glucagon response to glucose in patients with type 1 diabetes occurs as a consequence of the oral administration way, suggesting a role of the gastrointestinal tract, possibly via glucagonotropic signaling from gut hormones (e.g., glucose-dependent insulinotropic polypeptide), in type 1 diabetic...

  4. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria.

    LENUS (Irish Health Repository)

    Gallagher, P F

    2011-06-01

    Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalization, and wasteful utilization of resources. We randomized 400 hospitalized patients aged ≥ 65 years to receive either the usual pharmaceutical care (control) or screening with STOPP\\/START criteria followed up with recommendations to their attending physicians (intervention). The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge. Unnecessary polypharmacy, the use of drugs at incorrect doses, and potential drug-drug and drug-disease interactions were significantly lower in the intervention group at discharge (absolute risk reduction 35.7%, number needed to screen to yield improvement in MAI = 2.8 (95% confidence interval 2.2-3.8)). Underutilization of clinically indicated medications was also reduced (absolute risk reduction 21.2%, number needed to screen to yield reduction in AOU = 4.7 (95% confidence interval 3.4-7.5)). Significant improvements in prescribing appropriateness were sustained for 6 months after discharge.

  5. [Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation].

    Science.gov (United States)

    Pastor Cano, Josep; Aranda García, Ana; Gascón Cánovas, Juan José; Sánchez Ruiz, José Francisco; Rausell Rausell, Víctor José; Tobaruela Soto, Mariana

    2018-02-01

    To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  6. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

    Science.gov (United States)

    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-04-17

    Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections. We conducted a retrospective cohort study in Premier Perspective database (2009-2013) of 175 US hospitals. We included all adult patients with community-onset culture-positive urinary tract infection (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, treated with antibiotics within 2 days of admission. We employed regression modeling to compute adjusted association of presence of CRE with risk of receiving IET, and of IET on hospital mortality, length of stay (LOS) and costs. Among 40,137 patients presenting to the hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p pneumonia or sepsis was comparable to other national estimates. Infection with CRE was associated with a four-fold increased risk of receiving IET, which in turn increased mortality, LOS and costs.

  7. Effects of tannin-fluoride and milk-fluoride mixture on human enamel erosion from inappropriately chlorinated pool water.

    Science.gov (United States)

    Boonviriya, Sumalee; Tannukit, Sissada; Jitpukdeebodintra, Suwanna

    2017-01-01

    This in vitro study aimed to investigate the efficacy of tannin-fluoride and milk-fluoride mixtures on human enamel erosion after exposure to inappropriately chlorinated pool water. Enamel specimens were immersed in swimming pool water (pH 2.7) for 30 min and in each test reagent for 4 min once a day for 60 consecutive days (group I: control, group II: tannin-fluoride, group III: milk-fluoride, group IV: tannin-fluoride before and milk-fluoride after erosive challenge, and group V: milk containing tannin-fluoride before and after erosive exposure). Surface microhardness was assessed on days 0, 30, and 60. Scanning electron microscopy (SEM) and electron probe microanalysis (EPMA) were performed after treatment of samples for 60 days. Surface microhardness of experimental groups was ranked as follows: group III > group IV-group V > group II > group I (P erosive enamel surface after treatment with tannin-fluoride and milk-fluoride mixtures. Furthermore, EPMA profiles showed decrease of phosphorus and increase of fluoride content in groups II and IV. In conclusion, we demonstrated that treatment with fluoridated milk with or without tannin-fluoride has protective effects against enamel erosion caused by low-pH swimming pool water.

  8. Meaningful learning: The essential factor for conceptual change in limited or inappropriate propositional hierarchies leading to empowerment of learners

    Science.gov (United States)

    Novak, Joseph D.

    2002-07-01

    The construction and reconstruction of meanings by learners requires that they actively seek to integrate new knowledge with knowledge already in their cognitive structure. Ausubel's assimilation theory of cognitive learning has been shown to be effective in guiding research and instructional design to facilitate meaningful learning (Ausubel, The psychology of meaningful verbal learning, New York: Grune and Stratton, 1963; Educational psychology: A cognitive view, New York: Holt, Rinehart and Winston, 1968; The acquisition and retention of knowledge, Dordrecht: Kluwer, 2000). Gowin's Vee heuristic has been employed effectively to aid teachers and students in understanding the constructed nature of knowledge (Gowin, Educating, Ithaca, NY: Cornell University Press, 1981). Situated learning occurs when learning is by rote or at a lower level of meaningful learning. Concept mapping has been used effectively to aid meaningful learning with resulting modification of student's knowledge structures. When these knowledge structures are limited or faulty in some way, they may be referred to as Limited or Inappropriate Propositional Hierarchies (LIPH's). Conceptual change, or more accurately conceptual reconstrution, requires meaningful learning to modify LIPH's. Collaborative group learning facilitates meaningful learning and new knowledge construction. World-wide economic changes are forcing major changes in business and industry placing a premium on the power and value of knowledge and new knowledge production. These changes require changes in school and university education that centers on the nature and power of meaningful learning. New computer tools are available to facilitate teaching activities targeted at modifying LIPH's, and aiding meaningful learning in general.

  9. A Case Report of Tooth Wear Associated with a Patient's Inappropriate Efforts to Reduce Oral Malodor Caused by Endodontic Lesion

    Directory of Open Access Journals (Sweden)

    Masahiro Yoneda

    2009-01-01

    Full Text Available Here, we report a case of severe tooth wear associated with a patient's inappropriate efforts to reduce oral malodor. A 72-year-old male patient visited our breath clinic complaining of strong breath odor. Former dentists had performed periodontal treatments including scaling and root planing, but his oral malodor did not decrease. His own subsequent breath odor-reducing efforts included daily use of lemons and vinegar to reduce or mask the odor, eating and chewing hard foods to clean his teeth, and extensive tooth brushing with a hard-bristled toothbrush. Oral malodor was detected in our breath clinic by several tests, including an organoleptic test, portable sulphide monitor, and gas chromatography. Although patient's oral hygiene and periodontal condition were not poor on presentation, his teeth showed heavy wear and hypersensitiving with an unfitted restoration on tooth 16. Radiographic examination of the tooth did not reveal endodontic lesion, but when the metal crown was removed, severe pus discharge and strong malodor were observed. When this was treated, his breath odor was improved. After dental treatment and oral hygiene instruction, no further tooth wear was observed; he was not concerned about breath odor thereafter.

  10. Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor α1.

    Science.gov (United States)

    Warner, Amy; Rahman, Awahan; Solsjö, Peter; Gottschling, Kristina; Davis, Benjamin; Vennström, Björn; Arner, Anders; Mittag, Jens

    2013-10-01

    Thyroid hormone is a major regulator of thermogenesis, acting both in peripheral organs and on central autonomic pathways. Mice heterozygous for a point mutation in thyroid hormone receptor α1 display increased thermogenesis as a consequence of high sympathetic brown fat stimulation. Surprisingly, despite the hypermetabolism, their body temperature is not elevated. Here we show, using isolated tail arteries, that defective thyroid hormone receptor α1 signaling impairs acetylcholine-mediated vascular relaxation as well as phenylephrine-induced vasoconstriction. Using infrared thermography on conscious animals, we demonstrate that these defects severely interfere with appropriate peripheral heat conservation and dissipation, which in turn leads to compensatory alterations in brown fat activity. Consequently, when the vasoconstrictive defect in mice heterozygous for a point mutation in thyroid hormone receptor α1 was reversed with the selective α1-adrenergic agonist midodrine, the inappropriate heat loss over their tail surface was reduced, normalizing brown fat activity and energy expenditure. Our analyses demonstrate that thyroid hormone plays a key role in vascular heat conservation and dissipation processes, adding a unique aspect to its well-documented functions in thermoregulation. The data thus facilitate understanding of temperature hypersensitivity in patients with thyroid disorders. Moreover, the previously unrecognized connection between cardiovascular regulation and metabolic activity revealed in this study challenges the interpretation of several experimental paradigms and questions some of the currently derived hypotheses on the role of thyroid hormone in thermogenesis.

  11. Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor α1

    Science.gov (United States)

    Warner, Amy; Rahman, Awahan; Solsjö, Peter; Gottschling, Kristina; Davis, Benjamin; Vennström, Björn; Arner, Anders; Mittag, Jens

    2013-01-01

    Thyroid hormone is a major regulator of thermogenesis, acting both in peripheral organs and on central autonomic pathways. Mice heterozygous for a point mutation in thyroid hormone receptor α1 display increased thermogenesis as a consequence of high sympathetic brown fat stimulation. Surprisingly, despite the hypermetabolism, their body temperature is not elevated. Here we show, using isolated tail arteries, that defective thyroid hormone receptor α1 signaling impairs acetylcholine-mediated vascular relaxation as well as phenylephrine-induced vasoconstriction. Using infrared thermography on conscious animals, we demonstrate that these defects severely interfere with appropriate peripheral heat conservation and dissipation, which in turn leads to compensatory alterations in brown fat activity. Consequently, when the vasoconstrictive defect in mice heterozygous for a point mutation in thyroid hormone receptor α1 was reversed with the selective α1-adrenergic agonist midodrine, the inappropriate heat loss over their tail surface was reduced, normalizing brown fat activity and energy expenditure. Our analyses demonstrate that thyroid hormone plays a key role in vascular heat conservation and dissipation processes, adding a unique aspect to its well-documented functions in thermoregulation. The data thus facilitate understanding of temperature hypersensitivity in patients with thyroid disorders. Moreover, the previously unrecognized connection between cardiovascular regulation and metabolic activity revealed in this study challenges the interpretation of several experimental paradigms and questions some of the currently derived hypotheses on the role of thyroid hormone in thermogenesis. PMID:24046370

  12. Inappropriate Antidiuretic Hormone Secretion

    African Journals Online (AJOL)

    1974-06-08

    7. 4;5. Blood urea (mg/l00 ml). 28. 26. 28. Serum osmolality (m-osmole/kg). 262. 270. 280. Urine osmolality (m-osmole/kg). 675. 515. 306. Plasma cortisol (l'-g/100 ml). 25. Creatinine clearance (ml/min). 70. Urine Na+ (mEq{L).

  13. Inappropriate requests from patients

    African Journals Online (AJOL)

    Patients occasionally request interventions that doctors are reluctant to provide. Some of these requests are plainly inap- propriate — requests for actions that are illegal, for instance, or for interventions that are clearly and uncontroversially inef- fective. But other requests are more diffi- cult. At issue are ethical questions ...

  14. Factors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: a study in a small teaching hospital in Brazil.

    Science.gov (United States)

    Kawanami, Gustavo Hideki; Fortaleza, Carlos Magno Castelo Branco

    2011-07-01

    The identification of patterns of inappropriate antimicrobial prescriptions in hospitals contributes to the improvement of antimicrobial stewardship programs (ASP). We conducted a cross-sectional study to identify predictors of inappropriateness in requests for parenteral antimicrobials (RPAs) in a teaching hospital with 285 beds. We reviewed 25% of RPAs for therapeutic purposes from y 2005. Appropriateness was evaluated according to current guidelines for antimicrobial therapy. We assessed predictors of inappropriateness through univariate and multivariate models. RPAs classified as 'appropriate' or 'probably appropriate' were selected as controls. Case groups comprised inappropriate RPAs, either in general or for specific errors. Nine hundred and sixty-three RPAs were evaluated, 34.6% of which were considered inappropriate. In the multivariate analysis, general predictors of inappropriateness were: prescription on weekends/holidays (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.20-2.28, p = 0.002), patient in the intensive care unit (OR 1.57, 95% CI 1.11-2.23, p = 0.01), peritoneal infection (OR 2.15, 95% CI 1.27-3.65, p = 0.004), urinary tract infection (OR 1.89, 95% CI 1.25-2.87, p = 0.01), combination therapy with 2 or more antimicrobials (OR 1.72, 95% CI 1.15-2.57, p = 0.008) and prescriptions including penicillins (OR 2.12, 95% CI 1.39-3.25, p = 0.001) or 1(st) generation cephalosporins (OR 1.74, 95% CI 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR 0.34, 95% CI 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR 0.04, 95% CI 0.01-0.26, p = 0.001) and requests for agents with an insufficient antimicrobial spectrum (OR 0.14, 95% CI 0.03-0.30, p = 0.01). Our results demonstrate the importance of

  15. Can patient safety be improved by reducing the volume of “inappropriate prescribing tasks” handed over to out-of-hours junior doctors?

    Directory of Open Access Journals (Sweden)

    Amis SM

    2018-03-01

    Full Text Available Samuel Martin Amis, Tobin Henry Edgar Osicki Department of Acute Internal Medicine, South Warwickshire Foundation Trust, Warwick, UK Background: First-year doctors found that during out-of-hours shifts they were being delayed and distracted from reviewing potentially sick/deteriorating patients by a high volume of prescribing tasks. This predominately consisted of oral anticoagulation prescribing and rewrites of drug charts. We hoped that if we could reduce this burden of “inappropriate prescribing tasks”, we could not only improve junior doctors’ job satisfaction and opportunities for training but also give them more time for patient reviews. Methods: Three weekends were initially audited to quantify the number of “inappropriate prescribing tasks” using data from the hospital’s computerized task assigning system. On three subsequent weekends, a checklist was handed out to the ward teams on Friday mornings. This checklist was designed to encourage the day teams to check that drug charts would not need oral anticoagulation or rewriting over the weekend. Results: An overall reduction in “inappropriate prescribing tasks” of 46% with a specific reduction in inappropriate oral anticoagulation prescribing of 65% was observed. Inappropriate drug chart rewrites were reduced by 30%. The reduction in the mean number of pre-intervention inappropriate prescribing tasks (as a percentage of total prescribing tasks and the post-intervention mean was 6.94% (95% confidence interval −0.54 to 14.42, p-value=0.062. Conclusion: Improved job satisfaction and a perceived reduced workload were noted from post-intervention qualitative surveys. While improved patient safety directly resulting from this intervention is more difficult to establish, and the observed reduction in inappropriate prescribing was only approaching statistical significance, our colleagues commented in post-intervention feedback that they felt they had more time, and felt less

  16. Hospitalizations for hyponatremia and syndrome of inappropriate antidiuretic hormone hypersecretion at the Policlinic of Modena, Italy from January 2006 to September 2008

    Directory of Open Access Journals (Sweden)

    Lucio Brugioni

    2013-04-01

    Full Text Available Introduction: Hyponatremia is the most common electrolyte imbalance among hospitalized patients. The cause is not always identified, but 30-40% of cases are the result of the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH. The aim of this study was to determine the frequency of hyponatremia in our hospital, its underlying causes (in particular the proportion of cases caused by SIADH, and approaches to treatment. Materials and methods: We retrospectively analyzed all nonpediatric hospitalizations occurring between 1 January 2006 and 30 September 2008 in which the discharge diagnosis was hyponatremia or SIADH. Results: A total of 64 cases were reviewed; 56 of the patients were aged > 60. The hyponatremia was classified as severe (< 125 mEq/L in 36/64 cases (56% (most involving patients aged >70; moderate (129-125 mEq/L in 22 (34%; and mild (134-130 mEq/L in 6 (9%. Neurologic symptoms were present in 11 patients with severe hyponatremia (confusion, hallucinations, coma and 9 with moderate hyponatremia (weakness, impaired memory. Thirteen had hypovolemic hypotonic hyponatremia, 16 had hypervolemic hypotonic hyponatremia, and 35 had normovolemic hypotonic hyponatremia, including 23 who met the criteria for SIADH: 5 patients with neoplastic disease, 6 with pulmonary disorders, 3 with drug-related hyponatremia (a selective serotonin reuptake inhibitor in 1 case, a tricyclic antidepressant in 1, carbamazepine in 1, 2 whose SIADH developed after surgery, 4 with head trauma, 1 receiving noninvasive ventilatory support, and 2 elderly patients whose SIADH appeared idiopathic. Thirteen patients had hyponatremia related to the use of diuretics (thiazides in 7 cases, and one other had long-standing untreated hypothyroidism. In most cases, treatment consisted of infusion of hypertonic saline (sometimes with fluid restriction and/or furosemide administration. Discussion: Over one third (36% of the adults hospitalized in the Policlinic of

  17. Inappropriate analysis does not reveal the ecological causes of evolution of stickleback armour: a critique of Spence et al. 2013.

    Science.gov (United States)

    MacColl, Andrew D C; Aucott, Beth

    2014-09-01

    In a recent paper in this journal, Spence et al. (2013) sought to identify the ecological causes of morphological evolution in three-spined sticklebacks Gasterosteus aculeatus, by examining phenotypic and environmental variation between populations on the island of North Uist, Scotland. However, by using simple qualitative assessments of phenotype and inappropriate measures of environmental variation, Spence et al. have come to a conclusion that is diametrically opposite to that which we have arrived at in studying the same populations. Our criticisms of their paper are threefold: (1) using a binomial qualitative measure of the variation in stickleback armour ("low" versus "minimal" (i.e., "normal" low-plated freshwater sticklebacks versus spineless and/or plateless fish)) does not represent the full range of phenotypes that can be described by quantitative measures of the individual elements of armour. (2) Their use of unspecified test kits, with a probable accuracy of 4 ppm, may not be accurate in the range of water chemistry on North Uist (1 to 30 ppm calcium). (3) Their qualitative assessment of the abundance of brown trout Salmo trutta as the major predator of sticklebacks does not accurately describe the variation in brown trout abundance that is revealed by catch-per-unit-effort statistics. Repeating Spence et al.'s analysis using our own measurements, we find, in direct contradiction to them, that variation in stickleback bony armour is strongly correlated with variation in trout abundance, and unrelated to variation in the concentration of calcium in the lochs in which they live. Field studies in ecology and evolution seldom address the same question in the same system at the same time, and it is salutary that in this rare instance two such studies arrived at diametrically opposite answers.

  18. P-Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism.

    Science.gov (United States)

    Field, Michael E; Donateo, Paolo; Bottoni, Nicola; Iori, Matteo; Brignole, Michele; Kipp, Ryan T; Kopp, Douglas E; Leal, Miguel A; Eckhardt, Lee L; Wright, Jennifer M; Walsh, Kathleen E; Page, Richard L; Hamdan, Mohamed H

    2018-04-19

    The mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. We prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis atrial tachycardia (AT Group). P-wave amplitude in lead II and PR interval were measured at a lower and higher heart rate (HR1 and HR2, respectively). P-wave amplitude increased significantly with the increase in HR in the IST Group (0.16±0.07 mV at HR1=97±12 beats per minute versus 0.21±0.08 mV at HR2=135±21 beats per minute, P =0.001). The average increase in P-wave amplitude in the IST Group was similar to the Isuprel Group ( P =0.26). PR interval significantly shortened with the increases in HR in the IST Group (146±15 ms at HR1 versus 128±16 ms at HR2, P PR interval was noted in the Isuprel Group ( P =0.6). In contrast, patients in the atrial tachycardia Group experienced PR lengthening during atrial tachycardia when compared with baseline normal sinus rhythm (153±25 ms at HR1=78±17 beats per minute versus 179±29 ms at HR2=140±28 beats per minute, P PR shortening similar to what is seen in healthy controls following isoproterenol infusion. The increase in P-wave amplitude and absence of PR lengthening in IST support an extrinsic mechanism consistent with a state of sympatho-excitation with cephalic shift in sinus node activation and enhanced atrioventricular nodal conduction. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  19. Influence of Admission to a Tertiary Care Hospital after a Fall on Use of Potentially Inappropriate Medications among Older Patients.

    Science.gov (United States)

    Francis, Erin; Dyks, Derek; Kanji, Salmaan

    2014-11-01

    Each year, about one-third of individuals over the age of 65 years will experience a fall, and half of these will experience a subsequent fall in the following year. The use of potentially inappropriate medications (PIMs) is an important factor contributing to increased fall risk in geriatric patients. To determine the proportion of patients over the age of 65 admitted to orthopedics and general medicine services with diagnosis of a fall who experienced a change in the total number or dosage of PIMs, as defined by the Beers criteria, upon discharge from hospital. This retrospective observational study involved patients admitted to a tertiary care hospital with diagnosis of a fall between January 1 and December 31, 2011. Those aged 65 years or older with at least one PIM on admission were eligible for inclusion. Data analysis included χ(2) and Fisher testing, as well as multivariate analysis. A total of 148 patients were included, of whom 63 (43%) had an overall change in the dosage or number of PIMs during their hospital stay. Forty patients (27%) had an overall reduction in the dosage or number of PIMs upon discharge from hospital, whereas 23 (16%) experienced an overall increase in the dosage or total number of PIMs. The mean number (± standard deviation) of PIMs decreased during the hospital stay, from 1.6 ± 0.8 on admission to 1.4 ± 0.9 on discharge (p = 0.03). Benzodiazepines were the class of PIMs most frequently discontinued or reduced in dosage. One-quarter of patients admitted with falls had de-escalation of PIMs upon hospital discharge. Although dosage reduction or drug discontinuation may not be appropriate for all patients, a standardized approach to medication review during the hospital stay and improved prescriber education and awareness of PIM use among elderly individuals are warranted.

  20. Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators.

    Directory of Open Access Journals (Sweden)

    Murray Hinder

    Full Text Available Non-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or 'rainout' from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.To assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.Seven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH2O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.Several ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H2O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from 'specific' (tube occluded to 'ambiguous' (Safety valve open. Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH2O compared to the measured values of 13cmH2O.This study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.

  1. Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France.

    Science.gov (United States)

    Bongue, Bienvenu; Naudin, Florence; Laroche, Marie-Laure; Galteau, Marie-Madeleine; Guy, Claire; Guéguen, René; Convers, Jean-Pierre; Colvez, Alain; Maarouf, Nabil

    2009-12-01

    To describe the trends of potentially inappropriate medication (PIM) use in older adults from 1995 to 2004 in the East of France, by using the 1997 Beers criteria and its French update, and to assess risk factors for this PIM use. We carried out a repeated cross-sectional study using data collected among people aged >/=65 years, examined in the Center for Preventive Medicine. Studied variables were socio-demographic, clinical data, medication consumption and the self-health status. Joinpoint regression analysis was used to estimate the temporal changes in PIM rate. 30 683 participants were included. 51.2% were women. The mean age was 70.1 +/- 4.3 years [65-99]. The annual overall rate of PIM use decreased significantly during the study period. These rates range from 14.9% in 1995 to 9.0% in 2004 according the Beers criteria (-3.4% per year) and from 33.5% in 1995 to 19.3% in 2004 according to the French update criteria (-3.6% per year). The annual rate of medication users increased during the same period (+0.75% per year). The risk of PIM consumption increased with age, number of drugs and frequency of the visits to the physician (OR = 1.26 [1.18-1.35]). This risk was also higher among women (OR = 1.29 [1.18-1.40]), elderly living alone (OR = 1.09 [1.02-1.17]) and with those with low education level (OR = 1.19 [1.02-1.38]). This study shows a decrease in PIM consumption. Despite an increase of drug use in the elderly, an improving of the quality of this consumption remains possible. Copyright (c) 2009 John Wiley & Sons, Ltd.

  2. Polypharmacy and use of potentially inappropriate medications in long-term care facilities: does coordinated primary care make a difference?

    Science.gov (United States)

    Andrew, Melissa K; Purcell, Chad A; Marshall, Emily G; Varatharasan, Nirupa; Clarke, Barry; Bowles, Susan K

    2017-09-27

    Polypharmacy is both common and harmful for frail residents of long-term care facilities (LTCF). We aimed to study rates of polypharmacy and potentially inappropriate medications (PIMs) before and after the implementation of a new model of coordinated primary care in LTCF, 'Care by Design (CBD)'. This was an observational before/after study in 10 LTCFs in Halifax, NS, Canada. Chart reviews were conducted for 529 LTCF residents for whom medication use was available. Both regularly scheduled and PRN medications were included but topical, inhaled and other non-systemic agents were excluded. Polypharmacy was defined as the concomitant use of more than 10 medications. PIMs were identified using Beers Criteria. Mean age of LTCF residents was older pre- versus post-CBD (85.7 versus 82.1 years; P = 0.0015). The burden of polypharmacy was high, but decreased significantly from 86.8% pre-CBD to 79.5% post-CBD (P = 0.046). The mean number of medications per resident decreased from 16.7 (SD 5.6) pre- to 15.5 (SD 6.2) post-CBD (P = 0.037). Residents with dementia were taking fewer medications both overall and following the implementation of CBD (mean 15.9, SD 0.6 pre-CBD versus 14.4, SD 0.4 post-CBD; P = 0.04). PIM rates were high and showed no change with CBD (86.2% versus 81.1%, P = 0.16). Polypharmacy was the norm of this sample of LTCF residents. Implementation of coordinated care through the CBD model was associated with a small decrease in polypharmacy but not overall use of PIMs. Further targeted efforts are required to substantially reduce both polypharmacy and PIMs in clinical practice. © 2017 Royal Pharmaceutical Society.

  3. Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study.

    Science.gov (United States)

    Haasum, Ylva; Fastbom, Johan; Johnell, Kristina

    2012-03-01

    Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% CI 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% CI 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% CI 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% CI 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% CI 0.55 to 0.65). Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Research is needed to identify underlying risk factors for PIDU within these settings.

  4. To Call or Not to Call a Spade a Spade: The Dilemma of Treating 'Offensive' Terms in Duramazwi Guru reChiShona

    Directory of Open Access Journals (Sweden)

    Emmanuel Chabata

    2011-10-01

    Full Text Available

    ABSTRACT: As noted by Béjoint (2000: 6, the main objective in dictionary-making is to define words and terms. This is especially the case if the fact is accepted that dictionaries are mostly con-sulted for word meaning and that, in the consultation process, the user hopes to acquire and/or verify certain information. However, as again noted by Jackson (1988, Landau (1984, Svénsen (1993 and Zgusta (1971, among others, the description of word meaning is one of the greatest difficulties with which the lexicographer has to cope. This article discusses some of the challenges facing lexicographers when defining 'offensive' headwords in a monolingual dictionary. It is based on experiences of defining such headwords for the general-purpose, medium-sized, synchronic, monolingual Shona dictionary, Duramazwi Guru reChiShona (henceforth DGC (Chimhundu et al. 2001. DGC was compiled and edited by a six-member team of mother-tongue speakers of Shona who are researchers at the African Languages Research Institute (ALRI. The article also discusses some of the strategies the team of editors adopted as ways of dealing with offensive words in DGC. One such strategy is the use of euphemism in defining.


    Keywords: ALRI, CULTURE, DEFINITION, THEORETICAL DEFINITION, PRACTICAL DEFINITION, DICTIONARY, EUPHEMISM, LEXICOGRAPHY, MONOLINGUAL DICTION-ARY, OFFENSIVE HEADWORD, SHONA

    *****

    OPSOMMING: Om die kind by sy naam te noem of nie te noem nie: Die dilemma van die behandeling van "aanstootlike" terme in Duramazwi Guru reChiShona. Soos deur Béjoint (2000: 6 opgemerk, is die hoofdoel van woordeboekmaak om woorde en terme te definieer. Dit is veral die geval as die feit aanvaar word dat woordeboeke meestal geraadpleeg word vir woordbetekenis en dat, by die raadplegingsproses, die gebruiker hoop om sekere inligting te bekom en/of te kontroleer. Soos weer eens opgemerk deur onder andere Jackson (1988, Landau (1984, Svénsen (1993 en Zgusta (1971, is

  5. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis.

    Science.gov (United States)

    Gomes, Tara; Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

    2014-10-01

    The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p monitoring system (p = 0.05), which together reduced potentially inappropriate prescribing by 50.0% between October 2011 and May 2013 (from 0.4% to 0.2%). The prevalence of potentially inappropriate prescribing of stimulants was significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This

  6. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

    Directory of Open Access Journals (Sweden)

    Opondo Charles

    2011-11-01

    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  7. Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder.

    Science.gov (United States)

    Suehs, Brandon T; Davis, Cralen; Ng, Daniel B; Gooch, Katherine

    2017-07-01

    Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB). A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined. Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p cost associated with potentially inappropriate use of antimuscarinic

  8. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.

    LENUS (Irish Health Repository)

    Ryan, C

    2009-08-01

    Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing.

  9. Decreasing Inappropriate Use of Mobile Devices in Urban High School Classrooms: Comparing an Antecedent Intervention With and Without the Good Behavior Game.

    Science.gov (United States)

    Hernan, Colleen J; Collins, Tai A; Morrison, Julie Q; Kroeger, Stephen D

    2018-03-01

    As the capabilities of portable technology continue to advance and become more accessible, educators express concern about the impact of the inappropriate use of mobile devices on academic engagement and learning. An alternating treatments design was used to compare the effectiveness of an antecedent (Clear Box) intervention and an interdependent group contingency (Clear Box + Good Behavior Game [GBG]) intervention to typical classroom management techniques (Control) in increasing the academic engagement and decreasing mobile device use of high school students during instruction. The results indicate an increase in academic engagement and a decrease in the inappropriate presence of mobile devices in both classrooms with the implementation of the Clear Box + GBG, as compared with the Clear Box and Control conditions. In addition, teacher and student social validity data suggested that teachers and students viewed the Clear Box + GBG intervention favorably. Discussion focuses on contributions to the current literature, implications for practice, and suggestions for future areas of research.

  10. Superoxide and hydrogen peroxide play different roles in the nonhost interaction of barley and wheat with inappropriate formae speciales of Blumeria graminis.

    Science.gov (United States)

    Trujillo, Marco; Kogel, Karl-Heinz; Hückelhoven, Ralph

    2004-03-01

    Nonhost resistance of cereals to inappropriate formae speciales of Blumeria graminis is little understood. However, on the microscopic level, nonhost defense to B. graminis is reminiscent of host defense preventing fungal development by penetration resistance and the hypersensitive cell death response (HR). We analyzed histochemically the accumulation of superoxide anion radicals (O2*-) and hydrogen peroxide (H2O2) at sites of B. graminis attack in nonhost barley and wheat. Superoxide visualized by subcellular reduction of nitroblue tetrazolium accumulated in association with successful fungal penetration in attacked cells and in cells neighboring HR. In contrast, H2O2 accumulated in cell wall appositions beneath fungal penetration attempts or in the entire epidermal cell during HR. The data provide evidence for different roles and sources of superoxide and H2O2 in the nonhost interaction of cereals with inappropriate formae speciales of B. graminis.

  11. Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study.

    Science.gov (United States)

    Wallace, Emma; McDowell, Ronald; Bennett, Kathleen; Fahey, Tom; Smith, Susan M

    2017-02-01

    Potentially inappropriate prescribing (PIP) describes medications where risk generally outweighs benefit for older people. Cross-sectional studies suggest an association between PIP and poorer health outcomes but there is a paucity of prospective cohort studies. This study investigates the longitudinal association of PIP with adverse drug events (ADEs), health related quality of life, and accident & emergency visits. Study design: Two-year (2010-2012) prospective cohort study (n = 904, ≥70 years, community-dwelling) with linked pharmacy dispensing data. Baseline PIP: Screening Tool for Older Persons potentially Inappropriate Prescriptions (STOPP) and Beers 2012 applied 12 months prior. ADEs (patient interview), health related quality of life (EQ-5D-3L: patient questionnaire), and accident & emergency visits (general practice medical record review). Descriptive statistics: Poisson (incidence rate ratio [95% confidence interval [CI

  12. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis

    Science.gov (United States)

    Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J. Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

    2014-01-01

    Background The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. Methods We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. Results After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). Interpretation For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern. PMID:25485251

  13. Extent and cost of inappropriate use of tumour markers in patients with pulmonary disease: a multicentre retrospective study in Shanghai, China.

    Science.gov (United States)

    Zhang, Haichen; Song, Yunxiao; Zhang, Xiong; Hu, Jun; Yuan, Suwei; Ma, Jin

    2018-02-28

    The currently implemented healthcare reform in China requires substantial capital investment. Although overtreatment results in serious waste, inappropriate laboratory use is widespread, and overuse of tumour markers (TMs) has attracted increasing attention. Retrospective study. The respiratory, thoracic surgery and oncology departments of three hospitals in Shanghai from 2014 to 2015. Patients with chronic obstructive pulmonary disease (COPD) and primary bronchogenic lung cancer (PLC). Based on clinical guidelines and physician experience, the criteria of suitability of TM examinations were determined, and the number, cost and proportion of inappropriate TM requests were analysed. The area under the receiver operating characteristic curve for carcinoembryonic antigen+cytokeratin fragment 21-1+squamous cell carcinoma antigen+neuron-specific enolase in patients with COPD and PLC was 0.813, in accordance with the cost-effectiveness principle, indicating good clinical and health economics values. In the 2706 patients, 12 496-16 956 (58.27%-79.06%) of TM requests were inappropriate. Furthermore, the involved expense was 650 200-1 014 156 yuan, accounting for 7.69%-12.00% of examination expenses and 1.35%-2.11% of hospitalisation costs. We found that the inappropriate use of TMs was widespread for patients with pulmonary disease. Clinicians should use TMs strictly according to the guidelines to effectively manage laboratory resources and control costs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study).

    Science.gov (United States)

    Massa, Ilaria; Balzi, William; Burattini, Costanza; Gentili, Nicola; Bucchi, Lauro; Nanni, Oriana; Gallegati, Davide; Pierini, Andrea; Amadori, Dino; Falcini, Fabio; Altini, Mattia

    2017-08-01

    In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Prescription of potentially inappropriate medication in older persons in Switzerland: does the dispensing channel make a difference?

    Directory of Open Access Journals (Sweden)

    Blozik E

    2015-04-01

    Full Text Available Eva Blozik,1,2 Roland Rapold,1 Oliver Reich1 1Department of Health Sciences, Helsana Group, Zürich, Switzerland; 2Department of Medicine, Division of General Practice, University Medical Centre Freiburg, Freiburg, Germany Background: Drugs can be supplied either directly from the prescribing physician (physician dispensing [PD] or via a pharmacy. It is unclear whether the dispensing channel is associated with quality problems. Potentially inappropriate medication (PIM is associated with adverse outcomes in older persons and can be considered a marker for quality deficits in prescribing. We investigated whether prevalence of PIM differs across dispensing channels. Patients and methods: We analyzed basic health insurance claims of 50,747 person quarter years with PIM use of residents of the Swiss cantons Aargau and Lucerne of the years 2012 and 2013. PIM was identified using the Beers 2012 criteria and the PRISCUS list. We calculated PIM prevalence stratified by supply channel. Adjusted mixed effects logistic regression analysis was done to estimate the effect of obtaining medications through the dispensing physician as compared to the pharmacy channel on receipt of PIM. The most frequent PIMs were identified. Results: There is a small but detectable difference in total PIM prevalence: 30.7% of the population supplied by a dispensing physician as opposed to 29.3% individuals who received medication in a pharmacy. According to adjusted logistic regression individuals who obtained the majority of their medications from their prescribing physician had a 15% higher chance to receive a PIM (odds ratio 1.15, 95% confidence interval 1.08–1.22; P<0.001. Conclusion: Physician dispensing seems to affect quality and safety of drug prescriptions. Quality issues should not be neglected in the political discussion about the regulations on PD. Future studies should explore whether PD is related to other indicators of inefficiency or quality flaws. The present

  16. Potentially inappropriate prescribing and its association with health outcomes in middle-aged people: a prospective cohort study in Ireland

    Science.gov (United States)

    Moriarty, Frank; Cahir, Caitriona; Bennett, Kathleen; Hughes, Carmel M; Kenny, Rose Anne; Fahey, Tom

    2017-01-01

    Objectives To determine the prevalence of potentially inappropriate prescribing (PIP) in a cohort of community-dwelling middle-aged people and assess the relationship between PIP and emergency department (ED) visits, general practitioner (GP) visits and quality of life (QoL). Design Prospective cohort study. Setting The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort study of ageing. Participants Individuals aged 45–64 years recruited to TILDA who were eligible for the means-tested General Medical Services scheme and followed up after 2 years. Exposure PIP was determined in the 12 months preceding baseline and follow-up TILDA data collection by applying the PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria to participants’ medication dispensing data. Outcome measures At follow-up, the reported rates of ED and GP visits over 12 months (primary outcome) and the CASP-R12 (Control Autonomy Self-realisation Pleasure) measure of QoL (secondary outcome). Analysis Multivariate negative binomial (rates) and linear regression (CASP-R12) models controlling for potential confounders. Results At 2-year follow-up (n=808), PIP was detected in 42.9% by the PROMPT criteria. An ED visit was reported by 18.7% and 94.4% visited a GP (median 4 visits, IQR 2–6). Exposure to ≥2 PROMPT criteria was associated with higher rates of healthcare utilisation and lower QoL in unadjusted regression. However, in multivariate analysis, the associations between PIP and rates of ED visits (adjusted incidence rate ratio (IRR) 0.92, 95% CI 0.53 to 1.58), and GP visits (IRR 1.06, 95% CI 0.87 to 1.28), and CASP-R12 score (adjusted β coefficient 0.35, 95% CI −0.93 to 1.64) were not statistically significant. Numbers of medicines and comorbidities were associated with higher healthcare utilisation. Conclusions Although PIP was prevalent in this study population, there was no evidence of a relationship with ED and GP visits and Qo

  17. Fatores associados ao comportamento alimentar inadequado em adolescentes escolares Factors associated with inappropriate eating behavior in adolescent students

    Directory of Open Access Journals (Sweden)

    Leonardo de Sousa Fortes

    2013-01-01

    Full Text Available CONTEXTO: Evidências demonstram que a prevalência do comportamento alimentar inadequado (CAI entre jovens tem aumentado nos últimos anos. Parece que a insatisfação corporal (IC, a prática excessiva de exercício físico, a composição corporal, o nível econômico (NE, além da etnia, podem ser fatores de risco para o CAI. OBJETIVO: Associar IC, grau de comprometimento psicológico ao exercício (GCPE, adiposidade corporal (AC, estado nutricional (EN, NE e etnia ao CAI em adolescentes. MÉTODOS: Participaram 362 jovens de ambos os sexos com idades entre 10 e 19 anos. Utilizou-se o Eating Attitudes Test para avaliar o CAI. O Body Shape Questionnaire e a Commitment Exercise Scale foram utilizados para mensurar IC e GCPE, respectivamente. Aferiram-se dobras cutâneas para classificar a AC segundo sexo. Peso e estatura foram aferidos para calcular-se o índice de massa corporal (IMC e classificar o EN. O NE foi avaliado pelo Critério de Classificação Econômica Brasil. Aplicou-se questionário que buscava avaliar etnia, idade e sexo. RESULTADOS: Os resultados evidenciaram associação do CAI com IC, GCPE e NE no sexo feminino (p BACKGROUND: Evidence shows that the prevalence of inappropriate eating behavior (CAI among young people has increased in recent years. It seems that body dissatisfaction (IC, the practice of excessive exercise, body composition, the socioeconomic status (NE, and ethnicity may be risk factors for CAI. OBJECTIVE: To associate IC, degree of psychological impairment to exercise (GCPE, adiposity (AC, nutritional status (EN, NE and ethnicity with CAI in adolescents. METHODS: Participants 362 young people of both sexes aged between 10 and 19 years. We used the Eating Attitudes Test to assess the CAI. The Body Shape Exercise Questionnaire and Commitment Exercise Scale were used to measure IC and GCPE, respectively. We evaluated skinfold thickness is to classify the AC second sex. Weight and height were measured to

  18. Gas and electricity providers. Offensive of alternate providers, launching of green offers, price-based conquest: which perspectives for the market and the competitive game by 2019?

    International Nuclear Information System (INIS)

    2017-02-01

    As the end of regulated tariffs for industries and local communities resulted in a total new deal on the electric power and gas providing market, notably with newcomers who decided to cut prices, this study aims at identifying actual perspectives for the power and gas markets by 2019, and actual levers of action for providers to gain market shares. After a synthesis and a proposal of some strategic conclusions, the report proposes an analysis of the activity and of its perspectives: determining factors, overview of the activity until 2016 (power and gas provisions in France, production and consumption prices for gas and for electric power, regulated tariffs), and provisional scenario by 2019 regarding electricity and gas provisions in France. A second part analyses the external environment through a discussion of external drivers and brakes, and an analysis of demand. The third part reports an analysis of the competitive landscape (market shares per strategic groups, in power providing and in gas providing, and switch rate between residential and non-residential customers). The last part addresses development axes and proposes a discussion of offensive conquest strategies, a discussion of actor positioning on green energies, a discussion of supply adaptation and targeting depending on customers with an analysis of three specific segments (mobility, data centres, and self-consumption), and a discussion of the diversification of services

  19. Comparison by crime type of juvenile delinquents on pornography exposure: the absence of relationships between exposure to pornography and sexual offense characteristics.

    Science.gov (United States)

    Burton, David L; Leibowitz, George Stuart; Howard, Alan

    2010-01-01

    Previous literature on pornography indicates that pornography use for men at risk for aggression may result in sexually aggressive behavior, but very little research has been reported on juvenile sexual abusers' exposure to pornography. The current study compared pornography exposure between male adolescent sexual abusers (n=283) and male nonsexually offending delinquent youth (n=170). Sexual abusers reported more pre- and post-10 (years of age) exposure to pornography than nonsexual abusers. Yet, for the sexual abusers, exposure is not correlated to the age at which the abusers started abusing, to their reported number of victims, or to sexual offense severity. The pre-10 exposure subscale was not related to the number of children the group sexually abused, and the forceful exposure subscale was not correlated with either arousal to rape or degree of force used by the youth. Finally, exposure was significantly correlated with all of the nonsexual crime scores in the study. Implications for forensic nursing are discussed. © 2010 International Association of Forensic Nurses.

  20. The Criminal Offense of Credit/Debit Card Fraud and the Implementation of Its Sanction on Indonesian Criminal Law

    Directory of Open Access Journals (Sweden)

    Antonius Maria Laot Kian

    2015-04-01

    Full Text Available The aims of the study are to determine the legal arrangements and the application of criminal sanctions against the crime of credit/debit card fraud in Indonesia. The type of study was a normative research by classifying the provisions relevant to the crime of credit/debit card fraud is based on Law No. 11 Year 2008 concerning Information and Electronic Transactions; otherwise it is used also Convention on Cyber crime 2001. Analysis of legal materials made through a law (statue approach to create an ius constituendum regarding the application of criminal sanctions against crime credit/debit card fraud. The results of the research indicated that the legal arrangements and criminal sanctions against the crime of credit/debit card fraud in Indonesia is still relatively minimal. First, not integrated article that directly regulates computer related fraud. Second, not arranged in the form of criminal sanctions for actions that are restitution culprit.

  1. Assessing gender differences and co-offending patterns of a predominantly "male-oriented" crime: a comparison of a cross-national sample of juvenile boys and girls arrested for a sexual offense.

    Science.gov (United States)

    Vandiver, Donna M

    2010-01-01

    This study examines male-female differences of juveniles arrested for a sex offense. A cross-national sample of juvenile boys (n = 177) and a population of juvenile girls (n = 177) arrested for a sex offense are utilized for this analysis. It is hypothesized that (1) boys and girls differ substantially in their offending patterns. Based on Moffitt's social-amplification hypothesis, it is also hypothesized that (2) juveniles who act with a co-offender commit more serious offenses (i.e., more likely to be arrested for rape and have more victims) compared to those who act alone. The results show boys differ from girls: juvenile girls are slightly younger, more likely to be White, more likely to have a co-offender, less likely to commit rape, and be processed formally by law enforcement. The results yielded indicated social amplification appears to occur when girls offend with a co-offender, but not when boys acted with a co-offender.

  2. Alimentação complementar: práticas inadequadas em lactentes Complementary feeding: inappropriate practices in infants

    Directory of Open Access Journals (Sweden)

    Michelle Cavalcante Caetano

    2010-06-01

    , from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. RESULTS: The median of the infants' age was 6.8 months (4.0-12.6 months. We found that 50.3% of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7% among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7% of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75% and iron (45%. CONCLUSION: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

  3. Dictionary materials engineering, materials testing

    International Nuclear Information System (INIS)

    1994-01-01

    This dictionary contains about 9,500 entries in each part of the following fields: 1) Materials using and selection; 2) Mechanical engineering materials -Metallic materials - Non-metallic inorganic materials - Plastics - Composites -Materials damage and protection; 3) Electrical and electronics materials -Conductor materials - Semiconductors - magnetic materials - Dielectric materials - non-conducting materials; 4) Materials testing - Mechanical methods - Analytical methods - Structure investigation - Complex methods - Measurement of physical properties - Non-destructive testing. (orig.) [de

  4. Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis.

    Science.gov (United States)

    Yoon, Young Kyung; Park, Dae Won; Sohn, Jang Wook; Kim, Hyo Youl; Kim, Yeon-Sook; Lee, Chang-Seop; Lee, Mi Suk; Ryu, Seong-Yeol; Jang, Hee-Chang; Choi, Young Ju; Kang, Cheol-In; Choi, Hee Jung; Lee, Seung Soon; Kim, Shin Woo; Kim, Sang Il; Kim, Eu Suk; Kim, Jeong Yeon; Yang, Kyung Sook; Peck, Kyong Ran; Kim, Min Ja

    2016-07-15

    The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB). A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses. In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71-2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14-13.87), Charlson's comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27-1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08-9.67) were independent risk factors for mortality. Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence.

  5. The Robustness and Effectiveness of the Triage System at Times of Overcrowding and the Extra Costs due to Inappropriate Use of Emergency Departments.

    Science.gov (United States)

    Cremonesi, Paolo; di Bella, Enrico; Montefiori, Marcello; Persico, Luca

    2015-10-01

    Overcrowding is one of the most harmful problems for Emergency Department (ED) management and the correct estimation of time resource absorption by each type of patient plays a strategic role in dealing with overcrowding and correctly programming ED activity. We aimed to investigate how overcrowding may affect urgent patients' waiting times (i.e., the robustness of the triage patient priority system) and to evaluate the extra costs due to inappropriate use of EDs. Data referring to 54,254 patients who accessed the ED of a major Italian hospital in 2011 were analyzed to study patient flows and overcrowding. To define an average per-patient cost, according to the severity of his or her health condition, the 2010 profit and loss account of the aforementioned hospital was studied and the time devoted by physicians to each type of patient was estimated by means of a self-reported survey. Empirical findings confirm a positive correlation between overcrowding and the time a patient has to wait before receiving treatment. This effect is relevant only for non-urgent patients who are responsible for the overcrowding itself. However, urgent patients' waiting times do not increase in the presence of overcrowding, confirming that the triage priority system is robust against the overcrowding situation. The analysis estimates, using 2010 data, that the actual per patient cost incurred by the hospital when treating white-coded patients is, on average, 36.54 euros; a green code costs 93.17, yellow 170.62, and red 227.62. It emerges that 4% of all the personnel costs are attributable to white color-code assistance, 67% to green codes, 23% to yellow codes, and the remaining 6% to red codes. The implementation of effective policies intended to improve both efficiency and quality in providing emergency health services has to deal with the systemic problem of inappropriate use of EDs. Policy-makers should be aware of the fact that there is a considerable portion of ED demand for

  6. Is modification of the VVI backup mode in implantable cardioverter-defibrillators from St Jude medical required due to increased risk of inappropriate shocks?

    DEFF Research Database (Denmark)

    Philbert, Berit T; Tfelt-Hansen, Jacob; Jacobsen, Peter K

    2017-01-01

    to VVI backup mode. All four patients were implanted with a St Jude Medical ICD since 2010. The reset to VVI backup mode happens as a 'safety' response when the ICD encounters errors in the software or hardware often due to electromagnetic interference. The ICD then operates in a simple mode, with only...... during sinus rhythm. The VVI backup mode has to balance between protection from failure of ICD therapy during life-threatening ventricular arrhythmias and from inappropriate shocks. It seems the non-programmable parameters in VVI backup mode of St Jude Medical ICDs carry an unacceptable high risk...

  7. Implementation of Electronic Medical Record Hard Stop Alerts for Inappropriate Clostridium difficile Tests in Academic and Community Hospital Setting; Impact on Testing Rates and Clinical Outcomes

    OpenAIRE

    Rock, Clare; Mizusawa, Masako; Small, Bryce; Hsu, Yea-Jen; Kauffman, Christopher; Trivedi, Julie; Landrum, B Mark; Feldman, Leonard; Pahwa, Amit; Carroll, Karen C; Maragakis, Lisa L

    2017-01-01

    Abstract Background Ensuring appropriate C. diff nucleic acid amplification testing is increasingly important. We implemented electronic medical record (EMR) hard stop alerts across our health-system to reduce inappropriate tests. We review the impact on testing rates and outcome of those where testing was not pursed. Methods C. diff order in a patient with previous test (14 or 7 days for positive or negative), or receipt of laxative in past 48 hours triggered an EMR alert; test could only pr...

  8. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment

    Directory of Open Access Journals (Sweden)

    Guruprasad P Bhosale

    2015-01-01

    Full Text Available Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L and severe metabolic acidosis (pH 6.65 that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurological sequelae. To the best of our knowledge, this is the first case report in adults of severe hypernatremia along with severe metabolic acidosis due to error in the preparation of dialysis fluid.

  9. The barley apoptosis suppressor homologue BAX inhibitor-1 compromises nonhost penetration resistance of barley to the inappropriate pathogen Blumeria graminis f. sp. tritici.

    Science.gov (United States)

    Eichmann, Ruth; Schultheiss, Holger; Kogel, Karl-Heinz; Hückelhoven, Ralph

    2004-05-01

    BAX inhibitor-1 (BI-1) proteins have been characterized as suppressors of programmed cell death in mammals and plants. The barley BI-1 is a suppressor of nonspecific background resistance and mlo-mediated penetration resistance to the biotrophic fungal pathogen Blumeria graminis f. sp. hordei when overexpressed in epidermal cells of barley. We report here that BI-1 expression is also slightly up-regulated during interaction with the inappropriate wheat pathogen Blumeria graminis f. sp. tritici. Significantly, overexpression of BI-1 in single epidermal cells of barley by microprojectile-mediated transformation rendered cells susceptible to penetration by inappropriate B. graminis f. sp. tritici. The degree of transgene-induced accessibility to B. graminis f. sp. tritici was thereby similar to the effect achieved by overexpression of the defense suppressor gene Mlo and could not be further enhanced by double expression of both BI-1 and Mlo. Confocal laser scanning microscopy was used to locate a functional green fluorescing GFP:BI-1 fusion protein in endomembranes and the nuclear envelope of barley epidermal cells. Together, enhanced expression of barley BI-1 suppresses penetration resistance to B. graminis f. sp. tritici, linking barley nonhost resistance with cell death regulation.

  10. Noble gases and the early history of the Earth: Inappropriate paradigms and assumptions inhibit research and communication

    Science.gov (United States)

    Huss, G. R.; Alexander, E. C., Jr.

    1985-01-01

    The development of models as tracers of nobel gases through the Earth's evolution is discussed. A new set of paradigms embodying present knowledge was developed. Several important areas for future research are: (1) measurement of the elemental and isotopic compositions of the five noble gases in a large number of terrestrial materials, thus better defining the composition and distribution of terrestrial noble gases; (2) determinations of relative diffusive behavior, chemical behavior, and the distribution between solid and melt of noble gases under mantle conditions are urgently needed; (3) disequilibrium behavior in the nebula needs investigation, and the behavior of plasmas and possible cryotrapping on cold nebular solids are considered.

  11. Strategic Materials

    National Research Council Canada - National Science Library

    Buhler, Carl; Burke, Adrian; Davis, Kirk; Gerhard, Michelle; Heil, Valerie; Hulse, Richard; Kwong, Ralph; Mahoney, Michael; Moran, Scott; Peek, Michael

    2006-01-01

    Some materials possess greater value than others. Materials that provide essential support for the nation's economic viability or enable critical military capabilities warrant special attention in security studies...

  12. Study of the Appropriate and Inappropriate Methods of Visual Arts Education in the Primary Schools According to the Types of Multiple Intelligences

    Directory of Open Access Journals (Sweden)

    Atena Salehi Baladehi

    2017-01-01

    Full Text Available In the current changing world, named the era of knowledge explosion, specialists and those involved in education have been attracted finding a response to a question: what should we teach today’s students that to be useful for them in the future life? The main objective of this study is to investigate the appropriate and inappropriate methods of visual arts education in pre-school. According to the types of multiple intelligences, reaching to this goal requires careful planning, proper training and proper content selection along with talent and interests of learners along with the use of appropriate practice training and educational staff training. The research handles descriptive and analytic methods as well as academic literature. The results suggest the importance of understanding the multiple intelligences in the visual arts education.

  13. Inappropriate cervical injection of radiotracer for sentinel node mapping in a uterine cervix cancer patient: importance of lymphoscintigraphy and blue dye injection

    Directory of Open Access Journals (Sweden)

    Sima Kadkhodayan

    2014-10-01

    Full Text Available Herein, we report a case of sentinel lymph node mapping in a uterine cervix cancer patient, referring to the nuclear medicine department of our institute. Lymphoscintigraphy images showed inappropriate intra‐cervical injection of radiotracer. Blue dye technique was applied for sentinel lymph node mapping, using intra‐cervical injection of methylene blue. Two blue/cold sentinel lymph nodes, with no pathological involvement, were intra‐operatively identified, and the patient was spared pelvic lymph node dissection. The present case underscores the importance of lymphoscintigraphy imaging in sentinel lymph node mapping and demonstrates the added value of blue dye injection in selected patients. It is suggested that preoperative lymphoscintigraphy imaging be considered as an integral part of sentinel lymph node mapping in surgical oncology. Detailed results of lymphoscintigraphy images should be provided for surgeons prior to surgery, and in case the sentinel lymph nodes are not visualized, use of blue dye for sentinel node mapping should be encouraged.

  14. A Rare Presentation of the Syndrome of Inappropriate Antidiuretic Hormone in a 12-Year-Old Girl as the Initial Presentation of an Immature Ovarian Teratoma.

    Science.gov (United States)

    Iqbal, Anoop Mohamed; Schwenk, W Frederick

    2018-02-01

    Immature ovarian teratoma is very rare in childhood. We report on a 12-year-old girl with immature ovarian teratoma who presented initially with syndrome of inappropriate antidiuretic hormone. A 12-year-old girl presented with acute abdomen and distention. Initial laboratory tests showed hyponatremia (sodium, 123 mmol/L), that did not respond to fluid management. Computed tomography imaging showed a 15 cm × 9 cm × 20 cm mass in the right ovary with multifocal internal fat, and dystrophic calcifications. She underwent exploratory laparotomy with a right salpingo-oophorectomy, omentectomy, and peritoneal stripping. The pathology revealed metastatic immature teratoma. Hyponatremia resolved soon after the surgery. Although a rare diagnosis, immature ovarian teratoma must be considered in a girl who presents with abdominal mass and hyponatremia. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  15. Media audit reveals inappropriate promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes in South-East Asia.

    Science.gov (United States)

    Vinje, Kristine Hansen; Phan, Linh Thi Hong; Nguyen, Tuan Thanh; Henjum, Sigrun; Ribe, Lovise Omoijuanfo; Mathisen, Roger

    2017-06-01

    To review regulations and to perform a media audit of promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes ('the Code') in South-East Asia. We reviewed national regulations relating to the Code and 800 clips of editorial content, 387 advertisements and 217 Facebook posts from January 2015 to January 2016. We explored the ecological association between regulations and market size, and between the number of advertisements and market size and growth of milk formula. Cambodia, Indonesia, Myanmar, Thailand and Vietnam. Regulations on the child's age for inappropriate marketing of products are all below the Code's updated recommendation of 36 months (i.e. 12 months in Thailand and Indonesia; 24 months in the other three countries) and are voluntary in Thailand. Although the advertisements complied with the national regulations on the age limit, they had content (e.g. stages of milk formula; messages about the benefit; pictures of a child) that confused audiences. Market size and growth of milk formula were positively associated with the number of newborns and the number of advertisements, and were not affected by the current level of implementation of breast-milk substitute laws and regulations. The present media audit reveals inappropriate promotion and insufficient national regulation of products under the scope of the Code in South-East Asia. Strengthened implementation of regulations aligned with the Code's updated recommendation should be part of comprehensive strategies to minimize the harmful effects of advertisements of breast-milk substitutes on maternal and child nutrition and health.

  16. Inappropriate use of standard error of the mean when reporting variability of study samples: a critical evaluation of four selected journals of obstetrics and gynecology.

    Science.gov (United States)

    Ko, Wen-Ru; Hung, Wei-Te; Chang, Hui-Chin; Lin, Long-Yau

    2014-03-01

    The study was designed to investigate the frequency of misusing standard error of the mean (SEM) in place of standard deviation (SD) to describe study samples in four selected journals published in 2011. Citation counts of articles and the relationship between the misuse rate and impact factor, immediacy index, or cited half-life were also evaluated. All original articles in the four selected journals published in 2011 were searched for descriptive statistics reporting with either mean ± SD or mean ± SEM. The impact factor, immediacy index, and cited half-life of the journals were gathered from Journal Citation Reports Science edition 2011. Scopus was used to search for citations of individual articles. The difference in citation counts between the SD group and SEM group was tested by the Mann-Whitney U test. The relationship between the misuse rate and impact factor, immediacy index, or cited half-life was also evaluated. The frequency of inappropriate reporting of SEM was 13.60% for all four journals. For individual journals, the misuse rate was from 2.9% in Acta Obstetricia et Gynecologica Scandinavica to 22.68% in American Journal of Obstetrics & Gynecology. Articles using SEM were cited more frequently than those using SD (p = 0.025). An approximate positive correlation between the misuse rate and cited half-life was observed. Inappropriate reporting of SEM is common in medical journals. Authors of biomedical papers should be responsible for maintaining an integrated statistical presentation because valuable articles are in danger of being wasted through the misuse of statistics. Copyright © 2014. Published by Elsevier B.V.

  17. Materials Chemistry

    CERN Document Server

    Fahlman, Bradley D

    2011-01-01

    The 2nd edition of Materials Chemistry builds on the strengths that were recognized by a 2008 Textbook Excellence Award from the Text and Academic Authors Association (TAA). Materials Chemistry addresses inorganic-, organic-, and nano-based materials from a structure vs. property treatment, providing a suitable breadth and depth coverage of the rapidly evolving materials field. The 2nd edition continues to offer innovative coverage and practical perspective throughout. After briefly defining materials chemistry and its history, seven chapters discuss solid-state chemistry, metals, semiconducting materials, organic "soft" materials, nanomaterials, and materials characterization. All chapters have been thoroughly updated and expanded with, for example, new sections on ‘soft lithographic’ patterning, ‘click chemistry’ polymerization, nanotoxicity, graphene, as well as many biomaterials applications. The polymer and ‘soft’ materials chapter represents the largest expansion for the 2nd edition. Each ch...

  18. Mechanical Material

    International Nuclear Information System (INIS)

    Kim, Gap Yong; Jang, Gun Ik; Kim, Dung Jung; Kim, Ui Do

    1999-02-01

    This book introduces characteristics of metal with crystal structure and plastic deformation of metal, equilibrium diagram of alloy, steel such as constitutional diagram and structure of carbon steel, and heat treatment of steel, structural alloy steel, tool material, corrosion and anticorrosion of steel and stainless steel, heat resisting material and properties of steel against high temperature, strengthening of surface of steel, cast iron, nonferrous metal material and materials test.

  19. Magnetic Materials

    Science.gov (United States)

    Spaldin, Nicola A.

    2003-04-01

    Magnetic materials are the foundation of multi-billion dollar industries and the focus of intensive research across many disciplines. This book covers the fundamentals, basic theories and applications of magnetism and conventional magnetic materials. Based on a lecture course given by Nicola Spaldin in the Materials Department at University of California, Santa Barbara, the book is ideal for a one- semester course in magnetic materials. It contains numerous homework problems and solutions.

  20. Material Programming

    DEFF Research Database (Denmark)

    Vallgårda, Anna; Boer, Laurens; Tsaknaki, Vasiliki

    2017-01-01

    In the near future every other smart material will have computational power embedded in the form of graphene transistors or nanotubes. These will be the ultimate computational composites: materials that hold classic material qualities, such as structural durability, flexibility, texture, weight, ...